Orthodontics

• Invisalign
• What is Orthodontics
• What problems can be treated with orthodontics?
• Do Braces Hurt?
• What to expect when getting braces
• What Causes misalignment of teeth?
• What's involved when a child gets braces?
• Braces for Adults
• Care Following Orthodontics - Retainers
• The Phases of Orthodontic Treatment

Invisalign®

One of the primary concerns people often have about dental braces is the aesthetic impact of the metalwork on their smile.  Especially for adults, the prospect of wearing unattractive metal braces for long periods of time can be very discouraging.  Invisalign^® offers an almost invisible aligning system that straightens teeth fast and contains no metal.

Invisalign^® treatment consists of a series of custom-made aligning trays.  The dentist changes the trays every several weeks to fit the new tooth configuration.  In addition to the reduced visual impact, Invisalign^® aligning trays can be temporarily removed for important occasions – meaning that treatment duration is patient-controlled.  A great number of people report complete satisfaction with both the Invisalign® treatment and the stunning results.

What kind of bite problems can Invisalign^® correct?

Invisalign^® corrects the same dental problems as traditional metal braces; the only difference is that Invisalign^® trays are almost invisible to the naked eye, and can be removed at will.

Here are some problems that are commonly corrected with Invisalign^®:

• Overcrowding – This occurs when there is too little space for the teeth to align normally in the mouth.  Overcrowding can cause tooth decay and increase the likelihood of gum disease.
• Large gaps between teeth – This can sometimes occur because teeth are missing or because the jaw continues to grow abnormally.
• Crossbite – This common dental problem occurs when one or multiple upper teeth bite inside the lower teeth.  As a consequence, uneven wear can lead to bone erosion and gum disease.
• Overbite – This problem occurs when the upper teeth project further than, or completely cover, the lower teeth.  Eventually, jaw pain and TMJ may occur.
• Underbite – This is the inverse of the overbite; the lower teeth project further than, or completely cover the upper teeth.  Eventually, jaw pain and TMJ can occur.

What advantages does Invisalign^® offer over traditional braces and veneers?

Traditional dental braces, Invisalign^® aligning trays and dental veneers are three different ways to perfect the alignment of the teeth.  There are many different considerations to make when considering which treatment will be best, and each of these options works better in certain situations.

Invisalign^® differs from traditional braces in that the aligning trays are fully removable.  This means that more discipline and commitment is required from the patient.  This is not usually a problem since the trays are comfortable and nearly invisible.  Almost identical results can be obtained by using either treatment.

Invisalign^® is preferable to veneers in many cases because unlike veneers, Invisalign^® actually straightens the teeth. Veneers are thin covers that the dentist permanently affixes to the teeth.  Teeth must be etched beforehand, meaning that to remove dental veneers, an alternative covering must be constructed.  In addition to being somewhat expensive, veneers can break and often last for less than 20 years.

What does Invisalign^® treatment involve?

First, the dentist needs to devise an initial treatment plan before creating the special aligning trays.  Three-dimensional digital images are taken of the entire jaw.  These images allow the dentist to move specific teeth on the screen, view the jaw from different angles, and also foresee what the face might look like in years to come.  In essence, this technology can show how Invisalign^® trays will change the facial aesthetics.

Once planning is complete, a unique set of aligners is made.  The total amount of aligners required varies with each individual case, but 20-29 sets per arch is typical.

What are some considerations when wearing Invisalign^® trays?

Life with Invisalign^® aligning trays may take several weeks to get used to.  The trays should be worn constantly, except when eating and drinking.  It is important to remove the trays when consuming food or drink because food can become trapped between the tray and the teeth, causing tooth decay.

Usually, new trays are necessary every two weeks and progress between appointments can be seen with the naked eye.  There is no doubt that Invisalign^® aligning trays have revolutionized orthodontics.  Invisalign^® is renowned for being both comfortable and effective.

Orthodontic Treatment Phases

Orthodontic treatment is highly predictable and immensely successful.  Depending on the severity of the malocclusion (bad bite) or irregularity, orthodontic treatments may occur in either two or three distinct phases.

