Friday, December 11, 2015

How anterior overbite relates to extraction needs.  The amount of anterior overbite or openbite a patient has plays an important role in uncrowding of the dentition.  When we see a slightly open or shallow overbite malocclusion that displays crowding a red flag can go up.  Uncrowding of the teeth tends to lean the incisors somewhat labially and this will lead to more opening of the anterior overbite.  Even if the vertical elastics are used to deepen the bite, open bite tendencies may return after removal of the braces.  On the other hand, spaced dentitions will tend to deepen during orthodontics and space closure.  An easy way to visualize this is to think of a draw bridge and what happens as the two halves are leaned upward or brought back toward the water. 

Friday, November 20, 2015

More about expansion versus extraction treatment.  I prefer to treat cases in a non-extraction manner whenever possible.  If the patient does not display posterior crossbites we must be careful to not overly expand the maxillary arch into buccal crossbite.  If the lower arch needs, and will withstand, some expansion I will expand the upper arch slower in hope that the occlusion with "drag" the lower posterior teeth along.  Severe mandibular crowding may necessitate premolar extraction treatment so that we do not flare the lower incisors labially and out of the alveolar bone.  This can lead to future boney and gingival dehiscence and periodontal problems.  Over the next few Weekly Tips we will discuss how lip appearance, class II and class III occlusion, overbite and upper/lower tooth size discrepancies affect extraction decisions. 

Friday, November 13, 2015

Expansion versus extraction treatment decisions.  I probably get the most questions regarding the decision to expand the arches versus extract permanent teeth.  I'll limit the discussion here to children and adolescents.  Anatomical development finds the mandibular midline suture closed before one year of age while the maxillary midline suture can widened into the teens in many cases.  For this reason significant upper expansion is much more obtainable than the same procedure in the lower arch.  Thus, extraction decisions in many cases are made after carefully reviewing the amount of space needed in the mandibular dentition.  We have to look not only at the amount of crowding present but also the degree of overbite correction, class II or III correction and tooth uprighting necessary.  More on how I make these decisions next week.

Friday, October 23, 2015

Tip of the Week

When I use our diode laser.  I have successfully used a laser in our office for over 10 years to enhance speed of treatment and esthetics.  The laser is routinely used 2-3 weeks prior to bracket removal in order to size back the enlarged and fibrous gingival tissue that can occur with less than excellent oral hygiene.  The gingival margins can be leveled bilaterally giving symmetry to the completed smile.  The soft tissue diode laser is invaluable when tissue removal is necessary to bracket an erupting canine or lower second molar.  This can save months of treatment time instead of waiting for that one tardy tooth! 

Tuesday, October 6, 2015

Tip of the Week

Digital radiographs, models and photographs offer efficiency.  In almost every case our records are now completely digital and require no lab time before I can fully diagnose the patient's case. This allows us to start their treatment the day of their initial orthodontic consultation with me if they wish.  We save time daily in order to fit these procedures into the schedule.  The patient is never pressured to begin treatment immediately but many appreciate the time saving this allows, especially if they have busy home schedules.

Wednesday, September 30, 2015

Tip of the Week

Catching impacted maxillary canines early.  Small permanent maxillary lateral incisors are a red flag.  Whenever these are noticed in a young patient be careful to watch the eruptive path of the adjacent canines.  The short and late developing roots of small lateral incisors are thought to be a contributing factor.

Tuesday, August 11, 2015

Tip of the Week

Space Maintenance It can be difficult to know when and where to place space maintainers in children.  I feel the most important location is usually after early  loss of the deciduous second molars.  Loss of the mandibular canines can lead to loss of archlength and attention needs to be given to holding the permanent lower incisors from collapsing in a lingual and distal direction.

Thursday, July 30, 2015

Tip of the Week

Ways to break a thumb sucking habit. The most important aspect of stopping a thumb habit is getting the patient (and parent) to desire to cease the habit. Without both of them on board you are doomed to fail. I usually try to utilize a long athletic sock stretched over the offending hand and place it all the way up to the armpit.  If they pull it off at night in their sleep I ask the parent to safety pin or sew the sock to the sleeve of their pajamas.  They are instructed to utilize the sock for at least one month.  After that if they revert back to sucking the finger even once I have them wear the sock for at least one more month (habits are sometimes hard to break quickly.) They are also instructed to move their teddy bear or blanket down to the foot of the bed if they have a rubbing/sucking habit.  We can fabricate a thumb appliance that we cement into place if necessary.

Wednesday, June 10, 2015

Tip of the Week

When do you know if children will display future crowding? The intercanine archlength in most children is established by age 6 and almost always by age 8.  Parents many time think that an early orthodontic evaluation is not necessary at age 7 since they will "surely grow more room over the next few years."  The arches enlarge for posterior tooth eruption but not anteriorly after that early age.

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