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Orthodontic Treatment Sequence

Orthodontic treatment is very predictable and extremely successful with good patient compliance.  Depending on the severity of the malocclusion (bad bite) or irregularity, orthodontic treatments usually follow the sequence below..

The benefits of correcting misaligned teeth are many. Straight teeth are pleasing to look at and greatly boost confidence and self esteem. More importantly, properly aligned teeth enhance the biting, chewing and speaking functions of the jaw. There are several types of irregularities, including:

  • "Overbite" – The upper teeth protrude further than or completely cover the lower teeth. In dental terminology, this is actually called overjet.

  • "Underbite" – The lower teeth protrude further than the upper teeth causing the chin to look prominent. In dental terminology, this is actually called negative overjet. 

  • Crossbite – Some of the upper teeth may close inside the lower teeth rather than on the outside. This can occur in the front or in the back, or both. If it is in the back, it can be on one side (unilateral) or on both sides (bilateral). If left untreated in the back, it can cause jaw growth to deviate (shift), resulting in a jaw that curves towards one side.

  • Crowding – Insufficient room on the arch causes some adult teeth to erupt incorrectly, growing off towards the cheek or tongue. Sometimes, the teeth can cause damage to another permanent tooth as they erupt and patients can lose a permanent tooth. In some cases, permanent teeth can become impacted, where they can't erupt at all. 

The Sequence of Orthodontic Treatment

Treatment time varies depending on the needs of each patient. Some cases requiring minor intervention may be finished within six months, while more extensive cases requiring expansion, braces, and alignment of the jaws can take years.

Here is a general overview of the three major stages of treatment:

Phase 1 – The Planning Stage

Dr. Renzi and Dr. House makes a diagnosis in order to realign the teeth in the most effective and expedient way.  The first several visits may comprise of some of the following evaluations:

  • Medical and dental evaluations – Dental and physical problems tend to go hand in hand.  Problems in the oral cavity can lead to (or be caused by) medical problems.  The goal of this evaluation is to ensure that prior medical and dental issues are stable before treatment begins.

  • iTero 3D digital study model (castings/bite impressions) – At Orange County Pediatric Dental Group, we utilize state-of-the-art iTero 3D digital imaging for our study models. Patients  appreciate this technology as it avoids gooey traditional dental impressions. Study models enable Dr Renzi and Dr. House to scrutinize the position of each tooth, and how it relates to the other teeth.

  • Panoramic X-rays – X-rays are fantastic tools for viewing potential complications or pre-existing damage to the jaw joint.  Panoramic x-rays show the positions of the erupted teeth and roots, as well as the positions of all of the developing teeth and roots. 

  • Cephalometric x-ray and tracing – This x-ray allows Dr. Renzi and Dr. House to evaluate the relationship of the jaws and teeth to other bones in the skull. It helps them to evaluate if the orthodontic problems are dental, skeletal, or both. It also helps them to anticipate growth patterns (vertical vs. horizontal).Such images allow the orthodontist to treatment plan and examine how specific treatments may affect the shape of the face and symmetry of the jaw.

  • Photographs – Photographs are an important part of the orthodontic assessment. We are not just treating teeth. Our goal is to achieve harmony between the teeth, skeletal pattern, and soft tissue. It is also important to evaluate how the teeth align with the middle of a patient's face. 

Phase 2 – The Active Phase

All of the above diagnostic tools will be used to diagnosis and develop a customized treatment plan for each patient.  Next, Dr. Renzi or Dr. House will have a consultation with the family and recommend specific orthodontic appliances to achieve the desired goals.  This orthodontic appliance may be fixed or removable. Most commonly, traditional fixed braces are affixed, which utilizes individual dental brackets connected by an archwire.  In most cases, appliances are fixed (cemented or bonded) as compliance is usually inadequate for achieving desired results with removable appliances.

Whatever the orthodontic appliance used, Dr. Renzi and Dr. House will regularly adjust it to ensure adequate and continual pressure is being applied to the teeth. It is essential to visit Orange County Pediatric Dental Group at the designated intervals and to call if any part of the appliance becomes broken, loose, or bent. Keeping regular appointments will help to ensure that treatment is completed in the suggested time frame. Repeated breakage of appliances will prolong treatment time as we can't move forward as quickly as we normally would.

Phase 3: The Retention Phase

When the teeth have been correctly aligned, fixed braces and removable devices will be removed and discontinued. The most extensive of the orthodontic treatment is now over. Dr. Renzi or Dr. House will next create a custom retainer. Patients enjoy these because they can choose fun colors and designs. The goal of the retainer is to ensure that the teeth do not begin to shift back to their original positions. Retainers need to be worn for day and night for the first 18 months. This is critical, because the teeth will shift back into their previous position rapidly until the bone stabilizes around the teeth.  Patients who wear their retainers as recommended find them to be comfortable and their speech adjusts rapidly. 

If you have any questions about orthodontic treatments, please contact our office.