The benefits of correcting misaligned teeth are many.  Straight teeth are pleasing to look at and greatly boost confidence and self esteem.  More importantly, properly aligned teeth enhance the biting, chewing and speaking functions of the jaw.  There are several types of irregularities, including:

• Overbite – The upper teeth protrude further than or completely cover the lower teeth.
• Underbite – The lower teeth protrude further than the upper teeth causing the chin to look prominent.
• Crossbite – Some of the upper teeth may close inside the lower teeth rather than on the outside.
• Overcrowding – Insufficient room on the arch causes some adult teeth to erupt incorrectly and become rotated.

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What is Orthodontics 

Orthodontics is one of many dental specialties. The word “orthodontics” is derived from the Greek words orthos, meaning proper or straight and odons meaning teeth. Orthodontics is specifically concerned with diagnosing and treating tooth misalignment and irregularity in the jaw area. Initially, orthodontic treatments were geared toward the treatment of teens and pre-teens, but these days around 30 percent of orthodontic patients are adults.

There are many advantages to well-aligned teeth, including easier cleaning, better oral hygiene, clearer speech and a more pleasant smile. Though orthodontic treatment can be effective at any age, the American Dental Association suggests that an orthodontic assessment should be performed around the age of seven. The earlier orthodontic treatment begins, the more quickly the problem can be successfully resolved.

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What problems can be treated with orthodontics? 

Orthodontics is a versatile branch of dentistry that can be used alone, or in combination with maxillofacial or cosmetic dentistry.

Orthodontics is a versatile branch of dentistry that can be used alone, or in combination with maxillofacial or cosmetic dentistry.

Here are some of the common conditions treated with orthodontics:

• Anteroposterior deviations – The discrepancy between a pair of closed jaws is known as an anteroposterior discrepancy or deviation. An example of such a discrepancy would be an overbite (where the upper teeth are further forward than the lower teeth), or an underbite (where the lower teeth are further forward then the upper teeth).
• Overcrowding – Overcrowding is a common orthodontic problem. It occurs when there is an insufficient space for the normal growth and development of adult teeth.
• Aesthetic problems – A beautiful straight smile may be marred by a single misaligned tooth. This tooth can be realigned with ease and accuracy by the orthodontist. Alternatively, orthodontists can also work to reshape and restructure the lips, jaw or the face.

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Who Can Benefit From Orthodontics? 

Orthodontics is a specialized branch of dentistry that is concerned with diagnosing, treating and preventing malocclusions (bad bites) and other irregularities in the jaw region and face. Orthodontists are specially trained to correct these problems and to restore health, functionality and a beautiful aesthetic appearance to the smile. Though orthodontics was originally aimed at treating children and teenagers, almost one third of orthodontic patients are now adults. A person of any age can be successfully treated by an orthodontist.

A malocclusion (improper bite) can affect anyone at any age, and can significantly impact the individual’s clarity of speech, chewing ability and facial symmetry. In addition, a severe malocclusion can also contribute to several serious dental and physical conditions such as digestive difficulties, TMJ, periodontal disease and severe tooth decay. It is important to seek orthodontic treatment early to avoid expensive restorative procedures in the future.

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Do Braces Hurt? 

One of the most commonly asked questions about dental braces is whether placing them causes any pain or discomfort.  The honest answer is that braces do not hurt at all when they are applied to the teeth, so there is no reason to be anxious.  In most cases, there may be mild soreness or discomfort after the orthodontic wire is engaged into the brackets, which may last for a few days.

There are two common types of fixed dental braces used to realign the teeth: Ceramic fixed braces and metal fixed braces.  Both types of fixed appliances include brackets which are affixed to each individual tooth, and an archwire the orthodontist fits into the bracket slot to gently move the teeth into proper alignment.  Elastic or wire ties will be applied to hold the wire in place.  Some orthodontists may use self-ligating brackets which do not require a rubber or wire tie to secure the wire.

Fixed dental braces are used to treat a wide variety of malocclusions, including overbite, underbite, crossbite and overcrowding.  If the orthodontist has determined that the malocclusion has been caused by overcrowding, it is possible that teeth may need to be extracted to increase the amount of available space to properly align the teeth.

