In the previous blogs we emphasized the need to allow the patient’s face and profile to largely determine the decision to extract. This would further be influenced by projected changes to the person’s facial structure during the aging process. A good measuring tool to help determine if a person was a candidate for non-extraction treatment was the position of the mid-facial area in the profile relative to the rest of the face.
If it has been decided facially, that non-extraction treatment is preferable, how can it be achieved in patients that appear to have severely crowded teeth and no room? How and where will the space be created?
As we are all aware, a beautiful broad smile is viewed as much more attractive to the eye. Although this is not the only determinant, it is certainly vital in the patient achieving that desired look. Treatment that will cultivate this broadening puts us on the correct track. The wider the diameter of the dental arches, the more room to fit teeth.
There are several ways to achieve this result. Some more preferable than others. The most common is to attach an appliance to the roof of the mouth containing an expansion screw that is turned open over the course of several days. This is used more commonly in pre-teen patients who are still growing. The opening of the screw can become quite uncomfortable and may lead to gum problems on the involved teeth. For adult patients, additional surgical assistance is often needed.
With the introduction of more modern orthodontic technology that use light forces to stimulate “novel bone modeling”, we can now change the shape and size of the bone area in which the teeth reside. This now replaces the heavy uncomfortable forces of the palatal expander with light biologically friendly forces of certain varieties of orthodontic braces. Facial and lip muscles can now be involved to encourage the development of width of the dental arches to help achieve the desired effect. Although this is not always possible in all patient profiles, it has little to do with the degree of crowding or spacing present.
By using these technologies, we can expand our treatment from simply dental goals to include facial goals as well. These types of braces as well as the incorporation of other “Face First” orthodontic methods open up the vistas of increasingly beautiful orthodontic smiles which were previously achieved less often.
Dr. Joel Schacher
Phone: (905) 281-8200
Fax: (905) 281-8188