Orthodontic Problems and Solutions
Cases are presented here to illustrate different kinds of orthodontic problems and options for their correction. This is not necessarily a showcase for my treatment expertise (although many of the cases that I am displaying here are difficult and I am proud of the results). More often than not, orthodontists will only show cases where the results are close to ideal. As anyone involved in the practice of medicine will tell you, the human body is not obligated to respond the way we think it is supposed to. This is why we need to discuss the risks of treatment with you before treatment is started. This area of the site is meant to help my patients understand the possible treatment options and outcomes for their type of problem. Unless otherwise noted, you may assume that the patients presented here were treated by me.
Excessive Overbite (vertical overlap) and/or Overjet (horizontal overlap)
- Case 1. Excessive overbite and overjet can be caused by many different combinations of factors. In this patient’s case, he had a deep overbite caused mainly by over-eruption of his lower front teeth, and excessive overjet from the flaring of his upper teeth.
Impacted Teeth
- Case 1 (lower molars). This patient had lower second molars that were tipped forward and caught on the backs of the teeth in front of them. A series of x-rays shows the progression of their correction.
- Case 2 (lower molars). This patient’s lower third molars developed above the second molars and had a severe downward inclination that impacted the second molars. The severity of the problem lead to a less than ideal result. This case is presented to illustrate some of the negative side effects that can occur when attempting to bring in impacted teeth.
- Case 3 (lower canine). One of the options when dealing with an impacted tooth is to extract it. This patient had a lower canine that was transposed with the lateral incisor (the canine was erupting between the lateral and central incisors, instead of between the lateral incisor and first premolar), and impacted between the lateral and central incisors.
- Case 4 (upper molar). An upper second and third molar appeared to be fused.
Underbite
- Case 1. A severe underbite in a non-growing patient (Class III skeletal discrepancy). This patient’s underbite was due to misalignment of her jaws. She required jaw surgery to correct her problem.
- Case 2. A boy with an anterior crossbite that left uncorrected, would likely have resulted in the loss of one of his permanent teeth.
Open Bite Due to Thumb Sucking
- About Thumb Sucking
- Case 1. Habits such as thumb sucking interfere with the normal balance of forces that determine tooth positions. This case illustrates the dramatic improvement in tooth positions that can occur simply by eliminating the habit. See this case first for a general description of the problem.
- Case 2. A comparison of two patients. One had a dramatic improvement in her open bite when she stopped her habit. The other person maintained her anterior open bite even after her habit stopped.
- Case 3. See Case 3 under Crowding below.
Congenitally Missing Teeth
This refers to teeth that were missing at birth (never had the genetic potential to form). Options are to 1) replace the missing teeth prosthetically (bridge, implant, removable appliance); 2) close the space orthodontically. Leaving the space where the tooth is missing is not a good option; the adjacent teeth drift into the space, frequently causing periodontal and bite problems.
- Case 1. This girl was congenitally missing both of her upper lateral incisors (the teeth second from the middle). Based upon the positions of the permanent canines (the teeth third from the middle), I decided to move all of her upper teeth forward to close the spaces where the lateral incisors were missing.
Early Treatment for Cosmetic Reasons
Early treatment refers to orthodontic treatment that takes place before the patient would otherwise be ready for comprehensive treatment. Sometimes, this is necessary to prevent a problem from getting worse, or to intercept a problem that is compromising the health of the patient. In some situations, early treatment is not medically necessary, but the patient and/or parents are concerned enough about the appearance of the teeth that they want to treat early for cosmetic reasons (usually to align the front teeth).
- Case 1. Early treatment to align the upper incisors.
Crowding
The options that we as Orthodontists have available to us to create space are 1) increase the size of the arch that the teeth need to fit on; 2) make the teeth more narrow to fit on the existing arch form (this is done by removing enamel from the contact area. This is commonly referred to by Orthodontists as stripping, inter-proximal reduction or IPR or slenderizing. I usually refer to it as stripping.); 3) extracting teeth; 4) combinations of the above.
- Case 1. Severe crowding where three of his canines were blocked out (had no space to fit into the arch).
- Case 2. Complex case with moderate crowding, impacted lower second premolars, and a Class II skeletal discrepancy (the lower jaw is back relative to the upper). Periodontal surgery (free gingival grafts) were needed to protect three of his canines from loss.
- Case 3. This girl had a digit sucking habit until age 7, which caused an anterior open bite and crowding due to narrow arch forms.
Transposed teeth
A transposition refers to a situation where teeth have switched positions. There are most commonly two options: 1) leave the teeth transposed; 2) correct the transposition.
- Case 1. Lower left lateral incisor transposed with the lower left canine. The transposition was corrected.
Misalignment
This is a general term that refers to any teeth that are not aligned on an ideal arch form. The teeth could be rotated (twisted), to the inside or outside of the arch form, forward or backward of their ideal positions, or any combination of the above. All else being equal, misalignment problems are relatively easily corrected with braces.
- Case 1. Anterior (front teeth) misalignment.
