Orthodontic Treatments for Adults

At what age can the patients have orthodontic treatment?

Orthodontic treatment in the last 20-30 years has been applied to adults as well as children. Adult patients who have healthy teeth, gingiva and no aggressive alveolar bone loss can be treated with orhodontics. There is no age limit for orthodontic treatments.

Early tooth extractions lead to undesired tilting of the teeth into the edentulous space by causing disfunctions. This undesired teeth movement can be treated with orthodontics to help open space for future dental implantation. When the patient has crowding of the teeth of more than 1mm overlapping, before the porcelain laminates, for minimum teeth preparation orthodontic treatment can be applied to solve the crowding.

Adult orthodontic treatment has to be short and invisible to maintain individual’s maximum aesthetic look in business and social life. For this concern alternatives to aesthetic porcelain brackets are;

* Lingual brackets which are placed on inner tounge- surfaces of the teeth (STB Ormco, Incognito 3M Unitek, Win Lingual Orthodontics Dr Wiechmann).
* Also invisalign is a popular treatment amongst patients.

What is invisalign? Who can be treated with Invisalign?

Invisalign can be applied to adults, and children who have completed the eruption of all permanent teeth, and young adults who do not have skeletal malfunctions. It is an aligner that is made of transparent acrylic / plastic. These aligners are covering all teeth surfaces of all teeth with a finish line at gingiva. They are easy to use and help maintain the patients natural look during treatment.

What is the treatment procedure?

The dental impressions are taken from the patients to make cast models. These cast models and radiographs are analized by the orthodontist. After the treatment planning confirmation by the patient, new impressions which are more stable and long lasting are taken from the patient. This impressions are then sent to the USA , where the Invisalign center is located. Here, the cast models are obtained from the impressions and these models are then scanned and carried to computers. A treatment simulation video based on the treatment planning will be send online to the orthodontist within 15-20 days following the impressions. The orthodontist shows the treatment simulation video to his/her patient. After confirmation of the patient the fabrication process of the aligners starts. For every tooth movement a new aligner will be fabricated. The number of aligners vary depending on the amount of teeth movements and the difficulty of the case. All of the aligners are delivered to the orthodontist at the same time, in 1-3 months time depending on the location of the country. The patient uses each aligner for 2 weeks. The aligners should be used 16- 20 hours a day except when eating.

Another option is 3D scanning of the dental arches instead of classical impressions. The scanned images are send online toinvisalign laboratory by decreasing the laboratory process.

What is the price?

According to the difficulty of the treatment, the total number of the aligners the price varies. The price of invisalign is almost comparable with the fixed brace orthodontic treatment cost.

Lingual brackets (brackets applied to tongue facing surfaces of the teeth)

Almost everyone is familiar to the concept of classical metal/porcelain braces placed on the outer surfaces of the teeth. Orthodontic treatments generally take 1-2 years time, and most of the adult patients complain about the discomfort and aesthetic looks. Contemporary orthodontic treatments such as invisalign and lingual braces are satisfactory for the patients since they are invisible.

No matter with what type of orthodontic system the patient is treated, the result of the treatment is not only a great smile but also a regeneration of the bone and the soft tissues due to orthodontic teeth movement.

What are the dissadvantages of Lingual Brackets?

Fotoğraf: Incognito ® 3MThere might be slight phonation problems due to the tongue and the lingual bracket contact during speaking. The patient will get used to the feeling of the brackets in time. Also in the first stage of the treatment irritation and light wounds of the tongue is possible.

Who are the best candidates for Lingual Brackets ?

Lingual brackets can be used for all age groups of patients with permanent dentition.

Will there be any discomfort such as pain and mobility of the teeth during orthodontic treatment?

