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!

What is the reason and timing of deciduous tooth extractions?  An early panoramic radiograph is important to uncover developmental dental problems.  Determining if there are missing teeth allows us to direct them down the proper path for either future restoration or complete space closure.  This gives the child's parent relief that the prognosis for an excellent dental environment is great.  Parents never like to be surprised by the report of missing permanent teeth when their child is expecting eruption of those teeth.  Finding deviant eruption of permanent teeth early allows us to guide these tooth into the proper position thus lessening the amount of future orthodontic movement.  Impacting canines is what we probably see the most. 

Missing Permanent Teeth (Hypodontia/Oligodontia).  Third molars are the teeth found to be most commonly missing (about 23% of the population).  Second premolars are next followed by maxillary lateral incisors.  Keeping mandibular second deciduous molars presents an interesting situation since they tend to be much wider mesio-distally than the underlying premolars (average 1.7mm wider).

Orthodontic intrusion of worn anterior teeth.  I recently had a study club discussion regarding proper positioning of worn anterior teeth in preparation for restorations (crowns, veneers or composite build ups).  Orthodontics is many times necessary for these patients due to the supereruption that occurs as attrition takes place.  We can orthodontically intrude either the upper, lower or all anterior teeth.  I base a lot of this decision on the upper lip to incisor relationship both during rest and smiling.  We also need to take into account the clinical crown length of the worn teeth.  If I can place the teeth in the correct position with proper overjet, a fantastic functional and esthetic result can be had.  These patients refer others to your office since they are walking billboards for your practice.  By the way, we always get before and after photos that you are welcome to use.