BEFORE TREATMENT - Frequently Asked Questions
Please click on the question to see the answer:
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I'm still not convinced that getting braces at this time is a good idea. I know people who had braces as a child and when their wisdom teeth came in, their teeth became crooked again. What do you think?
You have inquired about the relevance of wisdom teeth (3rd permanent molars) and the possibility of future crowding of teeth. This is a common topic of discussion with varying opinions. However, amongst the scientific research, the story is fairly consistent. Wisdom teeth do not significantly contribute to someone acquiring crowding of their teeth. See one of many articles.
Anterior teeth crowding (especially lower teeth) can be regarded as a normal maturational event. You tend to see this crowding of teeth start to develop in the late teen years (which happens to coincide with the emergence of wisdom teeth - but there is no cause-and-effect relationship since the crowding is seen equally in people who are congenitally missing their wisdom teeth or have already had these teeth extracted for some reason). However, because of this coincidence in time, it is very easy to convince people of a cause-and-effect relationship - and there are many anecdotal stories about just that. So why do teeth move and become more crowded? Well, teeth are always moving our whole life. They move at different rates of speed at different times for different reasons. And, it is a good thing that teeth can move or else we would not be able to move them orthodontically. Teeth move within the bone due to forces applied to the teeth. Typically, teeth stay contained in a balance between pressures from the tongue; pressures from the lips and cheeks; and pressures from chewing, biting, and clenching or grinding. Orthodontists move teeth with continuous gentle forces. So why would teeth crowd with age? There may be several contributing factors, but most typically, a person in their late teens has developed more muscle, and has more stresses in life (e.g. relationships, schooling, leaving home,...) and they will deepen their bite (i.e. acquire more overlap of their teeth vertically; deeper overbite) and to accommodate this vertical change, the lower teeth need to crowd (or less typically, the upper teeth need to space apart). The upper teeth fit over and around the lower teeth like a cap fits onto a bottle. Once the lower teeth get misaligned, because of this cap on a bottle fit, the upper teeth may start to acquire irregularities too as the lower teeth can act like a template for the positioning of the upper teeth.
No doubt you must find this very discouraging since you have already implied that you have concerns about teeth crowding after orthodontic treatment. Well, this is a concern for me too and I have often told people that sometimes it is harder to keep teeth straight than to get them straight to begin with. This is why I use a 2-retainer system for keeping teeth straight following most treatments. As one part of this system, typically, I use upper and lower fixed lingual retainers. These are little, thin wires bonded to the tongue-side of the anterior teeth. See the picture:
Usually I bond such retainers to the top and bottom anterior teeth. These are very good long-term retainers. I have had one bonded to my own teeth for approximately 15 years. (I do not use words like "permanent" of "forever" when discussing these retainers since they are only bonded to the teeth and they will eventually become loose at one or more teeth.) A person may notice a loose wire themselves, or it may be noticed when someone is visiting their family dentist and hygienist for a dental cleaning. In the future, when such a wire retainer becomes loose, a person can return to an orthodontic office and request that the wire be removed or that it be repaired and bonded again. If someone requests that it be removed, I would remind the person that teeth tend to crowd with age and if they'd like to ensure that their teeth stay straight, then I would recommend that they have the wire bonded again. The only time that I would be in favour of removing such a retainer wire is if the person does not floss those teeth and/or brush vigorously enough around the wire. Flossing can be done quite easily with the use of Superfloss and my office staff provides samples to all of our patients and trains them how to use this. Once your fingers have tried the technique a couple of times, it is quite easy. See the following pictures:
Now, said that I use a 2-retainer system. In addition to the fixed lingual retainers, I usually provide patients with a clear, removable nighttime upper retainer called and Essix retainer. See this image:
