Orthodontics is when the teeth are straightened or moved in order to achieve a more ideal relationship with each other. Generally, people get braces to improve the look of their teeth and smile.
On this page you will find:
1. Why use Marius St Family Dental for orthodontics
2. Methods we use to align teeth
3. Benefits to orthodontic treatment
4. How to get started
5. Orthodontic Terms Explained
Why Marius Street Family Dental?
1. A comprehensive treatment plan with a team approach. We combine our knowledge of the different areas of dentistry to give you a treatment plan that will include considering not just aligning the teeth but
- Smile Design - Get the foundations right. Are some teeth too small. Will we use orthodontics to get the foundation and spacing correct then change the shape/size with fillings or veneers?
- Individualised Oral Health Plan including assessment of decay and gum disease risk and treatment needs.
- Long term treatment considerations: Crowns, bridges, Implants - all of these should be taken into account when making the Plan
- Jaw Joint and TMD (temporomandibular dysfunction)
- Muscle function and resting positions. Eg. Tongue tie, nasal breathing, snoring, swallowing patterns
2. Treat the cause, not just the symptoms. This is our philosophy. Although genetics play a role, crooked teeth are not natural, they are a sign that something has not gone according to nature's plan. It is a symptom of underdeveloped jaws and/or incorrect muscle function. Have you ever wondered why some children grow up needing braces and some children don't? Genetics? What about siblings?
Did you know orthodontic treatment has a 50% relapse rate in the long term? Why is this? Because the underlying causes weren't addressed and the muscles pushed the teeth back to where they want to be - that't why we bond wires to the inside of the teeth forever to try and fight the muscles! But what if you got the muscles right, so that they help keep the teeth in the right position?
3. Treat the patient, not the teeth! As said before, the teeth are just one part of the equation. Talk to use about your budget, wants and needs to we can make a plan that suits your individual circumstances. Not everyone is striving for perfection, people have different goals, so don't go for a treatment plan that only considers your teeth.
2. Methods we use to straighten teeth
Here at Marius Street Family Dental, we provide many options for achieving this goal, and often combine many therapy methods together to get you the best result (read below)
- Conventional Braces (brackets and wires) - full upper and lower, or sectional (just focused on one area)
- Clear Aligners such as Invisalign. Read more
- Maxillary Expander - when you have underdeveloped jaws and crowded teeth, the space needs to come from somewhere. A maxillary expander puts gentle pressure on the top jaw to encourage the body to lay down more bone and grow. It is done before braces or can be done during braces, to get room for the teeth to move into.
- Removable Appliances - One that you can take in and out, puts pressure on the teeth or jaws to achieve a certain result. Most commonly used in growing children
- Myofunctional Appliances including MRC appliances. These are used in conjunction with muscle and breathing exercises to improve muscle function and correct incorrect muscle patterns (eg mouth breathing, reverse swallowing, incorrect tongue posture etc). We believe that correct form follows correct function.
- TADs - Temporary Anchorage Devices - we will advise you if we think this is required. It is a great tool to be able to offer patients as in certain cases, it greatly increases case result. To move teeth, you need to put pressure on them (push or pull). To push something, you need to push AGAINST something, ie. you need an anchor point. We normally use the other teeth, but if you want to move molars, what you will get is the molar moving a bit, and the other teeth moving a bit. A TAD allows you to anchor on something that isn't the teeth (and isn't out of the mouth like orthodontic headgear - works amazing but most people won't wear it).
- Referral to specialists: ENT if we suspect nasal or airway obstruction as a contributor to the tooth alignment; orthodontists or orthognathic surgeons if case is severe
3. Benefits of getting orthodontic treatment with us
4. How to get started
Start with a comprehensive check up and treatment plan. Discuss at this appointment your budget, wants and needs, including why you're interested in orthodontic treatment and what your goals are.
Here we will discuss your options and possible alternatives. If we both decide orthodontics is a good option, we will make a comprehensive treatment plan for you and do the initial assessment. If there aren't any issues that need to be addressed first (gum disease, decay, etc), we will book you in for a records taking appointment.
