Dental Braces, or more commonly called Orthodontic Brace is a device used in orthodontics to straighten malposed teeth teeth according  to the individual’s  bite. They pose as a perfect solution to occlusal problems like underbites, overbites, cross bite and open bites, deep bites, or crooked teeth and various other flaws of teeth and jaws, whether cosmetic or structural. Thus improving the aesthetics of the face and smile.

THE  HIDDEN  PHYSIOLOGY

- Pressure applied on the teeth, cause them to move in a particular direction. The pressure exerted by the archwire, builds up pressure in the Periodontal Ligament, thus altering its blood supply.

- This elicits a  biological response which leads to Bone Remodelling, where bone formation occurs on one side of the tooth by Osteoblast cells (bone forming cell) and resorbed on the other side of the tooth by Osteoclast cells (bone resorption cell).

Two different kinds of bone resorption are possible.

a. Direct resorption, starting from the lining cells of the Alveolar Bone,

b. Indirect or Retrograde Resorption, where osteoclasts start their activity in the neighbour bone marrow. This occurs  when the periodontal ligament has become subjected to an excessive                       amount and duration of compressive stress.

• A compressed Periodontal Ligament is necessary to start the process of bone resorption.
• Another important phenomenon, which is bone deposition, occurs in the distracted periodontal ligament. Lack of  bone formation, will lead to loosening of teeth in its socket, and formation of voids distal to the the direction of tooth movement.
• A tooth usually moves about a millimeter per month during orthodontic movement, but there is high individual variability.

TYPES

• Traditional braces are stainless steel, sometimes in combination with nickel titanium, and are the most widely used. These include conventional braces, which require ties to hold the archwire in place, and newer self-tying  brackets.

• “Clear” braces serve as a cosmetic alternative to traditional metal braces by blending in more with the natural color of the teeth or having a less conspicuous or hidden appearance. Typically, these brackets are made of ceramic or plastic materials and function in a similar manner to traditional metal brackets.

• Gold-plated stainless steel braces are often employed for patients allergic to nickel (a basic and important component of stainless steel), but may also be chosen because some people simply prefer the look of gold over the traditional silver-colored braces.

• Lingual braces are fitted behind the teeth, and are not visible with casual interaction. Lingual braces can be more difficult to adjust, and they can hinder tongue movement.

• Progressive, clear removable aligners (examples of which are Invasalign , Originator, ClearCorrect) may be used to gradually move teeth into their final positions. Aligners are generally not used for complex orthodontic cases, such as when extractions, jaw surgery, or palate expansion are necessary.

• For less difficult cases spring aligners are also an option that can cost much less than braces or Invisalign (one example is NightShiftOrtho) and still align primarily the front six top and bottom teeth.

• A new concept under development is the “smart bracket.” which contains a microchip capable of measuring the forces applied to the bracket/tooth interface. The aim  is to significantly reduce the treatment duration  and to set safe, optimal range of force.

• A-braces are another new concept which is in the shape of a capital letter A.  A-braces are applied, adjusted, removed and completely controlled by the user. At the ends of the A’s arms are angled knobbed bits that the user bites down over. The width between the bits is adjusted by turning the crossbar, housed across the arms. A user never has to experience pain because the pressure is so easy to control. A-braces may serve as self-adjustable retainers and palate expanders.

THE  RIGHT  TIME  TO  GET  THEM  FITTED

• Braces for the teeth can be fitted at any age, although ideally the procedure is carried out in children, and is less common in adults.
• The reason being that the teeth and surrounding jaw bones are more flexible and  malleable in children, and therefore respond better to therapy.
• Orthodontic procedures must be planned as soon as the first sign of any occlusal disturbance is detected in a child.
• It is recommended to wait until there are enough adult teeth.

PROCEDURE

• First a complete dental examination is carried out, then X-rays taken, after which plaster moulds of the teeth are made. Sometimes teeth may have to be extracted, if there is crowding of teeth, before the braces can be fitted.

Teeth are polished and air-dried

(to ensure proper bonding of the brackets)

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Cheek retractor used to keep the teeth visible and air dry during the procedure

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Conditioner applied on  the tooth surfaces to be bonded, for 30 sec.

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This is cleaned, dried, followed by application of an  adhesive primer.

