Orthodontics (Braces treatment)

Orthodontics is the specialty of dentistry focused on the diagnosis and treatment of dental and associated facial irregularities. The results of orthodontic treatment can be dramatic – beautiful smiles, improved dental health and an enhanced quality of life for many people of all ages. Orthodontic problems, which can result from genetic and environmental factors, must be diagnosed before treatment begins. Proper diagnosis involves taking photographs, x-rays, and dental impressions, which enable our practice to make informative decisions about the form of treatment necessary. Treatment typically lasts from 6 to 24 months, depending on age and the severity of the orthodontic problem. Outstanding results are also dependent on maximizing the coordination of care between you and our practice. We are committed to delivering the best possible service in order for you to achieve your orthodontic objectives

Invisible Braces (Clear Path Aligners) – Patient Case Study from InvisibleBraces3

Types available:

• Clear Braces: normal and self ligating
• Metal Braces: normal and self ligating
• Damon Braces
• Lingual braces
• Clear aligners
• Damon system
• 6 months smile
• Removable retainers

Why Orthodontics at Smile Architect?

• Treating the face not only the teeth
• You are greeted and seen on time. We know your time is valuable and we care about our patients.
• You see the same orthodontist each month who knows what was done at your last visit and what you need next.
• Dr.Girish is available all the days of the week (except Sunday) and your appointments will be flexible unlike other clinics where you will be seeing the orthodontist only once a month and at strict timings.
• You receive personal attention from our orthodontist. We don’t deliver your care in assembly line fashion. We take enormous pride in the relationships we build with our patients and families.
• We don’t take shortcuts when planning your treatment. We advise complete diagnostic tests (x-rays, digital/photos and impressions of the teeth) at your consultation when treatment is indicated. There is no substitute for having all the diagnostic information. A lack of information can lead to improper treatment.
• You receive care in a stable practice from the same orthodontist
• You receive personalized appointment reminder telephone calls.
• Your treatment is “state of the art”- tooth colored brackets, invisible braces, gold braces, latex-free elastics, virtually invisible Clear Aligners that can straighten adult and mature teen smiles without traditional braces and space age low force/high comfort wires are all available.
• Our office has made it a policy not to recycle supplies such as orthodontic bands and brackets.

What is Orthognathic Surgery?

Which combines orthodontics with jaw surgery to correct certain severe deformities such as a narrow upper jaw, a “gummy” smile, or protusive or recessive jaws. This technique involves a joint effort between the orthodontist and an oral surgeon. While not necessary in most instances, it makes a dramatic improvement in patients who previously could not be helped by traditional orthodontics.

Tooth Coloured Braces

Different materials are used to manufacture tooth coloured brackets. Ceramic brackets are the most popular. Ceramic brackets with metal inserts are more advantageous to use because the teeth get corrected faster with these. Ceramic brackets are strong, not very visible, inert and stable in the oral conditions.

Lingual (Invisible) Braces

Lingual braces are fixed onto the inner sides of the teeth. These braces have been used for many years. Their popularity is now growing as more adults are seeking orthodontic treatment. They are not seen at all so the patients who are conscious about wearing braces can get their teeth repositioned to get an aesthetic smile.The latest lingual brackets are highly refined and low profile. Therefore, they are more comfortable for the patients. We use the Multi-Purpose Attachments for many of our patients wherever possible. These are the thinnest possible brackets available and therefore are most comfortable for our patients.

All kinds of irregularities of the teeth can be treated with lingual braces. The patients are uncomfortable for a few weeks due to confined tongue space and speech problems but get adjusted later. Time required for every appointment is more. The treatment time is the same as that with the regular braces. It depends on the severity of the irregularity.

