Orthodontic Treatment

Orthodontics derives from the Greek words 'ortho' ("correct", "straight") and 'dontia' ("teeth"). Orthodontics involve monitoring, guidance and manipulation of the dentofacial (jaw and face) structures of growing and adult individuals and their manipulation. Orthodontics is a specialty of dentistry which uses force in order to reroute and fix the malformations of these relevant structures.

The scope of application in Orthodontics are;

1. Diagnosis, prevention and treatment of improper bites.

2. Design, application and control of functional and straightener apparatus

3. Guiding the teeth and supporting tissue in order to facilitate ideal relationships for physiological and aesthetic harmony between the face and cranial structures (bone structure around the head area)

Who Is An Orthodontist?

Orthodontists are dentists who finished the Orthodontics expertise program that takes 4-6 years or Orthodontics doctorate program who conducted a thesis study in the field of Orthodontics after attending 5 years of dental school. They are experts in the application of functional jaw orthopaedics, extra-oral apparatus and fixed brace treatments. Orthodontic treatments must be applied by Orthodontists.

Why Do Orthodontic Malformations Occur?

1. Genetic Factors: It is vital to identify whether individuals with skeletal malformations, missing teeth, maxilla narrowness and crowding issues have a family history of similar conditions.

2. Various Otorhinolaryngologic Problems: Nose deviation, existence of adenoid and breathing by mouth all have an effect on the development of jawbone.

3. Bad habits: Thumbsucking, cheeksucking, prolonged use of pacifier, tongue sucking etc. negatively inluence the development of the jawbone. As a consequence, children with such habits should be monitored closely and make them shake the habit off early.

4. Early teeth loss: Because of the premature extraction of baby teeth without placing space maintainers, neighboring tooth moves to the location of missing teeth, consequently occupying the space for permanent teeth. Therefore, crowding and pushing issues can be observed.

Frequently Encountered Orthodontic Malocclusions

Open bite: When the back teeth are clenched with the front teeth, the front teeth won?t cover each other and there is an opening between the upper and lower incisors.

Crossbite: Normally the ideal situation is the upper teeth being more prominent than the lower teeth and covering them to a certain degree. When the condition is vice-versa, it is called crossbite.

Crowding: This is when there is not enough space for the teeth to be aligned on an arc or a region.

Diastema: Diastema is the gap between two neighbor teeth. It is seen especially between the two upper front incisors. However, it is normal to encounter diastema during the phase of milk dentition.

Ectopy: Ectopy is the displacement of teeth from their normal position.

Impacted Teeth: It is the condition of tooth getting blocked (generally due to lack of space) as it is pushing through the gum into your mouth.

Lip shortness: It is the inability of the lips to cover the teeth and achieve a relaxed, consistent, lips-together rest posture. The lips of the individual remain open, with some upper front teeth still showing.

Deep bite: For an ideal bite, upper incisors should cover the lower incisors for about 2 to 3 mm or one third of the lower incisors. When the upper incisors cover the lower incisors more than normal, the condition is called deep bite.

Overjet: This condition occurs when there is a gap which is bigger than normal between the upper incisors and lower incisors (this gap can be examined by placing the little finger between the upper incisors and lower incisors).

Rotation: The condition where the teeth is situated differently on the alveolar bone facing another direction than its normal position.

Transposition: The condition occurs when two teeth push in place of each other.

Why is Orthodontic Treatment Necessary?

The majority of the patients who seek orthodontic treatment do so in order to improve their looks and smile. Orthodontic treatment esthetically benefits patients and reinforces their self-confidence. However, most of the orthodontic issues can affect oral and dental health. For example, crowding teeth are harder to scale and clean. Because of this, predisposition to tooth decay and periodontal disease increases. Malocclusions can cause rapid corrosion on teeth. Orthodontic issues can cause temporomandibular conditions, sore face and headaches. If there is a condition of open bite on the area of front teeth or space between the front teeth, the patient will have misarticulation and issues with speaking.

Orthodontic Treatments are separated Into 4 Categories;

1. Preventive Orthodontics

2. Interceptive Orthodontics

3. Corrective Orthodontics

4. Retention Treatment

What's the Ideal Age for Orthodontic Treatment?

Generally the ideal treatment period for dental defects are between ages 10 and 12, when the development of milk teeth are almost complete and canines are about to change. However, early treatment is essential for jawbone conditions and breaking the bad habits. Consequently, An orthodontist examination is required during the period between ages 6 and 7 where dental sealants are being used (apparatus protecting the surface of teeth against decay).

