GALLERY OF SMILES
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This patient wanted to have her upper jaw expanded so that she could have a broader smile. She was treated with a palate expansion appliance that is used for adults. You can see the improvement in the width of her smile. She also had mild crowding of the teeth causing some irregularity in the alignment of the teeth. She also had an overbite. This means that the top front teeth are protruding forward past the bottom front teeth. In her case, she used orthodontic elastics pulling back from the upper front teeth to the lower back teeth. Orthodontic elastics are put in place by the patient and removed when eating. Typically, elastics should be used at least 20 hours per day for the optimal rate of bite correction.
This patient had an anterior open bite. This means that the front teeth do not come together when the patient is biting down on the back teeth. In an adult, this is a very difficult problem to correct. In this case orthognathic surgery (jaw surgery) was performed while the braces were on to allow all the teeth to come together simultaneously.
This patient had an open bite as well as a gummy smile. Because the upper jaw was longer than normal, too much gum tissue was visible when she smiled. It was also difficult for her to close her lips without straining her chin muscles to do so. For this reason, she was constantly breathing through her mouth instead of through her nose. To correct her problems, she had braces and jaw surgery to raise her upper jaw so that less of her gums show when she smiles and she is able to comfortably close her lips together.
Crowding of the top teeth was corrected using brackets and wires. Shape-memory metal alloys are used to create wires that return to their original shape even after they have been severely bent. These special wires are engaged tightly into the braces and over time “bring the teeth with them” as they return to their original shape.
This patient had a deep bite. This means that the top front teeth overlap the lower front teeth. This type of bite can lead to more rapid wear of the front teeth simply because they rub together more during function, especially if the patient has a tooth-grinding habit. One thing many people do not realize is that teeth can move vertically with braces. That is what was done with this patient. It is important to understand that as the top and bottom front teeth move vertically away from each other, they do not become shorter and disappear into the gums. Instead, the entire supporting bone and gum tissue remodel and the teeth remain the same size.
This patient had an underbite. We used braces and orthodontic elasitics to pull the teeth into the correct position. It is extremely important that patients with difficult bites such as this are diligent when it comes to wearing elastics. This type of correction would require jaw surgery if good patient compliance is not achieved.
Underbite correction is often aided by an attempt to modify a problematic growth pattern. The use of a night time headgear pulling the top jaw forward can correct an underbite that is detected in a young child. This type of “orthopedic” movement is most effective in younger children 7-10 years old.
This patient had upper crowding with high canines. This is a common presentation of crowded upper teeth because the canines are usually the last teeth to grow in. Because of this, they often are trying to come in when there is no room for them. The result is that they commonly stick out and are high relative to the adjacent teeth. This patient also had a large overbite. He was treated with an appliance that created room for the crowded upper teeth and also encouraged growth of the lower jaw. This type of treatment is called functional appliance therapy. The idea is to hold the lower jaw into a new functional position using an appliance and after several months, the jaw adapts to that new position.
This patient had a crossbite on the left side of her mouth. This happens when the perimeter of the dental arch in the upper jaw is not wide enough to fit around the perimeter of the dental arch in the lower jaw. When this occurs, the upper and lower teeth do not fit well together when the bite closes. Typically, the patient will subconsciously compensate for this mismatch by shifting the jaw to one side or the other so that the teeth can at least close all the way together. In her case, her lower jaw shifted to the left side. In orthodontic terms, this is called a “left posterior crossbite with a functional shift.” A crossbite because the upper back teeth are biting on the wrong side of the lower back teeth on the left side. A functional shift because the jaw is shifted to the left in order to compensate for the uncoordinated dental arches. The correct treatment for this problem is to expand the upper jaw using a palate expander. A palate expander is attached to the upper molars and is equipped to apply pressure to push the upper back teeth away from each other. This pressure is translated from the teeth to the supporting jaw structure and the bones of the upper jaw themselves separate from one another. Once the desired width of the upper jaw is obtained, the appliance remains for several months to allow new bone to fill in where the expansion occurred. While this sounds painful, it really is not a painful procedure in young patients. As you can see, once the width has been established, the lower jaw naturally finds its true “centered” position relative to the rest of the face. This type of problem is best corrected as early as possible because the longer the functional shift is taking place, the more ingrained the lower jaw position becomes making correction more difficult and less predictable.