Here we will take moulds, photos, xrays and gather any other information we need. We will then sit down for a second consultation that will go through this information and give you specific orthodontic treatment plan options, cost and estimated time-frames for each.
5. Orthodontic Terms Explained
We assess this with an xray of the skull and jaws, and look at the relationship between the different skeletal structures. This is called cephalometric analysis.
It is important because we need to figure out where the problems are: whether it is the relationship of the teeth that is the problem, and the jaws are in the right place; or if the jaw/s are the issue and the teeth are trying to compensate for this.
The skeletal structures are the biggest component of facial profile and the hardest to change. They are best addressed while the patient is still growing as we can influence growth direction.
- The maxilla is the upper/top jaw bone, which is actually formed as two bones which join together in the middle during childhood growth. The maxilla bones form the top jaw, the floor of the nose, the sinuses and a large part of your upper airway.
- Growth: From birth until around the age of 12, the maxilla bones grow bigger and then join together. Sometimes these bones do not grow sideways enough before fusion, and as a result the upper jaw bone is narrow.
- Why is it a problem?
- This becomes a problem down the track, as a narrow upper jaw means that there is a difference between the jaw size and the teeth, causing crowding.
- Also, as the maxilla grows first, then the lower jaw follows, if the maxilla is too small, it restricts the lower jaw. The lower jaw often then compensates, and its growth is affected.
- It can also lead to other problems; such as breathing obstructions (underdeveloped upper airway can be linked to UARS and OSA as well as other airway issues), a sunken midface appearance, and a discrepancy between upper and lower jaw sizes.
Mandible too forward (skeletal Class 3)
- Medically referred to as skeletal class 3.
- The mandible is the lower jaw bone, which moves to open and close your mouth with the help of the jaw joints (TMJ) and muscles of your face. A skeletal class 3 is when the lower jaw has grown horizontally more forward than the top jaw.
- It has been found that at least two-thirds of the time, this is because the top jaw has been restricted (too small), but can also be due to genetics.
- If it is severe, then surgery may also be considered in conjunction with dental braces.
- This is when both the upper and lower jaws are too forward. It gives an appearance of the lips being pushed out, which could lead to difficulty keeping the lips fully closed (lip incompetence).
It can be associated with a tongue thrust (see below)
Dolichofacial or Brachyfacial growth pattern
The relationship between the upper and lower teeth, looking at the front and back teeth and how they fit together when the mouth is closed. The top and bottom jaw are meant to be a set which fit together in a way that gives you the best function, as well as protects from wear and trauma by distributing the force properly across the teeth, and protects the jaw (tooth guidance)
Class 1 Dental Bite
Generally considered as the ‘normal’ bite, and the ideal position of teeth after braces are complete. The lower jaw fits into the top jaw.
Class 2 Division 2 Dental Bite
The lower teeth are set back relative to the top teeth. The front teeth are flared out (sticking out), and gives the appearance of “buck teeth”. The top jaw is generally underdeveloped and narrow.
The lower jaw and chin appear small relative to the face (when you look at the face sideways, the lower jaw looks like it is set back).
The lower lip can be trapped under the top teeth (lip trap). This means that it pushes the lower teeth backwards and increases the distance between the edge of the top front teeth and the edge of the lower front teeth (overjet). A lower lip trap is associated with open bite and overactive chin muscle (see below – overactive mentalis) and if not diagnosed properly can lead to relapse after orthodontic treatment.
In children who have a thumbsucking habit which continues, the upper jaw and teeth can be pushed out into “Class 2” as their bones are still forming. This is why it is important to help the child stop their thumbsucking early, to prevent a severe malocclusion.
Class 2 Division 2 Bite
The lower teeth are set back relative to the top teeth, but the upper front teeth are tilted inwards. Rather than having a positive angle where the front teeth gently slope forwards, the instead are straight up and down, or have a negative angle.
