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Introduction
Orthodontists use several different appliances in their
profession. Braces are one of the appliances they use to
move the teeth themselves, while other appliances are used
to move the jaws. Having straight teeth is not the only
goal of orthodontics. You also want to have the jaws aligned
and the face in balance, in addition to having straight
teeth. Several different appliances can be used at the same
time to achieve this optimal result Braces
straighten teeth by holding onto a wire as it returns to
its original, straight shape. When this wire is first tied
into a brace, you have to bend it slightly to get it to
fit in. As it returns to its original shape, it applies
pressure to the tooth. This pressure is felt by the bone,
which switches on signals to call in new cells that allow
the tooth to move through the bone.
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Archwire
The archwire is the wire that connects each brace together.
It does the actual work of aligning the braces, which will
line up the teeth. It is made from a very resilient material
that allows it to spring back to it's original shape, after
you bend it. Not like a paper clip that will stay bent.
The wires come in different sizes, shapes, and composition
of materials. The size of the wire is measured by the thickness
of the cross-section in thousandths of an inch. A common
round wire size is 0.016-inch, whereas a common rectangular
wire is 0.017 by 0.025-inch. All of them are made from stainless
steel materials. The various combination of materials like
chromium, cobalt, nickel, titanium, and copper will greatly
influence the bending properties of the wire.
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Band
A band is a metal ring that fits around the tooth. It will
have a brace welded to it and is held onto the tooth with
dental cement. They are only used on back teeth, because
they do not look very nice with all that metal showing.
In years past, all of the teeth had bands on them; which
is where the term "metal mouth" comes from. But with the
invention of bonding (gluing) a brace directly to the tooth,
you do not have to use bands on the front teeth anymore.
Holding a brace onto a tooth with a band is much more durable
than bonding it directly to the tooth. This durability is
very important when you have people exerting hundreds of
pounds of pressure to their teeth when they chew. They can
easily break a bonded brace loose from a tooth, but not
a banded one. This is why bands are still used today and
why the orthodontists ask their patients not to chew hard
or crunchy food.
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Braces
Braces are the tiny brackets that are attached to the teeth.
They act like handles that allow you to grab onto the teeth
to move them. They are usually bonded (glued) directly to
the enamel of the tooth. Except on a back tooth, where it
is first welded to a band of metal and the band is then
held onto the tooth with dental cement.
There are different types of braces: metal, clear, and gold.
Metal braces are the most popular with orthodontists, because
they are the most durable. They are made from stainless
steel materials like chromium, zinc, nickel, or titanium.
The braces today are much smaller than they were several
decades ago. Clear braces are made from a ceramic material,
aluminum oxide. They are more fragile and are bulkier. As
a consequence, they are more irritating to the lips. You
have to be very close to someone to be able to see them,
which is why they are so popular with adult patients. Gold
braces are stainless steel braces that are coated with a
gold material. They have the strength of metal and blend
in with the color of the teeth and gums much better than
the plain metal ones.
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Clear Braces
These are braces that are clear or opaque. They match the
tooth color very well. Almost all of them are made from
a ceramic material, aluminum oxide. A few of them are made
from plastic, which is not as durable. When the ceramic
ones were invented in 1987, almost everyone stopped using
the plastic ones and the lingual braces. Ceramic braces
are more fragile than the metal ones and are actually bulkier.
As a consequence, they are more irritating to the lips.
They work the same as metal braces, but have a little more
friction and can prolong the treatment time. You have to
be very close to someone to be able to see them, which is
why they are so popular with adult patients.
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Elastics (rubber bands)
Elastics are rubber bands that you hook from one brace to
another to provide a force that will move the teeth. They
can be used to slide one tooth along an archwire or to move
a group of teeth. They come in a variety of sizes and strengths.
Not everyone needs to wear these, as they are only needed
for specific movements.
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Extraction
An extraction is the removal of a tooth. It is utilized
when the teeth are crowded and there is not enough room
for all of them. The space from the removal of the tooth
provides room for the others to rotate and line up straight.
All of the extraction space is completely closed; there
are no gaps at the end.
Deciding which tooth to remove is a big deal. You usually
take out the side tooth closest to the crowding, but other
factors may interfere with this decision. If in taking out
a side tooth, you leave in a tooth with a short root, you
will have compromised the case. As short roots have a greater
long term risk of failure than normal roots. Other features
which put a tooth at risk are fillings, crowns, root canals,
and bone loss. Having to take out a different tooth will
make the case more difficult and cause the treatment time
to be extended. But it is of paramount importance that you
keep the most important teeth.
