The Art and Science of Dentofacial Orthopedics

The field of dentistry has many spheres, including general dentistry, cosmetic and restorative dentistry, with approaches both minimally invasive to full maxillofacial surgery. There is one sub-field that requires quite of a bit of training and is truly unique in its ability to help prevent some of dentistry’s biggest challenges. We are referring to dentofacial orthopedics.

Dentofacial Orthopedics Defined

While this is not a term often heard out and about–it is very important work. Dentists working in this sphere focus on helping to guide the growth of properly sized and shaped jaws and correctly spaced teeth as they emerge into the gumline. Parents who wish to have their children assessed for future orthodontic problems must bring them along to a consultation, while the doctor evaluates whether the shape and size of the skull/jawline and current teeth eruption pattern indicates the need for special appliances.

Headgear and TADs

These are usually headgear or expanders. The headgear is perhaps the most dreaded of the orthodontic appliances, but also one of the most useful for healthy dental formation in the future.

The reason for headgear is that sometimes extra anchorage is needed to really pull the teeth into the position they need to go than can be gathered from the force of other teeth in the mouth. Then, the entire head or jaw may be used to anchor the appliance. This makes it very effective, when the shape of the facial structure is being moulded into the proper shape for good tooth emergence.

These appliances need not disrupt a patient’s life either, as the external devices only require to be worn for twelve hours per day. Now, there are also temporary anchorage devices (TADs) available, which are basically very small screws installed into the jaw to produce the anchorage effect with minimal visual impact.

Palatal Expanders

Palatal expanders are devices worn inside the top jaw, most usually, to expand a too-narrow skeletal structure that often leads to teeth overcrowding or an incorrect bite between the maxilla and mandible.

There are various types of expansion schedules. The rapid expansion has the dentofacial orthopedic specialist put in the device, which has a key or screw at the center that kicks up the expansion/stretching process when necessary. Then, the patient is told to turn the screw every day resulting in a 1/2mm to 1mm expansion each time until the desired expansion is achieved. The expander is kept in for several months after the initial stretching period, to allow this change to become permanent. A less accelerated plan allows the patient to achieve a change of 1mm expansion every week for a period of 8-11 weeks. This allows the expansion to be more cemented into the skeletal structure of the jaw and not to just be a change strictly in the teeth. There are also implant-assisted and surgical expansion plans available, but those are rarely necessary unless the case is severe or the patient is outside their growth spurt window.

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