Navigating Claims and Reimbursements Step by Step: A Parent's Guide to Orthodontic Coverage
As a parent, dealing with orthodontic insurance claims can feel like navigating a maze blindfolded. Trust me, I've been there - staring at complicated forms, wondering how to make sense of dental coverage for my kids' braces.
Let's break this down into simple, manageable steps that won't make your head spin. First, understand your insurance policy inside and out. Not all plans are created equal when it comes to orthodontic treatment. Some cover a percentage, others have a lifetime maximum, and some barely cover anything at all.
Start by calling your insurance provider and asking specific questions. Jaw growth issues are easier to correct at an early age Orthodontics for young children deciduous teeth. What percentage of orthodontic treatment do they cover? Is there a waiting period? Do they require pre-authorization? These details matter more than you might think.
Next, gather all necessary documentation. This typically includes treatment plans from your orthodontist, X-rays, and detailed cost estimates. The more organized you are, the smoother the process will be. Pro tip: make copies of everything and keep a dedicated folder for these documents.
When submitting claims, be meticulous. Double-check every single detail before sending. Small errors can delay reimbursement or cause outright rejection. Most insurance companies now allow online submissions, which can speed up the process significantly.
Don't be afraid to follow up. Insurance companies process hundreds of claims daily, and sometimes things slip through the cracks. A friendly phone call can often clarify issues and keep your claim moving forward.
Consider flexible spending accounts (FSAs) or health savings accounts (HSAs) as additional financial tools. These can help offset out-of-pocket expenses and provide tax advantages.
Lastly, remember that patience is key. Reimbursement can take weeks, sometimes months. Stay organized, persistent, and don't get discouraged.
Navigating orthodontic insurance doesn't have to be a nightmare. With the right approach and information, you can successfully manage your child's treatment costs and ensure they get the care they need.
Navigating the world of insurance coverage for pediatric orthodontic treatment can feel like trying to solve a complex puzzle. As a parent, you want to ensure your child gets the best dental care possible without breaking the bank. Let me walk you through the ins and outs of understanding your insurance coverage.
First things first, not all insurance plans are created equal when it comes to orthodontic treatment. Some plans offer partial coverage, while others might provide minimal support or no coverage at all. The key is to start by carefully reviewing your specific insurance policy. Don't just skim through the document - take the time to read the fine print and understand exactly what's included.
Most insurance providers consider orthodontic treatment a specialized service, which means it often requires additional documentation. You'll typically need a detailed treatment plan from an orthodontist that clearly outlines the medical necessity of the procedure. This isn't just about aesthetics - many orthodontic treatments address critical dental health issues that can impact your child's overall well-being.
Before committing to treatment, call your insurance provider directly. I can't stress this enough. Insurance representatives can help you understand your specific coverage, explain any potential out-of-pocket expenses, and guide you through the pre-authorization process. Some plans require pre-approval before you can proceed with treatment, so it's crucial to get all the details upfront.
Be prepared for some potential challenges. Many insurance plans have age restrictions, lifetime maximums, or specific criteria for coverage. Some might only cover treatment if it's deemed medically necessary, which means you'll need comprehensive documentation from your orthodontist explaining why the treatment is essential.
Don't forget to ask about payment plans and flexible spending options. Many orthodontic offices work with insurance providers and can help you navigate the financial aspects of treatment. They might offer payment plans or suggest ways to maximize your insurance benefits.
Keep detailed records of everything - every consultation, every communication with your insurance provider, and every piece of documentation. This can be a lifesaver if you need to appeal a decision or clarify coverage.
Remember, understanding your insurance coverage is a process. It takes time, patience, and a bit of detective work. But by being proactive and thorough, you can help ensure your child gets the orthodontic care they need without unexpected financial surprises.
The most important thing is to be an informed and engaged parent. Ask questions, seek clarification, and don't be afraid to advocate for your child's dental health. With the right approach, you can successfully navigate the complex world of insurance coverage for pediatric orthodontic treatment.
Initial Consultation and Documentation Requirements: A Crucial First Step in Claims Management
Navigating the complex world of claims and reimbursements can feel like traversing a maze blindfolded. The initial consultation serves as your guiding light, setting the foundation for a successful claims process. Think of it as your first critical checkpoint in the journey of financial recovery.
