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Bad Teeth: Orthodontic Function


Multiple Failure Causes

Orthodontic issues in dentistry can develop during early stages of physical develop, during later stages (pre-adult) and during adulthood, even after completion of the usual growth spurts that typically occur until we reach 21 years of age, or so.

Growth patterns of the upper and lower jaw structures, eruption process of a normal tooth count and replacement process of supplanting primary teeth with permanent, adult teeth are growth activities that can become disrupted for a seemingly unlimited number of reasons.

Traditional orthodontic treatment is common during early years, administered during key developmental stages that focus on achieving a normal occlusal plane comprised of an upper and lower arch that are well matched in size and width.

Ortho issues involving specific tooth structures (malpositioned, non-erupting, etc) can be treated simultaneously or individually as needed, depending upon the overall orthodontic status of the patient's bite.

Some of the more common problem issues stem from obtaining (or failing to obtain) treatments that are untimely. Adults frequently discover that an orthodontic issue that was deemed non-significant during earlier years can worsen with age... as tooth structures age or "out of occlusion" teeth cause cumulative damage and change to teeth and jawbone relationships.

Conditions of overbite and underbite, for young or older adults are some of the initial signs of treatment need for a changing bite.

Other types of orthodontic changes accruing to trauma, active disease process, excesssive loss of teeth (unwarranted extractions, excessive caries) are also frequent among adult populations.

This gallery contains examples of orthodontic issues that are caused by some of the more unusual or uncommon causes of occlusal or alignment issues that can accrue.





Orthodontic non eruptions are a common occurrence with youngsters, as is the condtion of gingival hyperplasia.... especially when braces are being worn. In this photo it can be seen that two structures haven't erupted, requiring intervention.

A popular method for exposing the tooth structures is the use of a laser to remove a small quantity of hard and soft tissues sufficient to expose an area that can accommodate a special bracket or cementation area. Once exposed, the orthodontic wires can be modified to create a "pull down" force necessary for repositioning the teeth and eventually bringing them into occlusion.


Anterior Retrusion
Orthodontic Non-Eruption
Gingival Hyperplasia
Marie C. Schweinebraten, DMD


By far, one of the worst cases of adult overbite we have seen in a long long time. How this person manages to eat a variety of foods comfortably is a mystery. Anterior occlusion is literally non existent.

While the cosmetic impact of this degree of abnormality can be significant, the effects upon self confidence and social functioning, in some settings, are probably unimagineable for many adult patients.

Treatment will be complex and likely include reconstructive dentistry, possible dental implants and a variety of choices for completing the final restorations.


Bad Adult Overbite
Indescribable Overbite Occlusal Disorder
Kristin Petulla, DDS


A very unusual case of severe underbite that has incorporated the use of partial dentures over the years. The only natural teeth left are the lower anteriors and a few in the posterior. Over the years the four partials have been practically destroyed due to severe underbite issues. Bite collapse has been significant.

Rescontructive prosthodontics would be required to effectively treat the underbite condition that could involve a variety of products and services including dental implants, bone leveling, bone grafts, denture prosthetics or fixed bridgework.


Underbite Failed Prosthetics
Severe Prosthetic Underbite
Richard Winter, DDS, MAGD


Senior Citizen Ortho: What makes this case especially unique is not so much the amount of malocclusion, tooth rotations and overall poor alignment.... but rather the AGE of the patient.

This patient is 80 years old and is now requesting reconstructive treatments that will include orthodontic services to straighten alignment and normalize her bite... along with new porcelain anterior crowns to create the cosmetic result she has always wanted.

An amazing case.... an amazing lady.


Orthodontics for Seniors
80 Year Old Ortho Patient
Kristin Petulla, DDS


A "not-so-obvious" overbite can easily destroy opposing tooth structures if left untreated too long. In some cases the relationship between the opposing teeth may not represent a true overbite but a condition of angulated teeth where the incisal, or biting, surfaces do not "mesh" properly.

Upper teeth relentlessly grind away on the front surfaces of the lower teeth.

