Class II, Div 1, Lower Jaw Advancement Surgery

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Some patient’s lower jaw is retrusive enough to require jaw surgery to correct their bite. Lower jaw retrusion is hard to diagnose when looking straight at a patient.

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Diagnosis of lower jaw retrusion is easier to do from the side photo. This patient’s chin is retrusive although in this photo she is posturing forward, somewhat.

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Intraorally, her upper teeth overlap the lower teeth more than they should. This is called a deep bite.

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Intraorally from the side, her front teeth are well ahead of the lower teeth. This is called excess overjet, although many people call it “overbite.” You can see the upper molar is well ahead of the lower. Ideally, the arrows should be in line.

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At the completion of treatment the front smile is similar to where we began.

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From the side, you can notice an improvement in the chin position.

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Intraorally, the deep bite has been corrected.

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Also, the “excess overjet” and alignment of the molars have been corrected.

Class II, Div 1, Congenitally missing two lower, permanent premolars

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This patient is similar to the previous case in that she has a retrusive lower jaw. Sometimes patients with this retrusion will show an extra fold of tissue under their chin on the front photo.

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From the side you can see her chin is retrusive compared to the upper jaw.

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Front dental view shows spacing between the upper teeth and malalignment of the upper and lower front teeth.

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The upper teeth stick out well past the lower teeth. Also notice the lower silver tooth. This is a retained baby tooth that has a stainless steel crown placed on it.

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The radiograph shows that our patient is missing both lower permanent second premolars (teeth under the stainless steel crowns).

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After surgery the extra fold of tissue is not present primarily due to the advancement of the lower jaw and liposuction of this area.

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Profile picture shows the advancement of the chin with the lower jaw surgery.

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Intraoral photo shows well aligned upper and lower front teeth.

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From the side photo the back bite is what is called a functional Class III occlusion since the lower space was closed and the lower molar brought forward.

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Radiograph showing space closure in the lower arch. One problem with this type of bite is loss of contact to the upper second molars. In this patient contact was established with the lower first molars to prevent extrusion of the upper second molars.

Braces

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We use the “Empower” bracket which is a self-ligating bracket manufactured by “American Orthodontics”, a company that prides itself in selling only “Made in the U.S.A.” products.

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The top front braces can be the almost invisible ceramic brackets or metal brackets. Dr. Griffies only uses metal on the bottom teeth because ceramic brackets have the potential to cause wear to the top teeth if they rub together.

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Take a look at the brochures to understand the advantage of using a “self-ligating” bracket for your orthodontic treatment.

 

Lower Lingual Arch

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The lower lingual arch is used both as a Space Maintainer in young patients without all of their permanent teeth and an “anchorage” appliances in patients with full braces.

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This patient presents with upper spacing and minimal overlap of the upper and lower front teeth.

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In the upper arch the second premolar teeth are blocked from the arch and require removal.

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From the side the back molars occlude in a good Class I relationship (we want them to stay just like this). In order to obtain a good bite the lower front teeth need to be moved back under the upper front teeth. With removal of one tooth on either side the canine teeth will be moved into the place of the first premolar and the lower front teeth brought back.

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To keep the lower molars from moving forward we use a Lingual Arch to anchor as anchorage.

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Finished treatment

 

Space Maintenance using the Lower Lingual Arch

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This patient is missing two lower baby teeth and we are awaiting the eruption of the two permanent premolars. The lower left back molar will have a tendency to move forward and block the eruption of the premolars. The Lingual arch will maintain the space and prevent movement of the molar forward.

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Approximately 5 months later the two permanent premolars have erupted into place.

 

Nance Holding Arch

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The Nance Holding Arch is used both as a Space Maintainer in young patients without all of their permanent teeth and an “anchorage” appliances in patients with full braces.

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This patient presents with protrusion of her upper front teeth.

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The upper canine is forward of where it should be so an upper first premolar is removed and the canine brought back into position.

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This shows the Nance in place with a space available after removal of the tooth. The blue on the back molars is the “bite plate” which helps prevent the top teeth from hitting the bottom brackets and also opens the bite slightly to allow easier movement of the canine tooth.

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Here an elastomeric chain (power chain) is used to slowly pull the canine back.

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Finished treatment with all spaces closed and the canine in its proper position.

 

Space Maintenance using the Nance Holding Arch

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This patient is missing two upper right baby teeth and we are awaiting the eruption of the two permanent premolars. The upper right back molar will have a tendency to move forward and block the eruption of the premolars. The Nance Holding arch will maintain the space and prevent movement of the molar forward.

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Approximately 5 months later the two permanent premolars and the upper left premolar have erupted into place.