I usually instruct patients to wear this every night for the first 6 months after they finish their orthodontic treatment. After that period of time, the instructions become individualized. They become individualized because not everyone is the same with respect to how straight their teeth will stay. For some people (very few) they may be able to never wear a retainer and their teeth would stay straight. Other people (very few) will experience their teeth starting to move unfavourably after just a few days of not wearing their Essix retainer. And, most people will find themselves somewhere in the middle between these two extremes - you just don't know where you'll be. So, after the first six months of nighttime Essix retainer wear, I will ask the patient if they would like to continue with this. Some (many) patients say yes since they are very comfortable with this and have this as part of their bedtime routine and they do not want to change. Further, some people know that they tend to grind their teeth at night and want to keep wearing their Essix retainer nightly in order to prevent tooth wear. Now, other people will be interested in starting to taper-off the number of nights that they wear their Essix retainer. For these people, I suggest that they start to wear their Essix retainer every-other night for the next few months; and then a couple times a week for the next few months. I inform them that they can keep tapering-off from the Essix retainer wear until they reach a point in time where they find that the retainer is starting to become tight and/or their teeth are sore in the morning. Once they find that level of frequency of Essix wear, they can start to wear their retainer slightly more frequently so that the retainer does not fit tightly (only passively) and their teeth are not sore in the morning. I never tell people not to wear their Essix retainer. They can always do this testing of its fit. Otherwise, teeth move with aging to some extent.
I was recently talking to my dentist about the possibility of getting Invisalign treatment for a slight overbite (no tooth extraction required). My bottom teeth are also a bit misaligned, but I am not concerned about correcting that. My dentist recommended you as a specialist, but I was surprised that my dentist suspected that such a simple overbite correction would require treatment of about 18 months duration. Is this correct?
Specifically, you mentioned that you have crowed lower anterior teeth but you are just seeking to have a slight or simple overbite correction. Of course, I have not seen you, but I suspect that you are underestimating the complexity of your malocclusion. For starters, I can never be certain if a non-orthodontist is using the term "overbite" to mean the horizontal or the vertical overlap of the anterior teeth.
(See http://www.braces.org/braces/dentists/glossary/index.cfm) These definitions are often misused by lay-people. Regardless, ideally the top teeth should fit over the bottom teeth like a cap fits onto a bottle. Now, if there is crowding of the lower teeth (the top of the bottle) then the cap won't fit - it will be too big and the upper teeth may extend vertically too far; or there may be too much vertical overlap of the teeth. Other times, the teeth will compensate by tipping (in order to try to make a cap on a bottle fit), but it is the underlying skeletal structure that is the source of the disharmony - ultimately leading to the cap not fitting on the bottle. Therefore, one aspect of a malocclusion, whether it is overbite, overjet, or crowding is usually related to another aspect hand-in-hand. It is difficult to treat or correct one aspect without dealing with all the aspects if the goal is to: 1) have the teeth fit together properly in the end for functional reasons; and 2) have the teeth and face (the lips and cheeks are like curtains that hang over the maxilla, alveolar bones, teeth, and mandible) appear attractive.
I have heard that orthodontics can be expensive. Do you offer payment plans?
Orthodontic treatment is often considered expensive. This is usually due to the technologically advanced systems used in assessment and treatment, and the fact that there are many appointments for several years. Considering the time spent, orthodontics is often regarded as dentistry's best value. (Active treatment duration may range from a few months to a few years. Typical treatment duration would be around 18 months, and then we follow-up most patients periodically for two years following their active treatment while they are in 'Retention'. All of these appointments, and almost any time you would need to see me during that whole time is covered in the orthodontic fee.) In the end, I am confident to speculate that most, if not all, of my patients would feel that their result is worth every penny. See http://www.cao-aco.org/MEDIA/Esteem.html
Often financing is a concern to patients. This is usually since fees, payment plans, possible insurance coverage,... are all confusing before my office staff has a chance to answer all of your questions and outline all of the above for you on a written form. Before this becomes a concern for you, I would recommend that you come to my office for an Initial Exam and I can evaluate you teeth and occlusion. I will inform you of your possible treatment options, the treatment duration, and provide you with an estimate of the treatment fees and possible payment plans.
