Case Study: William

This young man came into my practice with his mother. She was concerned about the way that his teeth “stuck-out.” The dentist was still waiting for the eruption of more teeth, but his parents thought it might be wise to just get an opinion from an orthodontist while he was still growing. This case is an example of a growth deficiency in the lower jaw requiring a stimulus to help the jaw grow. This would not have worked if he had waited on all the permanent teeth to erupt because growth of the lower jaw would have been largely completed. As it happens with other structures in the human body, growth of the lower jaw reaches its peak at different times and tapers-off just after puberty begins. It does not correlate directly with the eruption of teeth or the growth in the long bones. Therefore, it is best to assess the growth potential of the jaws using a diagnostic cephalometric radiograph or a hand-wrist radiograph.

After analyzing his cephalometric radiograph, I noticed that he was in the midst of his pubertal growth spurt and we began treatment immediately directed solely at growing his lower jaw until the remaining teeth erupted. Using a growth appliance cemented to his molars we were able to advance the lower jaw a full eight millimeters! This had a major impact on his facial profile and consequently his personal confidence. Once we corrected the jaw imbalance, I aligned all his teeth in a little over one year for a total treatment time of twenty months. His parents were astounded by the growth change in his face and glad that they came to see me for an evaluation. I have no doubt that if they had waited for all the teeth to erupt, we still could have corrected the bite, but he would have missed-out on the growth opportunity and his jaw would have been severely retrusive. In cases involving facial imbalances, it is always prudent to get an orthodontic assessment before puberty begins so growth timing can be predicted and treatment can be optimized as well.