Orthodontics

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Orthodontics is an odontology speciality which studies, prevents and corrects alterations in the development and shape of the dental arches and the position of the jaws, in order to re-establish the morphological balance and function of the mouth and face, improving the facial appearance.

Orthodontics is much more than just moving teeth, it resolves problems much greater than the placement of single or more complex dental structures, by correcting changes in the jaws, to the face and above all to the functional disorders of mastication.

The technical term for these problems is malocclusion, which means to bite badly. The age at which to treat malocclusions varies according to the problem and its severity. For this reason it is advisable to consult an orthodontist as soon as you are aware of an anomaly. In any case, we recommend that whether you detect a problem or not, you should take children for a check up with an orthodontist no later than when they are six years old.

Treatment

Orthodontic procedures can be INTERCEPTIVE or CORRECTIONAL.

INTERCEPTIVE TREATMENT

The aim of interceptive orthodontics is to interrupt the development of an incipient malocclusion. That is to say, that there are means by which a specialist can early on limit a malocclusion so that further severe changes do not take place. This is not just confined to the teeth but also to the growth and development of the bone structure which affects the look of the child’s face. Generally, this is begun during temporary or mixed dentition. This treatment does not rule out later correction if a similar or other anomaly is discovered later.

This type of treatment is regularly used to correct abnormal habits, which could interfere with the normal growth pattern of the face and jaw. Some malocclusions may occur from such habits as thumb sucking and can correct themselves on stopping this habit. Unfortunately, in many other instances they form malocclusions which require orthodontic treatment albeit with simple devices.

Interceptive treatments are therefore aimed at the correction of all incipient changes, given that, if no measures are taken, the malocclusion will get worse.

CORRECTIVE TREATMENT

When interceptive treatment has not been carried out or has not been able to correct the malocclusion, a corrective treatment has to be performed. In this instance aimed at correcting a consolidated malocclusion.

For corrective treatment three types of appliances are used:

• Functional appliances
• Removable appliances
• Fixed appliances

The ideal time to begin this treatment is around 10 - 12 years. It usually takes between a year and a half and three years, and usually finishes when the permanent teeth, apart from wisdom teeth are in place.

The fact that this is the ideal age does not discount the fact that these corrective treatments can be started later in adolescence or even in adulthood.

Of course, depending on age, orthodontic treatments will have different aims and results. Although we would stress the importance of early treatment in adolescence, more and more adults are being treated successfully for irregularities.

In cases of extreme deformity it is necessary to combine orthodontics with surgery. The orthodontist will recommend a mouth or maxillofacial surgeon and together a process of treatment will be established.

FUNCTIONAL APPLIANCES

These appliances are at the beginning just used to make functional alterations, followed later by structural changes. This type of functional orthopaedic appliance is recommended in particular during temporary or mixed dentition and requires great collaboration on the part of the patient, who must wear it whenever indicated. These appliances, just by their presence, alter the function of the system they are working on. By varying the function of the masticatory and face muscles they encourage more favourable development of the jaws and optimise their growth potential.

Alterations in the growth of the jaw can be of genetic origin or be as a result of harmful habits and changes in oral function which if they are persistent and long term, can cause malocclusion.

These habits and changes in function are: the use of a dummy over a long period (more than two years) as well as thumb sucking, problems with swallowing and atypical swallowing such as using the tongue strangely when swallowing, sucking or biting of the lips and oral respiration (which could be adenoidal).

Removable appliance

Patients can take these out to clean them, but when they are in use they are fixed firmly to the teeth. These appliances are acrylic, which fit to the molars by means of metal hooks. With these a controlled amount of pressure can be applied to the teeth which need moving, by means of active mechanical parts such as springs, arches and screws among others.

All this pressure is artificial or mechanical and acts specifically to alter the position of the teeth having nothing to do with the strength created by the action of the muscles which are part of the mastication, swallowing, speaking and other, processes.

Removable appliances are very useful for expanding the jaw bones, in particular the upper jaw and also for very specific movements of the teeth . The longer they are worn, the quicker and more visible is the correction. They need to be used a minimum number of hours, that is to say, it is essential to wear them at night and four to six hours during the day.

Fixed appliances

Fixed orthodontic appliances can only be used when the permanent teeth have come through or, in any case, when there are only the milk teeth molars left. So it is getting more and more frequent to see children between six and nine who are wearing brackets just on the upper teeth as these are the teeth which guide the way for the molars.

It is from 10 to 12 years when fixed appliances are used incorporating all the teeth. Today orthodontists can choose between different types of appliances to suit the needs of each patient, their budget and the dental problems that need treating.

Fixed orthodontics includes various types: bands, brackets, tubes, ligatures and arches and once these are fitted to the teeth, provide the necessary pressure for the movement required to correct bad positioning, rotated teeth, spacing and malocclusion.

Brackets can be metallic and aesthetic (porcelain or sapphire).