Budgeting for Long Term Orthodontic Care

Budgeting for Long Term Orthodontic Care

* Type of orthodontic treatment needed for the child.

So, you're thinking about braces for your kiddo? Kids may feel mild discomfort when braces are first applied Child-friendly orthodontic solutions dentist. That's awesome! A straight smile does wonders for confidence, but let's be real, it's also a significant investment. Understanding the 'overall cost' part is key to budgeting, and trust me, it's more than just the sticker price on the braces themselves.


Think of it like buying a car. The car's price is one thing, but you've got gas, insurance, maintenance, right? Orthodontic treatment is similar. The initial consultation is usually a separate charge, sometimes free, sometimes not. Then there's the cost of the braces themselves, which varies wildly depending on the type – metal, ceramic, Invisalign, even lingual (behind-the-teeth) options. Those fancier ones cost more, plain and simple.


But wait, there's more! Regular adjustment appointments are where a good chunk of the money goes. These are crucial for the treatment to work, and they're built into the overall cost, usually spread out over the duration of the treatment. Don't forget retainers after the braces come off! They're essential to keep those pearly whites in their new positions, and they come with their own price tag. Sometimes, there are even extractions or other procedures needed before the braces go on, adding to the total.


And finally, consider the potential for unexpected costs. A broken bracket? An emergency appointment? These things happen, and while your orthodontist might cover minor repairs, major issues could mean an extra fee.


Basically, budgeting for long-term orthodontic care means looking beyond the initial price quote. Ask your orthodontist for a comprehensive treatment plan that outlines all the costs involved, including those retainers at the end. Don't be afraid to ask about payment plans, insurance coverage, and any discounts they might offer. Knowledge is power, and knowing the true overall cost lets you plan accordingly and ensure your child gets the smile they deserve without breaking the bank. It's a marathon, not a sprint, so pace yourself and plan ahead!

Okay, so you're staring down the barrel of braces, or Invisalign, or whatever fancy teeth-straightening contraption your orthodontist recommends. Great! A beautiful smile is definitely an investment. But let's be real, it's an investment that can seriously dent your wallet. That's why exploring insurance coverage and potential out-of-pocket expenses before you even get fitted is absolutely crucial.


Think of it like this: you wouldn't buy a car without checking the price and financing options, right? Orthodontic work is the same deal, maybe even more important considering it's your health we're talking about. First things first, dig out your dental insurance policy. Most policies offer some degree of orthodontic coverage, especially for younger patients. But the devil's in the details. What percentage do they cover? Is there a lifetime maximum? Are there age restrictions? These are key questions to ask your insurance provider directly. Don't rely on assumptions; get the specifics.


And even if your insurance covers a portion, you're likely facing out-of-pocket expenses. This could include deductibles, copays, and amounts exceeding your insurance's maximum coverage. Talk to your orthodontist's office about their payment plans. Many offer flexible options, like monthly installments, or discounts for paying upfront. Don't be shy about asking for a detailed breakdown of all costs involved. Transparency is key. Also, explore potential financing options like healthcare credit cards or personal loans if needed. Budgeting for long-term orthodontic care is a marathon, not a sprint. A little planning and research at the beginning can save you a lot of stress (and money) down the road.

* Duration of the orthodontic treatment plan.

Okay, so you're staring down the barrel of braces. Or maybe Invisalign. Either way, you know it's going to be an investment. And let's be real, "investment" is just a fancy word for "expensive." But don't freak out just yet! One of the biggest things to explore when you're budgeting for long-term orthodontic care is the payment plans offered by different practices. It's not a one-size-fits-all situation, and that's a good thing.


Think of it like buying a car (hopefully a less painful experience, though!). You wouldn't just hand over a giant wad of cash, right? Most people finance. Orthodontists often work the same way. They understand that dropping a few thousand dollars at once is a major ask. So, they typically have a range of payment options to make things manageable.


What kind of options are we talking about? Well, you might find some offices offer an upfront discount for paying in full. If you've got the cash, that can be a smart move. But more common are installment plans. These break down the total cost into monthly payments, often spread out over the duration of your treatment. Some might be interest-free, which is obviously ideal! Others might have a financing fee or interest rate attached, so be sure to ask about the details. You also might find some offices offer longer payment plans than others, even extending beyond the active treatment time.


