Braces

Introduction

Orthodontists use several different appliances in their profession. Braces are some of the appliances they use to move teeth, whilst other appliances are used to move the jaw.

Producing straight teeth is not the only goal of orthodontics. One would also wish to have the jaw aligned and the face in balance.

Several different appliances can be used at the same time to achieve this optimal result. Braces straighten teeth by holding onto a wire as it returns to its original, straight shape. When this wire is first tied into a brace, you have to bend it slightly to get it to fit in. As it returns to its original shape, it applies pressure to the tooth. This pressure is felt by the bone, which switches on signals to call in new cells that allow the tooth to move through the bone.

Archwire

The archwire is a wire that connects each brace. It does the actual work of aligning the braces, which will line up the teeth. It is made from highly resilient material that allows it to return to its original shape, after you have bent it. It is not like a paper clip that will stay bent.

The wires come in different sizes, shape and composition of materials. The size of the wire is measured by the thickness of the cross-section in thousands of an inch. A common round wire size is 0.016 inch, whereas a common rectangular wire is 0.017 by 0.025 inch. All of them are made from stainless steel materials. The various combinations of materials like chromium, cobalt, nickel, titanium and copper will greatly influence the bending properties of the wire.

Band

A band is a metal ring that fits around the tooth. It will have a brace welded to it and is held onto the tooth with dental cement. Bands are only used on back teeth, because they do not look very attractive with all that metal showing. In years past, all of the teeth had bands on them which is where the term “metal mouth” originates. But with the invention of bonding (gluing) a brace directly onto the tooth, you do not have to use bands on the front teeth anymore.

Holding a brace onto a tooth with a band is much more durable than bonding it directly onto the tooth. This durability is very important when you have people exerting hundreds of pounds of pressure to their teeth when they chew. They can easily break a bonded brace loose from a tooth, but not a banded one. This is why bands are still used today and why orthodontists ask their patients not to chew hard or crunchy food.

Brackets

Braces are the tiny brackets that are attached to the teeth. They act like handles that allow you to grab them to move them. They are usually bonded (glued) directly to the enamel of the tooth, except on a back tooth, where the braces are first welded to a band of metal and the band is then held onto the tooth with dental cement.

There are different types of braces: metal, clear and gold. Metal braces are most popular with orthodontists, because they are the most durable. They are made from stainless steel materials like chromium, zinc, nickel, or titanium. Today braces are much smaller than they were several decades ago. Clear braces are made from a ceramic material, aluminium oxide. They are more fragile and are bulkier. You have to be very close to someone to be able to see them, and that is why they are so popular with adult patients. Gold braces are stainless steel braces that are coated with a gold material.

Clear Brackets

These are braces that are clear or opaque. They match the tooth color very well. Almost all of them are made from a ceramic material, aluminium oxide. When the ceramic ones were invented in 1987, almost everyone stopped using the plastic and lingual braces.

They work the same as metal braces, but produce a little more friction and can prolong the treatment time. You have to be very close to someone to be able to see them, and that is why they are so popular with adult patients.

Elastics (rubber bands)

Elastics are rubber bands that you hook from one brace to another to provide a force that will move the teeth. They can be used to slide one tooth along an archwire or to move a group of teeth. They come in a variety of sizes and strengths. Not everyone needs to wear these, as they are only needed to move teeth specifically.

Extraction

An extraction is the removal of a tooth. It is used when the teeth are crowded and there is not enough room for all of them. The space created by removal of the tooth provides room for the others to rotate and line up straight. All of the extraction space is completely closed; there are no gaps at the end of treatment.

Deciding which tooth to remove is very important. You usually extract the side tooth closest to the crowding, but other factors may interfere with this decision. If in taking out a side tooth, you leave in a tooth with a short root, you will have compromised the case, as short roots have a greater long-term risk of failure than normal roots. Other features that may put a tooth at risk are fillings, crowns, root canals, and bone loss. Having to take out a different tooth will make the case more difficult and cause the treatment time to be extended. It is of paramount importance that you keep the most important teeth.

