What is Orthodontic Treatment?
Orthodontics derives from the Latin words (orthos = smooth) and (dontos = tooth) and is a branch of science that corrects malocclusion and crooked teeth. In some countries, this science is also called jaw orthopedics.
Orthodontics (orthodontist = orthodontist), a branch of dentistry, is a branch of science that deals with the teeth, jaw and face complex in terms of normal structure and development, anomalies and treatment of anomalies.
Today, the target audience of orthodontics has expanded considerably and its application area has increased at the same rate. According to the results of research conducted in recent years, the importance of preventive dentistry all over the world has created a more conscious audience and there has been a visible decrease in the number of tooth decay cases. Accordingly, the interest in orthodontics has increased as a result of disorders caused by factors such as heredity, developmental deficiencies, various wrong habits (thumb sucking, using false breasts and bottles for a long time, biting lips).
The opportunities offered by preventive medicine to patients may not have been utilized; For example, caries in milk teeth may not have been treated with the logic of "it will change anyway", teeth may have been extracted prematurely, and fluoridation and fissure protection applications may have been ignored.
Each milk tooth has a time and order for it to fall out, and the permanent tooth coming from the bottom also has a time and order for it to erupt. If this order is disrupted, there is a possibility of crookedness in the permanent teeth. For example, the upper canine teeth (canine teeth) are the last teeth to erupt in the mouth. Therefore, the upper primary canine teeth should be the last primary teeth to fall out. If the primary canine tooth is lost early, the upper midline will shift towards that side and the permanent canine tooth will erupt from above and outside the arch. There may even be a possibility that this tooth will remain impacted.
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Genetic factors: It is important, especially in individuals with skeletal disorders, whether there is a similar anomaly in their family history. Hereditary tooth deficiencies, narrow upper jaw, and crowding problems can also be passed on to the child. In this case, the emergence of orthodontic problems is inevitable. What needs to be done is; is to take the child for regular dentist check-ups, starting from the primary dentition period.
Additionally, the child may inherit a small jaw gene from one parent and a large tooth gene from the other. In such a case, the teeth will not be able to fit into the jaw and will be arranged crookedly. Similarly, a large jaw gene can be inherited from one parent and a small tooth gene can be inherited from the other. In this case, gaps (diastema) will form between the teeth.
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Ear - nose - throat problems: (such as tonsillitis, presence of nose and adenoids; constant mouth breathing) can prevent the formation of jaw bones and cause tooth eruption disorders.
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Bad habits: Bad habits such as thumb sucking, using a pacifier or bottle for a long time, tongue sucking, lip sucking, pen biting can also cause orthodontic disorders in teeth and jaw structures.
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Some muscle disorders can also cause orthodontic problems.
After the first orthodontic examination at the age of 7;
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The locations of prematurely lost milk teeth should be protected with fixed or removable space maintainers until the permanent tooth underneath erupts. This prevents the permanent tooth from remaining impacted or protruding towards the cheek or lip.
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Each baby tooth has a fall sequence. When this order is disrupted, the eruption order of the permanent teeth below is also disrupted and this usually results in orthodontic problems. For this reason, even if there is no crowding, it is extremely useful to have children under passive orthodontic follow-up every 6 months.
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Skeletal problems are detected at this age and the family is informed about the treatments (Ex: Protrusion of the lower jaw).
Possible treatments for ages 7-12:
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Jaw stenosis can be easily corrected with screw expansion appliances.
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Teeth in reverse bite are corrected with removable appliances as soon as they are seen.
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The treatment of anterior open bite caused by habits such as long-term use of bottles and pacifiers and thumb sucking is done with habit-breaking appliances.
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Treatment of skeletal problems can be started. Non-oral devices such as face mask, Headgear; The growth of the jaws is directed using functional devices such as bionators.
After age 12 (after permanent teeth are completed);
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'Fixed orthodontic treatment' is started at this age. Teeth are straightened with the help of brackets and wires attached to the teeth.
