Early Treatment

Seek treatment earlier than age 7 if your child has:

Difficulty chewing
Open-mouth breathing
Thumb or finger sucking
Overlapping or crowding of erupting permanent teeth
Jaws that click or pop
Biting of the cheek or into the roof of the mouth
Speech problems
Grinding or wearing down of teeth
Obvious abnormal bite development of any kind

Adolescent Treatment

Most permanent teeth erupt around age 12 or 13, including what are called 12-year molars. This is when full orthodontic treatment for adolescents usually starts. Duration of full treatment can be anywhere from 18 to 36 months. 24 months is common. Treatment time depends on many factors such as the difficulty of the case, patient compliance, hygiene, and so forth.

The braces we use are the newest technology. They are "self-ligating" which means they do not need to be tied in with elastic ties. Instead, they have a little clip that snaps into place. In the early stages of treatment this reduces friction, which allows teeth to move faster with minimal force and discomfort. Clear brackets are also available. We also have an option of digital treatment with Insignia. We use Insignia software to personally design each patient's smile for precise, comfortable tooth movement.

Adult Treatment

Crowded teeth and a "bad bite" can contribute to gum and bone loss, tooth decay, abnormal wear, headaches and jaw joint (TMJ/TMD) pain. Many orthodontic problems can be corrected as easily and as well for adults as children. Orthodontic forces move the teeth in the same way for both a 75-year-old adult and a 12-year-old child. Some factors, such as lack of jaw growth, may create special treatment planning needs for the adult. Orthodontic treatment in adults can restore good function, increasing the health of the teeth, gums and jaw joint while improving personal appearance and self-esteem, no matter the age.

The new techniques and appliances we use greatly reduce discomfort levels, decrease the frequency of visits, and shorten treatment time. Your options may include metal braces, ceramic (tooth colored) braces, lingual braces (Incognito) or clear aligners (Invisalign) that can be worn to improve mild cases of misaligned teeth. We also can provide clear aligners as a service to our patients. This technique is basically a series of computer generated, clear, trays that fit over the teeth. The patient wears the trays ("aligners") full time except to eat, and changes them approximately every two weeks. Each tray moves the teeth a small amount. The teeth are aligned in a stepwise process.

TMJ Dysfunction

Headaches, facial or neck pain can be a sign of Temporomandibular Joint Dysfunction or TMJ. Other symptoms include muscle pain, limitation of jaw movements, tooth wear, receding gums, notching of the teeth at the gum line, and adverse bony changes within the joint. TMJ dysfunction can be caused by disharmony between teeth and jaws. Treatment can reduce or eliminate the possibility of further damage. When a patient shows signs or symptoms of TMJ dysfunction additional records may be ordered for a complete diagnosis, such X-rays or a CT scan. Treatment for TMJ dysfunction usually involves splint therapy. The splint is a very effective appliance that is custom made for each individual. The splint is adjusted as needed to reduce painful symptoms and stabilize the entire chewing system.

Orthognathic surgery

The upper and lower jaws are the bases upon which the teeth are aligned. When the jaws are too short or long, or too wide or narrow, the proper bite often cannot be achieved with braces alone. The orthodontist together with an oral surgeon formulates a combined treatment plan. In some severe cases orthodontics and orthognathic surgery may be the only treatment option.

Bioesthetic Orthodontics

Often times patients have teeth that in addition to being misaligned are not the proper shape and form. Although the teeth can be orthodontically straightened, proper function is unachievable due to inadequate tooth form. Proper form can be reestablished with restorative dentistry followed by orthodontic treatment. Teeth with the proper form are not only more beautiful, but function together better. Bioesthetic orthodontics is based on a combination of biologic form and functional occlusion goals.

Expansion Therapy

We are all naturally nose breathers, so if you breathe mostly out of your mouth it is important to determine the underlying cause. Mouth breathing may be caused by a deviated septum, nasal and sinus inflammation or allergies, enlarged tonsils or adenoids, asthma, a narrow palate, or low tongue posture. Mouth breathing is associated with poor sleep quality, snoring, reduced cognitive function, and problems focusing. Mouth breathers often have dry or cracked lips, bad breath, dry mouth, increased risk of cavities, crowded teeth, slouched posture, and shadows or bags under the eyes. In growing children, mouth breathing changes the craniofacial development pattern and can have a permanent effect on skeletal growth of the face. 

