Orthopaedic Therapy

We often find that the jaws are not developing properly in young children; the upper jaw is sometimes too small or the lower jaw may be too far back or forward, all of which can result in:

  • Functional problems with the bite
  • The adult teeth not having enough room to grow in straight
  • Compromised aesthetics of the face and teeth

Treatments

  • Expansion:If treated early enough, the upper jaw can be expanded with a simple appliance over the course of a few months, correcting bite problems and giving more space for all the adult teeth to develop properly.
  • Jaw advancement:Orthopaedic appliances can be used to bring the lower or upper jaw forward, putting the jaws in harmony with each other and the rest of the face. This is most effective at around the age of eight to nine years although later treatment may also be successful.

Mandibular (Lower Jaw) orthopaedics  is carried out for the correction of a lower jaw which is too small resulting in the top teeth seeming like they stick out, with a growing patient. For choice this type of treatment is carried out around 9-11 years of age, although older patients can also benefit if facial growth is still taking place. Patients of this age are generally much more amenable to treatment with removable appliances and tend to spend more time with parents than older children.

Bass Dynamax Orthopaedic Appliance

This results in more conscientious use of the appliances, an essential for effective progress. Younger children around nine years of age are also growing proportionately at the same rate as they would do later on during their adolescent growth spurt. These two factors generally combine to allow for rapid progress to be made.

We primarily use the Dynamax appliance for orthopaedic development of the mandible www.bassdynamax.com. This is an unobtrusive removable appliance, very well tolerated and able to produce significant changes in facial growth.

The Dynamax Appliance in Dentofacial Orthopaedics

Here is such a case treated without orthopaedics.

Note the excellent dental result (teeth aligned nicely)…

…but note the marked compromise in facial aesthetics. Unfortunately, these facial changes are irreversible

It  is much preferable to harmonise the jaw relationship in a skeletally based malocclusion, rather than compensate for the underlying defect simply by moving teeth. This allows us to provide the maximum improvement in facial aesthetics and, by minimising the amount of movement of the upper teeth backwards, leave these teeth in the optimum position for the most attractive smile.

Furthermore, it avoids the need for extractions to provide space for moving the teeth backwards.  Treatment is carried out without removing teeth in nearly all cases.

A similar case treated with Orthopaedics and fixed appliance therapy

Note the retrusive lower jaw resulting  in the top teeth looking like they are sticking out.

Note the retrusive lower jaw

After 10 months treatment with Dynamax orthopaedic appliance

The active orthopaedic phase generally lasts 8-10 months and is followed by alignment of the dentition and final detailing of the occlusion with fixed appliance therapy, over a similar period.

A significant advantage of the Dynamax appliance is that its use can be continued at the same time as the fixed braces, to stabilise the orthopaedic correction while the soft tissues and especially the musculature, adapt to the new position of the mandible.

Without this stabilisation, the lower jaw tends to revert back to its original retrusive position, causing much of the relapse often seen with functional appliances.