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orthodontic problems

Orthodontic problems
Fabio Savastano, M.D., M.S. Orth
Orthodontics or more specifically orthognathodontics is the branch of dentistry that studies and corrects teeth malpositions, both from aesthetical and functional viewpoint, so that our mouth has not only a beautiful look but also a "functioning" occlusion. The conformation of face bones and the size (sometimes the number) of teeth are common problems associated with the need for orthodontic care. Maxillo-facial surgery is sometimes the only issue to the solution of this problem. As already seen elsewhere in these pages, improper alignment of the dental arches may be a primary cause of gnathologic problems and Mother Nature, too, may force our mouth to a physiologically distorted adaptation, resulting in pathologic disorders .
A correct mastication model shall respond to the following three basic principles:
1) The upper molars and premolars shall overlap the lower by about half a tooth.
2) The upper central incisors shall overlap the lower by about 1/3 of their height.
3) All teeth of the upper and lower jaws shall meet with two antagonists, i.e. the teeth of the opposite arch. Just like the bricks of a wall, probably providing more stability to the "palissade". .
A proper centric occlusion shall have the following features: the upper teeth slightly externally overlapping the lower and the incisors overlapping their antagonists by about 1/3. Each tooth shall meet with two teeth of the opposite arch.
Deep bite occurs when the upper incisors deeply - sometimes completely - overlap the lower and are bent backward. This situation may affect jaw movement, forcing the mandible to recede.
Deep bite also occurs when the upper incisors deeply - sometimes completely - overlap the lower and are projecting. This situation inhibits closing the lips and forces the tongue to an abnormal activity whenever saliva is swallowed.
Open bite occurs when there is much space between upper and lower incisors. Besides making lip seal impossible, this disorder also involves "infantile" swallowing, in which the tongue pushes violently against the front teeth, probably in an attempt to find a closure providing the depression required for swallowing.
Dental crowding: this "disorder" usually stems from a discrepancy between space available in each jaw and the size of the teeth. Apart from the fact the "one-to-two teeth" contact is missing and causes a real occlusion instability, there is poor specific dental function.
In this case, the right canine guide is missing whereas the left is reversed. These conditions may well be predisposing factors for bruxism and mandibular joint overload. The muscles of mastication are tense.
Edge-to-edge occlusion occurs when the "one-to-two teeth" contact is missing, which causes an unstable occlusal contact. Many patients refer that they feel like "standing on eggs". Frequently the patient has the impression not to fit a stable bite and attempts to compensate
the problem by wedging his/her tongue so as to form a sort of resting pad. It ensues that its border becomes indented and exhibits the impression of the teeth. Swallowing is abnormal and associated with a severely altered and tense facial musculature.
Dental extrusion: occurs when antagonist teeth are since long missing and the remaining, which do not meet with anything, have grown to close the whole existing space and sometimes touch the gingiva of the opposite arch.
Under these conditions, the posterior masticatory plane - which is a real support for the joints - is completely missing. This will result in compression, early wear and derangement of the disk. The ipsilateral face muscles are particularly tense and overstrained.
Embedded dental extrusion: it occurs when antagonist teeth are since long missing and the remaining, which do not meet with anything, have grown embedding in the opposite mucosal area.
Under these conditions, the range of masticatory functional movements of the mandible is severely impaired. This will cause an abnormal muscle contraction which will restrain jaw movement, to prevent it from hitting against the adjacent teeth. The face muscles are particularly tense and overstrained

Monolateral cross-bite occurs when there is an abnormal reversed occlusal relationship on one side. This will result in a deviated smile midline and quite often the mandible deviates, too.

The figure shows a deviation to the right. This problem may easily cause joint overload on the deviated side and asymmetric muscular contracture. Visually, the chin, too, deviates to the right.
Bilateral cross-bite occurs when there is an abnormal reversed occlusal relationship of teeth on both sides, except for the two front incisors of the upper arch.
The result is that symmetry may be maintained but the "scissors-type" occlusion will limit the range of functional movements of the mandible and cause spasm to the facial muscles.
Autotest problemi Ortodontici
Do you have a deep overbite with retruded incisors?
Do you have a deep overbite with protruding incisors?
Do you have an open bite?
Do you have severe dental crowding?
Do you have an edge-to-edge occlusion at least monolaterally?
Do you have a dental extrusion in the posterior quadrant?
Do you have an embedded dental extrusion?
Do you have a monolateral cross-bite?
Do you have a bilateral cross-bite?
Do you have a "scissors" tooth?    
Examine these figures carefully and answer the above questions. If you identify yourself in at least two of these situations, you are probably affected by a tooth borne gnathologic disorder. If your answer to either question is YES, you might be more predisposed to gnathologic disorders than a person with no malocclusion problems. This might be related to temporomandibular joint disorders like popping, clicks, locks, restricted opening, stuffed ears, vertigo or head and neck pains, such as headaches, wryneck, cervical pain.

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