Orthodontic Treatment and Our Goals
Orthodontics is a department that aims to diagnose and treat dental and skeletal disorders and, if possible, to prevent disorders that may occur in the early stages. In all orthodontic treatments, it is aimed for patients to gain an ideal facial aesthetic as much as possible and to regulate the patient’s smile line. It is aimed to create more easily cleanable surfaces by correcting the anomalies in the alignment of the teeth, thus prolonging the duration of the teeth in the mouth. It is aimed that the teeth and jaws function ideally by correcting the occlusion disorders, thus minimizing the adverse forces on the teeth and the harmful effects of these forces. It has been reported that there are positive developments in the self-confidence of the patients as a result of the improvement of the dental and skeletal disorders of the patients following orthodontic treatments.
Orthodontic Treatment Planning and Types of Treatment
The priority in orthodontic treatments is to determine the treatment need of the patient with clinical examination, records taken from the patient and radiographic analysis. The patient’s need for treatment may be dental, skeletal, or a complicated condition involving both. The patient’s treatment expectation, habits, socio-economic status, age, work or school life are taken into account when creating the treatment plan. The treatment plan is explained to the patient in detail and the treatment plan that the patient can adapt to is preferred. Sometimes the ideal treatment may not be a good choice for the patient. Especially in adult patients, it is tried to reach an optimum point.
Dental problems are corrected with removable appliances or fixed braces, depending on the level of completion of the patient’s dentition. If skeletal disorders are to be treated in individuals in the growth and development period, treatment with removable appliances can be started in the early period, followed by fixed treatment, and even an extraoral device can be added to the treatment plan depending on the type of disorder.
The period when milk and permanent teeth are together in the mouth is the mixed dentition period. This period is considered the early period for orthodontic treatments. In this period, which is suitable for minor corrections involving one or more teeth, effective results can be obtained with the use of intraoral removable appliances and orthodontic treatment can be completed without the need for fixed treatment.
Fixed orthodontic mechanics are used for dental corrections if no orthopedic or orthognathic surgery is to be applied in patients who have no deciduous teeth left in the mouth and have erupted permanent teeth. In this treatment, while tape or tube is placed on the rearmost teeth, brackets are attached to the remaining 10-12 teeth. Brackets can be metal or ceramic. In addition, with the help of wires and tires, both stability and force transmission are provided. Different orthodontic treatments can be applied according to the attachment places of the brackets; The standard fixed orthodontic treatment applied from the outer surfaces of the teeth is called the labial technique, and the fixed orthodontic treatment applied from the inner surfaces of the teeth facing the tongue and palate is called the lingual technique. Although it has been reported as an advantage that the lingual technique stays behind the teeth and eliminates the aesthetic anxiety of the patients, the long adaptation period of the patients to the treatment has been reported as a disadvantage in the literature. Situations such as increased salivation, tongue sores, and in some cases, opening of the posterior lateral teeth due to early contacts in the closing of the jaws, may disappear in about 3-4 weeks. Unlike bracketing methods, orthodontic treatments are also carried out with transparent plaques, where wires are no longer used. Orthodontic treatment with clear aligners is not suitable for every case. However, if the orthodontist decides that the case is appropriate, the measurements taken from the patient are sent to the center where the planning is made, and computer-aided analysis and treatment planning is created. The initial state of the case for which treatment planning was created and the possible ending state of the treatment are shown to the patient. In addition, the patient is informed about how long the treatment will take on a weekly basis. Regardless of the treatment method, the general principle is to change the positions of the teeth as desired by applying constant and light force in a controlled manner. With the developing technology, more comfortable, less noticeable and faster tooth movement materials can be reached for patients.
Treatments are longer-term treatments compared to other areas of dentistry. Giving patients an exact time can be misleading. Therefore, each case is evaluated individually. Disruptions that may occur during the treatment may affect the duration of the treatment.
General Discomfort and Adjustment
In the first week after your braces are put on, you are likely to experience increased salivation, sores on the lips and cheeks, difficulty in making certain sounds in speech, pain, and a general feeling of discomfort. This period can be up to 1 month in the lingual technique, and the area where the wound is formed is the tongue, not the lips and cheeks. It takes time to get used to the strings that have never been in the mouth before. In this process, the use of painkillers may be required to relieve the pain. The parts of the cheek and lips or tongue that come into contact with the brackets change after a while to protect themselves. Protective waxes are used to prevent irritation of soft tissues.
