Surgical Orthodontics

Surgical orthodontics, also known as orthognathic surgery, is a type of orthodontic treatment used to correct severe cases that include bad bites, jaw bone abnormalities, and malocclusion. Oral and maxillofacial surgery is one of the nine recognized dental specialties, and it focuses on treating complex craniofacial cases that involve the mouth, jaw, face, and skull. If you need surgical orthodontics, Dr. Milstein will work with an oral and maxillofacial surgeon to ensure that you receive the best care possible.

Surgical orthodontics may be used to treat adults with improper bites or other aesthetic concerns. Typically, jaw growth stops by age 16 in females and 18 in males. In order to receive orthognathic surgery, the jaw must be done growing. The need for surgical orthodontics occurs when the jaws do not line up correctly, and a proper bite cannot be achieved with orthodontic treatment alone. Orthognathic surgery will help properly align the jaw, and orthodontic braces will then be used to move the teeth into their proper position.

How does orthognathic surgery work?

An oral and maxillofacial surgeon will perform your orthognathic surgery, and the surgery will take place in a hospital. Orthognathic surgery can take several hours depending on each individual case. Once the surgery is complete, you will have about a two-week rest period. Since orthognathic surgery is a major treatment, we recommend that you schedule some time away from work and school during the healing process. After your jaw has healed, your orthodontist will once again “fine-tune” your bite. After surgery, you will have to wear braces, and most braces are removed within six to 12 months following surgery. After your braces are removed, you will wear a retainer to help maintain your new smile.

For many patients, the most important reward of having orthognathic surgery is achieving a beautiful, healthy smile that lasts a lifetime. Whether you need orthodontic treatment to correct a bad bite, malocclusion, or jaw abnormality, orthognathic surgery can help restore your confidence and leave you smiling with confidence for many years to come.

Impacted Canines

An impacted tooth is a tooth that is blocked or “stuck” underneath the gum line, and does not erupt into its correct position on its own. Most often, an impacted tooth will be a third molar, or wisdom tooth, though it is a common occurrence in canine teeth as well. Canine teeth are located at the corners of the arch, next to the incisors. They have one pointed edge (cusp) which is used for holding, grasping, and tearing food. Because of the canine’s long root, they are very strong, stable teeth. Canines are usually the last teeth to erupt, and usually do so when your child is around the age of 12 or 13.

The American Association of Orthodontists recommends that children have an orthodontic examination by the age of seven, which allows us the opportunity to monitor your child’s teeth eruption and detect impactions early.

If your child does develop an impacted canine, a simple surgical procedure is recommended to assist the eruption of the tooth. We will surgically expose the tooth by cutting a small flap in the surrounding gum. After the tooth is exposed, we will either leave the tooth to erupt on its own, or attach an orthodontic bracket to the tooth to help guide its descent.

With early detection and combined surgical and orthodontic treatment, impacted canines can be allowed to erupt and/or be guided to the most ideal position in your child’s mouth.

Early Prevention (Phase I)

At Marina Milstein Orthodontics, we believe that early intervention can make a significant difference in your child’s oral health and overall well-being. Early treatment, also known as Phase 1 Treatment, is a proactive approach that addresses orthodontic issues in young children before they become more severe. Our goal is to provide personalized, effective care that sets the foundation for a healthy, beautiful smile.

Phase 1 Treatment typically begins when a child is between 7 and 10 years old. This early stage of orthodontic care focuses on addressing and correcting developmental issues related to the teeth and jaws. By intervening early, we can guide the growth of the jaw, create space for incoming permanent teeth, and prevent more complex orthodontic problems in the future.

Phase 1 Treatment can address a variety of orthodontic issues, including:

• Crowded or Misaligned Teeth — Creating space for erupting teeth and guiding their proper alignment.
• Bite Problems — Correcting overbites, underbites, and crossbites to ensure proper jaw alignment and function.
• Tooth Eruption Problems — Addressing issues related to the eruption of permanent teeth, such as impacted or missing teeth.

