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Orthodontic Appliances

Definition

Orthodontic appliances are corrective and supportive braces, designed and prescribed by an orthodontist. The appliances treat malocclusions, including crooked, crowded, and protruding teeth that do not fit properly together.

Purpose

In a controlled manner, dental appliances gently force teeth to move through the supporting bone to a desired position. The purpose of the appliances is to correct tooth crowding, overjet or protruding upper teeth, deep overbite, spacing problems, crossbite and underbite, or lower jaw protrusion.

Precautions

Orthodontists applying orthodontic appliances should make sure that a patient's bones, gums and tooth roots are in a healthy condition. They should also prepare the patient emotionally for the experience of wearing orthodontic appliances. The cooperation of the patient is important in achieving a successful result. Patients with emotional or self-image problems can be difficult to treat.

Description

Orthodontic appliances are custom-made appliances, or braces, which are designed by orthodontists to fix bite problems, or malocclusions. There are two large classifications of these appliances: fixed (cemented and/or bonded to teeth) and removable. Appliances can be active or passive—some actively move the teeth, while others, such as retainers, are designed to keep the teeth where they are. Orthodontic appliances, or braces, can be made of metal, ceramic, or plastic. In recent years, there have been advances in the materials used to make braces. The wires used on today's braces are stainless steel, alloys of nickel, titanium, copper, and cobalt, and some are heat-activated. They are designed to exert pressure so that results are faster and more comfortable for patients. Clear orthodontic wires are being studied for application in the general population of orthodontic patients. New braces are smaller and more efficient. The wires cause teeth to continue to move during some treatment phases, which can result in a patient having to make fewer appointments for wire adjustments.

Specific examples of orthodontic appliances include headgear, the bionator, Herbst, the Frankel and maxillary expansion appliances. These are orthodontic appliances designed to actively guide the growth and development of the jaw. Headgear or the Herbst appliance can, over the course of treatment, make the lengths of the upper and lower jaw compatible. An upper jaw expansion appliance can significantly widen a narrow upper jaw. One of the newer orthodontic appliances is a plastic aligner, used to move teeth around without requiring brackets. Orthodontists have a wide range of options in selecting an orthodontic appliance for a particular application.

Another advance in the area of orthodontic appliances is that modern braces are less noticeable than those in which a metal band and bracket were placed around each tooth. In many cases, patients have brackets bonded directly to the front teeth, minimizing the "tinsel tooth" appearance. Patients can choose between clear, metal, or colored brackets. Some braces are bonded behind the teeth.

Preparation

Orthodontists have patients undergo diagnostic testing, prior to applying braces, to help plan the best course of treatment. Diagnostic records usually include a medical and dental history, clinical examination, plaster study models of the teeth, photos of the patient's face and teeth, a panoramic or other type of x ray of the teeth, a facial profile x ray, and other x rays. The cephalometric film, or profile x ray, shows the patient's facial form, growth pattern, and front teeth positions. Other x rays, including panoramic x rays, reveal impacted teeth, missing teeth, and shortened or damaged tooth roots.

Aftercare

Patients who have dental appliances have to take special care of their teeth. They must be careful to avoid hard or sticky foods, which can loosen their appliances and therefore diminish the effect. Orthodontic patients must not chew on hard things, such as pencils or nails, because these can damage the appliances. Cleanings must be more thorough than ever. Teeth should be brushed immediately after eating sweet foods. Special floss threaders are available to make flossing easier.

Complications

Successful orthodontic treatment with appliances requires a consistent, cooperative effort by the orthodontist and the patient. A patient's failure to clean his or her teeth, or to wear rubber bands, headgear, or other prescribed appliances, can result in failure of the teeth to move to their desired positions, and can even prolong treatment.

Ankylosis is a condition that in many cases cannot be controlled or detected by the orthodontist. It occurs when the tooth and underlying bone fuse together and become one. Should a patient have this condition, the braces will not be able to move the fused tooth or teeth.

Results

Orthodontic treatment with orthodontic appliances results in improved aesthetics and better function of the teeth and jaws. Left untreated, crooked or crowded teeth can become worse, sometimes requiring costly treatment to address serious problems that can develop over time. Orthodontic problems can contribute to conditions that cause tooth decay and gum disease. They also can help to cause abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and supporting bone, as well as jaw misalignment, resulting in headaches and face or neck pain.

Health care team roles

The general dentist can identify a malocclusion and refer patients to specialists, such as orthodontists. Dental hygienists may help to identify malocclusions during routine dental hygiene appointments. Together with dentists, hygienists watch the development of pediatric dental patients. They look at how teeth mesh together, examine the patient's profile, and identify instances of crowding or too much space between teeth. Hygienists in the general or pediatric dental office help patients to maintain healthy teeth and gums while the braces are on, by in-office cleanings and education about proper home-care techniques (brushing, soaking, and removal of removable appliances) to maintain overall oral health. Dental assistants are ancillary personnel in dentists' or orthodontists' offices who assist in recording data, taking study models, and performing procedures.

KEY TERMS

Ankylosis— A condition where the tooth fuses to bone.

Bionator— An orthodontic appliance that actively guides the growth and development of the jaw.

Bracket— The braces part that holds the wire.

Crossbite— The condition in which the upper teeth bite inside the lower teeth.

Deep overbite— The condition in which the lower front teeth bite too closely or into the gum tissue behind the upper teeth.

Headgear— An orthodontic appliance, which actively guides the growth and development of the jaw.

Herbst appliance— An orthodontic appliance that actively guides the growth and development of the jaw.

Malocclusion— Misaligned bite.

Maxillary expansion appliances— An orthodontic appliance used to widen a narrow upper jaw.

Overjet— The condition in which the upper front teeth extend beyond normal contact with lower front teeth.

Retainer— A passive orthodontic appliance designed to keep teeth in place.

Resources

ORGANIZATIONS

Academy of General Dentistry. 211 East Chicago Ave., Chicago, IL 600611. (312) 440-4800. 〈http://www.agd.org〉.

American Association of Orthodontists. 401 N. Lindbergh Blvd. St. Louis, MO 63141-7816. (314) 993-1700. 〈www.aaortho.org〉.

American Dental Hygienists Association. 444 North Michigan Avenue, Suite 3400, Chicago, IL 60611. (312) 440-8900. 〈http://adha.org〉.

OTHER

Callahan Barnard, Susan. American Dental Hygienists' Association. Interview with Lisette Hilton, conducted April 16, 2001.

Preis, Frederick (president). American Association of Orthodontists. Interview with Lisette Hilton, conducted April 16, 2001.

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Orthodontic Appliances

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