Re-shaping and polishing edges of teeth after braces

 

Re-shaping edges of teeth as part of Orthodontic Treatment

 

Orthodontics has been correctly described as part art, part science and part mechanics.  No other field in my opinion balances these disciplines as well as the specialty of Orthodontics.  So it is probably no surprise to most that Orthodontists are somewhat perfectionists.  And although we strive to restore ideal function and provide a solid and stable occlusion for each patient, we also want to provide a beautiful smile.  Sometimes this may mean leveling the teeth, adjusting the gum level of teeth, closing spaces, correcting rotations, reducing overjets and/or overbites, etc., etc.  But one area we also can correct is the incisal edges of teeth.

 

 

Adult with severe wear from heavy long-term hyper-occlusion.  Alignment complete but incisal edges un-supported and fragile as well as unsightly.

 

 

Following re-shaping to restore strong edges to the teeth to resist future wear now that alignment has restored proper function.

 

Imagine teeth that have been sitting rotated or crooked for years; even a teen may have front teeth for 6 to 8 years until they are corrected. Now imagine how the edges of the upper and lower teeth abrade and wear against each other.  Over time, the edges will start to flatten based on the opposing teeth.  Then imagine that the teeth are abruptly straightened so that all roots are parallel.  In these cases what we see is that the edges of the teeth are no longer level (they were level relative to the original opposing teeth which are now straightened).  So the teeth after braces are straight but the edges can be angular/un-level/flattened or even chipped.

 

Initial photo of a young adult with a full underbite and damage to edges.

 

Once the underbite has been corrected, you can see the damage to the edges from the previous poor occlusion.

 

Note that we aren’t trying to shorten all the teeth to the highest point where the fractured edge reaches; we only want to restore any sharp edges with a softer and stronger rounded edge.

  

So why are irregular edges bad?  The main concern is that they will be difficult to place into ideal function with the new position of opposing teeth.  Also, teeth that are irregular and chipped will tend to chip more due to areas of un-even enamel or sharp edges hitting poorly with opposing teeth.  Finally, teeth with rough and uneven edges look older and worn, they will likely cause the bite to appear asymmetric or canted to one side.

After braces removed we can see small variations in the edges that will interfere with opposing teeth as the bite is shifted forward; placing edges at risk of fracture and irregular wear.

Following re-shaping to level rough and irregular edges for better function with interference in incisal edges when chewing side to side and front to back.  Note we are not trying to take all of the personal character from the teeth; they are improved but the changes remain subtle.

 

Can we level the gingival margins with braces?

 What is normally and regularly done with Orthodontics is that the teeth are aligned and roots made parallel; this is normally confirmed with a progress radiograph.  Once aligned, the edges are re-adjusted or polished to match the new axial position of the teeth.  Small differences in gingival height can be adjusted by moving the teeth with the braces but the edges may require adjustment following the leveling of the gingiva.  This can be a problem in kids where primary teeth remain too long and affect the eruption of one or more teeth on one side; it can also happed as poor occlusion causes asymmetric wear and a tooth keeps erupting as it is worn down (bringing the gum level with it until the gums are un-even).

 

Braces have straightened the teeth and leveled them based on gingival margins of the front teeth; unfortunately, previous position of the teeth led to excessive eruption on one central incisor; pushing this incisor up would have also pushed the gingival margin up creating an appearance of recession.

 

Following re-shaping of the edges.  Now the level of the gingiva can be appreciated as the edges are re-matched.

 

Does re-shaping teeth hurt the teeth or make them weaker?

Does this “hurt” the teeth?  Doesn’t “grinding the teeth down” weaken the teeth?  In truth, there is no loss of strength with minor adjustments as Orthodontists are only polishing down un-supported areas of enamel already at risk of fracture.  Plus, it is extremely rare to get a cavity on the edge of an incisor once placed into good function. 

 

After alignment, edges show irregular developmental ridges and some chipping.

 

After re-shaping to polish edges and provide solid rounded enamel for better strength.

 

 

After re-shaping with bite closed showing the fit and occlusion with new edges.

                     

What is used to re-shape the edges?

 

Orthodontists have all of the restorative tools that general dentists possess so they have many options based on the amount of the re-shaping; everything from soft rubber discs to Emory-board discs to steel burs and even diamond impregnated burs.   I use Sof-Lex discs which are rubbery plastic discs impregnated with particles of varying grits similar to fine wet-sand paper; these are normally used to polish white composite fillings.  In fact, Orthodontists can make teeth smoother and shinier than they naturally form so you can trust the teeth will look great when completed.

Slow speed handpiece used polish and re-shape edges; the same handpiece used for typical prophy cleanings at the dentist and to polish tooth-colored fillings.  Also the same handpiece used to remove cement

 

Sometimes, re-shaping the teeth may be all you need to restore a beautiful smile even without alignment of the teeth with Orthodontics.  Consider the patient below that was the mother of an active teen patient and was simply asking about her teeth at her son’s appointment:

Patient before any adjustments.

Patient after simply adjusting her edges with Sof-Lex discs at her son’s Orthodontic appointment; no Orthodontics was performed.

 

If you are opposed to adjusting the edges, you may not receive the most ideal correction and could experience more wear including fractures in the future.  By not re-shaping un-supported/rough edges, you will not be maintaining any strength of the teeth but will instead be compromising the esthetics and possibly the long-term wear and function of the very teeth you are wishing to protect.   Trust your Orthodontist; they are specialists not only in function and alignment of teeth but in esthetics and preventing long-term wear while reducing risks of chipping and fracture to teeth.  Orthodontics is never just about lining up teeth as many advertisers of tray systems such as Invisalign may suggest; try not to limit your own correction by limiting the abilities and/or tools of your Orthodontist and you will get the best and most stable smile possible.

If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35^th street and MoPac.

 

Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 20 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com.