Case of the Month


Decmber case of the month picture


Improvement in jaw alignment, smile esthetics and healthy bite function! Having a great smile and proper bite sometimes requires a team approach where Dr. DiGiovanni works with colleagues in a team approach to obtain the best result possible. This patient had significant bite problems that stemmed not only with improper tooth alignment, but also jaw misalignment. In these situations, the orthodontist becomes "the captain of the team" and establishes an interdisciplinary plan with other dentists (here an oral surgeon and a cosmetic/restorative dentist) to establish quite an improvement in his dental health and esthetics. Other amazing multi-specialty and jaw surgery results of our patients can be seen on the following pages WORKING WITH YOUR DENTIST, and JAW SURGERY on our website.


September 202 case of the month photo 1
Timely treatment of skeletal problems is essential!. Phase I treatment is only recommended by Dr. DiGiovanni if there is a developing problem in a growing patient that will worsen over time if not corrected. In this sweet patient, she had a cross bite due to a narrow palate, an asymmetrical lower jaw position and an anterior open bite. When a patient presents with any of these problems they should be corrected as soon as possible because they will only worsen over time and be more difficult to correct. In her case after only 14 months all of the developing skeletal problems were corrected and have been stable since.
September 2020 case of the month photo 2
The top x-ray shows SEVERE crowding and ectopic eruption due to the underlying skeletal malformations.  The lower x-ray reveals all the space created from the orthodontic treatment that occurred.




Non-surgical elimination of gummy smile. There have been a lot of studies on what constitutes the most "ideal" smile. When it comes to how much gum tissue is diplayed, the most esthetic smiles show all of their upper teeth and 2-3mm of gum tissue. Some people don't show enough of their teeth when they smile and others, like this patient showed excessive gum tissue when smiling. New innovations in orthodontics allow Dr. DiGiovanni to properly position the upper anterior teeth while decreasing the 8-9mm of gums showing to the ideal 2-3mm. Use of small removable "temporary anchorage devices" make contemporary orthodontic tooth movement accomplish things that once could only be accomplished using surgery. But now, like in this patient braces and TADS dramatically improve the smile without surgery. 22 months of treatment with braces


March Case of the Month
What a difference a space makes! A gap between the teeth is known as a "diastema" here caused by improper swallowing or a "tongue thrust". The pressure of thetongue against the teeth can profoundly displace teeth to cause serious bite problems and negatively affect the esthetics of the smile. It is necessary for all teeth to be able to touch for proper bite function. If only the back teeth touch they will wear and can break or fracture over time even involving tooth loss. Sometimes the imbalance in the bite caused by a tongue thrust results in the need for jaw surgery. The persistence of a tongue thrusting against the front teeth when swallowing can prevent or prolong orthodontic treatment and even worse cause a total relapse of the corrected result. This patient had complete upper and lower braces in conjunction with tongue thrust therapy (during treatment for 6 weeks) to correct the cause of the splaying of the front teeth. The right-side photo (18 months after braces were removed) shows a beautiful and stable result.


April case of the Month 2019

Severe Crowding (9 year old)

Interceptive (phase I) treatment was used to expand the upper jaw to create space and maximize smile esthetics. During phase I the bite was corrected and space was created to avoid tooth extractions. Many patients are now using Invisalign in phase 2 in lieu of braces in that they are opting for a less noticeable appliance in middle and high school. Invisalign would NOT have been an option if the correction achieved in phase I did not occur.


May case of the month 2019

Note: Lip closure obtained after the bite is corrected.  We focus on "facial balance" not just aligning the teeth.

Orthodontic Magic

Underbite corrected, teeth nicely aligned, decrease gum tissue display! This is one of many cases we have treated on patients who have gone their entire life being told they need jaw surgery. Dr DiGiovanni was able to camouflage the underlying skeletal problem and obtain a very healthy and functional bite with great esthetics. If you've been told you need jaw surgery and would like to see if there is a way to have the bite and smile you've always wanted, see a board certified orthodontist. Other examples on our website can be viewed on our Alternatives to Jaw Surgery page.


June case of the Month picture 1
xray of impacted tooth


Orthodontists use palate expanders to correct narrow upper jaws (cross bites), create room for crowded teeth to avoid extractions and for esthetically enhance the smile to a full and symmetric smile. Palate expanders can also help make space for "ectopic" teeth to help them grow in often eliminating surgery or the need to extract baby or adult teeth.


December case of the month

It's easy to make teeth straight but it is difficult to do it correctly Photo on the left is a deceptively difficult case. Our beautiful patient has almost no crowding and often patients with a nice smile like hers are hesitant to have braces or Invisalign. But if you look closely the smile is narrow, the midline is fully off center which reveals an underlying bite problem. Dr. DiGiovanni placed braces with custom wires to aesthetically broaden the arches while correcting the midline and hence the bite. If you look closely at the two smiles you will see a subtle yet improved wider smile.



Canine Substitution

SHE HAS A MISSING TOOTH ??? I BET YOU CAN'T TELL! Congenitally missing teeth are more common than you might think. A decision needs to be made in these situation whether to open space for an implant or to close the space. Dr. DiGiovanni always tries to eliminate implants but only if it is the best approach for the patient. Careful orthodontic set up is needed in either situation to ensure every patient has a fantastic smile that is stable and healthy. The patient above has a very challenging case that was successfully treated with braces and minor cosmetic dentistry.


WHY would my child need 2 phases of braces.... Great question!


ANTERIOR CROSS BITE (underbite) (8 year old)

Interceptive treatment was used to expand the upper jaw and with braces to position the upper front teeth ahead of the lower front teeth. Notice the difference in the gum tissue display when the upper teeth are properly aligned. Interceptive treatment at this dental stage is predictable and stable. Leaving this condition until all the permanent teeth erupt (age 11-12) could result in strain on the jaw by constantly protruding it and breaking the front teeth. She is now wearing a retainer and the result is stable! Success!

To see other "2 phase magic" cases on our website: CLICK HERE!



October 2020 case of the month photo 1
In contemporary orthodontics tooth extraction is not a common treatment approach especially if the crowding is identified at an early age when space can be created for the crowded erupting teeth. In situations like this when extractions are needed special care must be taken to align the teeth in and esthetic position that is stable and healthy. If this is not done properly, it can result in a compromised smile and bite. In this patient the teeth were extracted to create room for the canines (upper arch) and impacted 12 year molars (lower arch-see x-rays and much care was taken to broaden the arch for esthetics and bite function while creating room for the impacted lower molars which are now in alignment.
October 2020 case of the month photo 2
Due to the crowding pattern, the lower 12 year molars were horizontally impacted. Selective closing of the lower space created made room for the 12 year molars which are now in a proper position