Can Adults Receive Orthodontic Treatments?

Yes, adults can comfortably receive orthodontic treatments. Contrary to popular belief, it is possible to manipulate teeth in all age groups with healthy gums. However, due to the abundance of treatment options of early diagnosed anomalies, it is essential to get an examination of the bite at an early age by an orthodontist.

How Long Does Orthodontic Treatment Take?

Active treatment takes about 1.5-2 years. Although, treatment duration varies according to the treatmenty type, age and compatibility of the patient.

What Are The Orthodontic Apparatus?

The choice of orthodontic apparatus depends on the type of the problem and development of the individual. To this end, in cases with skeletal deviations, various types of fixed and removable apparatus are employed. Detachable apparatus can also be used for several simple teeth movement. On cases of crowding instead of skeletal problems, fixed treatment types are applied.

Fixed Treatment Options

Fixed orthodontic treatments are applied in cases where there is no deviation or skeletal deviation is unable to be performed, however the presence of various levels of crowding is present. Fixed orthodontic treatments, namely dental corrections, are applied after all permanent teeth are established in their respective positions.

There are sockets in the middle of the brackets attached to teeth. These sockets are filled and tied with braces of high elasticity, or braces which were made more flexible by bending. Thanks to these tied braces, teeth move to their targeted ideal positions in the mouth. In fixed treatments, various springs and bands are also utilized.

Aesthetic Brackets

Especially adult patients do not wish to undergo orthodontic treatments due to the appearance of the orthodontic apparatus, which will help them get perfectly aligned teeth. Most of these patients prefer to get their crowded teeth extracted, or get porcelain crowns where the teeth are cut and made smaller. However, with orthodontic treatments, by preserving the health and structure of existing teeth, more natural and aesthetic results can be achieved.

In order to satisfy the aesthetic preferences of adult patients, the usage of tooth-colored porcelain brackets instead of metal brackets increased the interest in orthodontic treatments and it has becane an acceptable form of treatment for a group of patients. The cost of these types of braces is a little higher.

Rules to Follow for Fixed Treatment

  • On the first week after the bracket insertion, temporary wounds can happen in the cheeks and inner lips. This condition gets better in about 1-2 weeks during the adaptation period. Protective wax can be used in order to protect the soft tissue.
  • Refrain from eating solid food (green almond, plum, apples, carrots, dried nuts and fruits, chips etc), sticky candy (gum, jelly tots) and drinking fizzy drinks (cola, fanta, sprite etc). When eating food such as sandwiches, the patient should slice them into smaller pieces instead of biting. This type of food can break down of brackets, braces and orthodontic bands, extending the time needed to complete the treatment.

Treatment with Removable Apparatus

This treatment option is applied before permanent teeth, milk teeth or mixed teeth stages. The purpose of this treatment is to provide teeth eruption for appropriate positions by controlling the development of the teeth and establish the dimensional relationship between the upper and lower jawbone.

Functional Apparatus

During developmental stage, these apparatus are utilized in order to correctly guide the jaw development stage  in cases of lower and upper jaw development deficiency or over-development.

Extra-oral Apparatus

Thanks to apparatus such as headgear and facemasks, lower-upper jaw development can be increased or decreased by gaining support from extra-oral regions according to the patient's condition.

How Do The Teeth Move in Orthodontic Treatment?

Orthodontic treatment is a biological treatment while Orthodontic movement is a physiological occurence. By applying a mild pressure on the tooth with a fixed or removable orthodontic apparatus, the tooth is pushed towards its own alveolar bone which surrounds the root. This mild and constant force causes bone thinning on the side where pressure is being applied, thus forming a new bone socket for the teeth to settle in. Bone fill begins in the cavity which is on the other side of the tooth and this facilitates the tooth to keep staying in the new location. The process of bone loss on one side and bone fill on the other side is called "apposition".

Who Is Not Suitable for Orthodontic Treatments?

Usage of orthodontic apparatus isn't suitable for several medical conditions. Plasma levels are not normal in blood diseases such as leukemia and hemophilia. Special treatments need to be applied on these kinds of patients before extractions. For patients with recurring aphthous ulcers, orthodontic wires could be harmful. For mentally disabled patients, orthodontic treatment applications are limited.