The key here is to be proactive and ask questions. Don't be shy about discussing your budget and what you can comfortably afford. Find out if they work with specific financing companies or offer in-house payment options. What's the down payment? What's the monthly payment? What happens if you miss a payment? Are there any penalties for early payoff? Get everything in writing!


Ultimately, finding the right orthodontic practice isn't just about the best treatment; it's also about finding a place that works with your financial situation. Don't be afraid to shop around and compare payment plans. A little research can save you a lot of stress (and money!) in the long run. Good luck getting that perfect smile!

* Geographic location and its cost of living.

Okay, so you're thinking about straightening your teeth, which is fantastic! But let's be real, braces or Invisalign aren't exactly cheap. That's where investigating financing options comes in. Think of it like this: you're not just paying for a straighter smile, you're investing in your long-term oral health and, let's be honest, your confidence.


First things first, talk to your orthodontist's office. They often have payment plans or in-house financing options that can break down the total cost into manageable monthly installments. Don't be afraid to ask about discounts for paying upfront or for having multiple family members in treatment. They're used to these conversations and genuinely want to help you find a way to make it work.


Next, consider your insurance. Even if your plan doesn't cover the full cost, it might cover a portion, which can significantly reduce your out-of-pocket expenses. Understand your policy's limitations and annual maximums before you commit to anything.


Then, explore third-party financing options. Companies specializing in healthcare financing, like CareCredit, offer loans with varying interest rates and repayment terms. Compare these options carefully, paying attention to the APR (Annual Percentage Rate) and any potential fees. A lower monthly payment might seem appealing, but make sure you're not paying significantly more in interest over the long run.


Finally, don't rule out personal loans from your bank or credit union. Sometimes, these can offer more favorable interest rates than healthcare-specific loans. Shop around and get quotes from different institutions to see what they can offer.


The key takeaway here is to do your homework. Orthodontic treatment is a big investment, but with careful planning and a thorough investigation of financing options, you can make that dream smile a reality without breaking the bank. It's about finding the option that fits your budget and allows you to prioritize your oral health without causing undue financial stress. Good luck!

* Orthodontist's experience and specialization.

Okay, so you're staring down the barrel of braces, or Invisalign, or some other orthodontic adventure. It's exciting, imagining that perfect smile, but then reality hits: the price tag. Ouch. That's where budgeting comes in, and a big part of smart orthodontic budgeting involves figuring out if you can use a Flexible Spending Account (FSA) or a Health Savings Account (HSA).


Think of FSAs and HSAs as pre-tax dollars you set aside specifically for healthcare. You contribute to them throughout the year, and then use the money for eligible expenses. The beauty of it is that the money isn't taxed going in, grows tax-free, and isn't taxed when you withdraw it for qualified medical costs. Orthodontic work definitely falls under that umbrella.


Now, here's the catch: understanding the rules. FSAs are often "use-it-or-lose-it," meaning you have to spend the money within the plan year, though some plans offer a grace period or allow a small amount to roll over. So, you need to realistically estimate your orthodontic costs for the year. If your treatment is spread out over two years, you could potentially contribute to your FSA in both years to cover the costs.


HSAs are different. The money rolls over year after year, so you don't have the same pressure to spend it quickly. However, you need to be enrolled in a high-deductible health plan to be eligible for an HSA.


The trick is to do your homework. Check with your employer's benefits administrator to understand the specific rules of your FSA or HSA. Talk to your orthodontist about payment plans and how they align with your contribution schedule. Can you front-load your FSA contributions to pay a larger initial down payment? Can you pay your orthodontist in chunks that match your HSA contributions? These are questions worth asking.


Ultimately, leveraging an FSA or HSA can significantly reduce the overall cost of orthodontic care. It's a smart way to budget, plan ahead, and make that dream smile a little more affordable. Just be sure to crunch the numbers carefully and understand the fine print.

* Use of advanced technology or techniques.

Okay, so you're thinking about braces, or Invisalign, or some other orthodontic treatment for yourself or your kids. That's fantastic! A healthy, confident smile can be life-changing. But, let's be real, orthodontic care can also be a significant financial commitment. Fitting it into the family budget? That takes some planning and a bit of prioritizing.


