Treatment with braces

It is a treatment with an irremovable orthodontic apparatus that is used to straighten teeth and treat anomalies of occlusion.

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Braces

Braces are attached to the teeth with special filling, after preparing enamel, in a similar way that is used before filling of the teeth.

When can treatment with braces be started?

The best time to start orthodontic treatment with braces is between the ages of 12 and 13; because at this age, all permanent teeth have come in. In certain cases, treatment with braces can be started in composite occlusion, when there are still baby teeth present. In cases when there are occlusion growth abnormalities, orthodontic treatment must be delayed until the period of active growth is over.

Is treatment with braces effective at an older age with grown up patients?

Treatment with braces at an older age is not problematic, but there are certain particularities when treating adults:

  • the movement of teeth in older patients tends to be at a slower pace; but after treatment has been started, it catches up and becomes similar to that of teenagers;
  • with older patients, a growth correcting apparatus is not used; that is why, in some cases, the treatment method is different from that used when treating teenagers.

Types of Braces

Metal Braces

This is the type of braces that are most commonly used. Metal braces differ by:

  • size (standard and smaller sized braces);
  • height of the profile (standard and low profile braces);
  • inner qualities that determine friction and fluidity of the wire movement;
  • patient convenience (low profile braces are more comfortable and tend to irritate oral membrane less);
  • he method of attaching the wire (self-ligating brackets, that have special doors or other mechanism to keep wire inside the brace, differ from standard braces that are attached to the wire with an elastic rubber band or wire ligature);
  • price.

 

Braces are chosen by the orthodontist based on the clinical situation and patient‘s request.

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Ceramic Braces

More and more patients are requesting aesthetic braces.

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Advantages:

  • these braces are less noticeable and more popular amongst adult patients;
  • ceramic braces can be attached to the whole dental arch or to the more visible (front) teeth only, in which case metal braces are attached to the less noticeable teeth that are on both sides.

Disadvantages:

  • orthodontic treatment with ceramic braces takes a few months longer than with metal ones;
  • broken ceramic braces must be replaced with new ones;
  • ceramic braces are more expensive than the metal ones;
  • ceramic braces can crack and must be replaced with new ones;
  • removing ceramic braces is more complicated than removing metal ones.

Can ceramic braces change color?

Ceramic braces don’t change color. Rubber bands that hold the bracket attached to the wire can change color. Ask your doctor to attach the wire with a ligature and not with a rubber band.

Self-ligation braces

Self-ligation braces include systems from Damon, Smart Clip, Bioquick and others.

Self-ligation braces are:

  • ceramic and
  • metal.

As a doctor, I believe that, quality-wise, the Damon system self-ligation braces are the best, because, compared to other braces, the quality of the closing mechanism and the overall design are more superior.

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The orthodontic wire in self-ligation braces is being affixed by a special door inside the bracket, which is why it is not being pressed as usual. For this reason, there is less friction inside the system and less power is being used for the movement of the teeth. Studies have not shown that treatment with these braces is faster than with regular metal braces. The only advantage of these braces that is shown in independent studies is that the visit to the orthodontist takes a shorter time and that oral hygiene is better. If your orthodontist claims that treatment with a self-ligation system is less painful and faster, please note that there is no scientific proof.

Lingual braces

Patients ask if there are unnoticeable braces.

Yes. Those types of braces are being placed on the inner side of teeth and are not noticeable. Ceramic braces, even though they are very aesthetic looking, are still noticeable.

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Advantages:

  • braces are completely unnoticeable because of special fixation.

Disadvantages:

  • it is more complicated to clean teeth well while wearing lingual braces; it is easy to miss pieces of food that are stuck under the braces;
  • lingual braces can irritate the tongue, as it is more sensitive than the inner side of the cheeks or lips (standard braces that are being placed on the outer side of the teeth rub against them);
  • Quality lingual braces are significantly more expensive than standard metal or ceramic ones.

Is treatment with braces painful?

It takes about 45 minutes to place braces on one jaw. This procedure is not painful at all. During the first 3 to 7 days after the braces have been placed, teeth will be sensitive, and braces can scratch inside of the mouth; for this reason non steroid, anti inflammatory pain medication is given by the doctor.

Brackets or wires that cause scratching can be covered with special orthodontic wax, cotton or gum. Sores that might appear will heal themselves. Two to three days after the visit when the braces system has been activated, it is not unusual to feel some pain.

Can you treat teeth during orthodontic treatment?

It is allowed, although it is better when teeth are finished treating before orthodontic treatment starts. It is important that the orthodontist would be present/involved when the treatment plan is being set, because in some cases, teeth have to be removed and treating them is not necessary. Aesthetic filling and teeth whitening should be postponed until orthodontic treatment is finished.

How often do you need to visit an orthodontist?

Follow-up appointments are every 4 to 6 weeks. Sometimes, appointments might be more frequent depending on the mechanism that is being used.

How long does an orthodontic treatment last?

On average, a treatment plan lasts 18 to 24 months, though it varies on a case-by-case, and depends on its complexity and the treatment methods that are being used. To set an exact time period of treatment is difficult, as it may shift a couple of month from the original plan. Negligence, missing appointments and ignoring doctor’s orders makes treatment take longer.

Can braces solve all orthodontic problems?

Braces straighten teeth and can solve occlusion growth problems; however, when serious occlusion anomalies are diagnosed, other orthodontic apparatus might be used or surgery might be necessary (view: drgrybauskas.com )

Will additional apparatus be needed after braces are removed?

After orthodontic treatment is over, retention appliances or other orthodontic apparatus are made that have to be worn at night for the period of time directed by the doctor. Neglecting to wear retention appliances will cause teeth to move into their previous positions and orthodontic treatment might have to be started anew.

On the upper and lower dental arches (inner side), irremovable arches are glued on; they are unnoticeable. See retention apparatus (Stable result)

Micro-implants and Bollards

Micro-implants are skeletal anchorage devices that make teeth movement easier and are often used to reduce wear time of orthodontic rubber bands, also making patient-doctor collaboration easier.

Micro-implants are also sometimes necessary to be able to make teeth move in ways that are not possible using regular braces.

Micro-implants are screwed in by the orthodontist. They come in different sizes and are used according to indications. Individual constructions on implants are being made in the laboratory.

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Bollards are another type of skeletal anchorage device that are used to create greater movement of the teeth.

Micro-implants are not capable of providing such movements or they prevent teeth from moving in the desired direction. Bollards are screwed in by a jaw surgeon.

Micro-implants and bollards can be used by adults and children, depending on the treatment mechanism. Screwing them into the jaw requires local anesthesia to be used.

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After the local anesthesia wears off, the patient might feel some dull pain and feeling of stretching. The unpleasant sensation might last a few days and can be reduced by taking some non-steroid anti-inflammatory medication.

If you feel that a micro-implant or bollard has become loose, contact your doctor. Looseness of the anchorage doesn‘t mean that it has to be removed immediately, as they can still function properly without being stabile inside the bone.

If you feel that tissue around the anchorages has become swollen or painful, contact your doctor immediately, as it can be a sign of an infection.  If that is the case, the anchorage needs to be removed.