Orthodontics

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What is orthodontics?

Orthodontics is a specialized branch of dentistry that focuses on diagnosing, preventing and correcting dental malpositions and jaw dysfunctions. In other words, orthodontics treats problems with the alignment of teeth and jaws, ensuring not only an aesthetic appearance, but also correct functionality of the masticatory system.

Misaligned teeth or improper jaws not only affect the smile aesthetically, but can cause a series of functional problems, such as chewing difficulties, incorrect diction and periodontal diseases. Orthodontics intervenes through personalized treatments, adapted to each patient, to correct these deficiencies.

What does orthodontics do?

Orthodontics is not just about fitting dental braces to straighten teeth. It includes a variety of techniques and procedures, all aimed at correctly aligning teeth and harmonizing occlusion. The objectives of orthodontics can be grouped as follows:

  • ● Correcting dental malpositions: Crowded, crooked or widely spaced teeth represent aesthetic and functional problems. Orthodontics intervenes to return each tooth to its place.
  • ● Jaw adjustment: Orthodontics also deals with structural problems of the jaws, such as reverse bite (when the lower teeth overlap the upper ones) or open bite (when the upper and lower teeth do not touch during biting). These conditions can seriously affect oral health and even the structure of the face.
  • ● Improving masticatory functionality: A correct bite not only improves mastication, but also contributes to gum health, preventing periodontal diseases and tooth decay.
  • ● Smile aesthetics: In orthodontics, an aesthetic smile is a major goal, but not the only one. Correctly aligned teeth not only bring added confidence, but also an improvement in long-term oral health.

Orthodontics is applied to both children and adults, and modern treatments allow for effective interventions, regardless of age. Orthodontics also frequently collaborates with other dental specialties, such as oral surgery or dental prosthetics, to ensure a treatment plan with optimal results.

How is the diagnosis made in orthodontics?

Causes of dental malocclusions

Dental malocclusions, i.e. incorrect alignment of the teeth and jaws, can be caused by a variety of genetic and environmental factors. Among the most common causes are:

  1. 1. Genetic factors: A large part of dental malocclusions are inherited. If a parent or other family members have had dental alignment problems, there is a high chance that the child will develop the same problems. For example, jaws that are too large or too small, supernumerary teeth, or missing teeth are conditions that are genetically transmitted.
  2. 2. Environmental factors: These include habits and behaviors that, over time, can lead to the development of malocclusions. These include: Thumb sucking: The habit of sucking your thumb after the age of 4 can influence the development of the jaws and the positioning of the teeth, leading to open occlusions or incorrect alignments. Mouth breathing: Constant mouth breathing, due to respiratory conditions or nasal obstructions, can affect the correct positioning of the jaws and teeth. Prolonged use of a pacifier or bottle: Continuing these habits after the age of 2-3 years can lead to abnormalities in dento-maxillary development.
  3. 3. Trauma: Accidents that affect the teeth or jaws can cause them to move, leading to malocclusions that require orthodontic treatment.
  4. 4. Premature loss of baby teeth: If a baby tooth is lost too early, permanent teeth can migrate into the gaps, causing crowding or misalignment.
  5. 5. Jaw growth problems: In some cases, the jaws grow unevenly, either too large or too small in relation to the teeth, which can lead to malocclusions.

Symptoms of dental malocclusions

Dental malocclusions are not just an aesthetic problem. They can cause a number of symptoms and complications, which range from mild to severe, depending on the degree of dental malposition and the type of occlusion. Among the most common symptoms are:

  • ● Visibly misaligned teeth: This is the first and most obvious manifestation of malocclusions. Teeth may be crowded, spaced, or unevenly spaced.
  • ● Chewing difficulties: Misaligned teeth can make it difficult to chew food, which can lead to digestive problems or ineffective chewing.
  • ● Jaw pain or discomfort: An incorrect bite can put excessive pressure on certain teeth and jaw muscles, causing pain or fatigue during chewing.
  • ● Headache: Severe malocclusions can cause frequent headaches, due to increased tension in the muscles of the face and jaw.
  • ● Speech difficulties: Severe occlusions, such as open bite, can affect the ability to pronounce certain sounds correctly, causing difficulty speaking.
  • ● Mouth breathing: If malocclusions are associated with breathing problems, patients may develop the habit of breathing through their mouths, instead of through their noses.

