Underbite
Treatment of the "Underbite"
Orthodontists refer to the underbite as a prognathic lower jaw (mandible) or as a retrognathic upper jaw (maxilla). In layman terms this is a case where the upper teeth are behind the lower teeth (anterior crossbite).
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Before Phase I Treatment Crossbite
- the upper teeth fit
inside the lower teeth
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After Phase I Treatment
Crossbite has been corrected
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These cases are best treated at an early age because once the bone sutures develop and close, the upper jaw cannot be moved forward as easily.
Upper jaw moves forward at suture locations
Treatment usually involves a reverse-pull headgear attached to an upper expansion appliance.
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| Reverse Pull Headgear in place. |
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Before Using The Reverse Pull Headgear
After Using The Reverse Pull Headgear
Some patients still require Orthognathic surgery (jaw surgery) even after wearing the reverse pull headgear. Notice how the upper teeth and upper lip have moved forward.
After Orthodontic Treatment
Underbite Corrected Without Surgery
Underbite Corrected Without Surgery
Underbite Corrected Without Surgery
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Openbite
Treatment of the Open Bite
This patient had an open bite of 5mm and a protrusion of 9mm before treatment. He was treated with two stage orthodontic treatment. First, functional appliances were used to alter the direction of the jaw growth. This was followed by full braces after all of the teeth erupted.
Open bite treated with Phase I treatment
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Pegged Tooth/Implant
Pegged Lateral Incisor
Before
After Orthodontic Treatment
After Dental Work On Pegged Lateral Incisor
Pegged Upper Right Lateral Incisor & Missing Upper Left Lateral Incisor
This patient had a pegged upper right lateral incisor and a missing upper left lateral incisor with an anterior crossbite. Orthodontic treatment corrected the crossbite and adjusted the spaces to balance the size. The upper right lateral incisor was enlarged and the missing tooth was replaced with an implant after treatment.
After Orthodontic Treatment Before Implant
After Orthodontic Treatment, Implant and Crown
Before Treatment
After Treatment
Crossbite Lateral Incisors Enlarged
Before:
After:
Missing Tooth and Pegged Tooth
Before:
After:
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Cleft Palate
Our practice has treated many cleft palate patients, and we have found the outcomes to be very rewarding both for our patients and our staff. These cases require expanding the palate to a normal width usually followed by bone grafting. It usually requires two to three stages, and we work closely with the general dentist, the oral surgeon and the plastic surgeon.
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Cuspid Treatment
When an upper lateral incisor is missing, there are several options for replacing the missing tooth. (The upper lateral incisor is the second tooth from the front.)
- Bridge the area
- Place an implant and a crown (There is a write-up on this procedure listed in this section - see Pegged Tooth and Implant.)
- Move the upper cuspid forward to the lateral incisor position.
The photographs below demonstrate moving the cuspid forward.
Before Orthodontic Treatment
Progress Records
Treatment Completed
Missing upper lateral incisors/ Recontoured maxillary cuspids.
Before
After
Impacted Cuspid
Impacted cuspids are a fairly common orthodontic problem. They are exposed and bone is removed to create a channel to allow the tooth to be moved into the arch using orthodontic forces. The usual method used to attach to the impacted tooth is a bonded pad and chain. Sometimes the tooth has to be moved to the mesial or the distal to avoid the roots of the adjoining teeth before the tooth is moved into the arch. With modern surgical techniques and orthodontic treatment alignment is almost always successful.
In the x-ray and photos below the upper right cuspid was impacted on the palate behind the lateral incisor. Note that the lateral incisor was displaced from this.
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Crossbite
This patient required a surgical correction of an upper crossbite. Notice how the lower jaw had shifted to the right because of the way the teeth met. After the surgery, most of this was corrected; and the chin moved back toward the center. It is interesting to note that most crossbites that are treated before puberty do not require surgery. Crossbites that are corrected early (ages 7 to 13) can be viewed under the topic of Expansion Appliances.
Before Treatment
After Treatment
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Third Molar
Third molars (wisdom teeth) usually cannot be kept due to the lack of space in the back of the mouth. The third molars are usually extracted between the ages of 14-21. Some oral surgeons prefer to extract them early before the roots develop since this usually makes the extraction easier and less complicated.
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