When we breathe through our noses, we are warming, humidifying, and moisturizing the air. This prevents the drying out of our sensitive nasal tissue. There are also tiny filters in the nasal passages that clear out debris, bacteria and viruses, and potential allergens. Nose breathing is also important to craniofacial development. Proper function of facial muscle and bones in growing children allows for good airway, jaw, and dental development.

Palatal expansion increases the width of the floor of the nose, decreasing nasal airway resistance and often improving nasal breathing. Many patients also benefit from Myofunctional therapy to train the tongue posture into its proper position on the roof of the mouth. Depending on the skeletal discrepancy further treatment may be warranted to alter jaw position and improve breathing. An interdisciplinary approach is implemented in airway cases to ensure all underlying causes are addressed by the appropriate specialist. 

Benefits

Expansion of the upper jaw is a common method for widening the roof of the mouth as indicated in children, teens, and adults. Dental crossbites, a high arching palate, or crowding of the upper teeth may necessitate this treatment. Expansion is highly effective, non-invasive, and well-tolerated by patients. It improves nasal air flow, stabilizes asymmetric TMJ loading, and improves aesthetics in patients with maxillary constriction. Teeth can be ideally aligned with expansion of the arch form, preventing unnecessary extractions, gum recession, or stress loading on teeth.

Child Expansion

How it works

Expansion in children under 12 years of age is referred to a “Rapid Palatal Expansion”, or RPE. It is accomplished while the elastic membrane in the center of the upper jaw (mid-palatal suture) is still patent. Expansion is accomplished by attaching an appliance directly to the upper molar teeth and activating the appliance daily or a few times a week, as instructed. The activation induces stretching of the mid-palatal suture, followed by bone formation to stabilize its new shape.

How long will treatment take?

The upper arch is usually sufficiently expanded in 30-40 days, after which the appliance will be “locked” and held in place for approximately 6 months to allow for hardening of the new bone. It is normal to see a space develop between the upper front teeth while expanding, and this will close naturally over time. Your upper arch expansion treatment may be offered concurrently with lower arch treatment to upright constricted lower teeth, using aligners, braces, or another appliance, where appropriate.

Is it uncomfortable?

A pressure or tingling sensation may be felt along the base of the nose or the upper teeth during the first few days of treatment. Any soreness should subside within 3-7 days. Avoiding crunchy or hard foods and opting for softer food will help with adjusting to the appliance.

Teen Expansion

How it works

After the age of 12, the elastic membrane in the center of the upper jaw (mid-palatal suture) begins to harden and is less malleable to traditional expansion. To overcome this, bone-borne expanders are the preferable treatment option to minimize side effects like too much force applied to the upper molars. The teen expansion appliance looks similar to the children’s RPE appliance, with the addition of a bone-anchored system to transfer activation directly to the upper jaw instead of through the teeth.\

The Procedure

We will send you to a periodontist (gum specialist) to place 2 special mini-pins on the palate under local anesthesia. Then you will return to our office for a 3D digital scan of your teeth on which we design your custom appliance. At the next visit, we will deliver your appliance so that it fits onto the mini-pins, and you will start activating it at home 2-3 times a week, or as instructed.

How long will treatment take?

Expansion in teens is often utilized as an adjunct therapy to comprehensive orthodontic treatment. Upper arch expansion will be done in conjunction with braces or aligner treatment, the total time of which usually takes 18-24 months, depending on complexity of your case.

Maxillary Skeletal Expansion (MSE)

Innovative Technology

Maxillary Skeletal Expansion (MSE) emerged with the advent of orthodontic mini-implants, also known as Temporary Anchorage Devices (TADs). Its creator is Dr. Won Moon of UCLA, who began developing the technique in 2004. MSE allows for orthopedic expansion of the maxilla beyond age 12. The novel technique for nonsurgical expansion of the constricted upper jaw can be completed in the orthodontic chair with only local anaesthesia. Digital intraoral scanning and 3D Cone-Beam CTs make MSE the most accurate and efficient way to expand the maxilla in adults.