Think of it less like a sudden expense and more like a long-term investment in overall well-being. First, honestly assess your budget. Where does your money go each month? Can you trim back on dining out, entertainment, or subscriptions to free up some funds? Even small changes can add up over the treatment's duration, which can be a year or two, or even longer.


Then, explore all your payment options. Many orthodontists offer flexible payment plans, sometimes even interest-free, that can spread the cost out over several months or years. Don't be shy about asking about discounts for paying upfront, or if they accept insurance plans that cover orthodontic work. Some employers also offer health savings accounts (HSAs) or flexible spending accounts (FSAs) that you can use to pay for eligible medical expenses, including orthodontics.


Don't forget to shop around a little. Get consultations from a few different orthodontists. This isn't just about finding the cheapest option, but about finding someone you trust, who offers a treatment plan that suits your needs and budget. They can also help you understand the breakdown of costs involved.


Ultimately, prioritizing orthodontic care is about making informed decisions and finding creative ways to make it work within your family's financial reality. It might mean making some sacrifices in other areas, but the long-term benefits of a healthy, beautiful smile can be well worth the effort. It's a conversation worth having as a family, weighing the pros and cons, and figuring out the best path forward together.

* Insurance coverage and payment options.

Okay, so you're staring down the barrel of long-term orthodontic care. Braces, Invisalign, the whole shebang. And you're thinking, "My wallet is going to cry." Totally understandable! Budgeting for this isn't just about finding the first orthodontist and saying, "Take my money!" It's about being smart, resourceful, and advocating for yourself. That's where seeking second opinions and comparing treatment costs comes in.


Think of it like buying a car. You wouldn't just walk into the first dealership and buy the first car you see, right? You'd shop around, compare prices, maybe even test drive a few. Same deal with orthodontics. Different orthodontists might have different approaches to your specific case, and those approaches translate into different costs. One might recommend a shorter treatment time with a slightly different method, while another might suggest a longer, more traditional route.


Getting a second opinion isn't about distrusting the first orthodontist. It's about equipping yourself with information. It's about understanding all your options and feeling confident in your decision. Plus, different orthodontists use different labs for appliances and have different overhead costs, all of which impact the final price. Don't be afraid to ask for a detailed breakdown of the costs involved. What's included? Are retainers extra? What about emergency appointments? Knowing all this upfront helps you avoid nasty surprises later on.


Comparing treatment costs isn't just about finding the cheapest option. It's about finding the best value. What are you getting for your money? Is one orthodontist more experienced with a particular technique? Does one offer a payment plan that fits your budget better? These are all important factors to consider. And remember, a friendly, communicative orthodontist who takes the time to explain things clearly is worth their weight in gold. So, shop around, ask questions, and don't be afraid to negotiate. Your wallet (and your smile) will thank you for it.

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  • Tooth decay
  • From a page move: This is a redirect from a page that has been moved (renamed). This page was kept as a redirect to avoid breaking links, both internal and external, that may have been made to the old page name.
"Deep bite" and "Buck teeth" redirect here. For the village, see Deep Bight, Newfoundland and Labrador.
Malocclusion
Malocclusion in 10-year-old girl
Specialty Dentistry Edit this on Wikidata
Look up bucktooth in Wiktionary, the free dictionary.

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864;[1] Edward Angle (1855–1930), the "father of modern orthodontics",[2][3][need quotation to verify] popularised it. The word derives from mal- 'incorrect' and occlusion 'the manner in which opposing teeth meet'.

The malocclusion classification is based on the relationship of the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar.  If this molar relationship exists, then the teeth can align into normal occlusion. According to Angle, malocclusion is any deviation of the occlusion from the ideal.[4] However, assessment for malocclusion should also take into account aesthetics and the impact on functionality. If these aspects are acceptable to the patient despite meeting the formal definition of malocclusion, then treatment may not be necessary. It is estimated that nearly 30% of the population have malocclusions that are categorised as severe and definitely benefit from orthodontic treatment.[5]

Causes

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The aetiology of malocclusion is somewhat contentious, however, simply put it is multifactorial, with influences being both genetic[6][unreliable source?] and environmental.[7] Malocclusion is already present in one of the Skhul and Qafzeh hominin fossils and other prehistoric human skulls.[8][9] There are three generally accepted causative factors of malocclusion:

