What are the options when you have several teeth that that are too small?

It is very common for me as an orthodontist to see teeth that are disproportionately small or large compared to the other teeth in the mouth. I see teeth that are too small much more often, and this is especially common with the upper lateral incisors (the second teeth back in your mouth starting from the front). Several times a week, I see new patients with laterals that are anywhere from a millimeter or two too narrow (which patents often never realized they were small), to ones that are very noticeably narrow, which we call “peg laterals”. When these patients are starting orthodontic treatment with braces or invisalign, it is important to recognize this size discrepancy so that their bite can be planned accordingly to fit ideally when we are finished.

The goal of this article is to explain what is involved with getting the bite to fit properly when there is a tooth size discrepancy, as this concept often can cause some confusion with parents. An analogy that I often use is that your bite is like a shoe box fitting together. The upper teeth are like the lid of the shoe box: they are  broader than the lowers, and they should make a framework around the lower teeth. The lower teeth are like the box itself, which should all fit securely inside the framework of the uppers. Picture what would happen if you took the snuggly fitting cap to a shoe box, and replaced it with a smaller lid (like having several upper teeth that are too small) and tried to place this on the box. If you forced it to fit, the lid would likely tear, and there would be extra space left at these tears when the lid was pushed down. This is what happens in the mouth when there are upper laterals that are too small, and the remainder of the teeth are positioned in a correct bite: there are spaces that are left over where the teeth are narrow, and we are often physically unable to close these spaces anymore (the upper “lid” would become too small and will not fit to the lower anymore).

So what options do we have when this occurs? Here are the three most common:

  1. Leave spaces adjacent to the small teeth at the end of orthodontic treatment, and after the braces are removed your general dentist will restore them to their proper width. I usually recommend this option when the laterals are noticeably small, and the “widening” of these teeth by your dentist results in a much nicer appearance. Your dentist will help you choose the best materials to use, whether it be bonded composite, or ceramic veneers or crowns. There is an extra charge outside of orthodontics for your general dentists to perform this procedure.
  2. Reduce the size of the lower teeth to match the missing width of the upper teeth. I usually recommend this option when the missing upper lateral width is relatively small and the upper laterals appear very nice even though they are a bit smaller. With this option, the front 6-8 teeth are made slightly narrower by sanding between where these teeth meet one another. It basically creates a number of small spaces, after which I close the lower spaces (which creates a smaller “lower box”), which then allows for full closure of the upper spaces (using the existing smaller “upper lid”). The advantage of this option is that no further dental procedures will be needed after orthodontic treatment. The downside is that there will be some removal of enamel- they key is to keep it conservative, and for me to go no where near the point that it causes increased risk of future decay, increased long term sensitivity, or an appreciable loss of tooth structure. If too much tooth reduction or slenderizing would be needed, I always recommend option 1 above.
  3. Leave the lower teeth “back” from an ideal bite. A skilled orthodontist will always try to get your bite as aligned and as healthy as possible, but sometimes this is an option if the size discrepancy of the laterals is small enough, and the bite can be left purposefully off a bit in order to close all the upper spaces. I don’t do this as commonly, but it is another option if patients don’t like the thought of the the other two options above.

Which option is best for you? If you know you have abnormally narrow teeth, I will be happy to help you decide which option is best. Every bite is unique, and we will decide on a custom treatment plan to finish your teeth as healthy and as attractive as possible!

 

Dr. Dan Rejman is board certified by the American Board of Orthodontics, and is the councilor for the College of Diplomates of the ABO for the Southwest and Rocky Mountain regions.

 

Not Just Braces at Meadows Orthodontics!

One of the fun things that we do at Meadows Orthodontics is to give our new patients the option to fill out a “fun” questionnaire. It is a list of their favorite things and interesting facts about themselves that they would like to share. Over the years it has provided a lot of laughs, topics for our staff to talk with them about (beats talking about the weather!), and often teaches parents a few things about their own kids! An example was our question, “What is your favorite band or singer?”, where a six year girl old wrote “Metallica”. Their mother laughed and had no idea she was picking up on the music that her father likes. The most common response? Taylor Swift and Imagine Dragons by far. Also surprising is that “sushi” is the most common response to “What is your favorite food?” for kids! We have found out that youngsters want to be very specific things when they grow up, like equine veterinarians, F-22 pilots, Denver Broncos, brain surgeons, and motocross racers (the ones that want to be an orthodontist get brownie points!).

