Orthodontic treatment is the correction of the maloccluded teeth by their displacement in the bone with help of wires and braces. Teeth are held in the bone with help of fibers which span in different directions between the teeth and the bone. This group of fibers is called P.D.L (periodontal ligament fibers).
Orthodontic correction of teeth is a complex interplay of factors that induces the movement of teeth in the bone. This movement of teeth occurs due to pressure and tension exerted by the wires on the braces when placed in ideal locations on teeth.
Who Is An Orthodontist?
Many times, the terms dentist and orthodontist have been used interchangeably. That is not the correct way as two professions do originate from dentistry, but they hold a lot of differences among them. Being a specialist, they treat certain dental problems which lie in their expertise. In most of the circumstance’s patients do not approach an orthodontist directly rather they prefer to visit a general dentist with their tooth-related problems. To have a better idea of what an orthodontist does we would like to provide an insight on orthodontists.
Defining an Orthodontist
A general dentist is a dental doctor who works on different areas of the mouth with a primary area of focus being the mouth, jaw, teeth, and gums. Orthodontist work is mainly targeted towards a more specialized section of the mouth i.e. straightening of teeth, correction of crowded teeth, etc. To compile the whole in simple terms, all orthodontists are dentists but only a few dentists are orthodontists.
An orthodontist holds expertise in diagnoses and correction of overbites, mal-occlusions, maligned teeth, and crowding in the oral cavity(mouth). The diagnosis of an orthodontist begins with a complete intra-oral examination of an individual. A cast or an impression of the mouth is taken after an intraoral examination. The impression serves as the purpose of diagnosis and treatment planning in absence of the patient. The treatment plan is formulated and accordingly, the treatment is initiated.
What is the work of an Orthodontist?
An orthodontist undergoes a training in diagnosis and treatment planning of the maligned, crowded, maloccluded teeth. This makes him a suitable person for performing the task of teeth movement for the correction of the above-given problems. Many times if left untreated/ ignored these problems lead to harmful results like periodontitis due to excessive deposition of calculus, loss of self-esteem of the individual, front teeth more prone to trauma due to outward positioning of front teeth during accidents, etc.
The identification of the issues with teeth and mouth by an orthodontic at an early stage can help prevent crowding and malignment of teeth. Sometimes there a gap is present in between teeth which can be annoying to the patient but if corrected at an appropriate time can help prevent spacing in the dentition. The spacing usually causes undue forces to be dealt by individual tooth leading to pathological movement of the teeth. The orthodontist will try to correct the issue by the active movement of the teeth closer to each other. Conversely, if there is crowding of teeth, especially for children an orthodontist is likely to extract the specific teeth to create a space. Space thus created is utilized for the correction of crowding.
An orthodontist utilizes several measures to correct the existing alignment problems. Braces being the most famous solution of them all. Braces are appliances that are adhered to a specific area on the teeth with the help of light cure composites. The orthodontist bonds brackets on the front surface or the inner surface of the teeth depending on the treatment initiated. The wires are then drawn inside the braces. Wires are held against the braces with help of ligatures either elastic or stainless-steel wires tied around the braces in the slot available. In combination, these structures pull the teeth in an upright alignment, thus straightening them with the passage of time. The process is quite slow and results begin to appear with different phases of the orthodontic correction.
Depending upon the needs of the patient clear aligners may be used for orthodontic correction. A well-known being Invisalign. These are more acceptable as they are not fixed to teeth, unlike braces where the will of the patient is not kept into consideration. Being transparent, the visibility of the Invisalign is barely possible from a distance. This makes them comfortable to wear by the patient. The non-usage of the metal braces and the wires either metal or ceramic makes Invisalign less cumbersome in comparison to the traditional fixed braces.
In extreme cases, an orthodontist may utilize palatal expanders during the growth phases of the patients. They help in creating the space required for the correction of the crowded teeth by widening the upper jaw from the midline. Headgears can also be put into use in severe cases of protrusion of upper and lower jaws. Headgears are meant to restrict the growth of the jaws and their subsequent movement in the opposite direction. The device is worn with a strap at the back of the head with a part of the strap being wired to the jaws.
Work done by an orthodontist in an appointment.