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If the patient is a case of orthognathic surgery, growth is expected to be completed and treatment begins by placing braces at the age of 16 at the earliest.
There is no age limit in orthodontic treatment. Only the treatment planning and sometimes its duration may change. As long as the teeth and the bone surrounding the teeth are healthy, teeth can move at any age.
The jaw bone is harder in adults. Therefore, the movement time of the teeth is slightly longer. In addition, some skeletal problems (upper jaw being backward, lower jaw being backward, etc.) can be corrected with functional jaw orthopedics at a young age - without the need for surgical intervention - while in adults they can be corrected with orthodontics-surgical cooperation.
Another issue is that adults have more aesthetic concerns. Many adults avoid this treatment because they are uncomfortable with the appearance of the braces. However, today, this concern can be completely eliminated with less visible porcelain brackets, removable transparent plates, or wires attached to the back of the teeth (lingual orthodontics).
Orthognathic surgery is the name of the combined procedure in which the jaws are brought to their correct positions by surgery in addition to orthodontic treatment, in cases of skeletal disorders where only orthodontic treatment is not sufficient to create a more aesthetic appearance on the face.
In cases where dental disorders are accompanied by jaw disorders, braces treatment alone is not sufficient; jaw surgery may also be required. Lower or upper jaw surgery planned by the orthodontist should only be performed by oral, dental and maxillofacial surgeons and plastic surgeons who specialize in this field.
Orthognathic surgical treatment is a surgical treatment for patients who are not satisfied with their facial appearance. In adult patients whose growth and development period has ended, incorrect jaw positions cannot be corrected only by orthodontic treatment (braces). The patient requires surgical intervention along with brace treatment. Thanks to public awareness on this issue and technological advances, orthognathic surgical treatment is becoming increasingly common.
Proper alignment of teeth can be achieved with orthodontic or orthopedic treatment. Interjaw relationships can also be corrected to a limit. However, in some cases orthodontic treatment is inadequate. In such cases, a maxillofacial surgeon can work with an orthodontist to surgically correct a severe anomaly.
Nowadays, with increasing aesthetic concerns, orthognathic surgical treatment is becoming increasingly common.
The treatment protocol applied in orthognathic surgery cases is as follows:
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The decision for orthognathic surgery is made based on the clinical examination of the patient, a number of x-rays (Cephalometric, PA, OPTG) taken from the patient and the results of the drawings made on these x-rays.
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The patient's measurements, photographic records, and medical history are taken.
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By looking at the orthodontic models obtained from the measurements, it is decided whether upper jaw expansion is required. If necessary, this usually requires surgical intervention called corticotomy (after the age of 15, maxillary expansion is not possible without surgical support called corticotomy). The device that will expand the upper jaw is glued to the mouth and a corticotomy is performed on the patient by the surgeon. Chin expansion takes an average of 15 days. Afterwards, the expander device is kept passively in the mouth for 3 months (for reinforcement purposes). At the end of 3 months, the expansion appliance is removed from the mouth. Classic wires are attached.
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If jaw expansion is not required, direct wires are placed and orthognathic surgery preparation begins. Since the treatment is performed according to the 'post-operative position' in cases preparing for orthognathic surgery, measurements are taken from the patient at certain periods (every 3-4 months), the need for treatment is determined and the treatment is directed accordingly.
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By the way, if the patient's wisdom teeth are in the mouth - especially the lower wisdom teeth - these teeth should be extracted at least 6 months before the surgery, as they will remain in the incision line during the surgery.
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The duration of treatment varies depending on the severity of the case. After approximately 12-18 days, the patient is ready for surgery.
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The patient receives an appointment for surgery from the surgeon.
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The orthodontist takes a new Cephalometric, PA and OPTG from the patient 10 days before surgery. The patient's final measurements and photographic records are taken. In the light of all these records, the Orthodontist (with the opinion of the Surgeon) plans the surgery.
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The orthodontist prepares the splints to be used during surgery in accordance with the surgery planning and tries these splints in the patient's mouth a few days before the surgery. He attaches surgical hooks to the patient.