I understand that my child has a narrow upper arch or narrow palate. Is it possible that he will outgrow this problem? What can I expect if this is left untreated versus treating this? Is this narrow arch due to his pacifier use?
When a maxillary transverse deficiency (with or without cross bite) is left untreated it typically will not self-correct and there is usually an associated asymmetric growth. Sometimes with a narrow upper arch or narrow palate (maxillary transverse deficiency), we will see a posterior crossbite and/or excessive lingual (toward the tongue) tipping of the lower molars. There is not always a posterior crossbite when there is a maxillary transverse deficiency. The palate is also not always "high" with a transverse deficiency. There can be, and often is, a vertical deficiency as well. [Vertical maxillary excess with a transverse deficiency is also seen but has a different etiology - usually related to hypotrophic muscles and/or excessive mouth breathing.]
Untreated posterior functional shifts (with or without crossbite) typically lead to progressive asymmetric compensation of the codyle-fossa relationship and result in a positional deviation of the mandible, which, along with a distinct dental alveolar asymmetry, maintains the occlusion into adulthood. A very high percentage of children have a functional shift (either laterally or anterior-posteriorly – or both), whereas a high percentage of adults do not have a shift. Therefore, it is reasonable to conclude that if functional shifts are not corrected at an early age, they are likely to result in dental alveolar asymmetry and positional deviation of the mandible in an adult.
Lets first understand how the transverse dimension is established – this will allow for an easier understanding of when it is established and whether or not further growth will be beneficial:
In a newborn child, the tongue fills the oral cavity and the tongue is an important factor in jaw growth and development. (See: Am J of Orthod and Dentofacial Orthop 2004; 126:91-99). In the absence of teeth, the tongue touches the palate and is in contact with the lip and cheek tissue. The tongue grows more quickly than the jaws, achieving its definitive size by the 8th year. With the eruption of teeth, the tongue position sinks and is shifted back. On one hand, the position of the teeth is fundamentally influenced by the force of the lip and cheek musculature and, on the other, by tongue musculature. So the teeth swim in a muscle balance. The growth of the maxilla and mandible become coordinated by the interdigitation of the molars, incipiently starting at the age of approximately 16 months, when the first primary molars move into contact. (See AJO/DO 2004;126:82-90.) The teeth take, as a reaction to the cusp-fossa mechanism, a suitable occlusal position. As soon as good intercuspation is obtained, the jaws find the same cusp-fossa relationship whenever the closing movement occurs. The typical occlusal morphology of the teeth and the correct interdigitation in a Class I occlusion, especially of the first molar permanent molars, play leading roles in the growth of the face. There is little change in facial width after age 6 years (i.e. after the first permanent molars have erupted). Certainly, the transverse width you see at ages 8 - or 9 years of age is what you get. The tongue usually reaches its approximate adult size when a child reaches the age of 8 years. By ages 6 – 8 years, the condyles and temporal fossas (together the TMJ’s) are as far apart transversely (i.e. left-to-right) as they are going to get. Anterior-posterior (i.e. sagittal) growth is basically complete by about the age of 14 years. Normal, vertical growth continues into adulthood. In the maxilla, the growth site is distal (i.e. posterior) to the upper molars; and in the lower jaw, growth is at the condyles (i.e. where the lower jaw hinges to the upper jaw (TMJ) at the base of the skull and anterior to the ears) while the ramus remodels. Beyond age 6 – 8 years, most of the facial complex is being displaced in a downward and forward direction; but is being remodeled in an upward and backward direction.
