What lies behind the effectiveness of orthodontic treatment?
Orthodontic treatment aims to correct dental, occlusal and skeletal irregularities. Commonly, orthodontics is associated with improving aesthetics. The correct positioning of teeth ensures their favourable appearance during speech and smiling, improves the features of the face and has a positive effect on the patient's self-acceptance and how they are perceived by those around them. Orthodontic treatment prevents the emergence of, or eliminates already existing, disorders within the masticatory organ. The orthodontic relief of tooth crowding eliminates retention sites for bacterial plaque and tartar, thereby preventing the development of caries and periodontal diseases (popularly called "periodontosis", although that name today has only historical significance) that favour the premature loss of teeth.
It is recommended that every child be examined orthodontically at the age of 7, unless irregularities are noticed earlier. Orthodontic treatment is most favourably introduced just before the growth spurt of puberty, occurring at around 8–9 years of age. Treatment of very severe irregularities can begin earlier.
Orthodontic treatment should be conducted according to the Two-Stage European Treatment System
The first stage of orthodontic treatment falls during the period of growth and the shaping of the patient's bite. It is then possible to use intensive growth changes to harmonise the bony bases, the muscular system and the temporomandibular joint. The correct positioning of the mandibular base relative to the maxillary base has an extremely favourable effect on the patient's facial features, especially in retrusive and protrusive defects. During this period the dental arches are expanded, thereby providing space for the permanent teeth. This stage of treatment is carried out using removable orthodontic appliances, inserted into the oral cavity by the patient themselves and worn for the number of hours a day recommended by the doctor.
The second stage of treatment falls during the period of completed growth. Only movements of the teeth themselves are then possible, without the ability to expand the bony bases or change their mutual position. In these cases it is often necessary to remove permanent teeth in order to provide space for others that are incorrectly positioned. This stage of orthodontic treatment is carried out using fixed orthodontic appliances, permanently attached to the teeth for the treatment period. The active period of treatment lasts on average from 1.5 to 2 years (in more difficult cases up to 3 years). After the fixed appliances are removed, a retention treatment period follows, whose task is to stabilise the teeth in their new position. The patient then uses retention appliances (retention plates, retainers), reporting for check-ups at intervals of on average 3–6 months for the required period of time.
Special cases of orthodontic treatment with fixed appliances
Adult patients with periodontal disease
As a result of periodontal disease, the bony support of the teeth is lost, they become loose and undergo aesthetically unfavourable displacements. The consequence of such a condition is above all the accelerated loss of teeth. In these cases orthodontic treatment restores the aesthetics and function of the masticatory organ. Most important is a positioning of the teeth that allows the correct (physiological) transfer of chewing forces onto the bones of the maxilla and mandible, which allows one's own dentition to be preserved for a much longer time.
Patients being prepared for the prosthetic reconstruction of lost teeth
Orthodontic treatment with fixed appliances allows, in these cases, the most favourable positioning – from the point of view of biomechanics – of the abutment teeth that provide support for future prosthetic restorations.
Patients being prepared orthodontically for the surgical correction of skeletal disorders (e.g. treatment of prognathism, i.e. an excessively large mandible).
Fixed orthodontic appliances
A cosmetic and elegant fixed appliance with brackets made of transparent sapphire
The appliance's brackets are made of pure, monocrystalline sapphire. Because of the properties of sapphire, these brackets do not discolour and are decidedly more durable, which gives them a considerable advantage over traditional aesthetic brackets made of composite (so-called plastic brackets) or ceramic (glass brackets, sometimes mistakenly called porcelain).
A traditional fixed appliance with small brackets
Most often, small brackets made of metal are fitted. Their retention on the teeth is possible thanks to the use of advanced bonding systems that give a high bond strength. Low-profile appliances and nickel-free orthodontic appliances are also available.
A fixed appliance with coloured ligatures on the brackets
The archwire of fixed appliances is tied to the brackets with so-called ligatures. Most often silicone ligatures are used. They can be invisible – made of transparent silicone – or silver, blending in with the metal brackets. To "cheer up" the metal brackets we offer coloured ligatures. They are changed during the monthly visits. The patient can then choose the colour depending on the season, mood, the colour of the dress for the New Year's ball, or the colours of the football team they support.
Orthodontic treatment of adult patients
There is no age limit above which it is impossible to undertake orthodontic treatment with fixed appliances. All that is needed is a little courage and a sufficient number of crooked teeth ;-)
We successfully treat patients over 50 years of age. Malocclusions in adult patients may be caused by not undertaking treatment in youth and by periodontal conditions colloquially referred to as periodontosis, leading to the spontaneous displacement of teeth. The correct positioning of teeth thanks to orthodontic treatment with fixed appliances makes it possible to preserve one's own teeth for many years – even ones that were previously qualified for extraction.
Orthodontic treatment of adult patients is conducted on the basis of the latest items of American, English and German literature and knowledge from national and international conventions, congresses and courses.
From the first visit to treatment with an orthodontic appliance
The first visit is an orthodontic consultation, getting to know the patient, a basic examination and qualification for treatment. Sometimes, before fitting an orthodontic appliance, a professional cleaning of the teeth of tartar and deposits is necessary. Complete treatment of caries is required before orthodontic treatment.
Orthodontic treatment, like any treatment, requires planning. Before fitting an orthodontic appliance, the doctor thoroughly diagnoses the patient – takes impressions, takes photographs, performs an X-ray examination including a cephalographic one. This data will be used to carry out the necessary measurements, calculations and individual planning of the treatment. Before fitting the appliance, the patient is informed about the predicted course and length of treatment, the benefits of treatment, possible complications and the costs. On average, orthodontic treatment lasts from 18 to 30 months. The length of orthodontic treatment results from the individual conditions of the patient and the type and size of the defect.
Usually a week after fitting the appliance the first check-up visit takes place, at which the orthodontist checks the condition of the appliance, advises how to maintain and clean the orthodontic appliance, and possibly makes the necessary corrections. Check-up visits are very important – the doctor can then supervise the treatment and introduce appropriate adjustments and repairs. An unplanned failure of the patient to attend a check-up visit may cause the appliance to act in an uncontrolled, harmful way.
Visits to the orthodontist are painless. Fitting the appliance does not hurt, but one has to endure lying still for 30–60 minutes. Check-up visits usually take 5–20 minutes. After the appliance is fitted, a feeling of discomfort on biting, numbness or tingling may occur for a few days. In a small group of patients a constant, slight pain and a feeling of tiredness of the facial muscles may occur in the first days of treatment. Long-acting painkillers prescribed by the doctor can then be used.
In the first days after fitting, a fixed appliance may act as an irritant on the mucous membrane of the cheeks – the doctor then advises the patient how to stick on protective orthodontic wax and prescribes appropriate rinsing liquids.
Adaptation to a fixed orthodontic appliance occurs after 2–3 weeks; the feeling of tiredness and irritation of the mucosa then passes and orthodontic wax or other medicines are no longer needed. Sometimes during treatment one has to wear elastics recommended by the doctor – these are thin little rubber bands placed on the brackets of the appliance; the patient is instructed in detail by the doctor on how to fit and when to wear the elastics.
Orthodontic treatment is smooth and trouble-free if the patient is determined to cooperate and to take seriously the recommendations of wearing the elastics or of correct hygiene of the appliance and teeth. At least twice a year a professional cleaning of the teeth and appliance of tartar, deposits and sediment is necessary. Correct hygiene, good eating habits and attendance at check-up visits lead to the correction of practically every malocclusion.
