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Orthodontics

Neat and tidy – This is also true for your teeth.

It is no use having bright and white teeth if they are crooked or abnormally arranged. Professional orthodontic treatment can help you have your teeth positioned properly.

Orthodontics (restoring proper alignment of teeth in the dental arch) is one of the oldest branches of dentistry. It deals with diagnosing, treating and preventing the abnormal shape and position of teeth, the alveolar socket and the jaws. Prevention aims at ensuring proper development of your dentition by eliminating potential obstacles in order to maintain normal (chewing) function and aesthetics. Orthodontic treatments aim at correcting abnormalities.

Orthodontics

Start treatment as soon as possible!

Whether it be adult or pediatric orthodontic treatment, whether we’re looking to solve esthetic or functional problems, it’s important to start the treatment as soon as possible. The ideal start to the treatment is during childhood, because the teeth and bones are still in development and can more easily be influenced. It’s recommended to see an orthodontist at the age of 6-7 so he can see if correction will be needed later on. Fixed braces are only started around the age of 12 or 13, since we must await for the eruption of the permanent teeth.

On the other hand, it’s not too late to start in adulthood. Good esthetic results can be achieved at any age. If your parents did not take you to the orthodontist to correct any occlusal problems, you can easily start the treatment whether you’re 20 years old or 50! Of course, esthetic problems are not the only reason why it might be important to start orthodontics in adulthood. Many problems arising in adulthood may be traced back to orthodontic problems. Sometimes prior to larger surgeries, or the preparation of dental prosthetic devices, some orthodontic treatment might be needed to make these procedures easier or have a higher success rate. We shouldn’t be scared if we hear that adult orthodontics is necessary, but rather look at the positive side that we will be one step closer to a healthier smile.

Orthodontic treatment includes:

  • muscle strengthening
  • preventive treatments
  • braces
  • a combination of braces and surgical intervention

Misaligned teeth can make even the most beautiful face ugly. Patients usually seek orthodontic treatment for aesthetic reasons, but establishing or restoring normal function is just as important. Orthodontic abnormalities are closely related to other problems in the mouth, such as decay or periodontal disease. Crowded teeth are prone to tooth decay, because they cannot be cleaned properly. Cavities can be filled, but new decayed areas will develop around the fillings. Crowding can also lead to mobility of the teeth. If the position of the teeth is abnormal, the biting pressure is not parallel with the vertical axis of the teeth, and it can cause gum inflammation, formation of pockets around the teeth, bone loss and mobility of the teeth.  Misaligned teeth can even lead to psychological diseases. Patients with improperly positioned teeth can have poor self-esteem, which can turn into a personality disorder.

What kind of braces should I choose?

The doctor is the one who decides whether removable appliances or fixed braces are needed. If fixed braces are selected, however, it’s an important decision to make as to which type of braces we can use because they will remain in the mouth for a few years. Luckily, we have multiple options to choose from, some of which provide for an excellent esthetic and may appear almost invisible. They can also be worn as a sort of a fashion statement or jewelry on the teeth.

Most of the time when people think of braces, they picture the typical metal brackets. However, many people are unaware that nowadays braces can be stylized with different color rubber bands and can actually look very cool. Most of the time, this is important for teenagers, who will have the opportunity to change the colors each week.

Porcelain braces are basically invisible except from a close distance, because their color matches that of the natural tooth color. Another great option is braces that are attached to the inner surface of the tooth, which are totally unseen by other people. This is the most common selection in case of adults undergoing orthdontic treatment.

If you’re looking for totally invisibile braces, then lingual braces (braces on the inner side of the teeth) are the option for you. These braces will be totally invisible even during speech, so the only person that will know you have braces is whoever you tell. Another invisible orthodontic device are plastic retainers, which can be worn totally unnoticed as well. This treatment type is recommended for those who can wear them for the alloted amount of time each day, since they can be easily removed it is possible that the patient may not wear them enough which will have a poor result in the end of the treatment.

Everyone will find the types of braces which suits them the best. The type of braces that will be worn can be discussed even during the first consultation, and it should be discussed because it will be worn in the mouth for a sizable amount of time. If you want to have orthdontic treatment done in Szeged, look for Fehér Dent esthetic dentistry, so we can help you make the best decision suited to your needs!

At what age is orthodontic treatment recommended and how long does it last?

