Welcome to ART Orthodontics slide series about orthodontics and dentofacial orthopedics. I am excited to introduce to you what orthodontics is, why have orthodontic treatment, and when should orthodontic treatment be done.

I will be posting information regularly to discuss various components of what I do at ART Orthodontics.

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I look forward to seeing you at my office in Davie Florida. We welcome patients from Broward county, Palm Beach county, Miami Dade county, Davie, Cooper City, Plantation, Weston, Fort Lauderdale, Boca Raton, Miami and surrounding areas.

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Orthodontists are dental specialists who diagnose, prevent and treat dental and facial irregularities. They receive an additional two to three years of specialized education beyond dental school to learn the proper way to align and straighten teeth and bite. Only those who successfully complete this formal education may call themselves Orthodontists and only orthodontists may be members of the American Association of Orthodontists (AAO).

https://www.aaoinfo.org/blog/what-is-an-orthodontist-and-dentofacial-orthopedist

The ABO Certification process requires the completion of peer-developed, externally validated written and clinical examinations. A Board Certified Orthodontist has reached this level of achievement by pursuing additional voluntary education and ongoing self- assessment. Board Certification is confirmation of an orthodontist’s personal commitment to providing lifelong quality patient care. The American Board of Orthodontics is the only orthodontic specialty board recognized by the American Dental Association and the American Association of Orthodontists.

https://www.americanboardortho.com

Orthodontic treatment is often sought for esthetic reasons to achieve facial harmony and a beautiful smile. However, another main objective of orthodontic treatment is to creates a functional bite (occlusion) by making the teeth fit together better and minimize the risk of future dental problems. Crooked and crowded teeth are hard to clean and maintain. A malocclusion (ill-fitting bite) may result in excessive wear of the tooth, difficulty in chewing and/or speaking, and excess stress on the supporting bone and gum tissue. Without treatment, many problems may become worse.

Orthodontic problems result from imbalances in the growth of the jaws and/or the alignment of teeth. Most orthodontic problems are inherited. Examples of these problems are crowding, spacing, protrusion, extra or missing teeth, and jaw growth problems. Other problems are acquired as a result of thumb- or finger-sucking, dental disease, accidents, and the early or late loss of primary teeth.

Some orthodontic issues compromise the esthetic of smile. Closing the gaps between teeth is a choice the most patient make to improve their smiles. If the gap is closed between the upper front teeth, a fixed wire is usually bonded behind the upper front teeth to keep the gap closed. This wire is left in place indefinitely.

Rotations of teeth can be mild in nature and not a concern to the patient. Proper bushing and flossing can maintain the health of the gum and bone. However, as a tooth starts to move and rotate away from the arch, the remaining teeth may continue to shift and the alignment may get worse over time. After completion of orthodontic treatment, retainers will need to be kept in place to maintain teeth in alignment.

Protrusion of the upper front teeth is not always a functional issue. In this example, the upper front teeth are forwards, however, the upper and lower front teeth still make contact against one another. Also, there is a mixture of baby and adult teeth present. Treatment can be delayed until all of the baby teeth exfoliate and adult teeth erupt naturally. However, if the esthetics of smile or lip protrusion and straining become a concern, early orthodontic treatment (known as interceptive treatment or phase I treatment) can improve the alignment of the teeth and bite at this stage of growth and development. This will then reduce the time for orthodontic treatment when all of the adult teeth are present.

Just like the cover of a box, upper teeth should cover all the teeth in the lower arch. When the arch of the upper teeth is narrow in dimension compared to the arch of the lower teeth, either the front, the back, or all teeth will be in “cross bite”. The orthodontist can identify crossbites at early age by examining the patients’ bite as they function and shift the jaw to find a comfortable bite. A functional shift of the jaw due to a crossbite is a significant orthodontic problem and if left untreated in a growing patient can lead to an imbalance in jaw growth. Early treatment is highly recommended.

An anterior open bite limits a person’s ability to chew and talk properly. Early closure of an open bite is recommended to improve the speech and the ability to chew. This treatment will help limit the tongue from posturing forwards. The open bite shown in this slide was caused by a thumb sucking habit. The thumb habit may stop at some point without orthodontic treatment; however, the forward posturing of the tongue may remain present and require intervention. If the tongue is allowed to be placed forwards, the open bite will worsen and becomes very difficult to close later on in life. Early treatment to restrain the tongue from sitting forwards is important to minimize the risk of severe open bites and the need for jaw surgery to close the bite in adult age.

Opposite to the open bite is the deep bite. A deep bite is more common than the open bite and doesn’t appear to be as much of a concern as the open bite. A deep bite allows the front teeth to touch and chew through food, however, the front teeth may touch too heavily and over time the lower front teeth will be worn out. If the teeth wear too much, they will have to be rebuilt in height and it can be a long and costly process to repair.

A missing tooth due to trauma is a functional concern since the bite is not optimized and also not stable. Other issues can arise from missing teeth and the bite can become severely compromised. Orthodontic alignment of the teeth prior to restoring the missing tooth allows for the best outcome esthetically and functionally. Orthodontic treatment is most beneficial to the patient and the restoring dentist.

Contrasted to mild lower crowding, severe lower crowding can lead to long term issues with the gum and bone health. Cleaning is much more challenging and sometimes impossible to perform properly. Generally, in situations like this, extractions are needed to balance the tooth size – jaw size discrepancy.

The American Association of Orthodontists recommends that your child get a check-up with an orthodontist at the first recognition of an orthodontic problem, but no later than age 7. By then, your child has enough permanent teeth for an orthodontist to determine whether an orthodontic problem exists or is developing. A check-up no later than age 7 gives your orthodontist the opportunity to recommend the appropriate treatment at the appropriate time. If early treatment is in order, the orthodontist may be able to achieve results that may not be possible once the face and jaws have finished growing.

Age is not a concern when it comes to orthodontic treatment. Healthy teeth can be moved at any age. Today, adults account for one in every five orthodontic patients. A consultation with an orthodontist will determine if you can benefit from treatment. Many of today’s treatment options such as clear braces and clear aligners (e.g., Invisalign, Sure Smile) are designed to minimize the appearance of the appliance and better fit an adult lifestyle.

Your orthodontist will need to consult with your dentist and/or periodontist about the health of your gums. If you are a candidate for orthodontic treatment, you will continue regular visits with your dentist and/or periodontist. For many patients, proper tooth alignment can contribute to healthy gums.

The image on the right shows post-treatment alignment of roots and better access for maintaining health of the bone and gums. Spaces are closed and distributed to replace the missing teeth with implants.

Orthodontic treatment averages less than two years, but can range from only a couple of months to three years or more depending on the severity of the problem and the stage of growth and development of the jaws and dentition. When “active” orthodontic treatment ends, retainers are prescribed for most patients to keep teeth in their new position. Advances in today’s orthodontic materials and technics have made it possible for patients to see the orthodontist only about once every six to eight weeks during active treatment.

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