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Posts for tag: orthodontic treatment

RemovingOneorMoreTeethCouldImproveOrthodonticOutcomes

Moving teeth through orthodontics may involve more than simply wearing braces. There are many bite conditions that require extra measures before, during or after traditional orthodontic treatment to improve the outcome.

One such measure is extracting one or more teeth. Whether or not we should will depend on the causes behind a patient's poor dental bite.

Here, then, are 4 situations where tooth extraction before orthodontics might be necessary.

Crowding. This happens when the jaw isn't large enough to accommodate all the teeth coming in. As a result, later erupting teeth could erupt out of position. We can often prevent this in younger children with space maintainers or a palatal expander, a device which helps widen the jaw. Where crowding has already occurred, though, it may be necessary to remove selected teeth first to open up jaw space for desired tooth movement.

Impacted teeth. Sometimes an incoming tooth becomes blocked and remains partially or fully submerged beneath the gums. Special orthodontic hardware can often be used to pull an impacted tooth down where it should be, but not always. It may be better to remove the impacted tooth completely, as well as its matching tooth on the other side of the jaw to maintain smile balance before orthodontically correcting the bite.

Front teeth protrusion. This bite problem involves front teeth that stick out at a more horizontal angle. Orthodontics can return the teeth to their proper alignment, but other teeth may be blocking that movement. To open up space for movement, it may be necessary to remove one or more of these obstructing teeth.

Congenitally missing teeth. The absence of permanent teeth that failed to develop can disrupt dental appearance and function, especially if they're near the front of the mouth. They're often replaced with a dental implant or other type of restoration. If only one tooth is missing, though, another option would be to remove the similar tooth on the other side of the jaw, and then close any resulting gaps with braces.

Extracting teeth in these and other situations can help improve the chances of a successful orthodontic outcome. The key is to accurately assess the bite condition and plan accordingly.

If you would like more information on orthodontic options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Removing Teeth for Orthodontic Treatment.”

DakotaJohnsonandHerMissingToothGapSparksOnlineDebate

Celebrities’ controversial actions and opinions frequently spark fiery debates on social media. But actress Dakota Johnson lit a match to online platforms in a seemingly innocent way—through orthodontics.

This summer she appeared at the premier of her film The Peanut Butter Falcon missing the trademark gap between her front teeth. Interestingly, it happened a little differently than you might think: Her orthodontist removed a permanent retainer attached to the back of her teeth, and the gap closed on its own.

Tooth gaps are otherwise routinely closed with braces or other forms of orthodontics. But, as the back and forth that ensued over Johnson’s new look shows, a number of people don’t think that’s a good idea: It’s not just a gap—it’s your gap, a part of your own uniqueness.

Someone who might be sympathetic to that viewpoint is Michael Strahan, a host on Good Morning America. Right after the former football star began his NFL career, he strongly considered closing the noticeable gap between his two front teeth. In the end, though, he opted to keep it, deciding it was a defining part of his appearance.

But consider another point of view: If it truly is your gap (or whatever other quirky smile “defect” you may have), you can do whatever you want with it—it really is your choice. And, on that score, you have options.

You can have a significant gap closed with orthodontics or, if it’s only a slight gap or other defect, you can improve your appearance with the help of porcelain veneers or crowns. You can also preserve a perceived flaw even while undergoing cosmetic enhancements or restorations. Implant-supported replacement teeth, for example, can be fashioned to retain unique features of your former smile like a tooth gap.

If you’re considering a “smile makeover,” we’ll blend your expectations and desires into the design plans for your future smile. In the case of something unique like a tooth gap, we’ll work closely with dental technicians to create restorations that either include or exclude the gap or other characteristics as you wish.

Regardless of the debate raging on social media, the final arbiter of what a smile should look like is the person wearing it. Our goal is to make sure your new smile reflects the real you.

If you would like more information about cosmetically enhancing your smile, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Space Between Front Teeth” and “The Impact of a Smile Makeover.”

NewBehindtheTeethBracesCouldGiveYoutheAdvantageofInvisibility

Orthodontic braces are a familiar sight, especially among tweens and teens: metal brackets and wires attached to the front of the teeth for all to see. Now imagine the opposite: much the same hardware, but now positioned out of sight on the back of the teeth.

It's not your imagination: It's the latest development in orthodontic technology called lingual braces. Developed simultaneously by two orthodontists in Japan and Beverly Hills, these appliances are placed on the tongue or “lingual” side of the teeth rather than the traditional labial or “lip-side.”

Generally, lingual braces can correct any bite problem labial braces can. The difference lies in how each method does its job: Traditional braces exert pressure or “push” against the teeth, while lingual braces “pull” the teeth into better alignment.

