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Orthodontic Treatment: Journey from Malocclusion to Perfection

Orthodontic Treatment Options

What Is Orthodontic Treatment?

The branch of dentistry which deals with the prevention, correction and intervention of malaligned teeth is known as orthodontic treatment. However since the past two decades, the definition has also included the correction of underlying bone along with the teeth. Thus the specialty has come to be known as orthodontics and dentofacial orthopedics. The branch makes use of forces with the help of various small appliances to bring teeth back into their original positions; similar actions can be done on the underlying bones as well.  A number of removable as well as fixed appliances are used for the correction of a condition called as ‘malocclusion’. A condition which tends to deviate the teeth from their original position causing a faulty or ugly or unaesthetic appearance is known as MAL occlusion. Malocclusion can be both dental and skeletal and can be corrected by various combinations of orthodontic procedures

Causes of Malocclusion:

  • Habits such as mouth breathing, thumb sucking, tongue thrusting cause adverse effects on the dentition. Teeth tend to protrude/procline from their destined positions, flare from their locations and appear to be coming out of the mouth.
  • Malocclusion can be hereditary signifying a great role of the genes. This mostly holds true for class III cases wherein the lower jaw is large and stands distinctly from the rest of the face. This is commonly known as the habsburg jaw condition.
  • Improper breast feeding habits can also lead to improper eruption of primary and permanent teeth into the oral cavity.
  • Malocclusion is also associated with birth defects such as cleft lip/palate, cleidocranial dysplasia, Treacher Collin syndrome, hemifacial microsomia etc which tend to alter the underlying jaw bone.
  • Exposure to agents such as radiation, alcohol; medicines such as aspirin, retinoic acid during the first trimester of pregnancy also leads to various different types of changes in the child’s face and pattern of dentition.

Signs and Symptoms of Malocclusion:

  • Change in the eruption pattern of the primary and permanent dentition. This may include over retained primary teeth or their early exfoliation, missing/impacted permanent teeth
  • Rotations of teeth
  • Presence of supernumerary teeth
  • Proclination of upper and lower front teeth
  • Spacing in between teeth
  • Habits such as tongue thrusting, mouth breathing and thumb sucking are persistent
  • Commonly impacted teeth are the canines after the third molars. These teeth may cause resorption of the roots of the adjacent lateral incisors
  • Transposition also is a common finding where places of the maxillary canines and premolars gets interchanged
  • Overlapping teeth
  • Deep bite; a condition in which the upper front teeth completely overlap the lower front teeth making the latter hardly visible
  • Open bite; a condition in which the upper and lower front teeth fail to meet, remain flared and a space is seen in the vertical dimension in the mouth.
  • Presence of a large tongue
  • Short upper lip; failure of upper and lower lip to maintain a seal.
  • Narrow or wide upper and lower dental arches
  • Concave/convex facial profile
  • Patient feels he or she has unaesthetic appearance, lessens public and social gatherings; low self esteem
  • Jaw deviated to either side, chin deviations
  • Forwardly or backwardly placed upper and/or lower jaws

Diagnosis Required Prior To Orthodontic Treatment:

  • History taking and clinical examination: A proper diagnosis of the malocclusion begins with the history taking. Orthodontic age group is mostly between 6 to 25 years of age where children and adults wish to bring about correction in their appearances. A detailed history of any dental treatments including any attempts to correct the malocclusion in the past, any history of the condition running in the family is taken. A clinical examination makes use of the diagnostic instruments to check the oral cavity for the positions of various teeth, where they are present more in number or are missing, over jet and over bite and various manners in which the teeth occlude and how they should be ideally placed.
  • Impressions and models: It becomes important to have a replica of the patient’s oral cavity when the patient is no longer available in the dental office. Stone models are prepared and various measurements are made on them in order to decide the treatment plan accordingly. 
  • Photographs: Intra oral as well as extra oral photos of the patient are taken for various linear as well as angular measurements. Photographs also help in comparing various parts of the face with each other. Pre, mid and post photographs also help in the comparative evaluations. 
  • Radiographs: The gold standard radiograph in cases of orthodontic remains a lateral cephalogram. It enables to study the hard and soft tissue landmarks and gives a proper insight into the underlying pathological condition. However it is a 2D image construction of 3D structures, few structures seem to be superimposed over one another, shadows can also be seen. Also an orthopantomogram OPG also is advised to view the entire dentition in a single go. 
  • Other imaging techniques: A cone beam computed tomography CBCT is a recent advancement in the field of dental sciences which allows a 3D imaging of the orofacial structures. Thus a clear view of the hard and soft tissues is obtained. Such views are recommended in cases of impactions, transpositions, any pathological conditions such as cysts associated with roots, in cases where orthognathic surgeries are planned, cleft palate cases to evaluate the depth of the defect. 

