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Orthodontics, now known as maxillary orthopedics, did not come into the sphere of medical interest until the 30th century. As a separate specialty in dentistry, it was distinguished in the XNUMXs and called dental orthopedics, and soon the name orthodontics appeared, from the Greek “ortos” – straight and “odus” tooth.
Prof. Dr. Marian Zeńczak in 1026 founded the first Orthodontic Department and Clinic in Warsaw at the State Dental Institute in Poland. This field deals not only with the teeth, but with defects in the structure of the dental arches and the interdependencies between the structure of the arches and the structure of the craniofacial elements. Orthodontics is commonly believed to be associated with the structure and mutual adjustment of the dental arches. The correct arrangement of the dental arches is based on the fact that all the teeth in the maxilla and mandible have direct contact with each other, and the upper incisors overlap the lower one 1/3 of their height.
A malocclusion is a departure from this situation. And yes; vertical changes consist in the fact that the teeth overlap too deeply, position themselves straight ahead, or even in certain sections do not touch each other at all. We are dealing then with a deep, straight or open bite. Lateral defects involve the teeth or the entire lower jaw moving backwards. We are talking then about a back-bite or back-bite. Frontal defects are undershot or front jaw. One should add here crowding, rotation (i.e. rotation of the teeth along their long axis), tilt, overbite (tilt), i.e. changes in the position of the long axes. When the axis of symmetry, i.e. the line between the central incisors in the maxilla and mandible, does not match, we speak of deviation, i.e. deviation. It can be both the maxilla and the mandible. When the axis of symmetry in the maxilla lies in the center of the face and the mandible is displaced, it is considered a deviation of the mandible (right or left). The displacement of individual teeth or entire sectors in relation to each other in the arch is a cross bite. However, if the displacements are so significant that the premolars or molars do not contact each other, or they only touch the side surfaces, we are dealing with an overhang (the teeth simply hang next to each other). These basic types of defects have their own definitions when they concern a single tooth, entire arches, right or left side, etc.
The defects rarely appear singly. The deep bite itself may not result in significant changes in the function and aesthetic appearance of the patient. In combination with an overshot or back bite, it causes dysfunction and significantly worsens the profile, and thus the aesthetics of the face. The lower incisors lose contact with the upper incisors, therefore they grow into contact with the palate mucosa, there is pain when biting and chewing, and the chin is shortened outside, i.e. the chin is small and the nose becomes prominent. We have the so-called “bird profile” (type of beak) – This arrangement causes a large dysfunction when chewing food, and also causes deep complexes against the background of your own appearance.
The straight bite slightly lengthens the chin section, without disturbing the appearance or function too much. The mandible, however, stops growing at the latest, so if a young woman becomes pregnant, an undershot bite may develop. In turn, the teeth wear with age, then the mandible moves up and forward, deteriorating the profile. Sufficient profile is the chin protruding and raised high. The young girl looks like an old lady. It is even worse when the straight bite goes hand in hand with the open bite. This results in a significant elongation of the chin section, a significant deterioration in function and aesthetics.
Overshot bite often disrupts function, but the front jaw is always dysfunctional and always disfigures the face.
Malocclusion may be the result of disturbances in the development of the face. There can be many causes, but most often they are genetic. In risk groups, they can be recognized and tracked in utero. After birth, we can recognize structural defects by the mutual arrangement of the maxilla and mandible. From the moment the first teeth erupt after the incisor system and then the next emerging teeth. We can also assess premature or delayed eruption of these teeth.
It is difficult to determine the date of treatment, because immediately after birth, development can be shaped even by appropriate positioning of the child to breastfeeding. We can use bottle feeding by arranging it appropriately. In the case of pronounced undershot bites, the bottle should be administered “from the top”, forcing the extension and accelerated development of the lower jaw. In the case of an undershot mouth, the bottle must be given “from the bottom”, for example by placing it on the child’s breast.
With a tendency to suck the finger, we can use, among others. gloves, various flexible plates (suitable pacifiers).
Failure to take countermeasures during this period always leads to more serious disadvantages. One of the basic activities that parents should implement in the period of milk teeth is the administration of food with a consistency that requires careful chewing. Such a procedure leads to a habit that causes the correct development of the alveolar processes and prevents the occurrence of most malocclusions and prevents the development of caries, because the teeth are then better mineralized.
This fact was confirmed at the conference on the problems of caries prevention in dentistry organized by the Ministry of Health in April in Warsaw. Bow. stom. Teresa Fehrenbach presented the concept of group prevention for preschoolers in Hesse (Germany). One of the elements is organizing the so-called “Crispy breakfasts” in kindergartens. They are based on hard vegetables, properly dressed, in a form that children associate with toys. e.g. a carrot shaped into a car (4 slices of carrot, 2 matches and a carrot) …
The sooner we start the therapeutic procedure, the better, because you can still use simple and effective methods, such as increased sleeping position in the form of applying a small “cushion” to the pillow, so that it protrudes slightly above the head. This causes the head to tilt forward slightly and the lower jaw protruding. For the youngest, we use exercises in the form of fun, e.g. blowing on our own hair, holding an ice-cream stick or a wooden laryngological spatula in the lips. In case of undershot bites, the habit of keeping the lower lip on the incisors and touching it lightly with the upper incisors is checked, but you cannot use a “cushion” or any head-lifting wedges, i.e. use the so-called flat pose for sleep. Make sure your baby does not curl up asleep. If this is the case, try not to let your chin tuck into your chest at least.
In the case of negligence, the treatment with apparatus remains. Depending on the type of defect, in the initial period, simple factory braces can be used, such as a vestibular plate in the case of overshot bite and deflection of the upper incisors, and in the case of undershot bite the cap with a chin lift, often in combination with an inclined plane, which guarantees that the lower teeth will slide under the upper teeth and these in turn will slide forward along that inclined surface.
Congenital defects and some acquired defects resulting from various accidents or diseases are treated surgically. It is a department of maxillary orthopedics. Apart from surgeons, orthodontists, speech therapists, phoniatrists and sometimes psychologists often cooperate here.
Defects that could not be healed by simple methods, as well as those that are a consequence of neglect, are treated with removable or permanent braces. Treatment with removable appliances can be extremely quick and in many cases very effective. The key to success is the patient’s attitude and the correct concept of the apparatus. In the case of fixed appliances, the role of the patient is limited to maintaining hygiene. It is not possible to choose a better or worse method without considering an individual case.
It should be taken into account, however, that in the case of fixed appliances there are constant forces which, if they are wrongly selected, can cause pain and unfavorable changes in the periodontium and bone around the roots, and even root resorption. In order to properly select the forces, it is necessary to have experience and use appropriate dynamometers to give the appropriate tension to the moving parts of the apparatus and to match the strength of their operation to the physical structure of the patient.
In general, it can be stated that in the case of defects related to genetic accretions or parafunctions (parafunction is an incorrectly performed physiological activity, e.g. swallowing, but with the tongue sticking out between the teeth or continuous breathing with the mouth), the most important is to unlearn from these parafunctions and develop appropriate corrective habits.
Mieczysław Król
Dentistry doctor
Ciężkowice
Polish Smile Association