New patients and parents can find discussing treatment options a little overwhelming. This can be because Orthodontists use a range of terms that can be confusing if you're not familiar with them. Understanding what each of the terms mean can help you prepare questions for your orthodontist as a parent or patient, and make you feel more at ease starting your journey.
With that in mind we have put together a list of 15 Orthodontic words you should know before you or your child starts treatment.
A-chains are connected strings of elastic. They attach to brackets to apply more force than the brackets and archwire alone. A-chains can run all around the teeth to close spaces or between selected teeth to move teeth around the archwire like a pearl on a string. Treatment time can decrease when a-chains are used. They’re particularly effective in closing gaps after a tooth is extracted but are also used to correct misaligned and crooked teeth.
The archwire is the component of the braces that does most of the work. It’s the wire that connects the brackets and bands together and aligns the teeth. Some archwires are flexible to align teeth whilst others are more rigid to establish the shape of the whole set of teeth and the teeth may be moved around the archwire like pearls on a string. Upper and lower teeth can then be shape matched so that they fit together.
3. Banding & Bonding
Banding and bonding is a two-step process when applying braces. Banding involves placing separators between the back teeth to ensure there is enough space to fit the metal band around the entire molar. In our office banding is usually completed one week before the braces/brackets are fitted but may be fitted at the same time as the braces.
Braces or brackets are usually applied to the teeth in the second stage, which is bonding. The braces may be directly applied individually to the teeth with a plastic based dental cement. Once the brackets and bands are attached, the cement is cured/set using a high density light. Every case is different, not every patient that has braces requires orthodontic bands.
4. Indirect Bonding
Indirect bonding is the fastest way to apply brackets. Before the appointment, a mould is taken of the patient’s teeth and the brackets set up on a model. The brackets are covered with a silicone tray and then picked up off the model and transferred to the patient's mouth all at once. Aplastic based glue is applied to each bracket. After conditioning the teeth in preparation for the bracket application, the tray is fitted over the teeth and held in place while the composite is cured with high density light.
Palatal expanders are most commonly used in growing children who have a narrow upper jaw and crowded teeth and are young enough. By increasing the circumference of the palate, the perimeter of the arch increases, providing more space for teeth and the smile width can be increased. Expanders are custom made appliances that are fitted at the roof of the mouth, near the back teeth. A special key is used to widen the arch in small increments.
6. Implant Supported Expanders
In older children and adults it is more difficult to expand because the two sides of the jaw become fused together. Historically a surgical procedure was incorporated to the expansion device. Small pins(temporary implants) may be inserted into the palate to enable the expansion force to be applied to the bone, rather than the teeth and expand the upper jaw without jaw surgery.
Expanders are most often used before braces to create enough room. The job of the braces is then to straighten teeth. An expander can improve or correct a crossbite, overcrowding and and improve breathing ability. Expanders can reduce the time and complexity of braces treatment and can eliminate the need for jaw surgery and tooth extraction.
7. Temporary Anchor Devices (TADS)
The anchor device is a small titanium alloy pin or implant attached to the bone during treatment. The screw-like device is needed when there is no viable tooth to use as an anchor or if an anchor tooth is at risk of moving too. The device is only kept in place for a small-time during treatment to help move teeth into place. TADS can reduce treatment time, eliminate the need for elastic bands and have increased the range of achievable tooth movements and can address some problems that did require a combination of orthodontics and oral surgery in the past. This must be carefully and wisely considered by your orthodontist to determine what the specific goals of treatment may be.
While braces are efficient at moving teeth, they sometimes need a helping hand with elastics to close spaces or address the bite relationship. Attached to the brackets of braces, the elastic bands attach from one jaw to the other or between front and back teeth in the same jaw.They apply pressure to move individual teeth or a group of teeth in a specific direction.
9. Fixed Appliances
Another term for braces, fixed appliances may be considered as all the appliances in the mouth such as bands and brackets attached to the teeth with dental adhesive and connected with a thin wire. Fixed appliances remain in place for an average of 18 months to two years, depending on the severity of the treatment required.
10 . Fixed Bite Correctors
Fixed bite correctors are used to correct the relationship of the upper and lower jaws and teeth if a problem in the bite relationship is present.These bite problems can also be treated with elastics but the bite corrector are usually more efficient and do not require the cooperation of the patient. The appliance usually stays in place for around 6- 12 months.
11. Molar Distalizers
Molar distalizers are devices that move molars back in the arch to make room for other teeth. Molars may be distalized to create space for crowded or impacted premolar and canine teeth. A range of appliances are available to move molars into their desired place.
In most cases, braces stay on teeth for at least 18 months to move teeth into their desired position, but they aren’t enough. Retainers are needed to continue the good work of braces to hold the teeth in position. It doesn’t matter how long a patient wears braces, or the type of treatment they had, teeth naturally want to return to their old position. Moreover there is a natural tendency for teeth to become slightly irregular with age even if people have never had braces. But a retainer, (if worn as directed by your Orthodontist) can ensure they won't move back to their original position or become irregular with age.
Retainers come in two kinds – fixed and removable.
Many orthodontists recommend a fixed retainer straight after braces. Your bottom row (arch) are more at risk of moving out of alignment so a thin wire is placed behind the teeth where it can’t be seen. Fixed retainers aren’t routinely used on top teeth after braces because the retainer can be easily damaged by chewing as the lower teeth touch the back of the upper teeth. Fixed upper retainers are usually used for a small number of patients who had presented originally with severely irregular upper teeth.
When braces are removed, it's the riskiest time for teeth to move back. Wearing a removable retainer for a few months full-time (except when eating and brushing), will hold teeth in the correct place. After a while, patient's can stop wearing retainers during the day and just wear them at night. In children we usually recommend that they wear them until facial growth has ceased. Eventually, the retainer is reduced based on the patient's individual circumstances. Many patients will wear their retainers intermittently for life to minimize any significant tooth movement.
Our orthodontists appreciate that every patients retainer plan is customised according to their individuals presenting problems and not all patients will follow the same regime.
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One week before braces are applied, an orthodontist will start the process by fitting separators. The small elastic bands are placed between the back teeth to separate them slightly. This extra space between the teeth allows the orthodontist to painlessly fit the thin metal bands that act as anchors. A separator may fall out before they’re due to be removed on the day the braces are applied.
Teeth staining occurs when patients don’t brush their teeth properly while wearing braces. Food is more likely to be stuck between teeth and around the brackets for patients with braces. Consuming certain food and drink that are heavily coloured daily can increase the likelihood of staining. Foods and drinks high in sugar such as soft drink, orange juice, lollies are some of the worst offenders for staining. Try to keep consumption to a minimum and brush your teeth thoroughly soon after eating or drinking to remove the sugar from your mouth.
Careful brushing and flossing while wearing braces can eliminate the risk of teeth staining. Regular trips to the dentist for a professional clean can ensure your teeth are a consistent white colour when the braces come off.
Dental wax is designed to cover brackets that are aggravating the inside of the mouth. It’s often used by new patients, while their mouth adjusts to the braces. A small amount of wax is placed over the bracket to provide relief. When a patient eats or brushes, the wax comes off, and a new piece of wax may be needed in its place. The wax is harmless if swallowed.
If you’re ever unsure of an orthodontic term or process, be sure to ask us. We’re always happy to provide our patients with more information.