We have had kids perform unique talents that make the whole room laugh, including talking clearly with their mouth closed (amazing), bending their double jointed thumbs in weird directions, making TWO rolls with their tongues at one time, making their eyebrows do a caterpillar, yodeling, turkey calls, all sorts of dance moves, making their hand spin over 600 degrees around, the old arm pit sound effects (parents are always so proud when their kids break that out!)… it goes on and on. Yes, it’s an episode of David Letterman’s stupid human tricks here most every day. Most common favorite TV show? That would be Friends and The Office. We have learned that in our patient family we have a cup stacking champion, competitive archers, an opera singer, a competitive barbershop quartet member, a recently crowned (or belted?- mixed martial arts) MMA champion, multiple state champion cheerleaders (yay CV!), several small business entrepreneurs under 15 years of age (wow!), young rodeo riders, and a Rubik’s Cube competitor.

The other day, one of my assistants asked if I had filled out one of these forms. After all this time I actually hadn’t, so here it goes. I’m certainly not as interesting as some of the people above, but I’ll try!

What is your favorite sport to play or activity? I love to ski, mountain bike, and golf. This year I started snowmobiling to backcountry ski.

What is your favorite sport to watch? College football and basketball. My favorite teams are the Michigan Wolverines, and the Syracuse Orange. I also make it a point to watch the lacrosse final four every spring.

Do you play an instrument? I love music but unfortunately I am sadly unmusical myself! And I am an awful singer☹

What is your favorite food? So many here! Pizza, Pho, Indian cuisine, Cornell chicken, and beef on weck. Those last two are Upstate New York specialties- ask me for the recipes!

What do you want to be when you get older? I LOVE what I do, but if I had to choose an alternate I’d go with a chef.

What is your favorite band or singer? Kenny Chesney, George Straight, the Pixies, Motley Crue, New Order and Red Hot Chili Peppers. Also Taylor Swift, and Bieber’s last album (just being real here).

What are some interesting places you have been? Russia and China (where we adopted three of our children), Greece, Belgium, France, Germany, the Netherlands, Anguilla and Hong Kong.

What is your favorite TV shows and movies? Movies- Step Brothers, Dunkirk, and we have a tradition to watch Love Actually every Christmas Eve. TV shows- The Office, American Chopper, Frazier and Chopped. When it is on I cant stop watching poker or curling, even though I don’t play either (is that weird?).

What are some interesting things about you? I was a dairy farmer until my mid 20’s, I have delivered hundreds of calves, I like to oil paint and cook, and I once biked from Florida to Canada in 12 days (almost-I flipped my bike in northern Pennsylvania, broke my wrist, and rode patches of the last leg in a cast!). I love boxers (I have had four: Gumby, Hank, Stanley and Nora), once had a 24 pound cat, have a large collection of ball caps (the camo hat from 105 West is my favorite), and cant stand raw onions, mushrooms and walnuts. This is kind of fun so I’ll keep going… I have bungee jumped in Whistler (terrifying!), I can waterski barefoot, have had Thanksgiving dinner with Jennifer Garner, was part of the world’s longest swim relay, and I had poison ivy that covered over 90% of my body on our entire honeymoon in Alsace, France. Also, my staff finds it is funny that I think “I want it that way” by the Backstreet Boys is the best song ever. It really is.

Well, there you go. One of the great things about being an orthodontist in Castle Rock is getting to know all types of people. And if you have a stupid human trick, feel free to stop in and share it with us!

Whitening Your Teeth after Braces or Invisalign

As an orthodontist, my patients often ask me about whitening their teeth, and when it should be done in relation to their orthodontic treatment. For patients who have braces, I almost always recommend having whitening done after braces are removed as opposed to before braces are put on. This is because the braces will partially cover the newly whitened teeth if done before treatment. Also, having teeth whitened after orthodontic treatment is complete is a nice gift to oneself now that the teeth are aligned beautifully, and can really put the final aesthetic touch on your teeth. Here is some advice and information to consider if you are thinking of whitening your teeth.

Whitening systems are considerably different in their effectiveness, method of application and cost. I almost always refer my patients to their general dentist for whitening, as the methods that they use are the most effective, and make my patients the happiest. Most importantly, the process is supervised by a professional who can address issues such as sensitivity, tooth and gum health issues, and different areas of teeth that may whiten incredibly well, to no change at all (more on that below).

