A beautiful smile is one of the first things people notice and can make a big first impression. It is common for patients to want a beautiful smile that makes them feel confident. Various types of dental issues can unfortunately impact the appearance of a patient’s smile. Issues such as a small shift in the alignment of the front teeth can affect the teeth. Misalignment can cause issues with the patient’s bite, a shift of the midline, and other oral health issues.
The midline is a dividing line between the center of teeth in the upper and lower jaw. The midline should ideally go through the center of the nose and between the eyebrows. A misaligned midline or midline shift can vary in severity from barely noticeable to incredibly obvious.
While a misaligned midline may not be overly concerning right away, it can result in other issues such as negatively affecting the patient’s bite. Other issues associated with a misaligned midline may include uneven wear, decay, grinding and damaged teeth.
Various issues can result in a misaligned midline. Common causes are summarized below:
- Injury, accident or trauma
- Baby teeth which fall out early
- Larger than normal teeth or macrodontia
- Smaller than normal teeth or microdontia
- Jaw misalignment
- Missing teeth
- Oral habits such as sucking the thumb
A misaligned midline is quite common with adult patients. Treatment will vary based on the severity of the issue, the patient’s oral health, cost, and treatment goals. The treatment options commonly used to correct a misaligned midline are summarized below.
Invisalign
Invisalign is an effective treatment option which is used to correct mild and moderate cases of a misaligned midline. This orthodontic solution is quickly gaining popularity. Patients with a deviated midline that also have a crossbite or other types of bite issues often benefit from the use of Invisalign. It can also be combined with other dental appliances to resolve bite issues. Invisalign works by using clear aligner trays. The trays are thin and very inconspicuous. Patients are instructed to remove the trays to clean the teeth, in addition to eating and drinking. The trays are expected to remain in the mouth for the majority of the day.
Traditional Braces
Another effective solution for repairing midline misalignment is traditional braces. Braces are highly effective in treating more complex issues such as a crossbite and are also effective in treating alignment issues for younger patients. Children often have a hard time remembering to keep the Invisalign trays in their mouth. Braces are combined with elastics and other types of appliances can be used in skeletal realignment. Challenges associated with braces include the bulky and visible metal and bracket used for the solution. They can also cause some discomfort as they rub against the gum tissue and tongue.
Hyrax Expander
Another solution that may be considered in the treatment of a misaligned midline is a hyrax expander. The expander is placed in the roof of the mouth and attached to the teeth. It slowly expands the upper jaw and works by creating additional space. This added space aids in shifting the teeth into the proper position in the mouth. In most cases, a hyrax expander is worn for up to nine months.
Tooth Extraction
Another solution that can be used to treat a misaligned midline is the removal of one or more teeth. When patients have overcrowding or a small jaw, extraction of a tooth can create additional space. Following the extraction, the remaining teeth begin to shift into the correct location. This treatment can also help eliminate spaces in the mouth. Dental professionals often combine tooth extraction with other types of treatments including braces or Invisalign to ensure the teeth are properly aligned.
In severe cases of a misaligned midline or when the patient has a structural issue, surgery may be needed. Extraction and surgery are often considered when other solutions cannot be used.
It is important for patients with a misaligned midline to follow up with a dentist to discuss their unique case and the possible treatment options.