 

Palatal Expander

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The Palatal Expander is used to increase the width of the upper jaw to correct cross bites and expand a narrow jaw to the correct width.

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Expansion of the palatal expansion is accomplished using a small “key” to turn the middle jackscrew of the expander.

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This patient has both crowding and a narrow upper jaw.

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The upper teeth on the right are position to the inside of the lower teeth. This is called a posterior cross bite.

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The palatal expander is cemented into place and expansion started.

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Finished photo showing correction of both the crowding and right cross bite.

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Finished photo showing correction of the right cross bite.

 

Transpalatal Bar

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The transpalatal bar fits on the roof of the mouth and anchors the molars in place while the remaining teeth are moved with braces. The transpalatal bar can also be used to move the molars either to expand or turn.

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This patient presents with a gap between the upper front teeth and overexpansion of the back teeth.

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A transpalatal bar was placed and slowly constricted to correct the overexpansion of the back teeth.

 

Retainers

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A lower wire bonded to the inside of the lower front teeth maintains their position.

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An upper wire bonded to the inside of the upper front teeth maintains their position. Dr. Griffies recommends maintaining both the upper and lower retainers for a minimal of one year. They however can be maintained for longer periods to insure retention of the correction.

Clear-Retainers

Clear plastic retainers are also worn for the first year after treatment and then weekly there after. Unfortunately teeth will continue to shift as we age and the best way to prevent movement is to use a retainer periodically to insure shifting is kept to a minimum.

 

Anterior Crossbite

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Patient with a Cross Bite of the front teeth in the “mixed dentition” showing the beginning recession to the lower left front tooth.

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Treatment with 2X4 braces (2 braces in the back on the top and bottom and 4 braces on the front teeth, hence 2X4 braces).

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The blue cement on the top of the back teeth help to open the front bite to allow correction of the cross bite.

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Cross bite corrected

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Upper fixed retainer, the lower will have one as well which will be maintained until all of the permanent teeth erupt. They will then be removed to allow placement of the final set of braces to align all of the permanent teeth.

 

Open Bite with Oral Habits

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Patient with an Open Bite due to a thumb habit.

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The tongue fence appliance has a duel function of stopping the thumb habit and blocking the tongue to allow the front teeth to naturally close together.

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After 5 months of having the tongue fence in the front bite is almost closed.

 

Deep Bite

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Young patient in the mixed dentition with a deep bite (lower front teeth hitting the gums behind the upper front teeth).

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Deep bite corrected, now waiting for the remaining permanent teeth to erupt in order to start full treatment.

 

Underbite with Narrow, Upper Jaw

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Young patient in the mixed dentition with an underbite and narrow upper jaw.

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X-ray showing the beginning of an impacting upper left canine tooth.

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Palatal expander and bite plates (blue cement on molars) in place. Braces were placed on the top front four teeth approximately 2 months after the expansion was complete.

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Completion of the Interceptive treatment with both the front and back cross bites corrected.

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X-ray showing the new path of eruption for the upper left canine, no longer impacting since the palatal expander was able to create space for eruption of this tooth.

Early Loss of Baby Molar

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Occasionally a baby molar is lost early. If this molar is the last one in the arch the first permanent molar may move forward and block the eruption of the permanent second premolar as in this case.

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You can see on the radiograph that there is not enough space to allow the eruption of the permanent second premolar.

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With the use of braces the first molar can be moved back to create space for eruption of the second premolar. Preferably this should be accomplished before the permanent second molar erupts in.

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Photo showing a good Class I molar relationship and space for the eruption of the second premolar.

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Occlusal view showing eruption of the second premolar. This patient will be ready for full braces in approximately one year.

 

Gingival Recession

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The crossbite in the mixed dentition can push a tooth out of position and cause gum loss.

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The gum loss (gingival recession) can become severe enough for the tooth to loose support and possibly be lost.

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Braces were placed to correct the cross bite and this patient received a gum grafting procedure to lift the gum tissue back to the correct position.

 

Impacted Permanent Tooth

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If trauma occurs to a baby tooth before the permanent tooth erupts it may delay or prevent the eruption of the permanent tooth as it did in this young man.

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Notice this patient is in the mixed dentition however the significant delay in eruption of the permanent central incisor necessitates early treatment.

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Limited braces are placed to allow forced eruption of the permanent tooth once a brace is placed under the gums.

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Impacted front tooth in place, now awaiting eruption of the remaining permanent teeth in order to start comprehensive orthodontic treatment.

 

Adolescent Class I, Crowded

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The most common malocclusion we treat is the Class Ⅰ crowded bite relationship.

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The Class Ⅰ notation indicates the position of the first molars in that the upper first molar is slightly behind the lower first molar.

