[Konkuk University Dental Clinic] Why Orthodontic Treatment Should Be Approached Differently by Age

Why orthodontic treatment is needed::

About the various types of malocclusion and the need for treatment

Hello, this is Konkuk University Dental Clinic, from S Leader Dental Hospital.

Orthodontic treatment is often misunderstood as simply a “cosmetic treatment that aligns teeth neatly.” Of course, straight, even teeth create a beautiful smile, but what is more important is restoring harmony between tooth function and oral structure.

Malocclusion does not simply mean crooked teeth. It is a broad concept that includes the relationship between the upper and lower jaws, how the teeth fit together, and even the functional balance of the temporomandibular joint. If it is not corrected, it can lead to reduced chewing force, speech problems, facial asymmetry, and even temporomandibular disorders.

Therefore, orthodontic treatment is a specialized treatment method for restoring oral function and maintaining long-term health, beyond cosmetic purposes. Let’s take a look at the main types of malocclusion and their characteristics.

🕒 Types of malocclusion and their characteristics

✅ 1. Class I malocclusion

Class I malocclusion refers to a condition in which the relationship between the maxilla and mandible is normal, but the teeth are uneven, rotated, or abnormally aligned. In simple terms, the jaw position is normal, but the teeth are crooked.

In many cases, this can be corrected without extraction, and the treatment period is relatively short with a generally favorable prognosis. Because it also provides a strong cosmetic improvement, it is one of the most commonly attempted orthodontic types during adolescence or early adulthood.

✅ 2. Class II malocclusion

This is a condition in which the maxilla (upper jaw) protrudes further forward than the mandible (lower jaw). It is often described as “protruding front teeth” or “the opposite of crowding + underbite.” The upper front teeth protrude, and the upper lip often appears pushed forward, affecting the side profile of the face.

This type can cause not only aesthetic concerns but also difficulty keeping the lips closed, dry mouth, and mouth breathing. In addition, if the front teeth protrude severely, they become more vulnerable to trauma, increasing the risk of dental injury.

Treatment varies depending on age and condition. During growth, growth-control devices such as a headgear may be used in combination, and in adults, extraction-based orthodontics or orthognathic surgery may be necessary.

✅ 3. Class III malocclusion

This is a condition in which the mandible (lower jaw) protrudes further forward than the maxilla (upper jaw), commonly called an “underbite.” The front teeth show a reverse bite, or crossbite, and in severe cases the jaw itself protrudes, greatly affecting the facial shape.

Class III malocclusion is strongly influenced by genetics, and many cases involve underlying skeletal problems in the jaw, making it difficult to resolve with orthodontics alone. Therefore, early diagnosis is especially important. During growth, attempts are made to guide growth using functional appliances, and in adulthood, orthognathic surgery (double-jaw surgery) is often combined.

✅ 4. Open bite

This is a condition in which the front teeth do not close and a space remains open, usually caused by habits such as tongue thrusting, mouth breathing, or prolonged thumb sucking. If the front teeth do not close properly, normal speech becomes difficult, and because the front teeth cannot be used for chewing, chewing force decreases.

Open bite can also lead to various complications beyond functional issues, such as dry mouth, bad breath, and increased load on the temporomandibular joint. Early diagnosis and habit correction are key to treatment.

✅ 5. Deep bite

This is a condition in which the upper front teeth excessively cover the lower front teeth, so that only the upper teeth are visible when smiling, or the lower teeth are not easily seen.

In severe cases, the lower front teeth may irritate the upper gums, leading to gingival recession, gingivitis, and periodontal problems. The added burden on the temporomandibular joint may also cause headaches or muscle pain.

In such cases, orthodontic treatment is needed to adjust the vertical position of the teeth and stabilize the bite. From a cosmetic standpoint, it can also improve the shape of the lips and the proportion of the lower one-third of the face.

🕒 How orthodontic treatment approaches change by age

Orthodontic treatment is not simply a treatment that changes tooth alignment. Because the treatment method and purpose differ depending on the growth period and skeletal development stage, it is important to approach it differently by age. People often think, especially for children, “Isn’t it too early?” but in fact, it is not always better to start orthodontic treatment late. On the contrary, starting early can guide skeletal growth, correct jaw position, avoid unnecessary extractions, or reduce the need for surgery.

