Before and After

Anterior (front) Crossbite Actual Patient of Dr. Robison

This patient came to us with an anterior (front) crossbite, which happens when teeth erupt out of place in such a way that an upper tooth becomes positioned behind a lower tooth. Front crossbites happen more commonly when the developing teeth are crowded, but can happen even without crowding.

In planning treatment, each case is different, but I always try to develop a treatment plan that is simple, non-invasive, rapid, and economical. For this patient, rather than use significant measures such as a Rapid Palatal Expander or Braces, we used a simple ramp made of tooth composite to help the upper tooth “jump” the lower tooth using the patient’s own biting force. After just 6 weeks and 2 appointments, the crossbite was gone, the composite was removed, and no retainer was needed!

Missing Teeth Actual Patient of Dr. Robison

This patient was congenitally missing the left upper lateral incisor (a permanent tooth next to the two front teeth) and the right upper lateral incisor was severely undersized.

One option would have been to treat this patient in preparation to receive costly implants that would not be placed until she reached adulthood. Another option was to close the spaces by bringing all of the upper teeth forward and reshaping the upper canines to function as lateral incisors and use the first premolars to function as canines. After consultation with the parents, it was decided to close the spaces, reshape the canines and give her a beautiful smile with her natural teeth in less time and with less cost than getting implants.

Open Bite Actual Patient of Dr. Robison

Open bites are not only an aesthetic concern to patients, but can affect a person’s ability to eat and speak properly. Each openbite case is different and requires a thorough evaluation to determine the best course of treatment. In some cases, there are severe skeletal jaw issues that can only be treated properly with jaw surgery. However, in most cases, even when there are mild to moderate skeletal problems, we are able to resolve openbites with the newest clear aligner techniques, or the Damon System, often in combination with TADs.

In this particular case, the patient also had severe protrusion of her front teeth so she was treated with the extraction of four premolars. Although extractions are rare in my office, they are indicated in some cases such as this one.

Overbite Actual Patient of Dr. Robison

An overbite is when the upper teeth overlap too much of the lower teeth vertically. While it’s not aesthetically pleasing, my primary concern is the function of the bite. A deep overbite can lead to future problems with the teeth and gums. By using only the Damon System we were able to broaden the arches, align the crowded teeth, and resolve the overbite without the use of heavy appliances like a Rapid Palatal Expander or Headgear.

Overjet Actual Patient of Dr. Robison

Excessive overjet occurs when the upper arch is too far forward, the lower arch is too far back, or a combination of the two. Traditional treatment methods would have required headgear, multiple phases of treatment, or even surgery to correct. However, we were able to correct this patient’s bite and give her a great profile and smile using a Herbst appliance.

Protrusion Actual Patient of Dr. Robison

This patient presented as an adult with severe protrusion, a Class II malocclusion (bite), and a narrow upper arch with a crossbite on the left side. The protrusion and bite were skeletal in nature, which would have required jaw surgery in the past to correct. However, using just the Damon system and elastics - her bite and crossbite were corrected and, as a result, her smile and profile improved dramatically.

Severe Crowding Actual Patient of Dr. Robison

This patient presented with very narrow arches and severe crowding to the point that two of the patient’s lower teeth erupted behind the rest of the arch. Rather than doing extractions, we created room and lined up the teeth utilizing passive self-ligation system and techniques. We were able to expand the arches, align the teeth, and give this patient a nice broad smile with the Damon System – no extractions and no expanders. I believe that there is no amount of crowding that cannot be corrected without extracting teeth as long as doing so supports good facial balance. In other words, we extract for the face, not for the space. As a result, it is very rare that we recommend the extraction of permanent teeth.

Skeletal Asymmetry Actual Patient of Dr. Robison

Everyone seems to understand that no one is perfectly symmetrical. Therefore, it should not surprise anyone that asymmetries can occur in the jaws. In most cases we can compensate or camouflage the asymmetry with our advanced techniques. However, in some rare cases the skeletal asymmetry is so significant that jaw surgery is necessary to achieve a good bite and good function. Orthodontic treatment is typically required before jaw surgery because the teeth need to be placed in the correct position to fit together during and after the surgery. This patient had braces in preparation for jaw surgery. Currently, most surgical preparation is done using Invisalign.

Spacing Actual Patient of Dr. Robison

Although many seek orthodontic treatment to resolve crowded teeth, spacing can also be a concern. Besides being a significant esthetic problem, spacing can also lead to food impaction. In adults, we occasionally see spaces appearing where they did not exist before. This is often due to changes in the bone support of the teeth. Such was the case with the patient in this example. Once we verified that the teeth and gums were healthy and stable, we utilized passive, low-force mechanics with Invisalign , to successfully close her spaces. For patients that prefer Invisalign rather than the Damon System, I manage the Invisalign treatment mechanics to emulate the forces of the Damon system as much as possible. Doing so ensures that we can treat cases with braces or Invisalign with forces sufficiently light to facilitate movement without negatively affecting the bone support.

Underbite Actual Patient of Dr. Robison

An underbite is when the lower teeth protrude in front of the upper teeth. This can be caused by tooth related problems or jaw related issues. For this patient, it was a jaw related problem. Even when bite problems are skeletal in nature, and would have traditionally required jaw surgery, we actively avoid surgery in as many cases as possible by camouflaging the skeletal problems. We often do this using the Damon System in combination with TAD's to either retract the lower arch and/or protrude the upper arch. However, if the skeletal problems are to the extent that camouflage is not possible then orthognathic surgery is the most appropriate solution. This patient was treated with Invisalign followed by surgery on both jaws.

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