OrthodonticsOrthodontics

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Who Needs Orthodontic Treatment?Who Needs Orthodontic Treatment?

Adults and children both seek orthodontic Adults and children both seek orthodontic treatment for:treatment for:Malocclusion (incorrect bite)Malocclusion (incorrect bite)Tooth alignment (crooked teeth)Tooth alignment (crooked teeth) Improvement of overall appearance, including Improvement of overall appearance, including

gaps between teeth gaps between teeth

Classification of OcclusionClassification of Occlusion

Class I Class II Class IIIClass I Class II Class III

Upper and Lower molars align

properly, but teeth are crooked. 72%

of ortho cases.

Upper molars are positioned too far forward (anterior) compared to the

lower molars. 22% of ortho cases.

The upper first molar is

positioned behind the lower first molar. 6% of ortho cases.

Examples of MalocclusionExamples of Malocclusion

Overbite – The upper front teeth cover too Overbite – The upper front teeth cover too much (more than 30%) of the lower front much (more than 30%) of the lower front teeth. Also called a deep bite. This may teeth. Also called a deep bite. This may be seen in a Class I or II malocclusion. be seen in a Class I or II malocclusion.

Examples of MalocclusionExamples of Malocclusion

Overjet – causes “buckteeth”. The upper front teeth are Overjet – causes “buckteeth”. The upper front teeth are positioned too far forward (normal distance between positioned too far forward (normal distance between upper and lower front teeth is 1-3 mm). This is typical in upper and lower front teeth is 1-3 mm). This is typical in Class II maloclussion.Class II maloclussion.

Examples of MalocclusionExamples of Malocclusion

Underbite – causes a “bulldog” appearance. Underbite – causes a “bulldog” appearance. The lower front teeth are positioned in front The lower front teeth are positioned in front of the upper front teeth. This is seen in of the upper front teeth. This is seen in Cass III malocclusions. Cass III malocclusions.

Examples of MalocclusionExamples of Malocclusion

Crossbite – The upper teeth should Crossbite – The upper teeth should overlap the lower teeth slightly when the overlap the lower teeth slightly when the jaws are closed. When this does not jaws are closed. When this does not occur, it is called a crossbite. May occur occur, it is called a crossbite. May occur in any class of malocclusion.in any class of malocclusion.

Examples of MalocclusionExamples of Malocclusion

Open bite – open space exists between Open bite – open space exists between upper and lower teeth when jaws are upper and lower teeth when jaws are closed. Often caused by thumbsucking, closed. Often caused by thumbsucking, seen in all classes of malocclusion.seen in all classes of malocclusion.

Examples of MalocclusionExamples of Malocclusion

Midline shift – the center of the upper front Midline shift – the center of the upper front teeth is not aligned with the center of the teeth is not aligned with the center of the lower front teeth. Can be seen in all lower front teeth. Can be seen in all classes of malocclusion. classes of malocclusion.

What causes malocclusion?What causes malocclusion?

Genetics - You may inherit a small mouth Genetics - You may inherit a small mouth from mom and large teeth from dad.from mom and large teeth from dad.

Tooth loss - If a tooth is lost from an injury, Tooth loss - If a tooth is lost from an injury, cavities, or gum disease, the remaining cavities, or gum disease, the remaining teeth may shift.teeth may shift.

Bad habits such as thumbsucking can shift Bad habits such as thumbsucking can shift teeth or cause them to erupt improperly.teeth or cause them to erupt improperly.

Malnutrition – Nutritional deficits can Malnutrition – Nutritional deficits can restrict the growth of jaws and teeth. restrict the growth of jaws and teeth.

When is the best time for ortho?When is the best time for ortho?

The jaws of pre-teens and teens are still growing. The jaws of pre-teens and teens are still growing.

Therefore, it is easier to shift teeth at this stage.Therefore, it is easier to shift teeth at this stage. Sometime, two separate phases of braces are necessary Sometime, two separate phases of braces are necessary

for treatment.for treatment. Phase I – when patients are 6 to 7 years old, to make room for Phase I – when patients are 6 to 7 years old, to make room for

the permanent teeth to erupt properlythe permanent teeth to erupt properly Phase II – at age 12 (or when permanent teeth have erupted) a Phase II – at age 12 (or when permanent teeth have erupted) a

second round of braces are applied to straighten teeth and second round of braces are applied to straighten teeth and correct bite.correct bite.

•It is becoming more common for adults to seek It is becoming more common for adults to seek orthodontic treatment. Their treatment may take longer to orthodontic treatment. Their treatment may take longer to complete.complete.

Space MaintainersSpace Maintainers

When a primary, or deciduous, tooth When a primary, or deciduous, tooth (commonly called “baby” tooth) is lost too (commonly called “baby” tooth) is lost too early, the space needs to be held open early, the space needs to be held open until the permanent tooth is ready to erupt.until the permanent tooth is ready to erupt.

