Orthodontics refers to the mechanical and gradual moving of misplaced or rotated teeth. It is a non-invasive, painless form of treatment to help improve the function and aesthetics of our patients. We are not specialists, but we are able to treat minor, uncomplicated orthodontic cases in our practice. Complex cases will be referred to a specialist orthodontist for further treatment.
A full dental examination is very important before we start any orthodontic treatment. We prefer to treat patients where the full permanent dentition is present; this is usually from the age of 12. All other dental problems have to be treated and cleared up before we can start any orthodontic treatment. Maintenance of good oral hygiene is very difficult during treatment with fixed appliances, and this can accelerate the progression of problems left untreated before placement of braces.
We start our examination by looking at the teeth and gums for any signs of decay and gum disease. All problems are charted and included in our treatment plan. The next step is to take impressions for study models, as well as a panoramic and cephalometric radiograph. We take extra oral and intra-oral photos of the face and dentition.
We will use all the above mentioned diagnostic aids to make an accurate diagnosis and provide you with a complete orthodontic treatment plan on your second appointment. During the second appointment we will discuss the treatment plan and all other aspects of the treatment.
Let’s take a look at each of the diagnostic aids and how it helps to plan a treatment:
The panoramic radiograph gives us a full frontal view of the lower jaw, upper jaw, sinuses and the nasal cavity. We start by looking for any pathological lesions in the jaws and sinuses. We look at the bone and teeth for any signs of decay and periodontal disease. We look at the length of the roots of the teeth and for any un-erupted, impacted or missing teeth. Our main aim is to rule out the possibility of any pathology that may interfere with our orthodontic treatment.
The cephalometric radiograph gives us a picture of the whole head from the side. We use this form of radiograph to carry out a cephalometric tracing of the patient’s facial features. A cephalometric radiograph is used to determine whether the orthodontic problem is a skeletal or dental problem, and whether the problem is in the upper jaw, lower jaw or both. We can also determine the facial profile of the patient. This can be straight, concave or convex. I will discuss skeletal problems, dental problems and facial profile later in this section.
Study models are used to determine the relationship between the upper and lower teeth and the space shortage in the arches. They are also used to track the progress of the patient. We can determine which teeth are rotated or misplaced; they also give a good indication of the shape of the arch and whether expansion of the arch will create enough space to align the teeth.
Extra-Oral and Intra-Oral Photos
Digital photos are taken to determine the facial profile of the patient and track his progress.Once all the information is compiled, we can make a diagnosis. The problem can be skeletal or dental and can affect the lower arch, upper arch, or both. We prefer to treat uncomplicated dental cases, and we will refer all complex skeletal cases to a specialist orthodontist.
Class I Skeletal Relationship
This is the ideal. Both the upper and lower jaws are in good relationship and the problem is tooth related. This relationship is determined by the cephalometric tracing.
Class II Skeletal Relationship
This is where the lower jaw is more posterior compared to normal in relation to the upper jaw. These cases need dental orthodontic treatment to align the teeth, as well as surgery to correct the misaligned jaws. These cases are best treated by specialists.
Class III Skeletal Relationship
This is where the lower jaw is more anterior compared to normal and in relation to the upper jaw. These cases also need dental orthodontic treatment and surgery.
All Skeletal cases are better treated by specialist orthodontists.
Class I Dental Malocclusion
To determine the dental malocclusion, we look at the relationship between the first molars in the upper and lower jaws. If the molars are in perfect relation, it is called a class I dental malocclusion. Again, we need to make sure that the jaws are in a Class I relationship.
Class II Dental Malocclusion
This is where the lower molar is more distal, compared to the upper molar.
Class III Dental Malocclusion
The lower molars are more mesial compared to the upper molars.
Now that we have made an accurate diagnosis, we can start with the orthodontic treatment. As mentioned, all other dental treatments need to be completed before we can place the braces.
The first appointment is a 90 minute appointment. The teeth are cleaned and the orthodontic brackets glued to the labial aspects of the teeth. Once all the brackets are in position, we place an inter-arch wire that fits into the slots in the brackets. The wire is kept in place by placing elastics around each bracket. The patient is instructed to maintain a soft diet and high level of oral hygiene.
The duration of treatment varies according to the severity of the orthodontic problem and can last anything from 12 to 24 months. We do follow-ups every six weeks to replace the elastics on the brackets. Patients are advised to come for a thorough cleaning every three months during treatment.
Once treatment is complete, the brackets, wires and elastics are removed. The teeth are cleaned, removing all residual cement. Impressions are taken of the upper and lower arches and retention plates constructed. The patient is advised to wear the retention plates 24 hours per day for the first six months after treatment and only at night for the next six months. We suggest a full dental examination and thorough scale and polish immediately after orthodontic treatment. In some cases, patients may need teeth whitening to remove staining caused by orthodontic treatment.
For more information about orthodontic procedures, please get in touch.