Posts for tag: orthodontics
The final emergence of permanent teeth in late adolescence marks the end of a long process beginning in the womb with the formation of our primary or “baby” teeth. Permanent teeth form in a similar way as buds high in the jaw, continuing to grow until the primary teeth ahead of them fall away. The crowns of the new adult teeth eventually break through the gum tissue and emerge (erupt) into view.
At least, that’s normally what should happen; sometimes, though, a tooth may only erupt partially or not at all, a condition known as impaction. The crown remains partially or fully submerged below the gum line, causing the tooth to press against other teeth, potentially damaging them. It can also make periodontal (gum) tissues adjacent to the area more susceptible to disease. Wisdom teeth are especially prone to this kind of impaction, to the extent they’re often surgically removed (extracted) to avoid future problems to adjacent teeth or the bite.
Upper canines (the “eye teeth” normally located directly below the eyes) are also subject to impaction. But because of their highly visible position, extracting them could have an adverse impact on the patient’s smile. In this case, we often attempt instead to expose and ultimately save the tooth.
Before taking any action, however, an orthodontic examination is conducted first to pinpoint the exact position of the impacted tooth and determine how that position might affect moving teeth into a more desired alignment. If we find the impacted canine is in a workable position, the next step is to surgically uncover the tooth from the gum tissue (a minor procedure usually performed by an oral surgeon or periodontist). Once exposed, an orthodontic bracket with a small attached gold chain is bonded to the tooth. The gums are then sutured back into place with the chain exposed and allowed to heal.
At some future point an orthodontist will attach the chain to orthodontic hardware that will pull the impacted tooth into proper position over several months. As a result, the upper canine becomes “un-impacted”; the dangers to surrounding teeth and tissues are also reduced. And, just as important, we can preserve the tooth and with orthodontics achieve an attractive, normal smile.
If you would like more information on the effects and treatment of impacted 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 “Exposing Impacted Canines.”
Not only can orthodontic treatment transform your smile, it can also restore function to your teeth and mouth that will improve both your oral and general health. But any treatment to straighten misaligned teeth requires careful planning. Depending on the exact nature of your misalignment, there may be some additional steps we would need to perform before undertaking orthodontic treatment.
One common need is space to help relieve overcrowding. To make room for tooth movement, often a tooth may need to be removed if the crowding is excessive. The most likely candidates are the first bicuspids, teeth located between the cuspids (or eyeteeth, located in line under the eyes) and the second premolar located in front of the molar teeth. The removal of these first premolars won't have a great effect on future form or function. Under the gentle pressure exerted by the braces, neighboring teeth will move and fill in the open space. Today's orthodontist goes to great lengths to avoid removing any teeth; in severe overcrowding, though, this is an acceptable way to create needed space.
Damaged teeth in need of replacement may also be removed before orthodontics and certainly more desirable — if any tooth needed to be removed, you would always choose a damaged tooth first. The object is to first preserve the underlying bone and close the space to avoid replacing that tooth or, if not possible, maintain the correct amount of space for any future restoration.
As living tissue, bone constantly reshapes in response to its environment. If it no longer senses a tooth (or the forces exerted by a tooth when biting or chewing), the bone will slowly disappear through a process known as bone resorption. To counteract this process, we may graft material (like processed donor bone) into the socket to encourage and maintain bone growth. This creates a platform for future tooth replacements like implants or bridgework after orthodontic treatment.
After orthodontics, it may also be necessary to install some type of “placeholder” (temporary bridgework or partial denture) in the area of missing teeth. Keeping the teeth from migrating into the space will improve the chances that any permanent restoration like an implant or fixed bridgework will look natural — as if it belonged there the entire time.
A complete dental examination will indicate whether any teeth need to be removed before undergoing orthodontic treatment. If necessary, taking this strategic step will help ensure we achieve the best result — a winning smile.
If you would like more information on tooth removal and other options to enhance 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 “Tooth Removal for Orthodontic Reasons.”
What is orthodontics?
Orthodontics is a sub-specialty of dentistry devoted to the study of growth and development of the teeth and jaws and treatment of improper bites (malocclusions).
