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Integrative Orthodontics

Orthodontics and Craniofacial Orthopedics

Orthodontics is that branch of dentistry that focuses on the "healthy" alignment of teeth so that the invdividual may achieve the most esthetic and functional alignment possible. Historically, the father of modern Orthodontics was Edward Angle, who was a very accomplished dentist in the late nineteenth century. Dr. Angle's main focus at the time was in the area of occlusal reconstruction. He helped patients who had lost, most if not all, their teeth return to proper function and esthetics using crowns, bridges and removable dentures. From his experience with patients who were missing their teeth, he developed sound occlusal principles and techniques to move crowded, misaligned teeth into a proper, functional occlusion (see Functional Occlusion). At the same time, he realized that not only was this the best position for the patient's teeth, but it was also the most esthetic. The methodology used today at Groton Dental Wellness is based on these tried and true principles.

Advances in the orthodontic field have been astounding over the years. Traditionally, in this 100 year old specialty, orthodontics was performed only on the mature (fully grown, complete permanent or adult) dentition. However, 30-40 years ago orthodontic researchers began to sturdy growth and development of the face in an attempt to correct poor growth trends that would otherwise make treatment of the fully developed individual more difficult. This new branch of this specialty was referred to as Craniofacial Orthopedics or Interceptive Orthodontics. It's guiding philosophy was that as long as the patient was able to receive care, interception of poor growth trends would allow for a redirection of facial growth and a greater chance that the full genetic potential for facial/dental form and function could be attained. Therapy on two 10 year old children under the precise conditions was possible. This allowed the patient to avoid less than ideal, aggressive orthodontic procedures that would have been previously performed during the teen years and with a less than optimal outcome.

Diagnosis of poor growth patterns and the identification of their root causes was the focus of researchers at the University of Michigan in the mid 70's. They recognized and evaluated poor growth patterns, early oral habits (finger/thumb sucking, overuse of pacifiers) and the inability to breathe through the nose (chornic nasal airway obstruction, see Nasal Breathing) for the impact they had on facial growth and maturity. In lab experiements they simulated chronic nasal obstruction and discovered that there was a profound effect on the growth of the face and jaw. They concluded that the environmental impact on the growing face was extremely significant. In the light of these discoveries we now pay close attention to any factor that may contribute to the inability to breathe and this in turn results in a directional change in facial form to the genetically programmed potential.

At Groton Dental Wellness we work hard to identify the causes of these growth alterations, especially looking at diet and specific allergy triggers as well as working closely with pediatric allergists, naturopaths and pediatric Ear, Nose and Throat specialists we we can help to restore proper growth. Speed of recognition and treatment are the keys to success. The faster the nasal airway is opened, the better the chance of success. Facially, a child matures very quickly and most critical growth is compoleted before the age of 10. Corrections after growth is complete are more prone to failure and relapse. Also, these early childhood growth problems can lay the groundwork for more severe medical conditions later in adult life - the most serious being Obstructive Sleep Apnea (OSA) and TMD. (see OSA/TMD)

All orthodontic/cranial orthopedic treatment begins with a thorough diagnosis (orthodontic diagnosis or "work-up") which includes an examination, impressions, facial and dental pictures, x-rays and a detailed computer aided assessment of key structures of the face, jaws and teeth. In addition, in the growing patient, a wrist film is taken to assess the true skeletal age of the patient (which may differ from the patient's chronological age). Recognition of this variability may profoundly affect the timing of treatment as well as the success. From this information we will consult with you on the best options for care along with estimating the treatment time and sequencing needed. In the growing patient, it may be advantageous to treat in phases. Phase One is usually implemented to help redirect growth more favorably, followed by a retention phase during which we wait for all of the remaining permanent teeth to grow into place. Once all the permanent teeth have erupted we will reevaluate to determine if a second phase is necessary to optimally achieve a functional occlusion. This Second Phase treatment is commonly shorter in duration compared to traditional orthodontics and often times is not required.

Treatment of the adult dentition falls into two main categories: 1) conventional orthodontics (braces) and 2) invisible braces (Invisalign). Invisalign came into vogue within the last six years as an esthetic means of moving teeth in the adult population. It consists of a series of thin, clear, plastic coverings that slip over the teeth and provide incremental correction of crowded teeth. They are worn full-time with the exception of mealtime and when brushing. Their advantage over conventional orthodontics is that they are more esthetic as well as more stable in the case of orthodontic correction of the TMD patient. This is due to their "mouthguard protection effect" upon the jaw. However, they are limited to treating only certain kinds of orthodontic problems and usually take longer to achieve orthodontic correction than conventional orthodontics. The decision to treat with Invisalign can only be determined after a comprehensive orthodontic diagnosis.