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Treatment Timing
Dr. deLorimier provides orthodontic treatment for adults, adolescents and children. We follow the guidelines established by the American Association of Orthodontists by recommending that an orthodontic evaluation take place at age 7 for all children. This early evaluation can help to determine the best time to begin any necessary treatment.
Many progressive treatments are now available for patients 7 to 11 years of age, that provide significant benefits, especially when jaw irregularities are present. These treatments may also prevent certain conditions from worsening. Treating children with these types of problems during their growth stages allows our practice to achieve results that may not be possible when face and jaw bones have fully developed. This early treatment can simplify or eliminate additional treatment for the child.
Treatment
We want to compliment your family dentist and specialists in providing the very best orthodontic care possible so that you may achieve optimal dental health throughout your lifetime. Orthodontic treatment involves much more than just straightening your teeth! Your tooth bite, jaw joint articulation and periodontal health are as equally important to us as your facial appearance and smile.
Goals of Orthodontic Treatment...
- The very best possible in tooth and facial appearance.
- The most stable treatment result possible
- Not just a static, but a functional occlusion
- Healthy jaw joints
- Healthy periodontium
- Resolve the patient's chief complaint
We feel we can best achieve the above goals by treating to a centric relation position of the lower jaw and joint (condyle), which requires that the models of the teeth be mounted on an articulator throughout treatment. Mounted models are as necessary an inclusion of the orthodontic record as are photos (facial & teeth), head films, and panorex x-rays. Articulated models expose any discrepancy between the tooth bite and jaw bite, and thus demonstrate where and what kind of adjustments need to be made to the teeth and bite to properly treat a case. Hand held models only demonstrate how their teeth fit, and are, therefore just not sufficient. Because people can only bite where the teeth fit, and disarticulation of the joint is not something they would normally be aware of.
Diagnosis and Treatment Planning...
Orthodontic mal-occlusions (bad bites) are primarily skeletal in origin. The more square one's jaw is, the longer the arch length and width and hence room for the teeth. The likelihood that permanent teeth need to be removed is less. Whereas, the longer the face as evidenced by an obtuse angle of the jaw, the shorter the arch length and room for the teeth (crowding), and thus the more likely teeth will have to be sacrificed to make room for the remaining teeth. Rarely is the size of the teeth the primary cause of crowding, necessitating the removal of permanent teeth. But when the teeth are truly large, tooth size alone could necessitate the need for removing teeth.
 Squared jawed people we call "bracyfacial," longer faced people we call, "dolichofacial." The brachyfacials (square jaw) tend to have longer arch lengths, deeper overbites, and less crowding. Dolichofacials (high angled jaws -- longer faces) tend to have open bites, shorter each lengths and more crowding. If everyone were one or the other, diagnosing would be simple. But most patients fall somewhere in between these two groups, and thus the diagnosis becomes a process of ferreting various bite parameters to arrive at the best possible outcome. On the average, about 45-50% of orthodontic patients require the removal of four bicuspid teeth to achieve optimal results and satisfy the six goals of treatment. There are consequences of not removing teeth when indicated, just as there are consequences of removing them too often.
TMD or Temporo-Mandibular Joint Dysfunction...
TMD is a multi causal collection of jaw joint problems sometimes associated with neck and back spasms, arthritis, cranial neuralgias, even fibromyalgia; but more often than not, it's the direct result of a bad bite with a heavy habit of tooth clenching and grinding. The more it is bite-related, the easier it is to treat. Typical symptoms include joint and/or face pain, clicking or crackling joints, ringing in the ear, headaches, limited opening of the mouth, and soreness after chewing certain foods or after long dental procedures. While 20% of the population are aware of one or more TMD symptoms, only about 5% think it's serious enough to seek treatment for it. Needless to say, the TMD should be treated and resolved before any definitive dental treatment is considered whether it be reconstruction or orthodontic treatment. Braces do not fix the jaw joint problem, splint therapy does.
Splint therapy has three aims: (1) eliminate the TMJ complaints, (2) identify the correct jaw-joint relationship, and (3) determine whether or not the complaints can be resolved. If all three aims cannot be achieved, there is no point pursuing orthodontic treatment for TMD, because the TMD will continue or possibly get worse. Splint therapy consists of biweekly or so visits of relining and/or adjusting the splint for 3-6 months or until the TMJ complaints are resolved. The splint construction incorporates an ideal functional occlusion and with adjustments and relines over time. It just might provide the most comfortable bite one will ever have... which is why it works. It must be worn full time, especially while eating, otherwise it will not work!
Tomograms (x-rays) are a good diagnostic tool for assessing tissue changes to the joint, but models mounted on an articulator are better for assessing whether or not the jaw (condyle) is seated into the joint.
Early Treatment...
Dr. deLorimier is really not an advocate of early "braces." However, there are some procedures that make sense to do early. Basically, anything that can be done later should be done later so that it's not done twice; e.g. why do braces twice? On the other hand, headgear works best if instituted about age 8 1/2 or 9, and preferably in September so that it can be completed prior to the next summer. Palatal expansion is another procedure... the earlier the better. Space maintenance as part of a serial extraction program to alleviate crowding or to guide all the permanent teeth into place, taking advantage of the "leeway space" and hopefully avoiding the extraction of permanent teeth, is also an important function of early treatment. But early braces on the front teeth is rarely required unless advancement of these teeth is prudent and part of a "guidance eruption" scheme. Finally, Anterior cross bites are much easier to correct prior to the eruption of the maxillary canines. Sometimes an upper "retainer" is appropriate if the front teeth stick out too far, and gathering them up and moving them back would prevent injury to them.
Full Treatment...
Generally, full orthodontic appliances are not placed on the teeth until all the permanent teeth have erupted, especially the second molars. This will generally occur between the ages of 10 and 13 in females and 12 and 14 in males. Waiting until these teeth come in will actually shorten the total time that the patient is in braces, which can figure significantly in the hygiene outcome. Even more importantly, these teeth have a significant effect on the patient's bite, and waiting for them just makes the articulated models that much more revealing.
Full orthodontic treatment should be possible to complete within 20-30 months depending upon the level of cooperation that the patient is willing to sustain. Adult patients may take slightly longer, however they seem to make up for the biological differences in treatment by being more committed. Clear, gold, and traditional braces are available.
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