When you first sit down with a claims specialist, you're essentially laying out the groundwork for your entire reimbursement strategy. This isn't just a casual conversation - it's a strategic meeting where every detail matters. The specialist will want to understand the complete context of your claim, asking probing questions that might seem overwhelming but are actually designed to protect your interests.
Documentation is the backbone of any successful claim. You'll need to bring every relevant piece of paper - medical records, receipts, incident reports, insurance documents. It's like assembling a puzzle, where each document represents a crucial piece. Missing even one can potentially derail your entire claim process.
What many people don't realize is that this initial consultation is more than just paperwork. It's an opportunity to establish a clear communication channel, understand potential challenges, and create a roadmap for moving forward. The specialist will help you understand what documentation is required, potential timelines, and realistic expectations.
Preparation is key. Coming organized, with all necessary documents neatly compiled, demonstrates your commitment and can significantly smooth the claims process. It's about being proactive rather than reactive.
Remember, this first step isn't just a formality - it's the foundation of your entire claims journey. Treat it with the importance it deserves, and you'll be setting yourself up for the best possible outcome.
Obtaining Pre-Authorization from Your Insurance Provider
Dealing with insurance can feel like navigating a complicated maze, and pre-authorization is often one of the most frustrating parts of the process. Let me break down what you need to know to make this journey a bit smoother.
Think of pre-authorization as getting a permission slip from your insurance company before certain medical procedures or treatments. It's basically their way of saying, "Okay, we'll cover this" before you actually receive the service. This step can save you from unexpected financial headaches down the road.
The first thing you'll want to do is contact your insurance provider directly. Have your policy number ready and be prepared to provide specific details about the medical service or treatment you're planning to undergo. Your healthcare provider's office can often help you with this process, as they're typically experienced in working with insurance companies.
When you're gathering information, be as detailed as possible. Include the specific medical codes, the exact procedure you need, and any supporting documentation from your healthcare provider. The more information you can provide upfront, the smoother the process will be.
Don't be discouraged if it takes a few phone calls or some back-and-forth communication. Insurance bureaucracy can be complex, but patience is key. Make sure to document every conversation, including the date, time, and the name of the representative you spoke with.
Some insurance plans have online portals that can streamline this process, so check if that's an option for you. These digital tools can often make pre-authorization faster and more convenient.
Remember, pre-authorization isn't a guarantee of payment, but it's a critical step in ensuring you have the best chance of coverage. It's your financial protection against unexpected medical bills.
If you're feeling overwhelmed, don't hesitate to ask for help. Your healthcare provider's billing department or a patient advocate can often provide valuable guidance through this process.
In the end, taking the time to get pre-authorization can save you significant stress and potential financial strain. It's a small step that can make a big difference in your healthcare journey.
Navigating the world of healthcare expenses can feel like walking through a maze blindfolded. Understanding potential out-of-pocket expenses and treatment costs is crucial for anyone trying to manage their medical finances effectively.
When you're facing a medical procedure or ongoing treatment, the first step is to gather information. Start by carefully reviewing your health insurance policy, paying close attention to deductibles, copayments, and coinsurance. These are the key components that will determine how much you'll need to pay out of your own pocket.
Call your insurance provider and ask for a detailed breakdown of your current coverage. Don't be afraid to ask specific questions about your particular treatment or procedure. Insurance representatives can help you understand exactly what will and won't be covered. It's like having a financial translator who can decode the complex language of medical billing.
Next, reach out to your healthcare provider's billing department. They can provide estimates of the total treatment costs and help you understand what your insurance might cover. Many hospitals and clinics now offer financial counseling services that can walk you through the potential expenses step by step.
Consider creating a spreadsheet or using a budgeting app to track potential costs. Include everything from medication expenses to potential follow-up treatments. This approach helps you prepare financially and avoid any unexpected financial surprises.
Don't forget to explore alternative options. Some providers offer payment plans or financial assistance programs. Medical costs can be overwhelming, but there are often resources available to help manage the financial burden.
Technology can be your ally in this process. Many insurance websites now offer cost calculators and detailed coverage estimations. Take advantage of these tools to get a more accurate picture of your potential expenses.
Ultimately, being proactive is key. The more information you gather upfront, the better prepared you'll be to manage your medical expenses. It's not just about understanding the costs, but about taking control of your financial health alongside your medical well-being.
Remember, knowledge is power - especially when it comes to medical billing and insurance. Take the time to understand your options, ask questions, and plan ahead. Your future self will thank you for the effort.
