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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).
Diagnosis and treatment planning
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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.
Therapy
Therapy 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
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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.
• 6. Which conditions cause orthodontic problems?
• Crowding
Severe crowding A mismatch of tooth and jaw size
• Upper and lower jaws out of proportion to each other
• Missing or extra teeth
• Premature loss of teeth caused by:
– Injuries
– Tooth decay
• Breathing problems
• Thumb sucking
The thumb sucker
Crowded and irregular teeth
treatment
before
treatment
after
• 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?
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Extraction of teeth
Space maintenance
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Orthodontic appliances
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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
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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
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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.
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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.
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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.
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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.
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Worn down or broken teeth
– These must be built up or restored before orthodontic treatment can start.
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Lack of commitment
– Adult patients may find it hard to commit to long term treatment, especially to wearing braces
for long periods.