It is best to start orthodontic treatment while the jaw bones are still developing, since abnormalities of the teeth and the jaw bones are usually caused by improper development. Bones have lifelong capability to restructure and thanks to modern methods orthodontic treatment can be very effective in adults, too. However, treatment will last longer, because gentle force is applied to guide the teeth. All in all, orthodontic treatment in adults can replace treatment that was not performed in the patient’s childhood.

If the teeth are properly positioned in the mouth, the lifetime of your dentition will be longer. It is recommended to start treating open bite at the age of 2 – 6. Cross bite (some upper teeth get inside the lower teeth when you bite) require treatment at the age of 6 – 12, when you have mixed dentition. This is the age when most orthodontic problems can be corrected effectively. After the age of 12 most people have permanent teeth only. These teeth can be treated with fixed orthodontic appliances, or sometimes oral surgical intervention is needed. It is essential to recognise abnormalities as early as possible

How long does orthodontic treatment last?

Orthodontic treatment aims at restructuring of the bone, which may take years. Shorter time is needed if the problem is detected in childhood and the treatment is started immediately. The length of treatment can also depend on the child’s general condition: ill or less developed children may respond to the treatment differently from healthy children. The orthodontic appliance and the patient’s cooperation can also influence the duration of the treatment. It is shorter if the patient wears the removable appliance as instructed by the dentist and comes to the appointments regularly.

Surgical removal of an impacted tooth

Sometimes, teeth are unable to erupt due to the crowding of the teeth in the dental arch, and they remain under the gum line. Prior to orthodontic treatment, sometimes we must surgically access the canine (for example) and pull it to its normal position with certain orthodontic tools. The most common case is the wisdom tooth, primarily because they are the last to erupt and by the time they do, there is not enough space in the dental arch for them to do so.

Kobayashi Ligature

This ligature type is used to close the space in the dental arch between teeth. It can perform the tightening of intermaxillary elements during orthodontic treatment.

Mini implants

Mini implants may be used in orthodontics in order to move the desired teeth without having other teeth in the dental arch move as well, thus avoiding negative side effects. They can also be used to reposition teeth in those cases where fixed orthodontic appliances cannot.

Mini implants are placed between teeth inside the bone structure, and they stay there as long as they are needed for the treatment. They are only used for a certain period of time, after which they are removed. Oral hygiene is of utmost importance here, as always, because the lack of good hygiene can result in gum disease and the loss of the stability of the implant.

Happy smile planning, curvature

Happy smile is a translucent manufactured orthodontic retainer which is designed by graphic software.

With the help of a comprehensive computer software, a removable appliance is created. With the exception of mealtimes, the appliance is designed to be worn all day, since it is capable of performing similar orthodontic movements as regular fixed appliances.

Ligature

The purpose of ligature is to keep the curvature of the braces. Regarding the material, it can be either rubber or metal, and comes in various colors.

Push and pull springs

During orthodontic treatment we use springs to move the teeth. These can come in various shapes and sizes, with varying strengths. They exert a balanced force on the teth and are therefore more advantageous than treatment with rubber bands.

TREATMENT

Removable appliances
Removable appliances

Treatment with removable appliances usually takes longer, because they are not in the mouth all the time. They must be worn at least 12-14 hours a day, which you can do in the evening and at night. They can be used both on the upper and lower jaw, and there are appliances that attach to both dental arches. Removable appliances are not suitable for treating all orthodontic abnormalities. They are recommended at the age of 10 – 15, after that fixed appliances are used.

Palatal expansion with screw appliance
Palatal expansion with screw appliance

Palatal expansion is required when the dental arch is too narrow for the teeth and it leads to crowding. The treatment is recommended for children with mixed dentition (milk teeth and permanent teeth in the mouth). The device is a plastic plate with a built-in expansion screw that is used to generate enough force to move the teeth.

A narrow dental arch can result from:
• inherited anatomical features
• abnormal bone development
• early loss of milk teeth
• erupting wisdom teeth

The treatment may involve removal of some teeth. Your dentist will decide about it only after careful orthodontic diagnosis and a detailed treatment plan. Palatal expansion can be continued when your child has permanent teeth only, in this case a fixed appliance is used.

Fixed appliances

Braces consist of
• band (ring) or nowadays tubes are also used
• brackets
• elastic rings
• arch wire

The bands or tubes are fixed around molar teeth. It requires some preparation: your dentist will make room around these anchor teeth by placing special separating rings on them. These rings will widen the gap between the teeth, and within a few days the bands can be bonded on the anchor teeth. The brackets are used to attach the arch wire and distribute the force required to move the teeth. Brackets are made of ceramics, other aesthetic materials, or metal. The arch wire is attached to the brackets with elastic rings. The arch wire is made of various materials, and they are available in various diameter and strength. The arch wire connects the brackets. Your dentist can also recommend mini implants to be used as anchors. The braces are attached to these implants and the teeth are moved towards these implants. After the treatment the implants are removed.

