The Advantage of invisalign^®
over Metal Braces

• When Should Children Be Evaluated By An Orthodontist?

  The American Association of Orthodontics recommends all children have their first orthodontic consultation around age 7 years old. Why? Because this is the ideal age to develop dental arches and is also the ideal age to make sure permanent teeth are going to emerge the right way.

• Dental Arch Development

  Traditionally, orthodontic treatment started after all permanent teeth erupted. If there was dental crowding, then it was common to undergo orthodontic treatment for 2-3 years with removal of 4 permanent premolars in order to align the teeth. This resulting dental arches were shorter than dental arches that have all permanent teeth by about 16 millimeters. In turn, it is thought that shorter dental arches crowd the tongue and contribute to adult sleep apnea.

  Now, however, modern orthodontics splits orthodontic treatment into “Phase 1” and “Phase 2” or an early phase and a later phase of orthodontic treatment. The early phase of treatment is the orthopedic phase where we are changing the facial bones to create healthy, beautiful, wide dental arches that can support all permanent teeth. These wide dental arches also allow the tongue to rest in a forward position which reduces the risk for adult sleep apnea. Additionally, flatter and wide dental arches allow the nasal passages to develop in a way that is better so that nasal breathing is improved.

  It is essential to develop the arches when the facial bones are soft and moldable. The ideal age for this is around 8 to 9 years old. The following cases were all done in children ages 6-9 years old using invisalign clear aligners, the most gentle way to develop dental arches. Some of these cases include using a palatal expander. There are many numerous advantages to palatal expanders but this is not required. Parents may discuss with the orthodontist and the orthodontist will come up with a customized plan that fits your child.

• Anticipatory Guidance in the Eruption of Permanent Teeth

  Around age 7-8 years old, we take a panoramic xray in order to check if permanent teeth are coming in straight. Very often, instead of a straight eruption trajectory, the permanent canines and first premolars are coming in diagonal and slanted. When these teeth are allowed to grow in a slanted direction, they often damage neighboring teeth and they often come in with damaged gums.

  Permanent Upper Front Teeth Damaged by Incoming Canines

  Photos 1

  

  Photo 1 shows permanent lateral incisors with badly damaged roots due to the permanent canines coming in slanted instead of straight.

  Photos 2

  

  Photo 2 shows what is looks like when a canine comes into the wrong place

  When permanent teeth are on a bad path of eruption, many will even need surgery and painful orthodontic procedures to make them come in.

  Upper Canines that Went into the Palate

  Photo 3

  

  Photos 3 shows canines that were hiding in the palate. This patient had to have surgery to expose these canines. The canines have been bonded with a gold chain which is used to bring these teeth into the dental arch. This process is quite painful and generally can be avoided if baby teeth are removed at the right time and if expansion is done at that time.

  Unerupted Permanent Teeth Can Develop Cysts Baby teeth do not fall out unless their roots are eaten away by the incoming permanent tooth. If the incoming permanent tooth is not aimed correctly, it will miss the root of the baby tooth and the baby tooth will not fall out correctly.

  When permanent teeth fail to come in, they can develop cysts. These cysts expand over time and eat away the bone around the teeth.

  Photos 4

  

  

  Photo 4 shows how much damage occurred with only 6 months time after a general dentist refused to remove the baby canine as instructed by the orthodontist.

  Damaged Gumline On Permanent Teeth Caused By Over Retained Baby Teeth

  The following are two examples of over-retained baby teeth that cause irreversible damage to the gumline of permanent teeth.

  Photos 5 and 6

  

  Photo 5 In this first example, this shows when a permanent tooth comes into the arch but not in the middle of the arch, the gumline is damaged.

  

  Photo 6: Even when the tooth is brought into the dental arch, the smile does not look symmetric because of the differing gumlines.

  Photos 7 and Photo 8

  

  Photo 7: This xray shows a baby tooth that is over-retained. Notice it is over-retained by only a tiny bit of remaining root. This caused the permanent tooth to rotate.

  

  Photo 8: when the upper front tooth came in rotated, the gumline was damaged. Even if this tooth is made straight, the smile will not look ideal because the gumlines are not even.

  Over Retained Baby Teeth Can Cause Permanent Teeth to Emerge in the Wrong Place

  When baby teeth stay too long, the permanent teeth are forced to come into the wrong place.

  The following are 3 examples.

  Photo 9

  

  Photo 9: Here the lower baby canines did not fall out. This forced the permanent teeth to emerge on the inside, closer to the tongue

  Photo 10

  

  Photo 10: Here the upper permanent laterals came in the wrong place because the roots of the baby teeth did not go away and the permanent teeth were forced to go towards the palate.

  Photo 11

  

  Photo 11: Here the lower baby canine was over-retained and the permanent canine was forced to show up in front of the front tooth. Correcting this requires painful surgery and painful adjustments to move the canine into the correct position. Now both the canine and the front teeth have irreversible bone damage.

  Timely Removal of Baby Teeth Can Prevent Many Orthodontic Problems

  The following photos show how removing over retained baby teeth can prevent many orthodontic problems:

  Photo 12 and 13

  

  Photo 12 shows the permanent canine is going in the wrong direction. The permanent canine also has a large cyst developing around its crown.

  

  Photo 13 shows what happened after the baby tooth was removed. The permanent canine became much straighter because erupting teeth follow the path of least resistance. Removing the over retained baby tooth helps to guide the permanent tooth to emerge in the right place!

  The following is another example that shows how removal of baby teeth helps to guide the successful eruption of the permanent teeth:

  Photo 14

  

  Photo 14 shows a panoramic xray. Here we can see permanent teeth erupting slanted instead of straight.

  Photo 15

  

  Baby teeth were removed leaving behind soft bone. Since permanent teeth tend to follow the path of least resistance, the permanent teeth later erupted straight.

  At TLC fo Smiles, our pediatric dentists and our orthodontists work as a team to provide your child with anticipatory guidance in the eruption of permanent teeth. At every dental visit, they are checking how your child’s baby teeth are falling out and how their permanent teeth are coming in. Around age 7 years old, they take a panoramic xray in order to check if permanent teeth are erupting straight or if they are headed the wrong way. Then they develop a customized treatment plan suited just for the unique needs of your child.

  If you would like a complimentary orthodontic consultation for your child, please callone of our two offices. Our Chatsworth office has a private room for each patient and can be reached at 818-729-0182. Our Granada Hills office has an open bay which many parents with young children prefer because more than one child can be seated in the same room and his/her siblings. The Granada Hills phone number is 818-360-2131. We look forward to meeting you soon.