Dental Braces

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About Braces / Orthodontic Cases

Dental braces (also known as braces, orthodontic cases, or cases) are devices used in orthodontics that align and straighten teeth and help to position them with regard to a person’s bite, while also working to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.

Mouth Braces Procedure

The application of braces moves the teeth as a result of force and pressure on the teeth. There are traditionally four basic elements that are used: brackets, bonding material, arch wire, and ligature elastic – also called an “O-ring”. The teeth move when the arch wire puts pressure on the brackets and teeth. Sometimes springs or rubber bands are used to put more force in a specific direction.

Braces have constant pressure which, over time, move teeth into the desired positions. The process loosens the tooth after which new bone grows in to support the tooth in its new position. This is called bone remodeling. Bone remodeling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoclasts and osteoblasts. Two different kinds of bone resorption are possible which are called direct resorption, starting from the lining cells of the alveolar bone, and indirect or retrograde resorption, which takes place when the periodontal ligament has become subjected to an excessive amount and duration of compressive stress. Another important factor associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament and without bone deposition, the tooth will loosen and voids will occur distal to the direction of tooth movement.

When braces put pressure on teeth, the periodontal membrane stretches on one side and is compressed on the other. If this movement is not done slowly then the patient risks losing his or her teeth. This is why braces are commonly worn for a year or more and adjustments are only made every few weeks. A tooth will usually move about a millimeter per month during orthodontic movement, but there is high individual variability. Orthodontic mechanics can vary in efficiency, which partly explains the wide range of response to orthodontic treatment.

Types of Dental Braces

  • Traditional metal wired braces are stainless steel and are sometimes used in combination with titanium. Traditional metal braces are the most common type of braces. These braces have a metal bracket with elastic (rubber band) ties holding the wire onto the metal brackets. The second most common type of braces are self-ligating braces that do not require the need of elastic ties. Instead, the wire goes through the bracket. Often with this type of braces, treatment time is reduced, there is less pain on the teeth, and fewer adjustments are required than with traditional braces.
  • “Clear” braces serve as a cosmetic alternative to traditional metal braces by blending in more with the natural colour of the teeth or having a less conspicuous or hidden appearance. Typically, these brackets are made of ceramic or plastic materials and function in a similar manner to traditional metal brackets. Clear elastic ties and white metal ties are available to be used with these clear braces to help keep the appliances less conspicuous. Alternately, clear braces can be self-ligating, meaning the wire clips into the bracket without the need for ligatures. Clear braces have a higher component of friction and tend to be more brittle than metal braces. This can make removing the appliances at the end of treatment more difficult and time consuming.
  • Gold-plated stainless steel braces are often employed for patients allergic to nickel (a basic and important component of stainless steel), but may also be chosen because some people simply prefer the look of gold over the traditional silver-colored braces.
  • Lingual braces are a cosmetic alternative in which custom-made braces are bonded to the back of the teeth making them externally invisible.
  • Titanium braces resemble stainless steel braces but are lighter and just as strong. People with allergies to the nickel in steel often choose titanium braces, but they are more expensive than stainless steel braces.
  • Multi-Loop Edgewise Archwire (MEAW) therapy employs loops in the wire between teeth. This allows for more efficient vertical alignment of teeth and bite adjustment.

Traditional braces consist of a small bracket that is glued to the front of each tooth and the molars are adjusted with a band that encircles the tooth. An advantage is one can eat and drink while wearing the braces, but a disadvantage is that one must give up certain foods and eating habits while wearing them, such as gum with sugar and potato chips. Another disadvantage is they have to be periodically tightened by an orthodontist, causing increased amounts of discomfort.

  • Customized orthodontic treatment systems (an example of which is Suresmile) combine high-technology including 3-D imaging, treatment planning software and a robot to custom bend the wire. Customized systems such as this offer faster treatment times and more efficient results. Treatment can be more expensive and is not available at all orthodontists.
  • Progressive, clear removable aligners (examples of which are Invisalign, Originator, and ClearCorrect) may be used to gradually move teeth into their final positions. Aligners are generally not used for complex orthodontic cases, such as when extractions, jaw surgery, or palate expansion are necessary. These braces are the most recent type of braces. Many orthodontists do not use these braces because they feel they do not produce the best corrective results compared to traditional braces, but opinions vary from person to person. This technique works by only tilting or rotating the teeth (including the roots), whereas traditional braces can parallel shift the whole tooth (including the roots). The braces are hardly noticeable on the teeth and work to gradually move the teeth into their right position without the need for wires or tightening. Like traditional braces, they do require an improvement in the amount of oral hygiene because they have to be removed to eat and one must brush and floss after every meal. Instead of using the traditional method where metal or clear braces were mounted for long periods of time. Each set of aligners is worn for about 2 weeks, and they are removed to eat, drink, brush and floss. As the aligners are replaced every 2 weeks, the teeth are forced to move to fit the new mold. The total treatment time averages 9-15 months and the average number of aligners worn is between 18 and 30.
  • For less difficult cases, spring aligners are also an option that can cost much less than braces or Invisalign (one example is NightShiftOrtho) and still align primarily the front six top and bottom teeth.
  • Smart brackets are the latest concept under investigation. The smart bracket contains a microchip that measures the forces that act on the bracket and subsequently, the tooth interface . The aim of these braces is to reduce the duration of orthodontic therapy and the related expenses and discomfort to the individual.
  • A-braces are another new concept in dental appliances. In the shape of a capital letter A, A-braces are applied, adjusted, removed and completely controlled by the user. At the ends of the A’s arms are angled knobbed bits that the user bites down over. The width between the bits is adjusted by turning the crossbar, housed across the arms, outside the mouth. A user never has to experience pain because the pressure is so easy to control. Though they are not designed or recommended for wearing while sleeping, A-braces may serve as self-adjustable retainers and palate expanders.
  • partial braces cover only 4 front teeth and the 2 very back teeth. This is later upgraded to metal wire. 10 years is the minimum age to be able to receive this treatment.

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