Braces are a set of brackets or clips that are bonded to the teeth to align them. The purpose of braces is to improve the facial aesthetics and create a healthy bite.
If you want to get braces you need to first go to a general dentist for a refferal. If you have a functional issue with the bite you’ll probably get a refferal to the specialist, however, if aesthetic is the main concern, you may be put on a waiting list or you may need to go to an orthodontist yourself.
Why do you need braces?
There are several reasons you may need braces.
- Crowded or crooked teeth
- Spaced teeth
- Upper or lower teeth that are too forward or backward.
- Crossbite (your lower jaw is outward when you bite or chew)
- Deep bite
steps of diagnosis
Access the problem
First, your orthodontist may ask you about your problem and, examine your teeth and bite.
Second, you may be asked about your past medical (any health problem) and dental history (fillings, root canals and previous history of orthodontic treatment etc.).
Medical history is important to obtain because there are certain disorders that either need to be controlled or make you unfit for braces. For instance, patients with uncontrolled diabetes have difficulty in healing and therefore, they aren’t fit for braces. Another such category of patients are the ones who are on chronic NSAIDs or bisphoshonates therapy. Since these drugs interfere with the bone resorption and eventually the tooth movement.
Patients with periodontitis are also not good candidates for fixed orthodontic treatment because orthodontic treatment involves the movement of teeth to a new position. Hence, teeth with weakened support aren’t ideal to start the treatment.
Patients with too many fillings or root canal-treated teeth are also questionable. As orthodontic treatment is a long treatment and may take 1.5- 2 years to complete. Moreover, the brackets on teeth make the cleaning difficult and make you more prone to tooth decay if oral hygiene is neglected.
After that, your orthodontist may run a couple of investigations that will help in diagnosis and make a treatment plan.
X-rays – Lateral Cephalogram and Orthopantomogram
Your orthodontist may request you carry out two x-rays.
The first one is the OPG, that captures the jaws and all the teeth in the mouth. This x-ray helps them identify any tooth hidden tooth in the bone that can interfere with the movement of the overlying erupted tooth, the position of wisdom teeth and any tooth decay.
The next x-ray that is required is the lateral cephalogram, which captures the side of the face. This x-ray helps the dentist to determine whether the jaws and teeth are in a correct position in relation to the face and diagnose the jaw or teeth that are at fault.
Your dentist may take some extraoral (facial) and intraoral (inside the mouth) pictures of you from different positions.
Your facial pictures are taken at three angles. Front (at rest and smile), side (right and left) and a 3-quarter picture of the face.
Intraoral pictures include an image from the front, the roof of the mouth, the floor of the mouth and the view of teeth from the side when they are in occlusion (right and left). Occlusion is the position of the teeth when the upper and lower back teeth are in contact. Dental retractors and mouth mirrors are used to retract your lips or tongue to capture the required structures.
The extraoral and intraoral pictures help in diagnosis and treatment planning. The pretreatment pictures are valuable in assessing the treatment progress and the success of the treatment at the end.
Impression taking for the cast making
Plaster models of upper and lower teeth are also an important diagnostic aid. For this reason, impression of teeth in both the jaws are recorded.
An impression material in the paste form loaded on a tray is seated in your mouth. The impression sets into a hard elastic material in a minute or two and taken out. It then poured with a dental plaster to create a positive replica of your teeth.
Several calculations are performed on these casts that assist in diagnosis and treatment planning. As for the pictures and x-rays, pretreatment casts also serves as records for the future comparision of treatment progress and results.
Steps of braces placement
first step – separator Placement
Orthodontic separators are elastic blue or grey components that are placed on both sides of the first molar (6th tooth on each side) and are left in place for seven days. The separators tend to expand or swell up to create space on both sides of the molar so a band can be placed.
Second step – Band Placement
Bands are ring-shaped metal components of the braces that are bonded on the four first molars. They have round tubes that hold the wire component of the braces in place.
They are also provided with hooks to provide attachments to the elastics such as power chain.
Third step – Bracket Placement
Brackets are square-shaped clips that are bonded to the 10 teeth (teeth between the right and left first molar) in each jaw.
Each bracket has a slot or groove surrounded by 4 wings. These slots hold the archwire in place and an o-ring (coloured small elastic band) is placed on the wings of the brackets to prevent the wire from displacement.
fourth step – archwire placement
The last step is the placement of an archwire. Initially, a thin wire is placed for a month. Every month the old wire is replaced by a thicker wire till the teeth move to the desired position.