The American Association of Orthodontists recommends that all children see an orthodontist by at least age seven and sooner if something is obviously wrong before age seven. Fortunately, most young patients don't need anything more than observation while the permanent teeth are growing into place.

Many young patients have problems, which will not, or should not wait. Most orthodontic problems are inherited and cannot be totally prevented; however something can usually be done before these problems become more difficult and more expensive to manage.

It is advisable to consult with an orthodontist prior to having your dentist remove any baby teeth or permanent teeth. To ensure the best overall dental and facial development, all patients should have an orthodontic consultation sometime between the ages of four and seven.

Dr. Bock offers early examinations and observation consultations. Contact us to schedule a complimentary consultation.

Classifications of Teeth

The classification of bites is divided into three main categories: Class I, II, and III. This classification refers to the position of the first molars, and how they fit together.

Class I
Class I is a normal relationship between the upper teeth, lower teeth and jaws or balanced bite.


Class I normal



Class I crowding

 

Class I spacing
 

 

Class II
Class II is where the lower first molar is posterior (or more towards the back of the mouth) than the upper first molar. In this abnormal relationship, the upper front teeth and jaw project further forward than the lower teeth and jaw. There is a convex appearance in profile with a receding chin and lower lip. Class II problems can be due to insufficient growth of the lower jaw, an over growth of the upper jaw or a combination of the two. In many cases, Class II problems are genetically inherited and can be aggravated by environmental factors such as finger sucking. Class II problems are treated via growth redirection to bring the upper teeth, lower teeth and jaws into harmony.

 

 
Class II division 1

 
 
Class II division 2

 

 

Class III
Class III is where the lower first molar is anterior (or more towards the front of the mouth) than the upper first molar. In this abnormal relationship, the lower teeth and jaw project further forward than the upper teeth and jaws. There is a concave appearance in profile with a prominent chin. Class III problems are usually due to an overgrowth in the lower jaw, undergrowth of the upper jaw or a combination of the two. Like Class II problems, they can be genetically inherited. Class III problems are usually treated via surgical correction of one or both jaws.

 
Class III functional or dental

 
 
Class III skeletal

 

 

Orthodontic Problems

 
Overjet
Upper front teeth protrude


 
 
Deep bite
Upper front teeth cover lower front teeth too much

 
 
Underbite
Lower front teeth protrude


 
 
Open bite
Back teeth are together with space between the front teeth


 

Crowding
Upper and/or lower teeth are crowded


 

Excess Spacing
There is excess space between teeth


 

Mid-Line Misalignment
Mid-lines of upper and lower arches do not line up

 

Crossbite
Upper back teeth fit inside lower teeth

Phases of Treatment

Phase I: Treatment usually takes 12 to 18 months and is done between the ages of 7-9. A variety of appliances may be used to correct specific problems.

Maintenance / Recall Phase: During the time between the first and second phase the patient will be seen every few months per year. This is to monitor the eruption of the permanent teeth and exfoliation of primary teeth.

Phase II (if required): During the first phase of treatment Dr. Bock has no control over 16 unerupted permanent teeth. If they grow in and problems still exist, further treatment, known as Phase II, will be required. A separate fee will be quoted at that time. Treatment usually takes 12-24 months.

Full Treatment: If you decide to wait, treatment will be started when all permanent teeth have erupted. Full treatment usually takes 18-30 months. The length of treatment depends on the severity of malocclusion and orthodontic problems.

Proper Braces Care and Brushing Techniques

Brushing and flossing your teeth can be challenging when wearing braces but it is extremely important that you do both consistently and thoroughly.

 
 
 


Foods to Avoid During Treatment: Eating proper foods and minimizing sugar intake are essential during orthodontic treatment. Your braces can be damaged by eating hard, sticky, and chewy foods.

  • Hard foods : Nuts, Candy, Hard Pretzels
  • Crunchy foods : Popcorn, Ice, Chips, etc.
  • Sticky foods : Gum, Chewy Candy (Skittles, Taffy, Gummy Bears, Caramel, etc.)
  • Chewy foods : Bagels, Hard Rolls, etc.
  • Foods you have to bite into : Corn on the Cob, Apples, Carrots (cut these foods up into smaller pieces and chew on back teeth)
  • Chewing on Hard Objects (for example, pens, pencils or fingernails) can damage the braces. Damaged braces will cause treatment to take longer.

Hard Foods

 

Soft Foods

 

Bone graft.Do you think of bone as a hard, rigid material that never changes? In fact bone remodels itself all the time: Your body is constantly depositing new bone cells and removing old ones. In the case of the bone that supports your teeth, this process can be helpful or harmful. For example, the jawbone's adaptability allows an orthodontist to move teeth into a better position with braces. But in the case of losing a tooth as an adult, the bone changes that result can have serious consequences.

When teeth are lost, the bone that used to surround them begins to melt away or “resorb.” Tooth-supporting bone can also be lost when you have periodontal (gum) disease. If you loose enough teeth and bone, your facial features will sag, giving you a more aged appearance; it can also complicate treatment to replace your missing teeth. Fortunately, with modern bone grafting-techniques, the bone that has been lost can be built up again. This can benefit both your health and appearance by strengthening your jawbone, allowing more effective tooth replacement, and increasing support to your facial features.

Bone grafting is a minor surgical procedure that is normally done in a dental office. An incision is made in your gum to gain access to the bone beneath it, and then grafting material is added. Most often, the grafting material is processed bone minerals around which your body will actually deposit new bone cells.

The grafting material itself can come from your own body, but very often it is bone from an animal or human donor that has been treated by a laboratory to make it sterile and safe. It can even be a synthetic substance. Grafting material comes in a variety of forms: powder, granules, putty or a gel that can be injected through a syringe. The graft, which is generally covered by a collagen membrane for optimum bone repair, will act as a scaffold onto which your body will build new bone.

Uses for Bone Grafts

Bone grafting for dental implants.

Bone grafts are used in dentistry to accomplish the following treatment goals:

  • Saving Teeth — When severe periodontal disease causes bone loss, teeth can become loose and at risk of being lost. In order to save them, the bone around them can be regenerated through grafting; this increases bone support and helps keep them in place.
  • Tooth Extractions — These days, it is very common to deposit bone grafting material into a tooth socket after a tooth has been removed. That way, should you want to replace your tooth with a dental implant later on, that option will be available.
  • Dental Implants — In this optimal tooth-replacement system, a small titanium post embedded in the jawbone is attached to a highly realistic dental crown, permanently replacing the missing tooth. Implants require good bone volume and density to achieve their excellent functionality and high success rates. If you have already experienced bone loss, a graft can help regenerate enough bone to place the implant successfully.

What to Expect

The procedure for placing a bone graft usually requires only local anesthesia, though oral or IV (intravenous) sedatives can also be used to achieve a higher state of relaxation. Since a small incision is made in your gum tissue to gain access to the bone that will receive the graft, you may experience some soreness in the area after the surgery. This can usually be managed by over-the-counter anti-inflammatory medication and/or pain relievers, as well as ice therapy after the procedure. Any discomfort should only last a day or two. Then, over the next several months, your body will replace the graft with its own bone, reversing the decline in bone quantity you have experienced.

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Bone Grafting - Dear Doctor Magazine

Can Dentists Rebuild Bone? Yes they can! It is very important to maintain bone volume following removal of a tooth so that dental implants remain a viable option for tooth replacement. This is easily accomplished with today's routine bone-grafting techniques... Read Article