Orthodontic Treatment

Orthodontics derives from the Greek words 'ortho' ("correct", "straight") and 'dontia' ("teeth"). Orthodontics involves monitoring, guidance, and manipulation of the dentofacial (jaw and face) structures of growing and adult individuals and their manipulation. Orthodontics is a specialty of dentistry that uses force to reroute and fix the malformations of these relevant structures.

The scope of application in orthodontics is as follows;

1. Diagnosis, prevention, and treatment of improper bites.

2. Design, application, and control of functional and straightener apparatus

3. Guiding the teeth and supporting tissue to facilitate ideal relationships for physiological and aesthetic harmony between the face and cranial structures (bone structure around the head area)

Who Is an Orthodontist?

Orthodontists are dentists who finished the Orthodontics expertise program which takes 4-6 years or the Orthodontics doctorate program who conducted a thesis study in the field of Orthodontics after attending 5 years of dental school. They are experts in the application of functional jaw orthopedics, extra-oral apparatus, and fixed brace treatments. Orthodontic treatments must be applied by orthodontists.

Why Do Orthodontic Malformations Occur?

1. Genetic Factors: It is vital to identify whether individuals with skeletal malformations, missing teeth, maxilla narrowness, and crowding issues have a family history of similar conditions.

2. Various Otorhinolaryngologic Problems: Nose deviation, the existence of adenoid, and breathing by mouth all have an effect on the development of jawbone.

3. Bad habits: Thumbsucking, cheek chewing, prolonged use of a pacifier, tongue sucking, etc. negatively influence the development of the jawbone. As a consequence, children with such habits should be monitored closely and make them shake the habit off early.

4. Early teeth loss: Because of the premature extraction of baby teeth without placing space maintainers, neighboring teeth move to the location of missing teeth, consequently occupying the space for permanent teeth. Therefore, crowding and pushing issues can be observed.

Frequently Encountered Orthodontic Malocclusions

Open bite: When the back teeth are clenched with the front teeth, the front teeth won't cover each other and there is an opening between the upper and lower incisors.

Crossbite: Normally the ideal situation is the upper teeth being more prominent than the lower teeth and covering them to a certain degree. When the condition is vice-versa, it is called crossbite.

Crowding: This is when there is not enough space for the teeth to be aligned on an arc or a region.

Diastema: Diastema is the gap between two neighbor teeth. It is seen especially between the two upper front incisors. However, it is normal to encounter diastema during the phase of milk dentition.

Ectopy: Ectopy is the displacement of teeth from their normal position.

Impacted Teeth: It is the condition of the tooth getting blocked (generally due to lack of space) as it is pushing through the gum into your mouth.

Lip shortness: It is the inability of the lips to cover the teeth and achieve a relaxed, consistent, lips-together rest posture. The lips of the individual remain open, with some upper front teeth still showing.

Deep bite: For an ideal bite, the upper incisors should cover the lower incisors for about 2 to 3 mm or one-third of the lower incisors. When the upper incisors cover the lower incisors more than normal, the condition is called deep bite.

Overjet: This condition occurs when there is a gap that is bigger than normal between the upper incisors and lower incisors (this gap can be examined by placing the little finger between the upper incisors and lower incisors).

Rotation: The condition where the teeth are situated differently on the alveolar bone-facing another direction than its normal position.

Transposition: The condition occurs when two teeth push in place of each other.

Why is Orthodontic Treatment Necessary?

The majority of the patients who seek orthodontic treatment do so to improve their looks and smile. Orthodontic treatment esthetically benefits patients and reinforces their self-confidence. However, most of the orthodontic issues can affect oral and dental health. For example, crowding teeth are harder to scale and clean. Because of this, predisposition to tooth decay and periodontal disease increases. Malocclusions can cause rapid corrosion of teeth. Orthodontic issues can cause temporomandibular conditions, sore face, and headaches. If there is a condition of open bite on the area of the front teeth or space between the front teeth, the patient will have misarticulation and issues with speaking.

Orthodontic Procedures

Orthodontic treatment involves a series of procedures that aim to correct dental misalignment and improve the appearance and function of teeth. The two main procedures involved in orthodontic treatment are bracket placement and wire insertion, and adjustments and follow-up care.

