Who is an Orthodontist?
Orthodontists are people who have completed 4-6 years of Orthodontic specialization or Orthodontic doctoral program after completing 5 years of dentistry faculty and have done a thesis in the field of Orthodontics. They are specialists in applying functional jaw orthopedics, extraoral appliances, and fixed wire treatments. Orthodontic treatments should be applied by orthodontists.
In Latin, “Ortho” means straight, and “donti” means tooth; In other words, “orthodontics” means “smooth teeth”. Orthodontics is moving teeth with the supervision and guidance of the dentofacial (jaw and facial) structures of growing or adult individuals; It is a branch of dentistry that deals with the correction of the disorders in the related structures by reorienting the relations of the teeth with each other and with the facial bones by applying force.
Areas of Responsibility of Orthodontics:
- Diagnosis, prevention, stopping, and treatment of closing disorders.
- Design, application, and control of functional and corrective appliances.
- Guiding teeth and supporting tissues to provide ideal relationships for physiological and aesthetic harmony between the facial and cranial structures (bone structure in the skull area).
Why Does Orthodontic Disorder Occur?
- Genetic factors: It is important whether there is a similar anomaly in the family in individuals with skeletal disorders, missing teeth, upper jaw stenosis, and crowding problems.
- Various ear-nose-throat problems: Conditions such as deviation of the nose and presence of adenoids, and mouth breathing have a negative effect on the development of the jaw bones.
- Bad habits: Thumb sucking, cheek sucking, using false breasts for a long time, tongue sucking, etc. Habits that are not left on time affect the development of the jaws in a bad way. For this reason, children with such habits should be followed closely and the habit should be stopped as early as possible.
- Early tooth loss: As a result of premature extraction of the primary teeth due to caries and lack of placeholders, the permanent teeth that will emerge from the bottom will be lost as the adjacent milk teeth will slip into the place of the prematurely extracted milk teeth. For this reason, crowding and riding problems may occur.
Common Orthodontic Disorders
anterior open bite: The anterior teeth do not cover each other while the posterior teeth are in contact with each other, and there is a gap between the upper anterior teeth and the lower anterior teeth.
Crossbite: Normally, the desired situation is that the upper teeth are ahead of the lower teeth and cover the lower teeth to a certain extent. When the opposite of this situation is in question, a cross-closing is mentioned.
Crowding: There is not enough room in an arch (tooth array) or in a region for the teeth to line up properly.
Spaces (Diastema): It is the presence of gaps between adjacent teeth. It is especially common between the upper central incisors. However, it is normal to have a diastema in the primary dentition.
Ectopia: It is the abnormal position of the tooth in a place other than its normal position.
Impacted tooth: Generally, because there is not enough space, the tooth cannot erupt and remains embedded in the jawbone.
Lip insufficiency: The lips cannot cover the teeth sufficiently when the lower jaw is in the free position.
Deep bite: In an ideal bite, the upper incisors should cover the lower incisors by 2-3 mm or 1/3 of the lower incisor length. If the upper incisors cover the lower incisors more than normal, it is called a “deep bite”.
Forward thrust: The gap between the upper and lower incisors is greater than normal when the lower and upper jaw teeth are closing with each other. (This range can be tested by placing the little finger between the lower incisors and the upper incisors.)
Rotation: It is the rotational positioning of the tooth in its socket relative to its normal position.
Transposition: It is the eruption of two teeth into each other, unlike normal.
Why Orthodontic Treatment Is Necessary?
The vast majority of people who receive orthodontic treatment apply to an orthodontist to improve their appearance and smile. The orthodontic treatment gives patients self-confidence by providing aesthetic benefits. But most orthodontic problems can affect oral and dental health. For example; Crowded teeth are more difficult to clean. In this case, the susceptibility to caries and periodontal disease increases. Occlusion disorders can cause teeth to wear more quickly. Orthodontic problems can cause jaw joint disorders, headaches, and facial pain. If there is an open bite in the front teeth area or if the front teeth are spaced, the sounds cannot be heard correctly and speech disorder is observed.
Orthodontic Treatments Are Divided Into 4 Sections
- Preventive orthodontic treatments,
- Stopping orthodontic treatments,
- Corrective orthodontic treatments,
- Reinforcement therapy.
What is the Ideal Age for Orthodontic Treatment?