A given individual does demonstrate an apparent linear consistency of growth pattern and direction. This consistency is not necessarily a result of regular equal increments of growth. It may be achieved by very unequal amounts of growth at the major growth sites accompanied by mandibular rotation and remodeling. Specifically, tooth movement and soft tissue remodeling masks the changes of dissimilar jaw growth by compensatory movements causing the occlusion to remain apparently in nearly constant spatial relations. Thus, the consistency of pattern and resultant growth direction is maintained, but the mechanism of manifestation is perhaps more complex than usually suspected. It is a misconception that growth is something getting larger since this ignores the progressive remodeling.
If the tongue at rest is against the palate with the lips lightly sealed with the teeth in or near contact, there will very likely be ideal facial and dental development. (See: AJO/DO 2004;126;79-38.) The typical primary dentition will have a shallow overbite and overjet, Class I canines, primate spaces (small spaces mesial to the upper canines and distal to the lower canines), flush terminal plane (at the distal aspect of the second primary molars), vertical inclination of the incisors, ovoid arch form. At approximately 6 years of age, the primate spaces close and this is referred to as “early mesial shift.” Drift of the first permanent molars following loss of the second primary molars is referred to as “late mesial shift” and occurs at approximately 11 years of age.
The anterior arch breadth will increase with the eruption of the permanent incisors. Following the eruption of the canines, there is a small increase again in the maxillary arch, but not so in the mandibular arch. It is normal for the lower incisor to erupt slightly crowded, but at this time, the anterior mandibular arch will widen and tongue and lower lip pressure will often straighten these teeth. Space for the larger erupting upper incisors is provided by existing incisor spacing, by inter-canine arch width increase, and by a greater proclination of the permanent incisors relative to the more upright primary incisors.
The arch length (incisors at midpoint to a perpendicular line connecting the distal of the E’s or 5’s) at age 18 years is generally shorter than it was at age 4 or 5 years.
Studies have shown that dental crowding appears to be related more to a deficiency in arch perimeter than to teeth that are too large. I have found much evidence that McNamara's rule-of-thumb for maxillary transverse widths is accurate - and beneficial to know. McNamara’s simple rule-of-thumb indicating the ideal average inter-molar width in males of 37.4 mm and in females of 36.2 mm. This was based on Howe et al. [1983], who compared arch widths of two subjectively selected groups of dental casts. (See: Am J Orthod 1983;83:363-73.) This measurement is made from the gingival margin of the palatal surface of one upper first molar directly to the gingival margin of the palatal surface of the other upper first molar.
Correction of posterior transverse deficiencies in young patients is often accomplished by a combination of skeletal and dental expansion. Skeletal expansion involves separating the right and left maxillary halves at the midpalatal suture (which has not fully fused in children); dental expansion results from the buccal (outward) tipping of the maxillary posterior teeth. The proportion of skeletal and dental movement is dependent of the rate of expansion and the age of the patient during treatment. The goal of palatal expansion is to maximize skeletal movement and minimize dental movement, while allowing for physiologic adjustment of the suture during separation. Skeletal expansion is usually accomplished through a procedure termed rapid Maxillary Expansion (RME). Although RME has been used routinely as a treatment approach for crossbite correction for several decades, it has only recently come into regular use for patients without crossbites. The incidence of posterior cross bites in white American children is approximately 7 %. (See: AJO/DO 2001;119:11-20.) The occurrence is higher in European children (13 % - 23 %) and lower in African-American children (1 % - 2 %). The incidence of maxillary transverse deficiency without a cross bite is significantly higher than these values.
With most boys, our window-of-opportunity to utilize RME is longer (to approximately age 14 years) by about two years than it is with most females. Due to this, boys can often be in the early permanent dentition and still have successful RME, whereas with females, it is almost always more desirable to have RME done in the mixed dentition. Almost without exception though, it is better to do RME early; around age 7 to 9 years. This results in proportionally more skeletal correction than dental, and allows for spontaneous re-orientation of the mandible to a maxilla with the proper transverse dimension. Beyond the age of 12 - 13 years for females and 13- 14 years for males the maxillary sutures are sufficiently fused that RME is not appropriate without surgically assisting the opening of the maxillary sutures.
