Types of braces
There are two types of braces: removable and permanent.
The type of brace depends on the category of defect, the patient’s age and oral hygiene practices. Today, orthodontic treatment not only serves the purpose of maintaining the health of teeth, temporomandibular joints and periodontium, but is also performed in order to enhance the comfort of the mouth, aesthetic image, and even social trends.
This type of brace consists of an acrylic plate and wire loops, which are matched to the shape of the teeth. Its capabilities are quite limited – it only allows for correction of excessive swinging of the front and back teeth. The effectiveness of treatment with a removable brace depends on the close cooperation of the patient with their dentist. The patient should closely follow the orthodontist’s instructions and wear the brace for the required number of hours.
This is a type of brace permanently attached in the mouth. Patients cannot remove or adjust it themselves, this can be done only by an orthodontist in our office. The components of this brace are: brackets, arc, elastic ties and fixing loops on the molars. Brackets are used to exert active forces on the teeth; one bracket is fixed on each tooth. The arc is an appropriate wire, which actively affects the brackets (generates a force moving the teeth). Elastic ties fix the brace arc in the brackets. Loops on the molars keep the arc in place and are used to adjust the permanent brace. Permanent braces constantly work on your teeth and can be used with any malocclusion. There are many variants of permanent braces:
Metal permanent braces enjoy great recognition among patients who want to treat malocclusion and the curvature of the teeth. The main advantages of this type of brace include the patient’s sense of comfort during the time of wearing and a relatively low price when compared to other braces.
Metal brackets are available in silver and gold colours, or coated with a special enamel matching the colour of the teeth. Metal brackets are relatively small. The size of a bracket depends largely on the relative size of the tooth. The larger the crown, the smaller bracket will seem.
Elastic ties are put on the brackets. The arc is strapped to the bracket slot thanks to the elastic ties. The colour of the elastic ties depends on the patient, who choose according to their preference.
Metal braces are made of high quality materials and are absolutely safe to use. They do not cause allergies and if they are correctly positioned, they do not cause irritation in the mouth.
Permanent ceramic braces – are the most aesthetically pleasing type from the wide range of traditional braces. Brackets of this brace are made of ceramic
. Treatment is conducted exactly the same way as in the case of metal braces. The ceramic brackets have milk-white colour which makes them less susceptible to discoloration and less visible. The highest level of natural aesthetics will be achieved with the use of coated arcs and transparent elastic ties.
Permanent crystal braces (sapphire braces). The brackets of the brace are made of crystal (sapphire), which makes them entirely transparent. It gives a great aesthetic effect, because the brace is almost invisible. Moreover, it can be fitted in an arc made of composite – which has a white colour, resulting in a visual effect which is even better than in the case of a metal arc (although it is not always possible to use this type of arc).
Crystal brackets are perfectly smooth, with no sharp edges and grooves, making it very easy to clean them, and are resistant to the retention of sediments and the formation of tartar.
Permanent crystal braces are made in non-elastic tie system, that is, they do not have elastic ties fixing the arc in the brackets. This promotes additional comfort as they do not require frequent adjustment and replacement of components.
Aesthetic braces have an advantage over conventional braces primarily because they are almost imperceptible at first glance. Their colour, and in the case of crystal braces – lack of colour – cause the braces to blend in with the teeth. Only after closer inspection, one can see its presence.
Among these malocclusions, the group of cross-bites is the most prominent. Their characteristic feature is that the overlapping of lower teeth over the upper most often combined with a shift of incisors’ midline and asymmetry in lip alignment The disorder of the function is associated with the reduction of transverse movement duringmastication of food.
The incidence of this group is relatively large, it amounts to from 12% to 14% in relation to all malocclusion cases.
Partial front crossbite is characterized by the overlapping of a part or the whole group of the lower front teeth over the upper. The shift of incisors’ midline and asymmetrical alignment of lips are characteristics that differ this malocclusion from partial anteroclusion.
Partial lateral crossbite usually appears on the background of the narrowing of the jaw. Lateral mandibular teeth overlap the upper teeth on one side in unilateral crossbite, or on both sides in the bilateral form of this malocclusion. The incisors’ midline is not shifted, facial features intact.