Invisible braces / Clear / Clear Aligner

Invisible braces / Clear/ Clear Aligner are appliances used for straightening teeth without the conventional fixed braces. A series of custom made trays are prepared according to the corrections required for a patient. These trays bring about changes in the positions of teeth sequentially. The patient is supposed to wear the trays as instructed and check ups are done every 6-8 weeks by the orthodontist or dentist to monitor the progress. They are not visible so adult patients not wanting to wear braces can get their teeth corrected. They are removable so the patients do not have restrictions on food as those with the fixed appliances. As they are removable, the forces do not act on the teeth all the time. Patient cooperation is very important.

Only mild to moderate malocclusions can be treated efficiently and effectively as the control needed over teeth for complex movements is less with Invisible braces/ Clear/ Clear Aligner as compared to that exerted by fixed braces. Patients may experience speech problems for a few days. In many cases, it may not be possible to achieve the best possible aesthetic smile; functional and stable results without repositioning teeth with orthodontic appliances. These patients have the option of choosing appliances which are not very visible or not visible at all.

Due to recent advances in orthodontics, the time taken for orthodontic corrections has reduced. In most cases aesthetic improvements can be achieved in a few weeks to a few months. Invisible braces is not available in India as of now.

Stages of Orthodontic treatment:

Bands, brackets, archwire, elastic ties are the appliances used for orthodontic treatment. They come in various shapes, size, colours etc.

First consultation:

Fitting the braces usually takes 1 to 2 sittings. Braces remain on the teeth for the entire duration of treatment. Patient needs to visit dentist every 4-6 weeks for adjustments, wire changes etc. The patient may need to wear items like rubber bands and/or headgears to provide extra forces for the correction of bite.

Duration of orthodontic treatment

Duration of the treatment depends on many factors like complexity of the case, age of the patient, the type of the treatment and patient cooperation etc. usually it takes from 6 months to 24 months.

Retainers

After the completion of the orthodontic treatment the patient is advised to wear retaining appliances (retainers) to prevent relapse and to hold the teeth in new position.

Damon system

Damon Braces TreatmentYoung people looking for a solution to misaligned teeth may benefit from a range of modern treatments available to straighten teeth.

Although many people may be uncomfortable with wearing braces at an older age, the development of new technology could mean long-term, positive results are achievable in a significantly shorter time period.

What are Damon braces?

Damon braces are popular braces in the United States, which use low-friction mechanics to create a fast, cosmetic orthodontic fixture using a slide system to minimise friction and binding associated with more painful conventional brace fittings.

An alternative to the traditional accessory, the innovative fixtures are created using a different form of wire and brackets brace, which allows wearers to remain comfortable throughout the alignment process.

The low-friction mechanics ensure faster treatment times and less frequent trips to the dentist during the corrective period. Overall, this means image-conscious individuals are able to enjoy optimum results from a more efficient dental treatment.

During the process, patients may hear their dentist mention ‘self-ligating’, which means the fixture is free of elastic or metal ties. The Damon system comes complete with a slide mechanism, which ensures faster results for patients.

What are the benefits of the Damon system?

The primary advantage of using Damon braces in order to straighten problem teeth is the significantly improved technology used throughout the process. This ensures the design of the fixtures is able to achieve the highest standard of results while ensuring the patient is as comfortable as possible.

Individuals who wear the corrective fixtures can often benefit from the desired results up to six months faster than traditional methods of improving the appearance of teeth.

In addition, this corrective method is more hygienic than conventional train track braces that can often attract plaque, which increases the risk of a number of oral health issues such as gum disease and tooth decay.

All kinds of irregularities of the teeth can be treated with lingual braces. The patients are uncomfortable for a few weeks due to confined tongue space and speech problems but get adjusted later. Time required for every appointment is more. The treatment time is the same as that with the regular braces. It depends on the severity of the irregularity.

The comfortable nature of Damon braces is also an advantage for prospective patients worried about the pain and discomfort associated with corrective procedures. Despite feeling almost unnoticeable, the fixtures are able to exert strong forces on even severely crooked teeth.

Patients looking for a smile makeover will be pleased to hear the fixtures are created using ceramics and stainless steel parts, making them less obvious to other people. This could act to increase the self-confidence of individuals worried about the stigma attached to wearing braces.

