Orthodontics is more than simply straight teeth. Orthodontic treatment influences facial growth and esthetics along with the fit and function of the bite, the alignment of the teeth, and other aspects of overall health and well-being.
Orthodontic treatment can include the use of expanders, space maintainers, braces, clear aligners (such as Invisalign), removable functional appliances, headgear, retainers and many others.
Orthodontists are generally familiar with the entire spectrum of appliances and techniques used in orthodontic treatment.
Treatment that is done in children around the ages of 7 to 10 years when there is a mix of baby teeth and adult teeth in the mouth is called early treatment, Phase I treatment, or interceptive treatment.
This treatment is intended to correct a problem with the normal development of the jaws and teeth.
Sometimes this early treatment can prevent the need for additional treatment later although most of the time a second phase of treatment called Phase II treatment will be required once all the adult teeth have grown into the mouth. For adolescents and adults with all adult teeth, a single phase of treatment is normally sufficient.
Braces are what most people think of when they consider orthodontics.
Braces consist of brackets that are glued to the outside surface of the teeth and an archwire that is attached to these brackets.
The bracket is like a handle placed on the tooth and the archwire provides the light force through these bracket “handles” to the teeth in order to move the teeth. With self-ligating brackets the archwire is held into the brackets with a sliding clip that holds it in place.
With regular brackets the archwire is held in place with small elastics. These elastics are available in a variety of colours and can provide some fun for patients to pick colours that they want for that appointment cycle. The elastics are changed at every visit so new colours can be chosen.
With the self-ligating brackets there is no need for elastics and oral hygiene is somewhat easier without the elastics. Brackets are available in metal, tooth coloured ceramic, or tooth coloured plastic.
When food gets stuck on metal braces it doesn’t show as much as on the tooth coloured braces. The tooth coloured braces can blend in nicely with the teeth and don’t show as obviously that you have braces. One downside of the tooth coloured braces is that when food gets stuck on them it really shows up so you have to brush your teeth frequently and carefully.
There is some controversy about any superiority of self-ligating brackets versus regular brackets.
Bracket manufacturers are now marketing directly to consumers to convince them to demand their brand of brackets for treatment and of course their marketing will strongly promote their product.
The research into various types of brackets regarding efficiency, comfort, and speed of treatment are quite variable and some current studies show that there is not a great difference in speed of treatment or comfort of the braces between the various types of self-ligating or regular brackets.
It is advisable to accept the advice of your orthodontist as to what type of brackets will be used in your treatment.
Invisalign is the dominant provider of clear aligners for orthodontic treatment and therefore has the name recognition.
It should be noted that there are other clear aligner providers in the marketplace such as Clear Correct or Orthoclear. Instead of using braces to move and align teeth a sequential series of thin clear aligners are used to move and align teeth.
This method of orthodontic treatment has become much more sophisticated and reliable over the approximately 20 years of development. One positive aspect of clear aligner treatment is that the aligners are almost invisible so others will not likely notice that you are in orthodontic treatment.
Another positive feature is that the aligners can be taken out to eat, brush your teeth, for important presentations, for photographs and so on. You do not have to be careful about hard, crunchy or sticky foods like you do with braces. Oral hygiene is easier than with braces.
Talk to your orthodontist about your treatment and if clear aligners treatment is a possibility for you.
Some problems that orthodontic specialists are trained to deal with involve correcting jaw disharmonies using dentofacial orthopedics.
In growing patients, removable functional appliances can be used to put the jaws in balance, achieve good facial muscle function and create natural facial proportions.
This treatment is most effective around the ages of seven or eight in order to take more advantage of growth. These appliances can be designed to not only move teeth but also correct the alignment of the jaws, which hold the teeth.
Functional appliances can sometimes be used alone to correct a problem but often additional treatment with braces may be required. An orthodontic specialist is properly trained to diagnose your problem correctly and recommend the right treatment.
An expander is frequently used in orthodontic treatment to widen the upper jaw to make room for the teeth and to match better with the lower jaw.
The most common type of expander is the Hyrax, which is also referred to as a rapid palatal expander or a rapid maxillary expander. This is a metal appliance that is attached to the upper first molars and has a screw assembly in the middle that is turned or “activated” every day to widen the upper jaw in approximately a month.
The suture at the centre of the upper jaw widens quite easily up with this expansive pressure and allows the jaw to widen very predictably up to the age of approximately 15 years. The expander remains in place for 2 to 6 months following the active expansion as the bone in the palate regrows in the area that the suture has widened with the expansion.
