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Orthodontics is a dentistry branch which is concerned with the diagnosis, prevention and treatment of irregularities of teeth, jaws and face. The most significant purpose of orthodontic treatment is to sustain required closing rapport in order that teeth on both maxilla and mandible can function properly. This is achieved through harmony between uniformly rowed teeth and the teeth on the opposite row. A good closure of mouth makes biting, chewing and speaking easier. In this way, it helps to improve oral health and health in general and enhances one’s self-confidence. In addition to functional straightening, another important target is to meet an individual’s aesthetic expectation. The reason for aesthetic dissatisfaction can sometimes be a simple occasion such as unevenness of a single tooth while sometimes it can be a severe condition such as volumetric anomalies and disharmony between mandible and maxilla. For this reason, the type, duration and results of orthodontic treatment show changes from person to person. The important thing is to determine a patient’s expectation and orthodontic anomaly and to achieve the best within the shortest time with appropriate planning and treatment.
Orthodontists are concerned with teeth arrangement and jaw relationships while general dentistry focuses on treatments concerning dental and gingival health. In our country, specialty on orthodontics require 4-6 years of specialty education after 5 years of dental education. Orthodontic treatment must be applied by an Orthodontist.
Jaws and teeth of some people do not develop uniformly. This results in uneven rows and irregular relationships with the teeth on the opposite jaw. Since it affects one’s facial and teeth appearance, this situation can give result to prudency, lack of self-confidence and even to depression. Advanced defects can aggravate functions such as eating and speaking, and make it difficult to clean teeth. Orthodontic defects can be seen on teeth or jaws, or on both.
Crowded Teeth : There are conditions in which no sufficient place is left to even alignment of teeth as a result of the reasons such as stenosis of jaws, oversized teeth and forward movement of grinder teeth subsequent to precocious loss of teeth and thus their pressing the places of forerunner teeth. Crowded teeth is seen as a result of this condition.
Diastema : It defines gaps between teeth. It can result from missing teeth, volumetric insufficiency of teeth or lengthiness and strength of muscle extensions which connect lips to gums.
Impacted Tooth : It occurs when teeth remain within bones due to dentition failures and narrowness of jaws.
Cross bite : It occurs when one or more teeth do not fall before as it should but behind in lower teeth. It can also occur with rear teeth as with incisor teeth.
Missing Teeth : It can occur innately as it can also be the result of tooth extraction due to tooth decay and trauma.
Deep Bite : It is the case when upper incisor teeth close lower incisor teeth disproportionately when jaws are closed.
Open Bite : It is the case when central or lateral teeth cannot be closed as they should, when there is a gap between them. It can be seen as a result of thumb sucking, teat sucking and tongue’s falling between two teeth when swallowing.
Stenosis in Jaws : It be seen in mandible and maxilla genetically or as a result of mouth-breathing, thumb sucking etc. The treatment is easily applied during growth development in case diagnosed in its early period. In case not treated, it can lead to disorders such as crowded teeth, impaction and mandible’s falling behind.
Positional Disorders of Jaws : Maxilla should take place a little bit before mandible, so that when maxillary incisor teeth is closed it can fall in just before the lower incisor teeth. However, mandible and maxilla can take place ahead or behind their usual positions due to genetic or environmental factors. This case leads to incompatibility between mandible and maxilla and to malocclusion. It should be treated during growth and developmental period since it is a disorder concerning also skeletal structure.
A general examination should be conducted prior to orthodontic treatment. Decays should be treated in case there are any on or between teeth. Any gingival diseases or disease onset should be treated, if any. It is crucial to remove decayed teeth, provide firmly filled teeth and healthy gingivas before orthodontic treatment is started. Panoramic x-ray should be obtained before the treatment. An examination should be made on x-ray in order to see whether there is a tooth decay which could not be detected in the general examination, whether there is an anomaly with teeth roots or whether there is a wisdom tooth and any impacted tooth or any extra tooth. Subsequent to examination and required precautions, the patient is given detailed information about oral health and is observed whether the patient applies it properly. In case the environment is suitable for treatment, treatment can be planned.
Subsequent to general examination and dentistry processes, orthodontic treatment can be started.