Treatment of narrowed dental arch with screw-type appliances

Reasons for narrowed dental arch:

- Genetic factors
- Developmental (growth) factors
- Early primary teeth extraction
- Erupting wisdom teeth

It is possible that teeth must be extracted during the orthodontic treatment. The dentist will decide based on the treament, how many and which teeth will be extracted. The treatment is continued into the time of the permanent dentition, but with the help of fixed orthodontic appliances.

The parts of fixed orthodontic appliances:

- Band (ring), or recently used „tube”
- Bracket
- Ligature
- Archwire

The rings or tubes can be placed adhesively, primarily on the molar teeth. In order to place the adhesive material, we must have enough space around the tooth. To acheive this, special separation rings are inserted onto the teeth which, after a few days of exerting their forces onto the teeth, will give us enough space to place the adhesive. The space necessary for this is created within the bracket itself, which is the same place the archwire is inserted. The bracket can be procelein or some other esthetic material (plastic, sapphire), or sometimes metal. The archwire can be manufactured from different materials, with varying cross sections, and different strengths. The archwire connects the brackets. We can also perform orthodontic treatment in conjunction with microimplant placement, which we use as fixed points in the mouth. We attach the orthodontic devices to these implants, and can subsequently move the teeth using them. After treatment, the implants are removed.

Invisible appliances (lingual STB appliances)

Invisible appliances have become widely available in the past ten years. These appliances are attached to the inner side of the teeth making them invisible to the outside world. They are becoming more and more popular. Thanks to the advance of technology, nearly all kinds of orthodontic problems can be treated with invisible appliances.

There are two types of appliances:

One of them are fixed lingual appliances. There are several types of lingual devices. We apply one of the latest high-quality appliances, called STB. It does not require laboratory preparation which is usually done abroad. We do all laboratory work at the clinic. Regular check-ups are recommended every 4 – 5 week.

The other type of invisible appliances are removable devices, which provide great comfort.

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What does orthodontic treatment involve?

At the first visit to the clinic we decide if your condition requires orthodontic treatment and discuss your expectations. You are also informed about the treatment options. Then we take X-rays and an impression for a dental cast so that your dentist can have an accurate picture of your teeth, the jaw bone, further development, the available area and the mobility of your teeth. Using these details your dentist can make an accurate treatment plan and choose an appropriate device. You are informed about the expected duration of treatment and the inconveniences caused by wearing the device. If you give your consent to the proposed treatment, we can start it. If you have decayed teeth, we treat them before using the orthodontic appliance. Proper oral hygiene is particularly important when you wear an orthodontic device, because you have a foreign object in your mouth that must be kept clean. Your dentist will explain you the proper usage and maintenance of your orthodontic appliance.

Regular check-ups are required to monitor the process. Further X-rays and casts may be necessary. Sometimes it may seem to you that your condition is getting worse, but your dentist will assure you that the outcome will be perfect. As soon as the teeth have reached their proper position in the mouth, the appliance is removed. In order to prevent further drifting of your teeth, you will be given a retainer to wear for some time. You will need more visits to your dentist before the treatment ends. Many people think that orthodontic treatment is only performed in children or young adults, but we can achieve very good results in people over 50 years.

WHAT ARE THE REASONS FOR ORTHODONTIC TREATMENT?

How will my speech be influenced by wearing braces?

One of the most common questions we get asked is: how will the wearing of braces influence speech? Traditional braces are glued to the outer surfaces of tooth, and since the inner surfaces of teeth are used to produce speech it will have very little effect on the ability to speak normally. Of course, the first few days of wearing braces may feel strange to have a foreign body in the mouth (which may affect speech somewhat), however this will quickly subside. The disadvantage of lingual braces (even though they are esthetically superior) is that, since they are glued on the inner surface of the teeth, they may interfere with the ability of the tongue to contact the teeth and thus produce speech. This is also, however, more noticable at the beginning of the treatment. Once time passes, it can be accounted for and speech will return to normal.

Is orthodontic treatment painful?