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Functional Appliances
These are used to help modify the growth of the jaws in
children. The theory behind their action is that if you
hold a jaw in a specific position long enough, that it will
grow into that position. What you usually get is a combination
of a little jaw growth with a lot of tooth movement. These
are not universally accepted, as they do not always work.
The first of these appliances were removable and are still
very popular. They are made of plastic and wire. Some of
their names are Frankel, Bionator, and Twin-block. A different
style is actually fixed to the teeth and uses a spring action
to hold the jaw into position. These have names like Herbst
and Jasper Jumper.
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Headgear
Headgear is an appliance that is worn on the outside of
the mouth, with an attachment to connect it to the teeth
on the inside. This is used when you have upper teeth that
stick out too far in front of the lower teeth, as in buckteeth.
It will move the upper teeth and jaw back to match the lowers.
There are several different types: cervical pull, high pull,
etc. The type utilized is dependent upon the skeletal growth
pattern. It is usually seen as a soft pad that is worn around
the back of the neck that attaches to a wire that reaches
forward to connect to a brace inside the mouth. It is used
for both movement of the teeth and for guiding the growth
of the jaws.
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Impressions
Taking an impression involves placing a putty-like material
in a mouth tray and positioning the tray over the teeth.
It is held in place for about a minute, until the material
hardens to the consistency of Jell-O. Your teeth will have
then left an impression of themselves in the gel. This is
then taken to the lab where a liquid plaster is poured into
it. After the plaster hardens, the tray is removed and there
is a duplicate of your teeth in the plaster models. This
has also been called taking a mold of your teeth.
The plaster study models are used to analyze a lot of features
about your mouth: tooth size, relationship of the teeth
to each other, amount of available space, how they come
together, etc. A lot can be learned from the models that
can't be seen by looking directly into the mouth.
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Interceptive treatment (Phase I)
There can be a lot of different types of Interceptive Treatment,
but their common goal is to stop a problem early enough
so that it does not become a big problem later on. This
is done for young children, before they have lost all of
their baby teeth. Not many people will need this intervention,
as most orthodontic problems can be solved later in adolescence.
But for those that do need it, it will make a world of a
difference. In addition to intercepting a problem, it can
also involve the correction of a jaw discrepancy. As you
want to prevent any damage from getting worse over time.
A good example of this is a crossbite. This is where the
upper teeth fit inside the lower teeth. Additionally, the
upper jaw will be fitting inside the lower jaw. The teeth
can be moved at anytime, but the bone can not. If left untreated,
the bone will stay this way. You can not orthodontically
correct it later. The bone shift will be very subtle at
first, but it will continue to grow crooked. Hence, the
damage will get worse over time.
Interceptive treatment has also been called Phase I. After
the permanent teeth come in, their straightening with braces
is called Phase II. If there is an early problem, but it
is not severe enough to require intervention, then it can
be corrected later during what is called Comprehensive Treatment.
This treatment takes into account the entire facial structure
as well as the permanent teeth. If the jaws need correction,
then the patient will start treatment a little earlier than
usual. With Comprehensive Treatment, all of the problems
are then corrected in one time frame.
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Invisible Braces
Several different types of braces are called invisible.
Clear braces are called this because it is difficult to
see them, unless you are very close to the person. Lingual
braces are also called this, because they are on the inside
of the mouth and you do not see them. Essix and Invisalign
removable appliances are also called this because they use
clear plastic for the appliance and are very difficult to
see.
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Jaw Surgery (orthognathic)
This is used to correct the jaws deformities of non-growing
patients, adults. For example, if the lower jaw is too far
behind the upper jaw, then the lower teeth are also too
far behind the upper teeth. In order to line up the teeth,
you need to move the lower jaw forward and the teeth come
with it.
Teeth have to be surrounded by bone, for blood supply and
nourishment. They can be moved around within the confines
of the jawbone, but not outside of it. If more movement
is needed, then you have to move the jaw. The braces are
used to straighten the teeth within each jaw and then the
surgery is used to line up the jaws, which will align the
teeth.
Some people that need jaw surgery refuse to do it. Sometimes
a compromised treatment can be done to align the teeth,
but the jaws and face will remain incorrect. If you decide
on doing a compromise, then realize that you will not get
an excellent result.