When it comes to navigating the complex world of healthcare claims and reimbursements, submitting comprehensive claims and supporting medical records is absolutely crucial. Think of it like putting together a detailed puzzle where every piece matters.
First, let's talk about why this process is so important. Insurance companies need clear, thorough documentation to process your claims accurately. This means gathering every single relevant medical document - from doctor's notes and diagnostic test results to treatment plans and prescription records.
The key is being meticulous. You'll want to ensure that each document is legible, complete, and directly relates to the specific medical service or treatment you're seeking reimbursement for. It's like creating a comprehensive story that explains exactly what medical care you received and why.
One practical tip is to create a systematic approach. Start by organizing your medical records chronologically and making copies of everything. Always keep the original documents safe and submit clear, high-quality copies. Double-check that patient information, dates, and diagnostic codes are correct and match across all documents.
Many people find the process overwhelming, but breaking it down into manageable steps can make a huge difference. Review each document carefully, ensure all required forms are filled out completely, and don't hesitate to follow up with your healthcare provider or insurance company if you need clarification.
Remember, attention to detail can significantly improve your chances of a smooth claims process and timely reimbursement. It might seem tedious, but taking the time to submit comprehensive claims and supporting medical records is worth the effort.
Tracking and Following Up on Insurance Claim Submissions
Navigating the world of insurance claims can feel like walking through a maze blindfolded. Anyone who's ever dealt with medical billing or insurance reimbursements knows the frustration of wondering where exactly your claim is in the process. Let me break down some practical strategies that can help make this journey less stressful.
First things first, organization is your best friend. The moment you submit a claim, create a dedicated file or digital folder where you'll store everything related to that specific submission. This includes copies of the claim form, date of submission, reference numbers, and any supporting documentation. It might seem tedious, but trust me, you'll thank yourself later when you need to reference something.
Most insurance companies now offer online portals or tracking systems. Take advantage of these! Log in regularly to check the status of your claim. These platforms can provide real-time updates about whether your claim is being processed, needs additional information, or has been approved or denied.
If you haven't heard anything after a couple of weeks, don't hesitate to pick up the phone. Customer service representatives can provide detailed information about your claim's current status. When you call, always have your policy number, claim reference number, and specific details ready. Being prepared makes these conversations much smoother.
Keep detailed notes of every interaction. Write down the date, time, name of the representative you spoke with, and a summary of the conversation. This documentation can be crucial if there are any disputes or delays in processing.
Remember, persistence pays off. Insurance companies process thousands of claims daily, and sometimes things slip through the cracks. Following up consistently but professionally can help ensure your claim gets the attention it deserves.
Don't get discouraged if the process seems complicated. With patience, organization, and a proactive approach, you can successfully navigate the insurance claim submission process. Each claim you successfully track is a small victory in managing your healthcare finances.
Navigating the world of healthcare claims can feel like walking through a maze blindfolded, especially when it comes to handling claim denials and understanding appeal procedures. Let's break this down in a way that doesn't make your head spin.
First off, claim denials happen more often than you might think. It's not necessarily a cause for panic, but it does require some strategic action. When you receive a denial, take a deep breath and start by carefully reading the explanation. Insurance companies typically provide a specific reason for the denial - maybe there's a coding error, missing documentation, or a service that isn't covered under your plan.
The appeal process is your lifeline in these situations. Think of it like having a second chance to prove your case. Most insurance companies have a structured appeals process that allows you to challenge their initial decision. You'll want to gather all relevant documentation - medical records, doctor's notes, and any supporting evidence that demonstrates why the claim should be approved.
Timing is crucial here. Most insurers have strict deadlines for filing appeals, usually within 30 to 180 days of the initial denial. Missing these windows can automatically invalidate your appeal, so mark those dates carefully.
When writing your appeal, be clear, concise, and professional. Explain the medical necessity of the service, provide any additional context, and include all supporting documentation. Sometimes, a well-documented appeal can turn a denial into an approval.
If your first-level appeal doesn't work, don't lose hope. Many insurance plans offer multiple levels of appeal, including external reviews by independent medical professionals. Some states even have insurance commissioners who can help mediate disputes.
Pro tip: Keep detailed records of everything. Every phone call, every piece of correspondence, every document. This documentation can be your best friend if you need to escalate your appeal.