Once the enamel is worn off and dentin is exposed..... the wear and tear accelerates, while caries and infection are actually promoted by physical behavior of eating. Treatment is anticipated to be comprehensive and likely include reconstructive dentistry, implants and bridgework.


Overbite Destruction Dentin
Mismatch of Biting Surfaces
Chris McFarland, DMD


Middle aged underbite. This is a good example of how multiple loss of teeth in the molar or posterior areas of the upper and lower jaws can cause unusual bite and orthodontic problems.

What may appear as an "underbite ortho issue" is probably more of an artifact of what happens when untreated loss of posterior teeth can cause significant changes in bite plane dynamics and overall dental function.

The All On Four reconstructive tooth replacement concepts were selected by the patient to not only replace teeth but to simultaneously rebuild her bite and overall dental function to what it was when she was a young adult, incorporating precision placement of dental implants and cosmetic prosthetics.


Tooth Loss Underbite
Adult Acquired Underbite
Kristin Petulla, DDS


What makes this situation interesting is that while having teeth growing behind the arch and rooted into the roof of the mouth is not an uncommon anomoly.... the treatment to correct it was.

A Reconstructive Periodontist performed periodontal surgery to "allow" the two tooth structures to migrate into the positions they are supposed to be in. The usual use of braces to pull the structures forward were NOT implemented. Once the critical periodontal tissues were modified, the teeth moved forward and, with the use of standard braces later, were eventually aligned correctly across the entire arch. A very unique method of tooth movement for a patient who wanted to avoid the use of braces as much as possible.


Periodontist Orthodontics
Congenital Tooth Positioning Defect
Edward Brant, DDS, MS


A good example of what can happen to adult dentition when ortho treatments during developmental years can correct or optimize canine guidance are postponed indefinitely.

Slowly, but predictably, extended delay of treatment subjects our dentition to biting pressures that are so disturbed that they "create" lateral forces on teeth (not a good thing).

The lower and upper arches of anterior teeth amply display the net effect of lateral forces that, over time, will move teeth into even more bizarre locations which, in turn, accelerates even more occlusal damage to the overall bite plane.

Treatment options could include the choice of accelerated orthodontics, standard braces, lingual orthodontics or reconstructive ortho.


Incisor Malocclusion
Long Term Occlusal Abnormalites
Kristin Petulla, DDS


Overcrowding in the upper arch can cause smaller tooth structures to emerge and grow in seemingly uncontrollable ways. In this photo two of the patient's (21 yr old female) teeth emerged and started development partially behind the natural arch. During this developmental process the overcrowding further caused distortions and partial rotations of the central incisors.

Treatment recommendations could include a choice of standard orthodontics, accelerated orthodontics, molar extractions, or Invisalign. Expanders may or may not be required, depending upon the decision to use extraction orthodontics (molars only).

Snaggle tooth
Crowding - Upper Arch Snaggle Tooth
Ara Nazarian, DDS


An unusual example of an adult orthodontic issue that is compounded by active periodontitis. Disturbances in the occlusal plane are quite obvious. Significant differences in the quantity of underlying bone tissue are also evident.

Treatment recommendations would include effective treatment and arrest of active disease process, fortification of bone tissue and gingiva (via grafting) as needed and replacement of treatment of certain tooth structures, as needed, through combinations of implants, crowns, dentures or partials, or fixed prostheses.

Bad Orthodontics Periodontitis Combination
Periodontitis - Adult Orthodontic Issues
Richard Winter, DDS, MAGD


Genetic - developmental orthodontic and occlusal disorder giving the outward appearance of a crooked jaw. Left untreated for too long, severe tooth breakage could occur, along with gingival lesions, damage to the tmjoints. In typical cases of this magnitude, surgery is usually indicated, along with traditional orthodontics.

Treatment recommendations could include orthognathic surgery, oral surgery, palate expansion, orthodontic teeth realignment (after surgery). Other possiblities, in an effort to avoid invasive surgery could include combinations of orthodontics, bridgework, crowns, implants and porcelain laminates (veneers).