Total crossbite is characterized by overlapping of the lower half of the dental arch over the upper. This diagnosis is also assumed in cases of increase or decrease by one of the number of teeth included in the crossbite. The incisors’ midline is not always shifted. The facial features show a visible bulge of the lower lip and subsidence of the upper lip on the side of the defect. In general, there is a one-sided chewing, which over time can lead to deepening of the malocclusion and the formation of lateral displacement of the mandible. This defect is formed on the background of disparities in the width of dental arches. The upper arch may be too narrow, or lower arch too wide. Presence of both of these characteristics is often observed.
Lingual occlusion usually arises as a result of the widening of the upper dental arch or narrowing of the lower, or both of these effects at the same time. It applies to the upper lateral teeth that contact the wall of the vestibule of the lower teeth with the palatal side. It can affect a single tooth, several teeth, or all lateral teeth. There is a one- or two-sided incidence of this defect. The bilateral form is usually a complication of severe forms of posteroclusion. This defect limits both front and lateral movements during mastication, inhibiting the growth of the alveolar part of the mandible.
Distal occlusions are generally referred to as posteroclusions as an expression of distal relation of the lower dental arch in relation to the upper. A common feature is the increase of overjet between the incisors, bigger in cases of anterior upper teeth inclination and smaller in case of their tilting. In the facial features, there is always a revocation or chilectropion of the lower lip.
The cause is often the use of the oral breathing tract for many years, the habit of sucking a finger or lower lip or body posture. During infancy, artificial feeding makes the correction of distal alignment of the jaw, with which the child is born, more difficult. Distal occlusions are among the most common, as they are observed in about 45% cases compared to all of malocclusion cases.
PARTIAL POSTEROCLUSION is characterized by withdrawal, or sometimes tilting of the lower incisors against on the background of inhibition of the growth of the alveolar part of the mandible. The distance between the first lower molars and incisors is reduced. In the facial features, there is a withdrawal or chilectropion of the lower lip and deepening of the mentolabial groove.
TOTAL POSTEROCLUSION is a defect, in which the whole lower dental arch is retracted in relation to the upper. The overjet is significantly increased with the inclination of the upper incisors, and slightly changed in case of their tilting. The overbite is often increased when in the resting position, the end of the tongue lies on the lower dental arch. In cases of inclination of incisors, the upper lip is shortened, slender, sometimes does not completely cover the upper incisors. The lower lip is turned up and the mentolabial groove is deepened. In cases of tilted of incisors, both lips are tight and the lower is withdrawn in relation to the upper. The mentolabial groove is slightly deepened.
FUNCTIONAL POSTERIOR OCCLUSION is a defect resulting from distal alignment of the mantibula without significant changes in its structure. Thus, in the facial features there is a withdrawal of the lower lip accompanied by the withdrawal of the chin.
Anterior occlusions are generally called mesioclusions as an expression anterior displacement of the lower dental arch in relation to the upper arch. A common feature is to alignmentof the lower front teeth in front of the upper. In the facial features, there is always a visible protrusion of the lower lip and smoothening of the mentolabial groove.
Functional changes are: the visible advantage of the muscles pulling out the jaw over those withdrawing it. Limitation of distal and partly also lateral, movements of the jaw associated with the opposite overjet of front teeth inhibits the growth of the jaw and impairs the function of chewing and biting of foods. Patient’s pronunciation is sometimes slightly impaired in articulating certain syllables. The presence of such defects hovers around 9% in relation to all of malocclusion cases.
Partial mesioclusion appears on the background of increase of the previous growth of the alveolar part of mandible. As a result of the lower front teeth alignment before the upper teeth, a negative overjet occurs. The distance between the first lower molars and incisors is increased. In the facial features, there is a protrusion of the lower lip and smoothening of the mentolabial groove.
Total masioclusion appears as a result of protrusion of the entire lower dental arch in relation to the upper one. Lower front teeth overlap the upper.
Changes in facial features are the same as in the partial form of this defect. The lower lip is pulled out and the mentolabial groove is smoothened.
Pseudo-mesioclusion is a defect that appears on the background of the inhibition of the previous jaw growth in relation to the cerebral part of the skull. The lower dental arch is pseudo-protruded in relation to the jaw inhibited in the previous growth. Middle front teeth overlap the upper. Changes in facial features include the collapse of the upper lip and the area around the upper lip.
Progenia – morphological protrusive occlusion. Innate defect created on the background of the previous excessive growth of the jaw. Following symptoms are observed: the extension of the body, sometimes the ramus of the mandibula and an increase of the angle of the jaw of varying severity. In the facial features, there is a considerable protrusion of the chin. Lower lip is pulled out, sometimes highly tense in cases retrusion of the lower incisors.