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Ligature tie (color & steel)
The archwire is held to the brace by means of a ligature
tie. This tie fits under the corners of the brace, but over
the archwire. This is needed to tighten the archwire into
the brace. The ligature ties are usually little rubber rings,
but narrow steel wires can also be used. The rubber ligature
ties are simply stretched around the corners of the brace,
whereas the steel ones are twisted into place. This twisting
action is where the term "tightening" comes from. The brace
is not actually tightened, it's the steel ligature tie that
is tightened. The rubber ties are usually gray in color,
but they also come in a variety of bright colors. So when
you see someone with colors on their teeth, it's the ties
that are colored, not the braces.
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Limited Treatment
This means that a very limited amount of treatment is going
to occur. It is to correct a specific problem only, even
though others may exist. The braces will not be placed on
all of the teeth, just the few that are being corrected.
This is in contrast to comprehensive treatment, where the
entire oral-facial complex is being treated.
One example of limited treatment is called uprighting a
molar. This is usually done when someone is missing a back
tooth and the molar has leaned forward and blocked off part
of the space of the missing tooth. The general dentist can
not make a proper bridge because the space is too small
and the molar is at an incorrect angle. The treatment will
be limited to pushing the molar back and into an upright
position.
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Lingual Braces
Lingual braces are placed on the inside of the patient's
teeth, so you do not see them. All the wires and brackets
are next to the tongue. Which is a problem because it constantly
rubs against them and causes more discomfort than standard
braces. It will also take some time to adjust your talking.
Another problem is that the treatment takes a little longer
and is more costly. They are not for correcting all malocclusions
and it is extremely difficult to get a perfect result. As
a result, many people also get braces on the outside, at
the end of treatment, to detail the final result. They were
used many years ago, before the advent of clear braces and
are rarely used anymore.
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Lingual Holding Arch
A lingual holding arch is a space maintainer for the lower
teeth. It maintains the molars where they are, it does not
move them. This is fabricated by placing bands on the molars
and connecting them to a wire that fits up against the inside
of the lower teeth. It keeps the molars from migrating forward
and prevents them from blocking off the space of teeth that
develop later. This is used when you have the early loss
of baby teeth or when you have lower teeth that are slightly
crowded in a growing child and you do not want to remove
any permanent teeth to correct the crowding
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Lip Bumper
A lip bumper is an appliance that fits between the lower
teeth and the lip. It has a plastic shield in the front
with wire arms that reach back to fit into a brace on the
lower molars. This holds the lower lip out away from the
teeth. It is used when you have crowded lower teeth. The
theory is that the pressure from the lip, pushing back on
the bumper, will push the lower molars back and open up
space for the front teeth to uncrowd. A lot of studies have
shown that what is actually happening is that the lower
front teeth just lean forward into the gap. This does result
in gaining space for uncrowding, but the forward lip position
can be unsightly in some people. Most of the time the lip
will move back later on and the teeth will crowd up again.
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Molar Distalizer
This is an appliance that is used to move the upper molars
back towards the rear of the mouth. Its action is similar
to that of a headgear, but this will only move teeth, not
jaws. This is utilized when the upper molars are too far
forward, but the jaw is in the correct position.
There are several variations to this appliance. Some use
little coil springs attached to a Nance while others use
thick wire extensions in place of the coil springs. A common
trait to all of them is that they fit totally inside the
mouth, without any extra-oral wires.
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Nance
A Nance is a space maintainer for the upper teeth. It maintains
the teeth where they are, it does not move them. It consists
of bands on the molars connected to a wire that extends
forward to a plastic disc on the roof of the mouth (palate).
It keeps the molars from migrating forward and prevents
them from blocking off the space of teeth that develop later.
This can be used when you have the early loss of baby teeth.
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Orthognathic (jaw surgery)
This is used to correct the jaws deformities of non-growing
patients, adults. For example, if the lower jaw is too far
behind the upper jaw, then the lower teeth are also too
far behind the upper teeth. In order to line up the teeth,
you need to move the lower jaw forward and the teeth come
with it.
Teeth have to be surrounded by bone, for blood supply and
nourishment. They can be moved around within the confines
of the jawbone, but not outside of it. If more movement
is needed, then you have to move the jaw. The braces are
used to straighten the teeth within each jaw and then the
surgery is used to line up the jaws, which will align the
teeth.
