Complex and interdisciplinary orthodontics in Broomfield, CO

A case may require advanced planning when the bite problem is driven partly or primarily by the size, width, position, or asymmetry of the jaws. Examples include:

• A skeletally narrow upper jaw in a late adolescent or adult
• A significant underbite or excessive overjet related to jaw position
• A severe open bite with a skeletal component
• Facial or jaw asymmetry
• A bite discrepancy that cannot be corrected predictably by moving the teeth alone
• Impacted teeth or missing teeth requiring complex space management
• Orthodontic preparation for restorative, periodontal, or prosthetic treatment
• A need for skeletal anchorage to move teeth while limiting unwanted movement elsewhere

The same visible bite can have different causes. Accurate diagnosis is what separates an appropriate advanced treatment plan from an unnecessarily complicated one.

Planning begins with a clinical examination and diagnostic records. At your consultation, we typically take facial and smile photographs, a 3D digital scan of your teeth with an iTero scanner, and 3D imaging to evaluate the teeth, roots, and jaws in detail. Depending on the question being evaluated, panoramic and cephalometric radiographs may also be used when their diagnostic value justifies the additional exposure.

We evaluate whether the discrepancy is dental, skeletal, or a combination of both. We also consider growth status, periodontal support, tooth position within the bone, previous treatment, missing or restored teeth, facial proportions, airway symptoms, and the patient's tolerance for different levels of treatment.

When surgery or another specialist is being considered, early coordination matters. The orthodontist and specialist should agree on the diagnosis and treatment objectives before irreversible steps are taken.

MARPE stands for miniscrew-assisted rapid palatal expansion. It is designed to widen a skeletally narrow upper jaw by directing expansion forces through temporary anchorage devices placed in the palate. Depending on the appliance design, the expander may be supported primarily by the palate or by a combination of palatal miniscrews and teeth.

Traditional tooth-borne expanders are most predictable in growing patients whose palatal sutures are more responsive. MARPE may allow skeletal expansion in selected late adolescents and adults while reducing the amount of force placed on the teeth. It is less invasive than surgically assisted expansion, but it is not guaranteed to open the midpalatal suture in every patient.

MARPE may be considered when a patient has a true transverse deficiency of the upper jaw. Findings may include:

• A unilateral or bilateral posterior crossbite related to maxillary width
• Upper and lower dental arches that cannot be coordinated without skeletal expansion
• Crowding that is partly associated with a narrow maxilla
• A high or narrow palatal form accompanied by a confirmed transverse discrepancy
• A need to create a more appropriate skeletal foundation before comprehensive orthodontic treatment

Crowding alone does not establish a need for MARPE. The decision should be based on the skeletal diagnosis, periodontal boundaries, age and maturation, appliance design, and the alternatives available.

The appropriate expansion method depends on skeletal maturity, the severity and location of the deficiency, periodontal support, and the amount of change required.

After the appliance and miniscrews are placed, the expander is activated according to an individualized schedule. Patients commonly notice pressure in the palate, teeth, nose, or cheek areas. A space may develop between the upper front teeth when the suture opens; this is an expected treatment sign in many, but not all, expansion protocols.

The expansion phase is followed by a retention period while bone forms in the expanded area. Braces or clear aligners may then be used to align the teeth, manage the temporary space, coordinate the bite, and complete treatment. See braces and Invisalign.

The activation schedule should not be changed without instructions. Faster activation does not guarantee a better result and may increase discomfort or unwanted effects.

MARPE is an advanced orthodontic procedure with meaningful benefits for selected patients, but it also has limitations and potential complications. These may include:

• Failure or incomplete opening of the midpalatal suture
• Asymmetric expansion
• Dental tipping or movement outside the intended position
• Inflammation, irritation, or ulceration of palatal tissue
• Loosening or mechanical failure of a miniscrew or appliance component
• Periodontal changes, discomfort, or the need to modify or discontinue the approach
• Some relapse after expansion and the need for adequate retention

If nonsurgical expansion does not succeed or is not sufficiently predictable, surgically assisted expansion may be the safer or more effective option. This possibility should be discussed before MARPE begins.

MARPE changes the width of the maxilla and may increase dimensions in parts of the nasal cavity and nasopharynx. Some patients also report a change in nasal breathing. However, current research is heterogeneous, long-term data are limited, and an anatomical change on imaging does not establish that obstructive sleep apnea has been treated.

