Orthodontic Services for Kids
Interceptive/Early Treatment/Phase I orthodontics is treatment for children who do not yet have all of their permanent teeth. Our philosophy is to be conservative and work with your child’s individual needs, intervening only when necessary and most efficient. The circumstances where early treatment is beneficial—or not—have been studied extensively by orthodontists in universities around the world, and Dr. Pompei believes adamantly in practicing only according to the best scientific evidence available.
The American Association of Orthodontists recommends that all children be evaluated by an orthodontist around age 7, when the first adult teeth have entered the mouth. There are cases where developing problems can be eliminated before a child has a full permanent dentition. Sometimes growth can be leveraged to achieve a more harmonious facial balance. Sometimes a child has missing teeth or extra teeth, and these problems can be addressed proactively when they are identified early.
We aim to make our early treatment oriented towards a specific goal and as short and sweet as possible. It is important to note that since Early Treatment (Phase I) is targeting one particular problem, most children will still need Comprehensive Treatment (Phase II) to address overall alignment and bite issues once all adult teeth are in. Successful Phase I treatment can reduce the complexity and duration of Phase II treatment.
Reasons why Early Treatment May be Indicated
When children have growth imbalances, their upper and lower jaws may not be aligned. Since teeth live in the jaw bones, misaligned jaws usually mean a misaligned bite. Gentle forces can be used to increase or decrease the amount or direction of jaw growth to improve these disharmonies.
All of your upper teeth should fit slightly over your lower teeth like a lid on a box. If an upper front tooth is on the inside of your lower teeth, you have an anterior crossbite. If upper back teeth are on the inside of your lower teeth, you have a posterior crossbite. Anterior crossbites are harmful because they often don’t direct biting forces down the long axis of a tooth and can push teeth outside of the gums or bone. They also may cause enamel wear or chipping. Posterior crossbites may cause you to have to shift your jaw to one side to get your teeth to fit together when chewing. After years of shifting your jaw to the side, your jaw can grow asymmetrically or joint problems may develop.
Guidance of Eruption/Severe Crowding/Space Maintenance
By age 7 or 8 it can be obvious that growing adult teeth are severely crowded. Radiographs can help us determine if developing teeth are at risk of getting impacted (stuck inside the bone) or entering into the mouth in a poor position. Interceptive treatment can be used to re-direct the way a tooth or teeth enter the mouth and can open or save space for these teeth. This maximizes the chances teeth will erupt into a more stable and well-aligned position.
Space maintainers can be used to prevent posterior adult teeth from drifting forward into the space vacated by primary teeth. This can prevent crowding from occurring, or if crowding is already present, can save space so that it can be used later to align overlapping teeth.
Habits such as finger sucking, tongue thrusting/low tongue posture, and mouth breathing all affect tooth position and jaw growth. For example, anterior open bites, where the teeth in front don’t touch, can be caused when thumb sucking pushes upper and lower front teeth apart. Habits should be stopped by the time the first adult teeth start coming into the mouth. Orthodontic appliances can help with habit elimination and correction of the problems the habits have caused.
Trauma Risk Reduction
When front teeth are protruding excessively making it difficult for a child to close his or her lips around the front teeth, these teeth are at a higher risk of being traumatized in an accident or while playing sports. Straightening these teeth and tucking them back behind the lips protects them and should be done as soon as possible.
Sometimes kids will feel self-conscious when their front teeth first grow in and are very crooked or spaced apart; this may cause them to be teased and not want to smile. It’s fine to wait until all the adult teeth have erupted so that alignment and bite issues can be addressed together in one phase of treatment. However, giving a child confidence to smile by straightening the front teeth early can be very valuable for self-esteem.
Orthodontic Services for Teens & Adults
Comprehensive treatment in orthodontics is treatment that corrects alignment AND bite issues, taking into account your facial bone structure, soft tissue structure, and growth potential. It treats both your upper and your lower permanent teeth. If you are a growing pre-teen or teen, we can leverage your growth spurt to maximize your jaw’s genetic growth potential to give you the best chances of an ideal outcome.
Some jaw discrepancies or asymmetries are significant and growth modification or straightening your teeth alone is not enough to fix your bite and smile. In these cases, surgery in conjunction with orthodontic treatment is an option that can be explored to idealize your result. Surgery is not something that anyone takes lightly, it has many benefits but many risks. At High Line Smile Design we will help you understand all your options and alternatives, working with trusted oral maxillofacial surgeons.
