Two Stage Orthodontic Treatment

For most of the last century, orthodontic treatment was not initiated until all of the “baby teeth” had fallen out. For most patients, this worked out fine with excellent final results. For some patients, however, results were less than satisfactory. These were patients with certain jaw problems, functional problems or problems that damaged or otherwise adversely affected the jaws or the permanent teeth.

We now know that these patients can be treated with the same excellent final results if treatment is done in two phases or stages. Generally, the first stage of treatment addresses the jaw problem, functional problem or problem adversely affecting the jaws or the permanent teeth. The second stage addresses the alignment and spacing of the teeth and the coordination of the upper and lower teeth.

Sometimes phase I treatment is initiated for elective, esthetic or cosmetic reasons. In these patients, the final results are the same, but some of the benefits of treatment can be enjoyed much sooner. The decision to start elective two phase treatment is often motivated by social factors. 

Compared to single stage treatment, the total treatment time may be more or the same and the cost is usually greater. This is more than made up for by the superior results of the orthodontic treatment.

For patients receiving phase I treatment, future treatment requirements are hard to predict, because they depend on growth and development that has yet to occur. Some patients will require no additional treatment. Most will require a second phase of treatment. Typically this involves full or partial braces and can last from as little as 6 to as many as 24 months or more. The specific treatment needs for your child can be determined by an orthodontic evaluation.

Dr. Frank R. Egan

www.TeethOnTheMove.com

Deep Bite

In orthodontics, the most eye-catching “before and after” photos are the severely crowded malocclusions (bad bite) with blocked out cuspids looking more like vampire fangs than human teeth. Most parents will notice the Class II malocclusion with the classic “buck teeth”. Crossbites are routinely diagnosed during dental checkups by dentists and hygienists. Often overlooked, however, is the deep overbite malocclusion. In the absence of crowding, the deep overbite maybe ignored. 

In a deep overbite malocclusion, the upper incisors cover the lower incisors excessively, sometimes completely, when the teeth are brought together to bite.

Unfortunately, deep overbite can be extremely destructive over time.  Typically by middle age, patients with untreated deep over bites have severely worn mandibular incisors (lower front teeth).  Many of these patients are bruxers (teeth grinders), but even in the absence of bruxing, the tooth wear can be devastating. Attempts at restoring the lost tooth structure end in frustration for the dentist and the patient because the restorations are subject to the same forces that ruined the natural teeth. TMJ dysfunction (jaw pain) is also statistically more likely in patients with deep overbites.

Prevention is the best treatment. In growing children, orthodontic treatment with braces or Invisalign can result in a stable occlusion with ideal overbite. One of the keys to a long–lasting result is correction of the angulation of the incisors. Typically, the upper incisors are tipped in with a deep overbite. Treatment may be initiated in younger patients if incisor impingement on the palate is causing pain. When achieved at an early age, however, overbite correction may be difficult to maintain during the loss of the remaining “baby” teeth. In these cases, retreatment may be necessary. Stable overbite correction can usually be achieved in adults as well. 

Each patient must be evaluated individually to consider any other orthodontic problems and to determine the best treatment. As with most orthodontic treatment, a timely evaluation can insure optimal treatment timing and the best possible result. 

Dr. Frank Egan

www.TeethOnTheMove.com

Open Bite

An open bite is usually described as vertical gap between the biting edges of the front teeth or the chewing surfaces of the back teeth. Open bites are often associated with jaw growth problems, but they are always associated with forward tongue position. Sometimes they are associated with thumb and finger habits.

It is normal for babies and very young children to suck fingers and pacifiers. It provides comfort and security. Most children stop sucking on fingers or pacifiers between two and four years of age and no harm is done to their teeth or jaws. If a child continues sucking beyond this age it may cause the upper front teeth to tip forward, the lower front teeth to tip back and the upper jaw to narrow. These changes in the teeth and jaws will cause abnormal tongue and lip function and development.

If sucking persists beyond four years of age, the child should be encouraged to stop the habit. A visit to the dentist or orthodontist can be a helpful way to explain why sucking is bad for the teeth and jaws. Once the child is interested in stopping, a stepwise approach is used until the habit is stopped. For very persistent habits, a special appliance may be needed. Soon after the sucking stops, the problems caused by it may begin to correct themselves. Depending on the child’s age and other conditions present, additional orthodontic treatment may be needed.

Forward tongue posture or “tongue thrust” is seen in open bite patients with or without thumb/finger habits. This too is normal in infants and is usually outgrown. Beyond this time, it can cause undesirable changes in the bite similar to those seen in thumbsuckers. In young children (8-10), forward tongue posture can be predictably corrected with appliance therapy. Myofunctional therapy, a behavioral approach to retraining the tongue, can be an extremely valuable adjunct to appliance therapy.

Posterior open bites are less common. When they do occur, they are often associated with baby molars that are ankylosed or fused to the bone. This becomes an even bigger issue when the permanent second premolars are missing. Posterior open bites are also associated with lateral tongue thrusts.

In patients with severe anterior “skeletal” open bite, orthodontics combined with jaw surgery may be the best treatment. A complete four dimensional evaluation is critical, since growth changes must be considered.

For patients with an open bite, early evaluation is critical in order to achieve the best results with the most conservative treatment.

Dr. Frank R. Egan

www.TeethOnTheMove.com