 

  • In office whitening is a procedure that usually takes 30-90 minutes, and a UV light or laser is used on the teeth to accelerate the whitening process by a form of hydrogen peroxide. Depending on the severity of your teeth’s discoloration, several visits may be required. Be careful- Blue LED lights sold on TV or the mall, etc., do not make whitening any faster that just the gel itself.
  • At home tray whitening with custom trays is where your dentists makes custom fit trays just for your teeth, and peroxide gel of different strengths are used for 1-2 weeks while you sleep at night. Again, this is supervised by your dentist, and they can make adjustments if there is tooth sensitivity, or more whitening is desired. The advantage of this system compared to over the counter products is the strength of the gel, and the custom trays ensure even, complete whitening to the tooth surfaces.
  • Whitening strips are purchased over the counter. The plastic flexible strips are stuck to your teeth, and the thin film of hydrogen peroxide will start to whiten the teeth. These products are generally weaker than the dentist supervised products, and whiten only the areas the tape-like film makes contact with.
  • Whitening toothpaste is the least expensive option, but these products do not actually change the color or shade of your teeth. Instead, they use abrasives to help remove surface stains. If it appears that your teeth are yellower or discolored, but do not have surface residue or staining, this will be of little help.

Your teeth have pores on the surface of the enamel that covers them. These pores trap the products that you place in your mouth, and products such as coffee, wine, tea, berries and smoking are especially notorious for changing the color of teeth over time. Hydrogen peroxide acts to remove the stains out of the pores in your enamel. The newly “cleaned” pores can cause a temporary increase in tooth sensitivity, especially to temperature. This is normal, and after several days the minerals in saliva or fluoride rinses will help bring things back to normal. The results of tooth whitening will last quite a while, depending on the individuals diet. Touch ups will be needed from time to time to re-whiten the teeth as they slowly discolor again over time.

It is especially important to consult your dentist about whitening if you have porcelain or ceramic crowns, veneers, or composite (tooth colored) fillings. These materials will not whiten as your natural teeth will! Your dentist can help you plan the color of future crowns or veneers based on how white you want your teeth to be in the long term. It is unfortunate to have a nice veneer or crown placed, and then decide you want to whiten your teeth, and now the crown does not match the rest of your teeth! If you have any questions at all, I will be glad to give you guidance and advice regarding these issues.

Dr.Dan Rejman is a board certified orthodontic specialist for children, teens and adults in Castle Rock, Colorado.

 

My Child has an “Overbite”. When Should this be Treated?

An “overbite” is the common term the public uses when the upper teeth protrude too far forward in relation to the lower teeth. The proper term for this relationship is actually called “overjet” (overbite actually describes the VERTICAL overlap of the front teeth!). No worry – I understand what is being described when I hear this term – what is important is: 1) What is causing the upper teeth to “stick out” too far in relation to the lowers, and 2) What should be done to correct this, and when?

How and when to correct an excess overjet is dependent on several factors, including the etiology (or “what is causing the issue?”), and the age and dental developmental stage of the patient. Lets take a look at several scenarios.

  • The upper teeth are flared forward due to a thumb sucking habit. When a child sucks their thumb or finger for an extended amount of time, they are actually placing forces on the teeth that disrupt the equilibrium within the mouth. Even a very gentle force placed on the back of the upper teeth will make the teeth start to move, if that force is consistent (this is actually how braces work- they placed a light force on the teeth for an extended period of time). If we see that there is a thumb sucking habit with a child whose front permanent teeth have not erupted yet , we will often monitor the situation only and see if the habit will terminate itself over time. However, we will usually intervene if the habit persists when the permanent front teeth erupt, or we see that teeth are noticeably starting to move in an undesirable direction. In addition to making the front teeth flare, thumb sucking can also make the lower teeth tip back. The negative pressure created by thumb sucking can also make the upper arch collapse inward, causing a posterior crossbite. Obviously if their are problems to this extent, we will usually recommend treatment to help end the thumb sucking habit, usually with a habit guard that is bonded to the upper teeth, and often in conjunction with limited braces or an expander if needed.
  • Upper teeth are too far forward due to a skeletal disharmony, or a growth issue with the upper or lower jaws.  This is a relatively common cause for excess overjet, and is caused by the lower law not growing forward enough compared to the upper jaw, or the upper jaw growing forward too much. There has been much debate over many decades as to the best time to treat this condition. Most of the current research supports waiting to treat this when the patient is in their adolescent growth spurt, and we can take advantage of the body’s natural growth to help us out. We can often do this in one complete phase of treatment. Of course there are exceptions, such as the overjet being so large that it presents a trauma risk to the upper teeth during the late childhood years,  social issues, or getting a head start on correcting this issue if there are other reasons that we are starting early orthodontic treatment (such as crossbites that are causing asymmetric shifts of the lower jaw, or creating space for teeth that are blocked out from erupting normally). In general though, I prefer to wait for the adolescent growth spurt if possible.

