Patient Education

Seligman Orthodontics

Common Problems

Phase I

Class II

Class III

Pseudo Class III

Crowding

Spacing

Deep Incisor Overbite

Openbite

Excess Gingival Display

Posterior Crossbite

Phase I

Phase I treatment is also known as early intervention and is a treatment technique applied to patients usually between the age of seven and years old when the patients still have a mix of permanent and primary teeth. The objective of Phase 1 treatment is to establish the foundation for dental and facial development as all the permanent teeth erupt. Phase I treatment can be used to correct a series of issues including a narrow upper or lower jaw or a cross-bite.

The doctor can also use phase I treatment to create the necessary space for the permanent teeth to erupt, therefore guiding the teeth into the correct positions. The second phase of treatment takes place after the permanent teeth have all erupted. In the majority of cases, the implementation of Phase I treatment will lead to a shorter treatment time and less invasive treatments required.

Class II

Class II problems describe a type of abnormal bite where the upper jaw and teeth protrude forward of the lower jaw and teeth. Patients with Class II problems usually have a recessed chin, these problems are typically genetic in nature.

A skeletal Class II problem describes a situation in which the upper back molars are in front of the lower back molars. This causes the patient to appear to have a recessed lower jaw or a protrusive upper jaw.

Class III

Class III problems are typically caused by genetic issues. In this type of problem, the lower jaw and teeth are situated in front of the upper jaw and teeth. The lower jaw in this case looks overly large in comparison to the upper jaw. However, in most Class III cases, the upper jaw is underdeveloped. Today, many treatment options can be used to treat a Class II or III problem.

Pseudo Class III

A pseudo Class III is caused by a bad habit and is not the result of a genetic malformation. A misaligned bite can lead to the lower teeth biting forward of the upper teeth exhibiting the appearance of a Class III problem. In this case, Phase I treatment is recommended to prevent abnormal growth of both the upper and lower jaws.

Crowding

Crowding is easily the most frequent orthodontic problem. The most common root cause of this orthodontic problem is easy to explain, the jaw is not big enough to accommodate the size of the teeth. However, this problem can also arise when there is a cross-bite of the front or rear teeth.

Crowding is typically part of a more complex case of orthodontic issues because crowding itself leads to other problems such as impacted teeth and retained teeth (baby teeth that do not naturally fall out).

Spacing

This common orthodontic issue is characterized by spaces between the teeth. Similar to the case of crowding, the spacing is caused by inappropriate tooth-to-jaw size proportions. Differences from the norm in teeth size including smaller teeth and abnormally shaped teeth can be responsible for creating spaces between the teeth. Spacing can also occur between the front and back teeth.

Deep Incisor Overbite

A deep bite or overbite involves uncontrolled vertical overlapping of the front teeth. This malformation typically occurs when upper and lower jaws are different in sizes. This problem usually comes with an excessive eruption of the upper and lower incisors.

Openbite

An openbite can be classified as anterior which involves the front teeth or posterior which involves the back teeth. An anterior openbite is usually caused by jaw disharmony or bad habits including thumb-sucking or thrusting of the tongue. A posterior openbite is when the back teeth do not meet vertically, therefore, preventing the jaw from functioning properly.

Excess Gingival Display

This malformation is simply a smile with a lot of the gum exposed on the upper arch. This condition is very treatable, depending on the severity surgery may be necessary. During surgery, a section of the upper jaw is removed causing the jaw to shift upward vertically, therefore, reducing the amount of upper gum tissue that is visible.

Posterior Crossbite

A posterior cross-bite is normally caused by two issues: a narrow upper jaw or an abnormally wide lower jaw. A narrow upper jaw will lead the patient to moving their lower jaw forward or to the side when it comes time to close a bite. When closed, the lower teeth will end up outside the upper teeth.

A posterior unilateral cross-bite takes place when only one side of the jaw is affected. A bilateral posterior cross-bite will involve both sides of the jaw.

