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Question:
Bucked Teeth - Overbite: I recently had my daughter evaluated by 2 different orthodontists to see about fixing her "bucked teeth" - overbite.
I always like to get a couple of opinions before making a major health decision. My problem is the doctors recommended completely different courses of treatment. Now I feel really lost.
One recommended an expander an then 4 brackets on the front top teeth over a course of 10 months. The other recommended the 4 brackets but with a head gear worn every day for 12 hours over a course of 14 months.
It seems like both would be recommending expanders or headgears. Also, I should mention my daughter is 8 and this would be phase 1 treatment. Should I continue getting opinions? ...Visitor from TX
Answer:
My philosophy is 95% of the cases I see can be treated in one phase of treatment once all the permanent teeth have erupted. But there are some situations where a first phase is recommended.
In a high percentage of cases most overbites are due to a lower jaw deficiency and not protrusive upper jaw or teeth. You can evaluate this yourself by looking at your child's profile and chin position. If the chin position appears set back ... then lower jaw growth is needed.
So the major goal is to influence growth of the lower jaw and not pulling the upper jaw back. I
would not recommend improving the position of lower jaw at 8 years of age because pubertal growth has not begun.
For this type of condition we use a choice of appliances such as the Herbst, Forsus, Mara, Twin-Block or Bite-Fixers. These appliances are more effective once all the permanent teeth have erupted and pubertal growth has begun at around 11- 12 years of age for females and little later for males.
Now, if the upper teeth are protrusive or the overbite is severe and/or an improvement in self esteem can be achieved, I would recommend a first phase of treatment.
If your child's overbite is severe, I would recommend the four brackets and headgear. The headgear will give you some force to help reduce the overbite.
Most children with overbites (what we refer to as a Class II Division I malocclusion) typically have an upper arch that will require some expansion. I would recommend asking the orthodontist who wants to use headgear if a rapid palatal expander could be used for arch expansion, if needed.
Expanding the upper arch will help reduce some of the overbite in conjunction with brackets and headgear. The rapid palatal expander is used in conjunction with the headgear. Keep in mind, however, that I do not have your child records so she may not require expansion.
You need to know that a 1st phase of treatment will not prevent your child from having a 2nd phase of treatment, but can improve your chances of reducing the overbite in the 2nd phase.
Once all the permanent teeth have erupted around the age of 12 your child will begin the 2nd phase of
treatment. At this time your child will be approximating puberty and a better time to reduce the rest her overbite with orthodontics and growth.
Be prepared that if the overbite is severe due to a lower jaw deficiency a surgical lower jaw advancement may be required to achieve the overbite reduction. We as orthodontists can modify growth to an extent, but we cannot alter growth any more than about 2 - 4mm.
If this is her treatment outcome, a first phase of treatment will never prevent her from going this route. However if her front teeth are protrusive and a she is good cooperator, go ahead with the orthodontist recommendation. This can improve the 2nd phase of treatment's outcome and her self-esteem.
James J. Awbrey, D.M.D.
4895 Windward Parkway, Suite 200
Alpharetta, Georgia GA 30004
(770) 751-1688
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