If there is any question at all about timing, please contact myself of your local orthodontist for guidance. We can detect this issues at a very early age (The American Association of Orthodontists recommend an initial exam around the age of 7), and can make a plan for the most ideal treatment and age to get started.

 

Dr. Dan Rejman is graduate of the University of Michigan at Ann Arbor School of Dentistry, and did his specialty training and orthodontic residency at Marquette University in Milwaukee, Wisconsin. He has been Board Certified by the American Board of Orthodontics since 2007.

What is the meaning of some of the “lingo” that we use in an orthodontic office?

Starting with a patient’s first orthodontic appointment with us, which is an  initial consult, families of our practice hear the orthodontist, coordinators and assistants use terms that may or may not be familiar to them. I thought it would be helpful to write an article that explains some of the terminology that we use. We try to do a great job explaining what these terms mean to the patients or their parents, but here is a “cheat sheet” to help de-mystify some of our fancy words!

Mesocephalic- Having a medium proportioned head shape

Dolicocephalic – Having a narrower elongated head shape

Brachycephalic – Having a shorter and wider head shape

Nasolabial angle – When looking at a patient’s profile, the angle formed between the upper lip and the bottom of the nose

Labiomental angle – When looking at a patient’s profile, the angle formed between the lower lip and the upper portion of the chin

Mentalis strain – The “wrinkled” appearance of the chin muscle when the lips have to work too hard to close

Retrognathic  – Too far back, often referring to the upper or lower jaws

Prognathic – Too far forward, often referring to the upper and lower jaws

Impacted tooth – A tooth that is “stuck” in the jaw bones, and is not erupting on its own

Blocked out tooth- A tooth that can erupt on its own, but is prevented from doing so by a lack of space available

Class I – A relationship where the upper and lower back teeth bite ideally with one another (in a front- to-back direction)

Class II – The upper teeth are relatively too far forward in relation to the lower teeth

Class III – The lower teeth are too far forward in relation to the upper teeth

Decalcification – The process of teeth loosing mineral structure, often resulting in permanant white spots. The initial stage of tooth decay.

Arch length – The amount of space available for the upper or lower teeth, usually measured from molar to molar (Crowded teeth usually arise from a lack of arch length)

Proclined incisors – The front teeth are excessively tipped outwards

Retroclined incisors – The front teeth are excessively tipped back

Anterior crossbite – The front teeth are located on the wrong side of an another (upper teeth behind the lowers)

Posterior crossbite – The back teeth are biting incorrectly in a lateral, or side to side direction

Curve of Spee – The upwards curve from the biting surface of the lower back teeth to the biting edge of the lower front teeth

Functional shift – When the bite is not fitting correctly, and the lower jaw must shift sideways or foreward to find a comfortable place to bite

Frenum or Frenulum – The small ridge of tissue that connects two areas, such as the base of the tongue to the floor of the mouth, or the fold of tissue that can be felt on the gums above and between the two front teeth.

Frenectomy – The removal or reduction in size of the above tissue

Ankyloglossia- The term for being “tongue -tied”, when the frenum beneath the tongue is short and decreases tongue movement

This is just a small sample of terms that you may hear around the office, but I hope it helps with your dental and orthodontic awareness!

 

Dr. Dan Rejman is a practicing, board certified orthodontist in Castle Rock, Colorado, and is the owner of Meadows Orthodontics!

 

 

 

 

Congratulations to Our Patients – The Cast, Crew and Musicians in Les Miserables!

Last night, Dr. Rejman and I went to see the Castle View high school performance of Les Miserables.

Our daughter, a Junior at Castle View, had several friends in the production that have grown up with her- so seeing the performance was a must!  We got tickets at last moment and ended up sitting in the front row, right by the orchestra, but it was the perfect view to see so many of our orthodontic patients who both performed, were behind the scenes as set directors and stage hands, and also played the beautiful music that accompanied the performers.