During the primary dentition stage or mixed dentition stage (usually around ages 6 to 11), first-phase orthodontic treatment is performed. This is the period when upper and lower teeth are mixed, and the focus is on adjusting the direction of jaw growth and correcting harmful oral habits (such as tongue thrusting, thumb sucking, and mouth breathing). At this stage, removable appliances or functional appliances are often used rather than fixed appliances. Because skeletal problems can be identified early and growth can be guided, diagnosis during this period is very important.

During adolescence (after completion of the permanent dentition stage to around age 18), full second-phase orthodontic treatment is carried out. Since most permanent teeth are already in place at this time, the focus is on aligning the teeth and stabilizing the bite. Because skeletal growth is still somewhat ongoing, treatment response is faster than in adults, and tooth movement is generally easier. Orthodontic treatment at this stage makes the plan for extraction, appliance selection, and treatment duration clearer, and usually takes about one and a half to two years.

In adulthood (age 20 and older), skeletal growth is already complete, so skeletal problems are difficult to resolve with orthodontics alone, and if necessary, orthognathic surgery (double-jaw surgery, jaw surgery) may need to be performed together. However, being an adult does not mean orthodontic treatment is impossible. In fact, many patients want to improve both aesthetics and function at the same time, so there is strong demand for aesthetic appliances such as clear aligners and lingual braces. Gum health and the presence of periodontal disease also become important variables in orthodontic treatment, so precise diagnosis and planning must come first.

🕒 Types and characteristics of various orthodontic appliances

Orthodontic appliances can be broadly divided into fixed appliances, removable appliances, and special appliances that consider aesthetic characteristics. Each appliance is selected according to the patient’s age, degree of malocclusion, and treatment goals, and each has its own advantages and disadvantages in terms of aesthetics, hygiene management, and treatment duration.

1. Metal brackets are the most basic and widely used orthodontic appliances. They work by attaching metal brackets to the teeth and connecting them with wires. They are highly efficient, allow precise adjustment, and can effectively address complex dentition. However, their aesthetics are low, so they may be less preferred among adult patients.

2. Ceramic or clear brackets are made from translucent or tooth-colored materials that are less noticeable than metal appliances, improving aesthetics. Their performance is similar to metal brackets, but in some cases, higher friction may make tooth movement somewhat slower.

3. Self-ligating brackets (Self-ligating Bracket, for example, Clippy-C) have a structure in which the bracket itself holds the wire without elastic bands. Because friction resistance is low, they offer the advantage of faster tooth movement. They are widely used recently because they may reduce pain due to lower friction, make hygiene easier, and shorten treatment duration.

4. Lingual braces are a method in which brackets are attached to the inside (lingual side) of the teeth, with the major advantage that the appliance is not visible from the outside. However, because they are attached on the inside, there may be initial speech discomfort or tongue irritation, and the cost is relatively high.

5. Clear aligners (Clear Aligner, 대표적으로 Invisalign) are a method of moving teeth gradually by replacing transparent plastic trays without attaching appliances to the teeth. They offer excellent aesthetics and are removable, making hygiene management easy, but if adaptation is difficult or patient compliance is low, it can be hard to proceed as planned. They are suitable for mild malocclusion, and complex cases may have limitations.

6. Removable appliances are mainly used in first-phase orthodontic treatment for children. They can be taken in and out and are mainly used to guide jaw growth, secure space, and improve bad habits. Because patient cooperation has a major impact on treatment results, it is important to strictly follow the usage instructions and wearing time.

Orthodontic treatment is not simply a task of “arranging teeth to look better,” but a customized treatment that considers each patient’s oral structure, growth status, lifestyle habits, and aesthetic needs. Even with the same malocclusion, the approach can change completely depending on age or the choice of orthodontic appliance, and this greatly affects the prognosis of treatment.

The most important thing is an accurate diagnosis and consultation with a trustworthy medical professional. Rather than starting treatment simply because “the teeth are crooked,” it is advisable to receive systematically planned orthodontic treatment after evaluating the overall oral function, including bite condition, jaw position, and gum health.

Take the first step toward a healthy, confident smile with an expert diagnosis and consultation.

Konkuk University Dental Clinic :: S Leader Dental Hospital