Orthodontics

Orthodontics is the specialty of dentistry that is concerned with the study and correction of:

  • Crooked, malaligned teeth
  • Crowding of teeth.
  • Proclined teeth/jaws (disproportionate jaw relationships)
  • Spaces, midline diastemas (Gaps)
  • Impacted canines
  • Palatal expansion
  • Interdisciplinary Orthodontics- involves the use of Orthodontics combined with other treatments especially for periodontal conditions. Eg: Correction of spacing following periodontal therapy, correction of midline diastema following frenectomy, intrusion of teeth with furcation involvement, slow/rapid orthodontic extrusion for crown lengthening, periodontally accelerated osteogenic orthodontics (PAOO)

Treatments

The most common form of orthodontic treatment is divided into removable and fixed.

  • In fixed orthodontics, metal wires are inserted into orthodontic brackets, made of stainless steel or a more esthetic material like ceramic. Nowadays clear brackets are also available which are more esthetic in appearance. Invisalign consists of clear plastic aligners that move teeth.
  • In removable orthodontics, (plates), headgear, palatal expansion appliances, tongue crib, and many other devices may be used to move the teeth and bones.
  • Functional appliances: are used in growing patients with aim of modifying the jaw dimensions, such as palatal expansion, headgear, etc.
  • Habit breaking appliances for tongue thrusting, mouth breathing, such as tongue crib, or palatal crib, etc.

Ideal age for Orthodontics

Interceptive orthodontics is done at the time when the jawbones are growing and the bone is not so dense or thick so that movement of teeth is easily possible before the growth of bones is complete. An age group of 11-14 years, which is in the mixed dentition stage, is ideal for initiating orthodontic therapy. However with recent advances any age group can be treated.
The routine orthodontic treatment lasts for about 1 year. After a course of active orthodontic therapy, patients will typically wear retainers, which maintain the teeth in their improved positions, while surrounding bone reforms around them. The retainers are worn full time for a period of anywhere from a few days to a year, then part-time (typically in the night).

Earlier Orthodontics was considered to be a part of treatment in the younger age group. However nowadays, the number of adult patients seeking orthodontic treatment has been increasing in the recent years. In adults the bone is more thick and mineralized compared to adolescents, thus more complications can arise. Growth of jaw bones is complete and more chances of hylanization compared to younger children. PAOO is a treatment modality for faster movement of the teeth. It can get accelerated by selective labial and lingual decortications of the alveolar bone at selective line/point angles, and a resorbable bone graft is placed over the surgical sites to augment the confining bone during tooth movement. Rapid tooth movement is attributed to a state of reduced mineralization or reversible osteopenia of the alveolar bone surrounding the involved teeth. Demineralization occurs in the alveolar bone after corticotomy, and the remaining collagenous matrix of bone is transported with the tooth during its movement which will be remineralized following orthodontic tooth movement.