How to Feed in Fixed Orthodontic Treatment?
Eating soft foods in the first days of treatment will facilitate compliance and cause less pain. Consumption of hard and crunchy foods, consuming foods such as carrots, cucumbers, apples, corn by biting, drinking acidic beverages, consuming core foods such as olives, cherries, plums, peaches, apricots, and consuming foods such as Turkish delight, dates, pulp, gum and dried fruits This may cause the brackets to become dislodged, thus prolonging the treatment period. Consumption of such foods should be reduced as much as possible. They can also form the beginning of caries around the brackets. During the treatment, care should be taken to eat as a service instead of the foods to be eaten by biting between bread, especially to cut and chop the hard and seeded foods and consume them in the form of small bites.
What to do if bracket, band or wire comes out in orthodontic treatment?
Breakage or dislocation of the bracket, tape or wire is common in the early stages of treatment, as the patient is in the process of getting used to it. When the familiarization process is completed, the patients learn the points they need to pay attention to and such situations are not observed. However, in cases that recur frequently, it is thought that the patient does not pay due attention to his treatment, and it is informed that the treatment period will be prolonged in this way. Because, sticking the broken bracket/tape continuously in the control appointments delays the progress to the next stages and accordingly prolongs the treatment period. The patient should change his eating and drinking habits as recommended and behave more carefully.
Patient Compliance and Paying Attention to Appliances
In order for the planned treatment to be concluded successfully and within the prescribed time, the physician and the patient should work in harmony, and the patients should use the recommended intraoral and extraoral appliances and elastics in the required shape and time. Being honest with their doctors and themselves about the use of appliances and elastics will contribute positively to the course of the treatment. It should not be forgotten that appliances and elastics that are not used as recommended by the doctor give the patient away as a result of the absence of expected changes in the teeth at the control appointments, and this not only prolongs the treatment period, but also prevents the expected ideal correction from occurring.
Ensuring Oral Hygiene
In fixed orthodontic treatments, brackets and bands attached to the teeth will make it difficult to provide oral hygiene. It is possible to provide complete oral hygiene by choosing orthodontic toothbrushes, single-bundle interface cleaners, interface brushes and dental floss suitable for the presence of orthodontic wires, and by giving more effort than normal dental care. Inadequate oral hygiene can cause various discolorations and even tooth decay during orthodontic treatment. In addition, as a result of poor oral hygiene, the formation of calculus and gum disease, bleeding, redness and swelling of the gums is inevitable. Patients have unhealthy teeth in the correct position by removing the braces. However, in patients who take the necessary care and have good oral hygiene, the teeth remain healthy during orthodontic treatment.
The Importance of Age in Orthodontic Treatments
If the orthodontic problem only consists of teeth in the wrong position such as crowding, interdental spaces, crooked and turned teeth, it is called dental orthodontic problems. However, in addition to these conditions of the teeth or if there is incompatibility between the jaws alone or if there is an open or deep bite, they are called skeletal orthodontic problems.
There is no age limit for treatments for dental orthodontic problems. Orthodontic treatment can be performed on patients of all ages. Even if the patient is at an advanced age, orthodontic treatments can be applied in the presence of healthy bones, gums and teeth.
In skeletal orthodontic problems, the age of the patient determines the treatment that can be done and the result that can be obtained. The jaws of the patient, who have not yet completed their growth and development, are guided by orthopedic forces. In adult patients without growth potential, orthopedic forces are useless to correct the skeletal defect. For this reason, the orthodontist and the surgeon carry out the treatment together in order to eliminate the skeletal bite disorder and they recommend the patient to have orthognathic surgery.
At What Age Should The First Orthodontic Examination Be Performed?
An orthodontist can be examined at the earliest around 6-8 years of age. If there is a visible front closing in the upper or lower jaws of the mother and / or father, if the child has used a pacifier for a long time, if the child’s upper front teeth protrude forward, if the milk teeth are lost earlier than they should, if there is mouth breathing, if there is a habit of thumb sucking Orthodontic examination is recommended without wasting time. Thus, it is possible to perform treatments such as rapid jaw expansion with preventive and protective procedures that can be done in the early stages. These treatments are usually treatments aimed at directing chin growth or slowing the growth of an overgrown chin. In addition, there may be the production of appliances that can eliminate bad mouth habits such as thumb sucking.