Rapid maxillary expansion (RME) can be used to correct transverse (i.e. left-to-right) and sagittal (i.e. anterior-posterior, or front-back) problems and to provide sufficient arch space to resolve borderline crowding in some mixed dentition patients. In addition, this procedure can be used to facilitate maxillary canine eruption, flatten the curve of Wilson, improve nasal airflow and “broaden the smile.” In addition, RME has been shown to have additional benefits, including facilitating the spontaneous correction of Class II and Class III malocclusions. This is due to the fact that many Class II or Class III malocclusions have a strong transverse component. (See: Orthod Craniofacial Res 2005;8:21-28.) A Class II or Class II patient with what appears to be a normal bucclingual relationship of the posterior dentition usually has 3 to 5 mm transverse discrepancy between the maxilla and the mandible. If you “hand articulate” the study models of a Class II patient to a Class I canine relationship, a unilateral or bilateral posterior crossbite is usually produced.
With establishing an improved maxillary transverse dimension many patients there will be a disruption of the occlusion and the patient posture his or her jaw into a harmonious sagittal occlusal relationship. Presumably, subsequent mandibular growth making this initial postural change permanent. So, will a child outgrow a jaw disharmony in the sagittal (i.e. anterior-posterior, or front-back) direction? Possibly if the proper transverse dimension (i.e. left-to-right) is established.
Further, there have been consistently reported resulted for decades (See: AJO/DO 2004; 126:576-82.) that show a permanent a permanent increase in the maxillary arch width leads to a spontaneous, permanent, and significant increase in mandibular arch width. This is due to a “de-compensation” and uprighting of the lower posterior teeth. Accordingly, it may be said that the position of the mandibular dentition might be influenced more by the maxillary skeletal morphology than by the size and shape of the mandible.
You will see a lot of self-correction of an anterior open bite due to a pacifier habit; but no self-correction of a posterior cross bite / narrow maxilla – and lots of children will have a posterior cross bite without a sucking habit.
It has been suggested that my daughter should get a frenectomy because of the space between her upper front teeth. What do you think?
Regarding a maxillary midline diastema, a frenum is usually only guilty by juxtaposition. There will likely be a cause for the midline diastema, it just is not the frenum that is sitting close to this. One should consider more likely reasons such as a supernumerary tooth (e.g. mesiodens); or the fact that the permanent canine teeth have not erupted yet; or that there is excessive overjet and or over bite that extend the upper arch length and create the necessity of spaces manifesting somewhere.
One needs to consider that a frenum stays in place as the alveolar process grows vertically. So, if the frenum appears to be right on the alveolar crest at age 6, then by age 16, it will probably be relatively normal.
Also consider that the upper midline diastema prevalence is 98 % in 6 year olds; 49 % in 11 year olds; and 7 % in 12 to 18 year olds.
However, a maxillary midline frenectomy may be indicated if there is significant blanching of the incisive papilla when the frenum is pulled; and when there is an apparent notch in the bone at the midline as seen on an occlusal radiograph (X-ray picture). The only other indication for a maxillary midline frenectomy is if the frenum is very unaesthetic, which is rare. Regarding frenal attachments in general, a frenectomy is indicated when a frenum is involved in causing localized gingival recession or in cases of ankyloglossia.(i.e. tongue-tied).
When there is a central diastema due to a strong frenal attachment; conventional thinking is for closing the space and then doing the frenectomy (so that you do not fight scar tissue when closing). The frenectomy should be done after the space is closed and about two months prior to debonding (i.e. removing the brackets and wires). A fixed lingual retainer wire will be required for retention. However, a midline diastema is notoriously unstable.
Lastly, one needs to consider that often a frenectomy will result in loss of papillae, which may be more serious aesthetically than the diastema opening again.
