Non-surgical anterior open bite closure.  Flaring of the upper and/or lower anterior teeth due to orthodontic unraveling of crowded teeth can lead to shallowing of the anterior overbite (called by some the drawbridge effect).  If the overbite was shallow prior to treatment an anterior open bite can result.  This is why I tend to prescribe more premolar removals for crowded cases with shallow overbites and proclined incisors.  If I suspect that first premolar removals may lead to loss of lip support I will suggest removal the second premolars.


 
 

 
 

 
 

Open bite surgical/orthodontic cases.  Open bite cases pose a challenging problem.  They can many times be closed by orthodontic means only but, have a high tendency for relapse (especially on a non-extraction basis).  In adults that do not require extractions, the orthodontic closure of anterior open bites utilizing elastics will many times reopen.  In these cases, surgical posterior maxillary impaction allows for auto rotation of the mandible and a stable open bite closure.  I will leave the second molars slightly out of occlusion and allow them to spontaneously erupt since these may have been the only teeth to occlude prior to treatment.  More next week on non-surgical open bite closure.

Class II surgical/orthodontic cases.  If the mandible is too retrognathic, surgical advancement may be in order.  Unlike class III surgical cases we do not always have to wait for growth to cease prior to pursuing the surgery.  The surgeons tell me that the mandible must be matured to the point that it does not splinter or greenstick fracture during surgery.  Prior to the surgery it is necessary for us to level the curve of Spee in the lower arch and close all lower spaces that are not planned for implants or restorations. Otherwise, maximum advancement of the mandible cannot be expressed.  Surgical advancement of the mandible will improve the airway in most retrognathic patients and may lessen the chance for obstructive sleep disorders in the future.

Class III surgical/orthodontic cases.  Patients that display significant class III malocclusions will many times require orthognathic surgery in cooperation with their orthodontic treatment (once growth has ceased).  It is not uncommon to find the upper incisors flared facially while the lower incisors are retroclined lingually.  It is important to consider the airway, overbite and profile when determining if the mandible needs to be positioned distally, the maxilla mesially or both.  Since it is wise to wait on definitive orthodontic treatment until growth has stopped, we will sometimes pursue a first phase of upper braces while the patient is growing to facilitate a nice smile and increased self-confidence. 

Mesially erupting mandibular second molars continued.  When we diagnose a mesially tipping mandibular second molar as it erupts we must look at the crowding present in the arch.  Many times crowding is present and that contributes to the molar’s deviation.  Premolar removal treatment must be considered as this will allow the lower first molars to drift mesially thus giving the second molar a better eruption path.  Lower second premolar removal facilitates this the best.  If the case is a borderline extraction case, mesially tipped mandibular second molars being present may swing the pendulum toward extraction of lower second premolars.

Mesially erupting mandibular second molars.  We have recently covered mesially erupting (ectopic) maxillary first molars.  It is not uncommon to see the lower second molars erupting with a mesial cant that can sometimes find them caught under the distal aspect of the first molar.  Diagnosing these early is important since once they are caught these second molars may continue to tip until they are almost horizontal and become unsalvageable.  If braces are in place and there is adequate room in the arch we can attach a second molar bracket and upright the tipped tooth.  It may be necessary to remove some of the buccal tissue with a laser in order place the bracket.  Next week more on this topic when there is lower crowding.
 
 
 
 

We're here every day.  Our practice model has been to stay at one location.  I'm here four days per week and keep support staff there the fifth day in order to answer phone calls and take care of minor emergencies.  I'm the only orthodontist at the office and they see me each appointment.  Patients seem to like the continuity of care and the fact that the office is always fully staffed if they need us.  All of our orthodontic records and bracket placement appointments are accomplished in the office location they have chosen without them wondering where we are practicing today.  We are able to have a full service in-house lab daily for immediate repairs and excellent Doctor/Lab communication.  Come by anytime for a tour of our facility at 12800 Metcalf Avenue!