Crooked Jaw Occlusion
Crooked Jaw - Severe Crossbite
Ara Nazarian, DDS


Occlusal abnormalities and orthodontic issues left untreated for too long have caused breakage of several teeth resulting in an over closed bite and collapse of the vertical dimension. Cosmetically the collapsed bite will "increase the age" of the patient's facial characteristics.

Treatment recommendations could include a orthodontics, extractions, dental implants, bridgework, crowns, grafting procedures to address loss of bone and gum tissue in selected areas, possible denture partials.


Occlusal Orthodontic Breaking Teeth Damage
Untreated Orthodontic - Malocclusion Needs
Richard Winter, DDS, MAGD


Orthodontic treatment that was apparently "dismissed" during this adult male patient's more formative years has now developed into a situation where the lower anterior teeth are "biting against" upper jaw gum tissues rather than teeth.

Soft tissue damage caused by this degree of malocclusion can create complex treatment needs for adult patients since the incidence of gum disease is higher for adults.

Treatment options will include a variety of reconstructive orthodontics, reconstructive restorative dentistry, possible palate expansion, porcelain crowns, dental implants, bridgework and porcelain veneer jackets.


Adult overbite severe
Cumulative Effects of Overbite
Kristin Petulla, DDS


Another case of "reap what you sow" in terms of avoiding or dismissing recommended treatments for routine orthodontic care. When occlusion "did exist" it appears that it caused more damage to opposing teeth, creating a net effect of increasing degree of malocclusion.

Normal eating and chewing behaviors are now achieved with shifting the jaw structures to the extent bite is "created".... necessary to eat normally. Bone and gum loss has accumulated, as well as supereruptions of critical tooth structures.


Adult no bite occlusion
Overbite - Open Bite Malocclusion
Kristin Petulla, DDS


What was a probably a minor tooth crowding issue in the lower jaw was "allowed" by the patient to cause structural changes in jaw and tooth alignment over a course of several years. While numerous teeth appear to occlude naturally on one side of the jaw nonetheless poses risk for wearing down surface enamel on the other side of the lower jaw.

Normal "biting" with the anterior centrals is almost impossible. Treatment options could include extraction orthodontics (a speedier means for creating room for teeth) or the use of appliances to expand the lower jaw that retains the normal complement of opposing teeth (requires longer treatment time).


Anterior Guidance Dysfunction
Faulty Anterior Guidance - Non Symmetrical Bite Dynamics
Kristin Petulla, DDS


As a youngster, this female patient probably had ortho issues that weren't deemed severe or warranted treatment.

Minor crowding and routine alignment issues were allowed to continue to the point now where a crowded tooth has now developed an amount of bone and tissue loss. Almost the entire span of the lower jaw now has angulated teeth (angle inwards) that likely may have been caused by the upper jaw "trying to create a bite" that was acceptably functional.

Treatment options would include treatments to create a normal, matching pair of upper and lower bony ridges that contain properly aligned tooth structures. Gum grafting may be required for 2, possibly 3 lower anterior teeth.


Mild ortho problems become more severe
Seemingly Mild Ortho Issues becoming Worse
Kristin Petulla, DDS


An unbalanced bite left untreated can cause very unusual wear and tear patterns as patients age.

It is difficult to visualize what the specific elements were for this unbalanced bite when the patient was younger. Nonetheless it is obvious that the anterior areas of the upper jaw sustained more wear than the posterior areas. Creating tooth replacement options will be difficult since opening the anterior portion of the bite with standard tooth replaement sizing will require bite height adjustments to teeth in the posterior areas.

Treatment options could include conventional orthodontics combined with selective crown and veneer treatments.


Unbalanced bite odd wear and tear
Odd Wear and Tear
Kristin Petulla, DDS


Significant angulated bite. Nearly all of the upper and lower teeth are angulated lingually, including the central incisors.

What probably started out as very minor orthodontic need has developed to the point where teeth crowding issues now require treatment along with possible treatments for creating a level bite plane between the biting surfaces.

Treatment options could include conventional orthodontics, selective crown and veneer treatments, gingival recontouring for aesthetics.


Angulated Teeth
Odd Wear and Tear
Kristin Petulla, DDS






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