An appointment with an orthodontist is conducted in a similar fashion as done with a general dentist. A visit to an orthodontist scheduled with a prior appointment wherein the examination of the patient and an impression of the mouth is taken. Any systemic condition, oral hygiene, gum disease if present is taken into consideration. This impression serves as a replica of the mouth in absence of the patient. Every detail of the mouth is visited again in the cast made from the impression. The mode of the treatment and the treatment protocols are realized, and the patient is given a separate appointment for the treatment procedure to be initiated. An OPG/ lateral CEPH if required is advised to be taken for the patient before the treatment.
The treatment begins with informed consent taken from the patient or the guardian concerned. The braces then adhere to the designated places on the teeth with help of the composite. The wires are placed inside the slots provided in the braces. These wires are held with the help of elastic or metal ligatures. Then subsequent monthly visits are scheduled for the patient. During these visits, the wires and ligatures are changed as per treatment needs. This is followed for a period of 1 year to 3 years depending on the treatment and age of the patient. Once the orthodontic correction of the teeth is completed the braces are removed and retainers are placed. The retainers are placed for a period of 3 years or more.
Placement of the braces is often followed by a detailed description of the oral hygiene measures to be done. These are as follows: –
Daily dental hygiene protocols include:
- Brushing the teeth and the gum linewith an orthodontic toothbrush having round-bristle at the ends of the toothbrush. Brushing should be performed religiously twice a day for least 3-5 minutes. Brushing must be done after the patient has food in the morning as well as before going to bed at night.
The use of electric toothbrushes provide the advantage of having a built-in mechanism which causes the toothbrush to undergo pulsation for 30 seconds or more, thus directing the person to move to the next quadrant once the beep sound for the initial quadrant is heard.
- Flossingis required after tooth brushing to help remove the food debris and plaque accumulated between the teeth and behind the braces which is difficult to be removed with brushing alone.
- Use oforal irrigation devicesmay serve as an adjunct to flush out loosely attached = food particles around the teeth and the braces. Furthermore, the removal of food particles is a less cumbersome task moments after having a meal rather than hours later.
- Professional Ultrasonic Scaling
Diligently cleaning of teeth while wearing braces substantially decreases the chance of the appearance of white spots or cavities after removal of braces once the treatment is complete. These can be prevented by undergoing professional dental ultrasonic cleaning of the teeth every six months. This helps in cleaning any remaining plaque and debris before it can build up.
Types of braces used in orthodontic treatment
Several distinct types of dental braces have been recommended to correct the malalignment of teeth namely Metal braces, Ceramic braces, Lingual braces and last but not the least the Invisalign. There are several advantages and disadvantages that must be taken into consideration before making an informed decision about the best treatment option available for the individual patients.
These are often traditional braces which make use of metal brackets and stainless steel or niti wires, which when attached to the teeth with help of composite light cure material help in proper alignment of the teeth in their desired positions as required.
With the advent of Niti archwires which are relatively flexible, the initial alignment phase of orthodontic treatment has become an effortless work. These wires have a property of shape memory. Shape memory refers to the property of the wire by which it maintains its original shape and is unlikely to be bent or entangled that hinder the movement of the teeth. Thus, utilizing their flexibility for returning to the initial shape the wires when placed in braces helps in tooth movement in the direction of the wire movement.
These are the most common braces used traditionally. These are the least expensive option for the treatment while being equally effective as other braces in use nowadays. However, being easily visible these types of braces may make some individuals self-conscious about their appearance in public. Sometimes when used in kids, coloured bands may be used to make these braces look more pleasing to the patient.
Ceramic braces are like traditional metal braces in shape, size, and design with the difference in colour and material of which braces are made. Ceramic braces are made from ceramics which attains a colour like the tooth thus making them less visible in comparison to metal counterparts.
Since the ceramic braces are less likely to be visible due to their matching tooth colour are often favourable alternatives of choice for orthodontic treatment. These braces are equally effective in the movement of teeth as metal braces. These are more expensive in comparison to metal braces and can be used with metal or tooth-coloured arch wires.
Often if due care is not taken staining of the ceramic braces may take place. This provides a yellowish look to the ceramic braces in due course of the treatment. These braces are more brittle in comparison to metal braces when put into use.
Lingual braces hold close similarity to metal braces in size and shape with the only difference in placement of the braces. The lingual braces are placed on the inner surfaces of teeth which makes them invisible from the front. These braces require expertise for treatment to be initiated and completed by an orthodontist.
A visit to an orthodontist is required more frequently for check-ups for traditional braces, while adjustment and tightening of the wires in lingual braces require to be performed every six to eight weeks.
