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Posts for tag: orthodontic treatment

By Kenneth J Oskowiak & Associates, DMD, PC
August 07, 2019
Category: Dental Procedures
ALittleOrthodonticMagicCouldHelpanImpactedToothErupt

Bite problems aren't limited to teeth simply out of position. The problem could be some teeth aren't there—visibly, that is. They still exist below the gums and bone, but they've been crowded out and blocked from erupting. We call this condition impaction.

Any tooth can become impacted and affect the bite, but a person's smile suffers more if it involves visible front teeth. This is especially so if the teeth in question are upper canines or "eye teeth"—the smile doesn't look normal without these pointed teeth on either side of the central and lateral incisors.

Impacted teeth can also contribute to more than a cosmetic problem: they're more susceptible to abscesses (pockets of infection) or root damage both to themselves or neighboring teeth. To minimize these potential health issues, we'll often remove impacted teeth surgically (as is often done with wisdom teeth).

But because of their important role in not only appearance but also bite function, we may first try to assist impacted canines to fully erupt before considering extraction. It takes a bit of orthodontic "magic," but it can be done.

Before we can make that decision, though, we want to precisely locate the impacted teeth's positions and how it may affect other teeth. This initial evaluation, often with advanced diagnostics like CT scanning or digital x-rays, helps us determine if the impacted teeth are in a workable position to save. If they're not, we may then need to consider removing them and ultimately replacing them with a dental implant or similar restoration.

But if their position is workable and there are no other impediments, we can proceed with helping them erupt. To do this we'll have to first expose them by creating a small opening in the gums through minor surgery. We then bond a small bracket to the tooth, to which we'll attach a small chain that we then attach to orthodontic braces. This enables us to exert continuous pressure on the tooth.

Over time, the pressure coaxes the tooth to erupt. We may still need to apply other forms of orthodontics and cosmetic procedures, but using this procedure to rescue impacted canines can produce a healthier and more attractive smile.

If you would like more information on treating complex bite problems, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”

By Kenneth J Oskowiak & Associates, DMD, PC
June 23, 2018
Category: Dental Procedures
RemovingTeethCouldImprovetheOutcomeforaCrowdedBite

The primary goal of dental care is to preserve teeth. But there are circumstances in which removing a tooth, even a relatively healthy one, could prove best in the long run.

A malocclusion (poor bite) related to crowding might fit such a circumstance. Crowding occurs when the size of the jaw is too small for the teeth coming in. With not enough space, some teeth could erupt out of their proper positions. Removing certain teeth frees up space to eventually allow braces or other orthodontic devices to re-align the teeth.

The teeth most frequently removed are the first bicuspids, located between the cuspid (the "eyeteeth" directly under the eyes) and the back teeth, and the second premolar. Removing these won't normally affect appearance or functionality once orthodontic or cosmetic treatments are complete.

Because of the mechanics of jaw development it might be necessary to perform these extractions several years before orthodontic treatment. This could create another potential problem: the time lag could adversely affect bone health.

This is because bone, as living tissue, has a life cycle with cells forming, functioning and then dissolving, and new cells taking their place. When teeth are chewing or in contact with each other they generate force that travels through the tooth roots to the bone and stimulates cell growth at a healthy replacement rate.

But when a tooth is missing, so is this stimulation. This slows the replacement rate and eventually leads to decreased bone volume. Too much bone loss could create obstacles for orthodontic treatment or a future dental implant.

To avoid this, the dentist will often place a bone graft with processed bone mineral within the empty tooth socket right after extraction. The graft serves as a scaffold for bone cells to grow upon. The graft (plus any other added growth boosters) can help maintain a healthy level of bone volume to facilitate future orthodontic or restorative treatments.

Since targeted extraction for orthodontics is time-sensitive, you should have your child's bite evaluated by an orthodontist by age 7 to see if any action is necessary. The earlier a malocclusion is detected, the more likely a more attractive and healthy smile will be the ultimate outcome.

If you would like more information on correcting poor bites, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Removal for Orthodontic Reasons.”

By Kenneth J Oskowiak & Associates, DMD, PC
May 14, 2018
Category: Dental Procedures
OrthodonticsCouldbeinYourSmileMakeoverPlan

When considering “smile makeover” options, it’s easy to focus on whitening, veneers or implants — techniques and materials focused mainly on the teeth and gums. But if you don’t also consider the bigger picture of how your upper and lower teeth come together to form your bite, these efforts may be a lot like picking out paint colors for a house with foundation problems.

That’s why orthodontics, the dental specialty concerned with the bite, could be a consideration in your smile makeover plan. Moving teeth into better positions not only improves your teeth’s function and health it could also help facilitate any cosmetic changes that follow.

The first step, of course, is to visit an orthodontist, a dentist with advanced training and experience in tooth alignment and function, for a comprehensive evaluation. Orthodontists are also knowledgeable in the growth and development of the bite, and so can develop a treatment approach that reflects the patient’s needs, whether a child or adult.

