Dentofacial Orthopedics

• December 15, 2024
• Dr. Bronsky
• Dental Health

What Is Dentofacial Orthopedics?

While orthodontics deals with tooth movement, dentofacial orthopedics is a sub-specialty of orthodontics focused on modification of the growth and development of the face and jaw structures as well as how the position of the jaws relates to the ultimate function of the teeth. 

Dentofacial orthopedics is particularly important during a child’s developmental years when the jaw and facial bones are still growing. Early intervention can help guide proper jaw alignment, correct imbalances, and prevent more complex orthodontic issues later in life. This specialized treatment can also enhance facial aesthetics and improve overall oral functionality, creating a harmonious balance between the teeth, jaws, and facial structure.

About the Specialty 

Orthodontics and Dentofacial orthopedics is 1 of 12 specialties recognized by the American Dental Association (ADA). Specialists complete a multiyear residency after dental school and undergraduate education as well as an original research project.  Interestingly, Orthodontics was the first recognized specialty of Dentistry established in the year 1900.

Dentofacial Orthopedics is primarily practiced in the treatment of children before the institution of fixed or removable orthodontic therapy.  Dentofacial Orthopedics takes advantage of a patient’s growth potential. Extraoral and intraoral forces are designed to guide the growth and development of the jaws in a more favorable direction. Timed and designed correctly, Dentofacial Orthopedics can help to optimize the position and function of the jaws and teeth while preventing several long-term jaw structural problems, oral health issues, and general health challenges. 

If implemented at the right time in a patient’s growth and development, Dentofacial Orthopedics can often help to obviate the need for future orthognathic surgery to address the adverse effects of any number of issues resulting from severe jaw discrepancies.  These discrepancies may include correction of narrow jaw structures, retrusive or prognathic/excessive upper and/or lower jaw positions, tooth extractions, resultant tooth fractures and wear, airway problems, periodontal bone and soft tissue problems, and psychosocial issues—just to name a few. 

The American Association of Orthodontists (AAO) recommends that your child get a checkup with an orthodontist at first recognition of an orthodontic problem, but no later than age 7. This is a crucial time for an orthodontist to determine whether intervention or close monitoring is necessary as the mouth and jaws grow.

Various Appliances Can Be Used

Appliances that can affect/change the rate, direction, or amount of jaw growth:

• Palatal Expansion Appliance (PE) – This fixed appliance rests on primary or permanent molars and helps to slowly and carefully broaden the upper jaw by exerting lateral pressure on the two halves of the maxilla in patients with a constricted upper jaw. Done properly, bone grows in the middle and a once-constricted jaw attains the proper width to improve the bite. Expanding the upper jaw most often helps to create space for the physiologic eruption of permanent teeth, prevent impactions, correct crossbites, and prevent facial asymmetries.
• Fixed Functional (Herbst) Appliance – This is a fixed (cemented) appliance that consists of individual maxillary and mandibular (upper and lower) custom stainless steel components that are connected via “telescoping” rods bilaterally. This method of treatment modifies jaw growth via the advancement of the mandible and affects the upward and backward movement of the maxilla during growth. This appliance helps to modify jaw growth discrepancies in the sagittal, vertical, and transverse planes of space simultaneously. Happily, this appliance is a great substitute for a “night brace/headgear” in the right patient.
• Facemask (Extra-Oral Protraction Headgear Device) – This is a removable extra-oral appliance used in patients with an underbite. It encourages maxillary protraction, corrects crossbites, and redirects the axis of growth.
• Trans-Palatal Arch Appliance (TPA) – This fixed  appliance is used to hold upper molars in place, stabilize the position of the teeth, and modify growth in a vertical direction.
• Fixed Pendulum/Expansion Appliance (FPAE) – This fixed appliance rests on the permanent first molars and bicuspids and affects simultaneous expansion and backward movement of molars to create space for permanent teeth to erupt naturally. It can help avoid extractions while also improving the bite.
• Nance Holding Arch with Bite Plane (NHA/BP) – This appliance maintains the established changes in transverse, vertical, and anteroposterior planes of space. It can augment anchorage to further modify growth via the bite opening and enables the natural eruption of permanent teeth.
• Mandibular (lower) Lingual Holding Appliance (LLHA)– This fixed appliance is placed on the tongue side of mandibular teeth and rests on primary or permanent molars. It’s used to preserve and create space in the lower jaw arch and aids in molar uprighting to establish optimal axial inclination of the mandibular molars while also modifying growth via bite opening.

Bone Anchored Maxillary Protraction (BAMP) – These plates are placed in the upper and lower jaws by an Oral and Maxillofacial Surgeon (OMFS) to affect protraction of the maxillary jaw base, correct crossbites, and redirect the axis of growth. BAMP uses inter-arch elastics for patients with a “Class III malocclusion” or underbite.

Dentofacial Treatments for Adults

The specialty is not limited to children. Adults will not have the same range of options available as children who still have growth potential, but procedures for adults may include orthognathic surgery to correct jaw discrepancies that can lead to debilitating structural and functional problems. These may include pathologic, dysfunctional occlusion (bite), airway disorders (such as sleep apnea), psychosocial self-esteem issues, TMJ disorders, tooth wear and chipping, and periodontal breakdown.

Want to Find Out More? 

Bronsky Orthodontics offers specific expertise in dentofacial orthopedics to address a wide range of orthodontic and jaw-related concerns. Whether your goal is to guide your child’s jaw growth for optimal alignment or explore treatment options for adult orthodontic challenges, our Manhattan orthodontic team has the experience and advanced tools to provide comprehensive care. We focus on creating personalized treatment plans to ensure the best outcomes for every patient.

Contact us today to schedule a consultation and take the first step toward a healthier, more balanced smile! Our friendly staff is ready to answer your questions, discuss your needs, and help you plan your journey to improved oral health and function. Call or visit one of our Manhattan offices—we’re here to help!