Remember, persistence is key. Many claims are initially denied but ultimately approved after a well-prepared appeal. It's not about getting confrontational, but about clearly demonstrating the medical necessity and appropriateness of the service.
While the process might seem daunting, you've got this. Take it step by step, stay organized, and don't be afraid to ask for help from your healthcare provider or insurance representative.
Exploring Alternative Financing Options for Orthodontic Care
Navigating the world of orthodontic treatment can be overwhelming, especially when it comes to managing the financial aspects of care. Many patients find themselves struggling with the significant costs associated with braces or other orthodontic procedures, but fortunately, there are several alternative financing options that can make treatment more accessible.
One of the most popular approaches is to investigate flexible payment plans offered directly by orthodontic practices. Many clinics understand the financial burden of treatment and are willing to work out monthly payment arrangements that can spread the cost over several months or even years. This approach can make the overall expense much more manageable for families and individuals.
Dental savings plans present another viable option for those seeking more affordable orthodontic care. These plans aren't traditional insurance but can provide significant discounts on treatment costs. They typically involve an annual membership fee that gives patients access to reduced rates at participating providers.
Health savings accounts (HSAs) and flexible spending accounts (FSAs) are also excellent resources for managing orthodontic expenses. These tax-advantaged accounts allow individuals to set aside pre-tax dollars specifically for medical and dental expenses, effectively reducing the overall financial impact of treatment.
Some patients might also explore third-party financing options like CareCredit or medical credit cards. These specialized financial tools often provide zero or low-interest periods, making it easier to budget for orthodontic care without immediate full payment.
Additionally, many dental schools and community health centers offer reduced-cost orthodontic treatments performed by supervised students or residents. While this might require more time and patience, it can significantly lower treatment expenses for those willing to explore these options.
The key is to be proactive and explore multiple avenues. Patients should discuss financial concerns openly with their orthodontist, research available options, and create a strategy that works best for their individual financial situation.
Ultimately, investing in orthodontic care is an investment in personal health and confidence. By understanding and utilizing alternative financing methods, patients can access the treatment they need without undue financial stress.
| Malocclusion | |
|---|---|
 |
|
| Malocclusion in 10-year-old girl | |
| Specialty | Dentistry  |
In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864;[1] Edward Angle (1855–1930), the "father of modern orthodontics",[2][3][need quotation to verify] popularised it. The word derives from mal- 'incorrect' and occlusion 'the manner in which opposing teeth meet'.
The malocclusion classification is based on the relationship of the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar. If this molar relationship exists, then the teeth can align into normal occlusion. According to Angle, malocclusion is any deviation of the occlusion from the ideal.[4] However, assessment for malocclusion should also take into account aesthetics and the impact on functionality. If these aspects are acceptable to the patient despite meeting the formal definition of malocclusion, then treatment may not be necessary. It is estimated that nearly 30% of the population have malocclusions that are categorised as severe and definitely benefit from orthodontic treatment.[5]
The aetiology of malocclusion is somewhat contentious, however, simply put it is multifactorial, with influences being both genetic[6][unreliable source?] and environmental.[7] Malocclusion is already present in one of the Skhul and Qafzeh hominin fossils and other prehistoric human skulls.[8][9] There are three generally accepted causative factors of malocclusion:
There is not one single cause of malocclusion, and when planning orthodontic treatment it is often helpful to consider the above factors and the impact they have played on malocclusion. These can also be influenced by oral habits and pressure resulting in malocclusion.[11][12]
In the active skeletal growth,[13] mouthbreathing, finger sucking, thumb sucking, pacifier sucking, onychophagia (nail biting), dermatophagia, pen biting, pencil biting, abnormal posture, deglutition disorders and other habits greatly influence the development of the face and dental arches.[14][15][16][17][18] Pacifier sucking habits are also correlated with otitis media.[19][20] Dental caries, periapical inflammation and tooth loss in the deciduous teeth can alter the correct permanent teeth eruptions.
Malocclusion can occur in primary and secondary dentition.
In primary dentition malocclusion is caused by:
In secondary dentition malocclusion is caused by:
Malocclusion is a common finding,[22][23] although it is not usually serious enough to require treatment. Those who have more severe malocclusions, which present as a part of craniofacial anomalies, may require orthodontic and sometimes surgical treatment (orthognathic surgery) to correct the problem.