  • Skeletal factors – the size, shape and relative positions of the upper and lower jaws. Variations can be caused by environmental or behavioral factors such as muscles of mastication, nocturnal mouth breathing, and cleft lip and cleft palate.
  • Muscle factors – the form and function of the muscles that surround the teeth.  This could be impacted by habits such as finger sucking, nail biting, pacifier and tongue thrusting[10]
  • Dental factors – size of the teeth in relation to the jaw, early loss of teeth could result in spacing or mesial migration causing crowding, abnormal eruption path or timings, extra teeth (supernumeraries), or too few teeth (hypodontia)

There is not one single cause of malocclusion, and when planning orthodontic treatment it is often helpful to consider the above factors and the impact they have played on malocclusion. These can also be influenced by oral habits and pressure resulting in malocclusion.[11][12]

Behavioral and dental factors

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In the active skeletal growth,[13] mouthbreathing, finger sucking, thumb sucking, pacifier sucking, onychophagia (nail biting), dermatophagia, pen biting, pencil biting, abnormal posture, deglutition disorders and other habits greatly influence the development of the face and dental arches.[14][15][16][17][18] Pacifier sucking habits are also correlated with otitis media.[19][20] Dental caries, periapical inflammation and tooth loss in the deciduous teeth can alter the correct permanent teeth eruptions.

Primary vs. secondary dentition

[edit]

Malocclusion can occur in primary and secondary dentition.

In primary dentition malocclusion is caused by:

  • Underdevelopment of the dentoalvelor tissue.
  • Over development of bones around the mouth.
  • Cleft lip and palate.
  • Overcrowding of teeth.
  • Abnormal development and growth of teeth.

In secondary dentition malocclusion is caused by:

  • Periodontal disease.
  • Overeruption of teeth.[21]
  • Premature and congenital loss of missing teeth.

Signs and symptoms

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Malocclusion is a common finding,[22][23] although it is not usually serious enough to require treatment. Those who have more severe malocclusions, which present as a part of craniofacial anomalies, may require orthodontic and sometimes surgical treatment (orthognathic surgery) to correct the problem.

The ultimate goal of orthodontic treatment is to achieve a stable, functional and aesthetic alignment of teeth which serves to better the patient's dental and total health.[24] The symptoms which arise as a result of malocclusion derive from a deficiency in one or more of these categories.[25]

The symptoms are as follows:

  • Tooth decay (caries): misaligned teeth will make it more difficult to maintain oral hygiene. Children with poor oral hygiene and diet will be at an increased risk.
  • Periodontal disease: irregular teeth would hinder the ability to clean teeth meaning poor plaque control. Additionally, if teeth are crowded, some may be more buccally or lingually placed, there will be reduced bone and periodontal support. Furthermore, in Class III malocclusions, mandibular anterior teeth are pushed labially which contributes to gingival recession and weakens periodontal support.
  • Trauma to anterior teeth: Those with an increased overjet are at an increased risk of trauma. A systematic review found that an overjet of greater than 3mm will double the risk of trauma.
  • Masticatory function: people with anterior open bites, large increased & reverse overjet and hypodontia will find it more difficult to chew food.
  • Speech impairment: a lisp is when the incisors cannot make contact, orthodontics can treat this. However, other forms of misaligned teeth will have little impact on speech and orthodontic treatment has little effect on fixing any problems.  
  • Tooth impaction: these can cause resorption of adjacent teeth and other pathologies for example a dentigerous cyst formation.  
  • Psychosocial wellbeing: malocclusions of teeth with poor aesthetics can have a significant effect on self-esteem.

Malocclusions may be coupled with skeletal disharmony of the face, where the relations between the upper and lower jaws are not appropriate. Such skeletal disharmonies often distort sufferer's face shape, severely affect aesthetics of the face, and may be coupled with mastication or speech problems. Most skeletal malocclusions can only be treated by orthognathic surgery.[citation needed]

Classification

[edit]

Depending on the sagittal relations of teeth and jaws, malocclusions can be divided mainly into three types according to Angle's classification system published 1899. However, there are also other conditions, e.g. crowding of teeth, not directly fitting into this classification.