There are also removable expanders that work on the same principle with an activation screw in the middle of the appliance. These removable appliances usually expand the upper jaw at a slower pace than the Hyrax expander.
Headgear is an extraoral (outside the mouth) appliance that connects with the teeth and jaws through braces or other inside the mouth appliance, to apply force to the upper jaw.
Headgear with straps that go around the neck or the back of the head are designed to pull the upper jaw back. This kind of headgear is very rarely used any more.
Headgear that has a support on the forehead and chin with elastics stretching from a framework attached to these supports to the upper teeth is designed to pull the upper jaw forward.
This kind of headgear is still used in the attempt to bring the upper jaw forward to properly match the lower jaw and is called “reverse headgear” or “face mask headgear”.
To work effectively, headgear must be worn 12 to 14 hours a day and this can be a challenge with the busy lives that kids lead these days.
Surgical orthodontics, also known as orthognathic surgery, is a type of orthodontic treatment used to correct severe cases that include bad bites, jaw bone abnormalities, and malocclusion.
If you need surgical orthodontics, your Orthodontist will work with an oral and maxillofacial surgeon to ensure that you receive the care you need. Your Orthodontist can tell you if orthognathic surgery may be needed as part of your treatment during your orthodontic consultation.
Before you can undergo surgical orthodontics, it is required that your jaw structure is nearly or fully grown. For female patients, this occurs around the age of 16, while male patients need to be at least 19 or 20 years of age. In other words, surgical orthodontics is for adult patients who suffer from bite issues or are concerned about their facial appearance.
Orthodontic treatment can have some impact on sleep disorders in patients.
In children, the most common sleep disorder is obstructive sleep apnea (OSA).
Sleep disorders in children are often called sleep disordered breathing (SDB). OSA in children is associated to some degree with a narrow upper jaw and a high narrow palate. There is abundant research that shows improvement in sleep disordered breathing in children with rapid maxillary expansion. Any treatment done by an orthodontist designed to improve a sleep disorder in children should be done in conjunction with a sleep physician.
In adults, OSA is also the most common sleep disorder. Expansion of the upper jaw is much more limited in adults than in children so improvement of sleep disorders is not very successful in this way. There are many types of removable appliances for adults that are worn during sleep that will hold the lower jaw forward, which has an opening effect on the airway and can improve OSA significantly. Some orthodontists provide this treatment.
Any treatment of sleep disorders in adults should be done in conjunction with a sleep physician.
Accelerated orthodontic treatment is used in combination with regular orthodontic devices (metal and ceramic braces, Invisalign® and lingual braces). In some cases, it involves a minor surgical procedure.
Patients who choose accelerated orthodontics over the traditional method can benefit from a shorter treatment time. There can be many reasons for desiring to shorten the time in braces, especially for adults.
Another benefit of accelerated orthodontics is that any type of braces can be used in combination with it. This includes metal braces (the most basic and widely used type), ceramic braces (white or clear brackets that are less visible), and lingual braces (placed behind the teeth so they cannot be seen).
Retainers are required following orthodontic treatment in order to hold the alignment of the teeth and the fit of the bite.
Without retainers, there are muscle forces and forces within the gum tissue that will try to move the teeth partially back to their original positions. The most common retainers are Hawley retainers, Essix retainers, or Bonded retainers. The Hawley and Essix retainers are removable retainers while the Bonded retainers are glued in place.
Hawley retainers consist of a plastic base that conforms to the shape of your mouth and is connected to a wire that wraps around your teeth to keep them in place.
Essix retainers are made of thin clear plastic that cover your teeth. They are almost invisible and do not cover the palate like Hawley retainers do. They are not as durable as Hawley retainers but many patients find them more comfortable.
Bonded retainers are small wires that are glued to the back of some of the front teeth, usually the front six teeth although sometimes just the front four teeth. These retainers are not visible. These bonded retainers hold the alignment of the front teeth very well but do not hold the alignment of the teeth further back.
Oral hygiene is easier with the removable retainers as they can simply be removed for brushing and flossing. These removable retainers can be easily lost. With the bonded retainer it is necessary to thread the floss through a small gap between the wire and the gum tissue in numerous locations to floss properly. These retainers are convenient in as much as you don’t have to take them in and out and they are not easily lost.
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