“Overview of orthodontic treatment”

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Orthodontics
Dr. Dimpal Thapa
BPKIHS Dharan

When you meet someone for the first time what do you notice? Well if I have to say I would say smile and I think many people would say so. Not being judgmental but a smile looks beautiful with nicely aligned teeth.

One of the branches of dentistry, ‘Orthodontics’ can help us create that beautiful smile. Simply saying Orthodontics is that branch of dentistry which correct the position of malaligned teeth by the movement of teeth, bone and soft tissues.

The aim of Orthodontics isn’t only limited to cosmetic treatment. Jackson has given us a triad which includes- Functional efficiency, Structural balance and Esthetic harmony as aims of orthodontic treatment. When teeth, bone and soft tissues are in normal relationship, then they are functionally efficient, structurally balanced and esthetically harmonized.

In medical term the condition with malaligned teeth is called as Malocclusion. But before saying it is abnormal we should always know what is normal so before looking for malocclusion we should know what normal occlusion is. Angle in 1899 defined Normal Occlusion as, “The mesiobuccal cusp of maxillary molar occluding in buccal groove of mandibular molar and teeth all arranged in a smoothly curving line.”

Malocclusion hampers both physical and mental health. Poor facial appearance due to malocclusion may lead to low self confidence, insecure feelings, depression, etc leading to severe mental problems. Similarly due to malocclusion there is greater chance of more plaque and calculus deposition and difficulty in maintaining oral hygiene leading to poor periodontal health and predisposition to caries.

Also due to malocclusion there can be temporomandibular joint problems, attrition of teeth, speech defects, risk of trauma, etc Now we know what malocclusion can lead to so let’s get some basic knowledge about orthodontic treatment.

There are 4 branches of Orthodontics:

  1. Preventive,
  2. Interceptive,
  3. Corrective,
  4. Surgical Orthodontics.

These treatment are for people of different age group. A person of any age can undergo orthodontic treatment if required. Most of the people think that getting braces is the only orthodontic treatment but it’s not correct.person of any age can undergo orthodontic treatment if required So let’s learn about all the branches of orthodontics in simple way.

Preventive orthodontics-

Before the appearance of malocclusion during child age. When deciduous tooth/teeth exfoliate before time the adjacent teeth drift and may block the eruption or cause the malalignment of subsequent permanent tooth/teeth which in future lead to malocclusion. So to prevent this, a space maintainer is given to child to preserve space for permanent teeth.

orthodontic

Interceptive orthodontics-

To halt the progression and severity of malocclusion which has already occurred. Procedures like serial extraction, space regaining, interception of skeletal malocclusion, control of abnormal habits are done. Serial extraction is the planned extraction of certain deciduous and permanent teeth in orderly sequence to guide erupting permanent teeth in correct positions.

If space is already lost and insufficient for erupting permanent teeth space regainers are used. Skeletal malocclusion is due to incorrect position of jaws either maxilla or mandible. In growing children we use different types of myofunctional and orthopedic appliances to intercept skeletal malocclusion.

  • Maxillary prognathism: Head gear
  • Maxillary retrognathism: Face mask or protraction head gear
  • Mandibular prognathism: Chin cup
  • Mandibular retrognathism: Myofunctional appliances (Activator, Bionator, Twin block, etc)

Abnormal oral habits are one of the predisposing factor for malocclusion. Habit breaking appliances like thumb guard, blue grass appliance, hayrake, quad helix for thumb sucking; vestibular screen for mouth breathing; palatal crib, nance palatal arch appliances can be used for tongue thrusting habit.

Corrective orthodontics

Done to treat the already established malocclusion after growing age is complete. Mostly teenagers and adults who are very concerned about their facial appearance come for corrective orthodontic treatment. Most of the complaints are: irregular arrangements of teeth, spacing, forward or backward placement of teeth, etc.

Before starting any treatment we should always diagnose the case, if the problem is due to dental or skeletal reason. For that we should go for radiographic examination(Lateral cephalogram, OPG). Removable or fixed appliances can be used depending on cases but mostly fixed appliances are required so we will talk about it.

Fixed appliances has various components-

  • Active: separator, spring, elastic, arch wire.
  • Passive: band, brackets, molar tubes, etc.

Sometimes when there is moderate or severe crowding and excessively proclined teeth, the space available may not be sufficient for their alignment. In such cases we have to extract some teeth (mostly premolars) to provide space. Whether to extract teeth or not is a very difficult decision for orthodontist so model analysis using patients’ dental cast is always done to determine this. Orthodontic treatment takes long time (around 2 years) to complete. It is a very complex process.

The basic steps are:

  • Placement of separator- to create space between molars for placement of molar bands.
  • Banding- appropriate band material is chosen and pinched around the tooth. Attachments like brackets or molar tubes are fixed on band which is then cemented on tooth.
  • Bonding of brackets- brackets can be of different materials & designs. It is used to hold the wire on place.
  • Arch wire placement- arch wire can be of Ni-Ti, stainless steel, etc according to the need. After it is placed ligature wire, modules are used to hold.

Every orthodontic case differs and treated in different way. The type of tooth movement, time period, materials and appliances used, procedure required, everything is different. After the treatment is completed, debonding of brackets is done. Since teeth have tendency to return to their original position, retention is a very important factor. Patient has to wear full time (24hours) retainer for 6 months and part time for another 6 months. –

Instructions for patient:

  1. Fixed orthodontic treatment are very costly as compared to others. So they should be notified about all the cost.
  2. Because of fixed brackets and wires there is high chance of plaque and calculus deposition and also very difficult to maintain oral hygiene for the patient. So, Patient has to brush 3-4 times daily using proxa brush and other problems like caries, endodontic and periodontal problems must be treated before doing ortho treatment.
  3. Hard and sticky food should be avoided as there is chances of bracket fracture.
  4. Patient must come for follow up every month until treatment is done.

Orthodontic treatment might be painful for some patient for which they can take painkillers (Patient can take Paracetamol 500mg but ibuprofen shouldn’t be taken as it can delay orthodontic treatment due to it’s mechanism of action). In case of wire distortion, bracket fracture or any other problem patient should always contact their orthodontist.

Surgical Orthodontics

Done to correct moderate-severe skeletal discrepancies after the growth is completed. Mild skeletal discrepancy can be corrected with orthodontic camouflage. Various orthognathic surgeries are done to correct skeletal malocclusion.

Maxilla- Le fort I osteotomy Mandible- Bilateral sagittal split osteotomy Before doing surgery, mock surgery should always be done to see the end result of the treatment. If the result is satisfactory then pre-surgical orthodontics is done.

To compensate the skeletal malrelation, teeth tend to incline in such a way that they best try to camouflage problem. For example if a patient has maxillary prognathism then his/her maxillary anterior teeth will be retroclined to camouflage.

So in pre-surgical orthodontics (decompensation), those retroclined maxillary anterior should be proclined to their original position because if it is left in it’s retroclined position, after the surgery teeth will return to their original position. Due to this decompensation procedure it is more unesthetic for time being and patient must be notified about this thing. Retention is again a crucial factor in surgical orthodontics too. So appropriate retainer should be given to patient.

This is just an overview of orthodontic treatment so that you can have basic knowledge about it. It is a very vast topic and it is impossible to comprise everything in few words. If you are thinking about going for and orthodontic treatment you should always consult an orthodontist.

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