In some adult cases, comprehensive treatment to correct your bite is not needed or desired. We may need to upright a tooth or consolidate space to make room for an implant, or fix a small area of crowding that has relapsed after previous orthodontic treatment. If you are a candidate for limited treatment, you will not have to go through the cost and time associated with traditional comprehensive treatment.
At High Line Smile Design, we know that maintenance is for life!! Just like you can’t go to the gym, get fit and strong, and expect to stay that way without regular exercise to maintain it, straight teeth need maintenance as well. We offer various retainer options to all patients who have had previous supervised orthodontic treatment by a licensed professional and can discuss pros and cons of fixed vs. removable retainers.
The beauty of seeing a specialist to fix your smile and your bite is that orthodontists have many tools in their toolkit. Orthodontists are well versed in all the various techniques that can be used to achieve the best end result, depending on what is best for your particular case and lifestyle preferences.
Clear aligners are a series of plastic trays that slowly move teeth a small amount (~.2mm) each tray. A patient wears the trays at all times except when eating, drinking, brushing, and flossing. Trays are changed periodically, about every week, to progress through the prescribed tooth movement.
Orthodontists have been moving teeth with removable plastic trays for decades. More recently, the science of moving teeth with plastic has advanced considerably with the advent of 3D digital technology. Orthodontists, in partnership with plastic aligner labs, have worked hard to improve the efficiency of aligner therapy. Today, orthodontists can achieve excellent results in complex cases using clear aligners as a primary tool. It bears repeating that clear aligners are only a tool. Although aligners may be available through various sources (online, in stores, without professional diagnosis and supervision), the result of your treatment is greatly dependent on the expertise of the tool operator. Both a Picasso and a kindergartener could be given a paintbrush, only one of them is likely to create a masterpiece with it.
Clear aligners have many benefits over traditional braces. They are often more comfortable, less noticeable, and require fewer office visits than braces. It’s also easier to keep your teeth clean during treatment since aligners are removed to eat, brush, and floss.
However, successful orthodontics with aligners require excellent compliance throughout the duration of active tooth movement. Spend too many hours without the aligners in and teeth will get off track. In addition, for optimal tooth movement it is necessary to adhere several attachments, or tooth-colored “composite bumps,” to the teeth. These allow the aligners to apply the necessary force vectors to move teeth in three dimensions, so this treatment technique is NOT invisible. If you have concerns about these attachments, Dr. Pompei can omit them from your treatment plan but explain the tooth movements that may be compromised. Lastly, if you ignore instructions and eat or drink with the aligners in, you are at a much higher risk of getting cavities.
Traditional Braces (steel, gold, ceramic)
Traditional braces made of metal or tooth-colored ceramic are still an excellent and popular option for making beautiful smiles. They allow the orthodontist to exercise tight control over tooth movement at each visit, and some tooth movements are faster with this treatment modality. Braces, or brackets, are bonded to all teeth. The brackets connect the teeth to a series of wires that exert forces on the teeth. These wires progress in dimension and stiffness, gradually moving the teeth into alignment. Braces are a great option for patients who don’t want to have to take an appliance in and out to eat and drink or who know they are unlikely to be compliant with aligner wear.
Lingual braces, or “inside” braces, are similar in concept to traditional braces except the brackets are custom-made for each tooth and adhered to the backsides of your teeth near your palate and tongue. These are the truly most invisible way to straighten your teeth. Lingual braces, while extremely esthetic, are not for the faint of heart. Although other people might not be able to tell you are wearing braces, your tongue will know! Theses brackets take the most amount of time to get used to and cause significant soreness in the early period after placement. They may cause a mild lisp that for most people will go away after a few weeks. Lingual braces also are more time-consuming, as they require longer orthodontic visits and diligent home care. It is important to carefully clean around the brackets and wires; this can be a bit challenging as it’s hard for you to see these braces in the mirror.
In addition to plastic, braces, and wires, orthodontists use several different tools to fix bites. These include bite plates, expanders, distalizers, elastics, telescoping springs, temporary anchorage screws or bone plates, tongue cribs, habit breakers, headgears, facemasks, space maintainers and more! If Dr. Pompei thinks one of these appliances would help during your treatment, she will carefully explain her rationale, how it works, and what to expect.
The benefit of seeing an orthodontist who specializes in tooth movement is that your treatment can be highly customized and adapted to your needs. If you start in clear aligners and it doesn’t fit your lifestyle, we can switch you to braces. Sometimes it’s most appropriate to do a combination of treatments, such as lingual braces on your upper teeth and clear aligners on your lower teeth, or clear aligners in the front and braces on the side where they are less visible. We are flexible and understand that treatment has to work for you or your child. Luckily, there are many methods for achieving great results!