The ultimate goal of orthodontic treatment is to achieve a stable, functional and aesthetic alignment of teeth which serves to better the patient's dental and total health.[24] The symptoms which arise as a result of malocclusion derive from a deficiency in one or more of these categories.[25]
The symptoms are as follows:
Malocclusions may be coupled with skeletal disharmony of the face, where the relations between the upper and lower jaws are not appropriate. Such skeletal disharmonies often distort sufferer's face shape, severely affect aesthetics of the face, and may be coupled with mastication or speech problems. Most skeletal malocclusions can only be treated by orthognathic surgery.[citation needed]
Depending on the sagittal relations of teeth and jaws, malocclusions can be divided mainly into three types according to Angle's classification system published 1899. However, there are also other conditions, e.g. crowding of teeth, not directly fitting into this classification.
Many authors have tried to modify or replace Angle's classification. This has resulted in many subtypes and new systems (see section below: Review of Angle's system of classes).
A deep bite (also known as a Type II Malocclusion) is a condition in which the upper teeth overlap the lower teeth, which can result in hard and soft tissue trauma, in addition to an effect on appearance.[26] It has been found to occur in 15–20% of the US population.[27]
An open bite is a condition characterised by a complete lack of overlap and occlusion between the upper and lower incisors.[28] In children, open bite can be caused by prolonged thumb sucking.[29] Patients often present with impaired speech and mastication.[30]
This is a vertical measurement of the degree of overlap between the maxillary incisors and the mandibular incisors. There are three features that are analysed in the classification of an overbite:
An average overbite is when the upper anterior teeth cover a third of the lower teeth. Covering less than this is described as ‘reduced’ and more than this is an ‘increased’ overbite. No overlap or contact is considered an ‘anterior open bite’.[25][31][32]
 |
This section may be too technical for most readers to understand. (September 2023)
|
Edward Angle, who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the maxillary first molar.[33] According to Angle, the mesiobuccal cusp of the upper first molar should align with the buccal groove of the mandibular first molar. The teeth should all fit on a line of occlusion which, in the upper arch, is a smooth curve through the central fossae of the posterior teeth and cingulum of the canines and incisors, and in the lower arch, is a smooth curve through the buccal cusps of the posterior teeth and incisal edges of the anterior teeth. Any variations from this resulted in malocclusion types. It is also possible to have different classes of malocclusion on left and right sides.
A major disadvantage of Angle's system of classifying malocclusions is that it only considers two dimensions along a spatial axis in the sagittal plane in the terminal occlusion, but occlusion problems can be three-dimensional. It does not recognise deviations in other spatial axes, asymmetric deviations, functional faults and other therapy-related features.
Angle's classification system also lacks a theoretical basis; it is purely descriptive. Its much-discussed weaknesses include that it only considers static occlusion, it does not account for the development and causes (aetiology) of occlusion problems, and it disregards the proportions (or relationships in general) of teeth and face.[34] Thus, many attempts have been made to modify the Angle system or to replace it completely with a more efficient one,[35] but Angle's classification continues be popular mainly because of its simplicity and clarity.[citation needed]
Well-known modifications to Angle's classification date back to Martin Dewey (1915) and Benno Lischer (1912, 1933). Alternative systems have been suggested by, among others, Simon (1930, the first three-dimensional classification system), Jacob A. Salzmann (1950, with a classification system based on skeletal structures) and James L. Ackerman and William R. Proffit (1969).[36]
Besides the molar relationship, the British Standards Institute Classification also classifies malocclusion into incisor relationship and canine relationship.
Dental crowding is defined by the amount of space that would be required for the teeth to be in correct alignment. It is obtained in two ways: 1) by measuring the amount of space required and reducing this from calculating the space available via the width of the teeth, or 2) by measuring the degree of overlap of the teeth.
