When the problem is that the top teeth stick out too far, causing the protrusive position, which is often accompanied by the lower lip being trapped under the upper front teeth and a visible “sucking in” of the lips during swallowing.
A common approach can involve the wearing of a traction device (headgear); the strategy is to move the upper teeth farther back on the upper jaw, putting them in a more favorable position with the lower teeth.
Often patients exhibiting this condition have a narrow, constricted upper jaw. When the upper jaw is widened to an appropriate width, space is provided for better alignment; and a natural “rounding out” will allow for the upper teeth settle back.
The removal of some of the upper teeth might be necessary.
When the problem is that the upper jaw sticks out too far, causing the protrusive position, which is also often accompanied by the lower lip being trapped under the upper front teeth and a visible “sucking in” of the lips during swallowing.
A common approach can involve the wearing of a traction device (headgear); the strategy is to slow the forward growth of the upper jaw and move the upper teeth farther backward.
Again, patients exhibiting a protruded upper jaw will often have a narrow, constricted upper jaw. Profound widening can increase the volume available for the tongue, improving the potential for a more normalized growth of the upper jaw.
If bringing the upper jaw backward with traction is not adequate the removal of some of the upper teeth becomes even more necessary. Surgery might even become a necessary option.
When the problem is that the lower jaw is under-developed, causing a retruded position of the lower lip, which is often accompanied by a convex profile; the patient looks better from the side when he or she holds their lower jaw forward. Again, lower lip trapping is a frequent accompanying phenomenon.
When the problem is detected early enough, many orthodontists will apply “functional” appliances in hopes that the lower jaw will grow more favorably than might be expected by normal growth. While studies results are controversial, excellent cooperation has blessed many children with profound improvements.
Historically, the application of traction (headgears and other devices) and extractions have tended to aid in bringing the upper teeth backward in order to correct this problem, and facial needs are not always met.
If there is little growth to work with, bringing the lower jaw forward with surgery has provided the best results. More recently, implanted temporary traction devices have been used to correct this condition.
The problem can be that the lower teeth are set back on the lower jaw, usually causing a rolling inward of the lower lip and an extreme vertical over-lapping of the upper and lower front teeth.
When the problem is detected early enough, many orthodontists will apply “functional” appliances that will be designed to push the lower anterior teeth forward during growth. Usually, the rest of the teeth will also migrate forward, helping to improve the fit between the upper and lower teeth.
This condition is usually treated using braces. In combination with other anchorage devices, the lower teeth can be pulled more forward into positions of fit.
More recently, temporary traction implants are being used with great success to bring the lower teeth more forward.
Finally, the problem could be that there is a combination of factors: upper teeth too far forward, upper jaw too far forward, lower teeth too far back on the lower jaw or a short lower jaw. Another possibility might be that one of these aspects has developed in an exaggerated manner vertically; this would cause the various components to rotate downward and backward, creating an anterior-posterior non-fit for the teeth.
Depending upon the severity of the various components, a combination of treatment options might be employed, primarily aiming at bringing the lower teeth forward enough and the upper teeth back enough so that the teeth will meet in a functional and stable way.
This might require any or all of the options presented earlier in this column. The best chances are provided by bringing such complicated cases to the orthodontist as soon as they are recognized. Timing, timing, timing!
Any of these conditions may exceed the limitations of orthodontics alone. In this case your orthodontist will work with an oral surgeon and/or a team of maxillofacial practitioners: family dentists, prosthodontists, periodontists, endodontists, plastic surgeons, and ear, nose and throat specialists.