Having a distinct advantage of being invisible from the front makes them a favourable choice of the patients. However, in terms of treatment results, they are less efficient than traditional braces. Treatment with lingual braces often requires longer time periods to attain the desired tooth alignment. Being in direct contact with the tongue they are usually uncomfortable to wear. They tend to be more costly than metal and ceramic braces when treatment cost is taken into consideration. Finally they are more difficult to clean which hinders proper oral hygiene.
Being placed on the inner aspect of the teeth the lingual braces tend severely impact the ability to spell the letter “s”. This may result in temporary lisping which might get resolved in a few days or few weeks. With the passage of time tongue gets adjusted to new space thus making it more comfortable for the patient to wear lingual braces. Some patients might experience strange whistling sounds during speech after the placement of lingual braces. Certain speech exercises can be performed with the help of which the speech problem can be resolved to normal. This may include recitation of phrases or words as frequently as possible.
Lingual braces have benefits that Invisalign cannot provide visa-versa, Invisalign also does offer certain distinct advantages over lingual braces. They are equally effective in the treatment of crooked teeth. However, being the more invisible option of the two, when given a choice the patients tend to opt for lingual braces.
With the advent of advancement in the field of orthodontics, the use of braces alone in the movement of the teeth into desired positions has been outrightly negated. Invisalign has emerged as the most distinct and unique type of orthodontic treatment procedure wherein the use of braces and wires is not done. Invisalign instead utilizes a series of custom-made plastic aligners. These clear plastic aligners are like mouth guards and are worn directly over the teeth. These aligners are removable and do not require fixation on the teeth for the alignment of teeth. The aligners are replaced with the next set in the series after every two weeks throughout the orthodontic treatment period. For the achievement of the desired results use of 18-30 aligners is required in most cases.
Unlike traditional braces, they are invisible, removable, and allow greater freedom to eat and drink as they are required to be removed while eating. They are considerably expensive in comparison to traditional and ceramic braces. They are helpful in the correction of minor to moderate dental problems often seen in teenagers and adults.
Use of Invisalign necessitates its proper cleaning every day by the patients to ensure the best possible results while maintaining a healthy oral cavity.
Every time the patient has taken his/her food it is mandatory to clean the teeth and the aligners before they are worn again. To clean the aligners, the following methods may be utilized:
1.Use of denture cleaning solutions for soaking the aligners overnight
2.Use of toothpaste with light brush strokes on the inner and outer surface of aligners with subsequent rinsing with cold water.
Often drinking a lot of coffee or tea with aligners still present on the teeth, improper oral hygiene, and improper cleaning of aligners may lead to staining of the aligners. Use of mouthwash while wearing aligners is prohibited as the chemical ingredients of the mouthwashes may interact with aligners and damage them. They may get discoloured due to mouthwashes.
Sometimes the aligners may get broken or lost by the patient. If such a case arises the orthodontist may advise the next set of aligners to be worn or may prefer the previous set of aligners for a few days if the need arises.
Self-ligating braces are like traditional metal braces being fixed on the front surface of the teeth making them visible. They utilize clips rather than elastic/metal ligatures to hold the wires in place for the effective movement of teeth. This results in reduced friction of wires on the braces. The reduced friction increases the pace of the movement of teeth in comparison to traditional metal or ceramic braces.
Self-ligating brackets are designed in a manner that does not require a removable component to hold the wire in place. Self-ligating braces are provided with a tiny spring-loaded door which helps in maintaining desired pressure on the arch-wires. By the use of this unique mechanism, the need for adjustment of wires in bracket slots is eliminated.
There is a significant reduction in the discomfort that patients might experience with traditional braces due to the use of ligatures for holding wires in bracket slots. Although it is worth mentioning that reduction in general soreness might not be achieved and cheeks and oral tissues are soft enough to avoid friction with bracket surface when placed in the mouth. The amount of food accumulation around self-ligating braces is much less as compared to traditional braces.
These braces are more expensive in comparison to traditional braces while ceramic braces are at par with self-ligating braces when the cost of treatment is compared. These braces require the same time span for treatment as with trading counterparts depending on the treatment concerned. These do come with a clear variant in braces, but the metal wires remain the same so visibility is not taken care of in conscious patients. There may be loosening or breakage of the spring-loaded door wherein the bracket needs to be replaced or metal or elastic ties can be used to hold the wire in place.