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Orthodontics is a field in dentistry, which focuses on improvement of teeth alignment, aesthetics of the face and smile as well as function of stomatognathic system.
Early treatment is used in small children (complete set of primary teeth) who require additional exercise to strengthen their facial muscles (mainly muscles of the tongue and the mouth opening) and in case, when it is necessary to eliminate harmful habits (most commonly thumb sucking, habitual mouth breathing, and nail biting). Recommended exercises are accompanied by the child’s first braces allowing restoration of optimal conditions for further teeth development.
The main group of orthodontic patients consists of young patients who have no yet achieved bone maturity, i.e. they are still growing, with both, primary and permanent teeth (mixed dentition) or early permanent dentition. It is the best moment to correct malocclusion and/or dental irregularities with removable and/or fixed braces.
Orthodontic treatment enjoys increasing interest, also among adults – students and working people, whose only treatment option is fixed braces. There is no upper age limit to start orthodontic treatment; only the reason of orthodontic consultation is different. It is often a preparatory measure before prosthetic restoration (prostheses, crowns, bridges) or implant-prosthetic treatment (crowns and bridges supported by dental implants). Usually cosmetic or sapphire brackets are chosen as they are less visible during treatment.
Removable braces – they are braces made of wire elements (clasps, arch wires, loops, and springs, etc.), acrylic part (in different colours), and a screw activated by the patient’s caretaker.
Trainers – they are also a type of a removable appliance (they can be taken out of the mouth) made of a soft, silicone material. They usually work on both dental arches and are designed to improve the maxilla and mandible alignment as well as improve the muscle tone within the area of the mouth opening.
Fixed braces – they are composed of fixed elements: brackets (1) glued to upper and lower teeth (incisors, canines, and premolars), bands wrapped around molars and replaceable elements: wire arches (3), ligatures (2), springs, chains, etc.
Fixed elements are glued to teeth at the visit in a dental clinic for the entire treatment period (they cannot be removed from the mouth). In regard of the type of brackets the following appliances are used:
Headgear is used in selected cases of malocclusion. It is usually worn for several hours during the day and the whole night. The most common types include:
-extraoral traction appliance
Thick-wire appliances: They usually provide determined movement of the tooth as well as perform other determined tasks. In view of that fact, they are usually an additional measure used with a thin-wire appliance.
Removable appliance treatment – the treatment is quite longterm and requires involvement of the young patient as well as his or her parents. To provide treatment outcome which is satisfactory to both sides the appliance must be worn for several hours during the day and for the whole night. Additional elements are designed to optimise the use of the appliance and doctor – patient cooperation but the scope of their action is limited. This feature often results in the use of a fixed appliance in the second stage of treatment.
Fixed appliance treatment usually lasts between 1.5 and 2 years and consists in regular follow-up visits at which the elastic ligatures and arches are replaced. Gradually the teeth are moved, which allows reconstruction of optimal occlusion. It is important that the patients adhere to the hygiene regime and adequate diet so the treatment might be conducted within the predetermined time limits.
Treatment retention is an integral part of any orthodontic treatment, both after using removable braces (usually the last set of braces is used for treatment retention) as well as fixed appliances (fixed retainers, retention/thermoformed plates, etc.).
Multi-team treatment – in adults orthodontic treatment often constitutes a part of complex treatment plan involving other dentistry fields like prosthetics, periodontology, implantology or surgery.
Hygiene with fixed appliances.
Throughout the entire treatment period teeth must be cleaned after each meal using manual or electric toothbrushes,
and rinsed with a fluoride mouthwash once or twice a day.
Diet of orthodontic patients.
Beginning with the visit at which the fixed braces are placed in the patient’s mouth until the last visit, when they are removed by the doctor, the patient is required to follow a special diet eliminating all hard foods (rusks, nuts, fruit drops). Other relatively hard food (e.g. fruit, bread, etc.) should be cut into smaller pieces before eating. It will protect the brackets against coming off and help to avoid extended treatment.
Sticky food intake should also be reduced (such as Mentos mints, buns, chips, toffee sweets) due to technical problems in accurate teeth brushing after having this type of foods.
Frequently asked questions:
Is it true that fixed braces damage teeth?
False! At the site of bracket adhesion there are no signs of decalcification or enamel damage. They occur around the fixed elements of the appliance, if the patient doesn’t brush his/her teeth correctly and does not adhere to doctor’s recommendations (see the picture).
Why should you come to follow-up visits while wearing fixed braces?
Depending on the technique used, the follow-up visits should be held once a month/once every 5-6 weeks. The attending doctor replaces the arches and uses other additional elements aimed at gradual positioning teeth at proper places. In case of longer intervals between visits the treatment will last longer compared to the plan.
Can you treat teeth with the fixed braces on?
In order to begin orthodontic treatment it is necessary to cure all the teeth that are going to be covered by the braces. If a cavity occurs during the treatment, it is possible to treat it having removed the arch and sometimes only after the bracket is removed (the cavity is filled after the conservative treatment is done).
Can your teeth be cleaned and subjected to fluoridation when you wear fixed braces?
The fixed braces increase retention of food debris, which being stuck to your teeth for a longer period of time (improper/unsatisfactory hygiene of oral cavity) transforms into tartar. If this is the case, it is necessary to remove it efficiently and regularly during the treatment and having the teeth cleaned of tartar – to cover them with fluoride polish to strengthen teeth against caries.
Can you treat any malocclusion?
Unfortunately not. To a large extent, it depends on the stage of the defect and the age of the patient. However, most types of malocclusion can be successfully treated or, if it is not possible, improved considerably.
Can you wear fixed braces on one dental arch only?
Most malocclusions involve both dental arches; therefore, majority of patients are treated with two appliances and only then you can expect accurate and complex correction of malocclusion.
However, if the abnormality is located in one dental arch only, orthodontic treatment may involve only this arch (upper or lower dental arch).
Is the clarity of speech going to deteriorate with fixed braces?
If the attending doctor decides on using a thick-wire appliance to be located on the palate, the speech might be less clear but it will return to normal in a couple of days.
The use of standard elements only will not affect your speech.
Can the teeth get crooked again after the appliance is removed?
Provided the patient wears the retentive plate in a correct way and protects the retainers from coming off, the malocclusion should not reoccur.
After the appliance is removed the teeth may change their alignment slightly (occlusion adjustment), which is a normal situation.