The following criterion is used:[25]
Genetic (inheritance) factors, extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth have been cited as causes of crowding. Ill-fitting dental fillings, crowns, appliances, retainers, or braces as well as misalignment of jaw fractures after a severe injury are also known to cause crowding.[26] Tumors of the mouth and jaw, thumb sucking, tongue thrusting, pacifier use beyond age three, and prolonged use of a bottle have also been identified.[26]
Lack of masticatory stress during development can cause tooth overcrowding.[37][38] Children who chewed a hard resinous gum for two hours a day showed increased facial growth.[37] Experiments in animals have shown similar results. In an experiment on two groups of rock hyraxes fed hardened or softened versions of the same foods, the animals fed softer food had significantly narrower and shorter faces and thinner and shorter mandibles than animals fed hard food.[37][39][failed verification]
A 2016 review found that breastfeeding lowers the incidence of malocclusions developing later on in developing infants.[40]
During the transition to agriculture, the shape of the human mandible went through a series of changes. The mandible underwent a complex shape changes not matched by the teeth, leading to incongruity between the dental and mandibular form. These changes in human skulls may have been "driven by the decreasing bite forces required to chew the processed foods eaten once humans switched to growing different types of cereals, milking and herding animals about 10,000 years ago."[38][41]
Orthodontic management of the condition includes dental braces, lingual braces, clear aligners or palatal expanders.[42] Other treatments include the removal of one or more teeth and the repair of injured teeth. In some cases, surgery may be necessary.[43]
Malocclusion is often treated with orthodontics,[42] such as tooth extraction, clear aligners, or dental braces,[44] followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgical intervention is used only in rare occasions. This may include surgical reshaping to lengthen or shorten the jaw. Wires, plates, or screws may be used to secure the jaw bone, in a manner like the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth with most problems being minor that do not require treatment.[37]
Crowding of the teeth is treated with orthodontics, often with tooth extraction, clear aligners, or dental braces, followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to secure the jaw bone, in a manner similar to the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth. However, most problems are very minor and do not require treatment.[39]
While treatment is not crucial in class I malocclusions, in severe cases of crowding can be an indication for intervention. Studies indicate that tooth extraction can have benefits to correcting malocclusion in individuals.[45][46] Further research is needed as reoccurring crowding has been examined in other clinical trials.[45][47]
A few treatment options for class II malocclusions include:
Low- to moderate- quality evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth (class II division 1) is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence.[50] There do not appear to be any other advantages of providing early treatment when compared to late treatment.[50] Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances is effective for reducing the prominence of upper front teeth.[50]
Treatment can be undertaken using orthodontic treatments using dental braces.[51] While treatment is carried out, there is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment in children.[51] A 2018 Cochrane systematic review anticipated that the evidence base supporting treatment approaches is not likely to improve occlusion due to the low prevalence of the condition and the ethical difficulties in recruiting people to participate in a randomized controlled trials for treating this condition.[51]
The British Standard Institute (BSI) classify class III incisor relationship as the lower incisor edge lies anterior to the cingulum plateau of the upper incisors, with reduced or reversed over jet.[52] The skeletal facial deformity is characterized by mandibular prognathism, maxillary retrognathism or a combination of the two. This effects 3-8% of UK population with a higher incidence seen in Asia.[53]
One of the main reasons for correcting Class III malocclusion is aesthetics and function. This can have a psychological impact on the person with malocclusion resulting in speech and mastication problems as well. In mild class III cases, the patient is quite accepting of the aesthetics and the situation is monitored to observe the progression of skeletal growth.[54]
Maxillary and mandibular skeletal changes during prepubertal, pubertal and post pubertal stages show that class III malocclusion is established before the prepubertal stage.[55] One treatment option is the use of growth modification appliances such as the Chin Cap which has greatly improved the skeletal framework in the initial stages. However, majority of cases are shown to relapse into inherited class III malocclusion during the pubertal growth stage and when the appliance is removed after treatment.[55]
Another approach is to carry out orthognathic surgery, such as a bilateral sagittal split osteotomy (BSSO) which is indicated by horizontal mandibular excess. This involves surgically cutting through the mandible and moving the fragment forward or backwards for desired function and is supplemented with pre and post surgical orthodontics to ensure correct tooth relationship. Although the most common surgery of the mandible, it comes with several complications including: bleeding from inferior alveolar artery, unfavorable splits, condylar resorption, avascular necrosis and worsening of temporomandibular joint.[56]