Some people that need jaw surgery refuse to do it. Sometimes
a compromised treatment can be done to align the teeth,
but the jaws and face will remain incorrect. If you decide
on doing a compromise, then realize that you will not get
an excellent result.
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Palatal Expander
A Palatal Expander will expand the upper jaw out to the
sides. This is the same as a Rapid Palatal Expander. It
is used when the upper jaw is too narrow for the lower jaw.
The bones of the palate (upper jaw) are actually moved apart
and then new bone grows back in the middle, to fill it in.
This is one of the few bones in the body in which this can
be done.
The expander can be either banded or bonded to the teeth.
Banded ones have the expander attached to a band around
the tooth. Whereas the bonded ones have a plastic section
that is bonded over the back teeth. Your vertical growth
pattern will determine which type is utilized. Both types
have a screw section that is turned for the expansion
Age can play a big factor in how easily this is accomplished.
Up to about age 15, the upper jaw can be moved apart easily.
After this age, the two halves of the bone have fused together
and you will need to have surgery first, to undo the fusion.
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Phase I (interceptive treatment)
There can be a lot of different types of Phase I treatment,
but their common goal is to stop a problem early enough
so that it does not become a big problem later on. This
is done for young children, before they have lost all of
their baby teeth. Not many people will need this intervention,
as most orthodontic problems can be solved later in adolescence.
But for those that do need it, it will make a world of a
difference. In addition to intercepting a problem, it can
also involve the correction of a jaw discrepancy. As you
want to prevent any damage from getting worse over time.
A good example of this is a crossbite. This is where the
upper teeth fit inside the lower teeth. Additionally, the
upper jaw will be fitting inside the lower jaw. The teeth
can be moved at anytime, but the bone can not. If left untreated,
the bone will stay this way. You can not orthodontically
correct it later. The bone shift will be very subtle at
first, but it will continue to grow crooked. Hence, the
damage will get worse over time.
Interceptive treatment has also been called Phase I. After
the permanent teeth come in, their straightening with braces
is called Phase II. If there is an early problem, but it
is not severe enough to require intervention, then it can
be corrected later during what is called Comprehensive Treatment.
This treatment takes into account the entire facial structure
as well as the permanent teeth. If the jaws need correction,
then the patient will start treatment a little earlier than
usual. With Comprehensive Treatment, all of the problems
are then corrected in one time frame.
TOP
Power Chain
Power chain is a row of rubber ligature ties that are connected
together. They resemble a chain because each little rubber
ring is attached to the next one in the row. The chain is
stretched over a group of braces, with each ring going around
one brace. As the stretched chain wants to contract, it
pulls the braces closer together. This is utilized when
closing gaps between adjacent teeth.
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Rapid Palatal Expander
A Rapid Palatal Expander will expand the upper jaw out to
the sides. This is the same as a Palatal Expander. It is
used when the upper jaw is too narrow for the lower jaw.
The bones of the palate (upper jaw) are actually moved apart
and then new bone grows back in the middle, to fill it in.
This is one of the few bones in the body in which this can
be done.
The expander can be either banded or bonded to the teeth.
Banded ones have the expander attached to a band around
the tooth. Whereas the bonded ones have a plastic section
that is bonded over the back teeth. Your vertical growth
pattern will determine which type is utilized. Both types
have a screw section that is turned for the expansion.
Age can play a big factor in how easily this is accomplished.
Up to about age 15, the upper jaw can be moved apart easily.
After this age, the two halves of the bone have fused together
and you will need to have surgery first, to undo the fusion.
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Recall
Recall is a re-examination of the patient while no actual
treatment is being done. This is to monitor the growth and
development of the child, before active orthodontic treatment
is started. As you want to make sure all of the teeth are
erupting correctly and the facial growth process is occurring
on schedule. If a problem starts to occur, you want to intervene
before it becomes a serious problem. A parent would have
no way of knowing if everything was proceeding properly,
because orthodontic problems do not cause any pain that
would alert you to something being wrong. Orthodontists
are not only experts in straightening teeth, they are also
experts in the growth and development of your child's mouth,
jaws, and face.
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Removable appliances (Invisalign)
These are retainer-like appliances that can move the teeth
a little bit. They are only good for rotating or tipping
a tooth; which is minor movement. They can not move the
roots of the teeth or the jaws, so they can not correct
a deep overbite or crowding. They work by tipping the crown
part of the tooth. Examples of these are the Spring Retainer
(plastic with metal wires), Invisalign (clear plastic),
and Essix (clear plastic).
