Orthodontics

Dr Gupta’s Multispeciality Dental Clinic

Smile By Design dental clinic

What is Orthodontics?

Orthodontics is the branch of dentistry that deals with straightening and correcting the tooth alignment and the dental specialist who does this is called an "Orthodontist".

Who Needs Orthodontic Treatment?

Today children as well as adults are choosing to have orthodontic treatment since age is no longer a factor that governs the feasibility of the treatment. But as you grow older the duration of the treatment is increased since it is easier to shift and align teeth during the growth phase of the jaws. Orthodontic treatment corrects
-malocclusion (bite or occlusion is off)
-tooth malalignment (crooked teeth)

Why Treat Malocclusion?

Orthodontics is not only used to improve your appearance. Malocclusion or malaligned teeth can have long term effects, such as:

  • Interference with normal growth and development of the jaws.
  • Abnormal swallowing patterns.
  • Abnormal facial muscle function.
  • Impairment of chewing.
  • Speech defects.
  • Susceptibility to cavities due to the difficulty of removing plaque from crooked teeth vulnerability to accidents or fractured teeth (if your front teeth stick out, they may be more easily injured).

How Do Braces Work?

Teeth can slowly be moved and shifted into proper position by applying pressure in certain directions. Bands, wires and elastics are placed on the teeth to move them in the right direction. This takes place slowly and carefully over an extended period of time. Shifting teeth back into a functional position can take months to years, but eventually you'll have a new and improved mouth. Retainers are often used after the braces, to hold the teeth in their new position until they are stable. It is important to wear the braces or an appliance for however long it takes. If you quit at any point during treatment, the teeth can shift back into their old position.

Conditions Requiring Braces

This is the most simple step of all. Just stand in front of the mirror and check out the following. Are your teeth:

  • Crowded teeth
  • Upper teeth protruding far ahead of the lower
  • Lower teeth closing ahead of the upper this is called cross bite
  • Upper rear teeth, i.e. chewing teeth, closing inside the lower teeth
  • Teeth falling into extraction spaces
  • Upper front teeth falling backwards and grinding against the lower teeth
  • Lower teeth hitting the roof of the mouth behind the upper teeth on closing
  • Pain in the jaw joint just ahead of the ear
  • Clicking sound in the joint during opening and closing
  • Seen from the side the lower jaw looks very small
  • Seen from the side the lower jaw looks very large
  • If one or more conditions exist. Then you need to consult an ORTHODONTIST

Benefits of Early Detection for Orthodontic Treatment

A check-up with an orthodontist no later than age 7 for children who enable the orthodontist to detect and evaluate problems (if any), advise if treatment will be necessary, and determine the best time for that patient to be treated. Patients who have clear indications for early orthodontic intervention, early treatment presents an opportunity to:

  • Guide the growth of the jaw
  • Regulate the width of the upper and lower dental arches
  • Guide incoming permanent teeth into desirable positions
  • Lower risk of trauma (accidents) to protruded upper incisors (front teeth)
  • Correct harmful oral habits
  • Reduce or eliminate abnormal swallowing or speech problems
  • Improve personal appearance and self-esteem
  • Potentially simplify and/or shorten treatment time for later corrective orthodontics
  • Reduce likelihood of impacted permanent teeth
  • Preserve or gain space for permanent teeth that are coming in

 

Healthy teeth can be moved at almost any age. Many orthodontic problems can be corrected for adults as children. Orthodontic forces move the teeth in the same way for both a 75-year-old adult and a 12-year-old child. However for adults, complicating factors such as lack of jaw growth, may create special treatment planning needs.

Common Malocclusion Problems

                    

Deep Bite                                                            Crooked Teeth

         

Flared Anterior Teeth                                            Cross Bite of Back Teeth

  

Open Bite                                                             Reverse Bite

Cross Bite of Front Teeth                                        Spacing

Causes Leading to These Conditions

1. Genetic and 2. Acquired

Genetic Conditions are inherited from either or both parents. The person may have large tooth size from one parent and a small jaw size from another. These then produce a situation wherein the teeth either protrude out or are arranged in a haphazard crowded manner. A large or small lower jaw may be inherited from one parent and upper face may be from another. Thus causing disproportion in the face.