Treatments vary, depending on your particular needs. Fixed appliances like metal or clear braces that can’t be removed by the patient are the standard treatment for most malocclusions (bad bites). Clear aligners, removable trays that fit over the teeth with programmed incremental movements of the teeth, find the greatest application with adults. Orthodontists may also use specialized appliances, like temporary anchorage devices (TADs), which work to isolate teeth that need to be moved from those that don’t.

In comprehensive makeovers, orthodontists will work with a team of other dentists and specialists, including periodontists (specializing in the gums, bone and other supporting structures of the teeth) and oral surgeons. In these cases, orthodontic treatment may occur before or after other treatments with the overall goal of producing a beautiful, transformed smile.

If you would like more information on how orthodontics can transform your smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “The Magic of Orthodontics: The Original Smile Makeover.”

By Kenneth J Oskowiak & Associates, DMD, PC
April 17, 2017
Category: Dental Procedures
TechniquesforKeepingImpactedCanineTeethfromSpoilingYourSmile

Although usually an orderly process, some permanent teeth don't come in as they should. In fact, they may not come in at all and remain hidden in the gum — a situation called impaction. This creates multiple problems for function, health and, in the case of front canines, appearance.

Canines are the longer and more pointed teeth on each side of the front-most incisors. They help tear and cut food during chewing, a function impaction eliminates. Besides a higher risk for developing abscesses (isolated areas of infection) and cysts, they can also put pressure on neighboring teeth and damage their roots or cause them to erupt abnormally.

Dentists often remove impacted wisdom and other back teeth to lessen these potential problems. Removing canines, though, has additional considerations: besides compromising ideal chewing function, missing canines often create an unattractive smile.

But before considering removal, there's another technique we might be able to use to save the canines and actually draw them down through the gums to their correct position. It's usually part of an overall orthodontic plan to correct a poor bite (malocclusion).

After pinpointing their exact position with x-rays or CT scanning, a surgeon surgically exposes the impacted canines' crowns through the gums. They then bond small brackets to the crowns and attach a small gold chain to each bracket. They fasten the other end of the chains to orthodontic hardware that exerts downward pressure on the impacted teeth. Over several months this pressure can help move the teeth into their normal positions.

Unfortunately, this technique isn't always advisable: one or more of the impacted teeth may be in a difficult position to attempt it. It's usually best in these situations to remove the teeth, usually sooner rather than later for the sake of neighboring teeth.

Fortunately, with today's advanced restorative techniques, we can eventually replace the canines with dental implants, although that's best undertaken after the patient enters adulthood. In the meantime, we can utilize orthodontic means to preserve the open space and provide a temporary restorative solution.

Whatever route taken, these teeth don't have to become a source of problems, especially for your appearance. Whether through orthodontics or restorative dentistry, impacted canines don't have to ruin your smile.

If you would like more information on various orthodontic procedures, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Exposing Impacted Canines.”

By Kenneth J Oskowiak & Associates, DMD, PC
September 03, 2016
Category: Dental Procedures
IfYoureConsideringBracesHeresHowTheyWork

If you or a family member has problems with teeth alignment or your bite, you may be considering braces. This tried and true method can straighten out most smiles — but there's more to braces than you may realize.

For one thing, orthodontic treatment wouldn't work if it weren't for the natural mechanism for tooth movement that already exists in the mouth. It may seem your teeth are rigidly set in the jawbone but that's not how they maintain their attachment: that's the job of an elastic connective tissue known as the periodontal ligament that lies between the tooth and the bone. The ligament has tiny fibers that attach to the tooth on one side and to the bone on the other to actually hold the teeth in place, much like a hammock secured between two posts.

The ligament attachment also allows the teeth to move incrementally in response to environmental factors or the aging process. We harness this natural movement ability with braces to move teeth to a more desirable position. We first attach small brackets to the front crowns of the teeth (the visible portion) and then string arch wires through them. We then attach the wires to anchor points where we can adjust the amount of tension they're exerting through the brackets against the teeth. By gradually increasing that tension, the teeth respond as they would when any force is applied against them and begin to move.

By precisely controlling that movement we can transform a patient's smile. But we believe the advantages are more than cosmetic: the teeth will function better and will be easier to care for and keep clean. These benefits, though, have to be balanced with heightened risks for root resorption (something that occurs only about 10% of the time) in which the ends of the roots can shrink, or loss of mineral content in teeth enamel where the hardware makes it more difficult to remove bacterial plaque. These risks can be reduced by closely monitoring dental health during the entire treatment process and through stepped up efforts in daily oral hygiene.

The starting point for deciding on an orthodontic treatment is a thorough dental examination with x-rays or CT scan imaging. Once we have a complete picture of your misalignment problems and any other extenuating circumstances, we can recommend a treatment plan just for you.

If you would like more information on orthodontic treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Moving Teeth with Orthodontics.”