Bracket Placement and Wire Insertion

The first step in orthodontic treatment is the placement of brackets on the teeth and the insertion of wires. Brackets are small, metal or ceramic devices that are attached to the teeth using a special adhesive. Wires are then threaded through the brackets and secured in place using small elastic bands.

The wires are gradually tightened over time, which puts pressure on the teeth and gradually moves them into the correct position. The length of time required for this process varies depending on the severity of the dental misalignment and the type of treatment being used.

Orthodontic Treatments are separated into 4 categories:

1. Preventive Orthodontics

2. Interceptive Orthodontics

3. Corrective Orthodontics

4. Retention Treatment

What's the Ideal Age for Orthodontic Treatment?

Generally, the ideal treatment period for dental defects is between ages 10 and 12, when the development of milk teeth is almost complete and canines are about to change. However, early treatment is essential for jawbone conditions and breaking bad habits. Consequently, An orthodontist examination is required during the period between ages 6 and 7 when dental sealants are being used (apparatus protecting the surface of teeth against decay).

Can Adults Receive Orthodontic Treatments?

Yes, adults can comfortably receive orthodontic treatments. Contrary to popular belief, it is possible to manipulate teeth in all age groups with healthy gums. However, due to the abundance of treatment options for early diagnosed anomalies, it is essential to get an examination of the bite at an early age by an orthodontist.

How Long Does Orthodontic Treatment Take?

Active treatment takes about 1.5-2 years. However, treatment duration varies according to the treatment type, age, and compatibility of the patient.

What Is The Orthodontic Apparatus?

The choice of orthodontic apparatus depends on the type of the problem and the development of the individual. To this end, in cases with skeletal deviations, various types of fixed and removable apparatus are employed. Detachable apparatus can also be used for several simple teeth movements. In cases of crowding instead of skeletal problems, fixed treatment types are applied.

Fixed Treatment Options

Fixed orthodontic treatments are applied in cases where there is no deviation or skeletal deviation is unable to be performed, however, the presence of various levels of crowding is present. Fixed orthodontic treatments, namely dental corrections, are applied after all permanent teeth are established in their respective positions.

There are sockets in the middle of the brackets attached to teeth. These sockets are filled and tied with braces of high elasticity, or braces that were made more flexible by bending. Thanks to these tied braces, teeth move to their targeted ideal positions in the mouth. In fixed treatments, various springs and bands are also utilized.

Aesthetic Brackets

Adult patients do not wish to undergo orthodontic treatments due to the appearance of the orthodontic apparatus, which will help them get perfectly aligned teeth. Most of these patients prefer to get their crowded teeth extracted or get porcelain crowns where the teeth are cut and made smaller. However, with orthodontic treatments, by preserving the health and structure of existing teeth, more natural and aesthetic results can be achieved.

To satisfy the aesthetic preferences of adult patients, the usage of tooth-colored porcelain brackets instead of metal brackets increased the interest in orthodontic treatments and it has become an acceptable form of treatment for a group of patients. The cost of these types of braces is a little higher.

Rules to Follow for Fixed Treatment

In the first week after the bracket insertion, temporary wounds can happen in the cheeks and inner lips. This condition gets better in about 1-2 weeks during the adaptation period. Protective wax can be used to protect the soft tissue.

Refrain from eating solid food (green almonds, plum, apples, carrots, dried nuts and fruits, chips, etc.), sticky candy (gum, jelly tots), and drinking fizzy drinks (cola, fanta, sprite, etc.). When eating food such as sandwiches, the patient should slice them into smaller pieces instead of biting. This type of food can break down brackets, braces, and orthodontic bands, extending the time needed to complete the treatment.

Treatment with Removable Apparatus

This treatment option is applied before permanent teeth, milk teeth or mixed teeth stages. The purpose of this treatment is to provide teeth eruption for appropriate positions by controlling the development of the teeth and establishing the dimensional relationship between the upper and lower jawbone.