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This patient had four first premolars removed to eliminate the crowding and allow alignment of the teeth.

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Finished front photo

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Finished side photo showing closure of all spaces.

Adolescent Class II, Div 1

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A patient with a Class Ⅱ div 1 malocclusion.

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Notice the Class Ⅱ molar (upper molar ahead of the lower).

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This patient was missing the two lower permanent second premolars. The two baby teeth remaining have not erupted as the other teeth have. In this patient these two lower baby teeth were removed and the upper first premolars removed to allow the upper front teeth to be moved back to meet the lower front teeth.

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Finished treatment photo.

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Finished Treatment photo from the side.

Adolescent Class II, Div 1- Example 2

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Another common malocclusion seen is the Class Ⅱ patient where the lower teeth are situated behind the upper teeth.

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The upper teeth stick out past the lower. Many people call this an “overbite”.

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In this patient Dr. Griffies decided to remove two upper first premolars to allow the front teeth to be moved back to meet the lower front teeth.

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Finished treatment photo.

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Finished treatment showing a “functional” Class Ⅱ bite.

Adolescent Class III, treated with extractions

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This patient presents with a Class Ⅲ bite and crowding.

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From the side you can see the lower molar is far forward of the upper molar.

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The upper second premolars and lower first premolars were removed to allow correction of the bite and elimination of the crowding.

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Finished treatment photo.

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Finished Treatment photo from the side.

Adolescent Class III with underbite

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The underbite is evident in this patient

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To correct the underbite and allow the lower front teeth to be moved back behind the upper front teeth one lower front tooth was removed.

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Finished treatment. In order to gain proper alignment of the upper and lower front teeth the upper front teeth will require reshaping to reduce their width.

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Finished photo from the side.

Deep Bite

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The deep bite malocclusion is very common. Our concern is the possible trauma the lower front teeth can cause to the gum tissue behind the upper front teeth.

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From the side you can see another concern and that is the possibility of the upper front teeth causing the gum tissue on the lower front teeth to recede down.

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Braces along with a bite plate have improved the deep bite.

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Finished photo from the side.

Extra Teeth

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Some people are born with extra teeth which we call supernumerary teeth.

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This patient had one extra lower front tooth.

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This lower front tooth was blocking the eruption of the permanent canine tooth.

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The extra tooth was removed and the canine brought into the arch.

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Finished radiograph showing the removal of the extra tooth.

Impacted Teeth

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Teeth that do not erupt and remain in the bone of the jaws are called impacted teeth.

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This patient has an impacted canine tooth with a retained baby tooth.

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Radiograph showing the impacted canine tooth.

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After a small surgery a brace is placed on the impacted tooth to allow eruption of the impacted tooth.

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Treatment completion with the canine in place.

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Final radiograph showing the canine in place.

Missing Teeth

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This patient is congenitally missing the two upper lateral incisors

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Radiograph showing the missing lateral incisors.

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Finished treatment using the canines as lateral incisors

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This patient was also missing the two upper lateral incisors.

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Radiograph showing the two missing upper lateral incisors.

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Space was developed for replacement teeth.

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Retainer in place with plastic replacement teeth.

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Retainer in place. Once the patient has finished growing (around the age of 18 for girls and 21 for boys) a permanent bridge or implant will be used to replace the missing tooth.

Spacing

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Spacing is a commonly seen problem.

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Once the space is closed often times a small gum procedure is required in order to keep the space closed. Also permanent retention is recommended to maintain the space closure.

You’re never too old to benefit from orthodontic treatment.  Orthodontic treatment can help correct crooked teeth or spaces that you’ve been self-conscious about for years.  It can give you the confidence and pride that comes with straight teeth and a great smile.

Problems to watch for in adults

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Anterior Crossbite

Top teeth are behind bottom teeth.

02-spacing

Spacing

Gaps between teeth

03-crowding

Crowding

Teeth are out of alignment due to lack of space

04-open-bite

Open Bite

Front teeth do not meet when back teeth are closed.

05-protrusion

Protrusion

Upper teeth stick out beyond lower teeth

06-impacted-tipped-missing-teeth

Impacted/Tipped/Missing Teeth

X-ray shows problem areas

07-periodontal-problems

Periodontal Problems

A bad bite can contribute to gum recession & loss of support for teeth.

08-tooth-wear-bruxism

Tooth Wear/Bruxism

 

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Class II

 

11-vertical-problems

Vertical Problems

 

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Class III

 

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Images and captions, courtesy of the American Association of Orthodontists.

Straighten-up Orthodontics

910 878-5796

301 Birch St

Raeford, NC 28376

 

Seven Lakes Orthodontics

910 673-0820

1064 Seven Lakes Dr

West End, NC 27376