Common Questions About Orthodontics

What Is Orthodontics?
Orthodontics is a specialty within dentistry that focuses on the diagnosis, prevention, and treatment of dental and facial irregularities. The official name for these problems is “malocclusion” which in simple terms means bad bite. Orthodontics requires a highly specialized set of professional skills that allows the doctor to design, apply, and control corrective appliance to bring the teeth, lips, gums, and jaws into the proper balance to achieve facial harmony.
What Is An Orthodontist?
To become an orthodontist, the individual must first become a dentist, then complete an additional two to three-year residency program accredited by the ADA. During the program, aspiring orthodontists receive specialized training and experience to make their highly precise orthodontic work possible.
What Causes Orthodontic Problems?
Most malocclusions can be traced to hereditary conditions. However, some problems can also be acquired through bad habits. Problems caused by genetics include crowding of teeth, space between teeth, additional teeth, congenitally missing teeth, and a wide range of discrepancies of the jaws, teeth, and face. Problems acquired can be triggered by trauma, thumb or finger sucking, airway obstruction by tonsils and adenoids, dental diseases, and premature loss of baby or adult teeth. Whether they are acquired or genetic in nature, these malocclusions affect the alignment of the teeth and disrupt facial development and appearance.
How Do I Know If My Child Needs Orthodontic Treatment?
It is recommended by the American Association of Orthodontics to take your child to be evaluated by an orthodontist age 7. Most parents are not experts in orthodontics and will, therefore, find it difficult to identify orthodontic problems in children. Many problems can exist even when the teeth appear to be perfectly straight. Some orthodontic issues in children may resolve on their own with time while other problems will need intervention. A screening by a general dentist can provide some insight but it is recommended that you still seek the opinion of an orthodontist since he would be the most qualified to make a diagnosis.
What Are The Early Signs Of Orthodontic Problems?
We do not recommend that parents try to diagnose or determine if a treatment will be necessary. However, the following signs indicate that seeking orthodontic advice is urgent: crowded or overlapping teeth, gaps between the teeth, front top teeth not lining up with the bottom teeth, top front teeth not meeting with bottom teeth and top front teeth covering more than 50% of the bottom teeth. If you observe any misalignment or shifting of the jaw, your child could have a skeletal problem, which may require early orthodontic treatment to avoid invasive surgery in the future. These are the most obvious signs that there are orthodontic problems with your child, however, even with straight teeth, it is important to receive a comprehensive exam around the age of 7 to determine if the child currently needs treatment or will need treatment in the future.
At What Age Should My Child See An Orthodontist?
The American Association of Orthodontics recommends that every child be evaluated by an orthodontist by age 7. A comprehensive orthodontic exam at that age will allow the doctor to diagnose any existing issues and to determine the optimal time for treatment to begin if it is necessary. If orthodontic issues are detected early, you will be able to work with your doctor to determine the optimal time to start treatment, therefore, avoiding more invasive treatments and allowing your child’s smile to attain its full potential.
Can Adults Have Braces?
Absolutely! The best time to seek orthodontic treatment is right now. In general, adults in good general health who have healthy gums and good bone support for the teeth are candidates for orthodontic treatment. Approximately a quarter of all of our patients are adults and that number continues to grow.
Is Orthodontic Treatment Painful?
Orthodontic treatment is not painful but you may experience some discomfort after placement or adjustment of your appliances. The discomfort should only last for a few days and it can be alleviated with salt-water rinses and an over-the-counter pain reliever. Today, technological advances have made braces and other orthodontic appliances more comfortable than ever before. We consider it a duty to our patients to stay up to date with the latest technological advances to increase patient comfort and reduce treatment time.
What Is Phase I (Interceptive) And Phase II (Comprehensive) Treatment?
Phase I or Interceptive Treatment takes place when the child has most of their baby teeth and a few of their permanent front incisors. This means that Phase I treatment can typically begin between the ages of seven and nine. The objective Phase I treatment is to treat a moderate or severe orthodontic problem early enough to reduce or eliminate it. If the problem is not fully corrected in Phase I, the Phase II treatment will typically be less invasive and shorter than if Phase I treatment had not occurred. The problems eligible for phase I treatment include skeletal discrepancies, cross-bites, and severe crowding. Phase I treatment takes advantage of the developing jaw and mouth to reduce or eliminate the severity of a problem.

Phase II treatment typically takes place years later after waiting for the remaining permanent teeth to erupt, including second molars. This level of development is typically completed around the age of 12 or 13. The goal of Phase II treatment is to fine-tune the bite and smile with all of the permanent teeth.
Does Everyone Need A Phase I Treatment?
No, not every child is a candidate for Phase I treatment but those who are eligible can benefit greatly. Only some children with certain bite problems require early intervention. All others can wait until most or all of their permanent teeth erupt. However, it is still recommended that every child be evaluated by age seven to determine if they can take advantage of Phase I treatment.
What Is The Duration Of Orthodontic Treatment?
The total time it will take to complete treatment will vary but will usually fall within the range of 6-24 months. In some less frequent cases, treatment can be longer. The length of time is determined by several factors including the stage of dental development, the seriousness of the problem, the patient’s commitment, and the amount of tooth movement required to align the teeth.
What Is The Difference Between Extraction And Non-Extraction Therapies?
Both of these therapies are used to treat crowding of the teeth. Extraction therapy as implied by the name involves extracting one or more teeth to make room for the other teeth in the mouth. Meanwhile, non-extraction therapy makes room for the teeth by broadening the jaw or by adjusting the size and shape of some teeth to allow them to fit within the jaw. At Orthodontics New York, we believe in exploring non-extraction treatment options first and reserving extractions for only the cases where there are no other viable options.