Many authors have tried to modify or replace Angle's classification. This has resulted in many subtypes and new systems (see section below: Review of Angle's system of classes).

A deep bite (also known as a Type II Malocclusion) is a condition in which the upper teeth overlap the lower teeth, which can result in hard and soft tissue trauma, in addition to an effect on appearance.[26] It has been found to occur in 15–20% of the US population.[27]

An open bite is a condition characterised by a complete lack of overlap and occlusion between the upper and lower incisors.[28] In children, open bite can be caused by prolonged thumb sucking.[29] Patients often present with impaired speech and mastication.[30]

Overbites

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This is a vertical measurement of the degree of overlap between the maxillary incisors and the mandibular incisors. There are three features that are analysed in the classification of an overbite:

  • Degree of overlap: edge to edge, reduced, average, increased
  • Complete or incomplete: whether there is contact between the lower teeth and the opposing teeth/tissue (hard palate or gingivae) or not.
  • Whether contact is traumatic or atraumatic

An average overbite is when the upper anterior teeth cover a third of the lower teeth. Covering less than this is described as ‘reduced’ and more than this is an ‘increased’ overbite. No overlap or contact is considered an ‘anterior open bite’.[25][31][32]

Angle's classification method

[edit]
Class I with severe crowding and labially erupted canines
Class II molar relationship

Edward Angle, who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the maxillary first molar.[33] According to Angle, the mesiobuccal cusp of the upper first molar should align with the buccal groove of the mandibular first molar. The teeth should all fit on a line of occlusion which, in the upper arch, is a smooth curve through the central fossae of the posterior teeth and cingulum of the canines and incisors, and in the lower arch, is a smooth curve through the buccal cusps of the posterior teeth and incisal edges of the anterior teeth. Any variations from this resulted in malocclusion types. It is also possible to have different classes of malocclusion on left and right sides.

  • Class I (Neutrocclusion): Here the molar relationship of the occlusion is normal but the incorrect line of occlusion or as described for the maxillary first molar, but the other teeth have problems like spacing, crowding, over or under eruption, etc.
  • Class II (Distocclusion (retrognathism, overjet, overbite)): In this situation, the mesiobuccal cusp of the upper first molar is not aligned with the mesiobuccal groove of the lower first molar. Instead it is anterior to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars. There are two subtypes:
    • Class II Division 1: The molar relationships are like that of Class II and the anterior teeth are protruded.
    • Class II Division 2: The molar relationships are Class II but the central are retroclined and the lateral teeth are seen overlapping the centrals.
  • Class III: (Mesiocclusion (prognathism, anterior crossbite, negative overjet, underbite)) In this case the upper molars are placed not in the mesiobuccal groove but posteriorly to it. The mesiobuccal cusp of the maxillary first molar lies posteriorly to the mesiobuccal groove of the mandibular first molar. Usually seen as when the lower front teeth are more prominent than the upper front teeth. In this case the patient very often has a large mandible or a short maxillary bone.

Review of Angle's system of classes and alternative systems

[edit]

A major disadvantage of Angle's system of classifying malocclusions is that it only considers two dimensions along a spatial axis in the sagittal plane in the terminal occlusion, but occlusion problems can be three-dimensional. It does not recognise deviations in other spatial axes, asymmetric deviations, functional faults and other therapy-related features.

Angle's classification system also lacks a theoretical basis; it is purely descriptive. Its much-discussed weaknesses include that it only considers static occlusion, it does not account for the development and causes (aetiology) of occlusion problems, and it disregards the proportions (or relationships in general) of teeth and face.[34] Thus, many attempts have been made to modify the Angle system or to replace it completely with a more efficient one,[35] but Angle's classification continues be popular mainly because of its simplicity and clarity.[citation needed]

Well-known modifications to Angle's classification date back to Martin Dewey (1915) and Benno Lischer (1912, 1933). Alternative systems have been suggested by, among others, Simon (1930, the first three-dimensional classification system), Jacob A. Salzmann (1950, with a classification system based on skeletal structures) and James L. Ackerman and William R. Proffit (1969).[36]

Incisor classification

[edit]

Besides the molar relationship, the British Standards Institute Classification also classifies malocclusion into incisor relationship and canine relationship.