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What to expect when getting braces 

Here is an overview of what you can expect when getting braces:

• Placement day – The placement of braces will not be painful in the slightest.  It may take longer to eat meals, but this is largely because it takes some time to adjust to wearing the braces.  In some cases, the teeth may feel more sensitive than usual.  Hard, difficult to chew foods should be avoided in favor of a softer, more liquid-based diet for the first few days after placement of braces.

• Two days after placement – The first several days after placement of braces can be slightly uncomfortable.  This is because the teeth are beginning the realignment process and are not used to the pressure of the archwire and orthodontic elastic bands.  The orthodontist will provide relief wax to apply over the braces as necessary.  Wax helps provide a smooth surface and alleviates irritation on the inner cheeks and lips.  Additionally, over-the-counter pain medication (e.g., Motrin^® and Advil^®) may be taken as directed to relieve mild soreness.
• Five days after placement – After five days, any initial discomfort associated with the braces should be completely gone.  The teeth will have gradually acclimated to the braces, and eating should be much easier.  Certain hard foods may still pose a challenge to the wearer, but normal eating may be resumed at this point.
• Orthodontic appointments – Regular orthodontic appointments are necessary to allow the orthodontist to change the archwire, change the rubber or metal ties, and make adjustments to the braces.  Fixed braces work by gradually moving the teeth into a new and proper alignment, so gentle pressure needs to be applied constantly.  The first several days after an orthodontic adjustment may be slightly uncomfortable, but remember that this discomfort will quickly fade.

Dealing with discomfort– Over-the-counter pain medication and orthodontic relief wax will help alleviate any mild soreness and discomfort following placement o braces and orthodontic adjustments.  Another effective remedy is to chew sugar-free gum, as this increases blood flow which helps reduces discomfort and can also encourage the teeth to align quicker.

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What Causes misalignment of teeth? 

Poorly aligned teeth often cause problems speaking, biting and chewing.  Most irregularities are genetic or occur as a result of developmental issues.  Conversely, some irregularities are acquired or greatly exacerbated by certain habits and behaviors such as:

• Mouth breathing
• Thumb or finger sucking
• Prolonged pacifier use
• Poor oral hygiene
• Poor nutrition

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What’s involved when a child gets braces? 

The orthodontist initially conducts a visual examination of the child’s teeth.  This will be accompanied by panoramic x-rays, study models (bite impressions) and computer generated images of the head and neck.  These preliminary assessments are sometimes known as the “planning phase” because they aid the orthodontist in making a diagnosis and planning the most effective treatment.

In many cases, the orthodontist will recommend “fixed” orthodontic braces for a child.  Fixed braces cannot be lost, forgotten or removed at will, which means that treatment is completed more quickly.  Removable appliances may also be utilized, which are less intrusive, and are generally used to treat various types of defects.

Here is a brief overview of some of the main types of orthodontic appliances used for children:

• Fixed braces – Braces comprised of brackets which are affixed to each individual tooth, and an archwire which connect the brackets.  The brackets are usually made of metal, ceramic, or a clear synthetic material which is less noticeable to the naked eye.  After braces have been applied, the child will have regular appointments to have the braces adjusted by the the orthodontist. Orthodontic elastic bands are often added to the braces to aid in the movement of specific teeth.
• Headgear – This type of appliance is most useful to treat developmental irregularities. A headgear is a custom-made appliance attached to wire that is worn to aid in tooth movement. A headgear is intended to be worn for 12-20 hours r each day and must be worn as recommended to achieve good results.
• Retainers – Retainers are typically utilized in the third phase (retention phase). When the original malocclusion has been treated with braces, it is essential that the teeth do not regress back to the original misalignment. Wearing a retainer ensures the teeth maintain their proper alignment, and gives the jawbone around the teeth a chance to stabilize.

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Braces for Adults 

Orthodontic braces were historically associated with teenagers.  Today, an increasing number of adults are choosing to wear braces to straighten their teeth and correct malocclusions (bad bites).  In fact, it is now estimated that almost one third of all current orthodontic patients are adults.

