Understanding your options:-
Before embarking on orthodontic treatment, one needs to appreciate the nature of treatment, what it involves and that there are many treatment options available, from retainers to clear aligners to invisible, removable appliances, metal, ceramic and lingual fixed appliances available in the market. Each of these treatment modalities have their use in modern day orthodontics. Orthodontists are well equipped with the specialised knowledge to consider all diagnostic possibilities, based on variables like one’s age, possible jaw and dental discrepancies, differences in the size of your teeth, and more. They would be able to offer you appropriate advice on what to use and when to use it as well as work with you for your best occlusion (“bite”) and smile.
Over the years, with the vast advances in dental and medical technology, orthodontic appliances are now much simpler and less traumatic to the wearer. An in depth knowledge in the field of orthodontics enables orthodontists to make the right treatment decision for their patients such that their treatment outcome is a safe and stable one.
Image above: Example of an older generation of fixed appliances with bands and wire attached on each tooth.
Fixed Appliances/ “Braces “
Traditional braces consist of brackets that are attached to the surfaces of teeth using a dental composite and archwires that are secured within slots in the brackets. Some patients may also have metal rings (molar bands) encircling back teeth (molars). The archwires are usually held to brackets by tiny rubber bands called “elastic ligatures” or “O-rings.” These brackets are generally made of high-grade stainless steel that does not corrode when placed in the mouth for the entire duration of treatment. The archwires are made of metal alloys (eg: nickel titanium, stainless steel etc…) and deliver a constant, gentle force to move teeth. Duration of orthodontic treatment may vary but on average will last for an average of 2 years. A period of retention is recommended as soon as your active treatment is completed and your braces are removed. You are likely to achieve a good and stable result as long as you follow the instructions of your Orthodontist and maintain a good oral hygiene level.
See your orthodontic specialist for the treatment option that is best for your individual needs.
1. Conventional metal braces
Image: Conventional fixed appliances. These metals are usually of the high quality stainless steel brackets and metal archwires that are resistant to corrosion when placed in the mouth for long periods during treatment.
2. Conventional Ceramic fixed appliances:-
Image: Ceramic braces. Ceramics braces are more expensive. They are more delicate to manage and care for.
3. Self-ligating braces
Image: There are many self-ligating braces in the market these days. These bracket system has an internal opening/closing clip system to secure the archwires to the bracket slot and therefore does not require elastomeric ligatures (O-rings) to secure the archwire.
4. Ceramic self-ligating braces
Image: Ceramic slef-ligating fixed appliances. The clip are usually made of metal to avoid fatigue failure in the opening /closing clip mechanism. In many cases, only the anterior teeth are fixed with ceramic braces. Posteriorly the metal ones may be used as they are more robust. Your orthodontists will be able to provide you the appropriate advice.
5. Lingual braces
Lingual braces are a form of braces that are attached to the inner side of the teeth so that they are not visible by others. These types of braces are more intricate than the conventional ones, costs more to have and are more difficult for the wearer to care for.
Aligners are aesthetically pleasing transparent, thin, plastic-like trays that are customised to fit an individual’s dentition. Aligners are an alternative treatment modality that may be used to move teeth. Patients are then taught to be responsible for putting in and removing their aligners. A series of aligner is worn for 2-3 weeks each full time that can move teeth a fraction of a millimeter at a time. Patients must remove aligners for meals and when brushing their teeth.
The number of aligners needed to correct malocclusions may vary varies based on the individual’s orthodontic problem and the type of orthodontic intervention needed. Not all orthodontic conditions are suitable to be treated with clear aligners. The trays are generated based on diagnosis and proper records of a particular individual. The outcome can be different from person to person depending on the experience of the orthodontist and the compliance of the patient as regards wearing them.
The public is advised to seek consultation with your orthodontic specialist for the treatment option that best suits your individual needs.
Image: Clear Aligners
Removable appliances can help to move specific teeth into their correct position and they can also help guide the eruption of one or more teeth. Removable appliances consist of custom made and fitted plastic plates that cover the roof of the mouth and clip on to some teeth. These can be removed and inserted by the patients themselves upon instructions by the orthodontist. They have some active components such as springs, screws etc which can be utilised to carry out simple and limited tooth movements. You are likely to achieve good results within 6-9 months of starting treatment as long as you maintain a good oral hygiene and wear your appliances as instructed by your orthodontist.
Removable appliances may be used in a combination with other fixed appliances. Though removable appliances are very good, they are not suitable for every type of orthodontic situation. Much skill, along with sound experience and knowledge in orthodontic tooth movement, are needed in order to realise which conditions require the use of removable appliances for effective treatment.
Since removable appliances can be removed with relative ease by the patient, patients must be sure to comply with the instructions of the orthodontist about the proper usage of the removable appliances in order to be able to achieve the desired outcome.
It can be easy for people to forget to wear their removable appliance. Patients must be very diligent in wearing their removable appliances as per the instructions of their orthodontist to avoid failure of treatment and relapse of the condition.
Image: removable appliance with a head-gear attachment.
Image: Removable appliances may be used in conjunction with fixed appliance therapy where indicated.
Once your fixed braces have been removed, it is most certain that you will need to wear a retainer to make sure your teeth does not move back to their original position. The trend in most developed countries currently is that retention is life-long. On average, patients are advised to wear their retainers for a minimum of 1 year – full-time at first, and then probably just at night. You are advised to follow the advice of your orthodontist who will tell you when you can make this change. Do not be tempted to reduce your wear of the retainer yourself, as this could have a negative impact on your outcome of orthodontic treatment.
Brushing your teeth twice a day with a fluoride toothpaste and keeping your diet healthy is important whether you wear a retainer or not, but you should be especially aware of cutting down on sugary snacks and fizzy drinks, as these may cause more damage to your teeth while you are wearing your retainer.
Even if your brace is removable, you should still wear it for the amount of time recommended by your orthodontist. Do not be tempted to flick it in and out as, not only will this not help your treatment, it may also damage your retainer. You should take your retainer off when you brush your teeth. These retainers can be of the fixed, removable types. Increasingly, the use of clear plastic retainers is being prescribed due to its aesthetically pleasing nature. For care of your retainer, please refer to your orthodontist.
Image: Hawley retainers, a form of removable appliances
Image: Clear vacuum formed retainers
Image: Permanent bonded retainer. Involves a specialised stainless steel retainer wire which is adapted and cemented on to the back of the front teeth, usually the lowers.
Malaysian Association of Orthodontists
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