When we talk about Orthopedics, we associate it with orthodontic treatment, since we refer to the capacity of the dental appliances that we use to modify the growth of bones. This is useful when the girls / you have some alteration of growth of the bones of the face.

Fig. 1

Orthopedics

In most cases, a narrow palate (fig 1), a maxilla behind the mandible (fig 2), or a retracted mandible (fig 3), represent the majority of occasions in which we perform orthopedics. This type of treatment requires specific training, and it is advisable for the exclusively trained orthodontist to treat these cases and apply the best treatment criteria.

Fig. 2

Fig. 3

The age to start orthopedic treatment is different depending on the problem that our patient has. For example, to treat a narrow palate or a hypoplastic maxilla (with little growth), we should start around 6-7 years or as fast as we see it, but usually not before this age. Treatments that start soon should have very clear and simple objectives so as not to turn them into “years of treatment”, in principle 12 or 15 months of treatment should be enough to solve almost everything that may arise. A narrow palate is usually treated with a fixed expander (fig 4), since it can provide a better result, since being fixed, the patient cannot remove it or forget it. This expander needs to be turned around at home every day for about 1 month. The orthopedic treatments that we do in younger children should not be too long, in this way we avoid “burning” the patient, and that they arrive with desire if it is finally necessary to perform a second phase with braces on all teeth (about 12 or 14 years).

Fig. 4

In cases of small jaw we should not start before the age in which the patient is in a moment of growth acceleration. The moment of growth can vary for each child, so it will be the orthodontist who finally decides what is the best age to start treating the case. If we start too early we will not be able to take advantage of the patient’s full potential to grow, and if we start too late all that growth will no longer be there to take advantage of it. In the following graph (fig 5), we can see how, in general, growth is different for girls and boys. Girls mature earlier than boys and may be accelerating growth by about 11 years (ascending red line), and boys begin that acceleration somewhat later (ascending blue line), around 13 years of age. As this is highly variable for each patient, it is very important to always check the growth status of the patient. For this there are different ways to find out; the simplest would be to ask parents about the physical changes they observe in their children.

Fig. 5

The appearance of pubic or armpit hair usually marks the onset of puberty. Another very simple method is to take a small X-ray of the third phalanx of the middle finger of the hand (Fig 6, area outlined in orange). This X-ray, which can be performed in any dental office in a simple way and with very little radiation, provides us with precise information on the moment of growth in which the patient is. All these tools can help us know when is the best time to perform an orthopedic treatment.

Fig. 6

Another important point to highlight is the real effect of the appliances on bone growth, apart from that which is predetermined by genetics. The genetic code that allows us to modify the amount of growth of the patients is still unknown. Although we try by all means to grow the bones with our braces, we do not always succeed. If the change to be made is too great, or the genetics of the patient does not respond well, we may not find the expected results. It is very important that this point is very clear with the parents before starting the orthopedic / orthodontic treatment. As we always say, reasonable and appropriate planning for the patient’s problem is what will always give good results.