Dental Orthopedics

Dental orthopedics is the area of dentistry concerned with the structure, function, and alignment of the upper and lower jaw bones.  It is some times referred to as dentofacial orthopedics, craniomandibular orthopedics, or jaw orthopedics.  The term is applied to efforts to expand the size of jaw bones (vertical and horizontal), lengthen the upper or lower jaws, or reposition either the upper or lower jaw.

There are many appliances that are designated as dental orthopedic appliances like Crozats, Bimler, Schwartz, Bionator, Sagittal, etc.  Splint therapy, occlusal guards, and sleep apnea appliances  are also a form of dental orthopedics as they reposition the lower jaw.

The American Dental Association some years ago changed the official title of orthodontists from “orthodontic specialist” to “orthodontic and dentofacial orthopedic specialist” without substantially changing their educational requirements.  Hence, many orthodontists know very little about dental orthopedics and concentrate on aligning teeth with braces.  This treatment often falls short of the most ideal treatment.  Giving someone a pretty smile does not assure that their jaw is appropriately developed laterally, vertically, or positioned properly in space.  This has to be done with proper assessment (medical history and functional tests), and often appliances other than braces.

Before the proper orthopedic treatment can be rendered to a patient, it is necessary to have a good understanding of ideal structure and function.  This is missing in orthodontic training.  Research shows that modern man has devolved with substantial retrusion of both the middle and lower face.  Too many orthodontists are too willing to work with the structure that their patients present with since most orthodontic training programs impart a poor understanding of ideal structure and how to achieve it.

In addition, in order to provide proper orthopedic treatment, it is critical that the correct diagnostics are perfomed before treatment begins.  Before orthodontic treatment is initiated there are certain dental records that are required legally to satisfy the standard of care.  They include study models, photographic pictures, and dental x-rays and cephalometric x-ray (side view of head).  These are only structural tests.  This list does not include the critical functional assessment of where the muscles want the jaw to be, nor how much tension is in the muscles when the teeth are brought together, etc.

It is not surprising under such circumstances, why many patients end up after orthodontic treatment with significant dysfunction and TMJ pain.  Corrective treatment then is to do the dental orthopedic diagnostics that were never done.

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