We do not use a CBCT image alone to diagnose sleep apnea, and we do not present MARPE as a stand-alone cure for a sleep disorder. Patients with habitual snoring, witnessed pauses in breathing, daytime sleepiness, or other concerning symptoms should be evaluated by the appropriate medical or sleep specialist. Orthodontic treatment can then be coordinated with that broader diagnosis when relevant.

Temporary anchorage devices, often called TADs or orthodontic miniscrews, are small devices placed in bone to provide a stable point of support during tooth movement. MARPE uses miniscrews to support expansion, but TADs can also be used for other complex movements.

Depending on the plan, TADs may help intrude teeth, close spaces, correct an open bite, manage asymmetry, or reduce unwanted movement of other teeth. They are temporary and are removed when they have completed their role. Not every complex case requires them.

Orthognathic surgery, also called corrective jaw surgery or surgical orthodontics, repositions one or both jaws when the underlying skeletal relationship cannot be corrected predictably with tooth movement alone. The surgery is performed by an oral and maxillofacial surgeon, while the orthodontist positions the teeth so they will fit appropriately after the jaws are repositioned.

Surgical treatment may be considered for significant jaw discrepancies, facial asymmetry, severe skeletal open bite, or other conditions in which orthodontic camouflage would create an unacceptable functional, periodontal, or facial compromise.

A recommendation for surgery is based on the diagnosis and the limits of nonsurgical treatment, not simply on how severe the teeth look. During planning, we discuss:

• Which part of the problem comes from the teeth and which part comes from the jaws
• What orthodontic treatment alone could reasonably accomplish
• Whether camouflage would move teeth outside healthy or stable boundaries
• Expected functional and facial differences between surgical and nonsurgical options
• The commitment, recovery, costs, and risks associated with each approach

Some patients choose a nonsurgical compromise after understanding its limitations. Others decide that correcting the skeletal foundation is the most appropriate path. The consultation should provide enough information for that decision to be deliberate rather than pressured.

Surgical orthodontic care commonly follows several coordinated stages:

Diagnosis and team planning. The orthodontist and oral and maxillofacial surgeon establish shared treatment objectives and review the proposed sequence.

Presurgical orthodontics. Braces or clear aligners position the teeth within each jaw so the arches can fit together after surgery. This decompensation can temporarily make the bite or facial imbalance look more noticeable.

Surgical planning and surgery. The surgeon finalizes the operative plan and discusses the procedure, hospitalization or surgical setting, risks, diet, and recovery.

Postsurgical orthodontics. After the surgeon confirms appropriate healing, orthodontic treatment refines the bite and tooth positions.

Retention. Retainers help protect the final tooth positions after active treatment is complete.

Some teams use a surgery-first sequence in selected cases, but it is not appropriate for every diagnosis. The sequence is chosen jointly by the orthodontist and surgeon.

Complex care is often interdisciplinary. The team may include:

• The orthodontist, who diagnoses the bite, positions the teeth, and coordinates the orthodontic sequence
• An oral and maxillofacial surgeon, who evaluates and performs jaw or surgically assisted expansion procedures
• The general dentist, who maintains dental health throughout treatment
• A periodontist or restorative dentist when gum support, missing teeth, implants, or restorations affect planning
• An ENT physician or sleep-medicine clinician when nasal obstruction or sleep-disordered breathing requires medical evaluation

The specialists do not work in isolation. Shared records, clearly defined responsibilities, and agreement on the final goals help reduce surprises as treatment progresses.

There is no single timeline for MARPE or surgical orthodontics. Treatment length depends on the diagnosis, growth and maturation, the expansion or surgical approach, healing, tooth movement, periodontal health, and whether additional treatment stages are required.

After the diagnostic workup and specialist consultations, we can provide an individualized estimate and identify the parts of the schedule that are least predictable. The timeline may change if the biological response, surgical timing, or treatment objectives change.

Fees for complex treatment vary widely because the diagnosis, appliance, and any surgical involvement differ from patient to patient. Surgical fees for the surgery itself are set separately by the oral and maxillofacial surgeon's office.

• Dental and medical insurance: orthodontic treatment is typically billed under dental benefits, while jaw surgery is often eligible for medical insurance coverage.
• HSA and FSA: accepted

At Sharp Smiles Orthodontics, advanced technology supports the diagnosis; it does not replace clinical judgment. We use records to define the skeletal and dental problem, establish realistic treatment goals, and communicate with the specialists involved.

We also make room for the patient's priorities. Questions about surgery, appearance, breathing, recovery, cost, treatment length, alternatives, and long-term stability are appropriate and important. Our goal is to explain what each option can and cannot predictably accomplish so the patient can make an informed decision.