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When does an underbite need surgery? The short answer is: when Dr. Cronin and our team recommend surgery as the best way to give you a healthy, functional bite. But let’s take a longer look, and see just why your doctors might come to that conclusion.

• First, what exactly is an underbite?

In a perfect bite, the upper and lower jaws align, well, perfectly. Upper teeth overlap lower teeth very slightly, upper and lower teeth meet comfortably, and jawbones and joints function smoothly. When the alignment is off, it causes a malocclusion, or “bad bite.”

When we talk about an underbite, or Class 3 malocclusion, it means that the lower jaw protrudes further than the upper jaw. This protrusion causes the bottom teeth and jaw to overlap the upper teeth and jaw.

• What causes an underbite?

Sometimes an underbite is caused by childhood behaviors while the teeth and jaw are developing, including tongue thrusting or prolonged thumb-sucking and pacifier use. (Working to stop these behaviors before they affect tooth and jaw formation is one of the many good reasons children should have regular visits with their dentists and pediatricians.)

Most underbites are genetic, however, and tend to run in families. It’s estimated that from five to ten percent of the population has some form of underbite. The lower jawbone (mandible) might be overdeveloped, the upper jawbone (maxilla) might be underdeveloped, both bones could be affected, or, sometimes, tooth size and placement might cause an underbite. These irregularities in jaw shape and size and/or tooth crowding are not something that can be prevented, and require professional treatment.

• Why? What’s the problem with an underbite?

Even a minor underbite can cause difficulties with biting and chewing. A more severe underbite can lead to speech problems, decay and loss of enamel where the teeth overlap, mouth breathing and sleep apnea, persistent jaw and temporomandibular joint pain, and self-confidence issues.

• Can’t my dentist treat my underbite?

Most probably not. A very mild underbite can be camouflaged cosmetically with veneers, but this does not address the cause of the underbite, and will not work for moderate or severe underbites.

• Can my orthodontist treat my underbite?

Dr. Cronin will create an underbite treatment plan after a detailed study of each patient’s individual dental and skeletal structure. Treatment options will vary depending on the cause of the underbite, its severity, and even the patient’s age.

Early intervention is especially important for children who show signs of an underbite. That’s why we recommend that children visit our Langley office by the age of seven.

If an underbite is caused by tooth misalignment or crowding, braces can reposition the lower teeth. Sometimes extractions are necessary to make room for proper alignment.

If the cause is due to jaw structure, children’s bones are still forming, so treatment can actually help correct bone development. Palatal expanders, headgear, and other appliances are various methods of encouraging and guiding bone development.

But braces and appliances aren’t effective for every patient with an underbite, and especially in patients (usually those in their late teens and older) when the jawbones are already fully formed. In this case, we might suggest coordinating treatment with an oral and maxillofacial surgeon.

• What does an oral and maxillofacial surgeon do?

An oral surgeon has the training, experience, and skill to help correct an underbite by surgically reshaping and repositioning the jawbone. This corrective jaw surgery is called orthognathic surgery.

• What will happen during orthognathic surgery?

Your treatment will be tailored to your specific needs. Two of the common surgical procedures for treating an underbite involve repositioning the upper jaw to lengthen it and/or reshaping the lower jaw to shorten it.

Bone is sometimes removed or added, small bone plates or screws are sometimes used to stabilize the bone after surgery—your surgeon will let you know exactly which procedures will give you a healthy, functional bite. The surgery itself is most often performed under general anesthesia and requires a brief stay in the hospital.

• How will my orthodontist and oral surgeon coordinate my treatment?

Correcting a Class 3 malocclusion can take time. Your oral surgeon will work together with Dr. Cronin to analyze the interrelationship of teeth, bones, and joints to determine dental and skeletal problems, and will develop the best treatment plan possible to create a healthy alignment.

• So, when does an underbite need surgery?

Sometimes, a minor underbite can be corrected with braces and appliances alone. A serious underbite, however, will often require the specialized skills of both Dr. Cronin and an oral surgeon.

