Orthodontics is a branch of dentistry dealing with the prevention and treatment of malocclusion and maxillofacial defects in children, adolescents and adults. Therapy, carried by an orthodontist (medical specialist in the field), affects not only teeth relationship but also the ratio of the lower and middle part of the face; therefore orthodontics is often called dentofacial orthopedics or conservative jaw orthopedics.
The first visit
The first visit is the most important both for a patient and a dentist. The patient, and children‘s parents, are informed by medical staff about malocclusion therapy but also build their opinion about the dentist and the practice, which is often crucial when taking a decision to commence the therapy. During the first visit a dentist examines the patient – their bite (occlusion) or teeth alignment, and soft tissue – the lips and cheeks which affect the facial profile. It may change significantly both because of the patient’s growth and as a result of an orthodontics treatment. After the initial examination, the photographs of an occlusion and of the face are usually taken and so are the impressions of teeth. The impressions are necessary to make plaster models which are then used for measurements and analysis; it is impossible to plan treatment without these models for most of the patients. To plan the treatment X-ray pictures are also required; they allow to evaluate such invisible structures as the teeth roots, buds of the teeth that have not erupted yet, or the lack of such buds. Two photographs are usually taken: pantomographic (DPT) and lateral cephalometric. The latter is sometimes not taken, especially in very young patients.
During the first visit a dentist informs about the general nature of a defect, likely method of treatment and an appliance suggested to correct the defect. However, the information is preliminary and general, and the detailed plan of treatment will be presented at the second visit, after the models, radiograms, photographs and notes from the first visit are carefully examined.
An orthodontic appliance - (from Greek: orthos-straight and odous-tooth), is used to restore proper physiological occlusion of the upper and lower jaw, to align and properly position the teeth in dental arches, and to treat malocclusion. At the moment a variety of orthodontic appliances is available on the market. They can be divided according to the bracket used. Still, the most popular division is into removable and fixed appliances (braces). The choice of an option depends on many factors such as the defect size or age of the person deciding to correct their teeth position.
No orthodontic appliance is „programmed“ for the entire treatment, and a patient requires regular check-ups during which the orthodontist adjusts the appliance to achieve a desired result. In fact, an orthodontic appliance is only an auxiliary tool in the hands of a specialist. Some patients believe that the appliance „knows“ what to do, and a doctor merely "services" it in the same way other mechanical devices are serviced. This is a completely wrong opinion because highly professional orthodontic treatment depends solely on a conscious effort of a doctor who applies an orthodontic appliance. Regular check-ups are basic for a successful treatment. Orthodontic appliances, including fixed braces, left without any control for a period of a few months may be harmful to a patient! It should be remembered that the negligence of check-ups prolonges treatment and in some cases provides the basis for an orthodontist to discontinue treatment.
Orthodontic treatment usually starts in children over the age of 5. Children 6-7 years old, still having some milk teeth being replaced by the permanent ones, are treated with removable appliances. Procedures, when started at this age, often provide best results. If not all the defects were managed to be corrected at this time, fixed braces are applied to 12-13 year-old patients already having their permanent teeth. Orthodontic braces with metal, porcelain or plastic brackets may be applied, or braces placed behind the teeth – the so-called lingual braces. Treatment with fixed braces usually lasts 1.5–2 years. Extraction of one or more teeth is often required to finally achieve an optimal bite.
Removable appliance is recommended for children aged 4 to 12 years, before an exchange of their milk teeth into permanent ones. The appliance is built of an acrilic plate and a wire loop adjusted to the teeth. Removable appliances, or removable dental braces, are the appliances which may be removed by their wearers. Such orthodontic appliances are usually worn for several hours a day. Unfortunately, their efficiency is much lower than those of fixed braces but they are less troublesome and easier to be accepted by a patient. If necessary, removable appliances can be easily removed which is their indisputable asset.
Fixed appliances (braces) are recommended for adolescents and adults with permanent teeth. They allow correction of more serious defects than it is done by removable appliances. They are built of brackets and rings fixed to the enamel with a special glue. Attached to them is a spring wire which exerts precisely defined constant force on the teeth. How long such an appliance should be worn depends on the defect. Fixed braces are divided into: aesthetic appliances (ceramic, cristal) and metal appliances (titanium, nickel). Fixed braces are glued to the teeth with a special glue. These orthodontic appliances are removed from the teeth only after treatment is completed.
The most visible elements of fixed braces are brackets. It is the brackets which make orthodontic appliances so easily visible. The cheapest and the most popular orthodontic braces have metal brackets. Recently, braces with white or transparent brackets are becoming more and more popular. The materials used to make braces vary; they have different aesthetics, durability and price. The cost of a fixed orthodontic appliance, as well as of a removable appliance, depends on a dental practice and brackets used.
Placing a fixed orthodontic appliance is a procedure which starts an active stage of orthodontic treatment. A fixed apliance is glued to the teeth with a special harmless glue of suitable properties. Precise attachment of the appliance to the teeth is very important to achieve correct treatment and its final effect. The dentist’s skill and experience is of key importance because lack of precision or wrong placement of the brackets largely complicates and prolongues treatment. Fixing an appliance is absolutely painless for a patient. It takes one hour for a well-cooperating team of an orthodontist and a skillful assistant to glue an appliance on both dental arches. Some dentists who care for maximum precision in fixing the brackets use special optical kits, i.e. surgical loupes which are used also by surgeons performing extremely precise surgeries, for instance eye surgeries.
Active stage of orthodontic treatment is completed with a removal of an appliance from the teeth. This procedure involves detachment of the brackets, tubes or rings, and lasts from several seconds to a few minutes; then, a time-consuming procedure of cleansing the teeth from glue remnants follows. Removal of the brackets is done mechanically; special forceps press on the bracket which resiles easily from the tooth. Some patients describe this moment as unpleasant, especially when it comes to ceramic appliances which fix tightly to the teeth. However, most of the patients do not complain about the procedure; probably it depends on an individual patient’s sensitivity and their attitude. It is our observation that the patients with more optimistic attitude do not report any complaints during treatment or during an appliance removal.