The best part about orthodontic treatment is that even though it happens in a dental office, it does not come with the same pain or unpleasant feelings. Brackets are glued to the teeth, which are polished prior to this, and does not cause any pain to the patient. During the treatment the archwire is changed, which may be uncomfortable during the first few days after the appointment due to tension within the wire. At the end of the treatment, the brackets are quickly removed and the teeth are polished from any remaning adhesive material, which yet again causes no pain to the patient.

X-Ray, MRI, metal detector – can braces cause problems with these?

Metal braces do not cause problems with these types of imaging devices, because they are made from a material which does not attract the magnetism of MRI devices. Regardless of this, removable appliances are usually removed from the mouth when undergoing MRI. Similarily, metal detectors are not sensitive to this type of metal so you won’t have to explain that you have braces in your mouth the next time you are at an airport or court.

How long do I have to wear braces?

There is no general rule regarding this because all cases are different. Smaller corrections can be made in as little as a year and a half. Larger deviations sometimes need a few years to correct.

How do we brush effectively with an electric toothbrush?

From many aspects, an electric toothbrush is much more advantageous than a manual toothbrush in removing plaque from the teeth. The technique for each electric toothbrush, however, can varying based on what kind of brush it is. In regards to oral hygeine, we should keep in mind that the brush head should be replaced every three months, we should keep the ideal duration of tooth brushing, and we shouldn’t use excess force on the teeth because it can easily cause damage to the enamel.

If I have braces, what should I look out for when I brush my teeth?

We must clean our teeth very carefully while wearing braces, because food particles can remain stuck in between the brackets very easily. Interdental brushes are just one effective measure we can take to ensure this. Special orthodontic toothbrushes can be bought which come in manual and electric forms. Cone shaped brushes are also able to perform the proper oral hygeine measures in this case. The use of an oral irrigator can also help to keep teeth clean.

What should I do if the bracket of my braces falls off?

If a bracket has fallen off, and it is located on the lower jaw in the back of the mouth, then attach the band onto the tooth immediately in front of it. Make sure to attach these band symmetrically on the left and right side, so if you attach a band to the tooth in front of the fallen bracket on one side, make sure to do it for the other side in the same place.

What do I do if multiple brackets fall off?

If these brackets do not bother you, leave them on the archwire. If they do, try to remove the band, and remove the bracket from the archwire.

What should I do if the wire is piercing my mouth?

Try placing orthdontic wax onto the end of the wire. If the pain is persistent after a few days, then call our office at +36 70 775 74 43.

What should I do in regards to placing bands, if I can’t come to receive a checkup examination for a long time?

Please, continue using the band. You can use each band for more than one occasion. If you ran out of them, please contact our office.

The fixed archwired has become loose/dislodged compeltely. What can I do, if I can’t come for a long time to correct it?

In this case, wear the removable retainer for 22 hours per day!

What do I do if I can’t come for a checkup, when I’m using a removable appliance?

Keep doing what the doctor said in the most recent appointment. Please do not touch or try to set the removable appliance.

What can I do in the case that we would have removed the fixed appliance during this time? Is there any need for activation?

The appliance should stay on the tooth in this position and functions as a space mainteiner.

What do I do if more than six weeks passes between appointments? Does it have any negative consequences?

This depends on what the dentist discussed in the most recent appointment. Most of the time, there will be no negative consequences. If you have any questions please contact our office at +36 70 775 74 43

I had a fixed appliance which was removed, and now I wear a removable retainer. Should I continue wearing it?

Yes, keep wearing the appliance according to the instructions you received in the last appointment until you receive new instructions.

Inherited abnormalities

The size and shape of your teeth are inherited from your parents. A narrow dental arch cannot accommodate bigger teeth. Teeth that do not break through or supernumerary teeth can also cause problems. If the germ of a tooth fails to develop, it will be missing from the dental arch. If it is the wisdom tooth, no treatment is required, but if a canine is missing, orthodontic treatment is recommended. Wisdom teeth are additional teeth, therefore they might not have enough room in the dental arch. When they break through, they may push the teeth forward. Tooth germs can be positioned abnormally and it results in improper tooth position, which also requires orthodontic correction. Many people have a wide gap between the incisors, and it can be a genetic problem. Deep bite is also genetic. It means that the edges of the upper incisors reach at least 3 mms below the edges of the lower incisors. Prognathism and progenism are also hereditary conditions. Prognathism is the protrusion of the upper jaw in relation to the lower jaw, whereas progenism is the extension of the lower jaw. A very small proportion of people (0.01 – 0.02%) develop a cleft lip or palate. They require comprehensive treatment by a team of specialists: an oral surgeon, a dentist, an ENT specialist and a speech therapist.