WOW!  The performance was over-the-moon incredible!  How could it possibly be a high school production, we kept wondering to ourselves!  Best of all, to see all of those incredible smiles that we’ve seen over the years in our office.  We were feeling so proud of everyone and just can’t say enough about the obvious effort that was put into this show.

The talent pool in Castle Rock is beyond words.  Every performer was unique in their own way and had impressive tone and range.   Best of all – the acting was believable and moving!  I sobbed in the last scene and couldn’t stop crying all the way until the last actor left the stage.

Well done Ben, Abigail, Claire, Keagan, Braden, Tatum, Brenna, Rebecca, Lauren, Amelia, Annie, Lucy, Lily, Ally, Haiden, Aaron, Grant, Ashton, Emma and Ayla!  We are so very proud of your hard work!

 

Julie Rejman is Dr. Rejman’s wife and the office manager at Meadows Orthodontics in Castle Rock, Colorado (www.MeadowsOrthodontics.com)

Pumpkins With Braces On Their Teeth?

 

Its that time of the year again! We really like holidays at Meadows Orthodontics-it gives us a chance to decorate the office and have some fun. Current patients also know that I do several pumpkin carvings every year that are really popular with the kids (and parents too!). I have carved a variety of characters over the years, including Yoda, Star Wars character Watto (the one with the wings), monsters from my imagination, and various characters with braces on their teeth. I use clay carving tools to sculpt the pumpkins and it takes me anywhere from 2-5 hours to finish the project.

We display them at the Founders and Meadows offices…for only a few days. Unfortunately once the carving starts, they start to dehydrate and shrivel away! Yes, I gave tried everything from spraying with water, vaseline,  a bleach spray… nothing seems to slow down the process. I guess that is part of what makes them spacial and so seasonal. Here are some past pumpkins that I have carved, and keep an eye out for the new ones for this year!

 

Dr. Dan Rejman is a board certified orthodontic specialist (braces and invisalign), and is the owner of Meadows Orthodontics in Castle Rock, Colorado. He and his great staff have been creating beautiful smiles for the children and adults of the Castle Rock area for years!

Our Talented and Artistic Patients at Meadows Orthodontics

Soon after I opened Meadows Orthodontics in Castle Rock, my wife, Julie, came up with fantastic idea. We had always stressed the artistic side of orthodontics, and its importance in creating the most  aesthetic results possible for our patients. We had decorated our office with my oil paintings to let patients know that art has always been a major part of my life, and that there isn’t a minute of my workday that I am not putting to use my training in the arts towards my work as an orthodontist. But there was something missing. I heard from so many of our young patients that they too had an interest in drawing and painting.

My wife suggested that we offer to supply a canvas, paints, and brushes to each patients that starts with us, and invite them to make a painting that we would hang on a wall in our practice to go along with my paintings. I was expecting to get 20 or 30 a year from our patients, but boy did I underestimate the response. The original wall we had set aside was soon full, so we opened the largest wall in our treatment area to display the all the amazing paintings that our patients were creating…and soon that wall filled up. So started to fill the walls of our game room!

Kids that had just started braces painted pictures of their favorite football teams, hockey teams, their pets, landscapes, Harry Potter characters, Dr, Who, Sponge Bob, Nemo, ballerinas, landscapes, dinosaurs, parents college mascots and logos, rainbows, unicorns, abstract art, family portraits, and much more! In addition to the acrylic paints that we supplied, they used oils, crayons, melted crayons, charcoal, sequins, feathers, glue, popsicle sticks, stones…

I certainly think my patients benefit greatly from the artistry that I introduce into their smiles, but it has been amazing how much they have given back to me and my staff. Many times every day, while I have time to look around for few moments, I see something new, inspiring, or just really cute in all the hundreds of paintings that are on the walls from our patients. It is also really nice to see parents that are sitting with their children checking out all the art work and smiling spontaneously when they see something that makes them happy.  Hundreds of children have also looked in pride at their artwork that is on display in a place where hundreds of other people get to view their work.  Many pieces have been given back to families as their children finish their time with us and leave with new smiles. Other paintings we just cant seem to part with, and have been on our walls since the first few months that we opened!

Early last year we opened our second office in Castle Rock near the Founders, and we have continued our tradition there also. The paintings are multiplying, walls are filling fast, and I am always amazed at our patients creativity and talent on a daily basis. Stop by anytime and take a look.

