Dentists extract millions of teeth each year, mostly because of disease. But sometimes a healthy tooth is removed to gain a more favorable, long-term dental health outcome.
An example of this is extracting teeth for the sake of orthodontic treatment. This is often beneficial when treating bite problems caused by crowding, a condition in which not enough space on the jaw exists to accommodate all of the teeth coming in. When this happens, the limited space can force teeth out of their proper alignment.
Crowding also complicates correcting the bite problem with braces: As with the eruption phase, there's no available room for orthodontic movement. One solution that may arise after a detailed examination is to open up space on the jaw by removing some of the teeth.
Planning this kind of tooth extrication requires careful forethought with the end in mind—ultimately, the dental providers involved want the resulting appearance after braces to look as natural as possible. For that reason, dentists usually choose teeth for extraction that are outside of the "smile zone" (the teeth visible while smiling) like premolars and molars.
Additionally, dentists are concerned about bone loss after extracting the teeth. Bone often diminishes around empty tooth sockets, especially if those sockets were damaged during extraction. This loss in bone can weaken the jaw structure and cause significant problems while moving teeth with braces.
To avoid this, dentists take great care during tooth removal not to damage the socket. Additionally, they may place a bone graft within the socket immediately after removing the tooth, especially if the space will remain vacant for a significant period of time. A bone graft serves as a scaffold upon which new bone cells can form and accumulate.
After the extractions, the orthodontist may then proceed with correcting the bite. Patients may also need some form of prosthetic teeth to fill in the spaces while wearing braces. Often prosthetic teeth can be incorporated with the braces for a more natural look. After braces, any remaining gaps may require further restoration, either with dentures, bridges or, later in adulthood, dental implants.
Complex bite problems like crowding pose unique challenges in correcting them. But using techniques like tooth extraction can help achieve a successful and satisfactory outcome.
If you would like more information on treatments for 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 “Tooth Removal for Orthodontic Reasons.”
Each year, millions of children and teenagers wear braces or clear aligners to straighten a crooked smile. But there may be a way to treat some of these bite problems and avoid braces—by intercepting the problem at an earlier age.
This can often be done if the bite problem stems from abnormal jaw development rather than misaligned teeth. An example of this occurs when the upper jaw growth outpaces the lower jaw, causing the upper teeth to protrude beyond the lower teeth. Aside from the effect on appearance, protruding front upper teeth may extend beyond the protection of the lip and be more prone to injury.
A device called a Herbst appliance could prevent this from happening. The top of the device has two hinged metal tubes that connect to elastic bands bonded to the back teeth on both sides of the upper jaw. The bottom also has tubes affixed in the same way to the bottom teeth, except they're slightly smaller and fit within the upper tubes.
The lower tubes sliding within the upper tubes produces slight pressure against the lower jaw to ease it forward. This gradually influences the lower jaw to grow at a pace equal with the upper jaw to decrease the chances of poor bite development. Unlike other corrective methods, the Herbst appliance fixed in place and out of the way won't interfere with sports or other physical activities.
An installed Herbst appliance may change a patient's sensations during swallowing, eating or speaking, but most children adapt to the changes within a few days. And, because the device can create challenges for keeping the back teeth clean, many dentists recommend adding a fluoride rinse to daily brushing and flossing as an added boost against tooth decay.
The Herbst appliance is most effective during the period of most rapid physical growth between the ages of 11 and 14, but if the teeth are already beginning to protrude it can be undertaken as early as 8 or 9. Either way, this important orthodontic tool could help address a complicated bite problem and reduce the need for more costly orthodontic treatment later on.
If you would like more information on early interventions for poor bites, 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 “The Herbst Appliance.”
Instagram, America's humongous digital photo and video album, is chock-full of the silly, mundane, and poignant moments of people's everyday lives. That includes celebrities: Tom Hanks buying a used car; Ryan Reynolds sporting tiny sunglasses; Taylor Swift and Ed Sheeran taking a hike. And then there's former Olympic alpine skier, Lindsey Vonn—posting a video of her recent dental visit.
Winner of several World Cup competitions and the first woman to gain the gold for downhill racing at the 2010 Winter Olympics, Vonn broke her two front teeth during a—you guessed it—skiing competition a few years ago. This past September, she went to the dentist to update her restoration and gave her followers a fascinating firsthand look at dental bonding, a technique for repairing a chipped or broken tooth.