  • Class I: The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors
  • Class II: The lower incisor edges lie posterior to the cingulum plateau of the upper incisors
    • Division 1 – the upper central incisors are proclined or of average inclination and there is an increase in overjet
    • Division 2 – The upper central incisors are retroclined. The overjet is usually minimal or may be increased.
  • Class III: The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.

Canine relationship by Ricketts

[edit]
  • Class I: Mesial slope of upper canine coincides with distal slope of lower canine
  • Class II: Mesial slope of upper canine is ahead of distal slope of lower canine
  • Class III: Mesial slope of upper canine is behind to distal slope of lower canine

Crowding of teeth

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Dental crowding is defined by the amount of space that would be required for the teeth to be in correct alignment. It is obtained in two ways: 1) by measuring the amount of space required and reducing this from calculating the space available via the width of the teeth, or 2) by measuring the degree of overlap of the teeth.

The following criterion is used:[25]

  • 0-4mm = Mild crowding
  • 4-8mm = Moderate crowding
  • >8mm = Severe crowding

Causes

[edit]

Genetic (inheritance) factors, extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth have been cited as causes of crowding. Ill-fitting dental fillings, crowns, appliances, retainers, or braces as well as misalignment of jaw fractures after a severe injury are also known to cause crowding.[26] Tumors of the mouth and jaw, thumb sucking, tongue thrusting, pacifier use beyond age three, and prolonged use of a bottle have also been identified.[26]

Lack of masticatory stress during development can cause tooth overcrowding.[37][38] Children who chewed a hard resinous gum for two hours a day showed increased facial growth.[37] Experiments in animals have shown similar results. In an experiment on two groups of rock hyraxes fed hardened or softened versions of the same foods, the animals fed softer food had significantly narrower and shorter faces and thinner and shorter mandibles than animals fed hard food.[37][39][failed verification]

A 2016 review found that breastfeeding lowers the incidence of malocclusions developing later on in developing infants.[40]

During the transition to agriculture, the shape of the human mandible went through a series of changes. The mandible underwent a complex shape changes not matched by the teeth, leading to incongruity between the dental and mandibular form. These changes in human skulls may have been "driven by the decreasing bite forces required to chew the processed foods eaten once humans switched to growing different types of cereals, milking and herding animals about 10,000 years ago."[38][41]

Treatment

[edit]

Orthodontic management of the condition includes dental braces, lingual braces, clear aligners or palatal expanders.[42] Other treatments include the removal of one or more teeth and the repair of injured teeth. In some cases, surgery may be necessary.[43]

Treatment

[edit]

Malocclusion is often treated with orthodontics,[42] such as tooth extraction, clear aligners, or dental braces,[44] followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgical intervention is used only in rare occasions. This may include surgical reshaping to lengthen or shorten the jaw. Wires, plates, or screws may be used to secure the jaw bone, in a manner like the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth with most problems being minor that do not require treatment.[37]

Crowding

[edit]

Crowding of the teeth is treated with orthodontics, often with tooth extraction, clear aligners, or dental braces, followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to secure the jaw bone, in a manner similar to the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth. However, most problems are very minor and do not require treatment.[39]

Class I

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While treatment is not crucial in class I malocclusions, in severe cases of crowding can be an indication for intervention. Studies indicate that tooth extraction can have benefits to correcting malocclusion in individuals.[45][46] Further research is needed as reoccurring crowding has been examined in other clinical trials.[45][47]

Class II

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A few treatment options for class II malocclusions include:

  1. Functional appliance which maintains the mandible in a postured position to influence both the orofacial musculature and dentoalveolar development prior to fixed appliance therapy. This is ideally done through pubertal growth in pre-adolescent children and the fixed appliance during permanent dentition .[48] Different types of removable appliances include Activator, Bionatar, Medium opening activator, Herbst, Frankel and twin block appliance with the twin block being the most widely used one.[49]
  2. Growth modification through headgear to redirect maxillary growth
  3. Orthodontic camouflage so that jaw discrepancy no longer apparent
  4. Orthognathic surgery – sagittal split osteotomy mandibular advancement carried out when growth is complete where skeletal discrepancy is severe in anterior-posterior relationship or in vertical direction. Fixed appliance is required before, during and after surgery.
  5. Upper Removable Appliance – limited role in contemporary treatment of increased overjets. Mostly used for very mild Class II, overjet due to incisor proclination, favourable overbite.