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The patient goes to the surgeon with these splints and has the surgery. The orthodontist also participates in the surgery - unless there is a significant obstacle. The operation takes an average of 4-5 hours (varies depending on the case).
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During the surgery, the upper jaw and lower jaw are fixed in their ideal positions. On the first day, the patient's mouth is left open (to avoid the risk of vomiting). On the 2nd day, the splint is placed back in the mouth and the mouth is closed with elastics attached between the lower wires and the upper wires. The patient can no longer open his mouth. The patient's mouth remains closed for 3-4 days (sometimes 1 week). The patient is discharged 2-3 days after the surgery (at the surgeon's discretion). Meanwhile, the patient is fed through a straw because he cannot open his mouth.
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At the end of a week, the patient comes to the Orthodontist and the mouth is opened. The splint is attached only to the upper jaw, leaving the patient's mouth open. However, we are taught how to remount tires. Thus, the patient takes off the elastics and opens his mouth while eating (in the meantime, he can start eating soft foods), and puts them back on after eating.
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At the end of two weeks, the splint is removed. After this stage, the Orthodontist continues the treatment to ensure the ideal relationship between the lower jaw and the upper jaw. This period varies between 3-6 months.
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After the ideal relationship between the lower jaw and upper jaw is established, the treatment is terminated by removing the wires and installing reinforcement devices.
A bad bite creates aesthetic problems. This is one of the main reasons why individuals go to the orthodontist for treatment. Additionally, functional losses occur in chewing. Another situation is the difficulties and restrictions in maintaining oral hygiene of individuals with orthodontic disorders, which causes tooth decay and inflammation in the gums.
If we briefly list the disorders in teeth and jaws;
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Crossbite
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Tooth crookedness
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Deep Closing
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Openbite in Front Teeth
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Jaw stenosis and other orthopedic anomalies.
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If you have easily noticeable crookedness in your teeth, glaring forwardness, backwardness, curvature in your lower or upper jaw, or any incompatibility with other parts of the face,
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If there is something that bothers you about your smile: for example, your gums are excessively visible when smiling or dark spaces appear at the corners of the mouth,
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If you have biting and chewing problems due to your jaw and teeth relationships,
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If you have severe mouth breathing, thumb sucking, nail biting, or have had some long-lasting habits like this in the past,
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If you have difficulty closing your mouth, if your lips are not enough to close it,
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If you are hearing noise from your jaw joints, feeling pain in your jaw muscles or experiencing jaw locking, if your lower jaw is trapped inside your upper jaw,
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If you were born with cleft lip and palate or a similar syndrome,
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If there are members of your family who have had orthodontic problems or lost their teeth at a very early age,
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If you have at least one missing tooth in your mouth and other teeth have started to shift towards that area,
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If you cannot clean your teeth well due to crookedness and therefore experience gum problems or if you need to whiten your teeth,
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If you have large gaps between your teeth,
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If your dentist has difficulty in making your crown or filling due to the position of your tooth,
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If early milk tooth extraction was performed,
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If you swallow and speak by putting your tongue between your front teeth, if your incisors do not contact each other vertically when you close your back teeth,
All of these are indicators that you may be a candidate for orthodontic treatment.
At the first appointment, cephalometric and panoramic x-rays are taken from the patient. Conditions in the mouth that you cannot see on an x-ray but may completely change the treatment plan may be detected. Photographs documenting the initial state of the patient and measurements are also taken to create a plaster model.
Treatment planning is made on these records as a result of some analyses. In the next 1-2 appointments, the planned procedures are performed and braces or other selected therapeutic orthodontic mechanics are applied to the patient. Treatment begins. Checks begin every 3 to 6 weeks, depending on the type of procedure being performed. Changes and activations are made to the wires, if necessary. This continues for the prescribed treatment period. The patient must follow exactly what his doctor says throughout the treatment. Therefore, orthodontic treatment is a treatment that requires family-patient-doctor cooperation.