Although dental bonding has been around for decades, it's taken a leap forward in the last few years because of improvements in bonding material. A mixture of plastic and glass components, composite resins can produce a strong and durable result when bonded to teeth. To begin the technique, the tooth's surface is prepared so that the composite resin can better adhere. Along with an adhesive agent, the bonding material is applied as a paste, which makes it easier to shape and sculpt for the most realistic look. This is usually done layer by layer, with each individual layer hardened with a curing light.
The technique allows us not only to achieve the right tooth shape, but also to incorporate your natural tooth color. We can tint the composite resin as we work so that your restored tooth blends seamlessly with the rest of your natural teeth. The result: A “new” tooth that's both beautiful and natural-looking.
What's more, dental bonding is more affordable than veneers or crowns and can often be done in a single visit. You will, however, need to exercise care with your new restoration. Although highly durable, it can be damaged if you bite into something hard. You'll also need to watch foods and beverages like tea or coffee that can stain the dental material.
Even so, we can help you regain the smile you once had before you took your teeth skiing—Lindsey Vonn-style—or whatever you were doing that resulted in a “whoopsie.” All it takes is a call for an appointment to start you on the path to a more attractive smile.
If you would like more information about cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Artistic Repair of Front Teeth With Composite Resin.”
Correcting a bite problem involves more than applying braces. Orthodontists must consider a wide range of factors, including the type of bite problem involved, complications like impacted or missing teeth, and their patient's overall dental condition.
Orthodontists must also keep in mind the future—how will a treatment implemented now impact a patient's appearance and dental function many years from now? In reality, orthodontists perform these treatments within a dynamic growth environment, especially involving children and teenagers whose mouth and facial structures are still maturing.
And although these growth changes slow in adulthood, they don't stop—orofacial structures continue to change throughout life. For example, a person's lips steadily thicken in size until the mid-teen years, and then slowly thin out over the rest of their lifetime. The distance between the lips both at rest and while smiling may also narrow in later years. Other changes continue to occur in the bones and soft tissues of the mouth and face.
Fortunately, this structural growth follows a fairly consistent track. Although variations do occur, an orthodontist can project the growth changes their patients will undergo as they age, and use that knowledge to plan out bite treatment. With this understanding, orthodontists plan not only what treatments will be needed, but when to perform them, and to what extent.
This may involve a number of treatment stages, spaced out to coincide with regular development. An orthodontist may focus first on general bite correction to bring the teeth and jaws into a reasonable state of alignment. Later, they'll use more refined methods to fine-tune corrections that better align with later adult growth.
More intensive treatments may be necessary to build a foundation for future treatment. For example, orthognathic surgery may be needed to correct a severe case of an over-extended lower jaw. During the procedure, surgeons move the lower jaw to a joint position higher on the skull. This retracts the lower jaw into a more normal alignment with the upper jaw, and can dramatically change the facial profile for the better.
Each orthodontic patient is different, and each requires their own a unique treatment plan. That plan has a greater chance of long-term success by applying knowledge of future growth changes.
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 “Understanding Aging Makes Beauty Timeless.”
While retainers are often viewed as a nuisance, they’re crucial to protect the gains made with bite correction. Without them, all of the progress achieved through braces or clear aligners could be lost.
Here’s why: The same elastic gum tissue called the periodontal ligament that holds teeth in place also allows them to move incrementally in response to changes in the mouth. That’s why we can move teeth with braces or aligners, which put pressure on the teeth toward a desired direction of movement while the periodontal ligament does the rest.
But the mechanics can also work in reverse: With pressure relieved when the braces are removed, the teeth could revert to their original positions through a kind of “muscle memory.” The light pressure provided by a retainer is enough to keep or “retain” teeth in their new positions.
The best known retainer is a removable appliance. Initially, a patient wears it continuously and only takes it out during oral hygiene. Wear duration may later be reduced to night time only and eventually not at all, depending on a patient’s individual needs.
While effective, removable retainers do have some downsides. Like braces, they’re visible to others. And because they’re removable, they’re frequently misplaced or lost, leading to the added expense of a new one.
An alternative is a bonded retainer, a thin piece of wire attached to the back of the newly moved teeth to keep them in place. Because it’s behind the teeth it’s not visible—and there’s no misplacing it because only a dentist can take it out.
A bonded retainer is a good option, especially if a patient is immature and not as diligent about wearing or keeping up with their appliance. But it can make flossing difficult to perform, and if they’re removed or broken prematurely, the teeth could revert to their former positions.
If you decide to go with a bonded retainer, be sure you get some tips from your dental hygienist on how to floss with it. And if you decide later to have it removed early, be sure to replace it with a removable retainer. Either of these two options can help you keep your new and improved smile.
If you would like more information on bonded retainers, 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 “Bonded Retainers.”
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