Treatment Procedures Of Orthodontic Treatment:

  • Preventive orthodontics: This is the choice of orthodontic treatment when malocclusion is anticipated, it has not occurred as such. Thus the treatment is begun to prevent the chance of malocclusion. Various methods can be adopted to prevent this condition. As for example, a tongue or glass beads appliance can be given to a child with tongue thrusting habit to prevent flaring and spacing of his upper front teeth. Space maintainers are given to children in the mixed dentition phase so as to prevent permanent teeth from migrating into the space; this prevents crowding of teeth in future.
  • Interceptive orthodontics: Once it is seen that the malocclusion has started to develop in the child’s oral cavity, it is recommended to start with the interceptive therapy. As for example, a class two molar relation in a 9 year old will call for a myofunctional type of orthodontic treatment. A headgear is the choice of appliance in cases of maxillary protrusions. These appliances tend to halt the malocclusion at the incipient stage and prevent the extensive orthodontic therapy that may be needed in future.
  • Corrective orthodontics: This is the choice of treatment when the malocclusion is well established in the oral cavity and now needs to be corrected. This includes both the non extraction and extraction procedures. In cases of extraction, it is majorly the first premolars which are extracted followed by second premolars or incisors according to the case. The routine method of banding the molars and bonding the rest of the teeth with brackets and connecting all of them with the help of various gauges of wires is what brings about the force application. 
  • The traditional labial method of fixed orthodontic treatment is being practiced since ages. This is inclusive of both metal as well as ceramic brackets. A recent advancement is the practice of lingual appliances where patients are more esthetically concerned. The use of invisalign technology is also on a rise among patients 
  • Surgical orthodontics: Here a surgical approach comes into play. It could be a frenectomy procedure in which a high labial frenal attachment causing midline diastema is surgically resected or a procedure like circumferential supracrestal fiberotmy CSF is done to prevent the relapse of derotation of the premolar teeth. Surgical correction for cleft lip and palate, orthognathic surgeries to correct prognathism or retrognathism of the maxilla and/or mandible and distraction osteogenesis form an integral part of surgical orthodontics.

Complications And Risk Factors Associated With Orthodontic Treatment:

  • Resorption in the roots of central incisors and/or upper and lower premolars may be seen. This can only be seen radio graphically unless the teeth start becoming loose, show clinical signs such as pain and mobility.
  • White spots lesions as a result of demineralization after acid etching technique. This leaves behind white spots on the labial surfaces of teeth and takes time to go away
  • Gingival swelling, bleeding from gums may persist for a while after the treatment is over
  • Relapse of the malocclusion occurs in most cases after the completion of the treatment when patient does not follow the retention regime. Relapse is a condition in which teeth or jaw bones tend to come back to their original positions once force acting on them during the course of the orthodontic treatment is removed. This becomes cumbersome for the orthodontist and quite disappointing for the patient. 

Am I Good Candidate For Orthodontic Treatment?

If you can relate with any of the following points, you surely can visit an orthodontist as soon as possible!

  • You feel your child has bucked out teeth
  • Your child has habits such as thumb sucking, finger licking beyond 6 years of age
  • You are being teased at school for your teeth
  • You become conscious while smiling because you know your teeth are not properly aligned
  • You feel your face is a little disproportionate in relation to your upper and lower jaw and wish to correct it.

Recovery Time:

  • Orthodontic treatment with a removable appliance lasts for an average period of 6 to 9 months, with activation appointments after every 21 days
  • A fixed orthodontic treatment takes about 12 to 18 months time followed by a 6 month period of retention. You are required to visit your orthodontist once every month
  • The bone and the surrounding tissues begin to remodel the day the orthodontic forces are applied and continue doing so till the end of retention period.

Success Rate:

  • Preventive orthodontic treatment is successful in almost 75 percent of cases. However a continuous monitoring may also be required till all the permanent teeth erupt.
  • Interceptive orthodontics is successful in almost 90 percent of cases. However, preventive as well as interceptive orthodontic treatments are highly dependant on patient compliance and co operation; for how long the child manages to wear the appliance.
  • Fixed orthodontic treatments including both the extraction and non extraction ones are successful in almost every case provided the correct protocol of retention is followed both by the orthodontist as well as the patient.

Benefits of Orthodontic Treatment:

Orthodontic treatment will benefit you in the following ways:

  • Boost your self confidence, make you look esthetically sound
  • If done at the correct age, it will prevent you from undergoing any surgical procedures to be done on the jaw in future
  • Children tend to get psychologically worked up due to mocking and teasing I school due to their appearance because of teeth. This can pose a problem for the parents as well. Orthodontic treatment protects children as well parents from such emotional dilemmas.

Cost Comparisons:

Orthodontic treatment will cost you around 25 to 40,000 for a span of 18 months during which you will be required to make 20 to 25 visits to the orthodontist. On the contrary, for the same span of treatment in the US/UK/Australia, you are required to pay an amount of something like 10 to 12,000 per visit!

Why choose India?

The specialty of orthodontics is the creamiest branch in the field of dentistry and is practiced by a lot of skilled and mastered orthodontists in India. We at team MedcureIndia make sure our clients are directed towards the best orthodontists in the country, assuring best treatment outcomes at simply affordable rates. 

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