Complex Orthodontic Treatments

While many teeth alignment problems can be fixed relatively easily, difficult cases will entail more complex orthodontic treatments.

Complex orthodontic treatments include:

• Tooth extraction.
• Correcting impacted teeth.
• Placing temporary anchorage devices.
• Gum reshaping with laser therapy.
• Jaw surgery.

When Tooth Extraction is Necessary as Part of Orthodontic Treatment

Sometimes an orthodontist has to extract one or more permanent teeth to achieve the most effective outcome of orthodontic therapy, particularly if the patient has a crowded mouth.

Most extractions can be carried out with just a local anesthetic, possibly with relaxant medication if you’re a nervous patient.

Your orthodontist will loosen the tooth with an instrument called an elevator and then remove the tooth with extraction forceps. You can expect some discomfort after an extraction but it’s usually mild. Over-the-counter pain-killers such as Advil or ibuprofen can help to ease soreness.

Tooth removal may be indicated in the following situations.

Severe Cases of Crowded Teeth

Dental overcrowding can leave no room for the repositioning of teeth that need to be moved. In some cases, expanding the dental arches can solve the problem but there are limitations to how much space can be created by this approach. This means that for many patients with severe teeth crowding, extractions may be the only option for the best orthodontic results.

Improving Appearance

Without tooth extraction, orthodontic treatment in a crowded mouth can lead to protruding lips or front teeth, negatively affecting facial appearance.

Avoiding Gum Recession

Straightening badly crowded teeth without extractions poses a risk that the teeth being repositioned will move excessively outward, leading to gum recession.

Correcting Impacted Teeth as Part of Orthodontic Treatment

Complex orthodontic treatments can work wonders for patients with impacted teeth. Impaction occurs when a tooth does not emerge through the gums properly, which can result in discomfort and problems with the bite function and appearance of the smile.

Impaction often affects the wisdom teeth, which come in during the late teens or early 20s. The problem can also arise with other teeth, including the two upper maxillary canine teeth, which generally start to appear in the early teens.

Impacted teeth can increase the risk of tooth decay because they make effective oral hygiene difficult. Impacted wisdom teeth can lead to gum inflammation.

While impacted wisdom teeth are typically removed, other cases of impaction can be resolved with orthodontic treatments, including:

Braces to move adjacent teeth to create room for the impacted tooth.

Surgery to remove gum tissue around the impacted tooth.

Temporary Anchorage Devices in Orthodontics

Temporary anchorage devices (TADs) – also called mini dental implants – are becoming increasingly common in orthodontics. They can be used in addition to braces or instead of headgear to speed up tooth movement and make treatment more effective and comfortable.

Placing a TAD is a quick procedure. A local anesthetic will be administered to numb the gum tissue and jaw and the TAD inserted into the jawbone through the gum tissue. Unlike a standard dental implant, a TAD is removed once it has completed its function.

About half the size of regular implants, TADs can also be used when an implant needs to fit into a narrow space or if a patient has lost a lot of jaw bone, which rules out a regular implant unless a bone graft is carried out. TADs can also be used to stabilize lower jaw dentures.

Gum Reshaping in Orthodontic Treatment

Laser therapy can be applied to reshape gums (gingival contouring). Dental lasers produce a beam of concentrated energy with a narrow pulse to remove specific areas of bone, teeth or the soft tissue of the gums.

Orthodontists can use soft tissue lasers to reshape gum tissue when the gum line appears uneven after teeth have been repositioned during orthodontic treatment. In other orthodontic cases, when the gums are partially covering the teeth, the excess tissue needs to be removed in order to fit braces.

Laser treatment can also be used to shorten connective tissue between the gums and lips to improve the position of teeth. The laser is so precise that surrounding tissue is left intact.

Corrective Jaw Surgery

In cases of a jaw deformity, braces alone will not address the problem of a defective bite function, and the supporting bones of the jaw have to be moved by corrective jaw surgery (orthognathic surgery).

This highly complex orthodontic treatment can also be used in cases of temporomandibular joint¹ (TMJ) disorders that affect the joints and muscles between the lower jaw and the base of the skull, and to address the problem of sleep apnea when recurring pauses in breathing restrict air getting into the lungs.

Why You Need an Orthodontic Specialist for Complex Treatment

Some orthodontic issues are fairly easy to correct. Others are more complicated. Unlike general dentists, orthodontists are trained in complex orthodontic treatments².

After dental school, orthodontists undergo a further two or three years of education in programs approved by the American Association of Orthodontists³ (AAO) and the American Dental Association⁴ (ADA).

This further dental education includes the study of craniofacial anatomy, bite disorders, jaw issues, and bone growth problems, and biomechanics. The extra training entails both clinical and academic education, as well as gaining experience in treating orthodontic patients. As the AAO points out, orthodontic treatment involves complex biological processes such as changes in facial and jaw bones and soft tissue as teeth are moved into new positions.

A good orthodontic specialist will offer a free orthodontic consultation⁵ to determine whether you need complex orthodontic treatment and give you a clear understanding of your personalized treatment options.

If you need complex orthodontic treatment, seeing a qualified orthodontist will give you the best chance of transforming your life in terms of dental function and facial aesthetics, which can provide a big boost in self-confidence.

Orthodontists will also provide post-orthodontic care, and advise you on oral healthcare at home, to make sure your teeth remain straight and healthy.

Resources

1. https://www.emedicinehealth.com/temporomandibular_joint_tmj_syndrome/article_em.htm#what_is_temporomandibular_joint_tmj_syndrome
2. https://www.webster-ortho.com/orthodontics-treatments/ 
3. https://www.aaoinfo.org/
4. https://www.ada.org/en
5. https://www.webster-ortho.com/patient-resources/