"For some patients there are limitations to what cosmetic dentistry alone can achieve. This is where specialised professionals like orthodontists and maxillofacial surgeons come in."

Combination Dental Treatments

There are many ways to enhance a smile and to obtain facial harmony. Cosmetic dentistry, orthodontics, jaw surgery, cosmetic surgery, and non-surgical treatments may be used separately or in appropriate combinations to provide a winning smile, to support oral health, and to elevate facial elegance.

Posted: 11 July 12

Unfamiliarity with the range and apparent complexity of treatment options available may seem overwhelming, and the prospect of combined or accelerated treatments can make choices even more difficult. Becoming better informed about your options will help remove apprehension, and allow you to make educated decisions.

In this article we take a broad look at how dentists, orthodontists and oral and maxillofacial surgeons might help enhance your smile.

Cosmetic dentistry

Cosmetic or aesthetic dentistry is a broad professional category offering a variety of dental treatments to improve the appearance of the teeth. Cosmetic dentistry can refine your smile by renovating stained, dark, chipped and crooked teeth. Cosmetic dentists can also help repair damaged teeth and replace missing teeth.

Tooth whitening (bleaching), veneers, bonding, crowns (caps) and bridges, dental implants, dental fillings, and root canal treatment to restore teeth, are treatments available to the cosmetic dentist.

For some patients there are limitations to what cosmetic dentistry alone can achieve. This is where specialised professionals like orthodontists and maxillofacial surgeons come in.

Orthodontics

Orthodontics is the dental specialty that helps diagnose, prevent and treat dental and facial irregularities called malocclusions. You may need an orthodontist if you have overcrowded or missing teeth. Orthodontists also treat rotated teeth, overlapping teeth, gaps between teeth, and other irregularities of the teeth, jaw or face. Conditions like an under-bite, overbite, deep bite, cross bite and open bite can also be properly assessed and corrected with orthodontic treatments. Dentofacial orthopaedics is a further category of orthodontics, primarily concerned with the guidance and management of the facial growth and development occurring predominantly during childhood.

The Australian Association of Orthodontists recommends that you see an orthodontist if any of the following applies:

  • Losing baby teeth too late or too early
  • Difficulties in biting or chewing
  • Breathing through the mouth
  • Thumb sucking or other habits affecting the teeth and mouth
  • Crowded, misplaced or obstructed teeth
  • Jaw problems – shifting, clicking sounds, a protruding or recessive jaw
  • Speech difficulties
  • Teeth biting the cheek into the roof of the mouth
  • Protruding teeth
  • Teeth that fail to meet together or meet in an abnormal way
  • Facial imbalance or asymmetry causing features to be out of proportion to the rest of the face
  • Grinding (bruxism) or clenching of teeth
  • Inability to comfortably close the lips

If you recognise any of the above in your child or yourself, it would be wise to schedule a consultation with an orthodontist.

Orthodontic treatment options

Treatment options in orthodontics include braces, lingual braces, functional appliances, headgear, elastics, removable appliances, maxillary expansion appliances, retainers, sequential plastic aligners (such as Invisalign) and other appliances including temporary anchorage devices.

  • Braces offer the most efficient and accurate method of moving teeth. Braces are fixed appliances that may need to be worn throughout the orthodontic treatment period.
  • Lingual braces are attached to the inside of the teeth. They are an attractive option because they are not visible, but can be relatively difficult to manage. Although increasingly popular, only a few Australian orthodontists are offering lingual braces to their patients.
  • Functional appliances are used during the initial treatment stages in a growing child to align the jaw, rather than to align the teeth, and may be fixed appliances or removable.
  • Headgear refers to devices that may be used to correct severe malocclusions. These can be attached to fixed appliances like braces or removable appliances to pull on the teeth as well as the supporting jaw.
  • Elastics are rubber bands stretched between the upper and lower braces to move teeth.
  • Removable appliances move teeth with the use of wire springs, but not as accurately as braces do. Their use is limited to achieving simple tooth movements, usually in children. Removable appliances are also used at times as retainers and functional appliances.
  • Maxillary expansion appliances help widen the top jaw where it is found to be narrow in relation to the lower jaw. Maxillary expansion appliances may be fixed or removable.
  • Retainers are worn at the end of the active orthodontic treatment period to hold teeth in their new position. While it may seem unnecessary to wear retainers, without them the teeth may move back to their original position.

You can learn about clear aligners like Invisalign in the Costhetics article on the topic.

Following a thorough clinical inspection, usually supported with tests and x-rays, an orthodontist will be in a position to diagnose and advise upon treatment options. Once your needs are clear, you can work with the orthodontist to decide which options appeal to you.

Gum Bleaching and Cosmetic Gum Surgery

Healthy looking gums are an important component of a beautiful smile. If the gums appear overly dark or discoloured, bleaching can help achieve even colouring across your gum line.

Cosmetic gum surgery can assist in reducing the excessive view of gums when you smile, and lengthen your dental crowns, for a more balanced smile. Ridge augmentation restores the natural contours of the gums and jaw, which can become distorted by tooth loss. Gum grafting is a solution for gum recession and the resulting over-exposure of teeth roots.

You can read more about gum bleaching in Green (Cosmetic) Dentistry Helps Preserve Natural Teeth.

Jaw surgery

Corrective jaw surgery or orthognathic surgery may be useful for treating a protrusive or recessive jaw, often a cause of sleep apnoea, malocclusion (bite problems).

Upper jaw surgery or maxillary advancement may help correct breathing issues, facial asymmetry or an under-bite. Lower jaw surgery or mandibular surgery is useful in some cases of sleep apnoea, facial asymmetry or an overbite.

While issues of asymmetry, bite problems and incorrect jaw alignment generally have inherent mechanical problems; corrective jaw surgery will indirectly contribute to an enhanced smile.

If problems with the jaws or the bite are detected in childhood and early adolescence, orthodontic treatments can be used to redirect growth into a normal pattern while the jaws are still growing and developing. If this is not done, corrections for adults may require jaw surgery.

Once jaw surgery is completed, you may benefit from the services of an orthodontist or a cosmetic dentist to resolve residual issues that will enhance your smile.

Combination treatments

Combination treatments refer to the use of more than one treatment to achieve a desired final outcome.

Sydney Orthodontist Dr Andrew Pitsis is an advocate of combination treatments, “Orthodontics is not just about straightening your teeth. It is also used to correct your bite (the way your teeth meet) as well as providing an aesthetic improvement to your lip position and profile. Sometimes, orthodontics can be combined with upper and lower jaw surgery to achieve a more pleasing facial appearance and improved function of the teeth.”

Whatever the treatments, the outcome should create a pleasing facial profile and a pleasant smile, together with a healthy bite, placing little stress on jaw joints, and with stable and lasting results.

In some cases, your dentist, an orthodontist, and a cosmetic dentist may need to be engaged in order to achieve the best results. They will communicate together to present an optimal treatment program and outcome. If you need jaw surgery, a maxillofacial surgeon will need to be consulted, and if you need to have dental implants or dentures, a restorative dentist or prosthodontist may need to join your treatment team.

Additional information

Read more about cosmetic dentistry options in our article, Green (Cosmetic) Dentistry Helps Preserve Natural Teeth.

You may also find our article on the dental facelift useful, Dentistry Can Improve More Than Just Your Smile.

When we change one aspect of our face or body, we create an impact on the total look. Read our article, What is Beauty to learn about the math’s and science behind all beautiful things.

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