Examples of typical orthodontic problems
In this area a series a frequent types of malocclusions are presented, and the results of their treatment.
Cases has been treated in our clinic and the mean treatment time was between 18 and 24 months followed by 6-12 months of retention.
Some cases has been treated with fixed appliance self ligating SPEED, others with removable appliances, functionals depending on the indications, often completed with excercises of functional rehabilitation.
In adult patients, in some types of malocclusions, the invisible appliance Invisalign can be used. This appliance allow tooth movement in a lot of malocclusions in adult patients. Invisalign has still some limits, but due to the fact that is a technique in evolution, limits will be less.
look at the cases “before and after”:
Dental crowding is one of the most common problems, associated with the need for orthodontic treatment. This problem usually starts from a discrepancy between the available space in the dental arch and the size of the teeth. When the crowding is too excessive, extractions may be needed. This is an example of a treatment performed without extractions in 18 months of treatment in an adolescent of 13 years with fixed, self ligating system.
Crowding in mixed dentition
In many cases, a two-phases orthodontic treatment may be useful to prevent that a malocclusion, if neglected, should be treated later with extractions of premolars. In this case, an 8 year old boy was treated in two phases: the first one, which lasted a year, the large crowding was corrected by recovering the form of upper and lower arches, working also on deciduous teeth. After a period of about two years without brackets, occlusion was finalized in the second phase.
The presence of impacted canines can be found both in the presence of deciduous and permanent teeth and in permanent dentition only, associated or not with a malocclusion of the masticatory system. It can affect the upper arch than more rarely the lower arch. One of the typical clinical signs is the delay in the “fall” of the related deciduous tooth and represents the first diagnostic element followed by a radiographic evaluation to locate the location of canine eruption. The prognosis is as less favorable as the older the patient is and as more diverted the axial position of the tooth compared to nearby teeth is. Their treatment usually involves the application of fixed appliances aiming first to recover the space of canine or impacted canines, followed by a surgical procedure in the area and the recovery of the tooth itself in the dental arch. This illustrates a case of bilateral upper impacted canines treated in about two years. In some cases, a 3D localized RX is carried out before the orthodontic treatment and it can be very useful from a diagnostic and prognostic point of view.
Dental Class II
Class II problems are made up of abnormal chewing ratio whereas the upper arch and its teeth are further ahead than the lower one.
Class II patients usually show a convex facial profile with a cribbed chin. In some cases, this relationship is due to constitutional features, in other cases to acquired factors.
In many cases, when they have a dental reason and are covered on time, class II problems can be solved with the use of brackets, as in this case of a teenager whose discrepancy was only dental and not skeletal.
Skeletal Class II
In this situation, the upper jaw and its teeth are much more forward than lower arch. Orthodontic treatment can not occur in some cases only with a dental approach, but also with a surgical approach when the discrepancy is too great. In these cases, as in skeletal Class III, you must use a combined orthodontic-surgical treatment through an orthodontic preparation with fixed brackets, followed by a surgery that can be combined or mono-maxillary, depending on the treatment plan, and finalized by few months of orthodontic finishing.
Dental Class III
Class III may be only dental and, for that purpose, have as a good prognosis as earlier the orthodontic correction starts. When this problem is found in a growing patient, the missed interception can lead to involvement of skeletal structures so what begins as dental malocclusion, if not intercepted, can result in a skeletal malocclusion, often with a negative prognosis or even more with a surgical solution at the end of growth. This malocclusion affects negatively the masticatory system the the occlusal relationships are reverted and can be treated with fixed or functional appliances designed to restore the relationship of occlusion. A major impact on aesthetics is always present in these situations for which the dental correction is always associated with recovery of the aesthetics regarding patient’s profile.
Skeletal Class III
Class III problems can have a skeletal or dento alveolar nature. In this malocclusion, for example, the lower jaw and its teeth are located ahead of the upper jaw. The appearance can often give the impression that the lower jaw is excessively large, but in many cases there is a lack of upper arch development. This requires an accurate differential diagnosis. In this case, for example, the malocclusion was treated in about 2 years with a combined orthodontic-surgical treatment. An orthodontic preparation made ??with fixed appliance for about 1 year has been made, followed by surgery in order to correct the discrepancy of the bone bases, then finalized in a few months with the same fixed appliance.
Usually they result from a contracted upper arch or a lower jaw too wide. A narrow upper arch will often force patient to bring the jaw forward or at side when closing in maximum intercuspidation. There are clinical situations in which the TMJ dysfunction is caused by a malocclusion with the presence of a displacing tooth, as in this clinical case where the second left bicuspid on the lower arch causes a pre-contact while closing. Orthodontic treatment is often associated with the use of a bite in the upper arch or lower depending on the treatment plan.
A lack of incisors overlap can be usually attributed to disharmony of the jaws or local factors (i.e. thumb sucking and tongue position between incisors) or excessive vertical growth of one or both arches. Early intervention on this type of behaviors is important to have an orthodontic success.
Open bite in deciduous dentition
An interceptive orthodontic treatment can often prevent that an open bite, from dental, could become be faced in adulthood through surgery. This case illustrates a treatment performed with fixed appliance close to the end of treatment; the closure of the bite is evident through a number of orthodontic movements, but also through favorable prognosis and early treatment.
Anterior cross bite
This is the clinical case of a 25 years old boy who showed up primarily for the correction of an anterior cross bite. The treatment was carried out with Invisalign system for a year.
Cross bite and surgical expansion
In some malocclusions, the contraction of the upper arch cannot be solved only with orthodontic expansion, but a surgical expansion is also necessary. The orthodontic expansion has limits that cannot be exceeded. The surgical one can be performed either through a surgically aided rapid expansion or through a local surgery, when the contraction of the upper arch is considerable.
Posterior cross bite
Usually it results from a contracted upper arch or a too wide lower arch. A narrow upper arch will force more often a patient to bring the jaw forward or side when close in maximum intercuspidation. In this position, the lower teeth are outside than those above.
Dental over bite
Un’eccessiva sovrapposizione degli incisivi è di solito associata ad una discrepanza tra lunghezza dell’arcata superiore ed Excessive overlap of the incisors is usually associated with a discrepancy between the length of the upper and lower arches. This usually leads to over eruption of incisors in both arches.
Some malocclusions in adults can be corrected only by a combined treatment of orthodontics and orthognathic surgery. The orthodontic treatment before surgery is used in the preparation of dental arches and after surgery to finish the occlusion.
Adult patients with dental migrations or flaring of incisors can be treated with an orthodontic treatment to recover the shape of the dental arches and the position of teeth with significant aesthetic and functional advantages. In all these cases, the orthodontic treatment is associated with periodontal therapy.
In adults who have parts of dental arches without teeth in need of prosthetic reconstruction with or without implants, initial orthodontic treatment is often expected, aiming to redistribute the space in the dental arches and to recover the axial position of teeth lost due to past migrations.