Dentofacial orthopedics is a specialized area of dental care that addresses underlying structural problems of the face and jaws, moving beyond the simple straightening of teeth. This discipline focuses on correcting the relationship between the upper and lower facial bones to ensure a proper foundation for the entire oral system. By influencing the growth and development of a patient’s facial skeleton, this treatment aims to achieve long-term functional and aesthetic balance. This specialized field manages complex issues affecting the entire facial structure.
Defining Dentofacial Orthopedics
Dentofacial orthopedics is a specialty dedicated to the modification, guidance, and correction of the growth and development of the facial bones, particularly the maxilla (upper jaw) and the mandible (lower jaw). Professionals in this field utilize a patient’s natural growth process to redirect the size and position of the jaws.
This approach is most effective in growing patients, where the bone sutures are still pliable and responsive to gentle, sustained forces. The primary goal is to establish a harmonious relationship between the jaws and the surrounding facial structures before growth is complete. The treatment involves specialized appliances designed to stimulate or inhibit bone growth in specific directions.
The ultimate success lies in optimizing the patient’s skeletal framework, which provides a stable environment for the teeth. This foundational correction addresses the root cause of many bite problems, leading to results that are often more stable and less reliant on compensatory tooth movement. By managing the underlying skeletal discrepancies, the specialty contributes significantly to functional improvements in chewing, speaking, and breathing.
The Key Distinction from Orthodontics
The major difference between dentofacial orthopedics and traditional orthodontics lies in their primary targets. Orthodontics focuses on moving the teeth within the jawbones to correct alignment and bite issues using devices like braces or clear aligners. It is a form of dental alignment that repositions individual teeth into their ideal spots.
In contrast, dentofacial orthopedics focuses entirely on modifying the actual size, shape, and relationship of the jawbones themselves. This skeletal modification aims to correct discrepancies in how the upper and lower jaws fit together.
While many specialists are trained in both disciplines, the distinction is based on the biological process being influenced. Dentofacial orthopedic treatment capitalizes on a child’s active growth phase to change bone structure, an opportunity that diminishes after adolescence. Traditional orthodontic treatment, which primarily involves moving teeth, can be performed effectively at nearly any age. The two treatments often work together, with orthopedic correction preceding the fine-tuning of tooth alignment.
Conditions Targeted by Dentofacial Orthopedics
Dentofacial orthopedics targets specific skeletal problems, known as malocclusions, that cannot be resolved by simply repositioning teeth. These conditions arise when the upper and lower jaws develop at different rates or sizes, leading to a structural mismatch.
A common target is severe Class II malocclusion, characterized by a significantly recessed lower jaw, which causes the upper front teeth to appear overly prominent. Another primary condition is Class III malocclusion, where the lower jaw is too far forward, resulting in an underbite. Significant transverse discrepancies, such as a narrow upper jaw or palate, are also addressed through orthopedic expansion.
These skeletal issues are often linked to genetic growth patterns and require intervention during childhood to guide the jaw development into a more balanced relationship. Correcting these discrepancies improves function and enhances overall facial symmetry and profile. Uncorrected skeletal problems can lead to long-term issues, including uneven tooth wear, chewing difficulties, and potential strain on the temporomandibular joints.
Treatment Timing and Approaches
The effectiveness of dentofacial orthopedics relies on precise treatment timing, intervening while the patient is still actively growing. This approach is often structured as a two-phase treatment, maximizing the body’s natural ability to remodel bone. Phase I, or interceptive treatment, typically begins around ages six to ten, when a child has a mix of primary and permanent teeth.
The goal of Phase I is to correct the skeletal discrepancy and guide the jaw growth into a more favorable position. Appliances used include palatal expanders, which widen a narrow upper jaw by gently separating the mid-palatal suture. Functional jaw orthopedic devices, such as the Herbst appliance or headgear, are used to modify the growth of the lower jaw.
Following Phase I, there is usually a resting period where the remaining permanent teeth are allowed to erupt naturally. Phase II, known as comprehensive treatment, begins once most or all of the permanent teeth have erupted, usually in early adolescence. This final phase involves traditional orthodontics, such as full braces or aligners, to precisely align every tooth within the newly corrected jaw structure.