Headgear

Headgear is an appliance that is worn on the outside of the mouth, with an attachment to connect it to the teeth on the inside. This is used when you have upper teeth that protrude too far in front of the lower teeth, as in buckteeth. It will move the upper teeth and jaw back to match the lower teeth.

Impressions

Taking an impression involves placing a putty-like material in a mouth tray and positioning the tray over the teeth. It is held in position for about a minute, until the material hardens to the consistency of Jell-O. An exact copy of teeth is obtained in this way. This is then taken to the lab where liquid plaster is poured into it. After the plaster has hardened, the tray is removed and a duplicate of your teeth remains in the plaster models. This is called taking a mould of your teeth.

Interceptive Treatment (Phase 1)

There can be many different types of interceptive treatment, but the common goal is to stop a problem early enough so that it does not have seious consequences later on. This is done in young children, before they have lost all of their baby teeth. Not many people will need this intervention, as most orthodontic problems can be solved later in adolescence. But for those who do need it, it will make a world of a difference. In addition to intercepting a problem, it can also involve the correction of a jaw discrepancy, as you want to prevent any damage from getting worse over time.

A good example of this is a crossbite. This is where the upper teeth fit inside the lower teeth, and the upper jaw will fit inside the lower jaw. The teeth can be moved at any time, but the bone cannot. If left untreated, the bone will stay this way. You cannot orthodontically correct it later. The bone shift will be very subtle at first, but it will continue to grow crooked. Hence, the damage will get worse over time.

Interceptive treatment is known as Phase I. After the permanent teeth have moved into position, their straightening by means of braces is called Phase II. If there is an early problem, but it is not severe enough to require intervention, it can be corrected later by what is called comprehensive treatment. This treatment takes into account the entire facial structure as well as the permanent teeth. If the jaw needs correction, then the patient will start treatment a little earlier than usual. With comprehensive treatment, all the problems are corrected in one time frame.

Invisible Braces

Several different types of braces are called invisible braces. Clear braces are called this because it is difficult to see them, unless you are very close to a person. Lingual braces are also called invisible, because they are on the inside of the mouth and you do not see them.

Jaw Surgery (Orthognathic)

This is used to correct the jaw deformities in non-growing patients. For example, if the lower jaw is too far behind the upper jaw, then the lower teeth are also too far behind the upper teeth. In order to line up the teeth, you need to move the lower jaw forward and get the teeth to move with it.

Teeth have to be surrounded by bone for blood supply and nourishment. They can be moved around within the confines of the jawbone, but not outside of it. If more movement is needed, then you have to move the jaw. Braces are used to straighten the teeth within each jaw and then surgery is performed to line up the jaw, which will align the teeth.

Some people who need jaw surgery refuse to have it. Sometimes a compromised treatment can be done to align the teeth, but the jaw and face will remain incorrect. If you decide on a compromised treatment, then you must realize that you will not obtain an excellent result.

Ligature Tie (colour & steel)

The archwire is held to the brace by means of a ligature tie. This tie fits under the corners of the brace, but over the archwire. This is needed to tighten the archwire into the brace. Ligature ties are usually little rubber rings, but narrow steel wires can also be used. The rubber ligature ties are simply stretched around the corners of the brace, whereas the steel ones are twisted into place. This twisting action is responsible for the term “tightening”. The brace is not actually tightened, it is the steel ligature tie that is tightened. The rubber ties are usually gray in colour, but they also come in a variety of bright colours. So if you see someone with colours on their teeth, it’s the ties that are coloured, not the braces.

Lingual Braces

Lingual braces are placed on the inside of the patient’s teeth, so you do not see them. All the wires and brackets are next to the tongue. This may cause a problem because they constantly rub against the tongue and cause more discomfort than standard braces. It will also take some time to adjust your talking. Another problem is that the treatment takes a little longer and is more costly. These braces cannot be used for correcting all malocclusions, and it is extremely difficult to get a perfect result.