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Cement is placed on the back of the brackets, and placed on the predetermined positions on the tooth

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Excess cement is removed, and brackets are allowed to harden under high intensity light.

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The cheek retractor is removed, and the arch wire is placed in the bracket slots.

• The entire process of bonding the brackets and placing the arch wires can take anywhere from 10 to 20 minutes.
• When dental braces are first placed and then later adjusted, you can expect to feel some tightness, which typically progresses to soreness, for approximately four to six hours post appointment.
• This soreness is a direct result of arch wires tightening the teeth into position.

DENTAL  BRACES  ADJUSTMENTS

Once your dental braces are in place, regular adjustment appointments are necessary. This is because the elastic ties holding the wires in proper place stretch and weaken over time. the weakene elastic bands would be incapable of creating the proper pressure to correct the dental issues requiring treatment. It takes a minimum of three weeks for tooth movement to occur, meaning that many adjustment appointments are made every three to 10 weeks.Adjustment appointments involve removing the colored elastic ties which hold the dental braces in place. The arch wires also are removed so that you may brush and floss your teeth thoroughly.The treatment progress is assessed, and new arch wires, elastic bands may be placed, to continue with the tooth movement.

OPTIMUM  MAINTENANCE  OF  DENTAL BRACES

• It is important to maintain proper oral hygiene and avoid certain types of food, especially sticky foods, since they can get lodged  under the braces and possibly cause detachment.
• Hard foods and candy also should be avoided; they may break the bond between the brackets and the enamel, or possibly the braces themselves.
• Foods such as apples should be cut into pieces to avoid damaging the dental braces. Avoid foods and drinks with high sugar and acid content, since they make oral hygiene much more difficult
• Inadequate brushing may lead to damage of the enamel, so it is very important to brush at least three times a day.
• Interdental brushes and a water pik should be used to clean underneath the dental arch wires for even better oral hygiene.
• Fluoride mouthrinses are also recommended to maintain the underlying enamel and tooth structure.

BRACES  REMOVAL

• Dental braces will be removed with a simple, painless process. The bond between the brackets and teeth is safely and gently broken.
• When the bases of the brackets are squeezed, the adhesive bond releases, and the brackets are removed. During this process, the adhesive is left on the teeth to prevent damage to the enamel and tooth structure.
• The remaining bonding cement is removed using a dental hand piece.
• Gums may be slightly inflamed, but this will usually subside in a few days with the right oral hygiene regimen advised.

AFTERCARE

• About one to two weeks after dental braces have been removed, an appointment is made for retainer placement. They can also be placed at the braces removal appointment itself.
• Retainers are removable orthodontic appliances which are necessary during the “retention period” of orthodontic treatment. During this stage of treatment, the teeth are relatively unstable and must be retained to avoid relapse of the condition.
• During the first six months following the removal of dental braces, it is often necessary for someone to wear the retainer full time. After this period, the duration for retainer, will be decided depending on the individual case requirement.

POSSIBLE  COMPLICATIONS  AND  RISK

• Plaque forms easily when food is retained in and around braces. It is important to maintain proper oral hygiene by brushing and flossing thoroughly when wearing braces to prevent tooth decay, decalcification, or unpleasant color changes to the teeth.
• There is a small chance of allergic reaction to the elastics or to the metal used in braces. In even rarer cases, latex allergy may result in Anaphylaxis. Latex-free elastics and alternative metals can be used instead. It is important for those who believe that they are allergic to their braces to notify the orthodontist immediately.
• Mouth sores may be triggered by irritation from components of the braces.
• Patients with Periodontal disease usually must obtain periodontal treatment before getting braces. A deep cleaning is performed, and further treatment may be required before beginning orthodontic treatment. Bone loss due to periodontal disease may lead to tooth loss during treatment.

TREATMENT  TIME  AND  COST

• Typical treatment time is from six months to six years, depending on the severity of the case, location, age, etc., although research has shown that the average duration is 28.6 months (2 years and 4 months).
• Treatment can be fastened using novel planning, unorthodox treatment goals and positioning techniques.
• The typical cost of braces ranges widely in various regions. The cost depends on whether both arches are being treated and the length of treatment.
• Typical orthodontic treatment comprises metal braces on both arches for 12 to 24 months.