Acquired disorders

Feeding infants with breast milk contributes to normal development of the jaw bones. The quality and composition of food consumed later in childhood is also important: avoid soft foods, give your child foods that need chewing. Thumb sucking may lead to an open bite, when there is space between the biting surfaces of the front teeth when the back teeth bite together. Using a pillow which is too high or low can cause swallowing problems that may result in dental abnormalities. Difficulty breathing through the nose can also lead to problems that require orthodontic treatment. Loosing milk teeth too early can result in crowding of permanent teeth. The teeth next to the gap try to fill the space and block the way from the erupting tooth. Crowding can be prevented with the use of space maintainers. Boys tend to suffer accidents that can cause injury to their teeth. The resulting deformities can be restored or corrected with orthodontic interventions. Dental abnormalities caused by damage to the baby in the womb or by a condition after birth rarely require orthodontic intervention.

What consequences can occlusal disorders (malocclusion) have?

• Esthetic problems: Esthetically, teeth that are aligned nicely are more advantageous than one that is all over the place
• Swallowing and breathing problems: Mouth breathing can cause the incisors to protrude forward. An improperly aligned dentition can also make chewing food properly difficult.
• Speech problems: The teeth are required to make numerous sounds when speaking. For example, a large distance between the two central incisors can cause a lisp or other speaking problems
• Psychic consequences: Patients with orthodontic problems can feel more inhibited than those without. Children with these problems can even be made fun of in school.
• Temporomandibular joint problems: Improper orthodontic status in the teeth cause cause jawbone (TMJ) to have severe symptoms such as pain, clicking, or crepitation.
• Gum disease: In an unruly dentition, plaque accumulates more easily, and therefore gingivitis can happen more easily or frequently.
• Cavities: Crooked teeth have a much higher instance of cavities due to the inability to clean them easily.

What kind of devices can be made from porcelein orthodontic appliances?

The components of the braces which we adhesively „glue” to the teeth are known as brackets, which can be made from porcelain, glass-ceramics, or even sapphire crystals. The price is based on the esthetic quality or the mechanical properties of the material. The forces needed to move the teeth during the treatment are actually found within the archwire.

What are the differences between the different types of porcelain braces?

They can mostly be differentiated between the exact material and composition. Some porcelein braces can function in the same way. The main difference, which we can see with our own eyes, is the fact that some are more transparent than others.

Who is the self-ligating orthodontic device recommended for?

Self-ligating devices are a modern invention pertaining to orthodontics. It is also known as a device which uses so-called „soft” forces in the mouth to function. This type of device uses gradual, and very fine forces in the mouth and allows the teeth to be moved in such a manner as well. It is recommended for patients with little time, who cannot attend regular adjustment recall appointments, or those have severly crooked teeth. Even though this treatment procedure requires fewer appointments, there are times (change of archwire, bands, or springs) when the patient must visit the dentist’s office.

What type of appliance should I pick?

The treatment plan is the most important factor when choosing an appliance. After a diagnosis and treatment plan is made, we must make a decision about which removable appliance we will use to move the teeth. Once this decision is made, we can then decide about the material of the appliance (whether that be metal, porcelain, or transparent material), as well as the color of the appliance.

USEFUL INFORMATION

Microimplants

Some occlusal disorders, such as crowding, open bite, or deep bite require us to perform orthdontic procedures which require the moving of the teeth. It is advantaegous when moving the teeth, that we use some kind of fixed retentive device in the mouth with which we can safely perform the treament without any unneccesary complications. In the past, headgear was used to acheive this function. Wearing them was unconfortable and highly unesthetic. Nowadays, we use microimplant retentive structures.

A typical treament:

Micro implants are small, biocompatible screw-like structures made from titanium which we can insert into the jaw, which help to either keep certain teeth in place, or function as a retentive device to move teeth which are in malocclusion. With the help of anaesthesia, the patient can then painlessly receive the microimplant into the jaw. The treatment is quick and painless, and only results in some cases of sensitivity for the following few days.

Thanks to our well-prepared and highly experienced doctors, as well as well-developed science of orthodontics, complications such as root injuries, implant mobility, and inflammation of the tissue next to the implant, happen very rarely.