Generally, the ideal age for the treatment of dental disorders is around the age of 10-12, when the replacement of deciduous teeth is about to be completed, and the time of replacement of canine teeth. However, early treatment is of great importance in problems involving the jaws and quitting bad habits. Therefore, an orthodontist examination is required around the age of 6-7, where fissure protectors (protecting the chewing surface of the tooth against caries) are applied.
Can Adults Have Orthodontic Treatment?
Yes, adults can also be treated easily. Contrary to popular belief, it is possible to move teeth at any age with healthy gum. However, it is important to evaluate occlusion at an early age with an orthodontist, since early-diagnosed anomalies have more treatment options.
How Long Does Orthodontic Treatment Take?
Active treatment lasts an average of 1.5-2 years. However, this period varies depending on the type of treatment, age, and compliance of the patient.
What are Orthodontic Appliances?
The choice of orthodontic appliances varies according to the type of problem and the growth of the individual. To this end; In cases with skeletal deviation, various types of removable and fixed appliances are used, which are applied intraorally and externally. For some simple tooth movements, removable appliances can also be used. Fixed treatments are applied in cases that do not have any skeletal problems and only have crowding in their teeth.
Fixed Treatment Options
Fixed orthodontic treatments are performed in cases where there is no skeletal deviation or skeletal correction cannot be made, but there are various levels of crowding in the teeth. Fixed orthodontic treatments, namely dental corrections, are applied after all permanent teeth have erupted.
There are grooves in the middle of the brackets attached to the teeth. Wires with high elasticity or wires that have become more flexible by twisting are placed in these grooves and connected. Thanks to these connected wires, the teeth move towards the targeted ideal position. In fixed treatments, various springs and tires are also used.
Aesthetic Braces
Especially adult patients do not want to be treated because of the appearance of orthodontic appliances, which will enable them to have straight teeth. Many of these patients prefer to have their crooked teeth extracted or to have porcelain veneer teeth where the teeth are cut and reduced. However, with orthodontic treatments, a more natural and aesthetic result can be obtained by preserving the health and structure of the teeth.
Especially to eliminate the aesthetic concerns of adult patients, the use of tooth-colored porcelain brackets instead of metal brackets has increased interest in orthodontic treatment and has been an acceptable option for a group of patients. The cost of this bracket variant is slightly higher.
Considerations During Fixed Treatment Period
- Temporary wounds may occur on the cheeks and inner parts of the lips and tongue in the first week of wearing the brackets. This situation improves within 1-2 weeks, which is the period of getting used to the brackets. In addition, soft tissues can be protected by using protective waxes.
- During the treatment, hard foods (çağla, plum, apple, carrot, nuts, chips, etc.) should be avoided. Sticky foods such as chewing gum and jelly beans should not be used. Acidic drinks (cola, fanta, soda, etc.) should not be drunk. The foods that are between sandwiches and bread should not be eaten by biting but should be eaten by hand. Such foods may cause the brackets and bands to break and the wires to break, thus prolonging the treatment period.
Treatments Using Removable Appliances
This treatment option is usually applied before permanent dentition, during primary dentition, or mixed dentition. This treatment aims to keep the growth and development under control, to ensure that the teeth come out where they should be in the jaw curves, and to establish the dimensional relationship between the jaws.
Functional Appliances
They are appliances that are used to direct the correct development of the jaws in cases of insufficient or excess development of the lower and upper jaws during the growth and development period.
Extraoral Appliances
The development of the lower and upper jaws can be increased or decreased according to the need by taking support from the extra-oral areas with appliances such as chinrests and headgear.
How Do Teeth Move in Orthodontic Treatment?
Orthodontic treatment is a biological treatment, and orthodontic tooth movements are physiological events. When slight pressure is applied on the tooth with fixed or removable orthodontic appliances, the tooth is pushed towards the alveolar bone surrounding its root. This light and the continuous force cause the bone to melt slowly on the side where the pressure comes from. Thus, a new bone socket is formed in which the forceful tooth can settle. The space on the other side of the tooth begins to be filled with new bone simultaneously, and this keeps the tooth in its new position. The process of melting bone on one side and making new bone on the other is called “remodeling”.
Who Cannot Have Orthodontic Treatment?
In some medical conditions, the use of orthodontic appliances is not appropriate. Blood elements are not normal in blood diseases such as leukemia or hemophilia. In these children, some special treatments should be applied before the shooting. Orthodontic braces can also be harmful in patients with recurrent aphthous ulcers. Orthodontic treatment is limited in the mentally handicapped.
