Articles

Protrusions: Point Me In The Right Direction

A common type of orthodontic problem seen in our office is some type of a protrusion [the upper teeth are markedly forward of the lower teeth]. In most situations the protrusion is accompanied by other problems ranging from crowding to excessive spacing. The patient could also have an open bite [usually the back teeth touch and the front teeth are vertically open] or a cross bite [the upper teeth fit inside the lower when biting]. Another problem associated with protrusions and all the other types of malocclusions is some form of agenisis [missing teeth] or undersized teeth.
The causes for protrusions can vary, but generally fall into two categories. The first is dental, when the teeth themselves are the problem. A good example might be a youngster who has had a prolonged finger or thumb sucking habit causing the teeth to tip forward. The second cause would involve the jaw bones, when the lower jaw is too far back or the upper too far forward or a combination of the two. Any number of combinations of a teeth/jaw problem can cause a protrusion. Obviously, the treatment in each situation will differ. The diagnostic and treatment skills of our trained orthodontist are critical in any of these malocclusions.
Most often protrusion problems are best treated at an early age. The sooner the teeth can be put into an optimal biting relationship the better the opportunity for proper growth and development. Often times it is best to approach a protrusive problem in two phases of treatment. The goal in the first phase [ages 6-9] is to create the best possible biting relation of the teeth. Then when the permanent teeth come in, [ages 11-13] we will determine how much additional correction is needed to achieve an ideal occlusion and esthetic result. By using this two- phase approach to the correction of a protrusive malocclusion it is often possible to eliminate the necessity for the extraction of permanent teeth and to reduce the total time necessary for the braces to be worn
The younger the patient the greater the potential for correction to allow for continued normal growth and development. However, if the patient is not seen until all of the permanent teeth have erupted excellent corrections can still be achieved. Seeing the patient for the first time at ages 12-15, when all of the permanent teeth have erupted, will still allow time to work with the patient's growth. The more potential for continued growth the better.
The approach to the treatment of adults [age 18 or over] with protrusions can be very different. Often, adult problems that are not too severe can be treated with conventional orthodontics. However, many cases of adult protrusions, especially those caused by mostly jaw problems, can only be treated with a combination of orthodontics and jaw surgery. The orthodontics is started first, followed by surgery and then the finishing orthodontic is completed. Spectacular results can be obtained with this treatment modality.