Comprehensive Treatment

Except for the few specific situations in which interceptive treatment can fully correct a crowding or bite problem, the majority of malocclusions require comprehehensive treatment to fully align the teeth and correct the bite.

Comprehensive treatment can be broadly divided into 3 categories:

1.      Braces only
2.      Braces in combination with a plate or expander (“two phase” treatment)
3.      Braces in combination with jaw surgery

Braces Only

Case 1

Class I  crowding  (Jaw relation normal, teeth crowded)

ct-c1a

After treatment with full upper and lower braces. Two premolar teeth extracted from the top jaw for space.

ct-c1b

Case 2

Class  III  crowding (Bottom jaw overshot and tooth crowding)

ct-c2a

Treated with full upper and lower braces. Two premolar teeth extracted from the bottom jaw to compensate for the overshot bite. Top jaw treated by expansion to make space and no tooth extractions.

ct-c2b

Case 3

Class I  missing upper teeth

Upper permanent lateral incisors congenitally absent (tooth germ never formed).

D229121327
D229121340

Treated with full upper and lower  braces to align upper teeth and open deep bite. Later upper canine teeth reshaped to look like the missing lateral incisors.

D229121756
D229121816

Case 4

Impacted canine teeth

The teeth maybe impacted in the roof of the mouth or less commonly, between the adjacent teeth. The impacted canine teeth are uncovered first – this would be done under local or general anaesthetic, depending on the depth of the impaction. The braces are generally placed about  2 weeks later, giving time for the gum to heal around the exposed tooth.

Photos: Single tooth exposed in roof of mouth, Radiograph shows the impacted , canine tooth on the upper right side, Both canines exposed and aligned from roof of mouth, No sign of upper canine teeth radiograph shows both upper canine teeth in roof of mouth, canine teeth uncovered, Aligning with braces, Both canines impacted between adjacent teeth - Canine teeth exposed and aligned with braces.

D229124242
D229124257
D229124342
D229124354
D22912450
D229124517
D22912511

Case 5

Deep bite (Class II division 2 malocclusion)

Causing damage to the gum on the bottom teeth. Full braces were required to open the bite and align the teeth accordingly. If left untreated, the lower gum would have been stripped away to a point where the bottom front teeth could be lost.

Photos: Deep Bite, Bite Opened

D229125122
D229125135
Two phase treatment

Case 1

Class II  upper incisor protrusion  (“Buck teeth” and undershot bottom jaw)

ctt-c1a

Child treated with  a functional plate first to correct the incisor protrusion, followed by upper and lower braces to fully align the teeth and “sock in” the bite. Tooth extractions were not required.

ctt-c1b
Braces combined with jaw surgery

Jaw surgery is generally recommended by orthodontists when the discrepancy in the jaw relationship is too severe to compensate with braces treatment alone and in adult patients with undershot jaws, where there is no growth left to help correct the incisor protrusion. Jaw surgery is generally not carried out until growth is substantially complete.

Some jaw discrepancies requiring surgery for correction:

1.      Undershot bottom jaw in an adult
2.      Overshot bottom jaw/ underdeveloped top jaw
3.      Open bite
4.      Excessively narrow top jaw in an adult, requiring expansion

Case 1

Overshot bottom jaw

ctbs-c1a

After treatment with braces and jaw surgery

ctbs-c1b

Undershot bottom jaw

ctbs-c2a

Braces to align teeth prior to surgery

ctbs-c2b

After surgery

ctbs-c2c

Underdeveloped  top jaw

ctbs-c3a

After surgery

ctbs-c3b

Surgery to assist expansion of the top jaw in adult patient

The top jaw forms as two halves, which are joined together and to other facial bone by sutures.  In adult patients, the sutures of the top jaw are fused, unlike in a child. So, before the top jaw can be expanded in an adult, the sutures need to be surgically split, allowing the two halves of the jaw to be separated. Once the expansion is done, the jaw bone heals back as a single unit again.

Before surgery, with RME appliance in place but not activated, on right, after surgery with appliance fully activated.  Note gap between incisor teeth

ctbs-c4a

RME is left in place for 4 weeks after to bone healing in jaw. Note gap between incisors has closed spontaneously.

ctbs-c4b

Braces placed to start aligning the top teeth. Bottom braces will be placed later.

D229142117

IMPORTANT INFORMATION:

Dr Tissa is now retiring. Our clinic is getting quieter and business hours are changing. More information coming soon

   

Monday- CLOSED- (may change for retainer check patients or catch up days)

Tuesday- 8:00-5:00

Wednesday- 8:00-5:00

Thursday- 8:00-5:00

Friday- 8:00-5:00

Saturday & Sunday Closed

PLEASE NOTE HOURS ARE SUBJECT TO CHANGE