And, while it’s not the primary purpose of surgery, corrective jaw surgery and orthodontics can also make you happier with your appearance and boost your self-confidence. Achieving a lifetime of beautiful, comfortable, and healthy smiles—that’s the answer to your question.

Getting braces is a huge step in creating the beautiful smile you want. It’s easy to see how important your wires and brackets are. Week by week, you and your family and friends can see the progress you’re making as your teeth become straighter. That makes all the careful brushing, periodic adjustments at our Langley office, and annoying loose ligatures worthwhile.

And while straight, even teeth are the visible reward you get for your months in braces, there’s a benefit that’s every bit as important that might go unnoticed by your friends and family—a healthy, properly aligned bite.

Many people have some kind of malocclusion, or bad bite. There are several different bite problems we treat. Some of the most common are:

• Overjet (the upper front teeth protrude too far forward over the bottom teeth)
• Underbite (the bottom teeth overlap the top teeth)
• Crossbite (one or more teeth haven’t come in in the proper position, often with an upper tooth fitting inside a lower tooth)
• Open bite (the upper and lower front teeth don’t touch).

When the jaws and teeth don’t fit together properly, you might be looking at damaged teeth, headaches, and painful problems with the temporomandibular joint, or jaw joint, in your future. That’s why correcting your bite early is so important. Using rubber bands with your braces is one of the most popular and effective ways to help create a better bite.

Bands are used with your braces to gradually move your teeth into their best position. Specially designed brackets with tiny hooks are bonded to very specific teeth. Why so specific? Because the placement of the brackets depends on which type of malocclusion we are correcting. Rubber bands are then attached to the bracket hooks, usually from an upper tooth to a lower one. When they are in just the right position, those little bands provide just enough force to move your teeth more quickly and effectively than braces alone can.

If you need bands to help correct any kind of malocclusion, you will play a very important part in your orthodontic treatment. It will be your job to attach your bands every day. Don’t worry—while it can seem confusing at first, we’ll make sure you know exactly how and where to place them.

How long should they stay in? You’ll probably need to wear your bands 24 hours a day. It’s while you’re moving your mouth and jaw muscles that your bands are working their hardest. Talk to us about removing them for brushing and flossing, and whether you should wear them while you eat.

Can you use the same bands over several days? Not a good idea. Bands are selected for size and strength to move your teeth very precisely from visit to visit. When bands stay on too long, they become too stretched out to supply the proper pressure needed to move your teeth efficiently. Dr. Cronin will let you know how long is too long for your specific bands.

Are two bands better than one? Absolutely not. Again, the bands you’re given at each visit are designed for your specific needs. Too much pressure can actually be harmful. Just keep to your recommended schedule of replacing bands, and your orthodontic treatment will stay right on track.

Attaching rubber bands? Keeping them on all during the day? Replacing them as needed? All of these responsibilities might seem a bit overwhelming at first, but we are here to give you all the information and support you need to succeed. Because straight, even teeth and a bite that is healthy and functional? That’s truly how you create your beautiful smile!

By now, you’re very familiar with the basic building blocks of your braces. Brackets, wires, and ligatures are no mystery to you. But suddenly, you’re hearing a brand new term—“power chains.” What exactly are these power chains, and why does your orthodontist think you need them? Let’s see how power chains are *linked* to your orthodontic treatment.

• First, why power chains?

They’re not really chains in the necklace or bike chain sense—in fact, they’re only very rarely made with metal. These chains are most often a string of O ring loops just like your elastic ligatures, attached in a row to resemble a chain.

Chain lengths are tailored to your specific needs. Dr. Cronin will attach each individual loop in the chain around a single bracket, linking selected teeth together. Chains might stretch across a few teeth, several teeth, or your entire upper or lower arch.

• Second, why power chains?

Because these chains are usually made of the same elastics that your ligatures, or bands, are made from, they want to hold their original shape. They will try to return to that original shape even as they are stretched between your brackets. As they contract, they help move your teeth together. 