In order to provide an accurate and a durable treatment, accurate planning is crucial. Accurate orthodontic planning also has various phases. The first stage of orthodontic treatment and planning is clinical examination. An orthodontist carefully examines a patient’s teeth, mouth-closing, jaws and face. Then, plaster models are prepared with the measurements taken from teeth for further treatment planning. X-rays are obtained from profile and, if needed, frontally and wrist x-ray is obtained for bone age determination in case growth development case of individual is critical for planning. Extra oral and oral photos are taken during the process. Orthodontist determines on treatment planning in the light of these data. Orthodontist makes millimetrical calculations on the models and conducts analyses on x-rays and photos in order to calculate the placements and lengths of jaws and teeth. Professional analysis programs are available today for these calculations. Dolphin Cephalometric Analysis Program is used in our clinics. Subsequent to planning, the patient is informed about the process, requirements and potential consequences of treatment. In case needed, tooth extractions are made and then orthodontic treatment is proceeded.
Early Period Orthodontic Treatment
The dentition of permanent teeth can be provided to proceed frontward or rearward through small etchings on incisor or molar teeth enamels of deciduous teeth. This method can be effective on the treatment of crowded teeth and the removal of slight gaps between teeth.
The treatment is conducted through serial extraction of first deciduous teeth and then permanent teeth in case crowded teeth is foreseen when permanent teeth replace the deciduous teeth. Thus, proper dentition is provided for permanent teeth since there will be enough place on jaw for dentition. Even though further treatment is needed after this stage, it can be concluded with a shorter and easier treatment.
These are apparatuses which can be applied and unapplied during deciduous or mixed dentition periods. These can be applied in case of anterior open-bite which is seen as a result of crowded tooth or crowded teeth, cross bite, stenosis of jaw, difficulty in swallowing and thumb sucking. Children can use their apparatuses in particular periods of time under the guidance of their parents. Some apparatuses can contain screws which can be opened by parents. Removable apparatuses can remove the need for future constant or long term orthodontic treatment or can reduce the duration and hardship of this treatment.
Today, the most common orthodontic treatment method is constant orthodontic treatment with brackets. Except for special cases, dentition of all permanent teeth is required in order to start treatment. All teeth are bonded with brackets specially designed for each tooth. In the bonding process, materials similar to general tooth filling material are used. The connection between teeth and jaws are adjusted with wires, springs and rubber bands which are placed among brackets.
Aesthetic brackets which are used among common metal brackets are developed in order to meet patient’s aesthetic expectation during treatment. These are produced from aesthetic materials such as composite, ceramic and sapphire. The biggest advantage of them is their aesthetic appearance. However, there are also some disadvantages such as extended treatment duration and increase in the contamination risk around brackets due to increased frictions of mechanical apparatuses. Today, new materials and aesthetic and metal combined systems are developed in order to minimize these disadvantages.
Generally applied to skeletal stenosis of maxilla in patients who are in growth and developmental period. Maxilla is composed of two joined bones both on the right and the left of the mouth. In cases of maxillary skeletal stenosis due to mouth breathing, thumb sucking and genetic inheritance, screwed apparatus is bonded to teeth prepared subsequent to measurement of maxilla. The distance between maxillary bones are extended through periodical activation of the screw and a skeletal augmentation is obtained. Subsequent to augmentation, constant orthodontic treatment is proceeded for reinforcement after apparatuses are kept in mouth for a particular time.
Functional apparatuses are used in the treatment of positional anomalies that are seen between mandible and maxilla. They can be applied as moving or stable apparatuses. The most common use is the case when mandible is located behind its usual position. Patient’s growth potential is conducted through applied functional apparatuses and mandible is placed in its ordinary location.
The use of extra oral apparatuses gradually decrease today. As the name suggests, they are supported by extra oral area, nape, head, forehead and jaw. They are used in the adjustment of anteroposterior relations of mandible and maxilla. They are generally used in growth developmental period.
In addition to brackets, oral apparatuses can be produced and used for stabilizing or moving upper grinder teeth backward and stabilizing lower grinder teeth after measurements are taken from teeth.
In current bracket systems, plastic or metal elements which are called ligature are placed among brackets bonded on teeth. In self-ligating brackets, ligatures are not needed thanks to self-ligating elements on brackets. In this way, since ligaturing is not required, orthodontic séance can be shortened and also the duration of total treatment period can be reduced thanks to decrease in friction. Besides, contamination risk of food residues or bacterial plaques is less compared to rubber ligatures. When there is a need to choose between exodontic treatment planning and vice versa, there is a chance to apply treatment without tooth extraction thanks to self-ligating brackets and augmenting braces.