Space MaintainersSpace Maintainers

A space maintainer is an appliance made A space maintainer is an appliance made of metal or plastic and may be removable of metal or plastic and may be removable or cemented onto neighboring teeth.or cemented onto neighboring teeth.

Removable space maintainer Band and loop maintainer Lower lingual holding arch

Why does malocclusion need Why does malocclusion need corrected?corrected?

An incorrect bite can have long-term An incorrect bite can have long-term effects including:effects including: Interference with normal growth and Interference with normal growth and

development of jawsdevelopment of jawsDifficulty swallowingDifficulty swallowing Impaired chewingImpaired chewingSpeech defectsSpeech defectsSusceptibility to cavities and gum diseaseSusceptibility to cavities and gum diseasePoor aestheticsPoor aesthetics

How do braces work?How do braces work?

Teeth can be GRADUALLY moved into proper position by Teeth can be GRADUALLY moved into proper position by applying pressure in certain directions using bands, applying pressure in certain directions using bands, wires, and elastics. A series of clear trays, such as wires, and elastics. A series of clear trays, such as Invisalign, may also be used. Invisalign, may also be used.

standard

braces

lingual

braces

“Clear”

braces

virtually

invisible

Invisalign trays

How do braces work?How do braces work? Removeable appliances may also be used such as:Removeable appliances may also be used such as:

Palatal expander to widen the archPalatal expander to widen the arch Jaw repositioning appliance, or splint, to retrain the Jaw repositioning appliance, or splint, to retrain the

jaw to close properlyjaw to close properly Headgear- involves a strap that wraps around the Headgear- involves a strap that wraps around the

head and attaches to a wire or face bow in the front. head and attaches to a wire or face bow in the front. used to slow the growth of the upper jaw and move used to slow the growth of the upper jaw and move

front teeth towards the back.front teeth towards the back.

palatal expander Jaw repositioning

appliance

Headgear

How do braces work?How do braces work? Treatment typically lasts 1 to 2 years. After Treatment typically lasts 1 to 2 years. After

braces are removed, retainers are used to hold braces are removed, retainers are used to hold the teeth in their new position. the teeth in their new position.

Typically, retainers are worn 24 hours a day for Typically, retainers are worn 24 hours a day for the first six months and then worn only at night the first six months and then worn only at night thereafter. Permanent retainers, bonded to the thereafter. Permanent retainers, bonded to the back side of front teeth, may also be used. back side of front teeth, may also be used.

Home care for ortho patientsHome care for ortho patients

Braces collect food and plaque very easily. Braces collect food and plaque very easily. Often, ortho patients are children or teenagers Often, ortho patients are children or teenagers

who do not have optimum brushing and flossing who do not have optimum brushing and flossing habits.habits.

If braces are not kept clean, tooth decay and If braces are not kept clean, tooth decay and gum inflammation easily occur.gum inflammation easily occur.

Orthodontists may decide to remove braces Orthodontists may decide to remove braces prematurely if the patients hygiene is poor. prematurely if the patients hygiene is poor.

Home care for ortho patientsHome care for ortho patients

Brushing Brushing Special orthodontic toothbrushes or battery Special orthodontic toothbrushes or battery

toothbrushes may be useful.toothbrushes may be useful. Patients need to brush both above and below the Patients need to brush both above and below the

brackets, paying special attention to the space brackets, paying special attention to the space between the gumline and the brackets.between the gumline and the brackets.

Home care for ortho patientsHome care for ortho patients

FlossingFlossing Flossing around braces is time consuming. Flossing around braces is time consuming.

Superfloss (strands of floss with stiff ends) or floss Superfloss (strands of floss with stiff ends) or floss threaders are used to floss beneath the wires.threaders are used to floss beneath the wires.

Interdental brushes can be used between the wire Interdental brushes can be used between the wire and the tooth, between brackets. and the tooth, between brackets.

Home care for ortho patientsHome care for ortho patients

• A fluoride mouthwash, either over-the-counter or A fluoride mouthwash, either over-the-counter or prescription, is usually recommended to help prescription, is usually recommended to help prevent tooth decay around the brackets and to prevent tooth decay around the brackets and to reduce decalcification. reduce decalcification.

• A oral irrigator such as a Waterpik, may be used A oral irrigator such as a Waterpik, may be used to flush debris from the brackets.to flush debris from the brackets.

Home care for ortho patients.Home care for ortho patients.

Dental Check-upsDental Check-ups

An orthodontic patient needs to visit his or An orthodontic patient needs to visit his or her general dentist at least every 6 months her general dentist at least every 6 months for a cleaning and check-up to monitor the for a cleaning and check-up to monitor the health of the teeth and gums, ensuring health of the teeth and gums, ensuring great results when treatment is complete!great results when treatment is complete!