Making the Extraction Decision in Orthodontic Treatment
If there is not enough room to bring the teeth into their correct positions, the orthodontist uses tooth extraction or some other means of gaining space to gain space. That is, orthodontic treatments can be performed with or without extraction. The orthodontist decides which method to choose. One of the most important factors considered in this decision is facial aesthetics. Extractive treatments allow the lips to be retracted in varying amounts, and non-extraction treatments to be advanced.
Reinforcement
After orthodontic treatment, teeth tend to return to their old positions from their new positions. To prevent this, the teeth should be kept in their corrected positions until the reorganization of the bone and surrounding tissues is complete. For this purpose, mobile or fixed reinforcement devices are used. Movable reinforcement devices should be used day and night, in line with the physician’s recommendation. This period starts from 3 months, it can last 2 years or more.
Fixed retainers (lingual retainers): lingual retainers are usually in the form of a thin wire and are attached to the inner surface of the tooth (to the tongue-facing side). The length of stay will be decided by your Orthodontist based on your initial condition.
Orthognathic Surgery
The operations performed to eliminate the defects in the face and jaw structure of the person and to regain the normal function of the teeth together with the jaw are called “orthognathic surgery”. In simple terms, it means the correction of the chin. Orthognathic surgery may be required when developmental disorders in the lower and upper jaws cannot be adequately treated with orthodontic treatment. There may be developmental disorders in the lower and upper jaws separately or together. Depending on the problem, it may be possible to move the jaws forward, bor ack, increase or decrease their height, or shift them to the right and left, by surgical operation.
Oral and Dental Care During Orthodontic Treatment
- Teeth should be brushed after every meal or snack.
- Interdental and bracket spaces should be cleaned at least once a day.
- A fluoride mouthwash should be used after brushing the teeth before going to bed at night.
- It is useful to use mouthwash. You should go to the dentist for regular checkups.
- Care must be taken in appointments with the orthodontist.
- In line with the recommendations of the orthodontist, all removable and functional appliances should be fitted without interruption.
- Avoid hard foods such as corn, hazelnuts, peanuts, carrots, apples, and sticky foods such as candy, chewing gum, or butterscotch.
These measures help prevent caries formation, reduce damage to appliances and brackets, and increase the effectiveness of orthodontic treatment.
What are the Discomforts and Risks of Working?
- It is quite normal to have pain in the teeth when orthodontic treatment is started. The pain will decrease in 3-4 days. It takes about a week to get used to the attached appliances.
- During orthodontic treatment, teeth may wobble slightly; It is a normal condition and the reason is the movement of the teeth.
- Permanent stains and caries may be seen on the teeth of patients who do not have good oral care during the treatment. Gum diseases may also occur in these patients.
- Rarely, dissolution of the tooth roots can be seen during the treatment.
- Orthodontic treatment can cause discomfort in the jaw joint.
- The growth that occurs during or after the treatment may contribute positively to the treatment result, as well as cause undesirable effects and prolong the treatment period.
Wireless Orthodontic Treatment (Treatment with Transparent Plaques, Transparent Braces)
Thanks to Invisalign, clear aligners, and orthoclear technologies developed in recent years, crooked teeth can be corrected without braces called brackets.
A series of transparent plaques designed and prepared in the computer environment can be changed every 1-2 weeks, removing the crowding in the teeth without using brackets, and the teeth can be brought to the desired position. Since these plaques are transparent, they are not very noticeable, they are removed during meals and are easy to use, and do not hurt. Your orthodontist will decide whether this system, which has been put into use in recent years and can be applied in some cases, is suitable for you.
Lingual Orthodontics (Internal Wire Treatment)
The lingual orthodontic system is a system in which brackets (braces) are adhered to the back surfaces of the teeth, instead of the anterior surfaces, to the tongue side. Therefore, they are not noticed from the outside, they are aesthetic. In this technique, the brackets cannot be attached directly as in the classical method, because the surfaces of the teeth on the tongue side are not fully visible and show a more variable surface compared to the anterior surface, which causes the brackets to not be adhered in the correct position. For this reason, in the lingual technique, the brackets are positioned with laboratory work on the measurement taken from the patient and transferred to the patient using a carrier spoon and adhered to the teeth.
In recent years, by scanning the back surfaces of the teeth with laser scanning methods, brackets that are fully suitable for the surface of the teeth, personalized, that allow the desired and correct movement of the teeth can be produced.
