Adolescent Treatment

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The most common time for orthodontic treatment is between the ages of 11 and 15, and for good reasons. By this time, most if not all of the permanent teeth have erupted and are in place. Crooked teeth and bad bites can easily be detected. These problems will not correct themselves. This is the best time to seek orthodontic treatment.
Kids at this age feel braces are cool! It is common for adolescents in this age range to undergo orthodontic treatment, so they are easily convinced to wear braces.
We have all heard of the terrible twos, there is also the terrible teens!  Early in adolescence is when young people are most cooperative. It is this cooperation that allows orthodontic treatment to finish in as short a time as possible.

Most importantly, children at this age are growing rapidly, and we can take advantage of this accelerated growth to help shape the bite and teeth correctly.

Overbite Correction

Growth works in our favor with the correction of overbites. Before we discuss how to correct an overbite, let’s first consider why some patients have them. Most patients and parents think of braces as moving and aligning teeth, however, there is one additional aspect to orthodontic treatment that is often not noticed. This is the relationship of the jaws to each other.

It is very significant, because the orthodontist has a much harder time influencing this skeletal relationship, and it is this relationship that is fundamental in creating a beautiful smile and facial balance.

A small lower jaw often creates the appearance of an overbite. At times the upper teeth protrude forward and the chin appears retruded and out of balance with the rest of the face. Fortunately for many young people, the lower jaw has a spurt in growth during the adolescent years.

Click on image for final result

It takes more than braces to take advantage of this growth spurt. When you carefully examine how braces work (see animation on Now That You Have Braces), you will notice that there is nothing connecting the top braces to the lower. While we use elastics between the teeth, they are not sufficient to correct a dramatic overbite.

To correct an overbite, it is necessary to use something in addition to braces. One method is the Forsus. In the Dolphin Imaging animation above, the action of the Forsus is illustrated. The effect is both to protrude the lower jaw forward and to retract the upper teeth back.For many years headgear was used, but it is often so challenging that many young patients do not find the time or discipline to be successful with it.

The Forsus is a much better way than the headgear. It is fixed in the mouth 24/7 and therefore has a greater probability of success. It is also reasonably comfortable to wear and not readily noticeable.

It is important to note that adolescence is the best time to correct an overbite. Without growth, overbite correction becomes more difficult and often requires a surgical procedure to correct.

Extraction vs. Non-Extraction

The decision to remove permanent teeth is one that as Orthodontic Specialists we are often called on to make. Our goal is not to remove permanent teeth unless absolutely necessary.
The decision is not always simple. Considering just the teeth alone can result in a very poor outcome. The need to consider other aspects of the face as well as consider the consequences of growth results in a more complex evaluation.

The decision is made by examining the balance of the lips to the chin and nose as well as the overall facial relationships of upper jaw to the lower jaw.

Our goal is to create a beautiful smile and at the same time create the best facial balance possible for each patient.

The above Dolphin Imaging animation illustrates one instance when extraction of permanent premolar teeth is necessary. It shows that when properly evaluated the removal of teeth can result in straightening while at the same time maintaining an ideal balance of lips to chin and nose.

Facial harmony is one of the primary goals of Orthodontic Treatment.

Let’s look at two cases, both with beautiful outcomes, one that involved no extractions and one that did.

The first case is one that by looking at the teeth alone you would say that there is not enough space and extractions were needed. This however, after careful analysis was not necessary.

The second case below is an extraction case. In this situation it was appropriate to remove permanent teeth. At the end of treatment it is not at all obvious that teeth have been removed.

Both patients have beautifully straight teeth!

Click on image for final result

Click on image for final result