Unlike Invisible braces/clear aligners, the treatment includes the attachment of brackets to the front of the teeth so the fixtures are not as invisible as Invisible braces. However, the advanced design of Damon braces means they are able to be removed after a much shorter period of time than their traditional counterparts.

Additionally, the increased force offered by Damon braces can be used to treat more severe oral health issues such as overbites, underbites and crossbites.

What is Six Month Smiles

Adult patients worried about the stigma attached to wearing train track dental braces during adulthood can now benefit from the six month smiles programme.

This corrective process significantly reduces treatment time by utilising natural-looking braces to gently re-align teeth over a six month period.

The procedure concentrates on areas of the mouth that are visible when smiling, to perform a transformation for people who experience low self-esteem as a result of crooked or misaligned teeth.

Six month smiles can be used to treat a wide variety of orthodontic problems, including crowding, crossbites, overbites and gaps between teeth.

01. When would one need orthodontic treatment?

Teeth are important for chewing food properly, for good appearance and for proper speech. If any one or more of these functions of teeth are adversely affected due to irregular teeth and/or jaws, one would need orthodontic treatment.

When teeth of the upper and the lower jaws do not meet properly with each other grinding of food properly is impaired. This may cause indigestion and related health problems. When teeth are projecting out, lips are not closing normally, or teeth are crowded and are spoiling the smile, one needs orthodontic treatment for aesthetic reasons.

One may need orthodontic treatment to correct discrepancies in jaw size and/or positions, which affect the facial appearance adversely. When the jaws and/or teeth do not meet properly with each other, excessive forces may be transmitted to some teeth leading to wearing out of the enamel of the teeth. Excessive forces may also cause damage to the tooth supporting structures like the gums and surrounding bone. This can cause weakening and early loss of these teeth.

Irregular teeth can also cause difficulty in brushing thereby leading to cavities and gum problems which may shorten the life of the affected teeth.

In rare cases irregularities like spacing in the front teeth can cause speech problems and orthodontic treatment can improve the speech as well.

02. How important is orthodontic treatment?

In today’s world good appearance and a good smile go a long way in making a person feel confident and comfortable with one’s self. People with good looks and a pleasant smile are perceived well by others and are treated favourably by them.

Good-looking children are subconsciously liked more by parents, teachers and other adults. Good-looking adults are more likely to get good jobs, more friends and better life partners. So, the value of orthodontic treatment cannot be overemphasized. It is a question of a child’s or an adult’s future physical and psychological well-being.

3. When should a child go for an orthodontic consultation?

It is recommended that the first check up by an orthodontist should be done by 6 years of age. If a dental or jaw problem is developing it can be corrected as the child grows. If the teeth and the jaws are developing normally then a regular check up should be done every six months to monitor the development.

In case the lower jaw is growing excessively, it must be corrected at the earliest because this condition becomes more difficult to treat as the child grows. Some conditions can be treated later. Certain teeth irregularities can be corrected earlier thereby preventing them from becoming more severe and would need less time to treat later.

4. Up to what age can an adult be treated for orthodontic problems?

There is no upper age limit for treating an adult. Persons in their 40’s and 50’s and even 60’s can also be treated for orthodontic problems. The deciding factors would be the condition of the teeth and the supporting structures like gums and bone.

5. How much time is required for orthodontic treatment?

The duration of orthodontic treatment varies according to the condition of the teeth and jaws at the beginning. On an average, treatment with the fixed braces takes about 1 to 2 years in cases where all the permanent teeth have erupted and there is minimal jaw discrepancy. The treatment time has reduced now with the use of “Friction-Free Ties” developed by us. We are able to complete treatment in a few months in some cases.

In growing children where jaw discrepancies have to be corrected it may take 3 to 4 years. The treatment may be split into two phases. Jaw correction is done in the first phase with one of the various growth modification appliances at the orthodontist’s disposal. In the second phase, fixed braces are given to set the teeth in their proper positions.

