Adolescent Treatment

adolscent treatmentThe most common time for orthodontic treatment is between the ages of 11 and 15, and for good reasons. By this time, most if not all of the permanent teeth have erupted and are in place. Crooked teeth and bad bites can easily be detected. These problems will not correct themselves. This is the best time to seek orthodontic treatment.

Kids at this age feel braces are cool! It is common for adolescents in this age range to undergo orthodontic treatment, so they are easily convinced to wear braces. We have all heard of the terrible twos, there is also the terrible teens!  Early in adolescense is when young people are most cooperative. It is this cooperation that allows orthodontic treatment to finish in as short a time as possible.

Most importantly, children at this age are growing rapidly, and orthodontists can take advantage of  this accelerated growth  to help shape the bite and teeth correctly.

Overbite Correction


Growth  works in our favor with the correction of overbites. Before we discuss how to correct an overbite, let's first consider why some patients have them.

Most patients and parents think of braces as moving and aligning teeth, however, there is one additional aspect to orthodontic treatment that is often not noticed. This is the relationship of the jaws to each other. It is very significant, because the orthodontist has a much harder time influencing this skeletal relationship, and it is this relationship that is fundamental in creating a beautiful smile and facial balance.

A small lower jaw often creates the appearance of an overbite. At times the upper teeth protrude forward and the chin appears retruded and out of balance with the rest of the face. Fortunately for many young people, the lower jaw has a spurt in growth during the adolescent years.



It takes more than braces to take advantage of this growth spurt. When you carefully examine how braces work (see animation on Now That You Have Braces), you will notice that there is nothing connecting the top braces to the lower. While we use elastics between the teeth, they are not sufficient to correct a dramatic overbite.

To correct an overbite, it is necessary to use something in addition to braces. One method is the Forsus. In the Dolphin Imaging animation above, the action of the Forsus is illustrated. The effect is both to protrude the lower jaw forward and to retract the upper teeth back. For years headgear has been used, but it is often so challenging that many young patients do not find the time or discipline to be successful with it. The Forsus is a reasonable alternative to this. It is fixed in the mouth and therefore has a greater probability of success. It is also reasonably comfortable to wear and not readily noticeable.

It is important to note that adolescence is the best time to correct an overbite. Without growth, overbite correction becomes more difficult and  often requires a surgical procedure to correct.

Extraction vs. Non-Extraction


The decision to remove permanent teeth is one that the orthodontist makes based on multiple variables. It is not obvious by just looking at the teeth. My goal is not to remove permanent teeth unless absolutely necessary.The decision is made by examining the balance of the lips to the chin and nose as well as the overall facial relationships.

The decision is not always simple. Considering just the teeth alone can result in a very poor outcome. The need to consider other aspects of the face as well as consider the consequences of growth result in a complex evaluation.

So when might it be necessary to remove teeth? Let's first look at a case, below, that involved no extractions. Looking at the teeth alone you would say that there is not enough space and extraction was needed. This, however, was not necessary.

The Dolphin Imaging animation illustrates when extraction of permanent premolar teeth may be necessary. First, there is obvious crowding. However it was just shown, in the previous case, that this alone is not always an indication for removing teeth.

The other factor is poor lip balance, represented in the animation by a protrusion of the lips. To effect this, it is necessary to remove four premolar teeth: two upper and two lower. At the end of treatment, the teeth are straight, the lips are pleasantly balanced and the spaces are closed.

The second case below is an extraction case. Notice how similar the result is, both patients have beautifully straight teeth!


Click on the photo to view the different phases


Non-Extraction Initial

Finished Non-Extraction

Non-Extraction Initial

Finished Non-Extraction

Extraction Initial

Finished Extraction

Extraction Initial

Finished Extraction

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