Class II Division 1

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Low- to moderate- quality evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth (class II division 1) is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence.[50] There do not appear to be any other advantages of providing early treatment when compared to late treatment.[50] Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances is effective for reducing the prominence of upper front teeth.[50]

Class II Division 2

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Treatment can be undertaken using orthodontic treatments using dental braces.[51] While treatment is carried out, there is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment in children.[51] A 2018 Cochrane systematic review anticipated that the evidence base supporting treatment approaches is not likely to improve occlusion due to the low prevalence of the condition and the ethical difficulties in recruiting people to participate in a randomized controlled trials for treating this condition.[51]

Class III

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The British Standard Institute (BSI) classify class III incisor relationship as the lower incisor edge lies anterior to the cingulum plateau of the upper incisors, with reduced or reversed over jet.[52] The skeletal facial deformity is characterized by mandibular prognathism, maxillary retrognathism or a combination of the two. This effects 3-8% of UK population with a higher incidence seen in Asia.[53]

One of the main reasons for correcting Class III malocclusion is aesthetics and function. This can have a psychological impact on the person with malocclusion resulting in speech and mastication problems as well. In mild class III cases, the patient is quite accepting of the aesthetics and the situation is monitored to observe the progression of skeletal growth.[54]

Maxillary and mandibular skeletal changes during prepubertal, pubertal and post pubertal stages show that class III malocclusion is established before the prepubertal stage.[55] One treatment option is the use of growth modification appliances such as the Chin Cap which has greatly improved the skeletal framework in the initial stages. However, majority of cases are shown to relapse into inherited class III malocclusion during the pubertal growth stage and when the appliance is removed after treatment.[55]

Another approach is to carry out orthognathic surgery, such as a bilateral sagittal split osteotomy (BSSO) which is indicated by horizontal mandibular excess. This involves surgically cutting through the mandible and moving the fragment forward or backwards for desired function and is supplemented with pre and post surgical orthodontics to ensure correct tooth relationship. Although the most common surgery of the mandible, it comes with several complications including: bleeding from inferior alveolar artery, unfavorable splits, condylar resorption, avascular necrosis and worsening of temporomandibular joint.[56]

Orthodontic camouflage can also be used in patients with mild skeletal discrepancies. This is a less invasive approach that uses orthodontic brackets to correct malocclusion and try to hide the skeletal discrepancy. Due to limitations of orthodontics, this option is more viable for patients who are not as concerned about the aesthetics of their facial appearance and are happy to address the malocclusion only, as well as avoiding the risks which come with orthognathic surgery. Cephalometric data can aid in the differentiation between the cases that benefit from ortho-surgical or orthodontic treatment only (camouflage); for instance, examining a large group of orthognathic patient with Class III malocclusions they had average ANB angle of -3.57° (95% CI, -3.92° to -3.21°). [57]

Deep bite

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The most common corrective treatments available are fixed or removal appliances (such as dental braces), which may or may not require surgical intervention. At this time there is no robust evidence that treatment will be successful.[51]

Open bite

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An open bite malocclusion is when the upper teeth don't overlap the lower teeth. When this malocclusion occurs at the front teeth it is known as anterior open bite. An open bite is difficult to treat due to multifactorial causes, with relapse being a major concern. This is particularly so for an anterior open bite.[58] Therefore, it is important to carry out a thorough initial assessment in order to obtain a diagnosis to tailor a suitable treatment plan.[58] It is important to take into consideration any habitual risk factors, as this is crucial for a successful outcome without relapse. Treatment approach includes behavior changes, appliances and surgery. Treatment for adults include a combination of extractions, fixed appliances, intermaxillary elastics and orthognathic surgery.[30] For children, orthodontics is usually used to compensate for continued growth. With children with mixed dentition, the malocclusion may resolve on its own as the permanent teeth erupt. Furthermore, should the malocclusion be caused by childhood habits such as digit, thumb or pacifier sucking, it may result in resolution as the habit is stopped. Habit deterrent appliances may be used to help in breaking digit and thumb sucking habits. Other treatment options for patients who are still growing include functional appliances and headgear appliances.