Orthodontic diagnosis

Orthodontic diagnosis involves a thorough evaluation of the position of the teeth and the structure of the jaws. The first step in establishing a correct diagnosis is a detailed consultation, during which the orthodontist will analyze the medical history and perform a series of investigations:

  • 1. Clinical examination: The orthodontist will examine the oral cavity, observing the alignment of the teeth, the occlusion and the symmetry of the face. This visual assessment is essential to identify any obvious problems related to dental malpositions or jaw development.
  • 2. Dental X-rays: Dental X-rays are essential to evaluate structures that are not visible to the naked eye, such as the roots of the teeth, their position in the bone and the development of permanent teeth. The most common X-rays used in orthodontics are: Panoramic X-ray: This provides an overview of all the teeth, jaws and temporomandibular joints. It is useful for identifying problems such as impacted teeth (teeth that have not erupted), fractures, cysts or other structural abnormalities and Cephalometric radiography: This type of radiography is used to evaluate the relationship between the teeth, jaws and facial structure. It is particularly important in planning orthodontic treatments that involve changes to the jaws.
  • 3. Intraoral and extraoral photographs: Photographing the teeth and face helps to document the patient's initial condition and monitor progress during orthodontic treatment. These images are essential for assessing the aesthetic and functional improvements that the treatment brings.
  • 4. Dental impressions and digital scans: The orthodontist can take traditional dental impressions or use modern digital scanning technologies to create a three-dimensional model of the patient's teeth. This model is used to plan and customize orthodontic treatments, ensuring that every detail is addressed correctly.
  • 5. Functional occlusion analysis: The orthodontist will also evaluate the functionality of the occlusion, that is, the way the upper and lower teeth meet during chewing. An improper occlusion can cause discomfort or functional problems that require orthodontic correction.

Based on these investigations, the orthodontist can establish a clear diagnosis and a personalized treatment plan for each patient. The correct diagnosis is crucial for choosing the treatment method and obtaining the best results.

Treatment methods used in orthodontics

Modern orthodontics offers a wide range of methods and devices for correcting dental malpositions and malocclusions. Treatments are tailored to each patient based on the severity of the problem, age, and aesthetic and functional goals. Below are detailed the most common orthodontic treatment methods.

Fixed orthodontic appliances

Fixed braces are the most common orthodontic devices and are used to correct moderate to severe malpositions. They consist of brackets that are attached to the teeth and a metal arch that exerts the necessary force to gradually move the teeth into the correct position.

There are several types of fixed braces:

  • ● Classic metal braces: This is the most well-known type of orthodontic braces, consisting of metal brackets and arches that are periodically adjusted to correct the alignment of the teeth. Although it is visible, it remains effective and affordable.
  • ● Ceramic braces: They work on the same principle as metal braces, but the brackets are made of transparent or tooth-colored ceramic, which makes them more discreet. This is preferred by patients who want an aesthetic solution, but as effective as the metal one.
  • ● Lingual braces: This type of orthodontic appliance is mounted on the inner side of the teeth (towards the tongue), being completely invisible from the outside. Lingual braces are ideal for patients who want to correct malpositions without the device being visible. However, being a more complex treatment, it requires a period of adjustment and can be more expensive.

Removable orthodontic appliances

Removable orthodontic appliances are removable devices that can be removed by the patient to eat, drink and clean themselves. They are more often used in children and adolescents, because their jaws are in the process of growing, and removable appliances can guide correct development.

Types of removable orthodontic appliances:

  • ● Functional appliance: This is a device that influences the growth and positioning of the jaws, and is used to correct bite problems in children and adolescents. For example, a functional appliance can help correct a deep or reverse bite by stimulating jaw growth.
  • ● Retention tray: After completing treatment with fixed appliances, the orthodontist recommends wearing a retention device, which can be a removable appliance. It is designed to keep teeth in the correct position, preventing relapse and maintaining the results obtained.

