Missing
teeth and their replacements
Teeth are missing due to two factors: they
are either congenitally missing or have been extracted.
During orthodontic treatment, if a front tooth
is missing we will strive to provide a temporary
replacement. Once enough space has been opened
for the false tooth (called a pontic), the following
occurs:
1)An impression
is taken and model is sent to the lab and a shade
is chosen
2) The lab makes a special
tooth for the area where the tooth is missing
3) We deliver the tooth,
glue a brace on the tooth and tie it to the wire
attached to the braces as well as the adjacent
tooth
The pontic is only for aesthetics. You cannot
bite or chew with it. It has no root for stability. |
 The
patient has to be careful with this tooth and
not get in the habit of pushing it with the tongue.
If this tooth is not stable, an appliance called
a flipper may be suggested. This is a removable
retainer-like appliance with a tooth on it.
As
braces move the teeth, additional pontics or flippers
may be needed. If so, additional lab costs are
generated and there will be additional fees. Also,
the bone in this area recontours and changes in
shape. This change may necessitate a new pontic.
Do
not expect the pontic to feel like a natural tooth.
It is only a tooth for "looks" and must
be cared for gently. After braces come off, a
more permanent replacement for the missing tooth
will be needed - like a bridge or implant. Your
general dentisit will do these. |
|
Cuspids
(or eye teeth) sometimes do not come down out
of the palate. These are considered Impacted.
If
the cuspid root is in a favorable position, we
try to bring it in. Frequently, the oral surgeon
has to surgically expose these teeth for us. The
process is:
1)
Place your braces
2) open a space for the impacted cuspid with braces
3) when in a strong wire, in your braces, we send
you to the oral surgeon for exposure of the cuspid
and the attachment of a button with a chain to
the impacted eye tooth;
4) oral surgeon attaches the button and chain
to braces with elastic thread
5) as we see you for subsequent braces adjustments,
we re-tie the elastic thread to attempt to bring
the cuspid down, into place.
Impacted
cuspids are very unpredictable. The amount of |
time it takes to bring them in is very difficult
to determine. Some possible pit falls of impacted
cuspids include:
1)
slow to come in
2) may be ankylosed (fused to the bone) and not
be movable
3) may be discolored
4) gum tissue may be high over impacted
cuspid, bone loss may occur around tooth
5) may be mobile (loose)
6) may devitalize (nerve may die) and need root
canal
7) may tend to spring up back toward the gum due
to strong ligament pull
8) may not be salvageable and we have to extract
Luckily
most of the time the issues listed above do not
arise. However, they are more likely with  an
impacted cuspid than a non-impacted tooth.
Treatment
time in braces with an impacted cuspid is very
hard to predict, because we can not tell exactly
when the cuspid will erupt and grow in. In extemely
rare cases, a second exposure surgery is needed
to remove scar tissue around the crown. |
|
 About
30% of the population retains a tongue thrust
habit past infancy. Virtually all infants swallow
with a tongue thrust(meaning to place the tongue
forward in the mouth to swallow). We feel this
is due to the fact that there are no teeth and
to eat or drink without losing the food out of
the mouth, the toongue must come forward to keep
it in. As growth and development occurs, most
children re-accomodate and the tongue is positioned
higher in the palate (behind the teeth) and does
not push against the front of the mouth.
For
those whose tongue thrust remains, long-term dental
and skeletal discrepancies (such as an open bite)
can occur that are increasingly difficult to correct.
Therefore, we attempt to assist our patients to
re-learn where to place the tongue. If the open
bite and attendant tongue thrust is due to mouthbreathing,
a referral to the ontolaryngologist (ENT) may
be necessary to check for nasal blockage or enlarged
tonsils or adenoids.
We
also may recommend placement of a fixed appliance
(called a "Tongue Thrust Appliance"
or TTA) in the patient's mouth to remind the tongue
of its desired position.
|
A
referral to a speech pathologist may be needed
to re-train the swallowing pattern.
Some
simple exercises may assist in this process, too.
·
No liquid should be taken when eating solid foods.
{Don't "wash your food down."} This
forces the tongue to push the food down the throat
rather than the liquid washing it down.
·
"Click" - Place tip of tongue in top
of palate, press and then bring it forcefully
down to make a click sound. Repeat as often in
the day as possible.
·
"Slurp" - After practicing the "click",
place your tongue in the same high palatal position
as if to "click", but instead, suck
in air. This pulls the tongue back. Now while
pressing the tongue against  the
palate, swallow without allowing your tongue to
thrust forward. After you can easily "click",
repeat "slurping" as often in the day
as possible.
·
"Squeeze" - While swallowing, tighten
your jaw muscles and force teeth together as strongly
as possible. |
|
 In
a large percentage of cases, wisdom teeth remain
impacted, trapped beneath the gum and bone and
against the teeth in front of them. They may partially
erupt because the jaw can be crowded by other
permanent teeth. The partially erupted teeth may
tilt sideways and may cause damage to adjacent
teeth.
Because
they are so far back in the mouth, wisdom teeth
often are not needed for chewing and they are
difficult to keep clean. Your dentist may recommend
the early removal of impacted wisdom teeth to
prevent against the potential complications of
the following:
· The wisdom tooth partially
erupts through the gum. This creates an opening
where bacteria may enter and cause infection.
Pain, swelling and jaw stiffness may result.
·
The impacted wisdom tooth may continue growing
without having enough room, which may damage adjacent
teeth.
·
A fluid-filled sac (cyst) or tumor may form on
or near the impacted tooth, destroying surrounding
bone or tooth roots. |
As
your orthodontist, we will have a final set of
x-rays taken after your braces are removed to
check the status of your wisdom teeth. Dr. Long
will advise you as to when they should be evaluated
for removal.
If bite problems are created because the jaws
do not align properly, "just braces"
cannot correct the problem. This is when both
braces and jaw surgery are needed.
A
team approach by the orthodontist and oral surgeon
occurs in this type of a treatment plan.
If
it is determined that you need jaw surgery, you
will go into braces first to align and straighten
the teeth and prepare for the jaw surgery. This
takes 12-18 months.  Then
the surgery is done and following that the orthodontics
is completed. You are in braces 2-2 1/2 years generally. |
