ART Orthodontics Davie FL https://www.artorthodontics.com Dr Shiva Khatami Board Certified Orthodontist Wed, 22 Jul 2020 20:16:17 +0000 en-US hourly 1 https://wordpress.org/?v=5.4.2 https://i1.wp.com/www.artorthodontics.com/wp-content/uploads/2019/10/cropped-Slide03.png?fit=32%2C32&ssl=1 ART Orthodontics Davie FL https://www.artorthodontics.com 32 32 168549424 EARLY ORTHODONTIC TREATMENT – ANTERIOR CROSSBITE https://www.artorthodontics.com/2020/01/early-orthodontic-treatment-anterior-crossbite/ Tue, 21 Jan 2020 18:49:17 +0000 https://www.artorthodontics.com/?p=2027

I am excited to start discussing clinical cases and examples of orthodontic treatment. I will discuss the diagnosis of the cases and their treatment plans. I will also show the results from cases. I will be discussing various orthodontic issues in each of the blogs and will assemble a comprehensive treatment library for the reader to refer back to and learn from. Let’s begin with early orthodontic treatment, specifically, anterior crossbites.

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 are narrow in dimension compared to the arch of the lower teeth, either the front, the back, or all the 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.

A crossbite involving the front teeth is an ANTERIOR crossbite. A crossbite of the back teeth is a POSTERIOR crossbite. Each of these discrepancies in bite can be due to a SKELETAL or a DENTAL imbalance. Proper diagnosis is key to devise the proper treatment plan. The image on the right is of a posterior crossbite.

In this image – one of the upper front teeth is misplaced behind the lower front teeth. This is an ANTERIOR crossbite. The front tooth is tipped towards the tongue. This is a DENTAL crossbite.

You can see an indentation (blue arrow) in the gum tissue above the patients upper right front tooth. This was from a baby tooth that was over-retained and did not fall out as the adult tooth was erupting. Therefore the upper right adult central incisor tooth was deflected towards the tongue and grew in behind the lower teeth. If the baby tooth was pulled out earlier, the upper tooth may have grown into the proper position.

It can also be seen that the root of the patients lower right central incisor is being pushed forwards (green arrow). This can lead to recession of the gum tissue around the lower central incisor. Other reasons to treat this condition at an early age is increased tooth mobility and risk of improper tooth wear. Correction of an anterior crossbite is important at an early age. 

These are two more examples of anterior crossbites that involve more teeth. 

As was mentioned before, some crossbites are due to imbalances in skeletal growth (top images). This can be diagnosed from x-rays of the upper and lower jaws (the cephalometric x-ray). Growth modification and orthopedic appliances are needed to address this problem. 

The bottom example shows a dental crossbite since some of the front teeth are in the correct orientation while some teeth are not. Simple tipping of the front teeth in crossbite is all that is needed to correct the crossbite.

A removable appliance (that looks like an orthodontic retainer) can be custom made to move one or more teeth. The appliance can also be designed to widen the dental arch. Both anterior and posterior crossbites can be corrected. There are clasps in the back of the appliance to hold it in the mouth. It is important to not play with the appliance otherwise these clasps will become loose. The springs in the front of the appliance are designed to tip the teeth in to position. The screw in the middle is opened/widened at home with a special key and can correct the posterior crossbite. Generally, these appliances are worn 20-22 hrs/day and taken out to brush, floss, and eat. Always put your appliance in your retainer case so it doesn’t get lost when it is not in your mouth! Monthly activations with the orthodontist is required to efficiently move the teeth.

A tongue depressor is one of the simplest removable appliances. In order to move a tooth, a force needs to be applied in the correct direction and for sufficient duration. For a tongue depressor, the patient is to use the tongue depressor for approximately 20-40 minutes per day when watching TV, reading, on the internet. The crossbite can be correct in 2 weeks and sometimes takes 2 to 3 months.

In this example of a very mild crossbite, where the patient can still bite the front teeth together and the patient shifts in to a crossbite, the tongue depressor was able to move the front teeth forwards. 

It is important for the orthodontist to realize that a shift in the lower jaw is important to correct and once eliminated, the teeth will sit in their correct position.

Here is a before and after picture of the anterior dental crossbite presented earlier. This correction was accomplished in about 3 months and the patient is about 7 years old. We will follow-up with patients until all of the adult teeth are erupted and re-evaluate for full treatment to close any spaces and align the teeth when the patients are about 12 years old. Sometimes this correction is all that is needed for the patient and the rest of the adult teeth grown in to an acceptable position. Generally, future treatment is only needed if there is an esthetic issue and the patient and parents can make a decision for future treatment. If a functional deficit is not corrected at an early age, future orthodontic treatment is necessary.

