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Posts for tag: orthodontic treatment

EarlyInterventioncanCorrectAbnormalUpperJawandPalateGrowth

Poor bites, also known as “malocclusions,” can have a dramatic impact on mouth function and appearance. Moving teeth to better positions will solve most of these bite problems — but not all.

A case in point is a malformed maxilla, the skeletal structure formed by the union of the upper jaw and the roof of the mouth (the palate). If the rear portion of the maxilla develops too narrowly, the back teeth will bite abnormally inside the lower teeth while the front teeth bite normally, creating what’s known as a crossbite. People with this kind of malocclusion often shift their lower jaw to one side to bite down completely.

This can be corrected without too much intervention if the problem is diagnosed while the person is young. This is because the maxilla is actually formed from two bones that don’t completely fuse together in the center of the palate until just after puberty. An orthodontic appliance known as a palatal expander takes advantage of this slight gap. The metal appliance is placed along the narrowed portion of the palate in the rear of the mouth: four metal “arms,” two on each side, attach to the inside of the back teeth with a tension device between them that extends the arms outward to put pressure against the teeth.

Every day the patient or a parent uses a special key to turn the tension device and cause it to expand slightly, placing additional outward pressure on the jaw. This will widen the gap in the center of the palate and new bone will grow to fill in the increased space. Over time this will cause the rear portion of maxilla to widen.

While effective, a palatal expander may not work in every case, and it must be done before the two bones fuse permanently. When it can be used, though, it’s a proven treatment that can restore proper bite function, as well as improve your child’s smile.

If you would like more information on palatal expanders to correct certain bite problems, 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 “Palatal Expanders.”

AnchorageDevicesProvideMoreAccuracyLessTreatmentTimeforBraces

Braces are a common part of many teenagers’ life experience — but not every bite problem is alike. Sometimes, there’s a need for accurately moving only a few teeth while making sure others don’t. This is where Temporary Anchorage Devices (TADs) can help streamline that effort and even reduce treatment time.

Orthodontics wouldn’t work at all if we didn’t already have a natural tooth movement mechanism in our mouths. That ability rests with the periodontal ligament, a tough, elastic tissue between the teeth and the bone that firmly attaches to both with tiny collagen fibers. Though quite secure in holding teeth in place, the ligament attachment also allows teeth to move in response to changes in the bone and jaw structure.

Braces are made of brackets cemented to tooth surfaces through which tiny wires pass. The wires are anchored, usually to other teeth or groups of teeth, and tightened to apply pressure against the other teeth. The ligament does the rest: as the teeth are “pressured” to move in a certain direction, new bone, ligament and an anchoring substance known as cementum forms behind it to secure the tooth in its new position.

The anchorage teeth are not intended to move. In some situations, though, it’s difficult to keep them from not moving — much like trying to keep a boat anchor from not dragging through sand on the sea bottom. TADs help alleviate this problem: it’s a mini-screw or mini-implant that’s temporarily placed in the jawbone to which the tension wire can be secured. They’re placed in the best positions for isolating the teeth that need to be moved without compromising the position of nearby teeth that don’t.

With the site numbed with a local anesthetic, we install the TAD through the gum tissue into the bone with a special device; their screw-shaped design holds them securely in place. They’re then removed when the orthodontic treatment is complete.

While a simple procedure, precise placement requires collaboration between the orthodontist and the oral surgeon or dentist who installs them. They also need special attention during daily hygiene to keep them clean. Still, with difficult bite situations they can help bring about the right outcome — a straight and beautiful smile.

If you would like more information on orthodontic treatment 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 “What are TADs?

OrthodontistscanUseOtherToolswithBracesforComplexBiteProblems

Braces utilize the mouth’s existing teeth-moving mechanism by applying pressure in the direction of the desired movement. This is done with a wire laced through metal brackets affixed to the outside of the teeth that’s then usually anchored to brackets on the back teeth to maintain constant tension.

This anchorage set-up alone, however, may not work effectively with all bite situations, which might require other points of anchorage. That’s where these other tools in the orthodontist’s toolkit can come in handy.

Headgear. These appliances not only aid with moving teeth but they also help influence the proper growth of facial structures (as when one of the jaws is too far forward or too far back). Because of this influence on jaw growth you’ll only find them used with pre-teens. The most typical application is a strap running around the back of the head or neck (or sometimes over the chin or forehead) that attaches in the front to brackets usually bonded to the molars. In this case the back of the patient’s skull serves as the anchor point.

Temporary anchorage devices (TADs). Orthodontists sometimes wish to isolate the teeth to be moved from nearby teeth that shouldn’t be. For example, they may want to move front teeth back to close a space without the back teeth moving forward. In this case, it may be necessary to create a separate anchorage point in the jaw. This can be done with TADs, which are made of either biotolerant (stainless steel, chromiumâ??cobalt alloy), bioinert (titanium, carbon), or bioactive (hydroxyapatite, ceramic oxidized aluminum) materials and shaped like mini-screws. Orthodontists insert them into the bone and then attach them to the braces using elastics (rubber bands). After completing orthodontic treatment they’re easily removed.