Background information about esthetic orthodontic devices

Just a few decades ago, it was a normal preceeding in orthodontics that every tooth receiving a metal appliance had a ring placed onto it, rather than the small brackets which are used nowadays which are much more esthetic. Adult orthdodontics were not commonplace then. The usage of metal brackets was a turning point because it meant we didn’t have to use the larger rings. This meant that more people were willing to start orthodontic treatment as an adult. Even the fixed appliances used today can be deemed as esthetic, however, the newer porcelain or glass-cermaic brackets are the most esthetic solutions on the market.

Reasons for the continued usage of metal bracket braces

• Available in small sizes, which is much more esthetic than the old bracket sizes
• The bands for the brackets are available in different colors, colors can be mixed and matched on each tooth
• Easier maintainance of oral hygiene
• The treatment time is shorter
• The wings of the porcelain brackets are more sensitive, harder to glue to the tooth as well as harder to remove
• Metal bracket braces are cheaper than the porcelain version

Trainer intermaxillary functional appliances

The main reason for the use of fucntional appliance is help stop the perpetuation of bad habits such as tongue thrusting, and mouth breathing. Thumb sucking is common in childhood, which leads to many occlusal problems.

These appliances are primarily used in childhood (which is the time period where these habits can be most easily influenced). It is possible, however, that adults have similar problems, which make the use of functional appliances feasible.

These appliances are made from silicone, and are available in many sizes and colors. Based on the patients dentition, the optimal type of appliance is selected. The treatment is a longer procedure, but if it is started in time, then fixed braces may be avoided entirely. Otherwise, these appliances set up a stellar working enviornment for fixed braces.

Fixed appliances

In the most basic sense, there are two types of orthodontic appliances: fixed and removable. The recommended type for use is dependent on the age of the patient and the deviation of the dentition from the norm. Both types have their own advantages and disadvantages, but nowadays the use of fixed appliances are becoming more and more common.

The fixed appliances must be worn at all times, and are generally used in case of more substantial occlusal disorders. On the other hand, this treatment modality is primarily shorter because they use more direct and larger forces to move the teeth than the removable appliances. Fixed appliances consist of brackets (previously rings), tubes, and an archwire.

Fixed self-ligating appliances

Self-ligating appliances are a modern external orthodontic appliance which uses continuous small forces to move the teeth, which allows for a smaller exertion on the periodontium (gum and supporting bone structure). It uses less powerful forces than the typical braces, and because of this has the following advantages:

• Fewer complications happen, and due to the smaller pulling forces the circulation is maintained around the tooth
• Larger occlusal disorders can be corrected
• Plaque is less prone to remain on the teeth, oral hygeine measures are easier to perform
• Treatment time is shorter

As is true for all orthodontic devices, it is important to keep all hygeine rules including during food consumption:

• It’s imporant to avoid biting into hard foods (such as apples) as they can dislodge the orthodontic devices. Try slicing these foods before eating them.
• Tooth brushing should be done more frequently when wearing braces. If possible, use specially designed orthodontic toothbrushes as well as interdental brushes to clean in between brackets.

Bracket

Brackets are the elements of fixed orthodontic appliances. It’s our job to adhesive bond the brackets to the teeth, and to place an archwire connecting these brackets which will transmit the forces needed to move the teeth into position. Based on their material, we can differentiate different types of brackets: plastic, metal, and porcelain, or a combination of them. The different materials don’t have an effect on the success or mechanical factors, they differ rather in their esthetic advantages.

Parts of an orthdontic bracket:

• Base
• Wings
• Slot base/point
• Stem

Metal, porcelain, or sapphire fixed appliances?

If, based on the diagnosis of the doctor, it is decided that the patient is in need of fixed appliances, the next step is to decide what type of fixed appliance will be used. Each type has its own advantages and disadvantages. In the next few paragraphs, we have briefly summarized the main indications, advantages, and disadvantages of each type of fixed orthdontic appliance.

Metal braces: Contrary to popular belief, metal braces are available in the „mini” version as well, which have a better esthetic advantage than their previous iron-looking solution. Due to their mechanical properties, the treatment time is much faster than other solutions.

Advantages:

• Treatment is much cheaper than porcelain braces
• More individuality, as the bands on each bracket can be colorized based on the wishes of the patient
Disadvantages:
• Esthetically, they are not optimal, since they can be seen during both eating and speaking

Porcelain braces: This type of fixed appliance is becoming ever more popular, since the brackets, which are adhesively applied to the patient’s teeth, are made from porcelain and are more esthetic than other solutions. They function quite efficiently, however due to their mechanical properties, their treatment time can be longer than their metal counterparts.