Here is what the removable appliance looks like when it is in the patient’s mouth. The pads in the back of the appliance are key to allowing us to quickly correct the crossbite by taking away overlap of the front teeth. 

Retainers are recommended to be worn 20-22 hours per day. 

After the bite is corrected, the retainer is generally worn at night. The retainer is taken out to eat and when brushing.

The retainer will fit until the baby teeth start to fall out. Then, generally, the retainer is no longer needed.

Here is another case of correction of the upper right central and lateral incisor teeth. Please note the improvement in the height of the gum tissue after treatment. This bite was also treated with only a removable appliance.

Sometime instead of a removable appliance, braces are used to align the upper front teeth. Here is an image of what it looks like when there are simply four braces placed to align the upper front teeth. Upper front braces are helpful for patients who tend to forget things…like their retainers!

This is an example of a skeletal crossbite. All of the upper front teeth are behind the lower front teeth. 

This patient needed to have upper and lower front and back braces to level their bite since the front teeth over-erupted because of their mis-positioning. The patient also needed a device that pulled the upper front jaw forwards. The device also changed the skeletal position of the upper jaw and helped set the lower jaw backwards as the bite opened and the lower jaw rotated open. You can see the hooks where the device attaches to rubber bands. 

This is an example where early treatment is key to reducing and possibly preventing extensive orthodontic treatment and jaw surgery when this patient grows up. I will discuss in detail the treatment of skeletal underbites in future blogs. 

Please stay tuned and Like and Share our blog!

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ORTHODONTIC BRACKETS (BRACES): HOW DO THEY WORK? https://www.artorthodontics.com/2019/12/orthodontic-brackets-braces-how-do-they-work/ Thu, 19 Dec 2019 21:24:40 +0000 https://www.artorthodontics.com/?p=1914

Orthodontic treatment involves attaching brackets (braces) and wires or Invisalign and attachments to teeth – but how do they move teeth? Here I explain the components of braces and clear aligners (e.g. Invisalign and Sure Smile) and the biological principles involved in tooth movement.

Here are three general bracket types. A tube bracket – on the left. A twin bracket in the middle. A self-ligation bracket on the right. 

Orthodontic brackets have different components including a “slot” to hold the wires and “wings” and “hooks” to hold ties or other attachments such as elastics. The ends of archwires pass through and are held in place in orthodontic “tubes”.

The tube bracket holds the wire after the wire is inserted. Tube brackets are generally used for the back teeth since the molar teeth are difficult to access and there are heavy bite forces. With a tube bracket no extra tying in of the wire is needed and the wire is held in place firmly after it is inserted.

Conversely, twin brackets support the wire in their slots with little elastics wraps around the wings to hold the wire in place. Those are the colorful ties that you choose every time you come in for adjustment visits!

Self ligation brackets have built-in “ties” in the form of a gate. When the gate is closed, the wire is held in place.

During the adjustment (tightening) visit, your orthodontist decides if a different shape, size, or material of archwires should be inserted into the brackets or the elastics are re-tied like your shoelaces to allow certain movements happen in your teeth. Sometimes, your orthodontist makes some bends in the archwires to move certain teeth in different directions. Gaps may be closed with use of “powerchains” which are elastic ties that are attached together. Gaps may be opened up with use of coil springs to create spaces around narrow teeth for reshaping by your restorative dentist. You may be advised to wear elastics that hook on your teeth in different areas and directions to help align your bite.

This picture shows the colors that can be added to the braces and the difference to self-ligation braces.

Self-ligating brackets have “gates” to cover the front of the slot. This minimizes friction of the wire with brackets as teeth slide along the wires and therefore makes tooth movement more efficient. Since there is no need to change the elastic ties, your adjustment intervals can be extended to 6-8 weeks. This reduces the number of visits to your orthodontist office since there is no need to change the old worn out discolored rubber ties!

The self ligating brace and the gate that is closed on the left and open in the middle and the gate locking the wire in place on the right.

Self ligation brackets don’t need to be tightened in the traditional way that twin braces are. Self ligation braces are only tightened when a new larger wire is used or when a bend is required in the archwire to move certain teeth in specific directions.