With an orthodontist examination at an early age, loss of time is prevented in case any orthodontic treatment is needed. The orthodontist monitors the growth and development of the jaws in patients who come for regular check-ups, makes relevant referrals if the teeth need to be guided, and tells the most appropriate age to start if orthodontic treatment is needed.
Intraoral Removable Appliances
They are appliances that are not attached to the teeth, can be easily used by patients, and are removable. They are generally used for simple tooth movements, correction of slight crowding and enlargement of the jaws. They can also be used as placeholders for missing milk teeth or as a retaining appliance after orthodontic treatments.
Extraoral Removable Appliances
They are appliances used to direct the development of the jaws by taking support from the chin tip, forehead, neck or head. In addition, they provide the force to change the position of the teeth collectively.
Functional Appliances
They are appliances that can be fixed or mobile, that use the daily functions of the patient (eating, speaking, swallowing, etc.), thus aiming to ensure a smooth relationship between the teeth and jaws by transmitting the forces created with the help of muscle tone to the teeth and/or jaws.
Bracket Types and Treatment Techniques Used in Fixed Orthodontic Treatment
Metal, ceramic or plastic brackets can be used in fixed orthodontic treatments. If the attachment points of the brackets are from the outer surface of the teeth, it is called the labial technique, and from the inner surface of the teeth, it is called the lingual technique. In addition to these techniques, orthodontic treatment options where brackets and wires are not used at all and transparent plaques are applied to the patient under the control of a doctor are also available today and successful results are obtained in appropriate cases.
Orthodontic Treatment with Transparent Plates
It is an orthodontic treatment method that can provide success in mild and partially moderate orthodontic disorders. They are transparent plaques that can be easily attached and removed by the patients and are difficult to detect by an outsider during use. The treatment begins with the measurement sent to the relevant centers, the necessary analyzes are made on the computer, and the stages and the end state of the treatment are created virtually. In this way, the final shape of the teeth, which is planned to take at the end of the treatment and when it is finished, can both be created and shown to the patient. The patient is expected to wear the plates for an average of 14-18 hours per day. Eating and drinking operations cannot be done with plaques. It is recommended to drink only water. Plates are planned to be changed to a new one on a weekly basis, so that in cases where the patient does not comply with the daily usage period, the treatment is usually blocked at a certain stage and the next plate does not fit in the mouth. For this reason, it is necessary to carry out the treatment under the control of the orthodontist, and if necessary, the orthodontist should intervene in the treatment. In some cases, it is prescribed for the use of plaques and the orthodontist may need to make minor additions to the teeth in certain weeks. In addition to many advantages of the treatment, its high cost and the fact that it is a suitable treatment only for some cases can be listed as disadvantages. In addition, transparent aligners can be used to preserve the condition obtained after active orthodontic treatment.
What Is Reinforcement Therapy and Why Is It Important?
At the end of active orthodontic treatment, the braces and braces are removed, but the teeth are not fully adapted to their new positions. In this period, there is a need to protect the position of the teeth for a while. In the early period when orthodontic treatment is finished, the tendency of the teeth to return to the top is high. This period is called the “Reinforcement Period” and the treatment is called the “Reinforcement Therapy”. The permanence of orthodontic treatment is directly proportional to this treatment. Depending on the type of orthodontic treatment performed and the initial position of the teeth, the time needed for the reinforcement treatment varies. Reinforcement appliances are transparent, removable appliances. Generally, it is recommended to use both day and night for the first 6 months, and only at night for the following 6 months. In some cases, longer times of reinforcement may be required to prevent the teeth from slipping, while in some cases permanent reinforcement may be required.
Why does tooth repositioning occur after orthodontic treatment?
Patients who do not use the reinforcements properly, patients with abnormal growth development after orthodontic treatment, patients with teeth clenching or grinding habits, patients with excessive muscle activity in their lips and cheeks, patients with wisdom teeth trying to erupt after orthodontic treatment, and patients who press on the front teeth, and lower incisors over time. Patients with changes such as wear in their teeth are the cases where the risk of repositioning of the teeth is high.