The result depends on the doctor's knowledge and care and the patient's cooperation. If these are in place, treatment success is 100%. At the end of the treatment, after the wires are removed, reinforcement appliances are applied to prevent the teeth from returning to their previous state. The doctor selects this device according to the patient's initial and final condition. A transparent plate, a boxer mouthguard-style appliance, removable palate or a thin wire adhering from the inside can be chosen as the reinforcement device. The ideal reinforcement period should be half of the active treatment period. While there may be situations that do not require reinforcement, there may also be situations that require reinforcement for a very long time. Reinforcement devices are gradually abandoned. Treatment cannot be stopped suddenly.
We can say that there are basically two types of treatment methods. 'Removable devices' that can be inserted and removed by the person themselves, and 'fixed devices' that are attached to the teeth by the doctor. These can also be divided into subgroups. For example, mobile devices: may be for treatment purposes or post-treatment reinforcement purposes.
Fixed devices can be roughly divided into wires attached to the back surface of the tooth and metal and aesthetic wires attached to the front surface. Everyone's problems and expectations are different. It is necessary to determine the type of treatment that will be most suitable for the patient. Materials and treatment types vary.
Just as the age of treatment varies from person to person, the duration of treatment also varies depending on the character of the problem. The shortest treatment period is 6 months. The majority of treatments last 1-2 years. There may also be treatments lasting 3 years. In some special cases, such as cleft lip and palate, the treatment period is extended.
Orthodontic treatment is definitely not a painful procedure. There may be some minor problems with getting used to it in the first one or two weeks. Apart from this, the patient continues his normal life by paying some attention to what he eats. Except for some special cases, it is generally necessary to see the doctor every 4-6 weeks for check-ups and adjustments.
Orthodontic treatment corrects crooked teeth and incompatibility between jaws. This treatment is not only for aesthetics, it also helps to prevent possible gum diseases and problems in the lower jaw joint in the future, as well as to correct chewing function and impaired speech.
How much is orthodontic treatment necessary?
Essentially, the main goals of orthodontic treatment are; The aim is to improve chewing function, improve speech function, help provide better oral hygiene, ensure aesthetics and provide psychological support by increasing the patient's self-confidence in society.
In this context, we can talk about 3 basic gains of orthodontics: Aesthetics, hygiene-health and function.
Aesthetic: With orthodontic treatment, it is possible to have a straight line of teeth and a more beautiful smile.
Hygiene-health: Caring for crooked teeth is much more difficult than properly aligned teeth. Even if great care is taken to clean the teeth, a crooked tooth is either positioned further forward or further back than it should be on the jawbone. For example, since there will be insufficient bone on the front surface of a tooth that lies outside the jawbone, the possibility of gum recession on the front of the tooth is extremely high (the gum follows the bone).
Function: If there is no correct bite, the possibility of jaw joint discomfort increases. In addition, unused teeth decay more easily because they cannot be cleaned well (chewing and saliva have a cleaning effect). An individual who does not have a correct bite feels uncomfortable because he cannot chew adequately, and may experience digestive problems because he swallows food without chewing completely.
In the light of all this information, the decision whether to receive treatment or not is made by the 'patient' after being informed about his or her situation.
Aparey means "device". All devices used in orthodontic treatment are referred to by this name. Appliances are very diverse.
Some appliances can be removed and worn orally. These are called "moving apparatus". The springs and screws placed on them apply a force to the teeth or jaw to be corrected. Some of the removable appliances sit on both the lower and upper jaw simultaneously, and orthopedic treatments are performed with these single-body (monoblock) devices.
Some devices consist of a corrugated metal (bracket) adhered to the teeth and wires applied to these corrugated metals. These are called "fixed appliances".
The decision regarding the selection of the appliance is made by the orthodontist. As a rule, the most effective treatment is considered as soon as possible. In addition, the child's desire for treatment, compliance and the family's economic conditions also affect the choice of appliance.
How many types of orthodontic appliances are available?
They are divided into two: fixed and mobile devices.
