I have previous blog entries about the difficulty of treating underbites, which can be the result of the upper jaw (maxilla) not growing enough, the lower jaw growing too much, or a combination of both. It is vital that underbites be identified as early as possible, as successful treatment of this type of bite is often largely dependent on a patients age. We are often trying to eliminate the need for a surgical correction later in life by identifying the problem and treating it appropriately at the correct age. For decades, the standard of care for treating underbites was the use of a facemask, or reverse pull headgear. Most studies have shown that the most successful results occur when treatment is started before the ages of 8 or nine (with the exception of severe cases, which should be identified early as needing surgical intervention at a later age). Some problems with this treatment option are: 1) If the child is brought in for an exam at a later age, say 12-14 years old, often a window for successful treatment may have been missed. 2) There are issues with children being compliant with wearing the facemask appliance (even if only at night), as there are obvious social concerns, and comfort issues. 3) Due to these social concerns, the realistic hours of using this appliance outside of school hours is inherently limited. 4) The appliance is removable, and can be removed easily even if parents check that it is being worn when they take a look at bedtime.
Recently, devices called miniplates have started to be used as an alternative to facemask therapy. Miniplates are biocompatable, titanium attachments that can be fixed to the upper or lower jaws. An oral surgeon uses very small screws to attach the miniplates to the upper and back areas of the upper jaw (usually at the zygomatic butress), and also to the more forward area of the lower jaw. Of course, this occurs under anesthesia, and this is a relatively non-invasive out patient visit. The orthodontist can then attach elastic rubber bands from the upper miniplate to the lower miniplate. Advantages of this treatment option, as contrasted to facemask treatment, include: 1) Research is supporting the idea that miniplate treatment is ideally started at a later age (around the age of 11-14) than facemask therapy, when the density of the maxillary bone has increased. 2) The social stigma is reduced, as the mini plates are located intraorally, and are quite small as they emerge from the gum tissue. 3) Due to the applaince being located entirely in the mouth, elastics can be worn 24 hours without concern about them being noticeable or looking “out of place”. 4) The miniplates are semi-permanantly fixed until they are removed by the oral surgeon. Largely due to these reasons, recently published research is showing impressive results using this method vs. traditional facemask treatment. In summary, orthodontists have another great option to help achieve more successful cases, and to reduce the number of surgeries needed to treat these cases.
There are some obvious downsides to using this technology that must be considered. Miniplates require two visits to the oral surgeon; one for having them placed, then another for removal after orthodontic treatment is complete. There is also the additional asscoiated cost of having an oral surgeon perform these procedures. As with any treatment, dental or medical, the advantages must be weighed against disadvantages, and risk vs. reward. I have been having these conversations with families of children with underbites, and each conversation is as unique as the child’s unique facial structure. Please g ive me a call if you have any questions regarding underbites, and we will determine if miniplates are an appropriate option for your family member.
Dr. Dan Rejman is the owner of Meadows Orthodontics in castle Rock, Colorado. He is Board Certified by the Amerivcan Board of Orthodontics.