Ortho 101 – Langley Orthodontics Information And Help

Walnut Grove Orthodontist

All About Orthodontics at Walnut Grove Ortho

Your ultimate resource for learning about the treatment you need is your Certified Specialist in Orthodontics, Dr. Richard Standerwick, and our team at Walnut Grove Ortho.

Whether you are an adult or teenager that needs braces, or a parent that is looking into treatment for your child, you will find this page is an excellent resource for learning about early orthodontics, orthodontic hygiene, retainers, tooth eruption and absence, and maxillary expansion.

Of course, if you have further questions about these treatments, feel free to contact us anytime or set up an appointment.

On This Page

Early Orthodontics

Orthodontic Hygiene

Retainers

Tooth Eruption & Absence

Maxillary Expansion

Early Orthodontics

The American Association of Orthodontists recommend that children be seen by an orthodontist by the age of 7 years. Most often no treatment is recommended at that time, however often problems that can eventually be expensive, require extraction of permanent teeth and/or surgical treatment can be avoided or at least less severe than they would have been without treatment.

Not all permanent need to be present before starting orthodontic treatment and females can sometimes be finished growing by the time all the permanent teeth have erupted. In these cases, extraction of teeth, surgery and/or periodontal gum grafting may be required.

Also be aware that some conditions that look like a problem are completely normal. It is normal to have 1-2mm of lower incisor crowding in the early mixed dentition (when there a mix of both adult and baby teeth). It is also normal for a child to have a chin that is relatively recessive rather than the typical adult profile and chin position. Normal growth will often allow the chin to grow with or without an expensive appliance.

It is normal to display a end to end or half cusp Class II molar relationship 50% of the time in the mixed dentition (see below). A normal adult Class I relationship is seen only 30% of the time in the mixed dentition. So again, if an appliance is placed to correct a 1/2 cusp Class II molar relationship remember that 75% of the time it would have done so spontaneously without the appliance.

Basically, our no-cost consultation should encourage you to come in and find out how things look and gather some information to allow an informed treatment decision about which are yours or your child’s best orthodontic options.

Orthodontic Hygiene

Perhaps the most concerning topic is dental hygiene during orthodontic treatment as damage can occur quickly and quietly. Plaque accumulation on teeth occurs more easily because of the orthodontic appliances (wires and brackets). In turn, this can cause gingival (gum) inflammation which further complicates dental hygiene. If left unattended long enough, the bacteria in the dental plaque with begin to etch the teeth with acids that they produce. This can leave white spots on the teeth which often cannot be removed long after the orthodontic treatment has been completed.

Extra visits with your dentist would be beneficial, in conjunction with proper daily flossing and brushing which takes the area between the brackets and gingiva (gums) into special consideration.

Another reason hygiene is so important is that the presence of bacteria cause an irritation of the bone under the gingival. This irritation creates an acidic environment which inhibits bone building cells, which creates a negative balance. This means that in the presence of inflammation, there tends to be bone loss even when bone should be added. This bone is not able to be replaced; once it is gone, it’s gone. Bone height contributes significantly to tooth stability.

Retainers

Retention of teeth after orthodontic treatment is important as the bone that is normally intimately adapted to the teeth is not well adapted at the time of orthodontic appliance removal. An immature form of bone fills voids between the tooth and bone within about 4 months in humans, but then bone mineralization is not fully matured until about 12 months.

Additionally, the connective tissue fibres in the gingival (gum) tissues do not remodel readily and act like elastic bands trying to pull the teeth back toward the original tooth positions; estimates for gingival remodelling have been placed at 232 days in beagle dogs; however, the adaptation of bone in small animals occurs more quickly that humans, which may also reflect the relative gingival metabolism; possibly gingival remodelling times beyond 232 days for humans should not be unexpected.

 

The bottom line is that the teeth will move back toward the original position if not maintained for an individually dependant “retention period”. For more about retainers click here.

These opinions are meant for educational purposes and are in no way an exhaustive explanation of orthodontic diagnosis. Any suspicion of a condition mentioned should be confirmed with a certified specialist in orthodontics.

Tooth Eruption & Absence

Tooth Eruption

The process of permanent tooth eruption resulting in the loss of primary (baby) teeth occurs through resorption of the primary tooth root as the permanent tooth erupts. Progressive eruption creates progressive resorption of the primary tooth root; which causes the tooth to become wiggly. Teeth should erupt in pairs, which should be within 6 months of each other. Delay, asymmetry and lack of space for an erupting tooth are examples that would warrant further investigation.

Earlier intervention of an eruption problem can significantly effect the success of a tooth erupting. The classic example being the impacted maxillary canine position relative to the lateral incisor root.

Image: Ericson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the primary canines. Eur J Orthod 1988;10:283-295.

Tooth Loss or Absence

Ideally, a space resulting from tooth loss or absence should be closed orthodontically. This is not always practical nor esthetically pleasing; in these cases a restorative replacement may be an option and should be coordinated by your treating dentist. If an implant is chosen, consideration must be given to timing of treatment due to residual growth into the late teens to early twenties. An implant placed would display an esthetic difference in tooth height relative to the surrounding teeth if residual growth occurred. Also, consideration must be given to growth pattern and the ridge of gum tissue; it may be preferable to allow teeth to be guided into the space of a missing tooth to allow bone development, and then later move the tooth orthodontically.

Missing adult teeth are often seen in the lateral incisor position in the maxilla(upper jaw) and/or the 2nd premolar position. Missing baby teeth tend to mean that the adult tooth will also be absent as the adult tooth arises from the bud of the baby tooth. (See below image).

These opinions are meant for educational purposes and are in no way an exhaustive explanation of orthodontic diagnosis. Any suspicion of a condition mentioned should be confirmed with a certified specialist in orthodontics.

Maxillary Expansion

Maxillary expansion can create room to alleviate crowding, align the jaw relationships, increase nasal airflow, treat certain cases of bedwetting and other airway issues. Maxillary expansion is considered essential in the presence of a posterior cross-bite.

Maxillary expansion has been successfully used to treat:

Maxillary expansion is more efficient at younger ages; the bones are more pliable and the suture between the two halves of the maxilla displays less “locking”. With aging, there is an increase in the amount of dental (tooth) expansion versus skeletal separation of the maxillary halves.

These opinions are meant for educational purposes and are in no way an exhaustive explanation of orthodontic diagnosis. Any suspicion of a condition mentioned should be confirmed with a certified specialist in orthodontics.