 

Dr. Dan Rejman is the owner of Meadows Orthodontics. Before his years of study in dental school and orthodontic specialty training, he studied studio arts in composition, color theory, drawing, painting and drafting.

Treatment Options for Missing Lateral Incisors

A relatively common problem that I see as an orthodontist is a patient who never developed upper lateral incisors. Lateral incisors are the teeth immediately to the right and left of the two front teeth. The first thing that I explain to the patient and their parents is that this is not something that went wrong with the way the child was raised- this did not happen because they didn’t eat enough broccoli, or because there was an accident or lack of fluoride! Technically, the condition is called lateral incisor agenesis, and the failure of these teeth to form is thought to have a strong genetic component, arising from mutations in specific genes that impacts about 2% of the population.

The earlier missing lateral incisors are detected the better, as early detection often keeps more treatment options open. This is one of the reasons the American Association of Orthodontists (AAO) recommends an initial orthodontic examination around the age of 7. At this age, we can clearly detect that lateral incisors are not developing, and start to review options for the family involved. Lateral incisors usually erupt and replace the existing primary (baby) teeth at the age of 7-8 years old. If the laterals are missing, the baby teeth usually will remain and the missing laterals could go undetected by the family unless detected by the dentist or orthodontist. The upper canines, which are the third teeth from the center, will often erupt where the lateral incisors should be, and make the lateral baby teeth fall out. This is the age (usually 10-13 years old) where the problem will become visibly apparent.  Young teens have social and aesthetic concerns, as the pointy canines are in a place that they don’t belong, and are often accompanied by excess spacing.

When missing lateral incisors have been identified by your dentist or orthodontist, the decision of how to treat this issue can be quite complicated, and involves many factors including facial and skeletal structure, dental relationships, individual tooth morphology (shape and appearance), aesthetic preferences, the age of the patient and financial considerations. Because I see so many of these patients in my practice, the following is a basic guide to properly treat this condition.

There are two main treatment options for replacing these missing laterals:

1) Opening the space where the laterals should be (and moving the canines back to their proper location if they erupted too far forward) which will set things up for implants and crowns to be placed in the future.

  • Advantages of this option are: 1) All the teeth are left in their natural, ideal position in the mouth, with all their individual shapes and contours looking like they “belong” in that position. 2) Once the implants are placed, they are extremely durable and should last a lifetime. 3) Placing an implant leaves the surrounding teeth in their natural healthy state, as opposed to bridges that require greatly reducing the tooth structure of the two usually entirely healthy adjacent teeth (this option has largely fallen out of favor for this reason).
  • Relative disadvantages/considerations of the implant option: 1) After the braces are removed, the patient usually has several years of open spaces where the space was left for the future implant (I will explain the reason for this below). 2) Because there are spaces, a removable retainer or “flipper” with plastic teeth will be worn in public so it appears that there are teeth in these areas. Usually these need to be removed while eating. For some patients there are there are “fixed” options that are bonded in place to the adjacent teeth, but they are not as durable as the future permanent tooth replacements. 3) The longer there are missing teeth in an area, the more supporting bone (called the alveolar ridge) disappears. A bone graft is often needed in these areas to make sure that there is a sufficient thickness of bone under the gingiva (gums) to support and completely surround the implant. 4) This is usually a highly visible area, and it may be difficult to make the gingival area look really nice, especially if there has been a fair amount of bone loss in this area. It is truly an art form to get the gum contours to look natural around an implant site! 5) Of course, finances are a consideration, as having bone grafts, implants and crowns done properly will come with their respective fees.

2) The second option for missing lateral incisors in what is called canine substitution. This is where the orthodontist moves the canine into the missing laterals space.

  •  Advantages of this option are: 1) All the teeth in the mouth are natural, 2) At the end of braces, all the spaces are closed, and there is no time period waiting with open spaces in the mouth, 3) there is no need for large procedures such as implant placement or bone grafts after the braces are removed, and therefore the associated costs are usually less. 4) The finish of the gingival (gum) structure is usually more predictable.
  • Relative disadvantages of this option: 1) The upper canines are taller, wider, have a more convex surface, have a pointed tip, and are a darker shade than the lateral incisors. Therefore, these teeth need to be extensively reshaped in order to have the appearance of lateral incisors, and may need additional cosmetic procedures by your dentist to get the color and shape correct (bonding, veneers, or whitening). 2) Every upper tooth other than the two central incisors are technically not in the correct space, they are one full tooth forward of where they should be located. Often they will fit great in this position, sometimes they will not- your orthodontist will have a good idea if your teeth will fit together nicely with this option.