Advantages:

• The most eshetic fixed orthdontic appliance
• Easy to keep oral hygeine

Disadvantages:

• More expensive than metal braces, and the treatment time is longer

Sapphire braces: Sapphire appliances exert a very strong force on the teeth, and excell in situations where larger malocclusions are present. Their mechanical properties are similar to porcelain braces, and therefore have a longer treatment time.

Advantages:

• Oral hygiene can be kept easily, similar to porcelain braces
• Transparent brackets are almost invisible, and are highly esthetic!
Disadvantages:

• More expensive solution, since the brackets are made from sapphire. The treatment time is longer

What is the Damon system?

The main tenant of the Damon system is the use of much weaker forces to move the teeth. The devices used in this system use much smaller forces.

The advantage of this system, which was invented by an American doctor, is that it produces fewer harmful side effects on the teeth than the conventional orthodontic treatments. Orthodontic treatment (which is usually more uncomfortable than it is painful) becomes substantially more bearable, and therefore the treatment process can speed up. In comparison to convential braces, the Damon system uses a self-closing bracket/tube system, which open and close using latches. Because of this self-closing system, the Damon system exerts substantially weaker forces to move the teeth than conventional braces.

Sometimes, when using the Damon system, we can avoid the extraction of teeth altogether. This of course depends on the malocclusions present and the individual patient case.

Láthatatlan (nyelv felől – lingualis) fix készülék

A láthatatlan fogszabályozó készülék lényege, hogy a készülék a fogak belső, nyelv felőli részére kerülnek felhelyezésre. A hagyományos, ”külső” fogszabályozóval szemben a bracket-eket teljesen a páciens fogaira (egyénileg) kell kialakítani, hiszen a fogak belső felszíne nagyobb diverzitást mutat.

A belső fogszabályozás hatékonyságát tekintve ugyanúgy funkcionál, mint a hagyományos társaik, továbbá ugyanazok az elvek és szabályok vonatkoznak a viselésére:

• Fontos a megfelelő szájhigiénia fenntartása, melyhez a fogszabályzó kezeléshez kialakított speciális fogkefe és fogköz tisztító kefe lehet a páciens segítségére.
• Kötelező fogszabályozó kontrollokon részt venni.
• A belső készülék lekerülése után ugyanúgy szükséges a retenciós készülék viselése.

Raising of the bite (raising of occlusal vertical dimension)

It may be necessary in patients with TMJ problems (due to deep bite) or patients with bruxism, to raise the bite. The goal of raising the bite is to raise the vertical dimension, or the height of the bite (occlusion) to eliminate some malocclusions. Raising the bite utilizes two main technique:

1. Artificial raising of the bite
a. A small device is placed on the inside of the front teeth or the occlusal surface of the posterior teeth which prevents the patient from biting together, therefore allowing for the bite to be raised

2. Splints used for raising of the bite
a. Splints are specialized occlusal devices which are made from an impression of the patient’s individual condition. Splints have many types and the individual condition of the patient decides the type of splint which is used
b. Splints must be worn at night during sleep: they can be uncomfortable for the first few occasions, but soon after feel absolutely natural

The device used for raising the bite allows for the TMJ to reach a „loose” state, which prevents the teeth from receiving further harmful forces as well as frictional forces. It also repositions the relationship between the upper and lower jaw to the most optimal.

Selective grinding

Selective grinding, explained here simply, is the removal of certain tooth structure in order to make them more esthetically balanced. This method is usually used in the front region, when the surfaces between each tooth (interproximal surface) need to have a more appropriate contour.

During the orthodontic treatment, the focus most of the time is on the larger malocclusions, and not on the esthetic problems of individual teeth (for example the pointiness of the canine tooth). When the main orthodontic treament is finished, however, these smaller esthetic problems become more noticable, meaning these should also be taken care of. With the consent of the patient, the doctor and correct and improve the esthetic problems of individual teeth.

Grinding is not just used for esthetic reasons, however, but also for functional ones. If there is not enough space in the dental arch, grinding of the interproximal surfaces. This can let us obtain up to 0.5 mm of space, which is quite a lot considering the small distances inside the mouth.

Orthdontic wax

During orthodontic treatment, wax is a very useful and important tool to alleviate some of the pain caused by the archwire on the oral mucosa (which can cause aphtha and ulcerations).

