ORTHODONTICS

Definition

Orthodontics is a specialty of dentistry that is concerned with the study and treatment of

malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw

improved bite (occlusion).

In diagnosis and treatment planning, the orthodontist must:

• recognize the various characteristics of malocclusion and dentofacial deformity;

• define the nature of the problem, including the etiology if possible;

• design a treatment strategy based on the specific needs and desires of the individual;

• present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision.

Diagnosis and Treatment Planning

TherapyTherapy can be:• Functional: indicated to reduce and

eliminate any possible problems, using muscular exercises and/or passive orthodontic devices, which guide mastication forces;

• Mechanical: when extra/intraoral devices are used, to correct the present anomalies

• Surgical: indicated especially in adults and/or when orthodontic methods can’t fix the problems

• 2. Why is it important to have orthodontic treatment?• Orthodontic problems can disfigure the face and mouth. • Orthodontics can improve the appearance of the teeth and face. • Normal speech and chewing can be made possible by orthodontic treatment. • A bad bite can make biting or chewing difficult or even impossible, and can cause

the teeth to wear down. • Crooked teeth are very hard to brush properly. • If teeth are not kept clean, this can result in tooth decay, and loss of teeth. • Orthodontic problems can damage the gums and underlying bone structure. • If the jaws are not properly positioned, pain in the jaw joints can result. • Orthodontic problems can get worse if they are neglected. They will not just "go

away". • If not treated in time, a problem can become more difficult and more expensive to

treat later on.

• 4. Why should orthodontic treatment start when the child is young?

• There are many good reasons for early orthodontic treatment: – When the jaws and teeth are still growing it is much easier to move

teeth and influence the position and size of the jaw. – Early treatment will shorten the treatment time. – Treatment of thumb-sucking and abnormal swallowing patterns is

more successful in a young child. – Protruding front teeth are easily damaged, so the sooner they are

corrected the better. – The space left by the early loss of a baby tooth must be kept open.

If left untreated, this space will close, as adjacent teeth will drift into it. The permanent tooth may then not have enough space to grow into and may become impacted. Early treatment can keep the space open and allow the permanent tooth to erupt normally. Insufficient space for permanent teeth often results in crowding.

before

treatment

treatmentafter

Crowded and irregular teeth

• Is orthodontic treatment painful?• When braces or other orthodontic appliances

are first placed in the mouth, some discomfort or pain is experienced, but this soon passes.

• Adjustments to appliances may cause temporary pain or discomfort.The appliances may initially irritate the lips, teeth or tongue, but the orthodontist will adjust them to minimise any discomfort.

• How long will the orthodontic treatment take to complete?

• Treatment takes from a few months to about 3 years. The average is about 2 years. – The length of treatment depends on how difficult and

complicated the problem is. – Some people respond to treatment more quickly than

others. – Co-operation by the patient, or lack of it, can affect

the length of treatment. – Your orthodontist will be able to give you an idea of

how long it will take.

• What is the plan of action for the entire treatment period?

• The treatment plan is divided into three parts. • The planning phase • The active phase • The retention phase

• 10. What happens in the planning phase?• A pre-treatment record is made, which includes: – A medical and dental history. – The making of casts for the upper and lower teeth

and jaws. – Photographs of the face and teeth for before and

after treatment comparisons. – A complete set of x-rays of the jaws and teeth. – A computer-generated photograph of the anticipated

result. – Formulation of the treatment plan.

What happens during the active phase?• Extraction of teeth • Space maintenance

• Orthodontic appliances – Orthodontic appliances are used in conjunction with braces to influence the

growth patterns of the jaws. – They can be either removable or fixed.

A. Removable appliances – Removable appliances are used to move one or a few teeth. – The appliances are made of plastic and may have wires that exert a slow

gentle pressure on the teeth to be moved. – Removable appliances must be worn continuously or as your orthodontist

instructs. – A removable brace may for example be used to correct teeth that have been

forced forward and outward by a thumb sucking habit.It can also be used to hold or retain teeth in their corrected positions.

– Removable and fixed appliances can be used to increase the width of the upper jaw.

– This influences the rate of upper jaw growth and tooth eruption. B. Fixed appliances

– Fixed appliances are attached to the teeth and remain in the mouth for the duration of the active phase.

• The placement of fixed braces – Little metal, ceramic or clear acrylic brackets are bonded or cemented onto

the teeth. – Specially bent wires are then attached to the brackets. – Tightening of the wires causes the controlled movement of the teeth. – Fixed or removable braces are used in conjunction with rubber bands. – Braces are designed to exert a constant gentle pressure on teeth in order to

move them into their correct positions. – New, high-tech materials and modern methods of bonding brackets to

teeth, make braces less obtrusive and easy to fit.

What happens during the retention phase?

• When active treatment is completed, the braces and other appliances are removed.

• To maintain the changes that have been made, a special removable retainer is made for the patient. – It is designed to keep the teeth and jaws in

their new positions, and to prevent a relapse.

– The retainer must be worn continuously until the teeth and bone have stabilised in their new positions.

– This may be a temporary or a long-term measure.

• Once the corrections have "set" in their new positions, the improvements should last a lifetime.

• 1. Is it unusual for adults to have orthodontic treatment?

• More and more adults are having orthodontic treatment to correct crooked or crowded teeth.

• Orthodontics can make the teeth more attractive and more functional, by improving jaw alignment, and correcting "the bite".

• Improved techniques have been devised for treating adults.

• Modern orthodontic braces are less obtrusive and adults are more willing to wear them.

• 2. Is adult orthodontic treatment successful?• Adult orthodontics is particularly successful

for correcting crowding and jaw problems. • Healthy teeth can be moved with braces at

any age. • Very similar treatments and appliances are

used for children and adults.

• 5. What problems could make orthodontic treatment for adults more difficult?• Periodontal Disease

– Adults may suffer from periodontal disease, which is a deterioration of the gums and underlying bone.

– Periodontal treatment will be necessary before the orthodontic treatment can start. • Tooth decay

– All dental decay should be treated before orthodontic treatment starts. – It is less comfortable to have dental treatment after braces have been fitted.

• Abnormal jaw relationships – The growth of the jaws has been completed in adults, and so this treatment is not always

possible. – In children, the ongoing growth of the jaw can be directed to correct the abnormalities that

are present. • Worn down or broken teeth

– These must be built up or restored before orthodontic treatment can start. • Lack of commitment

– Adult patients may find it hard to commit to long term treatment, especially to wearing braces for long periods.

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