The Procedure

You will have an orthodontic records appointment where photos, 3D CBCT, and digital study models are obtained. Advanced technology for 3D integration of the CBCT and intraoral scans allows the laboratory to develop a custom appliance with mini-implants of ideal length for the palatal bone. The procedure typically lasts about 30 minutes as the expander and mini-implants are inserted on the palate under local anesthesia. You will begin activation of the expander until sufficient width is obtained (usually 4-8 weeks), and you are ready to proceed with comprehensive orthodontic treatment using braces or aligners.

Is it uncomfortable?

Soreness may be felt by some patients along the base of the nose, the upper jaw, or the upper teeth during the first few days of treatment. Any soreness should subside within 3-7 days. Discomfort can be managed with over-the-counter pain medication. The adjustment period for your gums and cheeks is also under a week, during which time salt water rinses are recommended to reduce any irritation.

Corticotomy and Surgically-Facilitated Orthodontic Therapy (SFOT)

How it works

Corticotomy was first used in orthodontics to shorten treatment time, and has now been enhanced as a method for bone density improvement and an alternative to jaw surgery in some patients. The procedure is a minimally-invasive surgery usually performed under sedation. After orthodontic treatment commences with braces or aligners, you will be referred to an oral surgeon who will create small, shallow holes in the jaw bone along the emergence profile of the teeth. This stimulates more rapid tooth movement as the bone undergoes its healing metabolism, allowing for orthodontic treatment to proceed at up to 2X the usual speed. In younger patients, extra bone formation may occur which can help thicken thin bone in areas where teeth were poorly supported. This is an excellent treatment solution to periodontal problems such as gum recession. In older patients, surgically-facilitated orthodontic therapy (SFOT) may be employed. This therapy involves the same corticotomy procedure, but with the added benefit of bone grafts placed concurrently to improve thickness of the bone in any areas of concern.

Benefits

Corticotomy or SFOT is indicated in patients who have complex or lengthy orthodontic treatment such as tipped in molars, impacted teeth, severe crowding or spacing, or periodontal problems. In some cases, corticotomy is a suitable alternative to orthognathic (jaw) surgery. Corticotomy may also improve the stability of orthodontic treatment results, and can achieve an improve orthodontic result in less time.

Is it uncomfortable?

Corticotomy and SFOT is a minor surgical procedure, usually completed in under an hour and with minimal risk of complications. There is modest swelling and soreness to be expected in the first 4-7 days following the procedure, and any irritation is managed with a special mouth rinse prescribed by the oral surgeon. For reference, the swelling and discomfort is expected to be far less than that experienced after wisdom tooth extraction, and recovery is quicker and simpler.

Herbst

How it works

The Herbst is a fixed (cemented) “functional” appliance that works in children and young teenagers to direct the upper and lower jaws into their ideal positions. It is indicated in patients who have a larger upper jaw and smaller lower jaw, resulting in the appearance of a small or retruded chin. This is also known in orthodontics as a “Class II” skeletal appearance. The appliance is attached onto the upper and lower molars and consists of small free-gliding pistons that direct the lower jaw into a forward bite, simulating its final position. As the patient grows, the lower jaw adapts to this position and stabilizes in this bite. The Herbst appliance is used before or during orthodontic treatment with braces or aligners, and is part of a comprehensive orthodontic treatment plan.

Benefits

The Herbst appliance improves both the bite and facial profile of patients with a small, set-back chin and lower jaw. It also has shown to improve airway and stop mouth breathing habits in those patients and the lower jaw is brought forward into its ideal position. In some severe cases, proper use of the Herbst appliance while the patient is still growing will avoid the need for surgical jaw advancement. Modern Herbst appliances are small and low-profile, comfortable and well-tolerated by patients, and are used for approximately one year to optimize results.

SureSmile Technology

Digital Treatment Planning

Aligners

Custom Wires