Acquired conditions are generally associated with the growing years specially when the milk teeth are falling off and new permanent teeth are taking their place. Teeth which fall off before their time must be replaced with space maintainers to hold the space for the successor tooth. Otherwise the space may get filled up by the adjacent teeth leaving no place for the new tooth to grow into. Teeth which stay on in the gums even when their successors have erupted need to be removed so that their place may be rightfully taken by the successor tooth.

The milk teeth have a very important role to play and must be preserved and looked after till they fall off. Decay and early loss must be taken care of at the earliest.

Habits such as thumb sucking and tongue thrusting can lead to conditions requiring treatment with braces, These habits need to be corrected at the earliest to avoid major problems with the teeth and the supporting bones.

It is best to visit the ORTHODONTIST during the age of 8 to 11 year. This is the period when the teeth in the mouth are a mix of the milk and permanent teeth.

Best Age for Treatment

Humans are blessed with two sets of teeth in a life time. The milk teeth for the child years and the permanent teeth for the adult age. The transition from milk teeth to the permanent teeth takes place over a period of time usually from 6 years to 13 years of age. Most problems develop during this period. It is good to see a specialist ORTHODONTIST during this period.

Conditions requiring braces for treatment can be prevented to a good extent, and those conditions which have appeared can be prevented from growing in severity during this transition period from the milk to the permanent teeth. It is a good idea to start early and try to reduce the severity of the problems which have developed.

Problems to be treated with braces are problems of the growing child. These are best treated during the growing years. Children grow very fast at puberty. There are two periods well recognized for treatment. These are the pre puberty and the post puberty growth periods. These are the best times to treat as changes in the face can best be achieved at these times.

However, treatment with braces can be taken at any time. The age is not the guiding factor. What is important is the nature of the problem to be treated and the condition of the teeth and their supporting structures. That is if the gums and the holding soft bone are healthy, braces can be prescribed if indicated. Best bet is to consult the ORTHODONTIST.

Fixed Braces are never placed on milk teeth.

Treatment Procedure

The treatment would generally consist of the following steps:

  1. Consultation
  2. Records and investigations, consisting of x rays and plaster models and history
  3. Case analysis and case discussion, treatment planning
  4. Completion of all general dental work like filling and extractions
  5. Fabrication of appliances and fitting
  6. Follow up visits till treatment goals are achieved
  7. Models and x rays to compare with the record and evaluate the result. End of active treatment
  8. Retention appliance. To retain the result and allow setting down

Is Tooth Extraction Essential?

The diagnosis is the most important part. It is very essential to understand the nature of the problem being treated. Once that is done the treatment plan decides the requirement of the appliance.

If the diagnosis indicates it, it is essential to extract some teeth for the purpose of the treatment. This should not cause any alarm, It is an internationally accepted procedure and the decision to extract is taken with all considerations in mind.

Imagine a school bench meant for four children that gets occupied by six. The result is that the children have to sit haphazardly. If the teacher were to insist on order, then either the bench would have to be made bigger or the number of children reduced. In the mouth, a similar situation arises, since the jaw bones can not be made to grow to take all the teeth, some teeth have to be reduced in number for the others to be arranged perfectly well.

The decision is always made according to the space available in the bone as compared to the space required by the teeth to be arranged perfectly. If the space available for the teeth is less, then some teeth will have to be removed to adjust the arrangement of the teeth in the mouth.

Treatment Objective

A well treated case will have teeth well set with no spaces in between them, no rotations, near perfect setting (almost like in a denture) roots well aligned and paralleled, no cross bites, teeth well angulated and perfectly tipped not tilted too far back. This will add to the beauty of the smile and help retain the teeth for a long time without decay and gum problems.

Types of Braces

Braces are generally of two types:

1. Removable braces and 2. Fixed Braces

The removable braces as their name suggests, can be removed from and placed in the mouth by the patient. They are made of wire and plastic and are made outside the mouth on the plaster models of the mouth of the patient.

Removable braces require a great amount of co operation from the patient in order to produce the result. It is not possible to control the movement of each tooth of the patient during the treatment. The present day specialists do not prefer to treat with removable braces because of lack of patient co operation and inefficiency of the appliance system.