Generally with self ligation braces, patients do not have to come as often to have their braces tightened. Also, without the color ties around each brace, the braces are easier to keep clean. Another nice feature of self ligation is gentler forces on the teeth and less discomfort of having the braces tightened every month.

Braces are glued or bonded to the teeth. This can be done directly by the orthodontist one bracket at a time or can be done all at once with a jig or matrix that has the brackets pre-placed (i.e. indirect bonding). I use both systems in my office.

To adhere the bracket to the tooth, the tooth is first cleaned and conditioned with an etching material. Etching is done to create micrporosities in the enamel that can only be seen with an electron microscope. These microporosities allow little micromechanical locks for the thin resin bonding agents to be applied to the tooth. The tooth is now chemically prepared to adhere to the bracket with a composite resin paste that is applied to the back of the bracket and then placed on the prepared tooth. LED light is then used to set the polymers in the adhesive paste and harden the resin to attach the bracket to the tooth. This resin paste is the same as the tooth colored material used for fillings.

The bonding process of the teeth is reversible. Braces have to be taken off at the end of treatment. And when braces are removed, they are clicked off with use of an orthodontic plier and the mechanical bond between the tooth and brace is broken. Now if that bond were too strong, the enamel of the tooth would be damaged. So the bond strength is designed to be weak enough that the braces can be “broken off” without damaging the tooth.

Like any other adhesive, applying excessive force can sheer off the bond and result in detachment of brackets from the tooth surface. That is why, your orthodontist recommends avoiding certain food during your orthodontic treatment. Any food that is too hard, too chewy, or too sticky can compromise the bonding of the resin and detach your brackets from your teeth. Foods that are hard can impart enough pressure to give the energy to break the bond between brace and tooth. So, before you bite into anything, think about weather or not it would break the bond of brackets with your teeth. If the answer is yes, cut your food into pieces before eating or simply avoid eating them until your treatment is completed. Re-bonding the broken bracket is simple. However, broken brackets disturb the balance designed in the system of braces and archwires and can create undesirable movements or delay tooth movement.

Brackets are  generally bonded to the labial (front side) of the teeth using a resin based dental adhesive. 

Brackets serve as handles to hold the wire in place and insert the force of the wires to the teeth.

Today’s brackets are small and sleek, especially compared to brackets of  a generation ago– or even those from 10 or 15 years ago. Probably most of the brackets you will see will be made of stainless steel.  But  some patients opt for ceramic brackets.  Some may even have gold-plated brackets.

The “band” is a metal ring that wraps around a tooth – usually a molar – to provide an end point for insertion of the wire.  The band is cemented to help it stay in place for the duration of treatment. Bands can also be used as part of orthodontic appliances such as expanders.

The archwire, or wire,  fits in the horizontal slots in each bracket. The wire is secured to all of the brackets as discussed previously.

Ligature is a tiny rubber band or a metal tie that is stretched around the bracket.  It holds the wire in the slot of the bracket so that it can deliver force to the teeth and move them.

Patients often select fun colors for their rubber ligatures.  The ligatures are changed at each adjustment appointment. 

Sometimes a twisted wire is used instead of a rubber ligature.  There are some braces that don’t use ligatures at all.  Those are called “self-ligating” braces.  They have their own built-in method of holding the wire to the brackets.



Elastic hooks are used to attach rubber bands.

These are the rubber bands that patients put in and take out themselves.  They are often prescribed to help move the teeth toward their final positions and to align the bite.  Wires alone cannot always move teeth where they need to go or bring the bite into its final alignment. Rubber bands will not necessarily be prescribed for every patient. However, when prescribed, your cooperation with your orthodontist recommendation is essential in order to achieve ideal treatment outcome.

So putting it all back together, here are all of the components that can make up a set of braces.

Placement of wires into brackets leads to application of pressure to the teeth and surrounding tissues. This pressure will result in resorption (dissolving) of the bone around the tooth. Once the tooth is in its new position, new bone is formed around the tooth to maintain it. The direction and amount of the forces applied to teeth is determined by your orthodontist and should be closely monitored to prevent adverse effects such as resorption of the roots of teeth or bone.

Insertion of aligners applies pressure to the teeth. This pressure will result in resorption (dissolving) of the bone around the tooth. Once the tooth is in its new position, new bone is formed around the tooth to maintain it. The design of resin attachments bonded to your teeth, and direction of forces applied to them are determined by your orthodontist and should be closely monitored to prevent adverse effects such as resorption of the roots of teeth or bone.

Microosteoperforation is a procedure whereby small perforations are made in the bone surrounding the tooth to expedite its movement. This procedure recruits the cells involve in the process of remodeling the bone around the tooth.