Orthodontic camouflage can also be used in patients with mild skeletal discrepancies. This is a less invasive approach that uses orthodontic brackets to correct malocclusion and try to hide the skeletal discrepancy. Due to limitations of orthodontics, this option is more viable for patients who are not as concerned about the aesthetics of their facial appearance and are happy to address the malocclusion only, as well as avoiding the risks which come with orthognathic surgery. Cephalometric data can aid in the differentiation between the cases that benefit from ortho-surgical or orthodontic treatment only (camouflage); for instance, examining a large group of orthognathic patient with Class III malocclusions they had average ANB angle of -3.57° (95% CI, -3.92° to -3.21°). [57]
The most common corrective treatments available are fixed or removal appliances (such as dental braces), which may or may not require surgical intervention. At this time there is no robust evidence that treatment will be successful.[51]
An open bite malocclusion is when the upper teeth don't overlap the lower teeth. When this malocclusion occurs at the front teeth it is known as anterior open bite. An open bite is difficult to treat due to multifactorial causes, with relapse being a major concern. This is particularly so for an anterior open bite.[58] Therefore, it is important to carry out a thorough initial assessment in order to obtain a diagnosis to tailor a suitable treatment plan.[58] It is important to take into consideration any habitual risk factors, as this is crucial for a successful outcome without relapse. Treatment approach includes behavior changes, appliances and surgery. Treatment for adults include a combination of extractions, fixed appliances, intermaxillary elastics and orthognathic surgery.[30] For children, orthodontics is usually used to compensate for continued growth. With children with mixed dentition, the malocclusion may resolve on its own as the permanent teeth erupt. Furthermore, should the malocclusion be caused by childhood habits such as digit, thumb or pacifier sucking, it may result in resolution as the habit is stopped. Habit deterrent appliances may be used to help in breaking digit and thumb sucking habits. Other treatment options for patients who are still growing include functional appliances and headgear appliances.
Identifying the presence of tooth size discrepancies between the maxillary and mandibular arches is an important component of correct orthodontic diagnosis and treatment planning.
To establish appropriate alignment and occlusion, the size of upper and lower front teeth, or upper and lower teeth in general, needs to be proportional. Inter-arch tooth size discrepancy (ITSD) is defined as a disproportion in the mesio-distal dimensions of teeth of opposing dental arches. The prevalence is clinically significant among orthodontic patients and has been reported to range from 17% to 30%.[59]
Identifying inter-arch tooth size discrepancy (ITSD) before treatment begins allows the practitioner to develop the treatment plan in a way that will take ITSD into account. ITSD corrective treatment may entail demanding reduction (interproximal wear), increase (crowns and resins), or elimination (extractions) of dental mass prior to treatment finalization.[60]
Several methods have been used to determine ITSD. Of these methods the one most commonly used is the Bolton analysis. Bolton developed a method to calculate the ratio between the mesiodistal width of maxillary and mandibular teeth and stated that a correct and harmonious occlusion is possible only with adequate proportionality of tooth sizes.[60] Bolton's formula concludes that if in the anterior portion the ratio is less than 77.2% the lower teeth are too narrow, the upper teeth are too wide or there is a combination of both. If the ratio is higher than 77.2% either the lower teeth are too wide, the upper teeth are too narrow or there is a combination of both.[59]
Other kinds of malocclusions can be due to or horizontal, vertical, or transverse skeletal discrepancies, including skeletal asymmetries.
Increased vertical growth causes a long facial profile and commonly leads to an open bite malocclusion, while decreased vertical facial growth causes a short facial profile and is commonly associated with a deep bite malocclusion. However, there are many other more common causes for open bites (such as tongue thrusting and thumb sucking) and likewise for deep bites.[61][62][63]
The upper or lower jaw can be overgrown (macrognathia) or undergrown (micrognathia).[62][61][63] It has been reported that patients with micrognathia are also affected by retrognathia (abnormal posterior positioning of the mandible or maxilla relative to the facial structure).[62] These patients are majorly predisposed to a class II malocclusion. Mandibular macrognathia results in prognathism and predisposes patients to a class III malocclusion.[64]
Most malocclusion studies to date have focused on Class III malocclusions. Genetic studies for Class II and Class I malocclusion are more rare. An example of hereditary mandibular prognathism can be seen amongst the Hapsburg Royal family where one third of the affected individuals with severe class III malocclusion had one parent with a similar phenotype [65]
The frequent presentation of dental malocclusions in patients with craniofacial birth defects also supports a strong genetic aetiology. About 150 genes are associated with craniofacial conditions presenting with malocclusions.[66] Micrognathia is a commonly recurring craniofacial birth defect appearing among multiple syndromes.
For patients with severe malocclusions, corrective jaw surgery or orthognathic surgery may be carried out as a part of overall treatment, which can be seen in about 5% of the general population.[62][61][63]
cite book: CS1 maint: location missing publisher (link) CS1 maint: others (link)