6. How much would orthodontic treatment cost?

Different orthodontic problems need different treatment modalities and different duration of treatment time. So the fees are decided according to the condition to be treated. The treatment fees differ from patient to patient as their conditions differ. The fees may vary from Rs.10,000/- for minor corrections to Rs.50,000/- or more for the correction of severe irregularities. The fees for treatment with clear and invisible braces may be between Rs.50,000/- to Rs.1,00,000/-.

7. Is orthodontic treatment not very expensive?

It is a relative term. Orthodontic treatment costs so much because the treatment goes on for a long duration. There are certain expenses incurred to maintain a high level of sterilization of equipment and asepsis of the clinic. The appliances used are expensive. Thus some amount is spent for the patient himself/herself.

The fees are professional charges for the knowledge, experience and skill of the orthodontist. Considering the long term, positive, physical and psychological benefits of orthodontic treatment whatever spent on orthodontic treatment should be considered as a sound investment.

8. What is the procedure followed for starting orthodontic treatment in your clinic?

In the first consultation the patient is examined and the condition of the teeth, jaws, face and the function is assessed. History is taken to know the patient’s health condition. Then the patient and the parents are explained about the treatment procedures with the help of computer animations, photographs of treated cases, models etc. The patient is then sent for special x-rays needed for diagnosis and treatment planning.

In the next appointment impressions are taken and the x-rays are collected to study them. The final treatment plan, expected duration of treatment, and fees etc. are discussed in the next appointment. If the patient and parents are agreeable for the treatment then appointments are fixed for starting the treatment.

9. When are permanent teeth extracted for orthodontic treatment?

One or more permanent teeth may have to be extracted in some cases to create spaces in the upper and/or the lower arches. Extractions of permanent teeth are not necessary in all the cases. When the jaw and teeth sizes are normal the teeth can be set in their proper positions without extractions.

When the jaws are small and the teeth are large the teeth get crowded or proclined or both. In such cases extracting teeth creates the necessary spaces to move the remaining teeth in the extraction spaces. This helps in aligning and retracting teeth to more aesthetic positions. When the jaws are large and teeth small, the teeth get spaced out. These teeth can be aligned and spaces can be closed by orthodontic treatment without any extractions.

10. Which permanent teeth are removed for orthodontic treatment?

The decision to extract or not to extract teeth and which teeth to extract depends on a number of factors like the severity of the malocclusion, amount of space required, the area of crowding, presence of any decayed tooth/teeth or missing tooth/teeth, presence or absence of milk teeth, jaw discrepancies, presence of impacted teeth, presence of extra (supernumerary) teeth, amount of changes required in the facial appearance etc.

The orthodontist studies all the factors and charts out alternate treatment plans and decides on the most favourable treatment plan and then decides about extractions. Usually the first premolars are extracted but depending on the case requirements second premolars, second molars, upper or lower incisors and sometimes even canines may be extracted. The idea is to get the best possible result aesthetically and functionally with a long-term stability of the result.

11. Are extractions painful?

Extraction of teeth is not painful as the teeth are removed under local anesthesia. The healing also is very quick because there is no infection in the teeth and the jaws.

12. Does extracting teeth cause damage to the eyes or other parts of the body?

There is no evidence in scientific literature that extracting teeth weakens or damages eyes or any other parts of the body. In almost 6/7 out of 10 orthodontic cases teeth have to be extracted. If there actually was any damage to any part of the body it would be known and nobody would take orthodontic treatment.

13. Is orthodontic treatment very painful?

No. With better understanding of physiology of tooth movement and latest Technology, pain during orthodontic treatment is kept to the minimum.

Initially when an appliance is given there is pressure on the teeth that can cause some discomfort and pain. This can be minimized by timely medication as prescribed by the orthodontist. There is NO constant pain or discomfort during the entire duration of orthodontic treatment. When the appliance is activated to exert pressure on the teeth the patient may experience pain for a couple of days. This subsides on its own and is usually bearable. If it is more, then the prescribed medicine can be taken to relieve the pain.