The fixed brace as their name suggests are fixed to the teeth and can not be removed by the patient at his own free will. They are made of steel or ceramic and represent the greatest of advances in technology.

Fixed braces do not solely depend on the co operation of the patient. The result is excellent as they provide control on individual teeth. The part that is fixed to the tooth is called a BRACKET for the front teeth and a TUBE for the molar or posterior teeth. Both the bracket and the tube are examples of the ultimate in engineering and technology.

The wires that are used are a fall out of the alloys used in space research. Alloys such as Nickel – Titanium and Copper and Nickel Titanium help move teeth into perfect position. These wires are very comfortable and exert very comfortable forces over a long period of time thus reducing the number of visits.

The latest wires are thermal sensitive. They go soft at low temperature and harden up as the temperature rises in the mouth thus delivering constant force.

Removable Appliance | Fixed Appliance

Surgical Orthodontics

Surgery is a new dimension that has been added to Orthodontics. This is a combination procedure carried out by the Orthodontist and the Oral & Maxillofacial Surgeon, another dental specialist, to produce the best possible result for the patient.

There are some defects that may require surgery to correct to perfection. These are generally related to large jaws and open bite cases. With the advent of adult treatment the number of cases going up for final surgical correction is increasing. Teeth can be moved with Braces. But when the problem involves the bones of the face, they have to be set surgically.

The need for final correction with surgery is generally determined at the diagnosis stage. However, it is always treatment with braces before surgical correction.

Components of Braces

Braces are a complete force system capable of generating and transferring force to move teeth and align them in perfect positions. Braces consist of TUBES that are attached on the grinding or molar teeth and BRACKETS which are attached to all the rest of the teeth, premolars, canines and incisors, in the mouth. The BRACKET and the TUBES hold the WIRE which transmit the forces to the teeth. Sometimes elastics made of latex are used to generate extra force in the appliance. Teeth can be moved every which way-up, down, left, right, rotated, and pushed into the bone. In short everything that is needed to give the perfect setting to the teeth.

Types of Braces Available

Metal Braces

Metal brackets are the ones that are most frequently used. They appear as small metal buttons that are glued to the front of each tooth. These tend to be less expensive than other types of brackets. Additionally, they can be made colorful with ligature rubber bands that come in a wide range of colors.

A major drawback of these braces is there color which makes its use very limited in cases of adult orthodontics.

Invisible Braces

Invisible braces or Invisalign is a great treatment option for people who do not have severe problems and are concerned with esthetics during the treatment. Instead of bonding brackets to the tooth, a series of strong plastic trays are fabricated.

Disadvantages of "Invisible Braces"

  1. More expensive than metal braces
  2. Not suitable for all cases

Ceramic (Tooth Colored) Braces

Ceramic braces are very similar to metal braces in their function. The only difference is that the brackets are tooth colored. These brackets are nearly as strong as the metal counterparts and so they can treat almost all of the same cases (some exceptions exist).

Ceramic brackets are made of composite materials. They are very strong and generally do not stain. Adults like to choose ceramic because they "blend in" with the teeth and are less noticeable than metal. The ligatures (tiny rubber bands) that hold the arch wire on to the ceramic brackets are often white or clear. This looks great at first, but the ligatures can stain. Unless you eat a lot of curry, smoke, or drink a lot of black coffee, this generally isn't a problem. Note that the ligatures are changed each time you get an adjustment -- usually, monthly. It's only the ligatures that stain, not the brackets themselves!

Clear Sapphire Inspire! Brand Braces

Inspire brand brackets, are made of pure monocrystalline sapphire and are very translucent. They are very strong and do not stain. If your teeth are already very white, then Inspire braces will look best on you and seem to "disappear" on your teeth. If your teeth are less than white, they may tend to stand out (in this case, the Ceramic brackets would be a better choice). The pros and cons for Sapphire brackets are the same as those for Ceramic brackets.

Self-ligating Braces

Self-ligating Braces are brackets that do not need the elastic bands to hold the wire to the brackets. Instead, each bracket has a sliding door locking mechanism to hold the wire. The brackets allow the wire to slide back and forth which means fewer adjustments and, therefore, fewer appointments.

