 | Dr. Gina Pinamonti is an orthodontist in Pittsburg, KS. practicing since 1998. She is a graduate of Pittsburg State University. She completed her dental training at the University of Missouri-Kansas City School of Dentistry graduating with honors. She completed her Orthodontic and Dentofacial Orthopedic residency in 1998 from UMKC as well. Dr. Pinamonti is a member of the ADA, American Association of Orthodontists, Kansas Dental Association and the vice president of the Kansas Association of Orthodontists. For more information please call 620-231-6910 or visit www.smileoutloud.com. |
Orthodontics
2010-11-01 13:31:00
Braces for adults?
Question: My front teeth are so far away from my lower teeth I cannot bite them together. What can be done for an adult who did not have the benefit of braces when they were younger and growing?
Answer: There are a lot more possibilities today for someone to get that perfect smile they have always wished they had. Most cases are straight forward. The road to straight teeth is a straight line, but sometimes the jaws just do not fit together and no matter how straight the teeth are they will never fit together in their normal jaw position. Quite often the upper jaw and the lower jaw bones do not line up correctly and the orthodontist can use auxiliary appliances to influence the teeth to more closely approximate ideal, but there are cases that are outside the norm. In order for the orthodontists to make sure they give the patient the best occlusion or “bite” possible, braces must be accompanied by surgically repositioning the jaw bones.
The majority of the jaw imbalances in the United States are where the upper teeth appear to stick out too far and the lower jaw and chin are way behind. This jaw relationship is usually a lack of lower jaw growth and those patients can be treated surgically by repositioning the lower jaw forward. Lower jaw surgery will improve the function of the teeth, reduce the prominence of the upper front teeth, the chin will balance the face more, the nose usually appears smaller and the skin under the chin will become tighter.
When the lower teeth stick out ahead of the upper teeth, in an underbite, surgical treatment usually moves the upper jaw forward. Because the lower jaw continues to grow as long as the patient is growing tall, and that can be late in men, surgery is done when the patient is an adult or at least when growth has ceased. The surgical movement of the upper jaw forward allows the lower teeth to fit under the upper teeth. This makes eating easier, especially when biting into a sandwich. The cheek bones appear more prominent, the nasal airway becomes larger and the eyes have more lower lid support making the person look more rested.
The previous descriptions of jaw surgical needs are just skimming the surface. There are multiple ways to correct the facial imbalance other than what has been mentioned here and there are multiple variations of the jaw imbalance problems, such as the narrow upper jaw and teeth that fit inside the lower teeth; the open bite where only back teeth can touch and the front teeth do not work together; and the facial asymmetrical growth where one side is much smaller or out of proportion with the other not only front to back but sided to side.
Jaw imbalances are prepared for surgically corrected orthodontics in similar manners. The orthodontist will work with a maxillofacial oral surgeon to create a plan to correct the facial imbalance. The patient is informed about the entire process, risks and limits of the braces and surgery are presented to the patient, a pre-determination is sent into the patient’s health insurance, expected results are explained and once all is accepted the treatment can begin. Braces are applied to the teeth, they are aligned over their respective bones and in most cases the patient’s bite will become worse in preparation for surgically fitting the jaws together. When the dental casts of the patient’s teeth appear to fit well, the orthodontist will send the patient back to the oral surgeon. The surgeon will make sure everything looks good from their perspective or ask for adjustments to be made by the orthodontist, re-submit the insurance and make sure all is in order for the surgery.
The surgical procedure is usually completed in the hospital or surgical center. The patient will stay overnight and in most cases is released the next day at the discretion of the oral surgeon. The patient remains under the care of the oral surgeon for about 6 weeks. They usually do not have their mouth wired closed anymore because the bones are fixed with plates or screws and they are more stable. The jaws are guided to healing positions with rubber bands and a wafer thin plastic splint. After one week, the patient is feeling much better and in usually two weeks they are resuming their normal routines. In four to six weeks, the patient returns to the orthodontist who will continue to finish the treatment with the jaws in the new position. This could take a few months to a year depending on the amount of muscle pull or relapse that occurs after surgery.
The goal for the surgically assisted orthodontic treatment is a functional bite. The benefits of the surgical corrections is improved facial balance, improved facial esthetics, many times more room for the tongue, and many times improved airway. But most of all you will see a new air of confidence in the patient who has realized their dream of the beautiful smile they now have.
