6. What is a space maintainer? In addition to biting and chewing, primary (baby) teeth are very important because they hold space for the permanent teeth. When a primary (baby) tooth is lost prematurely, an orthodontic space maintainer is placed in the mouth to hold the space necessary for the permanent teeth that will come in later.

7. How can a child's growth affect orthodontic treatment?

Orthodontic treatment and a child's growth can often complement one another. Studies show that orthodontic treatment during periods of accelerated or intensive growth can contribute significantly to correction of teeth and jaw problems and improvement of facial appearance.

Occasionally, a person who has grown normally and in average proportion may not continue to grow favorably. It is not uncommon for some patients to experience multiple growth spurts, some later in life than usual.

If growth becomes disproportionate, the jaw positions can be affected, and the original treatment objectives may have to be re-evaluated or compromised. Dr. Shih will closely monitor your child's growth and development and inform you of any concerns as they may arise.


 

The process of dentofacial orthopedics allows Dr. Shih to correct jaw growth problems. This is often referred to as growth modification. The decision about which appliance to use for jaw growth modification is based on the individual problem. Usually, one of several appliances can be used effectively to treat a given problem. For the majority of appliances, patient cooperation is the critical element in determining the success of dentofacial orthopedic treatment. If your child would benefit from this kind of treatment, Dr. Shih will be happy to discuss with you which option is best for your child.

Some of the more common orthopedic appliances used by orthodontists today that help the upper and lower jaws become more compatible include:

 

Expander: A child's upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth, creating a crossbite. When this occurs, a palatal or lower lingual expansion appliance can be placed on the upper back teeth. This appliance can markedly expand the width of the upper jaw to make a broader, more attractive smile.

Activators: These removable appliances hold the lower jaw in a forward position to guide tooth eruption into a more desirable bite while helping the upper and lower jaws grow in proportion with each other. Patient cooperation in wearing this appliance is essential for successful improvement. There are many removable appliances used by contemporary orthodontists to treat underdeveloped lower jaws. They include the Twin-Block, Bionator, and Frankel, to name a few.

Herbst Appliance: For patients who have an underdeveloped lower jaw, it is important to begin orthodontic treatment several years before the lower jaw finishes growth. One method of attempting to correct an underdeveloped lower jaw uses an orthopedic appliance to reposition the lower jaw. Like activators, the Herbst appliance influences the jaw muscles to work in a way that may improve forward development of the lower jaw. One potential benefit of the Herbst appliance is that it is bonded to the teeth during treatment so patient compliance is assured.

Headgear: This appliance has been used for years in respected specialty orthodontic offices across the country. Headgear applies selective pressure to the upper teeth and upper jaw to guide the rate and direction of upper jaw growth and upper tooth eruption. The headgear may be removed by the patient and is usually worn only at night.

In some cases, Dr. Shih will recommend patient to go for corrective Orthognathic surgery treatment or other cosmetic procedures to achieve the desired result.

9. Why does orthodontic treatment sometimes last longer than anticipated?

Each patient is a unique individual and estimates of treatment time can only be that- estimates. Patients grow, mature, and get their permanent teeth at different rates and will respond in their own individual ways to orthodontic treatment. Rest assured that Dr. Shih has specific treatment goals and objectives in mind and is dedicated to continue treatment until they are achieved. The estimated time of treatment is usually very close to the actual treatment time.

The length of treatment largely depends on the severity of the initial problem, the patient's growth pattern, and the level of patient cooperation. Patient cooperation is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands or other needed appliances as directed, while taking care not to damage braces will most often lead to on-time and excellent treatment results. However, treatment can be lengthened if growth occurs differently than expected or if the patient's cooperation is less than ideal. Inability to keep appointments, excessive tardiness, poor appliance wear, and excessive breakage can all extend treatment time.

10. What are retainers?

When your braces are removed, you will need to wear a device called a "retainer" to hold your teeth in their new position. You will wear your retainer for as long as it takes your teeth to settle into their new position and for your jawbones and muscles to adapt to your new dental arrangement. This is called the "retention" phase of treatment. Dr. Shih may also evaluate your wisdom teeth during this phase of treatment.

Retainers are just as important as braces in the overall treatment plan. There are different types of retainers, and Dr. Shih will choose the right one that is perfect for you.

Warning! Pets love to eat retainers! Please take good care of your retainers and wear them as instructed. When not in your mouth, make sure to store them in a safe place. Be careful not to place your retainers on lunch trays or wrap them in napkins because you might throw them out by mistake.

11. Why are retainers needed after orthodontic treatment?

Retainers are extremely important after orthodontic treatment. Studies have shown that if retainers are not worn faithfully, teeth have a tendency to return to their original position after orthodontic treatment. This is called relapse. The more severe the original bite, the greater the tendency toward relapse. Periodontal (bone and gum) disease, mouth breathing, and harmful tongue or oral habits can also cause teeth to move.

To prevent relapse, retainers are worn after braces are removed to support and hold the teeth and jaws in their newly corrected position. Retainers provide the stabilization until the bones and gums adapt to treatment changes. If teeth are to remain in their ideal position, your cooperation is essential. Wearing retainers exactly as instructed is the best insurance that the treatment improvements will last a lifetime.
 

12. Will my child's tooth alignment change later?

Studies have shown that as people age, their teeth have a tendency to shift. This variable pattern of gradual shifting, called maturity changes, probably slows down after the early twenties, but still continues to a small degree throughout life for most people. Even children whose teeth developed into an ideal alignment without orthodontic treatment may develop problems as adults.

The most common maturity change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction. Beyond the period of full-time retainer wear, nighttime retainer wear can prevent maturational shifting of the teeth. We will be recommending special retainers and periods of retainer wear specific to your case. Make sure you keep appointments for retention checks and retainer adjustments as scheduled.

 

13. Why do teeth sometimes need to be removed?

On occasion, selective removal of primary (baby) teeth may alleviate future crowding by allowing permanent teeth to erupt in a more desirable location and in the correct order. Sometimes, particularly in cases of severe crowding, permanent teeth may need to be removed as part of your orthodontic treatment. Tooth removal will be recommended only if it is absolutely necessary and would improve your prospects for successful orthodontic treatment.

 

14. What is an ankylosed tooth?

In some instances, a tooth will not move at all because it is improperly attached to the jawbone. This condition is called ankylosis (pronounced ankle-o-sis). Occasionally, an ankylosed tooth may require a minor surgical procedure by your general (family) dentist or specialist to allow Dr. Shih to attempt to move it to the correct position. Sometimes, ankylosed teeth may even have to be removed.

 

15. What is an impacted tooth?

Teeth are impacted when they remain partially or completely under the gum tissue instead of coming into the mouth, as they should. While impaction usually occurs when teeth are very crowded, it can also happen for no apparent reason. Dr. Shih will explain all available treatment options if this situation applies to your child.
 

16. Should the wisdom teeth (third molars) be removed?

The most common impacted teeth are the upper and lower third molars, also known as the wisdom teeth. These teeth may not grow into place properly because the jawbone does not have sufficient room to accommodate them. In effect, they get stuck, or trapped, below the gums.

Careful studies have shown, however, that wisdom teeth do not cause or contribute to the progressive crowding of lower incisor teeth that can develop in the late teen years and beyond.

Dr. Shih will carefully review each situation and at times, may recommend that your wisdom teeth be removed. If extraction is indicated, it will usually be recommended when a person reaches mid to late teen years.