Lingual Braces

For those patients who want complete “obscurity,” lingual braces may be an option. Lingual braces are applied to the inside surfaces of the teeth. Many people (especially professionals such as lawyers, doctors and sales representatives) opt for these “hidden” braces. It’s important to discuss this option with an orthodontist as lingual braces are not applicable to all orthodontic problems.

Lingual braces are attached to the inside or lingual side of the teeth which makes them completely non-visible. Lingual orthodontics particularly well-suited for adults whose professions keep them in the public eyes. Lingual braces are designed and fabricated using new CAD/CAM and rapid prototyping technologies. The brackets are made out of a highly durable, dental-gold alloy. The precision wires are designed and bent to your specifications using robotic technology.

Usually, lingual brackets are made of metal.

Who Can Wear Lingual Braces:

  • People concerned about damaging the front surfaces of their teeth
  • Those who don’t want their braces to show
  • Adult professionals
  • Athletes involved in contact sports
  • Musicians who play wind instruments

Drawbacks of lingual braces:

  1. They tend to hurt your tongue and make it difficult to speak at first
  2. more expensive than traditional metal, because treatment is specialized
  3. Treatment may be longer than traditional braces
  4. Not every orthodontist does lingual treatment
  5. lingual treatment may not be applicable for all types of cases

Metal braces are the most widely used system of straitening teeth. Small metal brackets are bonded to the tooth with a wire passing through them. The wire is usually held tightly to the brackets with small elastic o-shaped rubber bands. The rubber bands can be metal colored (the most discreet) or colorful, depending on what you like. Metal brackets are very strong and can withstand most types of treatment. They tend to be the most inexpensive treatment and can treat the most severe cases.

Metal brackets can be silver or golden. The golden brackets look a bit more "jewelry-like" and are often a popular choice with young women.

Metal brackets are very strong and can withstand most types of treatment. At first they may irritate your gums, but after a few weeks, when your cheeks get "toughened up" they are not a problem anymore. Most traditional metal braces require an elastic o-shaped rubber band, called a ligature to hold the arch wire onto the bracket. Sometimes orthodontists use metal tie wires (little wires which are twisted around the bracket) in place of elastic ligatures.

Fast Braces Or The Viazi

A different type of metal bracket is called the Viazi (or Viazis) bracket, sometimes called "FastBraces." It uses triangular brackets and square wires instead of round wires used with traditional brackets. With Viazi braces the crown and root of the teeth are moved at the same time and comparatively less force is used which causes less pain.

Time Required for Treatment

Time for treatment varies from case to case. However, treatment with braces is a very transparent procedure. One can easily stand in front of the mirror with the pre treatment plaster models in the hand and check out the progress of the treatment at any given point in time.

There is no known method to predict the exact time for the treatment. The estimates given are on the basis of past experience of treating similar cases.

There may be some cases which show slow progress, however, no treatment goes on just endlessly without showing any significance.

Precautions With Braces

After braces are placed in the mouth it is normal for the teeth to be sore for about 1 to 3 days. . Some irritation to the cheeks and/or lips is normal.

There may be some discomfort at the beginning of the treatment and when new wires are placed on the teeth, some wire may poke at the soft tissues of the mouth. These are very small problem and can be attended to instantly.

A careful orthodontic patient can probably eat almost any food and do no damage to their appliances. However, these food may cause trouble so please do not eat hard foods: nuts, ice, whole apples and carrots (cut them into pieces first), hard French bread crust and rolls, spareribs, corn on the cob (cut the corn off the cob before eating), and popcorn. These foods risk breaking brackets and wires. Also beware of nail biting and pen or pencil chewing habits, since these can damage your braces. Do not eat sticky foods: taffy, caramels, bubble gum, and sticky candy of any sort. Use common sense about most foods.

Absolutely no:

  • Sticky Foods (sugarless or otherwise):
    • Gum
    • Caramels
    • Sugar Daddies
    • Starbursts
    • Caramel Apples
    • Sugar Babies
    • Licorice
    • Toffee
    • Tootsie Rolls
    • Etc.
  • Hard Foods:
    • Jolly Ranchers
    • Jaw Breakers
    • Lolli-pops
    • Nuts
    • Bagels
    • Apples (unless cut up)
    • Pizza Crusts
    • Carrots (uncooked, unless cut up)
    • Doritos
    • Pretzels
    • Etc.

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