Having said the above, these factors are “all things being equal” comparisons. Facial structures, teeth, and the upper and lower jaws come in all variety of shapes, sizes and relative relationships to one another. These individual factors will also largely influence the decision as to which option to choose. For example:

  • If your bite is fitting ideally with little crowding, you have a great profile and lip structure and you are just missing two lateral incisors, you will likely be a great candidate for two implants.
  • If the shape of your canines would require too much tooth removal to have an acceptable appearance (or your first premolars are very short and will not look acceptable in the canine position), then you may lean towards the implant option.
  • If you have upper teeth that protrude forward of the lowers, or have considerable crowding of your lower teeth, you may be a better candidate for canine substitution.
  • If your upper and lower teeth are both tipped outwards too much (called biprotrusion), with or without lower crowding, you may be a candidate for canine substitution, along with extraction of two lower teeth.
  • If the upper canines have erupted into the missing incisor spaces, and all the premolars and molars behind the canines have drifted forward a large distance, it may be extremely difficult to move them back to make space for implants, especially as a late teen or older.

These are just a few of the different factors that we consider when helping patients decide what is best for their situation. The take home message is that there are multiple factors that go into deciding the best course of action when dealing with the issue of missing lateral incisors. Your orthodontist and dentist should work together to determine the best plan for your individual teeth, facial structure, and esthetic preferences.

 

 

Dr. Dan Rejman is a board certified orthodontist in Castle Rock, Colorado. He maintains two busy practices exclusively in Castle Rock.

How long will orthodontic treatment take?

There is no easy answer to the question “How long will I be in braces or invisalign?” Every patient has a unique bite, jaw structure, occlusion (how teeth fit together), and personal goals on how they would like their smile finished. After treating thousands of patients, I can can give a relatively accurate estimate of how long treatment will take IF the patient is consistently excellent with compliance (how well they wear rubber bands, maintaining excellent oral hygiene, etc…). In the article below, I will discuss what influences how long orthodontic treatment will take.

1. Patients treated with braces and clear aligners in my practice have had treatment times ranging from one month to several years in length. IN GENERAL the most very minor cases take 6-12 months, “average” teen and adult cases are about 14-24 months, and more difficult cases involving severe malocclusions or a combination of orthodontics and orthognathic surgery can take over 24 months.

2. The above time frames are EXTREMELY influenced by the patient’s compliance with what the orthodontist asks them to do in addition to just being in braces or invisalign. One example is if the patient is asked to wear elastics (rubber bands). I usually instruct my patients to wear them 22-23 hours a day, which gives them time to brush their teeth, eat, or practice instruments or sports. If the patient wears the elastics 18 hours a day on average, this could delay treatment by 6, 9, or 12 months (or more), depending on individual biological variation. If they wear elastics only 12 hours a day, the delay will be even greater, to the point that no progress may be made after a certain point. We are in constant communication with our patients about this, and coaching and encouraging is a large part of our job.

3. If you have been given an estimate of 18-22 months for your orthodontic treatment, and if you are consistently compliant with elastics, the majority of patents will finish within this time frame… but some WILL NOT, even if they are doing the exact same treatment, with the exact same elastic compliance. Why? The human body is incredibly complex, and biologic variation with bone density, enzymes, genetic factors, etc… all vary from person to person. This may make treatment proceed faster, or it may make treatment take a bit longer!

4. A quality orthodontist will want to end treatment when your teeth are in their most ideal aesthetic, healthy, and stable position, not when a certain date is reached on a calendar. For me, many patients are thrilled that this occurs before the estimate, most are within the estimated range, while others are understandably disappointed that their treatment takes a bit longer than expected. This is part of being an individual human being! Orthodontic treatment is not like building something mechanical on an assembly line.

5. The take away message is, when your orthodontist gives an estimate of how long your treatment will take, it is an estimate and can vary significantly from patient to patient…some on the fast side, and some on the slower side. We are trying to be efficient and move things along as fast as possible! Do your part with wearing elastics 22-23 hours a day, and you are moving at your own personal maximum speed (which will vary from your friend’s and classmate’s maximum speed!).

 

Dr. Dan Rejman practices orthodontics exclusively in his two practices in Castle Rock, Colorado. He is a board certified specialist by the American Board of Orthodontics