Invisible orthodontic appliances

A major innovation in modern orthodontics is the invisible dental appliance, a set of clear aligners that are applied to the teeth and gradually move them into the correct position. These appliances are also known as aligners and are an excellent alternative to traditional orthodontic appliances, especially for adults.

  • ● Invisalign: The best-known clear aligner system is Invisalign, which uses a series of custom-made aligners to progressively align teeth. Each aligner is worn for approximately two weeks before being replaced with a new one, which brings the teeth closer to the desired final position.

Advantages of invisible braces include:

  • ● Superior aesthetics: Being almost invisible, these aligners are preferred by patients who want to correct their teeth without the treatment being visible. They are a popular choice among adults, especially those who work in professional environments.
  • ● Comfort: Aligners are made of soft, smooth plastic materials that do not irritate the gums or cheeks, unlike metal brackets.
  • ● Improved hygiene: Unlike fixed braces, aligners can be removed for brushing and flossing, which facilitates optimal oral hygiene during treatment.

Disadvantages include higher cost and the need for strict discipline, as the success of the treatment depends on wearing the braces as recommended, i.e. a minimum of 20-22 hours per day.

Palatine expansion

For children with narrow jaws, the orthodontist may recommend a palatine expansion device, also known as a palatine expander. This device is used to gradually widen the upper jaw so that the teeth have enough space to align properly.

Palatine expansion is most effective during childhood, because the jaw bones are still growing and more easily reshaped. In some cases, expansion can also be used to correct other conditions, such as a crossbite.

Orthognathic surgery

In severe cases of malocclusionor jaw development problems that cannot be corrected with orthodontic appliances alone, orthognathic surgery may be necessary. This procedure involves surgically repositioning the jaws to correct occlusion problems and restore facial balance.

Orthognathic surgery is indicated in cases of:

  • ● Mandibular prognathism (reverse bite), in which the lower jaw is more prominent than the upper jaw, causing a reverse bite.
  • ● Retrognathism (deep bite), where the upper jaw is more developed than the lower jaw, causing the upper teeth to excessively cover the lower teeth.
  • ● Open bite (open bite), when the upper and lower teeth do not meet when the mouth is closed, leaving a space between the dental arches.

Orthognathic surgery is usually recommended for adults and adolescents who have completed the jaw growth process. This intervention is planned with great care and can be combined with orthodontic treatments, such as wearing braces before and after surgery, to achieve an optimal functional and aesthetic result.

Temporary Anchorage Devices (TAD)

Temporary Anchorage Devices (TAD) are small titanium screws that are temporarily placed in the jawbone to provide a fixed anchor point during orthodontic treatment. They are used to move teeth into precise positions and achieve faster and more effective results in cases that would otherwise require surgical procedures or tooth extractions.

TADs are placed under local anesthesia and are removed at the end of orthodontic treatment. They give orthodontists greater control over tooth movement and allow them to correct severe alignment problems without compromising the stability of other teeth.

Duration and stages of orthodontic treatment

The duration of orthodontic treatment varies depending on the complexity of the case, the type of appliance used, and the patient's cooperation. In general, orthodontic treatments last between 12 and 36 months, and the process can be divided into several stages:

  • 1. Diagnostic and planning stage: In this phase, the orthodontist performs all the necessary investigations to establish an accurate diagnosis and create a personalized treatment plan. This includes clinical examinations, radiographs, dental impressions or digital scans, and photographs of the oral cavity and face.
  • 2. Active Treatment Phase: During this phase, the patient wears the braces, and the orthodontist makes periodic adjustments to guide the teeth into the correct positions. This is the phase that can take the longest, depending on the type of braces and the severity of the alignment problem.
  • 3. Retention Phase: After active treatment is complete, it is crucial that the teeth are maintained in their new position to prevent relapse. This is done by wearing retainers, which can be fixed (a thin wire placed on the inside of the teeth) or removable (a retainer worn at night).