What causes improper bites?
Malocclusions result from irregularities in the positioning of teeth, disproportionate jaw relationships, or both.
Why have orthodontic treatment?
Orthodontic treatment is carried out primarily to improve the alignment and function of your teeth and bite. It also results in improved oral health, easier maintenance, a better smile, and enhanced self-confidence and esteem.
What is the first step?
What do we need in order to plan your orthodontic treatment?
- Molds (impressions) of your teeth to study your bite (study models).
- “Articulated models” placing your study models in a machine that replicates jaw movement.
- Specialized x-rays showing your teeth and how your jaws align.
- Photographs of your smile and position of your teeth.
- Computer imaging.
What are braces?
Orthodontic appliances, commonly known as braces, are small brackets that are placed on teeth, through which thin flexible wires are threaded. They are the parts that move the teeth.
How do they work?
The wires tend to straighten out to their undistorted forms moving the teeth with them. Since the tissues that attach the bone to the teeth are living, they are constantly changing and remodeling themselves. Harnessing these natural forces allows the movement of teeth. Light controlled forces acting through the wires cause new bone to be formed as the teeth move into new improved positions.
What are current options for orthodontic appliances?
- Fixed appliances, traditionally known as braces, include brackets bonded to the teeth. These may be either metal or clear brackets, which are less visible but more susceptible to breakage.
- Removable appliances, or clear aligners. These consist of a series of computer-generated clear plastic custom fitted trays that progressively move the teeth into better alignment.
Orthodontic treatment is an ingenious scientific discovery that has allowed the dental profession to precisely move teeth for better appearance as well as improved function. It harnesses the body's natural processes by which tissues normally remodel themselves to maintain a steady state, allowing your dental team to move your teeth into improved position for a lifetime of dental health and a great smile.
For adults with a reasonably well fitting bite, but mild to moderate crowding or spaces between your teeth, clear orthodontic aligners can be an ideal solution for straightening your teeth. This is why we offer this treatment option to our patients experiencing these issues. However, for those of you who are unfamiliar with what they are or how they work, this will give you a brief understanding.
Clear orthodontic aligners consist of a series of clear “trays” that fit snuggly over all teeth to slowly shift them into alignment. Patients are typically required to wear them 20 hours per day for about 2 weeks before progressing to the next tray. With each new tray, you are one step closer to achieving your goal of perfectly aligned teeth. The entire process usually lasts 6-18 months depending on how much movement is required to achieve the goals.
Each aligner is individually made from very precise molds of the patient's teeth to ensure proper fit. And we map out the entire alignment process using computer generation from each patient's initial molds so that we can identify the number of trays required. But best of all, clear orthodontic aligners are perfectly smooth with no rough edges like traditional braces, and you can remove them for eating, brushing, and flossing teeth as well as for brief social events.
If you are insecure about your misaligned crooked teeth, then you may be a perfect candidate for clear orthodontic aligners. This system is an alternative to traditional braces that uses a sequence of individual, clear, removable “trays” that fit over your teeth to gradually straighten them. Each tray is completely clear and covers all the teeth thus making it virtually invisible. Each tray is designed to slightly move the teeth until the teeth are in proper alignment. Typically, each tray must be worn for 20 hours a day for 2 weeks before progressing to the next tray in the sequence with each tray moving you closer towards your goal — perfectly aligned teeth.
However, clear orthodontic aligners are not for everyone. If you are interested and wonder if they can benefit you, contact us so that we can schedule an appointment for a thorough evaluation to assess your specific situation. Below, we have briefly outlined some situations when they will and will not work.
Clear orthodontic aligners work if...
- You have mild to moderate crowding or spacing issues between teeth
- Back teeth fit together properly
They may not be the right choice if...
- You have moderate to severe crowding or spacing issues between teeth
- When your bite does not align properly (for example, if you have a large over-, under-, or cross-bite)
- When your teeth are “rotated” way out of position; such misaligned teeth will require special or complex techniques to rotate them back into position, or to pull them down into place or to fill the space left after pulling a tooth to resolve excessive crowding of teeth