So, why choose lingual over labial? For one, they're “invisible” to others: all the hardware is on the backside of the teeth, out of sight. They're also not as readily exposed to blunt force facial trauma, which can damage traditional braces (a driving impetus for the Japanese doctor to develop them for his martial arts patients, and his American counterpart for a law enforcement patient working in a rough area).

Patients may also prefer lingual braces over removable clear aligners, another popular tooth-movement option. Fixed lingual braces achieve the same quality of “invisibility” as removable aligners, but without the inconvenience of removing them as patients must with aligners for eating, snacking or cleaning.

They can, however, be costly, running 15-35% more than labial braces. Patients may also have difficulty adjusting to them because they can affect speech and tongue comfort. However, any discomfort and initial regret with choosing lingual braces tends to fade as most patients grow more accustomed to them after a week or so.

There's one other “perk” to lingual braces—unlike patients with traditional braces who have to wait for their removal to see the finished bite correction, patients with lingual braces get an unobstructed view of their progress all during wear. That can definitely boost morale during the long treatment period!

Lingual braces haven't been around long, so not every orthodontist offers them. But the list is growing, and there soon may be a provider near you for this new teeth-straightening alternative.

If you would like more information on lingual braces, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Lingual Braces: A Truly Invisible Way to Straighten Teeth.”

AnchorageToolsHelpOrthodontistsCorrectComplexBiteProblems

While braces are often the stars for straightening smiles, they're not the only cast members in an orthodontic production. Orthodontists occasionally turn to other appliances if the bite problem is challenging. Whatever the tool, though, they usually have something in common—they use the principle of anchorage.

To understand anchorage, let's first consider the classic kid's game Tug of War. With teams on either end of a rope, the object is to pull the opposing team across the center line before they pull you. To maximize your pulling force, the player at the back of your rope, usually your stoutest member, holds steady or "anchors" the rest of the team.

Like a Tug of War team, braces exert force against the teeth. This stimulates the supporting periodontal ligament to remodel itself and allow the teeth to move. The braces use the teeth they are attached to as anchors, which in a lot of cases are the back teeth. By attaching a thin wire to the brackets or braces on the teeth, the orthodontist includes all the teeth on the arch, from one end to the other. Anchored in place, the wire can maintain a constant pressure against the teeth to move them.

But not all bite situations are this straightforward. Sometimes an orthodontist needs to influence jaw growth in addition to teeth movement. For this purpose, they often use orthodontic headgear, which runs around the back of the head or neck and attaches to orthodontic brackets on the teeth. It still involves an anchor but in this case it's the patient's own skull.

In some situations, an orthodontist may feel he or she needs more anchorage as the teeth alone may not be enough. For this, they might establish a separate or additional anchor point using a temporary anchorage device (TAD). A TAD resembles a tiny screw that's inserted into the jawbone near the tooth intended for movement. The orthodontist can then attach the TAD to braces hardware using some form of elastics. After treatment, they remove the TAD.

These are just a couple examples of specialized tools an orthodontist can use for bite correction. Thanks to them and similar devices, even the most complex bite problem can be overcome to create a healthier and more attractive smile.

If you would like more information on correcting a poor bite, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Orthodontic Headgear & Other Anchorage Appliances.”

EarlyOrthodonticTechniquesCouldStopGrowingBiteProblems

The longer many health problems go on, the worse they become. Treating them as early as possible could stop or slow their development.

That holds true for poor bites: while we can certainly correct them later in life, it's often better to "intercept" the problem during childhood. Interceptive orthodontics attempts to do this with treatments that influence how the jaws and other mouth structures develop during childhood. Many of these techniques are usually best implemented before puberty.

For example, some very complex problems called cross bites can occur if the upper jaw grows too narrowly. We might be able to stop this from happening by using an orthodontic appliance called a palatal expander during the childhood years. It works because the bone at the center of the palate (roof of the mouth) has a gap running back to front until the early teens when the gap closes.

We fit the palatal expander up under and against the palate, then extend out metal arms from a center mechanism to the back of the upper teeth that exert outward pressure on them. This widens the center gap, which the body continually fills with bone as the device gradually exerts more pressure. Over time this causes the jaw to widen and lessens the cross bite. Timing, though, is everything: it's most effective before the gap closes.

Another way to aid jaw growth is a Herbst appliance, a hinged device that alters the movement of the jaws. As a child wears it, a Herbst appliance draws the lower jaw forward to develop more in that direction. Like the palatal expander, it's best used before significant jaw growth occurs.

These are just two examples of techniques and tools that can guide structural growth and prevent bite problems. Because they're most effective in the early years of oral development, your child should undergo an orthodontic evaluation as early as age 6 to see if they need and can benefit from an interceptive treatment.

Interceptive orthodontics can stop or at least slow a growing bite problem. The effort and expense now could save you much more of both later on.

If you would like more information on interceptive orthodontics, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Interceptive Orthodontics: Timely Intervention can make Treatment Easier.”