Complications and Risks of Orthodontic Treatment

Although orthodontic treatments are generally safe and effective, there are certain risks and complications that must be considered. These include:

  • ● Root resorption: During orthodontic treatment, there is a risk that the roots of the teeth will undergo a slight resorption, that is, they will become shorter. Although this is usually minimal and does not affect the functionality of the teeth, in rare cases, root resorption can be significant.
  • ● Relapse: After the removal of the dental braces, there is a risk that the teeth will begin to move back to their original positions. For this reason, wearing the retainer is essential to maintain the results obtained.
  • ● Gum problems: Patients who do not maintain adequate oral hygiene during orthodontic treatment may develop gingival inflammation, cavities or periodontal disease. Therefore, it is important that they are well informed and strictly follow the orthodontist's instructions regarding brushing and cleaning the appliance.
  • ● Temporary discomfort:

The importance of oral hygiene during orthodontic treatment

Oral hygiene is particularly important during orthodontic treatment, especially for patients who wear fixed braces. Because of the brackets and arches, food and bacterial plaque can accumulate more around the teeth, which increases the risk of cavities and gum inflammation. Patients should follow a strict oral hygiene regimen, which includes:

  • ● Brushing teeth after each meal: It is essential for patients to brush their teeth after each meal to prevent plaque buildup around brackets and archwires.
  • ● Flossing: Although it may be more difficult to floss while wearing braces, it is still essential to clean between teeth.
  • ● Using antibacterial mouthwash: To prevent gum inflammation and cavities, patients are advised to use antibacterial mouthwash.
  • ● Regular professional cleanings: In addition to daily hygiene, patients should go for professional cleanings every 6 months, or as recommended by their orthodontist.

Orthodontics is a vital branch of dentistry, with a profound impact on both the oral health and the confidence and aesthetics of patients. With a diverse range of treatment methods, from fixed braces to invisible aligners and orthognathic surgery, modern orthodontics can correct a wide range of malocclusions and dental alignment problems.

Orthodontic treatment requires patience and cooperation from the patient, but the long-term results bring significant benefits. A healthy and properly aligned smile not only improves chewing function, but also contributes to maintaining long-term dental health, preventing complications such as cavities, periodontal disease and jaw pain.

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Frequently Asked Questions (FAQ) about Orthodontics

  • When should I make my first visit to the orthodontist?

    The first visit to the orthodontist should take place around the age of 7, according to the recommendations of the American Association of Orthodontics. At this age, the orthodontist can assess the development of permanent teeth and identify potential problems. Early intervention can guide jaw growth and tooth eruption, preventing the need for more complex treatments in the future.

  • What are the signs that I need orthodontic treatment?

    Common signs that indicate the need for orthodontic treatment include crowded or spaced teeth, a reverse bite (when the lower teeth overlap the upper teeth), an open bite (when the upper and lower front teeth do not meet), and difficulty chewing or speaking. Other signs may include excessive tooth wear and jaw pain.

  • Is orthodontic treatment painful?

    Orthodontic treatment can cause some discomfort, especially after adjusting your braces. This discomfort is usually mild and temporary, lasting a few days after each adjustment. Your orthodontist may recommend mild painkillers to help manage the pain. However, most patients adapt quickly to orthodontic appliances and discomfort becomes minimal.

  • How long does orthodontic treatment last?

    The duration of orthodontic treatment varies depending on the complexity of the case and the type of appliance used. In general, treatment can last between 12 and 36 months. Your orthodontist will be able to provide a more accurate estimate of the duration of treatment after the initial assessment and establishment of a treatment plan.

  • Can I wear clear aligners instead of traditional braces?

    Yes, clear aligners, such as Invisalign, are a popular alternative to traditional braces. They are removable, nearly invisible, and comfortable. However, not all cases are suitable for treatment with clear aligners. Your orthodontist will assess whether clear aligners are right for your specific case.

  • Do I need to avoid certain foods during orthodontic treatment?

    Yes, if you wear traditional braces, it is important to avoid hard, sticky or crunchy foods that can damage your braces. These include hard candy, chewing gum, popcorn and nuts. In the case of clear aligners, they should be removed during meals, allowing you to eat without restrictions, but it is important to brush your teeth before putting the aligners back in.

  • What happens after I finish orthodontic treatment?

    After completing active orthodontic treatment, patients must wear retainers to maintain their teeth and in their new positions. Retainers can be fixed (glued to the back of the teeth) or removable (removable trays). Your orthodontist will recommend a retainer wearing schedule to prevent relapse and ensure long-term stability of the results.