The mentolabial groove is smoothened.. In cases of progenia with a large dilatation of the mandible angle – a relatively smaller protrusion of the chin is accompanied by elongation of the lower part of the face. Middle lower front teeth are positioned in front of the upper, sometimes compensatory tilted to contact with the tilted upper teeth. Biting and chewing are impaired. Often there is an increase in the size of the tongue, patients almost always have problems with speech.
OPEN BITES are analysed in relation to the horizontal plane. In these disorders, we consider the height disorder, that is the shortening and elongation of different parts of the jaw and mandible. In open bites, we observe more or less extensive malocclusing, also called negative vertical overbite. There appear dysfunctions of biting and chewing food.
Facial features are almost unchanged in the disorder of the anterior part of the jaws.
The formation of these defects is sometimes associated with habits such as sucking a finger, pacifier lower lip, etc. Common dysfunctions base on keeping the tongue between the dental arches in a resting phase, and while talking, or during the oral phase of swallowing. Usually there are speech disorders such as lisp.
PARTIAL ANTERIOR OPEN BITE – in the middle of the mouth, we observe a malocclusing created as a result of shortening the of the alveolar process of the jaw or sometimes the alveolar part of the mandible. Facial features are not changed. If the image of the defect is accompanied by a inclination of the upper incisors, upper lip is sometimes shortened and does not cover the front teeth.
PARTIAL OPEN BITE UNI-/BI- LATERAL is characterised by a malloclusing that may occur on one or both sides of the dental arches. Pushing the tongue or cheeks sucking are considered to be the causes of the shortening of the lateral alveolar process, which is the main morphological symptom of this defect. Facial features are not changed.
TOTAL OPEN BITE is a vast defect associated with a significant opening of the jaws base, which is also a result of the deflection of the mandibular body. In the facial features, there is a considerable elongation of the jaw. Lips can be flaccid, and the upper lip – shortened. In the middle of the mouth we observe extensive, both in width and height, malocclusing. In some severe cases, in only the last molars come in contact in clench. Chewing is severely impaired and biting is impossible. Pronunciation is always disturbed. The cause of this defect is primarily rickets.
A common feature is the increase of the vertical overbite of incisors. It limits the anterior movements of the jaw when chewing food. Facial features are not significantly changed in case of a disorder of the front part of jaw. Among the extensive changes, a characteristic feature is the reduction of the jaw part of the face.
PARTIAL DEEP BITE – is characterised by the excessive vertical growth of the anterior part of the alveolar process of the jaw. Upper incisors are elongated and tilted, overlapping the lower incisors, and in some cases they bite on gums in the vestibule of the mouth. In more severe forms of the defect, lower incisors are also inclined, elongated and bite on the front of the mucous membrane of the palate. In the the pulling-out movement of the jaw to contact the edges of the lower incisors with the upper, a vast vertical gap is created between the chewing surfaces of lateral teeth. Chewing is limited to vertical movements. In an uncomplicated overbite, facial features are not changed, only the lips are highlystrained, supporting the retrusion of incisors.
TOTAL DEEP BITE – deep vertical overbite of incisors is accompanied by low, inhibited in their upward growth, lateral alveolar processes of the jaw and alveolar part of mandible. The angle of the jaw, as well as the angle of the base of the jaw is reduced. As a result, there is a shorter maxillary part of the face, the lower lip is strongly turned up and the mentolabial groove is deepened. Vertical chewing movements dominate. Resting slit is in some cases, not associated with hypertrophy, considerably enlarged, which masks the jaw shortening until the patient starts to chew.
In cases characterized by muscle hypertrophy that raises the jaw, resting slit is significantly reduced and the shortening of the jaw section is accompanied by the expansion in the area of the angles of the mandible. The face looks square-like.
PSEUDO DEEP BITE is characterised by the reduced maxillary part of the face resulting from a weaker clench due to extensive loss of teeth in the early stages of development. Weakening of the clench may also be caused by damage to the chewing surface of milk-teeth by caries. It is a acquired defect with good prognosis for treatment.
Abnormal number of teeth
Assessory teeth (hyperdontia) occurs against the background of increased activity of the dental lamina. It usually occurs in the jaw in permanent dentition. Assessory teeth may be in the form typical of a certain group of teeth, such as incisors, or the unusual shape of the modified structure. The most commonly observed is unusual mesiodens tooth.