Dr. Khatami has been mentoring orthodontic residents and conducting several studies at Nova Southeastern University to explore which technique of accelerating tooth movement works best to produce healthier and faster outcome.

Use of Propel device and microosteoperforation accelerated movement of the second molar to replace the missing first molar.

Here is the before and after images of using the propel system and braces to accelerate tooth movement of the first and second molars forwards. The propel system also helps in the direction of movement to move the back teeth forwards, versus the front teeth back. This is a huge benefit to treatment and you can see the extra space for the third molars.

If teeth are moved too far beyond the biological limits of their surrounding tissues, the surrounding bone will resorb. Teeth will lose their support, may get loose, and eventually lost. Your orthodontist evaluates the amount of bone available and discuss options such as extractions to maintain your teeth within healthy bone while they are moved into ideal position.

I hope that this section of the ART Orthodontic Blog has been informative and educational. It is important to understand that there are many factors that go in to orthodontic treatment. It is not only about making a beautiful smile. It is important to understand the basic tenants of biology and physiology and to know how and where to move the teeth. It is also important to understand the mechanics and engineering involved in moving the teeth. I am proud of my training and background and my mentor Dr Subtelny was a pioneer in orthodontics early in his orthodontic career and he was a leader his whole career. He lead by example and he lead by making all of his students think and to understand that in orthodontics – the “root is the root of the problem”.

This means that the person moving your teeth needs to have an understanding of the biology, the anatomy, the physiology, and the mechanics of braces to properly align the teeth and their roots to have a successful result that is stable long-term and healthy for the gums and bones.

Coupling this series of slides with the previous set of slides hopefully provides and understanding of the complexity involved in orthodontic treatment and gives you confidence in seeking treatment at ART Orthodontics where we will use our training and expertise to give you the best results possible that will last your lifetime.

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THE ORTHODONTIST: EXAM, DIAGNOSIS, AND TREATMENT PLAN https://www.artorthodontics.com/2019/12/the-orthodontist-exam-diagnosis-and-treatment-plan/ Wed, 04 Dec 2019 19:32:11 +0000 https://www.artorthodontics.com/?p=1871

A comprehensive orthodontic exam is the most important aspect of your treatment. A comprehensive exam allows your orthodontist to diagnose all the problems that contribute to imbalances in bite and the jaw relationship and compromise your smile and facial proportions. A proper diagnosis is essential in developing a customized treatment plan that is aimed to address the specific issues with your smile and your bite and meet your expectations. Dr. Khatami dedicates all the time that is needed to listen to your concerns, to thoroughly evaluate your facial proportions and harmony, your jaw relationships, your nose, chin, and lip positions from all angles, and your smile esthetic. She will then evaluate your teeth one by one and in relation to each other to determine all your esthetic and functional needs in order to provide you with not only a beautiful smile, but also a healthy and functional dentition and bite for life.

Clinical exam starts with a discussion of your concerns and your expectations with your orthodontist. This includes your concerns about your smile, your lip projection, your facial proportion and balance and any issues you have experienced in relation to your bite and jaws. Your orthodontist will then review your medical history to evaluate your overall health and determine if any medications you take could potentially pose some limitations on tooth movement or result in overgrowth of the gum tissue during treatment. She will then review any history of trauma to your head and neck area to determine if there any changes have happened to your teeth or jaws or the bones and muscles of face and neck as a result of the previous trauma. She will also ask you questions about any possible breathing issues such as asthma or allergies and any sleep breathing disorders such as snoring and Obstructive Sleep Apnea. When necessary, your orthodontist may refer you to your medical doctor to complete a sleep study to determine the severity of the problem and proper diagnosis and treatment plan such as use of removable or orthognathic surgery to bring  the lower jaw forward and open the airway during sleep. The health of your jaw joint will also be evaluated to address any possible issues with the Tempromandibular Joint (TMJ).

Photos will be taken from the front and side of your face in neutral and smiling poses. This allows your orthodontist to measure different components of your face and smile to determine any imbalances or asymmetries. More photos will be take from your teeth from the front, side and chewing surfaces to identify problems with alignment or teeth or bite.