Tooth size discrepancy

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Identifying the presence of tooth size discrepancies between the maxillary and mandibular arches is an important component of correct orthodontic diagnosis and treatment planning.

To establish appropriate alignment and occlusion, the size of upper and lower front teeth, or upper and lower teeth in general, needs to be proportional. Inter-arch tooth size discrepancy (ITSD) is defined as a disproportion in the mesio-distal dimensions of teeth of opposing dental arches. The prevalence is clinically significant among orthodontic patients and has been reported to range from 17% to 30%.[59]

Identifying inter-arch tooth size discrepancy (ITSD) before treatment begins allows the practitioner to develop the treatment plan in a way that will take ITSD into account. ITSD corrective treatment may entail demanding reduction (interproximal wear), increase (crowns and resins), or elimination (extractions) of dental mass prior to treatment finalization.[60]

Several methods have been used to determine ITSD. Of these methods the one most commonly used is the Bolton analysis. Bolton developed a method to calculate the ratio between the mesiodistal width of maxillary and mandibular teeth and stated that a correct and harmonious occlusion is possible only with adequate proportionality of tooth sizes.[60] Bolton's formula concludes that if in the anterior portion the ratio is less than 77.2% the lower teeth are too narrow, the upper teeth are too wide or there is a combination of both. If the ratio is higher than 77.2% either the lower teeth are too wide, the upper teeth are too narrow or there is a combination of both.[59]

Other conditions

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Further information: Open bite malocclusion
Open bite treatment after eight months of braces.

Other kinds of malocclusions can be due to or horizontal, vertical, or transverse skeletal discrepancies, including skeletal asymmetries.

Increased vertical growth causes a long facial profile and commonly leads to an open bite malocclusion, while decreased vertical facial growth causes a short facial profile and is commonly associated with a deep bite malocclusion. However, there are many other more common causes for open bites (such as tongue thrusting and thumb sucking) and likewise for deep bites.[61][62][63]

The upper or lower jaw can be overgrown (macrognathia) or undergrown (micrognathia).[62][61][63] It has been reported that patients with micrognathia are also affected by retrognathia (abnormal posterior positioning of the mandible or maxilla relative to the facial structure).[62]  These patients are majorly predisposed to a class II malocclusion. Mandibular macrognathia results in prognathism and predisposes patients to a class III malocclusion.[64]

Most malocclusion studies to date have focused on Class III malocclusions. Genetic studies for Class II and Class I malocclusion are more rare. An example of hereditary mandibular prognathism can be seen amongst the Hapsburg Royal family where one third of the affected individuals with severe class III malocclusion had one parent with a similar phenotype [65]

The frequent presentation of dental malocclusions in patients with craniofacial birth defects also supports a strong genetic aetiology. About 150 genes are associated with craniofacial conditions presenting with malocclusions.[66]  Micrognathia is a commonly recurring craniofacial birth defect appearing among multiple syndromes.

For patients with severe malocclusions, corrective jaw surgery or orthognathic surgery may be carried out as a part of overall treatment, which can be seen in about 5% of the general population.[62][61][63]

See also

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  • Crossbite
  • Elastics
  • Facemask (orthodontics)
  • Maximum intercuspation
  • Mouth breathing
  • Occlusion (dentistry)

References

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Further reading

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  • Peter S. Ungar, "The Trouble with Teeth: Our teeth are crowded, crooked and riddled with cavities. It hasn't always been this way", Scientific American, vol. 322, no. 4 (April 2020), pp. 44–49. "Our teeth [...] evolved over hundreds of millions of years to be incredibly strong and to align precisely for efficient chewing. [...] Our dental disorders largely stem from a shift in the oral environment caused by the introduction of softer, more sugary foods than the ones our ancestors typically ate."
[edit]
 
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Frequently Asked Questions

Orthodontic benefits vary greatly between insurance plans. You should provide your insurance information to the orthodontists office so they can verify your coverage and provide an estimate of your out-of-pocket expenses. Understand what percentage of the treatment cost is covered, what the maximum lifetime benefit is, and if there are any age restrictions for orthodontic coverage.