During orthodontic treatments light forces are applied to the teeth to achieve a bodily movement and movement through the bone into the desired direction. At the beginning stage of treatment or after every wire changing visits, slight teeth pain, teeth numbness and teeth mobility may occur. These effects are temporary and during the first 2-4 hours the pain is at a maximum rate. In 1-7 days the discomfort fades away. The patient can use painkillers to ease the temporary pain felt during these stages if he/she does not have any systemic health problems. Until the patient gets used to the feeling of the brackets dental waxes are placed on the brackets. Within time the tongue, cheeks and lips will get used to the brackets, and pain and phonation problems will also fade away. Soft nutrients must be consumed during this time period. Biting should never be done by the anterior teeth. Food should be cut into small pieces and then chewed. Oral hygiene is very important. Every three months the patient should make a dentist visit for the professional cleaning, and must brush his/her teeth very well. Dental care should be supported with high fluoride toothpastes and mouthwash. Additional cleaning instruments such as water peek, dental floss and interdental brush should be used at least before going to bed after last brushing of the day.
Before orthodontic treatment patient should go for general dentistry check up, and have healthy gingiva, periodontal tissues, and healthy teeth. Also the hygiene level must be perfect during orthodontic treatment, otherwise, staining, cavities, tooth pain, gum tissue swelling , bleeding and inflammation followed by dental supportive tissue loss will occur.

Where can I buy additional dental wax?

These waxes are not sold in pharmacies, or at the groceries. The patients should get the dental waxes from his/her orthodontist. At the beginning we suggest our patients to use wax especially at the posterior regions above the brackets and wires, even if there is no discomfort or irritation of the soft tissues. Better to use it before going to bed for a comfortable sleep until you get use to the brackets.

During orthodontic treatment process can patients harm themselves?

During treatment process, fixed braces, wires and elastic bands, or removable orthodontic appliances should be used as recommended. Rarely, there is a slight chance of swallowing of the broken or detached pieces. In this case, for the necessary intervention, please go to a fully equipped hospital. Intra and extraoral removable orthodontic appliances should not be used while practicing sports and eating. Patient should take care of their oral hygiene. Braces create areas that retain food rest, if patients do not brush their teeth and caries lesions and gum inflammation will be occur.

Which medicines are used to heal wounds created by braces?

Placing dental wax above the brackets facing the irritated region and using gels on the irritated tissue such as Kenacort-A Orabase or Protefix wound healer can be recommended.

What is orthodontic retention treatment? Why is it done?

After placing the teeth to the new positions in the jaw bones and finishing active orthodontic treatment, this new position needs to be retained. To stabilize the new positions of the teeth fixed and removable retainers are used. Fixed retention wires are bonded with composite filling material to the tongue facing sides of the 4 incisors and the canines in both upper and lower arches. It is advised that the fixed retainers attached to the lower incisors should be permanent for a lifetime, and be present at least for 5 years. Removable invisible plastic retainers should be used day and night time both for the first month, following the first month retainers should be used while sleeping for a year or when needed as bruxism appliance forever. Patients are responsible for relapse and should be very well informed about the consequences. That is why besides 6 monthly dentist check-up and cleaning, at least an orthodontic control appointment once year is suggested.

During orthodontic treatment how frequently the appointments are scheduled?

Orthodontic treatment control appointments are scheduled in 4-8 week intervals depending on the bracket system and treatment protocols. At the finishing phase the appointments may be scheduled weekly. Regular control appointments are very important, and if the patients cannot come to the fixed appointment he/ she should cancel it 4 hours in advance and make a new appointment for a close date. If the braces or archwires pop off, please contact and schedule an appointment for the fixing procedure. Also please keep popped off pieces as they will be desinfected and reused in the same session. Otherwise you might be extra charged for the new material.

What does a successful orthodontic treatment depends on?

Orthodontic treatment is a longterm treatment. Cooperation of the patient and the doctor is essential for a good result. Patient should go through the treatment with good hygiene and cooperation until the end. The worst and harmful decision is to quit treatment before the treatment goals are achieved. Better not to start at all than giving up after a while.

Orthodontic treatment is a smart investment for your child’s longterm oral health and a nice smile!