The panoramic x-ray allows the orthodontist to see an overall picture of the jaw bones – it is a “low definition” view of the teeth. Your dentist will take “high definition” x-rays of the teeth to review for cavities, when indicated. Your orthodontist looks at the bones and the surrounding structures to identify any densities or areas of radiolucency that are outside of normal limits. She looks at the anatomy of the jaw joints and sinuses, looks for any extra or missing teeth or teeth that are stuck in bone and can not erupt on their own or are erupting in an abnormal path. In this panoramic x-ray, there are two permanent teeth missing in the upper right side of the patient (the left side of the screen).

The cephalometric x-ray allows the orthodontist to evaluate and measure the vertical and horizontal relationships of the jaw bones and teeth. The bony structures shown on the cephalometric x-ray give your orthodontist an idea of the growth potential of a growing patient. In a non-growing patient, it shows the severity of the discrepancy of the jaw proportions and the challenges in aligning the bite and decreasing or increasing the vertical overlap of the teeth. The horizontal relationship of the jaw bones determines if some teeth need to be removed in order to bring the protruding front teeth back to achieve proper bite and balance of the lips and maintain teeth within the confines of a healthy bone. Tooth movement is limited to the amount of the bone available around each tooth. If the jaw bones are too discrepant, then the position of the jaw bones needs to be changed with jaw surgery or growth modification in order to achieve a proper bite.

Study models  and digital scans of your teeth allow the orthodontist to closely review the dental relationships in horizontal, vertical, and transverse dimensions. These models are used to measure the size of the teeth to determine the amount of space available for their alignment. Your orthodontist also evaluates the size of the upper teeth relative to the lower teeth to determine if the size of the teeth are proportioned correctly or there is need for removal of certain teeth or reshaping them to proper proportions.

Dr. Khatami uses the iTero scanner and digital models to simulate tooth movement at your initial examination and discuss options for your treatment.

Use of current imaging software allows your orthodontist to take linear measurements and evaluate the relationship of teeth in different dimensions.

When the path of eruption of a tooth is altered, it may not erupt naturally into the mouth or cause damage to the root of the adjacent teeth. In order to evaluate the position of those teeth accurately and detect possible damages to the surrounding structures, your orthodontist may take a 3D xray (CBCT) of that area. The image is used to evaluate the current position of the impacted tooth and determine a proper path for assisted eruption.

A comprehensive exam and data collection is essential in proper diagnosis of all the issues that compromise the esthetic of your face and smile and contribute to imbalances in your bite and function. Following a comprehensive clinical exam and analysis of all the gathered data from pictures, radiographs and models of your teeth, your orthodontist identifies and lists and prioritize all the problems in relation to facial, skeletal and dental disharmonies and use this diagnosis as a basis of a customized treatment plan to address all your esthetic and functional needs.

With a comprehensive exam completed and diagnosis and problem list developed and prioratized, your orthodontist will then evaluates all the available options for your treatment. Advances in technology allowed orthodontists to achieve ideal outcomes within a shorter amount of time and less discomfort. Each patient’s treatment needs are unique and therefore each patient’s treatment options should be evaluated comprehensively and carefully to come up with the best option that addresses their health, esethetic, and functional needs. Your orthodontist will determine the proper timing for treatment, an estimate of the time that it will take to achieve ideal outcome, and if your treatment can be completed in one or more than one stages. This is essential in treatment of growing patients since treatment may be broken down to different stages depending on the stage of their growth and development and the pattern and timing of eruption of permanent teeth. Some bite or jaw growth problems require use of orthopedic functional appliances to modify growth of the jaws and aid in alignment of the bite. Many choices of brackets and aligners are available these days to meet your esthetic needs. At Art orthodontics we pride ourselves in using the best quality of brackets, all made in the US, Canada, and Japan (e.g., American Orthodontics, SPEED System, and GAC respectively). We also offer various clear aligner options such as Invisalign and Sure Smile aligners. Dr. Khatami will discuss with you if additional procedures such as extractions of teeth, surgical exposure and assisted eruption of impacted teeth, or jaw surgeries are required to provide you with the healthiest and most esthetic smile that your deserve. Prior to or upon completion of your treatment, you may be referred to different specialists to evaluate the need for periodontal surgeries or restorations of the missing or mis-shapen teeth. Once your treatment is completed, you will be given retainers to wear to maintain the alignment of teeth and bite.

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INTRODUCTION TO ORTHODONTICS AND ORTHODONTIC TREATMENT https://www.artorthodontics.com/2019/11/intro_braces/ Fri, 22 Nov 2019 22:00:00 +0000 https://www.artorthodontics.com/?p=1336

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.

Please feel free to share and like these posts on Facebook and to visit my Website. You can also follow my slide series on Instagram.

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.

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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