Over time, just like an over-stretched rubber band, they lose their elasticity, and won’t work as effectively. That’s why you’ll probably get a new power chain whenever you come in to our Langley office for an adjustment.

• Third, why power chains?

This is the most important question. How can a power chain improve your smile?

Usually, power chains become part of your treatment after the first phase of alignment. They can be used to help align your teeth or correct your bite, but are most often used to close gaps between the teeth.

You might have a gap after a tooth has been extracted. Or, as your teeth move into their new positions, you might suddenly see noticeable spaces between them. Power chains move the teeth closer together to eliminate these gaps, and do it more quickly than brackets and wires alone can do.

• How long will you need them?

This is something Dr. Cronin will discuss with you. Whether it’s a matter of weeks or months, your treatment plan is designed to move your teeth into their best positions, and to do it carefully for a lasting, healthy alignment.

• Power chain options

Depending on the size and spacing of your teeth and your treatment plan, these chains usually take one of three forms: closed/continuous, short, and long. The only difference is the distance between the rings.

We will choose the type of chain that’s best for your treatment. Your contribution is to personalize your power chain. Power chains come in a rainbow of colors, allowing you to mix and match. You can even coordinate with your ligatures if you have ties as well as chains. If your goal is to have your braces blend in, various shades of white, silver, or clear colors are available. Want to mix things up? Choose a different color with every adjustment.

• Anything else?

You might experience some discomfort for the first few days with a new power chain, just as you might with any adjustment. Dr. Cronin will have suggestions for making those first days as comfortable as possible.

Also, like brackets and ligatures, power chains can trap food particles, so be sure to follow our instructions for keeping your teeth and your braces their cleanest.

Now that you’re all caught up on what power chains are and what they can do for you, let’s mention one more benefit. This is a process where you can actually see the gaps between your teeth closing over the weeks you wear your power chains. Keep a selfie record of your progress as you create your beautiful, healthy smile. That’s an em*power*ing experience!

It's the big day and your braces are finally coming off! Does that mean you are completely done? Not so fast! After you complete your treatment here at Cronin Orthodontics, Dr. Cronin and our team will recommend you wear a retainer, which must be worn routinely after treatment in order to hold your teeth in their proper, new position while your gums, ligaments and bones adapt. Most patients are required to wear their retainer every night at first, with many also being directed to wear them during the day. It's important to know there are different kinds of retainers, and today we thought we would explain the differences between them.

Hawley Retainers

The Hawley retainer is one of the most common types of retainers. It is a removable retainer made of a combination of a metal wire that typically surrounds the six anterior teeth and is designed to keep your teeth in place. This retainer is made from impressions of your teeth so that it fits snugly and comfortably in the roof of your mouth, while the wire and acrylic framing keeps your teeth in an ideal position. The acrylic can also be personalized with a large number of colors or patterns.

Essix (Clear) Retainers

The Essix retainer is a transparent removable retainer that fits over the entire arch of your teeth. This clear or transparent retainer fits over the entire arch of teeth and is produced from a mold. Similar to Invisalign’s clear aligner trays, Essix retainers have no metal or wires. They can also be used to produce minor tooth movements and can be helpful in prevention of tooth wear due to tooth grinding at night.

Bonded Retainers

Bonded lingual retainers are cemented directly to the inside surface of your lower canines. Dr. Cronin and our team at Cronin Orthodontics encourage our patients with bonded lingual retainers to be careful with their bite as the bonding material may break due to incorrect biting and cause your teeth to shift. As with removable retainers, it is important to keep your bonded retainers clean. When brushing, make sure to carefully clean the inside of your lower teeth, as well as the wire itself.

The retention phase of treatment begins when the patient’s braces are removed. Retainers are worn full time, typically for the first nine months, except while eating. Retainers should also be removed before brushing your teeth.

If you have any questions about the retainers we offer or to learn more about post-orthodontic treatment, please feel free to contact us at our convenient Langley office and we will be happy to answer any of your questions!