Since the brackets and archwire function as an extra bulging material on the surface of the teeth, it can happen that they become impressed into the surrounding tissues, such as the cheeks or lips, which may be quite uncomfortable. By placing this protective wax, it prevents the sharp components of the braces from abrading the oral tissues. Wax is available in multiple flavors and colors.

Retainer

Just because the orthodontic brackets have been removed, it doesn’t mean the end of the orthodontic treatment. It’s important, due to the natural process of agining that we use some sort of retentive elements to maintain the teeth in their optimal position and prevent them from moving. This is why we use so-called retainer devices.
There are some different types of retainers, of which the correct type is selected by the doctor

1. Removable appliances (acryilic splint, or simple wire retainers) are transparent and discrete devices made for both the upper and lower arches which must be worn each day, albeit less and less as time goes on. If the dentist decides it is sufficient, they can be worn just at night
2. Fixed retainer (wire retainer) is a thin metal wire which can be placed on the upper or lower front teeth and helps to prevent the relapse of the teeth to their original position. Thanks to the thinness of the wire, it is easily cleanable and is totally unseen (since it’s placed on the inner surface of the teeth). Fixed retainers remain in the mouth at all times, and can even stay there for the rest of the patient’s life.

First orthodontic consulation

During the first appointment, we have to decide if orthdontic treatment is necessary, and we inform the patient about the possible solutions. We take note of the patient’s personal preferences and expectations during the treatment

Photo documentation

Photo documentation is necessary in order to compare the intial condition to the finished state of the teeth after orthodontic treatment.

It’s also vital to make an X-Ray when planning orthodontic treatment. With the help of special X-Ray devices, we can see with great detail: the facial profile of the patient, the tilt of the individual teeth, the relationship of the jaw bones as well as the measurements of the jaw bones.

Bite examination, bite registration

When performing the initial examination, we examine the temporomandibular joint (TMJ) as well. The point of bite registration is to examine the relationship between the upper and lower teeth as well as the jaws to one another.

Orthodontic treatment planning

Photo and X-Ray documentation as well as impression taking is absolutely vital in the planning stage of orthodontic treatment. Once all this information has been collected, treatment planning can begin with the precise measurements and analysis of the oral cavity.

Transpalatinal arch

The transpalatinal arch (TPA) is a fixed orthodontic device used for the treatment of open bite, and is placed on the upper molar teeth, and uses the forces of the tongue to slighly expand the palate.

Changing of the archwire

The archwire is the part of the fixed braces which exerts forces on the brackets and subsequently moves the teeth. The diameter and cross section of the archwire changes as the treatment progresses, which means that its flexibility decreases and strength increases and can then move the teeth.

How many times we need to change the archwire itself depends on the complexity of the treatment. In this case, we remove the old archwire and replace it with a new one.

Application of a new bracket

Since the elements of fixed braces (brackets, tubules) are adhesively placed on the teeth, it may happen that they become loose or dislodged. In this case, please contact your dentist as soon as possible, so that the bracket can be replaced with a new one, in order to prevent unecessary complications of the dental treatment.

Supervision of removable appliances

The success of the removable appliances is dependent on the patient’s ability to follow the given instructions just as must as it depends on the dentist. It is important to wear them as often as the dentist has said, as well as to come once a month (sometimes every 2 weeks) to check its proper function as well as to activate the device.

Removing the brackets, polishing of the teeth

Once the orthodontic treatment is finished, the removal of the brackets and the tubules happens at the same time. The adhesive that was used to glue the brackets is removed via polishing.

Removable retainers

After the removal of the fixed orthodontic appliances (braces) it is of upmost importance to keep the results that we have acheived. To do this, we must utilize removable retainers, which can have different types. Most of the time, they are worn at night, or according to the instructions of the doctor. As the bone tissue growth stabilizes, the use of the retainer can be less and less, always adhering to the strict instructions of the dentist.

Adhesive placement of the reatiner

We can distinguish between two types of retainers: fixed and removable retainers. Fixed retainers consist of a wire which is placed on the inner surface of teeth, from canine to canine (for example), and can be worn for the rest of the patient’s life. It is not unconfortable, doesn’t affect speech, and is easily cleanable. It keeps the teeth in the desired place and therefore ensures that the acheived results remain. This type of retainer requires the patient to come for recall first every three months, then every 6 months, and later just once a year.

Push- and pull- springs

We may utilize the use of springs during orthodontic treatment to move the teeth. These springs can have various sizes and stregnths, but all of them exert a continuous and even force on the teeth. For this reason, they are more advantageous than the use of rubber bands.