Orthodontic appliances are used to correct malocclusions – bad intermaxillary relations, establish the proper relationship between the upper and lower jaws, relieve the joint, obtain a satisfactory profile, fullness of lips and aesthetically shaped dental arches.
The ideal time for the first visit to an orthodontist is at the age of 7 because of all the possible dysfunctions in jaw development, premature loss of deciduous teeth and a large number of inheritable anomalies. It is never too late for orthodontic therapy.
In the grown-up age braces are worn as a prevention from periodontal diseases, help in periodontal treatment, preparation for prosthetic therapy, removal of traumatic occlusion, accelerated teeth wear and, of course, for aesthetic reasons.
Removable appliances are orthodontic devices which patients put on and take off. Their advantages are better hygiene, possibility of removal and easier mastication. The disadvantages are dependence on the cooperation of the patient, teeth shift by inclination and limited results. We divide them into two categories: passive and active.
Myofunctional appliances fall into this category. The source of the strength is in the muscles which contract when changing saggital and vertical position of the lower jaw. Therapy using these appliances is possible only with people with sufficient amount of remainig growth, which is before or during adolescent growth acceleration. We use more than one appliance, depending on the patient’s needs.
They involve retention, semi-active and active elements. Semi-active and active parts such as labial bow, screws, springs, pins and elastics are the source of the strength.
Fixed appliances are those orthodontic devices which the orthodontist installs using adhesive technique, which makes them impossible to take off. They consist of braces on each tooth, bands or tubes on molars, elastics and wire that connects all the teeth. Their biggest advantage when compared to removable braces is the ability to shift teeth in all directions with minimal inclination.
They are divided into different categories:
The wire is retained in the braces with the help of elastics which can be in different colours or wire ligatures
They can be made out of different materials:
1. Metal – excellent hygiene, durability and shifting precision,
2. Composite braces – satisfactory aesthetics
3. Ceramic – harder braces, good aesthetics,
They can be placed on the external or the oral side. The wire is retained in the braces by passive, active or interactive clips. Their advantage is the reduced friction in the beginning of the therapy, which creates milder forces. This makes systems more pleasant for patients, teeth correction faster, therapy shorter, and hygiene around the clips easier. We use:
1. Passive Damon System: possibility to choose aesthetic braces (polycrystalline aluminum oxide) on frontal teeth, the others are metal with passive closing clips.
2. Interactive In-Ovation: there are exellent metal and ceramic aesthetic braces with interactive metal clips.
3. Lingual: fixed appliances are placed on the oral side They are used for smaller corrections of teeth positions.
We use: 2D very thin and rounded metal braces and Eclips interactive self-litigating GAC braces
Social 6 is a method of lingual technique which uses 6 braces on front teeth (from 3 to 3). It is used for smaller quick aesthetic shifts which are over in the period of 6 months.
It is also a very good method to treat relapse in orthodontic therapy (undesired shifts of teeth after braces removal) which helps us reach the aim in a very short period of time.
Expanding the narrow upper jaw: It is expanded by the Hyrax screw, after 2-3 weeks of active therapy; 3 months are needed for stabilisation. The therapy ends with fixed braces.
We use titanium microimplants the size of an earring or a piercing. They are used as a help to fixed braces to treat any teeth shift. For example: closing the space in case of missing teeth.
Grassroller device is used to help the patient quit the deleterious oral habits of tongue thrusting or thumb sucking, which enables bringing upper incisors in the normal position and facilitates the closure of bite.
Retention devices are necessary after fixed braces therapy. The purpose of retaining is to keep teeth in the desired position until complete closure of growth, remodeling of support tissues and maturation of bone. Apical fibers of periodontal ligaments take 5 months, middle fibers and bone take 6 months, and supra alveolar fibers take a year. After that, teeth reach the desired stability. Retention can be fixed or removable.
Retainers are very fragile and require appropriate maintenance. If you have obtained a fixed retainer in combination with the removable one, take good care that the wire does not get pulled out. If it does happen, contact the clinic as soon as possible and while the wire is undone, wear your retainer more frequently.
You should not eat, smoke or consume hot or coloured drinks while wearing your retainer. In that case they can get irreversibly deformed. The fixed retainer is taken off only when the orthodontist agrees to do so and when the conditions are fulfilled. Mobile retainers need to be replaced once a year because of hygiene.
During the initial retention braces usage (12 months) it is necessary to come for checkups.
Removable retention with Essix retainers Fixed retention
Before setting fixed braces it is required to make a detailed dental examination with orthopantomographic scan, because one of the preconditions for therapy is healthy or well healed dentition. And after setting the braces, it is absolutely necessary to maintain the oral hygiene well, and use the interdental brush and floss after each meal. When eating, it is recommended to cut food in small pieces and chew moderately, which will prevent the braces from falling out and shorten the therapy duration.