14. What are the different kinds of appliances used for orthodontic treatment?

Depending on the condition of the patient the appliance or appliances are selected. When there is a need for modifying growth one of the growth modification appliances is given. This may be removable i.e. it can be removed by the patient or fixed.

When the lower jaw is deficient or placed behind in relation to the upper jaw either a bionator, activator, twin block may be given. When the lower jaw is more prominent or growing excessively a chin cap may be used. Foe a deficient upper jaw a reverse pull head gear may be used. In case of an excessively growing upper jaw a high pull, cervical pull or a combi pull headgear may be given to the patient. For setting the teeth properly usually fixed appliances are used which are commonly known as “braces”. These comprise of brackets, bands, tubes, arch wires, elastics, power chains, pins, ligature wires, elastic modules etc.

Usually the brackets used are of metal but aesthetic tooth-coloured (or clear) brackets are also available which are not very visible in the mouth.

Certain conditions like cross bites, mild to moderate spacing can be treated with removable appliances. Fixed appliances provide total control over tooth movements so they are routinely used. Removable plates have a limited use. Lingual or invisible braces are becoming more popular as more adults are seeking orthodontic corrections to improve their smiles.

15. What care should be taken during orthodontic treatment?

Since the brackets of fixed appliance are glued to the teeth they can get detached if anything hard hits them. So one has to avoid eating hard things like toast, “chikki”, “chakli”, cookies, banana chips, corn cab and such hard things. One must also avoid eating sticky things like “eclairs”.

If the brackets keep coming out, wires keep breaking due to negligence on the part of the patient the treatment takes longer time and the desired result may not be achieved.There are more chances of food collection around the brackets and under the wires. This can cause cavities, bleeding gums and bad breath. It can also cause permanent discoloration of teeth that would spoil the smile.

One must brush teeth with toothpaste after every meal to keep the teeth clean and to avoid problems mentioned earlier.

16. What should one do if a part of the braces hurts?

If there is any sharp, projecting part of braces, cover it with orthodontic relief wax or wet cotton pellet. Call the doctors at the earliest and it would be taken care of at the earliest. In case of pain, medication is prescribed to relieve it.

17. How stable are the treatment results?

The orthodontic treatment is planned and executed keeping optimal results and long term stability of the results in mind. Once the appliances are removed or discontinued retainers are given to keep the teeth in their new positions. Normally some settlement of teeth takes place in a few months. In some cases long term retention is recommended to prevent teeth from relapse.

18. What are retainers?

Retainers are plates or wires given to prevent teeth from moving after the orthodontic treatment is completed. The teeth have a tendency to shift from their new positions as the bone supporting them is softer when the braces are removed. Even after the bone gets back to normal there are a number of forces acting on the teeth. A retainer supports the teeth and keeps them in their desired positions.

There are two types of retainers, removable and fixed.

Removable retainers are plated which can be removed by the patient. They have to be worn all the time except while brushing and eating. The duration of wear of removable plates is gradually reduced over a period of time after first six months of full time wear.

The fixed retainers are thin wires glued to the teeth on the inner surfaces so that they are not visible at all. These can be kept in the mouth as long as necessary.

19. How long does one need retainers?

The recent studies in the orthodontic literature suggest that it is better to keep retainers for a long time. It is not possible to predict whose teeth are likely to move after the retainers are discontinued. The orthodontist would decide about the duration of the retainers for an individual based on her/his condition of teeth and jaw structures. Usually the retainers are worn at least for six months and are gradually weaned off. In some cases longer retention may be necessary for the long term stability of the results.

20. What is the role of the patient in successful outcome of the treatment?

The success or failure of orthodontic treatment very much depends upon the patient’s motivation and cooperation. Once the appliance is given to the patient it is her/his responsibility to take care of it and to follow the instructions given by the doctors.

If the patient does not take care and does not follow the instructions the treatment result cannot be what is desired and planned for.