Dental braces
Dental braces (also known as braces, orthodontic cases, or cases) are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, crossbites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.
Process
The application of braces moves the teeth as a result of force and pressure on the teeth. There are traditionally four basic elements used: brackets, bonding material, archwire, and ligature elastic (also called an “O-ring”). The teeth move when the archwire puts pressure on the brackets and teeth. Sometimes springs or rubber bands are used to put more force in a specific direction.[medical citation needed][1]
Braces have constant pressure which, over time, move teeth into the desired positions. The process loosens the tooth after which new bone grows in to support the tooth in its new position. This is called bone remodeling. Bone remodeling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoclasts and osteoblasts. Two different kinds of bone resorption are possible: direct resorption, which starts from the lining cells of the alveolar bone, and indirect or retrograde resorption, which occurs when the periodontal ligament has been subjected to an excessive amount and duration of compressive stress.[2] Another important factor associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen, and voids will occur distal to the direction of tooth movement.HTTP://[3]
Types
- Traditional metal wired braces are stainless-steel and are sometimes used in combination with titanium. Traditional metal braces are the most common type of braces. These braces have a metal bracket with elastic (rubber band) ties holding the wire onto the metal brackets. The second-most common type of braces is self-ligating braces that do not require elastic ties. Instead, the wire goes through the bracket. Often with this type of braces, treatment time is reduced, there is less pain on the teeth, and fewer adjustments are required than with traditional braces.
- Gold-plated stainless steel braces are often employed for patients allergic to nickel (a basic and important component of stainless steel), but may also be chosen because some people simply prefer the look of gold over the traditional silver-colored braces.
- Lingual braces are a cosmetic alternative in which custom-made braces are bonded to the back of the teeth making them externally invisible.
- Titanium braces resemble stainless-steel braces but are lighter and just as strong. People with allergies to nickel in steel often choose titanium braces, but they are more expensive than stainless steel braces.
- Customized orthodontic treatment systems combine high-technology including 3-D imaging, treatment planning software, and a robot to custom bend the wire. Customized systems such as this offer faster treatment times and more efficient results.[4]
- Progressive, clear removable aligners may be used to gradually move teeth into their final positions. Aligners are generally not used for complex orthodontic cases, such as when extractions, jaw surgery, or palate expansion are necessary.[medical citation needed]
Fitting procedure[edit]
Orthodontic services may be provided by any licensed dentist trained in orthodontics. In North America, most orthodontic treatment is done by orthodontists, who are dentists in the diagnosis and treatment of malocclusions—malalignments of the teeth, jaws, or both. A dentist must complete 2–3 years of additional post-doctoral training to earn a specialty certificate in orthodontics. There are many general practitioners who also provide orthodontic services.
The first step is to determine whether braces are suitable for the patient. The doctor consults with the patient and inspects the teeth visually. If braces are appropriate, a records appointment is set up where X-rays, molds, and impressions are made. These records are analyzed to determine the problems and the proper course of action. The use of digital models is rapidly increasing in the orthodontic industry. Digital treatment starts with the creation of a three-dimensional digital model of the patient's arches. This model is produced by laser-scanning plaster models created using dental impressions. Computer-automated treatment simulation has the ability to automatically separate the gums and teeth from one another and can handle malocclusions well; this software enables clinicians to ensure, in a virtual setting, that the selected treatment will produce the optimal outcome, with minimal user input.[medical citation needed]
Typical treatment times vary from six months to two and a half years depending on the complexity and types of problems. Orthognathic surgery may be required in extreme cases. About 2 weeks before the braces are applied, orthodontic spacers may be required to spread apart back teeth in order to create enough space for the bands.
The teeth to be braced will have an adhesive applied to help the cement bond to the surface of the tooth. In most cases, the teeth will be banded and then brackets will be added. A bracket will be applied with dental cement, and then cured with light until hardened. This process usually takes a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utilized when dental fillings or other dental works make securing a bracket to a tooth infeasible. Orthodontic tubes (stainless steel tubes that allow wires to pass through them), also known as molar tubes, are directly bonded to molar teeth either by a chemical curing or a light-curing adhesive. Usually, molar tubes are directly welded to bands, which is a metal ring that fits onto the molar tooth. Directly bonded molar tubes are associated with a higher failure rate when compared to molar bands cemented with glass ionomer cement. Failure of orthodontic brackets, bonded tubes, or bands will increase the overall treatment time for the patient. There is evidence suggesting that there is less enamel decalcification associated with molar bands cemented with glass ionomer cement compared with orthodontic tubes directly cemented to molars using a light-cured adhesive. Further evidence is needed to withdraw a more robust conclusion due to limited data.[5]
An archwire will be threaded between the brackets and affixed with elastic or metal ligatures. Ligatures are available in a wide variety of colors, and the patient can choose which color they like. Archwires are bent, shaped, and tightened frequently to achieve the desired results.
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