Elastics. We’ve already mentioned them, but elastics deserve their own category because they can be used in various kinds of anchorage. They play an important role, for example, in cross-arch anchorage that maintains tension between the upper and lower jaws. They can also be used to help move one or more groups of teeth — or isolate certain teeth from moving. They truly are flexible (no pun intended) in their uses for fine-tuned tooth movement.

All these devices can be used in various combinations to match and correct whatever bite situation a patient may have. The end result is straighter and better-functioning teeth — and a more attractive smile.

If you would like more information on orthodontic treatment, 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.”

By William Ralstin, D.D.S.
August 20, 2018
Category: Dental Procedures
HowtoTreattheProblemofTeeththatNeverDeveloped

About one-quarter of people have teeth that never developed. While most of these congenitally missing teeth are wisdom teeth, they can also include premolars or lateral incisors (the teeth right next to the two front teeth, the central incisors).

Missing teeth can have an adverse effect on smile appearance. But that’s not all: because each type of tooth performs a specific function, one or more missing teeth can lead to bite problems and disruption of dental function. In the case of missing lateral incisors, the canines (eye teeth) normally positioned beside and toward the back of the mouth from them may begin to drift into the empty space and grow next to the central incisors. This can result in greater difficulty chewing and a smile that “doesn’t look right.”

To correct this situation, we must often first attempt to orthodontically move any out of place teeth to their normal positions. This re-establishes the space needed for the missing teeth to be replaced, which we can then restore with prosthetic (artificial) teeth. If the permanent restoration of choice involves dental implants, we’ll usually need to wait until the completion of jaw development around early adulthood. In the mean time, we can use a retainer appliance to hold the teeth in their new positions with prosthetic teeth attached to fill the empty space for a better smile appearance in the interim.

The real issue is timing—beginning orthodontic treatment when appropriate to a person’s oral development, as well as completing the implant restoration when the mouth has matured sufficiently. There are other considerations such as bone volume, which may have diminished due to the missing teeth. At some point we may need to consider grafting to build up the bone sufficiently to support dental implants.

This all may entail a team approach by various specialties like orthodontics, periodontics and implantology. Working together and coordinating within a timely schedule, a mouth and smile marred by undeveloped teeth can be transformed.

If you would like more information on treating smiles with underdeveloped permanent teeth, 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 “When Permanent Teeth Don’t Grow.”

AnchorsMakealltheDifferenceinSuccessfulOrthodonticTreatment

Orthodontics shares a principle with the classic tug of war game: if you want things to move in the right direction you need a good anchor. Anchors help braces and other appliances apply constant pressure to misaligned teeth in the direction they need to go to correct a malocclusion (poor bite).

Orthodontic treatments work in cooperation with an existing oral mechanism that already moves teeth naturally in response to biting forces or other environmental factors. The key to this mechanism is an elastic tissue known as the periodontal ligament that lies between the tooth and the bone. Besides holding teeth in place through tiny attached fibers, the ligament also allows the teeth to move in tiny increments.

Braces’ wires laced through brackets affixed to the teeth exert pressure on them in the desired direction of movement –the periodontal ligament and other structures do the rest. To maintain that pressure we need to attach them to an “anchor”—in basic malocclusions that’s usually the back molar teeth.

But not all malocclusions are that simple. Some may require moving only certain teeth while not moving their neighbors. Younger patients’ jaws and facial structures still under development may also need to be considered during orthodontic treatment. That’s why orthodontists have other anchorage methods to address these possible complications.

One example of an alternate anchorage is a headgear appliance that actually uses the patient’s skull as the anchor. The headgear consists of a strap running around the back of the head and attached in front to orthodontic brackets (usually on molar teeth). The pressure it exerts can trigger tooth movement, but it can also help influence jaw development if an upper or lower jaw is growing too far forward or back.

Another useful anchorage method is a tiny metal screw called a temporary anchorage device (TAD) that is implanted into the jawbone above the teeth through the gums. Orthodontists then attach elastic bands between implanted TADs and specific braces’ brackets or wires to exert pressure on certain teeth but not others with pinpoint accuracy. After treatment the TADs can be easily removed.

Using these and other appliances allows orthodontists to customize treatment to an individual patient’s particular malocclusion. With the right anchor, even the most complex bite problem can be transformed into a beautiful and healthy smile.

If you would like more information on orthodontic treatment, 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.”



Fort Worth, TX Dentist D.D.S. and Lindsey Howedel, D.D.S.
2941 Oak Park Cir Fort Worth, TX 76109 817-926-8700 Dental Tooth Contact For Pricing options