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Questions about Orthodontics
- When do teeth need straightening?
- Can I get orthodontics as an adult?
- Will I need to have teeth extracted before I get braces?
- What kinds of problems in the mouth can braces take care of?
- I’ve heard there is Invisalign – are those braces or what?
- Are there advantages to Invisalign – are there problems that it won’t take care of?
- My child has all of the teeth crowded together, especially on the top – what can be done?
- After braces are done – how can the teeth bite down normally on each other?
- Should I get the cemented on brackets or the band for my son?
- How do they get the cemented brackets off the tooth again once the treatment is complete?
- How do we keep the teeth from moving back to the original location after braces are removed?
Answers about Orthodontics:
- When do teeth need straightening? The reason why teeth need straightening, and the time where it should best start are two different things. The dentist or orthodontist can get a pretty good picture of what will happen in the mouth as the teeth erupt by the age of 8 or so, and possibly even earlier. The X-rays, particularly of the front teeth and premolars will show if the remaining permanent teeth to erupt are in alignment or not. Also, it will be clear if the teeth on the right and left sides are symmetrically disposed – if not, that is a sign that “straightening” will be necessary. Maybe your esthetic issue with your teeth is that there is a SPACE between the upper central incisors. This diastema COULD be fixed by moving all of the teeth toward the middle, but it is a FAR easier solution to simply place veneers on the two centrals. That being said, if the space is too large, the anatomy of the wider centrals will appear unnatural, and there is the risk with some people that the porcelain veneers will wear away the opposing teeth – in that case braces would be better…………………BACK to questions
- Can I get orthodontics as an adult? Certainly, but the specific needs to be addressed and the approach to doing it can vary quite a bit. If it is simply a matter of esthetics, for example the alignment of the upper front teeth, it is generally not a simple thing. Your lateral incisors may be sticking out in front of the central incisors because there was not enough room for them when they erupted. The same with your canines perhaps. But – there was not enough room when you were young, and there STILL isn’t enough room – which is why they are still sticking out. IF your arch is rather small in circumference in the front top teeth, it is because they are pushed against the lower teeth by the pressure of the upper lip. It is POSSIBLE that the front teeth can be tipped forward, more away from the lower teeth, increasing the circumference of the arch, making more room for the lateral incisors, for example, to be pushed back into the more available space. But there are two problems with that – the first is that there may NOT be enough space available, and the second is that the teeth will really WANT to come back to the same arch form, unless you religiously wear a retainer that will work against the pressure of the upper lip. So, if as an adult, you are thinking that not much will need to be done, it may be more is needed than you think. It might be necessary to extract a premolar on each side to make more room in which to spread out the anterior teeth. It may be that the dentist decides to recontour the laterals, for example, to make them more narrow to fit in the available space. This latter approach will make the teeth more unnaturally narrow, and make them susceptible to decay on the sides of the teeth later. In any event – full arch wired braces may well be necessary to solve what looks like a simple anterior esthetic concern, and your patience with retainers may be no more than it would have been as a younger person…………………BACK to questions
- Will I need to have teeth extracted before I get braces? Quite possibly you will need premolars extracted, if your basic arch form is too narrow to fit the full complement of teeth. This is a pretty standard practice for most people………………… BACK to questions
- What kinds of problems in the mouth can braces take care of? When the teeth are malaligned in the front of the arches and this creates a displeasing appearance, this can be solved by orthodontics. If the back teeth are not in the appropriate positions in an inside-outward direction for ideal occlusion, this can be solved by orthodontics IF, typically, the upper arch is expanded at a young age, before the bone of the palate has completed its growth. If there are missing teeth and the teeth neighboring this space have tipped into this space, the orthodontist can tip it back, making it possible to do an implant, bridge, or partial denture to replace that tooth artificially. These are just some of the problems that can be solved with orthodontia…………………BACK to questions
- I’ve heard there is Invisalign – are those braces or what? That approach does not use brackets and wires. Many adults find them more acceptable socially and professionally than brackets and wires. Do they solve all alignment and positioning problems, no. They can tip teeth into various positions, but they are not designed to bodily MOVE the teeth from one place to another without tipping. The system uses a sequence of clear plastic trays that fit over your teeth, but not exactly – the difference between how they are made and your current positioning is what forces them a little at a time, more and more with each successive tray, into the final position desired. You will still need significant retention using either a long-term final tray, or a wire retainer as usually supplied after full orthodontia. ………………..BACK to questions
- Are there advantages to Invisalign – are there problems that it won’t take care of? The main advantage is your appearance while the work is being done, and yes, there are problems that require full wired orthodontia. The cost is not necessarily much different…………………BACK to questions
- My child has all of the teeth crowded together, especially on the top – what can be done? More room needs to be made on the upper arch for the teeth to be aligned in a smooth arch-form and fit with the expected rotation of each tooth. This will usually require extraction of a premolar or two to make the space. Ideally, after the teeth are moved into ideal arch form on the upper arch, the top and bottom canines have the appropriate relationship to each other. The canines are responsible for guiding the mouth to open as the jaw is moved left, right and forward. Whoever is moving the teeth should make sure that this relationship is appropriate at the end of treatment………………… BACK to questions
- After braces are done – how can the teeth bite down normally on each other? An insightful question! Sometimes they don’t bite down well. The precise positioning of the teeth for ideal occlusion requires a finer degree of movement control than is available, typically, with orthodontia. The orthodontist can get them close, but it is up to the teeth to finally guide each other into their optimal occlusal relationship, as much as possible. This may involve some shifting of the teeth from the exact setting achieved through orthodontia, but should not involve too much of a change. Your orthodontist may adjust your retainer later to take into account any occlusion-driven shifts…………………BACK to questions
- Should I get the cemented on brackets, either clear or metal, or the bands for my son? Of course this question strictly relates to the anterior teeth, where the visibility of the supports for the wires is greatest. Most people these days opt for the clear brackets – which are basically a ceramic material that is adhesively bonded to the tooth. One must be careful if they are placed on the lower teeth that the upper teeth do not touch them when biting down, or wear can result – these brackets can be abrasive, like any ceramic. In principle the clear ceramic brackets are just fine – as long as they are removed with care (see next question)…………………BACK to questions
- How do they get the cemented brackets off the tooth again once the treatment is complete? Basically they need to be cut off. If the bracket itself can be “popped” off, that is fine, but it will leave an amount of adhesive cement on the surface of the tooth after removal. This cement is ground off by the assistant using a high speed bur, just like when a tooth is being prepared for a filling. The assistant needs to be quite careful that the cement is removed WITHOUT touching the enamel at all. This takes time and care. I have seen people with considerable holes or indentations in their front teeth where the assistant carelessly ground off the remaining cement and took a lot of enamel with it!………………..BACK to questions
- How do we keep the teeth from moving back to the original location after braces are removed? There are various kinds of appliances that need to be worn to keep the teeth in their desired place. They REALLY want to move back, due to the various forces that are applied to them, and the fact that these forces are not necessarily balanced after orthodontia. You must wear the retainer religiously! If not worn every day, pretty soon you will only wear it every week, and pretty soon you won’t wear it at all because the teeth will move too much during that week and you can’t get it in again! Then you’ve wasted the money you spent on orthodontia. There are removable retainers, as described, but also there are cemented retainer wires that can be installed in certain areas, particularly the lower anterior teeth. A removable retainer may also be provided…………………BACK to questions