Similar to Dental Implants which are applied today in place of missing teeth, orthodontic implants are used which are smaller and should be placed in mouth temporarily. The purpose of this application is to obtain support from various skeletal areas while moving teeth thanks to mini-implants. It can be applied easily with local anesthesia and can be extracted easily once the process is completed.
Today, thanks to the developments in orthodontics, orthodontic treatment can be applied to almost all age categories. There is an increasing demand in orthodontic treatment thanks to contemporary aesthetic requirements and awareness. Adult orthodontic treatment is generally similar to standard fixed orthodontic treatment. Metal brackets or, in accordance with patients demand, aesthetic brackets can be used. The significant point is the changes in tissues surrounding teeth due to increasing age. Considering these changes, accurate treatment should be applied with suitable mechanics and forces.
In addition to current bracket systems, there are also various systems developed in order to meet aesthetic demands of adults. These are plaque systems which are called Lingual Orthodontics and Clear Aligner.
Lingual orthodontics is a system which is developed for back surfaces of teeth in order to fulfil the lack of aesthetics of bracket systems which are applied as a standard to front surfaces of teeth. Generally brackets are produced specially for each patient after teeth are measured. Since they are applied to back surface of teeth, they are not seen from outside. However, these brackets have some disadvantages for they discomfort tongue and affect speaking. In addition to this, since lingual brackets are produced specially for each patient, the prices of treatment is higher compared to fixed orthodontic treatment.
Generally applied in simple or midlevel crowded teeth and sparseness cases. It is a system which moves teeth through transparent plaques and which can be applied and extracted by patient. Plaques to be used during treatment period are produced after measurements are made on teeth and monthly plaques are produced in accordance with the measurements conducted each month. These should remain on teeth except for eating. They can discomfort speaking up to a degree since they surround teeth on both sides. However, since they can be extracted easily by patient, they are widely preferred.
Orthognathic surgery is a surgical method which helps to restore deformities of jaws. It is applied when maxilla or mandible is positioned ahead or behind their required location, and when an asymmetrical appearance occurs in frontal view. It is also a technique which can be required when maxilla and mandible are not accordant with each other or with teeth. In this type of treatment, an Orthodontist and a Plastic Surgeon work together. Teeth are prepared orthodontically and then jaws are repositioned surgically. These processes do not only improve facial appearance but also help teeth to be in accordance and to function properly. In this way, patient can chew and speak better. It provides both an aesthetic and functional betterment. It can be applied to either or both of the jaws according to severity of the case.
The most important factor of a successful orthodontic treatment is its permanency. For that reason, even though treatment is completed, braces should be left on teeth for a period of time for reinforcement. Apart from this, fine braces are applied to back surface of incisor teeth and transparent or braced plaques are applied to upper or lower or both teeth which can be applied or extracted easily. Reinforcement method and duration can show changes for each patient. The crucial point here is to abide by what Orthodontist suggests and not to miss routine controls. In case any problem occurs with reinforcement braces or apparatuses, routine controls should not be waited and an Orthodontist should be seen as soon as possible.
The duration of orthodontic treatment show changes according to the type and severity of anomaly, age and sex of patient, and whether patient follows rules and appointments. The duration of treatment differs for each patient. When treatment is started, orthodontist informs about the estimated duration. However, the anticipated duration can last longer or shorter due to various reasons.
The cost of orthodontic treatment can change according to type and severity of orthodontic anomaly, age of patient and treatment system to be applied. Charging is generally made in foreign currency since almost all the materials used in orthodontic treatment are imported and prices are periodically updated in accordance with the changes in currencies. Patients will be informed by an orthodontist about the cost of treatment after planning.
Orthodontic treatment is applied to almost all age categories thanks to the developments today. However, it is significant to be in growth developmental period for the treatment of certain skeletal anomalies. For this reason, children should be brought to orthodontic examination regularly.
During orthodontic treatment, activations on apparatuses and braces are generally made once in 3-6 weeks. The next control date is appointed by orthodontist during the previous treatment.
