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Frequently asked questions - Orthognathic classification
Retrognathia class II
My orthodontist tells me that he can avoid surgery by extracting two premolars in the upper jaw and closing the gaps orthodontically?
Some orthodontists certainly prefer not to send a patient to a maxillofacial surgeon for a lower jaw advancement. And so, they choose to extract two premolars in the upper jaw and retract the front orthodontically. This creates flat faces and virtually always compromises the facial aesthetics outcome.
The bottom line in a skeletal Class II 1 is always an excessively small lower jaw, not an excessively large upper jaw with too many teeth (or only in very exceptional cases). Please remember that the bottom line is bone, not teeth.
The bottom line in a skeletal Class II 1 is always an excessively small lower jaw, not an excessively large upper jaw with too many teeth (or only in very exceptional cases). Please remember that the bottom line is bone, not teeth.
Open bite
People say that open bites are caused by thumb sucking. Is that correct?
Many people think that open bites are caused by thumb sucking and/or pacifiers. Those habits are universally present. The truth is that those open bites close as soon as the habit stops. That is why well over 90% of open bites in children resolve themselves with no external help at all.
Is an open bite caused by tongue-thrust?
A skeletal open bite is a developmental disorder and is hardly ever provoked by bad habits. Tongue thrust (protruding tongue while speaking or swallowing) is present in most open bites. However, the tong-trust is not the cause of it. The tongue simply takes the extra offered space.
Why am I unable to close my mouth naturally and properly with my open bite?
A natural mouth closure is difficult in open bites. For a normal lip closure we use the upper lip muscles. In open bites excessive help from the lower lip muscles is needed in adjunct. This creates a restless and dimpled chin.
Can an open bite be corrected simply by orthodontics without surgery?
Correcting an open bite by orthodontics without surgery tends not to give a permanent result and leads almost always to relapse. As soon as the correcting forces offered by the braces with elastics are removed, the teeth tend to go back to their original open bite position, almost like a spring. The golden standard for open bites is orthognathic surgery: Le Fort I.
What is an important point to ask the orthodontist in open bites?
For the surgeon it is important that the orthodontist aligns the upper teeth in one plane with the front teeth in extra vestibular tipping. Otherwise, the result is not as good as it could be (front teeth being too straight).
My orthodontist proposes to align the upper jaw in three levels. Is this okay?
Some surgeons certainly align the upper jaw in three pieces. This means the orthodontist must align in three levels, and the surgeon needs to cut between the roots of the teeth between the three pieces… It is a choice and a method, but Dr Defrancq prefers one piece surgery.
Transversal problems
Does SARPE (smile distractor) affect breathing in a favourable way?
One of the benefits of maxillary expansion with the smile distractor (Titamed®) is better nasal breathing and a favourable effect on snoring and sleep-apnoea. This is because the wider the palate becomes, the more the suspensory muscles of the soft palate become stretched. Furthermore, the lower cage of the nose becomes wider.
Does SARPE (smile distractor) affect the smile and any black corridors?
Broadening the narrow upper jaw in a stable and bony manner enhances greatly the overall aesthetics and, in particular, the smile of a person. The procedure fills up the black corridors near the laughing mouth corners. Hence also the name of the distractor: smile distractor (Titamed®).
My orthodontist wants to use a hyrax after the SARPE instead of a bone borne device such as a Smile Distractor. Is this okay?
An major disadvantage of the hyrax is that mouth hygiene is difficult during the five to six months that the device should be in the mouth. And so, they often cut down the necessary time for this reason. Another major disadvantage is that during the time (six months) the device is in place orthodontics are impossible, since the device is tooth bearing. Cutting on the time frame makes the hyrax device even more unpredictable. Most importantly, the hyrax is fixed onto the upper teeth. All forces are applied directly to the teeth, and only indirectly to the bone. Therefore, this device often causes flaring of the teeth. This flaring of the more posterior teeth is cumbersome, since the final result becomes much less predictable and relapse is never far away.
From what age onwards do you recommend a smile distractor?
To perform a SARPE safely, the definitive teeth should be in place. If teeth still have to descend, then their roots can get damaged by the surgery, especially the canins. Practically, and after a mouth examination, 12-13 years old.
My daughter is seven years old and the orthodonist wants to apply a hyrax in order to widen the upper jaw?
Most probably this is a good idea since at that age the bone of the palate is not yet fused and can be distracted slowly. The mechanics are different. SARPE is in essence an RPE (rapid palatal expansion). The activation is 0.5mm a day. The Hyrax is an SPE device (slow palatal expansion) for young children 6-7-8 years old and is activated 0.5mm a week.