There are also extraoral appliances that are additional to fixed appliances. These are fixed appliances that are generally used in today's modern orthodontics. In some simple cases, removable appliances are also used. It is more comfortable for the patient to use, more hygienic and easy to clean, as opposed to removable and removable appliances. constitute its advantages. In fact, removable appliances have never been able to compete with fixed appliances in terms of treatment effectiveness and have remained as old technology.
You can choose from metal, porcelain and plastic brackets. But orthodontic treatment is generally performed using stainless steel brackets. Porcelain and plastic brackets are generally preferred for aesthetic reasons, but at the end of the treatment, plastic brackets may be stained and discolored. With brackets made of plastic or porcelain, treatment time may be longer because there is more friction between the wires and the bracket.
In addition, there are systems with and without lids for both metal brackets and porcelain brackets. In the valved system, the total duration of the treatment and the session duration are shorter than in the valveless system. However, the lidded system is compared to the lidless system; Porcelain brackets are also more expensive than metal brackets.
Your orthodontist will share possible options with you.
After orthodontic treatment, immediately after the teeth straightened, the structures around them (periodontium) could not adapt to the new position of the teeth. Additionally, bone tissue is immature. Therefore, if the appliances are removed, the teeth can return to their original positions. To prevent this, it is necessary to reinforce the straightened teeth with other devices. This final stage of treatment is called consolidation therapy. It is essential to take necessary care of the teeth during this period.
After orthodontic treatment, teeth tend to return to their original positions. To prevent this (until the realignment of the bone and surrounding tissues is completed), the teeth should be kept in their corrected positions. For this purpose, mobile or fixed reinforcement devices are used.
The word "Lingual" means the tongue side of the teeth. There are different types of this system using roughly fabricated or custom-made brackets. Brackets are glued to the inner surfaces of the teeth facing the tongue instead of the outer surfaces.
Lingual orthodontics is the most aesthetic form of orthodontic treatment performed by gluing the brackets to the back surface of the teeth, thus making the wires invisible. It is an ideal treatment, especially in the treatment of adult patients. The brackets applied are completely different from the brackets applied to the front surface of the teeth. Since the structure of the back surfaces of the teeth show different slopes and surface properties compared to the front surfaces, these brackets are indirectly bonded to the teeth as a result of a special laboratory process.
There are also special treatment methods known as Incognito and Harmony in lingual orthodontics. In these techniques, gold and nickel-titanium alloy brackets that can be completely adapted to the patient's teeth are produced with the CAD/CAM system. The treatment is applied with wires containing twists specially prepared for the patient.
Orthodontics corrects the disorders in the tooth rows due to various reasons with removable and fixed mechanisms; Jaw orthopedics covers orthodontic treatments that correct the incompatibility of the lower and upper jaw with each other or with the face.
Nowadays, due to the development of technology, it is possible to apply both treatments not only in children but also in adults.
It is possible to correct problems such as irregular tooth rows, crowding due to lack of space, teeth settling in a different position instead of where they should be due to various eruption disorders, with fixed devices (by attaching brackets and wires) or, in milder problems, with removable transparent plates.
These treatments can generally take 3-4 months if the problems concern one or two teeth, and approximately 18-24 months when the number of teeth is larger.
Orthopedic problems involving the jaw bones, such as the upper or lower jaw being too far forward/backward and the gap in the front area, can be caused by the use of various extra-oral headgear and face masks in children, depending on the needs of the case; It is corrected by using fixed or mobile intraoral devices. These treatments may have several stages.
For example, there is upper jaw retardation in the case. Treatment begins at age 8 with the use of a (non-oral) face mask. This treatment lasts for 6 months (varies depending on the case) and active treatment is terminated after the upper jaw has been moved forward sufficiently (after the skeletal disorder has been eliminated). Afterwards, the patient is waited until the permanent teeth erupt and the patient is followed up passively for 6 months. After the permanent teeth erupt, fixed orthodontic treatment (attachment of brackets and wires) is started to correct the crookedness and establish the ideal closing relationship between the lower jaw and the upper jaw.
