About Common Orthodontics Procedures
Many dental treatments like getting a cavity filled or having a crown placed can be done in one or two visits. In contrast, orthodontics procedures take place over a period of many months or years. These treatments are intended for patients who want to experience better dental alignment, function and aesthetics by using the body’s own growth and repair processes. This usually means that metal and/or plastic appliances are temporarily or permanently installed to reshape the interior of the mouth and move teeth into proper position. Here are some of the procedures and devices an orthodontist may use to achieve these results.
Moving Teeth and Aligning Bite with Braces
Metal braces with metal, ceramic or composite brackets are used to improve the spacing of teeth. They can also be installed to correct certain mild to moderate bite problems (overbite, underbite, crossbite). Traditional braces are installed on the outside of teeth next to the lips while lingual braces are installed on the surface that faces the inside of the mouth. Both work in a similar way by placing slow, steady pressure on the treated teeth. This causes changes in the shape of the tooth socket, creating a small space for the tooth to move in the desired direction and filling in the gap left behind with new bony tissue.
Prior to the placement of braces, molars may be prepared with small spacers. Separating the molars slightly allows room to fit these back teeth with metal bands that go all the way around the tooth. The bands provide a firm surface to which the rest of the braces components are anchored. Next, a bracket is attached to each tooth with a dental adhesive. A wire is threaded through clasps on the brackets or connected to the bracket with ties. This wire is malleable at room temperature but hardens once it is in the warmer environment of the mouth. The tension the stiff wire pulling or pushing on the brackets gradually causes the teeth to move. Rubber bands may be used to connect various brackets to add more pressure and increase the degree of movement as needed.
As treatment progresses, the wire and bands are adjusted. This is usually done in a monthly visit to the orthodontist. The total length of this orthodontics procedure varies depending on the amount of movement needed and how the patient’s teeth respond. Treatment often takes 12-30 months.
Controlling Jaw Growth with Headgear
The metal bands attached to the back molars generally feature small metal tubes. These are used to connect with headgear if needed. Headgear devices feature a metal bow or metal wires with hooks that attach to the braces and a strap that goes around the head or the back of the neck. Typically, headgear is used to keep the upper jaw from growing too much during childhood or adolescence. The goal is to ensure the upper teeth don’t protrude too far past the lower teeth (overjet). In adult patients, headgear is sometimes used in orthodontic procedures to hold back teeth in place as front teeth are shifted to fill a space left by an extraction.
Headgear may be installed at the same time as braces or in a later procedure. After the initial evaluation to determine the right amount and direction of pressure, the actual fitting does not take long. Rubber bands may be used along with the headgear when additional pressure is required. Patients should wear their headgear as instructed by their orthodontist (usually at least 10 hours per day). Treatment may last six to 18 months or more depending on the individual patient’s needs.
Increasing Jaw Size with Expanders
Orthodontists use palatal expanders to increase the size of the upper jaw. This may be done to relieve crowding or to correct an underbite (where the bottom teeth close in front of the upper teeth). These devices are generally used for children since they work best when the jaw is still growing. Once the two halves of the jaw have fused together along the suture line in the center, surgery is required prior to using an expander.
Depending on the type of palatal expander used, it may be attached to external headgear or directly to the metal bands on the molars. The expander is installed by an orthodontist. This process may take several visits to accomplish since spacers are placed to move the molars and allow room for the appliance. Unlike braces, the expander is usually adjusted at home by the patient using a key. Patients will generally adjust the expander twice a day. The patient sees the orthodontist about once per week during active treatment to ensure that everything is going as planned. Once the maintenance phase begins, visits are less frequent. The expander is usually left in place for several months after it is no longer being adjusted.
Straightening Teeth with Invisalign
Clear plastic aligner trays are used to correct tooth spacing, straighten crooked teeth and improve some bite problems. The orthodontist use x-rays, photos, and computer imaging to evaluate the patient’s teeth and determine the appropriate treatment approach. A complete procedure plan is developed at the outset, so the patient knows what the final result should look like. This information is sent to the Invisalign manufacturer and a series of plastic trays are custom made for the patient.
The patient can remove the trays as needed for eating and tooth brushing. However, the trays are intended for wear 22 hours per day to achieve the desired results. The patient inserts a new set of trays every two to three weeks to keep teeth moving in the right direction. Orthodontist visits are generally spaced six weeks apart to check progress. The entire procedure may take a year or two. Since Invisalign is not typically used to correct more severe misalignments, the treatment time may be shorter than with metal braces.
Keeping Teeth Straight with a Retainer
A retainer is prescribed after any orthodontics procedures involving metal braces or Invisalign. This is a custom fabricated metal or plastic device that fits over the treated teeth and holds them in place. The procedure for fitting a retainer involves taking a mold of the patient’s mouth at one visit and installing the custom molded retainer at the next visit. Both metal and plastic retainers can usually be removed by the patient as needed. The type of permanent metal wire retainer that may be applied to the lower teeth is an exception. Retainers are intended for constant wear (with brief removal for eating or dental hygiene). After an initial phase of treatment, the orthodontist may advise only wearing the retainer at night. Patients typically wear a retainer part time or full time for several years after braces are removed.