Does my dentist need to make a referral if I want to have an orthodontic assessment?
Your family dentist does not need to make a specific referral for you to come to our office. In fact, we welcome referrals from our other patients. Whichever way you may learn of our office we would be pleased to meet with you for an orthodontic consultation to discuss your concerns and make recommendations. However, we do require that all of our patients see their dentist for regular check-up visits during orthodontic treatment.
What options do adults have regarding braces?
Braces aren't just for kids. In fact, the American Association of Orthodontists estimates about 20 percent of orthodontic patients are adults (up from about five percent in 1970). Increased financial resources (or treatment financing), social awareness of the availability of braces, more comfortable materials, and faster techniques have contributed to the greater number of adults getting braces. Most adult orthodontic patients opt for the less noticeable, ceramic, tooth coloured, brackets. Another recent option is Invisalign®, a set of clear, removable appliances that gradually move the teeth into the proper alignment. With the orthodontist’s instructions, Invisalign creates a set of precisely calibrated aligners or trays that fit tightly over the teeth, holding the teeth in position. Each aligner is worn for about two weeks – taken out only for eating and cleaning of the teeth. As one aligner is replaced, fine tune adjustments in the next aligner gradually move the teeth into the desired positions.
When should I bring my child for and orthodontic check-up?
Most orthodontic treatment begins between the ages of 9 and 14, however, by age 7, most children have a mix of adult and baby teeth. Orthodontists can spot subtle problems with jaw growth and emerging teeth at this time. In some cases, we might find a problem that can benefit from early treatment. Early treatment may prevent more serious problems from developing, and may make treatment at a later age shorter and less complicated. Typically, early treatment guides the growth of young bones and creates a better environment for adult teeth as they emerge. For these reasons, it is recommended that your child get an orthodontic check-up at about age 7. Of course, the check-up may reveal that your child's bite is fine, and that can be comforting news. Even if a problem is detected, we may not recommend immediate treatment. Chances are, we will take a "wait-and-see" approach, checking on your child from time to time as the permanent teeth come in and the jaws and face continue to grow. For each patient who needs treatment, there's an ideal time for treatment to begin in order to achieve the best results.
My daughter, Mackenzie, has space between her baby teeth. But my son Braedan's baby teeth are nicely lined up. Will Mackenzie need braces?
The permanent front teeth are wider than the baby front teeth. So, if we have spacing, as in Mackenzie’s situation, the permanent teeth will have space to go into as they push the baby teeth out. However, in Braedan's situation, there is no space to start with. So when the permanent teeth erupt, they will have to overlap each other, or rotate & squeeze themselves into place. So it is Braedan, not Mackenzie who is more likely to require orthodontic treatment. It would be best however, to stop by for an examination.
Can I wear a mouthguard over my braces?
Back to school means back to football, soccer and many other sports. A mouthguard is a very important piece of protective equipment that athletes need to wear. Mouthguards protect your teeth and mouth from injury. This is important for all athletes but especially those wearing braces. Mouthguards come in different sizes, shapes and colours. If you are not wearing braces, a custom fit mouthguard made by your family dentist is usually the most comfortable to wear. Less expensive alternatives can be found at sporting goods stores. Orthodontic patients need a special type of mouthguard that allows room for braces and tooth movement. I supply all of my patients who are involved in sports with an athletic mouthguard. The only way to be sure that your mouthguard will be there when you need it is to wear it every time you play.
My neighbour's teenage son needs his teeth straightened but he won't wear braces. He is very concerned about his appearance. Can you help him?
Many orthodontic patients opt for the less noticeable, ceramic, tooth coloured, brackets. Another recent option is Invisalign®, a set of clear, removable appliances that gradually move the teeth into the proper alignment. With the orthodontist’s instructions, Invisalign creates a set of precisely calibrated aligners or trays that fit tightly over the teeth, holding the teeth in position. Each aligner is worn for about two weeks – taken out only for eating and cleaning of the teeth. As one aligner is replaced, fine tune adjustments in the next aligner gradually move the teeth into the desired positions.