Orthodontic braces are predictable, versatile and incredibly successful at realigning the teeth.  Braces work in the same way regardless of the age of the patient, but the treatment time is greatly reduced in patients who are still experiencing jaw growth and have not been affected by gum disease.  In short, an adult can experience the same beautiful end results as a teenager, but treatment often takes longer.

Can adults benefit from orthodontic braces?

Absolutely! Crooked or misaligned teeth look unsightly, which in many cases leads to poor self esteem and a lack of self confidence.  Aside from poor aesthetics, improperly aligned teeth can also cause difficulties biting, chewing and articulating clearly.  Generally speaking, orthodontists agree that straight teeth tend to be healthier teeth.

Straight teeth offer a multitude of health and dental benefits including:

• Reduction in general tooth decay
• Decreased likelihood of developing periodontal disease
• Decreased likelihood of tooth injury
• Reduction in digestive disorders

Fortunately, orthodontic braces have been adapted and modified to make them more convenient for adults.  There are now a wide range of fixed and removable orthodontic devices available, depending on the precise classification of the malocclusion.

The most common types of malocclusion are underbite (lower teeth protrude further than upper teeth), overbite (upper teeth protrude further than lower teeth) and overcrowding, where there is insufficient space on the arches to accommodate the full complement of adult teeth.

Prior to recommending specific orthodontic treatment, the orthodontist will recommend treatment of any pre-existing dental conditions such as gum disease, excess plaque and tooth decay.  Orthodontic braces can greatly exacerbate any or all of these conditions.

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Care Following Orthodontics – Retainers 

When braces are finally removed, the “retention” phase begins for most individuals.  The objective of this phase is to ensure the teeth do not regress back to their previous position.  A retainer will be used to maintain the improved position of the teeth.  A retainer is a fixed or removable dental appliance which has been custom-made by the orthodontist to fit the teeth.  Retainers are generally made from transparent plastic and thin wires to optimize the comfort of the patient.

Retainers are worn for varying amounts of time, depending on the type of orthodontic treatment and the age of the patient.  Perseverance and commitment are required to make this final stage of treatment successful.  If the retainer is not worn as directed by the orthodontist, treatment can fail or take much longer than anticipated.

What types of retainer are available?

There are a variety of retainers available; each one geared towards treating a different kind of dental problem.  The orthodontist will make a retainer recommendation depending on the nature of the original diagnosis and the orthodontic treatment plan.

The following are some of the most common types of retainers:

• Hawley retainer – The Hawley retainer consists of a metal wire on an acrylic arch.  The metal wire may be periodically adjusted by the orthodontist to ensure the teeth stay in the desired position.  The acrylic arch is designed to fit comfortably on the lingual walls or palate of the mouth.

• Essix – The Essix retainer is the most commonly used vacuum formed retainer (VFR).  A mold is initially made of the teeth in their new alignment, and then clear PVC trays are created to fit over the arch in its entirety.  VFR’s are much cheaper than many other types of retainers and also do not affect the aesthetic appearance of the smile in the same way as the Hawley retainer.  The disadvantage of VFR’s is that they break and scratch more easily than other types of retainers.

• Fixed retainers – A fixed retainer is somewhat similar to a lingual brace in that it is affixed to the tongue side of a few teeth.  Usually, a fixed retainer is used in cases where there has been either rapid or substantial movement of the teeth.  It usually consists of a single wire.  The inclination of the teeth to move rapidly means they are also more likely to regress back to their previous position if a fixed retainer is not placed.

What do I need to consider when using a retainer?

There are a few basic things to consider for proper use and maintenance of your retainer.

Don’t lose the appliance – Removable retainers are very easy to lose.  It is advisable to place your retainer in the case it came in while eating, drinking and brushing.  Leaving a retainer folded in a napkin at a restaurant or in a public restroom can be very costly if lost because a replacement must be created.  A brightly colored case serves as a great reminder.