Functional Apparatus

During the developmental stage, these apparatus are utilized to correctly guide the jaw development stage in cases of lower and upper jaw development deficiency or over-development.

Extra-oral Apparatus

Thanks to apparatus such as headgear and facemasks, lower-upper jaw development can be increased or decreased by gaining support from extra-oral regions according to the patient's condition.

How Do The Teeth Move in Orthodontic Treatment?

Orthodontic treatment is a biological treatment while Orthodontic movement is a physiological occurrence. By applying mild pressure on the tooth with a fixed or removable orthodontic apparatus, the tooth is pushed towards its alveolar bone which surrounds the root. This mild and constant force causes bone thinning on the side where pressure is being applied, thus forming a new bone socket for the teeth to settle in. Bone fill begins in the cavity which is on the other side of the tooth and this facilitates the tooth to stay in the new location. The process of bone loss on one side and bone fill on the other side is called "opposition".

Who Is Not Suitable for Orthodontic Treatments?

The usage of orthodontic apparatus isn't suitable for several medical conditions. Plasma levels are not normal in blood diseases such as leukemia and hemophilia. Special treatments need to be applied to these kinds of patients before extractions. For patients with recurring aphthous ulcers, orthodontic wires could be harmful. For mentally disabled patients, orthodontic treatment applications are limited.

Making the Decision for Tooth Extraction in Orthodontic Treatment

If there is not enough space to move the teeth into their proper positions, the orthodontist makes use of tooth extraction or other several methods to make room for teeth. In other words, orthodontic treatments can be performed with or without tooth extraction. The decision should be made by your orthodontist. One of the most important factors in this decision is esthetics. Treatments with extraction allow for lips to move back and treatments without extraction allow for lips to move forward.

Retention Treatment

After orthodontic treatment, teeth show a tendency to return to their old positions. To prevent this, surrounding tissue and bone need to be held in the corrected positions till the rearranging process is completed. For this purpose, removable or fixed retention devices are used. Removable retention devices should be used day and night, under supervision by a dental professional. The time needed for this treatment varies from 3 months up to 2 years or more.

Fixed retaining apparatus (lingual retainer): Lingual retainers usually are thin braces which are attached to the internal surface of the tooth (tongue side). The duration of the treatment is decided by your Orthodontist according to the initial status of your case.

Orthognathic Surgery

Surgeries that are performed to fix facial, and jawbone structure malformations and restoring the function of the teeth along with the jawbone are called orthognathic surgeries. Simply put, it is jawbone adjustment surgery. When the developmental malformations on the upper and lower jawbone are not suitable for sufficient treatment, orthognathic surgery may become necessary. Development malformations can appear on both the upper and lower jawbone separately or together. Depending on the problem, it is possible to move the jawbone forward or backward, adjust the height, or move it to the left or right with surgery.

Oral and Dental Health Care During Orthodontic Treatment

The patient needs to brush their teeth after every meal or snack.

The patient needs to clean their braces and diastema at least once a day.

The patient needs to use a fluoride mouthwash after brushing the teeth.

It is recommended to use oral irrigators and keep a regular schedule of follow-up appointments.

The patient needs to regularly attend the appointments with their orthodontist.

Orthodontic apparatus must be worn regularly without interruptions according to the instructions from their orthodontist.

It is highly recommended to stay away from solid food such as corn, dried nuts, carrots, apples, and sticky snacks such as gum, candy, or caramel.

These precautions help prevent tooth decay, minimize the possible damage to the apparatus and brackets, and improve the efficiency of orthodontic treatment.

What Are The Risks and Conditions When Working?

It is quite normal to have pain on the teeth when the orthodontic treatment has begun. Pain will subside in about 3-4 days. The adaptation period for orthodontic apparatus takes approximately one week.

During the orthodontic treatment, there may be mobility in the teeth. This condition is normal and is caused by the movement of the teeth.

Patients with poorly maintained oral hygiene may experience tooth decay or permanent stains on their teeth. These patients may also experience gingival diseases.

There may be decay on the tooth root depending on the problem, it is possible to move the jawbone forward or backward, adjust the height, or move it to the left or right with surgery.

Rarely bone resorption occurs during the treatment.

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