In the world of dentistry it is important to differentiate the concept of orthodontics and orthopedics, as many patients tend to confuse them. Most patients call orthodontics everything that involves placing an appliance in the mouth, which is not the case. There are specific appliances that are used when the child is growing, that is, when the objective is to mobilize the bone. This is what we call orthopedics.
If the patient’s mandible is in a more delayed position than the maxilla (bone class II), it will be necessary for the patient to wear a mandibular advancement orthopedic appliance to achieve harmony between both bones (maxilla and mandible), and thus correct this decompensation.
If, on the other hand, this decompensation occurs when the upper jaw is further back than the mandible (bone class III), for this type of patient an orthopedic appliance will be necessary whose function is the forward traction of the upper jaw, in order to achieve balance between both bones (upper and lower).
However, orthodontics is a treatment that can be carried out at any age, since its purpose is to move teeth and, in this case, it is not necessary for the patient to be growing. It consists of the traditional treatment with braces.
Most of the time, children usually go through a previous orthopedic phase and, once this is finished, the orthodontics (brackets) are placed. At other times, only multibracket treatment is necessary, so there is no rush to begin treatment.
Orthopedics for bony Class III malocclusion
It is important to diagnose and treat Class III patients at an early age, specifically before the age of 6-8 years, which is the time when the maxillary sutures close.
Early treatment of these children has a high success rate, achieving spectacular results. This treatment consists of the placement of a facial mask.
The facial mask consists of:
- A stem with two pads, one on the front and one on the chin passing through the midline of the face, connected between them with a transverse iron.
- A maxillary splint which can be an upper rigid appliance or a Hass or Hyrax type expansion screw, anchored in the maxillary first molars, made of stainless steel wire with an adjustable anterior arch and hooks at the level of the canines to traction the maxilla.
- Elastics that are changed every day until the end of the treatment. They should be worn at least 12 hours a day, although ideally they should be worn as much as possible.
At each check-up the displacement of the maxilla and the force exerted by the rubber bands are controlled. It is necessary to bring the child for periodic check-ups and monitor each case individually.
Orthopedics for bony Class II malocclusion
It is important to treat these patients, who in most cases present a delay of the mandibular position, orthopedically in the growth phase.
Treatment of children at their peak growth is ideal, and mandibular advancement appliances are used, such as the Twin-Block, which redirects the mandible to a more forward position.
The Twin-Block consists of two appliances that are articulated by means of a 70° ramp. It is a removable appliance that, in order for it to work properly, should ideally not be removed 24 hours a day, except only and exclusively when brushing teeth.
At the beginning it is difficult for children to get used to it, but after a few days they get used to it without any problem. It is usually worn for six months if the right time of growth is chosen by means of a carpal (hand) X-ray.
It should be noted that it is always necessary to bring the child to the dental specialist for periodic check-ups and to monitor each case individually.