Can orthodontic treatment improve a bed-wetting problem?
Recent research has demonstrated that upper jaw expansion could cause relief of a bed-wetting problem. Most investigators consider bed-wetting (nocturnal enuresis, NE) a multicausal disorder involving genetic and psychosocial factors. Upper airway obstruction is a factor in NE; and NE is a common symptom among children with breathing problems and sleep apnea. Upper jaw expansion is usually done in orthodontics when there is a narrow jaw and cross bites.
The increases in the nasophayngeal airway dimensions may allow for better breathing and a reduction NE.
I’m concerned that my child may become embarrassed during the orthodontic examination process if we are all looking at her crooked teeth and double chin. Can this be discussed without her being present?
Of course, it is the intent of an orthodontic Case Presentation to make a patient “conscious” (i.e. cognizant, mindful, and aware) but certainly not “self-conscious” (i.e. embarrassed or ill at ease) about their dental-facial characteristics. It is in the environment of an orthodontic office and within the context of an orthodontic analysis that many people receive their first professional opinion about their facial appearance and how this relates to their oral features.
Whether you like it or not, we live in a society that places a tremendous emphasis on appearance and attractiveness. The effect of attractiveness has been seen and studied in almost every social setting including: first impressions, friendship, dating choices, marriage choice, scholastic assessments, criminal identification, and simulated court settings. It is generally understood that your smile is one of the first characteristics noticed by others. Beyond the first impressions of a smile, due to the requirement to use one’s mouth in conversation; during meals; and intimately; studies have shown that most people would prefer to have a misshapen arm or leg rather than a misshapen mouth. The cosmetic impairment associated with a dentofacial anomaly may be disadvantageous in two ways; (1) its adverse effect on the individual’s self-esteem and (2) the unfavourable social response which it may evoke. The latter may blatantly manifest itself in the form of teasing and ridicule, partly during childhood, or it may occur more insidiously as bias in the attitudes of others during a range of social encounters.
I feel that it is my duty to examine each patient’s unique characteristics and explain to the patient and the parents that some malocclusions have both a skeletal and dental aspect to it that affect appearance. If we choose to proceed with treatment using orthodontics alone, then I can move the teeth but I have to keep the teeth within the bone and there will be limited change in her skeletal pattern and soft tissue proportions (the cheeks, lips, and chin are like curtains that hang over and cover the bones and teeth underneath). If it is a goal of theirs to also improve the disproportions and imbalance in the patient’s dentofacial skeletal architecture, then orthognathic surgery will need to be considered in addition to the orthodontic treatment.
Sometimes I cannot give a patient any other option than orthodontics plus orthognathic surgery if the skeletal dysmorphia is extensive. However, often there will be options and I believe that each patient should be aware of his or her characteristics and aware of his or her options. The selection of the appropriate treatment plan is based not only upon my assessment of the final result with regard to aesthetics, function, and stability but also upon the patient’s objectives and perceptions of need. Research[1] has shown that patients who do decide to proceed with orthognathic surgery do, in fact, see themselves as having profiles that deviated from the ideal range. Conversely, patients who had decided against surgery perceived their own profiles as being more within a normal range. It can be concluded that, despite the fact that orthognathic surgery is recommended by orthodontic professionals and its need is confirmed by cephalometric parameters, one’s self-perception of profile may be the most important factor in the decision to elect surgical correction. In other words, it has been shown that patients planning surgical correction of their jaw deformities demonstrate a high internal locus of control. Due to evidence like this, I am particularly comfortable presenting options to patients and being comfortable that they will make the appropriate decision for themselves once they are fully informed.
I have found that when patients and parents see that we genuinely present our findings and concerns in the best interest of the patient – that neither patients nor parents become embarrassed or self-conscious.
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