This is bad because it locks the lower jaw in. One of the functions of the top front teeth is to guide the jaw when the lower jaw goes forwards and backwards, it acts like a ramp for the jaw to slide on. If the teeth point inwards, then the lower jaw has to jump the teeth to go forward, which puts a lot of stress on the jaw joint, and leads to a lot of wear on the front teeth.
Sometimes the teeth next to the front ones will overlap the front teeth.
Usually a deep overbite (the top teeth overlap the lower teeth by more than 30%) which increases to excessive wear on the bottom teeth and risk of jaw joint disorders. When there is complete overbite, the lower teeth scissor with the top ones and bite onto the gums behind the top teeth (sometimes you can see bite marks) which leads to soft tissue damage.
This bite class is heavily associated with clenching, joint disorders and airway issues.
Class 3 Bite
Opposite to Class 2, this is when the lower teeth are positioned too forward relative to the top jaw. This is usually because the top jaw is underdeveloped, but can also be because the lower jaw has grown too large.
The front teeth can be “edge-to-edge” (where there is no overlap), open (there is space between the top and bottom teeth when biting down), or in “crossbite” (lower teeth overlap the top teeth – see below).
In children, this can sometimes be a “pseudo- Class 3” or have a functional shift (see below), which means the child postures their lower jaw forwards because of an interference or instability in their bite. This can be corrected more simply if detected early by removing interference and re-establishing correct bite.
Whats the problem?
This is not ideal as the lower teeth are designed to fit inside the upper teeth, and the upper teeth guide the lower teeth. Class 3 bites means that the stress through the mouth is incorrect and we see incorrect wear patterns and high risk of fracturing teeth or creating jaw joint problems. It also had a ‘prominent chin’ appearance.
Incisors are the front teeth. The front teeth are flared out (sticking out), and gives the appearance of “buck teeth”. The top jaw is generally underdeveloped and narrow.
Open bite - Anterior/Posterior
Cross bite aka Negative/reverse overbite – anterior, posterior
A deep overbite is when the top teeth overlap the lower teeth by more than 30%, which increases to excessive wear on the bottom teeth and risk of jaw joint disorders. When there is complete overbite, the lower teeth scissor with the top ones and bite onto the gums behind the top teeth (sometimes you can see bite marks) which leads to soft tissue damage.
The general population do not notice midlines so much, research shows a midline shift of 2mm does not get noticed by people who are not dentally trained.
Negative/Incorrect curve of spee
Maxillary Excess, Excessive Gingival Display
Muscle or Soft Tissue Disorders
The following is a really good resource.
A reverse swallow, also called an infantile swallow is a swallowing pattern that we used as babies to swallow breast milk. People with this swallowing pattern failed to develop a mature swallow, which uses the tongue to throw back the food bolus. Swallowing should be a passive function and you should see NO facial muscles used - ie. no facial expressions.
The mentalis muscle is the chin muscle. It is seen overworking when there is an anterior open bite or an incorrect swallow.
An overactive mentalis muscle can be seen dimpling (see picture on the right) when the patient swallows.
The effect is pushing the lower teeth backwards or crowding the lower teeth, increasing anterior open bite and relapsing orthodontic treatment.
Interfering Frenum Attachments
When there is a skin fold that is interfering with teeth alignment or function. Frenums are bits of 'skin' attachments. The labial frenum is what attaches the top or bottom lip to the jaw bone. An interfering frenum is one that runs high into the gums around the teeth or between the teeth. They can create a gap between the teeth (diastema).
The lingual frenum attaches the tongue to the floor of the mouth.
The potential consequences of a tongue tie are:
--compensation during function (swallowing, speaking) – the lower jaw or other muscles have to do more work because the tongue is less flexible.
-- a low tongue rest posture. At rest the tongue sits on the bottom of the mouth rather than pressed up against the palate (top jaw), leading to a narrow top jaw, droopy soft palate, risk of snoring or airway issues
--increased risk of clenching.
Consequences: This dries out the gums on the front teeth and mouth, increases decay rate, increases incidence of bad breath.