Lingual Holding Arch

A lingual holding arch is a space maintainer for the lower teeth. It maintains the molars where they are; it does not move them. This is fabricated by placing bands on the molars and connecting them to a wire that fits up against the inside of the lower teeth. It keeps the molars from migrating forward and prevents them from blocking off the space of teeth that will only develop later. This is used when you have the early loss of baby teeth or when you have lower teeth that are slightly crowded in a growing child and you do not want to remove any permanent teeth to correct the crowding.

Power Chain

A power chain is a row of rubber ligature ties that are connected together. They resemble a chain because each little rubber ring is attached to the next one in the row. The chain is stretched across a group of braces, with each ring going around one brace. As the stretched chain contracts, it pulls the braces closer together. This is used when closing gaps between adjacent teeth.

Rapid Palatal Expander

A rapid palatal expander will expand the upper jaw to the sides. This is the same as a palatal expander. It is used when the upper jaw is too narrow for the lower jaw. The bones of the palate (upper jaw) are actually moved apart and then new bone grows back in the middle to fill the space. This is one of the few bones in the body in which this can be done.

The expander can be either banded or bonded to the teeth. Banded ones have the expander attached to a band around the tooth, whereas the bonded ones have a plastic section that is bonded over the back teeth. A patient’s vertical growth pattern will determine which type to use. Both types have a screw section that is turned for the expansion.

Age can play a big role in how easy this is accomplished. Up to about age 15, the upper jaw can be moved apart easily. After this age, the two halves of the bone have fused together and surgery will need to be performed first to undo the fusion.

Recall

Recall is a re-examination of the patient whilst no actual treatment is being done. This is to monitor the growth and development of a child, before active orthodontic treatment is started, as you want to ensure that all the teeth are erupting correctly and the facial growth process is on schedule. If a problem occurs, you would like to intervene before it becomes serious. A parent will have no way of knowing if everything is proceeding properly, because orthodontic problems do not cause any pain that would alert you to something being wrong. Orthodontists are not only experts in straightening teeth, they are also experts in the growth and development of your child’s mouth, jaw and face.

Separator

A separator is also called a spacer. It is a rubber ring or a metal wire that is used to create space between teeth. This is used on teeth that will be getting a band placed around them. The teeth usually fit very tightly next to each other. This tightness is something you notice when you floss. In order to make space for the thickness of the band, you need to place a separator between the teeth for about a week to push them apart.

Serial Extraction

This is the sequential removal of specific teeth in children with crowding. The removal allows for the remaining teeth to uncrowd by themselves. It involves removing both baby teeth and permanent teeth. This needs to be done in proper order, as the specific teeth come into the mouth in the course of several years. When the remaining permanent teeth grow into the mouth, they will not be crowded and will bring their natural bone height with them. This is a feature that cannot be duplicated if you wait until all permanent teeth are in position, before extracting them.

You can tell if a child’s teeth will be crowded by age 7. If you are sure that the child will need removal of permanent teeth at some point, then it is best to follow this sequential extraction of them. First baby teeth are removed and then the child is re-examined at regular intervals to watch for the correct point at which the specific permanent teeth should be removed. The teeth are then monitored on a regular recall basis to decide when the most appropriate time will be to start comprehensive orthodontic treatment.

Tongue Crib (habit device)

This is used when the tongue has the harmful habit of pushing forward between the front teeth when a person is speaking or swallowing. It is also used to stop thumb sucking. Both of these cause an anterior openbite, which is when the front teeth do not touch when the back teeth are pressed together. The tongue crib appliance is made of metal and is usually attached to bands on the upper back teeth. The bands are connected to a wire that extends forward to a curved section that rests behind the upper front teeth and drapes down to keep the tongue back where it belongs.

Transpalatal Arch

A transpalatal arch fits on the inside of the upper molars. It consists of bands on the molars with a thick wire that connects them. It has several functions, but is mainly used to rotate molars.

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