Treatment lasts approximately 1 year (varies depending on the case) and orthodontic treatment is terminated. Thus, the total active treatment period lasted 18 months, but the patient will be followed by the orthodontist for 5 years between the ages of 8-13.
There is no need to worry too much about the position of the first teeth (baby teeth) in children. The gaps between these teeth are indicators of natural development. Tight contacts, as in the teeth of adults, may be an indication of lack of space and therefore crooked teeth that may occur in the future. Permanent teeth begin to erupt at the age of 6-7. However, there are not many problems between the ages of 7 and 9, until the incisors erupt. Each milk tooth has a falling time and sequence; Therefore, every permanent tooth has a eruption time and order. Until each milk tooth is permanently replaced should be kept in place. Disruption of this order causes loss of space, and loss of space causes clutter.
Even if your family doctor refers you to an orthodontist at an early age, this does not always mean that treatment will be started too early. Most careful dentists want to make sure that a potential problem is under control and that the optimal time for treatment has not passed. While it is necessary to intervene in children's jaw problems at an early age, there is time for treatment only in cases where the teeth are irregular.
The teeth of adult patients can also be moved, so there is no time limit for such treatments. It may be possible that increasing age will prolong the treatment period and make the treatment a little more difficult. However, the age factor is not as important as the health of the supporting tissues of the teeth.
Generally, tooth crookedness is caused by wires, rubbers and springs attached to metal buttons called brackets, which are glued on the teeth.
Orthodontic treatment with transparent aligners is a treatment method developed to be applied in appropriate cases - mild and moderate dental disorders. In this treatment method, the treatment stages of the teeth are planned on the digital platform and the teeth are moved towards their ideal posture positions.
Depending on the case, a certain number of transparent plates are prepared digitally. Each plate prepared is used by the patient for the period determined by the doctor. For example, if 5 plates are prepared for the patient (the number of plates may increase depending on the severity of the case), each plate is used for the period determined by the doctor and a gradual improvement is achieved in certain amounts in each plate.
In this method, it is possible to move the teeth effectively, accurately and quickly towards the desired ideal position by applying light pressure through almost inconspicuous transparent appliances.
Advantages of Transparent Records
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The biggest advantage is that the tooth and mouth structure that will emerge as a result of the treatment can be displayed to the patient as a 3D visual simulation.
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transparent appearance
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It is light due to its thinness.
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It provides maximum ease of use thanks to its extremely thin and soft elastic material.
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There is no need for anesthesia during the treatment process.
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The entire treatment is planned with just one measurement, there is no need to take measurements every session.
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The apparatus does not cause speech impairment. It can be used without any problems, especially when working in lines of business where voice and speech are predominant.
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It does not cause an allergic reaction. It can be put on and removed and thus does not cause any change in eating habits.
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It can be removed whenever desired, so it does not affect social life.
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It can be applied to both children and adults.
Disadvantages of Transparent Records
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They need to be removed before each meal and reinserted after the meal. It requires patient cooperation and discipline as it must be kept in the mouth at all times, except for meals.
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Because it is thin, it is fragile and must be kept in a box when removed.
Individuals receiving orthodontic treatment need to pay more attention to oral hygiene. Braces do not rot teeth. On the contrary, the areas where the brackets are glued are protected from decay because bacteria cannot get under them. However, more food accumulates on teeth with brackets.
If plaque is not removed from teeth and brackets, it can lead to gum disease, decay and bad breath. Plaque is a mixture of bacteria, debris and food particles. Bacteria feed on sugar and produce acid, which makes the gums sick and damages the enamel layer of the tooth. They cause bad breath in the mouth. It is important to clean the plaque regularly and properly. Thus, when the brackets come off, the tooth below will be healthy and strong. When the brackets come off in patients with poor oral hygiene, it can be seen that the part under the brackets is preserved and the surrounding area acquires a chalky white color, indicating that the enamel has weakened.
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Brushing teeth
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Floss
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Fluoride
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Auxiliary Tools
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Proper Nutrition
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Dentist Visits