At the completion of comprehensive treatment, we want the condyle (the ball of the socket of the jaw joint) centered in the middle of the cartilaginous disc and seated completely in the fossa (jaw joint socket). As the patient arcs to full closure, we want the teeth to meet in a functionally correct manner. If we have this harmony between the best jaw joint position and the best dental fit, the teeth will help support the jaw joints (temporomandibular joint), and the joints will help support the dentition. This proper relationship also helps maintain stability of the teeth and reduces dental relapse (shifting of teeth). This also gives the patient the best mechanical relationship of the jaw joint to allow for normal wear and tear on this joint and not accelerated wear. Hopefully, this will help reduce the risk of dysfunction (TMD, or temporomandibular dysfunction).
The second treatment objective is to complete treatment with all of the roots well-encompassed in the alveolar bone (the bone that holds the teeth), with adequate and healthy gingiva (soft tissue-gums). This may sound very obvious, but if one isn’t careful in the treatment planning stage, the roots can be placed in a precarious position. The roots can be placed too close to the edge of the alveolar bone, which can result in weakened bone and soft tissue (gum) support. If you have ever seen an eye tooth (canine) that has been crowded out of the dental arch, the tissue around this tooth is thin and quite often has receded. This loss of support has occurred naturally, but obviously, it is not good. This same loss of support for the teeth can occur when too large of dental compensations have been made for the existing underlying problems, such as narrow dental arches or large skeletal discrepancies treated with braces only. Many times, the problems created will not become apparent until the patient is in his or her mid twenties or later.
PROPER FUNCTIONAL OCCLUSION
Did you know that every groove on the surface of every tooth has a specific purpose as related to how your jaw and teeth function in harmony? We have very specific and technical treatment goals concerning function. This encompasses not only the teeth but also the jaw joints and the supporting structures. We mount every patient’s models on a mechanical device called an articulator. This device is adjusted from careful measurements of each patient to reflect the relationship of the upper jaw to the jaw joints, and it mimics the movement of the jaw in the best jaw joint position. Another device records the jaw joint position within tenths of millimeters. The treatment plan needs to be made from the best jaw joint position and not how the teeth are habitually put together. If our goal is to complete treatment with the best jaw joint position coinciding with the best functional occlusion (bite), this diagnostic procedure is critical to success. Without a map, how does one know where one is going?
MAINTAINING OR ENHANCING FACIAL HARMONY
The wonderful thing about human beings is that we are all unique. What a boring place it would be if we were all exactly the same in every way! It is our goal to enhance (when necessary and if possible) one's facial harmony. For example, in some instances, teeth displaced due to habits, such as thumb-sucking, can have a negative effect on one's facial harmony. This, in most cases, is easily corrected and can make a huge improvement in the harmony of one's facial features as well as improve the function. In other instances, the upper and lower jaws may not be in proper relationship to each other, making facial features less than desirable. This too can be corrected to ensure the best function and facial features. In many, if not most, of the situations presented to us, we want to complete treatment and maintain the favorable facial features that already exist. In other words; we want to choose the best treatment approach that fulfills all of our treatment goals and leaves the patient looking like the same individual when we complete the treatment! This sounds simple, but the proper treatment approach is critical to the outcome when we are presented with significant dental discrepancies and yet the patient has good facial harmony.
IMPROVE OR MAINTAIN AIRWAYS
Having appropriate airflow through the nasal passageways and the posterior pharyngeal passageways is very important to facial growth and the individual’s general health. If the palate is narrow, the nasal opening will also be narrow, restricting the airflow. If the lower jaw is too far back, it can have a significant effect on the airflow in the posterior pharyngeal passageway. In some severe cases, this may be the primary cause of sleep apnea. Each patient’s airways will be evaluated, and this information will be important in determining the best treatment approach. We work closely with ENT physicians to assist us as necessary.
Every one of us has an innate idea of what makes a pretty or handsome smile. The good news is that form follows function. This means that if we get the teeth in the proper functional relationships, we are 90% of the way there. However, one size does not fit all. One's facial form (square, square tapering, tapering, etc.), the width of the soft tissue smile, lip posture, and other factors can significantly affect the aesthetics of the smile. Other factors, such as tooth discoloration, misshapen and chipped teeth, and the level of the gum line, can also affect the aesthetics of the smile. These factors will be discussed with you and your family dentist, and the appropriate referrals will be made to address these problems. Nothing serves one better throughout life than a wonderful smile!
When the comprehensive treatment is completed, we would hope for the best long-term stability. It is our goal that treatment will never need to be repeated. Many factors play a role here. If the treatment goals above are achieved, this goes a long way in ensuring good, long-term stability. Habits, such as tongue thrust, mouth breathing, and making large dental compensations for significant skeletal discrepancies, all have an adverse effect on long-term stability. We want what you want, which are the best results possible given your specific situation. This requires the best diagnosis, treatment planning, and patient cooperation possible. This is why we feel your initial examination appointment is undoubtedly the very most important. After this appointment, we can then agree on a mutually acceptable treatment plan with clear objectives. If there will be limitations of treatment, we can discuss these at the outset.