Benefits of Early treatment

Early treatment offers numerous advantages, including:

• Phase 1 Treatment can help guide the growth of the jaw, ensuring that it develops in a way that accommodates all of the permanent teeth.
• Protruding front teeth are more susceptible to injury. Early intervention can reposition these teeth, reducing the risk of damage.
• Addressing issues like crossbites or underbites early on can improve your child’s ability to chew, speak, and breathe properly.
• Early treatment can correct developing issues before they become more severe, potentially reducing the need for more extensive treatment in the future.
• A healthy, beautiful smile can significantly boost your child’s confidence and self-esteem.

Dr. Milstein and her team are dedicated to providing personalized, expert care tailored to each child’s unique needs. Our approach includes:

We conduct a thorough examination to assess your child’s dental and jaw development, taking into account their individual needs and goals. Using state-of-the-art orthodontic technology, we create a treatment plan designed specifically for your child, ensuring the best possible outcomes. Our team is here to support you and your child throughout the entire treatment process, providing guidance and care every step of the way.

If you believe your child could benefit from early orthodontic intervention, don’t wait. Early detection and treatment can make a world of difference in their oral health and overall confidence. Contact Marina Milstein Orthodontics today to schedule a complimentary consultation for your child.

Orthodontic Retention

Finally, your braces have been removed and your smile is beautiful, straight, and best of all, free of appliances! However, your orthodontic journey isn’t quite completed. To keep your smile looking its best, you’ll have to wear a retainer to preserve and stabilize your results. Retainers are needed to control or limit potential changes in tooth position. They are used after braces treatment to hold teeth in their correct alignment while the surrounding gums, bone, and muscle adjust to the new positioning of your teeth.

Types of retainers

Retainers are custom-made and can be removable or fixed.

Traditional removable retainers typically include a metal wire that surrounds the front teeth and is attached to an acrylic arch that sits in the roof of the mouth. The metal wires can be adjusted to finish treatment and continue minor movement of the front teeth as needed.

Aligner-style retainers, or Essix retainers, look similar to clear aligners and offer a more aesthetic alternative to wire retainers. This clear retainer may fit over the entire arch of your teeth, or only from canine to canine (clip-on retainer). It is produced from a mold of your newly aligned teeth.

Fixed retainers consist of wires bonded behind the bottom and/or top teeth. While the device is usually required no more than a year after wisdom teeth have been extracted, it is often kept in place for life.

Retainer Instructions

You’ve worked hard for your beautiful smile, and we want to be sure you are able to keep it that way!

• Wear your retainer at all times, until our team instructs otherwise.
• Take your retainer out when eating, and always put it back in its case! (Most appliances are lost in school lunchrooms or restaurants.)
• Clean the retainer thoroughly once a day with a toothbrush and toothpaste. Use warm but not hot water. Brushing retainers removes the plaque, and eliminates odors. Efferdent® or other orthodontic appliance cleaners can be used but do not take the place of brushing.
• When your retainer is not in your mouth, it should ALWAYS be in its case. Pets love to chew on them!
• Initially, you may find it difficult to speak. Practice speaking, reading, or singing out loud to get used to it faster.
• Retainers are breakable, so treat yours with care. If your retainer gets lost or broken, call us immediately.
• If you have any questions or concerns about your retainer, or you believe it needs adjusting, call us. Do not try to adjust it yourself.
• Always bring your retainer to your appointments.
• Retainer replacements are expensive, but with proper care they will last for years!
• Remove your retainer when you go swimming.
• Keep retainers away from hot water, hot car dashboards, pockets, the washing machine, and napkins.

Pediatric Dentistry

Exceptional pediatric dental care is also provided at our facility. For more information, or to schedule an appointment, please contact Granite Bay Pediatric Dentistry at (916) 273-7495.

“At Granite Bay Pediatric Dentistry, we believe our success is built on love for children and the desire to make them comfortable with dentistry. We view each child as a unique individual who must be treated as such to accomplish our goals of a positive dental experience and quality care.” —Dr. Ranbir Singh, Practice Owner