Don’t drink while wearing a retainer – It is tempting to drink while wearing a retainer because of the unobtrusive nature of the device.  However, excess liquid trapped under the trays can vastly intensify acid exposure to teeth, increasing the probability of tooth decay.

Don’t eat while wearing a retainer – It can be difficult and awkward to eat while wearing a removable retainer and it can also damage the device.  Food can get trapped around a Hawley retainer wire or underneath the palate, causing bad breath.  When worn on the upper and lower arches simultaneously, VFR retainers do not allow the teeth to meet.  This means that chewing is almost impossible.

Clean the retainer properly – Removable retainers can become breeding grounds for calculus and bacteria.  It is essential to clean the inside and outside thoroughly as often as possible.  Hawley retainers can be cleaned with a toothbrush.  Because harsh bristles can damage the PVC surface of a VFR, denture cleaner or a specialized retainer cleaner is recommended for this type of device.

Wear the retainer as directed – This phase of treatment is critical. The hard work has been done, the braces are off and now it is tempting not to wear the retainer as often as the orthodontist recommends.  Retainers are needed to give the muscles, tissues and bones time to stabilize the teeth in their new alignment.  Failure to wear the retainer as directed can have regrettable consequences, such as teeth returning to their original position, added expense and lost time.

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What is Orthodontics 

Generally, orthodontic treatment takes between six and thirty months to complete.  The treatment time will largely depend on the classification of the malocclusion, the type of dental devices used to correct it and the perseverance of the patient.

Here is a general overview of the three major stages of treatment:

Phase 1 – The Planning Stage

The orthodontist makes an exact diagnosis in order to realign the teeth in the most effective and expedient way.  The first several visits may comprise of some of the following evaluations:

• Medical and dental evaluations – Dental and physical problems tend to go hand in hand.  Problems in the oral cavity can lead to (or be caused by) medical problems.  The goal of this evaluation is to ensure that prior medical and dental issues are completely under control before treatment begins.

• Study model (castings/bite impressions) – The patient is asked to bite down into a dental tray filled with a gel substance that hardens around the teeth.  The trays are removed from the teeth and filled with plaster to create models of the patient’s teeth.  Study models enable the orthodontist to scrutinize the position of each tooth, and how it relates to the other teeth.

• Panoramic X-rays – X-rays are fantastic tools for viewing potential complications or pre-existing damage to the jaw joint.  X-rays also allow the orthodontist to see the exact position of each tooth and its corresponding root(s).

• Computer generated images – Such images allow the orthodontist to treatment plan and examine how specific treatments may affect the shape of the face and symmetry of the jaw.

• Photographs – Many orthodontists like to take “before, during and after” photographs of the face and teeth to assess how treatment is progressing, and the impact the treatment is having on the patient’s face shape.

Phase 2 – The Active Phase

All of the above diagnostic tools will be used to diagnosis and develop a customized treatment plan for the patient.  Next, the orthodontist will recommend a custom orthodontic device(s) to gently move the teeth into proper alignment.  This orthodontic appliance may be fixed or removable.  Most commonly, traditional fixed braces are affixed, which utilizes individual dental brackets connected by an archwire.  Lingual braces are also fixed but fit on the inside (tongue side) of the teeth to make them less visible.

Removable devices are an alternative to fixed braces.  Examples of removable devices include the Invisalign system, headgear and facemask.  These devices are designed to be worn for a specified amount of hours each day to expedite treatment.

Whatever the orthodontic device, the orthodontist will regularly adjust it to ensure adequate and continual pressure is being applied to the teeth.  It is essential to visit the orthodontist at the designated intervals and to call if part of the device breaks or becomes damaged.

Phase 3: The Retention Phase

When the teeth have been correctly aligned, fixed braces and removable devices will be removed and discontinued.  The most cumbersome part of the orthodontic treatment is now over. The orthodontist will next create a custom retainer.  The goal of the retainer is to ensure that the teeth do not begin to shift back to their original positions.  Retainers need to be worn for a specified amount of time per day for a specified time period. ; During the retention phase, the jawbone will reform around the realigned teeth to fully stabilize them in the correct alignment.

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