Orthodontics for Children: American Association of Orthodontists recommends children are screened by orthodontist at age 7. Age 7 is the optimal age where growth patterns and relationships of the upper and lower jaws can be evaluated and modified. Orthodontists can assess for conditions that require urgent correction such as anterior and posterior crossbites, maxillary constriction, eruption problems, space management issues, excessively protruding teeth, and thumb or finger sucking habits. It is beneficial to catch these problems early on for the children because otherwise these existing conditions can adversely affect facial and dental development. For instance, if a child's upper jaw is too narrow, that child will have to choose to bite on one side to have at least one functioning side. This condition will result in asymmetrical growth of the lower jaw and lasting facial asymmetry. Narrow upper jaw can be corrected later; however facial symmetry will be permanent.
This is not a comprehensive treatment but rather targeted treatment aimed to enhance dental and skeletal development and to resolve the urgent problems that cannot wait until the patient has all adult teeth. Most people who undergo Phase I treatment will require a second phase of treatment when they are older and have all adult dentition. However, having first phase of treatment can make later treatment simpler and shorter in duration. It is estimated about one third of the children undergoing orthodontic treatment are treated in two phases.
Appliances and braces used will vary according to specific diagnosed problems and specific goals of the therapy. Usually, in addition to traditional braces, one or more of following appliances may be used: rapid palatal expanders, lower bite blocks, headgears, facemasks, lower lingual holding arch, transpalatal arch, or pendex. Treatment duration for Phase I treatment varies from 6 to 18 months with partial braces and appliances but it may be longer depending on underlying problems and growth of the patients.
Cautions for all expanders
- Do not skip any days of turning the expander. Skipping a day may lengthen the time for expansion.
- If nuts, seeds or hard food particles block the key hole, carefully clear the hole with a tooth pick before turning.
- If you cannot keep a scheduled appointment, DO NOT continue to turn the expander until after you have spoken to the doctor
Diet and cleaning your expander
- Maintain a soft diet for the first few days after receiving the expander.
- Avoid hard or sticky foods, like pop-corns or caramels, that might dislodge the expander.
- Brush thoroughly after meals to keep the expander free of food and plaque.
What to expect with an expander
A temporary lisp or slurred speech. Excess saliva for a few days. Possible initial difficulty in chewing and swallowing. Pressure on the teeth, palate and nose after adjustments. Temporary irritation of the tongue. Possible headache. A slight change in facial appearance. The bite may feel "off". Certain foods will catch on the expander. A Temporary space will appear between the upper front teeth as expansion progresses
With excess saliva, swallow before speaking. With discomfort use a mild, over-the-counter pain reliever.
These are normal and expected effects of a rapid palatal expander and are not reasons to remove the expander prematurely. Braces are usually required following palatal expansion to align the teeth and fine-tune the bite.
To remove the key from the keyhole, gently slide the key in a downward direction. Pulling a flexible key in an outward direction can cause separation of the metal portion, which may be swallowed
Have the child lie on his or her back with the head at the edge of a bed or over the arm of a sofa. Use adequate lighting from a bright lamp or flash. Opening as wide as possible will minimize the gag reflex. Place the key in the center hole and turn in the direction of the arrows that are on the expander. Turn the expander toward the back of the mouth until you can see the next hole. Carefully remove the key in a down-and back direction. Caution: Be very careful not to "unturn" the expander when removing the key. Be sure to follow the doctor's instructions as to how often to turn the expander. Try to make the adjustments at about the same time each day.
Protraction Facemask Therapy: Protraction Face Mask is utilized when growing child ages between 7 to 10 years of age exhibits crossbite of permanent adult teeth and developmental deficiency in maxilla (upper jaw). Timing is essential in this treatment modality because once sutures surrounding maxilla (upper jaw) mature, skeletal correction is difficult to achieve. This treatment works by applying prolonged pressure via patient placed elastics on sutures around upper jaw. This prolonged pressure stimulates formation of new bone to effect forward and downward movement of upper jaw. Studies have shown this treatment brings changes in bone and soft tissue that improves profile. Compliance is of utmost importance. Patients must have elastics and facemask for minimum of 12 hours per day for the treatment to be effective.
Headgears: Headgears are effective in treating excessive overjet (a condition where upper teeth appear to stick out) when a child is still growing. Headgears can modify growth of maxilla (upper jaw) relative to mandible (lower jaw). While children are still growing, headgears can slow down growth of maxilla (upper jaw) and allow normally growing mandible (lower jaw) to effectively "catch up" to maxilla (upper jaw). Depending on the direction of desired effect, one of three types of headgear can be selected. Headgears can be high pull, cervical pull, or combination. Headgears should be worn 12 to 14 hours per day to be effective.
Orthodontics for Teenagers: Comprehensive treatment will be carried out when full adult dentition is obtained in teenagers. Usually by age of 12 or 13, all baby teeth are lost and are replaced with adult teeth. Most orthodontic problems can be corrected at this age. Most common cases needing braces are: spaced or crowded teeth, crooked teeth, dental protrusion where teeth and lips sticks out, overbite or underbite, deep bite or open bite, impacted teeth and forced eruption, anterior and posterior crossbites, and undersized or missing teeth.
