The Clips Orthodontic Centre

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	Orthodontics

	What is the scope of orthodontic treatment?
	Teeth are moved to ideal locations by applying appropriate forces on them. Apart from moving the teeth, it is within the scope of an orthodontist to utilize the growth potential of a child and apply appropriate forces that are capable of restraining, promoting or redirecting the growth of upper and lower jaws. By doing all this, the treatment by itself brings about favorable changes in the facial appearance of an individual.

	At what age the treatment can be done?
	The treatment can be done at any age, provided the bone condition is good

	Benefits of Early Detection for Orthodontic Treatment
	A check-up with an orthodontist no later than age 7 for children who enable the orthodontist to detect and evaluate problems (if any), advise if treatment will be necessary, and determine the best time for that patient to be treated. Patients who have clear indications for early orthodontic intervention, early treatment presents an opportunity between you and our practice

	Guide the growth of the jaw Regulate the width of the upper and lower dental arches Guide incoming permanent teeth into desirable positions Lower risk of trauma (accidents) to protruded upper incisors (front teeth) Correct harmful oral habits Reduce or eliminate abnormal swallowing or speech problems Improve personal appearance and self-esteem Potentially simplify and/or shorten treatment time for later corrective orthodontics Reduce likelihood of impacted permanent teeth Preserve or gain space for permanent teeth that are coming in

	Healthy teeth can be moved at almost any age. Many orthodontic problems can be corrected for adults as children. Orthodontic forces move the teeth in the same way for both a 75-year-old adult and a 12-year-old child. However for adults, complicating factors such as lack of jaw growth, may create special treatment planning needs.

	Am I not too old for braces?
	In brief, no. Patients of all ages from eighteen to eighty have been treated successfully.
	Many things that are possible in adolescents are equally possible in adults. Crooked teeth can be straightened out in much the same way, although it may take a little longer to get there.
	The main differences arise because adults are not growing so orthodontists cannot harness the natural growth of the jaws to correct problems like prominent upper teeth. In adults the more difficult problems of this type cannot be corrected with braces alone and may need jaw surgery.

	How long will it take?
	It is impossible to give a definite answer. Simple cases may be completed in a few months, the average case may take 18-24 months, while complex cases may take three years or more, especially if jaw surgery is involved.
	Patients vary a lot as to how fast their teeth will move and this is something which cannot be predicted in advance of treatment.
	On average cases needing extractions take longer than non-extraction cases.
	Cases involving jaw surgery will take longer.
	Your orthodontist will be able to give you an estimate of the likely timescale, but this will be very approximate.

	Will I need to have teeth extracted?
	There is no single answer to this question. Much depends on the sort of problem which needs correcting and a decision can only be reached on the basis of a detailed case assessment. Specialist advice is essential.
	Crowded teeth need extra space to bring them into line. Several ways of obtaining space may be used depending on the case in question:
	* Extracting teeth. In many cases there is no satisfactory alternative to extractions to permit the remaining teeth to be aligned or retracted. The extraction spaces are normally closed up during treatment so that there should be no gaps left at the end. Your orthodontist will warn you if this is unlikely. In making a decision about which teeth extract, the orthodontist will give preference as far as possible to removing teeth which are unlikely to last indefinitely, perhaps because of previous decay or damage.
	* Thinning down the teeth. This procedure goes by various names such as "slenderising", "stripping" or "thinning". The process involves removing a fraction of a millimetre of enamel from the surfaces of teeth where they contact the adjacent teeth. For example, by removing a quarter of a millimetre of enamel from both sides of all six lower front teeth , three millimetres of space can be created, enough to allow mild crowding to be corrected without extractions. Care is taken to ensure that a continuous layer of enamel is left on each tooth and given this precaution no harm results from the process. There are obvious limits to the amount of space which can be provided in this way.
	* Moving the molars back to create more space for the teeth in front. This is a common procedure in adolescents. It can sometimes be achieved with a brace alone, but for larger movements often involves headgear. In adults there is no growth to assist and the process is more difficult. Nevertheless success can be achieved in some cases provided the objectives are set realistically.
	* Expanding the dental arches. Expansion increases the perimeter of the dental arch and thereby creates more room for the teeth. Expansion may not be difficult to achieve technically but a degree of caution is required. Substantial expansion increases the risk of relapse afterwards and requires careful retention after treatment. Moving the roots outwards thins the layer of bone over the root surface and may increase the risk of the gum receding. Excessive expansion may lead to undue prominence of the teeth with adverse effects on the overall appearance.

