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Orthodontics
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Orthodontics is a dentistry specialty which deals with the correction of the teeth and poorly positioned bones. Teeth in their incorrect positions and which do not adequately articulate with others are difficult to keep clean, run the risk of early loss due to caries and periodontal disease, and cause extra pressure on the mastication muscles which can generate headaches, TMJ syndrome and discomfort in the neck, shoulders and back. In addition, twisted teeth or poorly positioned teeth compromise our aesthetic appearance.
Orthodontic treatments have the advantage of providing us with a healthy mouth, a pleasingly attractive smile, and teeth with an increased likelihood of lasting a lifetime.
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How do I know if I need orthodontics?
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Only your dentist or orthodontist can determine whether you require orthodontic treatment, based on diagnostic elements such as full clinical and dental history, clinical examination, plaster models of your teeth, x-rays and photographs. Depending on the diagnosis, your orthodontist or dentist will decide whether you need it and will develop a treatment plan adjusted to your needs.
If you suffer from any of the following, it is probably that you need orthodontic treatment:
- Overbite: The crowns on the upper anterior teeth almost completely cover the crowns on the lower teeth.
- Anterior crossbite: This is when, while biting, the lower incisors cover the upper ones instead of the other way round.
- Posterior crossbite: Is when, while biting normally, the upper teeth do not fall slightly outside the lower posterior teeth, but rather do the opposite.
- Open bite: Space which appears between the incisal borders of the upper and lower anterior teeth with the posterior teeth being in normal occlusion.
- Displaced midline: Happens when the line that passes between both upper central incisors does not coincide with the same line between the lower central incisors, or when it is not in harmony with the rest of the central structures of the face.
- Diastema or gap: Separations or gaps between the teeth as a result of absent teeth or teeth which do not occupy the space available.
- Overcrowding: Disorder which presents when the teeth are too big to be accommodated within the space provided by the maxillas or when the space is insufficient despite the teeth being normal in size.
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| Anterior crossbite |
Open bite |
Overcrowding |
Edge-to-edge bite |
Overbite |
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How is orthodontic treatment performed?
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Diverse types of braces, both fixed and removable, are used to move the teeth, re-train the muscles and modify the growth of the maxillas. These braces work by applying gentle pressure on the teeth and the bones. The severity of the problem will determine the most effective orthodontic approach.
Fixed braces include:
Conventional orthodontics: The most common fixed braces consist of a system of bands, arches and brackets. The bands are attached around the teeth and are used to anchor the braces; while the brackets are cemented to the visible or lingual surface of the teeth. The arches pass on top of the brackets and through the tubes on the bands. By adjusting the arches, pressure is exercised on the teeth which permits a gradual movement towards the correct position. The orthodontic treatment is adjusted periodically for the purposes of achieving the desired results, which may take months or a couple of years. The braces used currently are smaller, lighter and with less metal than in the past, in bright colours for children or transparent models for adults.
*Cases treated with conventional orthodontics (metal brackets):
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In search of better aesthetics, we currently also work with devices such as:
Lingual orthodontics: the brackets are cemented to the lingual or palatine surfaces of the teeth, and therefore the orthodontics are not visible externally.
*Case treated with upper lingual orthodontics:
Cosmetic brackets: as they are ceramic, and therefore white, the braces are considerably disguised.
Special fixed braces: They are used to control the consequences of bad habits such as thumb-sucking, pushing the tongue against the teeth, etc. These braces are attached to the molars by bands.
Fixed space retainers: If a child prematurely loses a tooth, a retainer is used to keep the space open until the permanent tooth emerges. A band is placed on the tooth adjacent to the empty space and a wire is stretched from the tooth to the other side of the gap.
*Bilateral fixed space retainers
Rapid palatal expander: Is used to widen the arch of the upper maxilla. It is a resin plaque which is adapted to fit the roof of the mouth. By applying, through screws, external pressure on this plaque, a separation is forced between the bones of the palate, opening it lengthways and widening the area of same.
*Rapid palatal expander
Removable braces include:
Clear aligners or Invisalign: are a modern alternative in adult orthodontic treatments. The system consists of a series of specific aligners for each patient, with a specific sequence, made from transparent plastic material, invisible at a glance. These are changed approximately every 15 days and should only be removed during meals and dental hygiene.
Removable space retainers: They fulfil the same function as fixed retainers. They are made from an acrylic base which adapts to the maxilla, with branches of plastic and wires which extend between specific teeth to maintain the space between them.
Facial mask: The facial mask is an effective tool in the treatment of mild to moderate Class III skeletal malocclusions, with retrusive maxilla and a hypodivergent growth pattern.
In relation to the components of the brace, it has two anchorage points, one on the forehead and one on the chin, which may be joined by two wires or by just one; maxillary protraction is obtained by applying traction to the maxillary sutures, through the force exercised by the elastic on the intraoral brace, while reciprocally pushing the jaw and the forehead by means of the anchorage provided by the facial mask.
Extraoral traction (TEX): Extraoral traction is defined as the collection of braces which, supported on anatomical elements located outside of the oral cavity, exercise their force on the maxillas and/or teeth. It is of application in Class II skeletal malocclusions. Its classification is based in relation to the attachment or support area, which will also influence the direction of the force, we therefore have:
- Cervical traction braces, or of low traction, with point of support at the neck.
- Occipital traction braces, or of high traction, with point of support on the cranium.
- A combination of both to achieve medium traction, which consists in the union of cervical and occipital traction.
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Final retention
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Once we have completed the positioning of all the teeth, we can then remove the braces we have used to achieve our objective. But at that point we must use one of the existing methods of retention to ensure that the teeth do not move out of position, as they will try to return to the initial position they were in prior to the start of the treatment. This retention must be worn for the maximum time possible to guarantee the correct dental positions, with it even being advisable for it to be worn indefinitely.
Fixed splinting with gold thread: consists in joining the anterior teeth (normally from canine to canine) by a very fine piece of gold thread, attaching it to same with composite of the same colour as the teeth.
Clear acrylic splints: dental splints are removable devices which totally or partially cover the dental arches and impede movement of the teeth following orthodontic treatment. They must be used 24 hours a day for the first 6 months, only removing them to eat and for oral hygiene. After this time, they will be used as retention only when sleeping.
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