It is located mostly in the midline of the jaw or is sometimes stuck in the bone. It has a small size, its crown is generally conical. Supernumerary teeth are removed when adjusting the bite. It is generally better to watch the extra tooth placed highly in the bone because of the risk of damage to the roots of the incisors during surgery.
Missing teeth (hypodontia) is formed against the impairment of dental lamina as a sign of abnormal development of the ectoderm. The emergence of the disorder may also be affected by systemic diseases, inflammation of jaw bones, injuries.
Oral hygiene during occlusal adjustment
Only a patient after oral sanitation should be accepted for orthodontic treatment. Regardless of the type of the brace used, a patient should be trained for maintaining proper oral hygiene. Consolidation of right habits is one of the conditions which must be met prior to treatment.
Due to the long duration of orthodontic treatment, failure to maintain ideal conditions of oral hygiene and proper sanitation of the brace can lead to escalation of severity of dental caries and periodontal inflammation. Particular care should be provided to patients treated with permanent braces. Loops and brackets facilitate the accumulation of plaque and are a trauma factor in the mouth. This promotes decalciferation around the brackets and along the edges of the loops, the more so, that the rough surface also facilitates colonization of bacteria, that apart from producing acids which are one of the cariogenic factors, may be a major etiological factor in periodontal diseases. Patients who despite the training do not properly clean their teeth should not be treated with permanent braces. The treated person must refrain from eating hard foods, due to the possibility of detachment of brackets, and fibrous and viscous foods because the braces constitutes a natural retention device for this type of residues.
The main tool in maintaining good oral hygiene is properly matched tooth brush, manual or electric rotary-spinning, supplemented by an additional dental floss, toothpicks, or interdental brushes, especially in patients with permanent braces. Also highly recommendable are water sprinklers, which reduce the pH of the plaque and its chemical composition and effectively wash out food residue from gum pockets and retention places. In specific indications, a dentist may recommend the use of antiseptic washes. In addition to daily brushing teeth after every meal with fluoride toothpaste, it is necessary to use methods of prolonging the contact of fluorine compounds with the teeth surfaces.
Course of orthodontic treatment
1. Orthodontic consultation: During the first orthodontic visit, a doctor carries out a detailed interview with the patient. The aim is to understand the reasons for the visit and to get acquainted with the needs and the expectations of the patient. This leads to the creation and development of an individual treatment plan that is a prelude to reaching mutually satisfactory and desired results. During the first visit, the doctor makes a detailed examination of the bite and muscle function. In addition, photographic images of teeth are made, which are then attached to the digital documentation of the patient. In order to carry out a full analysis of the occlusion, it is also necessary to perform X-ray images (Pantomographic image). Patients are able to do them on the spot in our X-ray laboratory.
2. Treatment plan presentation: During the next visit, the patient is presented with an individual treatment plan, which takes into account the course and duration of treatment. It is also a suitable moment for the patient to ask any questions, prior to treatment. After the patient accepts his treatment plan, impressions are taken for dental diagnostic models. The starting date of the treatment is set.
3. Proper treatment: The purpose of the visit is to give the patient a moving brace (if it is in accordance with the treatment plan) or the establishment of a permanent brace. These are, of course, painless procedures. Then, the orthodontist gives the patient the necessary guidance and advice on wearing the brace. It should be emphasized that cured teeth (no plaque and tartar) and when it comes to gum – no signs of inflammation – are all essential elements of orthodontic treatment. Treatment with permanent braces varies from individual to individual but takes approximately two years.
4. Check-up vicits: Check-up visits are made at different time intervals. This depends on the method of treatment and the individual patient’s needs. As a general rule of thumb:
– Removable brace – every 2-4 months
– Permanent brace – every 4-5 weeks
The aim of such visits is to control the course of treatment and adjust the positioning of the brace.
5. Retention phase: The last and equally important part of the process is the retention phase of treatment. This is a very important step, because it stabilizes the achieved results and prevents recurrence of malocclusion.
In the case of mobile braces, the function of retention brace is supported by the brace previously used, without activation.
In case of treatment with a permanent brace, after the brace is removed, the teeth are cleaned from glue and polished. Then the patient receives a removable, acrylic retention plate for the upper teeth and a thin wire glued to the inner surface of the lower teeth.