Posts for tag: orthodontics
Most of us are quite familiar with what traditional braces look like. But occasionally we see more complex-looking devices being worn by young orthodontic patients: thicker wires that extend outside the mouth, with straps that may go behind the neck or over the chin. What are these devices, and why are they sometimes needed?
In general, orthodontic appliances with external parts braced by the head, neck or chin are referred to as “headgear.” These devices may be used to handle a number of particular orthodontic situations, but they all have one thing in common: They provide the additional anchorage needed to move teeth into better positions.
It may come as a surprise that teeth, which seem so solid, can actually be moved fairly easily over time. This is because teeth are not fixed directly into bone, but are instead held in place by a hammock-like structure called the periodontal ligament. Using a light, controlled force — such as the force of springy wires and elastics in traditional braces — teeth can be moved slowly through the jaw bone, like a stick being pulled through sand.
Of course, to pull a stick through sand, you need a firm anchorage — your legs, for example, bracing against a rock. Most of the time, the back teeth, with their large, multiple roots, provide plenty of support. But sometimes, the back teeth alone aren’t enough to do the job.
If a very large space between teeth is being closed, for example, the back teeth might be pulled forward as the front teeth are pulled back; this could result in poor alignment and bite problems. In other cases, the front teeth may need to be pulled forward instead of back. The back teeth can’t help here; this is a job for headgear.
Some types of headgear have a strap that goes behind the head or neck; they use the entire head as an anchorage. Other types, called “reverse pull” headgear, have a strap that comes over the chin or the forehead; they can pull teeth forward. Headgear can even influence the proper growth of facial structures — that’s why it is usually seen on preteens, whose growth isn’t yet complete.
Headgear is usually worn for 12 hours per day, for a limited period of time. In some cases, rather than headgear, appliances called “temporary anchorage devices” (TADS) may be recommended. These are tiny screws that are implanted into the jawbone in a minimally invasive procedure, and serve a similar function.
While it may not look pretty, orthodontic headgear is capable of moving teeth into their proper positions in a relatively short period of time — and ending up with a great-looking smile is what orthodontics is all about.
If you’ve ever looked at younger photos of yourself, you’re sure to notice differences with your present appearance. Of course, your basic features might appear much the same. But maybe your lips seemed a little thicker back then, or your nose a bit less prominent.
This is because your facial features don’t stop growing when you reach adulthood—they continue to change throughout your life. For example, lips reach their maximum thickness by around age 14 for girls or age 16 for boys; they’ll remain at that level of thickness for a few years before gradually thinning throughout adulthood. The nose will also continue to grow, becoming more prominent especially as changes in the lower part of the face can make the chin appear shorter.
Although each of us ages at different rates and in different ways, these general physical trends are somewhat predictable. That’s why we can use the knowledge of how our facial physiology changes with age to fine tune orthodontic or other cosmetic dental treatments. The most optimum approach is to consider treatment in the early stages of bite development during childhood or early adolescence.
This means we’re doing more than correcting a patient’s current bite: we’re also taking into account how tooth movement now might affect the jaw and facial structures later in life. By incorporating our understanding of age-related changes into our treatment we might be able to provide some hedge against the effects of aging.
This approach starts with early comprehensive dental care, preferably before a child’s first birthday, and an orthodontic evaluation at around age 6 to assess bite development. It may also be necessary to initiate interceptive treatment at an early age to lessen or even eliminate a growing bite problem to help ease the extent of future treatment. And if a bite requires correction, early evaluation can help create a timetable for effective treatment in later years.
Taking this approach can correct problems now affecting both dental health and appearance. But by acknowledging the aging process in our treatments, we can build the foundation for a beautiful smile well into the future.
There are an assortment of techniques and treatments in an orthodontist's toolkit, braces being the most common and best known. Of course, there wouldn't be any tools at all if teeth couldn't move naturally.
Teeth aren't directly connected to the jawbone. An elastic tissue called the periodontal ligament lies between each one, with tiny fibers attaching to the tooth on one side and to the bone on the other. The ligament's elasticity and other qualities allow micro-movements of the teeth as we bite.
The ligament can also adapt to changes in the mouth and teeth by allowing the teeth to move to different positions. That's the basic concept behind braces: we thread a thin wire through brackets attached to the teeth, which we then attach to anchor points (usually back teeth not intended to move) and apply tension to it. Gradually over time, the target teeth move.
But what if your malocclusion (poor bite) is more complicated or the back teeth can't supply enough anchorage for moving the intended teeth? That's where we take advantage of other sources of anchorage.
One such source is the patient's skull, which we can make use of through special headgear worn a few hours a day. The device consists of a strap under tension that runs around the back of the head or neck to a wire housing attached to brackets on the target teeth. If you want to “pull” the teeth forward, the strap would come over the chin, forehead or a combination of both.
We may sometimes want to isolate some teeth to move without moving nearby teeth, such as moving front teeth backward to close a space without affecting teeth further to the rear. We can create a separate anchor point in the jaw with a TAD or temporary anchorage device.
TADs are tiny screws made of stainless steel inserted temporarily into the bone. We loop an elastic band over the TAD on one end and to a bracket or tension wire attached to the target teeth on the other. When we've achieved the teeth's new position we can easily remove the TAD from the bone.
These various tools make it possible to correct difficult or complex malocclusions. They may not always look attractive, but they'll help ensure the final result is.
If you would like more information on available orthodontic treatments, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Orthodontic Headgear & Other Anchorage Appliances.”