Orthodontics, as a branch of dentistry, is concerned with the diagnosis, intervention, prevention, and repositioning of maligned teeth and jaws. It helps to achieve a better-aligned dentition with greater chewing efficiency.

There are various ways of correcting malocclusion based on the requirements of an individual patient. As far as growing patients are concerned, more options are available for treating skeletal discrepancies, either by promoting or restricting jaw growth using functional appliances, orthodontic headgear or a reverse pull facemask.

Most orthodontic treatment is initiated during the early permanent dentition stage before skeletal growth completion in an individual. Orthognathic surgery can be considered as an option upon completion of skeletal growth. Extraction of teeth may be required to aid the orthodontic treatment.

Where does orthodontic treatment begin?

It usually starts with a general check-up of the patient where the dentist ascertains the type of occlusion and severity of the malocclusion. Impression making wherein casts succeed, this is used to have a better judgment of the teeth and the occlusion in general when the patient is not available.

Casts help in providing an outline for the treatment process and amount of space required for tooth movement to the desired location in the mouth. Before the beginning of the orthodontic treatment process, the informed consent of the parent or the patient is taken.

Types of orthodontic appliances

Orthodontic treatments are performed by the use of basically two types of appliances:-

Removable appliance

Simple cases of primary dentition wherein little movement of teeth can provide for correction of malocclusion are suitable for removable devices.

They usually consist of an acrylic plate with wires extruding from the sides which hold anchorage from the posterior teeth. Due to the limitation in use, they can perform labial or lingual movements without any alignment in the teeth as done by fixed orthodontic treatments.

Often removable appliances are dependent on the patient will, which renders them useless if the patient is unwilling to wear the device.

Fixed appliance

With the advent of the fixed devices in orthodontic treatment, the correction and alignment of the occlusion have become an easy task as compared to the removable ones. Fixed braces provide greater control in tooth movement and final finishing of the corrected malocclusion allowing for the translation of teeth segment for ideal results.

Removable appliances are unable to perform alignment of the teeth and if excessive pressure is applied can lead to tooth mobility and eventual tooth loss. Hence fixed appliance is considered more accurate when orthodontic treatments are initiated.

With the success of Fixed Orthodontic Appliance Therapy, the use of removable appliances has been greatly reduced as a mode of orthodontic treatment. The outcome achieved from the use of fixed appliances is better than that of removable devices as the fixed appliances can provide greater control of the tooth movement under treatment.

When can a patient undergo orthodontic treatment

Typically, orthodontic treatment begins in the early permanent dentition stage before the skeletal growth completion. It may take up to 1-2 years for the procedure to complete, with braces being adhered to the tooth surface at desired locations with the help of archwires assisting the tooth movement. Appointments for the orthodontic treatment are scheduled once in every month.

According to the case and the age of the patient, there are multiple methods for the correction of malocclusion. In growing patients, ’ malocclusion can be corrected using headgears and functional appliances, thus restricting the growth of one part, thereby facilitating the growth of the other.

Space generation in the correction of the occlusion may be required entailing extraction of the teeth to aid in the orthodontic treatment process. The completion of the orthodontic treatment process is followed by the placement of retainers either permanent or removable to be worn by the patient to prevent any relapse of the treatment.

Role of oral hygiene in successful orthodontic treatment

Good oral health is a necessity for successful orthodontic treatment. The use of brackets for orthodontic treatments makes it difficult for oral hygiene to be maintained properly. From the start of the orthodontic treatment, good tooth brushing coupled with proper use of mouth wash should be adhered to till the completion of the procedure. Negligence on the part of the patient may lead to tooth decay and periodontal disease, which may adversely affect the outcome of the orthodontic treatment.

Diet plays an important role in the establishment of good oral health. During orthodontic treatment, soft foods are recommended to protect the brackets and wires from displacement and to debond. Reduction in the intake of sugar is recommended to prevent white spot lesions on the teeth. White spot lesions are the earliest sign of the beginning of the caries process. Avoiding hard or chewy foods such as apples and carrots are advised during orthodontic treatment.

Risk factors during orthodontic treatment

Decalcification of tooth enamel

Brackets edges and bands or buccal tubes are the potential areas of plaque accumulation that can cause demineralization of the tooth enamel. Therefore, regular use of mouth wash and proper brushing twice a day is recommended to the patients during the orthodontic treatment procedure.

Root Resorption

Fixed appliances often lead to root resorption in adult patients as the movement of teeth within the bone can lead to varying amounts of root resorption in teeth. Often the maxillary front teeth are involved the most. In cases of root resorption, adequate steps must be taken to ensure the tooth vitality.

Loss of periodontal attachment

Orthodontic treatment often involves the use of force, which can often lead to loss of periodontal attachment, if excessive force is applied.

Bone loss

The orthodontic procedure requires a bone remodeling which necessitates the loss of bone if not done carefully and excessive forces are applied for tooth movement.

Soft tissue trauma

Use of extraoral forces and functional appliances for tooth and jaw repositioning may lead to mild tissue trauma, which often can be irreversible if accompanied by loss of bone support.

Post-treatment precautions

After the culmination of orthodontic treatment, there is a tendency for relapse of the teeth back to their pre-treatment positions. A vast majority of patients suffer from deterioration to pre-treatment positions within 5-7 years following orthodontic treatment.

To prevent these relapse patients are offered a retainer either removable or fixed, once orthodontic treatment has completed.

Removable retainers are worn by the patients as prescribed by the dentist for 9-12 months, depending on patient needs.  Removable retains are solely dependent on the will of the patient.

Fixed retainers usually are wires attached to the lingual surface of the incisors using dental composite, thus eliminating the need of patient will for the fasteners to stay in place. Best fixed retainers are the brackets that are applied during the orthodontic treatment process, which serve the purpose until the solid wires can be placed.

We, as a dental clinic in Dwarka, provide for orthodontic treatments with the availability of stainless steel and tooth colored braces as desired by the patient.

Easy availability of appointments and thorough check-up of the patient makes us unique among the class of dentists in Dwarka. We even provide for the post-completion check-up of the patient ensuring the prevention of relapse in orthodontic cases

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