What is considered the correct bite?
Orthodontists evaluate occlusion based on several specific characteristics rather than a general impression. The upper front teeth should overlap the lower ones by about a third of the height of the crown, the midlines of the upper and lower rows should coincide with each other and with the center of the face, the lateral teeth should close in a certain pattern, in which each tooth contacts two teeth of the opposite jaw. In this case, the dentition should be without gaps and without crowding, and the upper teeth should overlap the lower ones along the entire lateral line.
It’s worth mentioning right away: ideal closure in all respects is rare, and the goal of treatment is not absolute geometry. A slight deviation that does not interfere with chewing, does not create areas inaccessible for cleaning, and does not overload individual teeth does not require treatment. The orthodontist distinguishes between a cosmetic nuance and a functional disorder, and the conversation about the need for treatment begins with this. Therefore, two similar-looking situations may receive different recommendations - one has a risk to teeth and gums, and the other does not.
What are the anomalies?
Deviations are described in several directions at once: how the jaws relate from front to back, how much the front teeth overlap each other in height, how the rows close in the lateral sections, and whether there is enough space for the teeth in the row. One person often combines several options at once, and that is why the treatment plan is drawn up individually, and not according to a template.
- Distal bite - the upper jaw or upper teeth are noticeably pushed forward, the chin appears slanted, the lip under the front teeth is often bitten
- Mesial bite - the lower jaw is pushed forward, the lower teeth overlap the upper teeth, the chin protrudes
- Deep bite - the upper incisors overlap the lower ones by more than half, sometimes the lower teeth rest against the mucous membrane of the palate
- Open bite - there is a gap between the upper and lower teeth when the jaws are closed, it is impossible to bite food with the front teeth
- Crossbite - the upper teeth close inward from the lower teeth on one or both sides, often accompanied by displacement of the jaw
- Crowding - there is not enough space for the teeth, they unfold and overlap each other, most often in the anterior part of the lower jaw
- Gaps between teeth and diastema - a gap between the front incisors, sometimes associated with the frenulum of the lip
Why it's not just aesthetics
The analysis of the misconception about “braces for beauty” should begin with a simple observation: the chewing load when closed incorrectly is distributed unevenly, and this is not an abstraction, but a very specific wear and tear. The tooth, which takes the contact first and for all, wears out, breaks off along the edge and begins to wobble over time because the bone around it cannot withstand the constant overload. Neighboring teeth, on the contrary, do not work at all, and this is also bad: without load, the bone around them loses density.
- Uneven wear of enamel, chipped cutting edges, cracks
- Wedge-shaped defects at the necks of overloaded teeth and increased sensitivity
- Caries on the contact surfaces of crowded teeth - where neither a brush nor a floss can penetrate
- Chronic gum inflammation and early periodontitis in crowded areas
- Trauma to the mucous membrane of the palate by the lower incisors during a deep bite
- Impaired pronunciation of whistling and hissing sounds in open bite
- Inability to bite food with the front teeth and overload of the lateral teeth
- Difficulties with subsequent prosthetics and implantation: tilted teeth do not have enough space for a crown, and the gap after a long-extracted tooth narrows
Where do anomalies come from and when to take a child
The basis is laid by heredity: the size of the jaws and the size of the teeth are transmitted independently of each other, so large teeth may well go to a person with a small jaw - and there will not be enough space for them with any care. But a significant part of the disorders develop after birth and are associated with how the child breathes, swallows and what he does with his own teeth. These factors, unlike heredity, can be corrected, and the sooner, the easier.
- Constant mouth breathing with adenoids, chronic runny nose or deviated nasal septum - the tongue moves down, the upper jaw narrows
- Prolonged pacifier and thumb sucking after three years
- Infantile type of swallowing, in which the tongue rests on the teeth rather than on the roof of the mouth
- Early loss of baby teeth without saving space - neighboring teeth lean into the gap, and there is nowhere for the permanent tooth to come out
- The habit of biting your lip, cheek, hand, or biting your nails
- Jaw injuries during growth
- Unerupted and supernumerary teeth that interfere with the normal eruption of the rest
The common belief that people go to the orthodontist only after all their teeth have been replaced is wrong and expensive. The first consultation is recommended at approximately six to seven years of age, when the first permanent molars and front teeth emerge. At this age, the jaws are still growing, and this growth can be influenced: to expand the narrowed upper jaw, to direct the growth of the lower jaw, to save space after an early lost milk tooth, to eliminate a bad habit. What can be solved with a small device in a few months at seven years old may require tooth extraction at seventeen, and in adulthood - the joint work of an orthodontist and a surgeon. At the same time, an early visit does not mean immediate treatment: most often the doctor simply takes the child under observation and prescribes monitoring once every six months or a year.
Examination and treatment plan
- Осмотр с оценкой смыкания, состояния зубов и десны, объёма движений челюсти и профиля лица.
- Фотопротокол лица и зубных рядов — база для планирования и для сравнения результата.
- Ортопантомограмма — обзорный снимок: показывает все зубы, их зачатки, непрорезавшиеся и лишние зубы, состояние корней и уровень кости.
- Телерентгенограмма головы в боковой проекции с расчётом — ключевое исследование, которое отвечает на вопрос, где именно проблема: в положении зубов или в размерах и положении самих челюстей.
- Слепки или внутриротовое сканирование с изготовлением моделей, анализ места в зубном ряду.
- КЛКТ — по показаниям: при непрорезавшихся зубах, планировании имплантации, оценке объёма кости и положения корней.
- Консультация оториноларинголога при затруднённом носовом дыхании и логопеда при нарушениях речи и глотания — без этого результат ортодонтического лечения неустойчив.
The calculation of a teleradiogram is important not as a formality, but because it determines fundamentally different paths. If the jaws are normal in size and position, and the problem is only in the inclination and position of the teeth, the problem can be solved with equipment. If the discrepancy is inherent in the jaws themselves and the person has already grown, braces can only mask the problem by tilting the teeth, which is not always stable and not always safe for the gums; in such cases, joint treatment with an oral and maxillofacial surgeon is discussed. Having an honest conversation about this before starting treatment saves frustration two years later. Based on the results of the diagnosis, the patient should receive a clear plan: what exactly will be done, whether removal will be required, how long it will take and how the result will be maintained.
Braces, aligners and most importantly about retainers
The choice of equipment depends on the task, and not just on preferences. Braces are a permanent system glued to the teeth, and that is why they cope with the entire range of movements, including the most complex ones: moving roots, stretching unerupted teeth, closing gaps after extraction. You don't have to remember to put them on, and the results don't depend on discipline. Aligners are transparent removable aligners that are changed according to a schedule; they are invisible, do not interfere with hygiene and are more convenient in everyday life, but they only work when they are worn 20–22 hours a day, and in difficult cases their capabilities are limited. There are also intermediate options: braces on the inside of the teeth, ceramic, combined schemes.
- The average period of active treatment in an adult is from one and a half to two and a half years; in children and adolescents it is often shorter
- The first days after installation and after each activation, the teeth are sensitive - this is expected and goes away within a few days
- Hygiene during treatment becomes much more complicated: you need brushes, a single-tuft brush, an irrigator and professional cleaning more often than usual
- Removing individual teeth is sometimes necessary to make room, but this decision is made by calculation, not by default.
- Orthodontic treatment is not started for active caries and gum inflammation - they are treated first
- In case of severe bone loss and periodontitis, treatment is possible, but it is carried out especially carefully and together with a periodontist