The first step in treatment is to fully understand the nature of the problem. In order to arrive at a proper diagnosis the dentist will take a series of records.
- Study casts
- Photographs of the face
- Panoramic radiograph
- TMJ radiographs
- Cephalometric radiograph (single x-ray of skull)
Orthopedics looks at the whole person and as such can be applied to all age groups. Our team will be looking for all aspects of dental, facial, cranial and skeletal structural imbalances Right from the outset, we recommend that a Cranial Osteopath assesses the new born baby soon after birth (especially if traumatic) and treat any abnormalities. As the baby develops into an infant it is important to interpret how any external factors (mouth breathing, thumb sucking, ENT problems etc) effect normal growth. When the baby molars and first permanent molars erupt into contact it locates and locks in the early skeletal development. . The teeth will make contact regardless of the size and position of the upper and lower jaws and at this stage, the dental interface becomes essential for the first time.
It is possible to interpret the extent of the bony discrepancy for each individual. This is achieved by clinical examination by the Osteopath and the Dentist, followed by the taking of study models and cephlometric radiographs. The radiograph is sent to a specialist lab for digitising and a Bimler Elite tracing is produced to show the actual size and position of the facial bones to a reference point (the anterior cranial base).
Many patients are treated osteopathically prior to any appliance treatment to ensure that any bony restrictions are resolved as far as possible. In many respects the teeth are the last things to sort out and once skeletal balance has been achieved, the orthodontic element can start.
On assessing the face it is possible to see many features that might be construed as not normal, such as:-
- Narrow palate with a high arch
- Mouth breathing and poor lip seal
- Lower jaw well behind upper jaw
- Lower jaw well in front of upper jaw
- Lower jaw deviating to one side
- Temperomandibular joint dysfunction
- Overcrowded teeth
- Teeth that do not meet normally
- ENT problems
- Facial disharmony
- Spinal imbalances
- Over crowded teeth
- Poor function of the teeth
- Headaches and various facial pains
- Self- consciousness
Protocols for Treatment
Every one is different and therefore it is essential to set up a treatment protocol that fits the individual. But orthopedic treatment is only required when there is a skeletal discrepancy. This fact leads us to follow a treatment plan that has an identical pathway in all cases:-
The required (or ideal) shape of the arch is assessed using a Schwarz—Korkhaus calculation. The width of the upper incisors is measured and this data is placed in a schematic that gives the dimensions for the ideal “Roman Arch” shape for upper and lower jaws. Orthopedic appliances are used to develop the arches to their correct shape and size.
The position of the lower jaw is brought into a classic skeletal position with respect to the Anterior Cranial Base and hence the upper jaw. Orthopedic appliances are used to create these changes. The skeletal midlines are balanced with the other cranial bones and cervical spine.
At this stage we consider the teeth and an orthodontic approach becomes viable. The practice uses the latest Delta Brackets and thermally activated nickel—titanium wires. This new system can reduce the length of this phase by as much as a third!