	Is it painful?
	A degree of discomfort is likely to start with. You can expect some aching and tenderness in the gums as the teeth start to move, but this mostly wears off after a few days
	Fitting the brace should not be painful. For a fixed appliance the brackets are simply glued to the faces of the teeth; metal bands may also need to be cemented round the back teeth. No anaesthetic is needed.
	As the biological processes get under way round the tooth roots to allow the teeth to move, you can expect some aching and the teeth will be tender to bite on. This usually settles down in a few days, although some patients do experience a degree of tenderness for a longer period. The amount of discomfort varies enormously from person to person. It may be helpful to take your normal painkillers or a day or two.
	Some further discomfort may be experienced when the brace is adjusted subsequently, but this depends very much on what adjustments have been made.

	I don't want to wear the metal braces. What are my options?
	Ceramic brackets are relatively inconspicuous on the teeth. Lingual braces are placed out of sight on the inner surface of the teeth. Aligners are clear plastic splints which fit over the teeth and progressively move them to the desired position.
	Each option has its advantages and disadvantages and specialist advice is essential.
	Ceramic brackets
	Ceramic brackets are tooth coloured or translucent. They are less conspicuous than metal brackets and therefore often favoured by adults. However they do have a number of drawbacks which need to be taken into account. The brace tends to become discoloured over the course of time by contact with foods and may become less pleasing in appearance. The brackets are more prone to breakage than metal brackets; the wires slide through the slots less freely so treatment may take longer; the brackets tend to be abrasive and may cause wear to teeth in the opposite jaw if they should make contact when biting; the brackets can sometimes be difficult to remove with a slightly higher risk of damage to the tooth surface. The brackets are also more costly than metal brackets, and with all the associated problems the overall treatment can be expected cost significantly more. Having said all this, if appearance is at a premium, ceramic brackets may still be the first choice for many patients.
	Lingual appliances
	These are attached to the lingual surface of the teeth, i.e. the surface towards the tongue. In this position they are virtually invisible. The technique involves special skills and needs considerable experience on the part of the orthodontist to achieve good results. Only a limited number of orthodontists offer this technique and you may need to search for a suitable practitioner who has the requisite experience. The main drawbacks are that it can cause soreness of the tongue and affect speech. Fees are always much higher than for conventional fixed braces because of the higher material costs, greater surgery time involved and the extra training needed. More information on lingual orthodontics
	Aligners
	These are often known by their commercial names such as Invisalign and Clearstep. They blend modern technology with the long-standing concept of using clear flexible splints to ease teeth into line. A succession of splints is worn, each splint bringing the teeth a little closer to the desired position. The splints are effectively invisible and are therefore an attractive option from the standpoint of appearance.a
	Aligners can be very effective if all that is required is to align mildly irregular teeth. However there are several drawbacks. In the more severe cases, notably those where extractions are required, aligners lack the necessary control of the teeth to give consistently good results and often lead to disappointment. Likewise they are not well suited to correcting problems like prominent upper incisor teeth.
	The cost is much higher than for conventional fixed braces owing to the high laboratory costs in making the aligners. In selected cases they they are very effective but their scope is limited.

	Will I need retainers?
	Most probably yes.
	The tissues around the roots take time to adjust to the new tooth positions and there is a particular risk of relapse in the early months after the brace is removed. Even in the longer term some risk remains and the best advice is to continue retention indefinitely if at all possible.
	Retainers may be removable or fixed, and there are advantages and disadvantages to both.
	* Removable retainers are usually worn full time initially, but reduced to night times only later. They are effective but obviously depend on the patient remembering to wear them. They will need occasional repair or replacement, a relatively simple task.
	* Fixed retainers are usually bonded to the back of the teeth. They are therefore in place all the time and are highly effective. A high standard of tooth cleaning in the vicinity of the retainer is essential to avoid gum problems. They do need regular inspection because if any of the bonds fails, the tooth in question may start to drift out of position. For this reason it is essential for the patient to contact the orthodontist at once if there is a breakage. Many general dentists are unhappy about repairing a fixed retainer and a visit to an orthodontist will be needed

	What can be done without wearing braces?
	Orthodontics can be a lengthy process. Some patients prefer to have crowns or veneers fitted to their teeth instead in order to mask the irregularity. Whether this is feasible in any particular case needs good professional advice
	Veneers are added to the front surface of the teeth to mask the irregularity. The teeth can be reduced in size and crowns or "caps" can be fitted to give a larger change in appearance. These approaches also allow defects in the tooth surface to be hidden.
	These restorative approaches offer the attraction of rapid results and may be the treatment of choice in some cases. Drawbacks that you need to be aware of are:
	* the preparation of the teeth is, to a greater or lesser extent, a destructive and irreversible process
	* the crowns or veneers cannot be expected to last indefinitely and the need for replacements over the years should be borne in mind
	* there are definite limits to the amount of irregularity which can be tackled successfully in this way. Veneers can be become excessively thick, crowns can only be reshaped by a limited extent
	* there may be adverse effects on the underlying gum tissues over the years from having the edges of the crowns or veneers close by

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Orthodontics