Patients in this group may be treated with traditional metal braces, ceramic braces, clear aligners, or lingual braces. Duration of full treatment with braces is usually 1.5 years to 2.5 years but may be even shorter or longer depending on the specific problems, goals, and growth of the patient.
Orthodontics for Adults: Adults can be considered for either comprehensive treatment with ideal goals or specific goal oriented limited treatment, for example, to obtain alignment or set up space for an implant to restore missing tooth. As long as bones, gums, and teeth are healthy, adults can be successfully treated with braces. Adults, just like teenagers, can be treated with traditional metal braces, ceramic braces, clear aligners, and lingual braces. With completion of growth, modification of growth is no longer possible; however, a new option of orthognathic surgery becomes available. Working with an oral surgeon, facial disfigurement such as asymmetry in lower jaw, severe underdevelopment or overdevelopment of upper or lower jaws, incoordination between jaw width, and skeletal open bites can be corrected. For patients who would not consider surgery as an option, TADs or Temporary Anchorage Devices can be used to move teeth to correct problems previously only correctable through surgery. Treatment with TADs will resolve dental problems and the way teeth fit each other but will not bring facial changes orthognathic surgery can.
Traditional braces: Traditional braces with metal brackets and wires are very efficient and cost effective way to align teeth or close spaces. Metal braces provide minimal friction environment for optimal movement of teeth. Children can choose and design their own color coordination of elastic modules to provide fun and interactive experience with braces.
Ceramic braces: Ceramic braces are esthetic and discreet upgrade to traditional braces. Polycrystalline construction delivers clarity and strength to bracket. Ceramic brackets can be coupled with white coated wires and white elastic module to create the most discreet and attractive looking braces.
Lingual Braces: Lingual braces are for professionals, athletes, and performers who need completely invisible braces. Type of lingual braces used will be Incognito manufactured by 3M Unitek. They are invisible on the outside because they are bonded to the inner side of the teeth. Due to large variation in the anatomy of inner surfaces of teeth, each individual brackets or appliances are custom made from a precision impression using help of computer aided design technology and accompanying wires with built-in customizing bends made with robotic arms. Brackets are made with biocompatible dental gold alloys.
In the beginning, you can expect some discomfort but as tongue is adjusted to intrusion, it becomes more comfortable. Advantages are that lingual braces do not show from the outside, customized to an individual for effectiveness, fixed to teeth so they are working to move your teeth at all times. Disadvantage may be the cost which can be substantially higher than traditional braces due to highly customized appliances, both wires and brackets and because they are individually customized, patients must take care not to lose the broken appliances.
Getting lingual braces is a process. First, precise impression must be taken and shipped to laboratory. At the laboratory, impression is scanned and customized brackets and wires are manufactured according to doctor's prescriptions. It takes five to six weeks for completed case to be delivered back to the office, and patient is schedule for bonding appointment. After initial bonding appointment, patient needs to come back four to six weeks for periodic adjustments.
Temporary Anchorage Devices (TADs): Temporary Anchorage Devices are temporary devices used for orthodontic purpose to enhance strength of anchoring teeth or act as anchors themselves to help control movement of teeth. Once their job is completed, TADs are removed and bone and tissue are healed. Orthodontic anchorage can be defined in many ways, simplest of which may be "resistance to unwanted tooth movement" as Daskalogiannakis defined it. There are many types, biological or biocompatible, and each is subtyped into biochemical or mechanical depending on the way they attach to bone.
TADs are different from dental implants in purpose, dimension, location of placement, and interaction with bone. Dental implants will osseointegrate and fuse with the bone for the stability to support a tooth like crown whereas TADs will not osseointegrate; rather TADs will mechanically lock into bone and this facilitates clean removal once they served their purpose.
TADs come in many shapes and dimensions with variable locations of application. However, they all serve one purpose, to help orthodontist control movements of teeth.
When there are severe discrepancies between the upper and lower jaws that create severe form of underbite or overbite or when there are disproportionate underlying bone structures causing openbite, asymmetry, or gummy smile, orthognathic surgery and orthodontics may be able to set the jaw into more harmonious position. Orthognathic surgery is performed by an oral surgeon in conjunction with orthodontist. So before any treatment can begin, surgeon and orthodontist will review the records together and determine the ideal position of the jaws, and will plan the movements that will allow the best surgical outcome. Presurgical braces must be completed first so that teeth are coordinated into a position to fit each other after the surgery. Presurgical braces will not improve the bite; in fact, it is most likely to worsen it because teeth are being moved to a position that will make them fit after the jaws are moved.
Once presurgical braces are completed, oral surgeon will perform the osteotomies, or cuts in the bone, to move the jaws into planned position where bite will fit the best. After the osteotomies, jaws are stabilized using rigid fixation and sometimes will be wired together in intermaxillary fixation. There is usually few months of postsurgical orthodontics to optimize and stabilize the bite.
Orthognathic surgery is not without complications. There can be bleeding, swelling, infection, nausea, and vomiting. Usually there is numbness, and sensation does return after several months, but in rare cases, nerve damage is permanent and sensation does not return. Generally, complications do not occur frequently, but always patients must weigh the benefit to risks of such a treatment.
With permission, we are posting before and after pictures of underbite patient.