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Retainers
Retainers are used to hold the teeth in place, after treatment
is completed. They are needed because the bone has a memory
which wants to move your teeth back to where they were.
A retainers can not move any teeth, it can only retain them
where they are. It is sometimes confused with a Spring Retainer,
which can move the teeth a little bit.
Retainers can be made from plastic, wire, or a combination
of the two. The standard retainer is the Hawley, which is
made of plastic on the inside and wire along the outside
of the teeth. This acts to retain the teeth in a narrow
groove between the plastic and the wire. The plastic can
be ordered in different colors and a sticker can be placed
on the inside, if you like. It must be worn to be effective,
since it is removable. Another removable type is the clear
plastic retainer.
Fixed retainers are made of wire that is bonded (glued)
to the inside of the lower front teeth. They are used in
cases in which the lower front teeth were crowded to start
with and teeth were not removed to correct the crowding.
They are also good for the forgetful patient, because they
can not be taken out or lost.
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Reverse Pull Headgear (facemask)
This is a very different type of headgear that is used where
you have upper front teeth that are in behind the lower
front teeth (anterior crossbite). The facemask is designed
to pull the upper jaw forward. It is removable and fits
in the front of the face. There are soft pads that allow
it to rest on the chin and forehead.
It is attached to the upper jaw by means of elastics that
connect the facemask to a bonded rapid palatal expander
appliance. It is very important that the bonded appliance
in the mouth be firmly fixed to the teeth, to anchor them
together and to the bone. Otherwise, you will be moving
the teeth and not the jaws.
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Separator
A separator is also called a spacer. It is a rubber ring
or a metal wire that is used to make space between the teeth.
This is utilized on teeth that are going to be getting a
band placed around them. The teeth usually fit very tightly
next to each other. This tightness is something you notice
when you floss. In order to make space for the thickness
of the band, you need to place a separator between the teeth
for about a week to push them apart.
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Serial Extraction
This is the sequential removal of specific teeth, in children
with crowding. The removal allows the remaining teeth to
uncrowd by themselves. It involves removing both baby teeth
and permanent teeth. This needs to be done in proper order,
as the specific teeth come into the mouth over several years.
When the remaining permanent teeth grow into the mouth,
they will not be crowded and will bring their natural bone
height with them. This is a feature that can not be duplicated
if you wait until all the permanent teeth are in, before
extracting them.
You can tell if a child will be crowded by age 7. If you
are sure that the child will need removal of permanent teeth
at some point, then it is best to follow this sequential
extraction of them. First baby teeth are removed, then the
child is reexamined at regular intervals to watch for the
correct point at which the specific permanent teeth are
removed. They are then monitored on a regular recall basis
to decide when the most appropriate time will be to start
comprehensive orthodontic treatment.
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Space Age wires
This is a class of wires that have the unique property of
being very flexible, without losing the memory of their
original shape. The flexibility is important to be able
to push the wire into the brace of teeth that are rotated.
The memory is important so that the wire straightens out
to its original shape and moves the braces with it. The
composition of nickel and titanium in the wire is what makes
this possible.
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Spacer
A spacer is also called a separator. It is a rubber ring
or a metal wire that is used to make space between the teeth.
This is utilized on teeth that are going to be getting a
band placed around them. The teeth usually fit very tightly
next to each other. This tightness is something you notice
when you floss. In order to make space for the thickness
of the band, you need to place a separator between the teeth
for about a week to push them apart.
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Spring Retainer
A spring retainer is more correctly called a removable appliance
and can move the teeth a little bit. It is only good for
rotating or tipping a tooth; which is minor movement. It
can not move the roots of the teeth or the jaws, so it can
not correct a deep overbite or crowding. It looks like a
retainer with metal levers (springs) on the inside.
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Tongue Crib
This is used when the tongue has a harmful habit of pushing
forward between the front teeth when speaking or swallowing.
It is also used to stop thumb sucking. Both of these cause
an anterior openbite, which is where the front teeth do
not touch when the back teeth are together. The tongue crib
appliance is made of metal and is usually attached to bands
on the upper back teeth. The bands connect to a wire that
extends forward to a curved section that rests behind the
upper front teeth and drapes down to keep the tongue back
where it belongs.
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Trans-Palatal Arch
A Trans-Palatal Arch fits on the inside of the upper molars.
It consists of bands on the molars with a thick wire that
connects them together. It has several functions, but it
is mainly used to rotate molars.
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