Friday, August 17, 2012

Teenager With Dental Crowding and Overbite

This young lady came in to my office when she was almost 12 years old. She and her mother were concerned with the crowding of her teeth.
When she smiled it was evident that she had "crooked teeth."  This was a result of a crowding problem.  The teeth that had grown in were too large for the current size of her jaws. 

One common presentation of crowding seen here is that the front two teeth (central incisors) are more forward than the teeth adjacent to them (lateral incisors).  Also, the canine teeth or "eye teeth" are out too far toward the lips and cheeks. 

This patient also had an overbite.  This means that the top teeth are more anteriorly positioned in the face than the bottom teeth.  Also, there will often be a forward angulation to the top front teeth as you can see here particularly of the central incisors.  This forward angulation is often referred to in orthodontic terms as flaring or dental protrusion. 

This is a view of the crowding of the upper teeth looking up into the mouth.

The bottom teeth also had some crowding but it was mild compared with the upper teeth.

This is a cephalometric x-ray that shows the teeth from the side.  This image helps the orthodontist to see more clearly the angulation of the front teeth, the amount of overbite, as well as how the jaws are developing.  The field of orthodntics has developed hundreds of ways to analyze these x-rays to help understand current jaw positions, identify facial growth patterns, and evaluate tooth angulations.  Average, normative values have been suggested which can help the orthodontist to quantify the severity of the problems as they relate to treatment goals. 

This is the final x-ray after the overbite has been corrected.  You can see that the tongue-facing surfaces of the top front teeth are resting on the lip-facing surfaces of the bottom front teeth.  This is the correct position of the teeth.  

Her jaws were expanded to accommodate the crowded teeth leaving her with a beautiful, broad smile.

Tooth alignment has been achieved using braces.

Overbite correction has been achieved using orthodontic elastics.  Elastics work by moving groups of teeth.  Specifically in this case, the top teeth were pulled back and the bottom teeth were pulled forward.  The elastics are attached to certain braces that have "hooks" designed to hold the elastics in place.  Consistency with elastic wear is very important to the success of this type of treatment.  Optimal tooth movement occurs with 20 or more hours of elastic wear per day.  Since patients are able to put the elastics in and take them out by themselves, they must be committed to keeping them in.  Parental reminders don't hurt either :)  Usually, elastics are removed while eating and brushing and flossing.  Otherwise, they are worn full time.     

You can see the broadness of the dental arches which contributes to her beautiful smile.

Happy Mother and Daughter!!!