Making the Decision for Tooth Extraction in Orthodontic Treatment

If there is not enough space to move the teeth onto their proper positions, the orthodontist makes use of tooth extraction or other several methods in order to make room for teeth. In other words, orthodontic treatments can be performed with or without tooth extraction. The decision should be made by your orthodontist. One of the most important factors in this decision is esthetics. Treatments with extraction allow for lips to move back and treatments without extraction allow for lips to move forward.

Retention Treatment

After orthodontic treatment, teeth show a tendency to return to their old positions. In order to prevent this, surrounding tissue and bone need to be held in the corrected positions till the rearranging process is completed. For this purpose, removable or fixed retention devices are used. Removable retention devices should be used day and night, under supervision by a dental professional. The time needed for this treatment vary from 3 months up to 2 years or more.

Fixed retaining apparatus (lingual retainer): Lingual retainers usually are thin braces which are attached to the internal surface of the tooth (tongue side). The duration of the treatment is decided by your Orthodontist according to the initial status of your case.

Orthognathic Surgery

Surgeries that are performed in order to fix facial, jawbone structure malformations and restoring function of the teeth along with the jawbone are called orthognathic surgeries. Simply put, it is jawbone adjustment surgery. When the developmental malformations on the upper and lower jawbone are not suitable for sufficient treatment, orthognatic surgery may become necessary. Development malformations can appear on both the uppwer and lower jawbone separately or together. Depending on the problem, it is possible to move the jawbone forward or backwards, adjust their height or move them to the left or right with surgery.

Oral and Dental Health Care During Orthodontic Treatment

  • The patient needs to brush their teeth after every meal or snack.
  • The patient needs to clean their braces and diastema at least once a day.
  • The patient needs to use a fluoride mouthwash after brushing the teeth.
  • It is recommended to use oral irrigators and keep a regular schedule of follow-up appointments.
  • The patient needs to regularly attend the appointments with their orthodontist.
  • Orthodontic apparatus must be worn regularly without interruptions according to the instructions from their orthodontist.
  • It is highly recommended to stay away from solid food such as corn, dried nuts, carrots, apples and sticky snacks such as gum, candy or caramel.
  • These precautions help prevent tooth decay, minimize the possible damage on the apparatus and brackets and improves the efficiency of orthodontic treatment.

What Are The Risks and Conditions When Working?

  • It is quite normal to have pain on the teeth when the orthodontic treatment has begun. Pain will subside in about 3-4 days. The adaptation period for orthodontic apparatus takes approximately one week.
  • During the orthodontic treatment, there may be mobility on the teeth. This condition is normal and is caused by the movement of the teeth.
  • Patients with poorly maintained oral hygiene may experience tooth decay or permanent stains on their teeth. These patients may also experience gingival diseases.
  • There may be decay on the teeth root Depending on the problem, it is possible to move the jawbone forward or backwards, adjust their height or move them to the left or right with surgery.
  • Rarely bone resorption occurs during the treatment.
  • Orthodontic treatment can cause discomfort on the temporomandibular joint.
  • Patient growth during or after the treatment may contribute positively or negatively to the treatment, which can extend the treatment duration.

Wireless and Braceless Orthodontic Treatment (Ceramic Braces)

Thanks to recently developed invisalign, clear aligner, orthoclear technologies, crowding teeth can be corrected without braces. A series of transparent aligners designed in computer environment makes it possible to align the teeth into desired positions by eliminating the crowding. Thanks to their transparent color, they are not easily visible to the eye. The aligners are easy to use and can be removed during meals. It doesn't sting and cause pain. Your orthodontist will decide whether aligners can be used in your treatment.

Lingual Orthodontics

Lingual orthodontic system is where brackets are placed behind the teeth rather than the front. Because of this, the braces are not visible to the naked eye and therefore, esthetically pleasant. Contrary to the classic orthodontic technique, the braces are not attached directly to the teeth because the surface on the side of the tongue are different compared to the frontal surface, consequently causing brackets to be attached in an incorrect position. To amend this, braces are positioned in the lab according to the impression of the teeth and conveyed with an impression spoon to the patient for attachment. In recent years, a technique is used where the backside of the teeth is scanned with laser imaging which allows to craft personalized brackets that match the teeth surface perfectly, thus making it possible. Lingual orthodontics require much more precision and care compared to classic orthodontics. There are disadvantages alongside advantages of this technique, which has several limitations.