Dental Specialties: Orthodontics (Continued)

There are three different classes of orthodontics:

1. Preventative Orthodontics
• this involves anything that could prevent the second and third level of treatment being necessary
• the dental team is concerns with preserving the normal bite of the teeth
• it is most important to maintain the arch length, particularly in the area of the primary molars.
2. Interceptive Orthodontics
• concerned with minor treatment that will control factors that may result in the need for the third level of orthodontic treatment
• includes any treatment used to manipulate growth for the natural elimination of crowding as well as extractions.
• this is the removal of permanent teeth, usually the first bicuspids, which are the teeth that are right beside the molars.
• a lot of orthodontist don't like to use this method because it is the removal of teeth, and its better to keep as many teeth in your mouth as you can.
3. Corrective Orthodontics
• include all active treatment that relocates or moves teeth in existing malocclusion.
• fixed appliances, braces, brackets, bands or removable appliances can be used to achieve this tooth movement.
• this is the last step, so the orthodontists will try as hard as they can to fix the problem preventative, or anticipative.

There are lots of dental instruments that are used to in orthodontic treatment, such as:

Band Pusher: used to push orthodontic bands into place during try-in and cementing phases
Band Bite Stick: to assist seating or placing of ortho bands for try-in or cementing
Band remover: to remove ortho bands from teeth
Bracket Remover: to remove anterior or postieor brackets from teeth
Three-Prong Pliers: to contour and bend light wire
Bird Beak Pliers: to bend and form ortho wire, to remove bonded bracket
Wire Bending Pliers: to bend arch wires
Ligature/Wire Cutters: to cut ligature after it has been tied to arch wire, to cut ligature tie to allow removal of arch wire
Contouring Pliers: to crimp and contour marginal edge of temp crown of stainless steel
Howe Pliers: to place and remove arch wires, to check for loose bands


Headgear

• is an ortho deice used to control and facilitate tooth movement by applying force from outside the mouth
• it is most affective when molars require stabilisation of distal (move towards the back of the mouth) movement.
• it is most commonly used in class II malocclusion. (see previous blogs)

Head gear consists of two parts:

1. Face bow (usually worn 10-12 hrs a day)
• used to connect the traction device to the bands on the molar teeth to be moved
• head gear tube: the inner bow of the head gear is inserted into these tubes on the band
• inner bow: attached to the buccal (tongue side) tube on the upper first molars
• outer bow: attaches tot he traction device
2. Traction Devices
• applies the outside force
• there are four different kinds available
1. High Pull
• fits around the top of the head to control growth of the upper jaw or retraction of anterior teeth
• it fits pretty high up on the head
2. Cervical Pull
• fits around the patients neck
• used when the upper first molars are stabilised or moved distally
3. Combination
• combination of high pull strap and cervical devices
• used to exert force along the biting surface and upward
4. Chin Cap
• combination of high pull and chin cap that fits on the lower jaw
• helps to control the growth of the lower jaw in patients with class III malocclusion.

There are seven typical phases of orthodontic treatment

1. Initial appointment
• once the dentist has presented the diagnosis and treatment plan, and treatment is accepted, financial arrangements are made and a contract is signed
• start with a polish and a check for cavities where teeth are to be branded
• if patient needs restorative work done, they are referred back to their general dentist
• at this point home care includes: brushing 2 times a day and flossing once a day
2. Separation of Teeth
• the contact between teeth can interfere with placement of bands on the teeth requiring them
• steel or elastic separators are placed up to a week prior
• patients must come to the office if any separators are lost
• home care includes: brush normally, floss all areas except where separators are
3. Fitting and Placement of Ortho Bands
• once the teeth have been sufficiently separated, the bands are cemented into the molars
• these are stainless steel rings
• placed on the molars that will need to be anchor teeth
4. Bonding of Orthodontic Brackets
• Direct Method
• bonded to the facial surface of all teeth that have no received bands.
• bonded to the teeth with a composite bonding
• takes a long time
• Indirect Method
• allows the brackets to be bonded to a complete arch at once
• the teeth to be bonded are cleaned and polished with a non-fluoride paste, rinsed with water, isolated, thoroughly fried and acid etched.
• home care instructions: brush twice a day, floss once a day using specialised ortho aids and technique
5. Placement and Removal of Arch Wire, Ligatures and Elastics
• the arch wire is the pattern toward which the teeth are moved
• home care instructions: brush twice a day, floss every day using specialised hygiene aids
6. Adjustment Visits
• make adjustments and check appliances
• arch wires are replaced along with new ligatures for increase tension
• elastics are replaced
• these appointments are generally spaced out 6-8 weeks apart so that the teeth have time to stabilise before more force is put on them
• appliances are checked for : broken or missing arch wires, loose brackets and bands, loosed or broken or missing ligatures, loose or broken or missing elastics.
7. Removal of Bands
• at the compilation of treatment all bands and brackets are removed

And now you have a pretty smile :)

There are four different kinds of appliances

1. Active Appliances
• used to move teeth in order to regain space
• most often used when tooth is prematurely lost and the adjacent teeth have tipped or moved into that space.
• can also be used to widen the palate or to lengthen the lower jaw
2. Functional Appliances
• use the muscles of the patient to achieve the results required
• often used before fixed appliances to reduce any existing discrepancy between the upper and lower jaws
• an example of this is headgear
3. Passive Appliances
• are used to maintain space or to retain teeth in their corrected position after ortho treatment is completed
• most common include the positioner, hawley retainer and the lingual retainer
4. Expansion Appliance
• the upper and lower jaw arches may be too narrow to accommodate the teeth
• without correction crowding will be inevitable