05/10/2023
An example of an underbite and permanent tooth wear.
In patients with underbites, there is often an initial contact between the edges of the upper and lower front teeth before the back teeth meet. If this is the first point of contact, there tends to be additional wear on these edges - leading to permanent damage to the adult teeth. This is one of the main reasons we aim to treat underbites early, if and when possible.
For this patient, the underbite and wear on the front teeth were compounded by a condition known as 'molar-incisor hypomineralisation'. For the affected teeth, certain areas of the outer surface of the tooth, known as the enamel, are significantly softer and more prone to fracture. In this condition, the tooth surface is also often discoloured, and the teeth can be more sensitive due to a difference in the composition of the enamel.
We treated this patient with upper and lower braces in order to push the upper teeth ahead of the lower teeth. Elastics were also used in order to establish a bite in which the teeth meet in an ideal relationship. This allowed us to eliminate the damaging contact of her front teeth, which was contributing to undue wear.
At this stage, two upper front braces were removed and she was referred to see a specialist prosthodontist (Dr Charlie Rowda) who restored the molar-incisor hypomineralisation affected upper right central incisor. Dr Rowda performed a beautiful and conservative restoration of this front tooth with tooth-coloured filling materials to mimic its opposing partner. Following the restoration of this tooth, the braces were then put back on to complete her orthodontic treatment.
Through combined treatment with braces and composite buildups, we achieved a stable, aesthetic outcome for this patient.