Dental Care

Teeth Braces

This teeth braces section is going to take you beyond the dental braces introduction you've already reviewed. 

In this article, we will discuss the process of etchant, placing brackets with cement on your teeth, arch wire, orthodontic spacers, and the closing of open bites. 

The first stage of applying teeth braces begins with an acid etch.  This is a preliminary preparation to the surface of each of your teeth.  The orthodontist is going to need to apply cement, and the smooth enamel surfaces are not meant as a foothold for cement.  The etchant, then, is actually a weak acid.  This is wiped liberally across each tooth to be braced. 

To understand the need for this step, think of dancing on a shiny floor in slippery new shoes.  It's easy to fall, right?  It's possible to help your shoes maintain traction on the floor by sanding the soles lightly. This etchant process does the same thing to your teeth. 

Once the surfaces of the teeth are ready, the orthodontist then applies dental cement to each tooth he will be bracing, and then the brackets are set into the cement.  You will know you are finishing this part of the process when the orthodontist exposes your mouth to the curing light, which is a small ultraviolet light.  It helps the cement harden so that the brackets attach firmly to your teeth. The brackets are actually small pieces of metal, shaped in a square. 

Your orthodontist also needs to insert spacers between your molars as part of the teeth braces procedure.  Sometimes the spacers are put in several days before teeth braces are installed.  They will hold space open in your teeth for metal bands, especially among your molars.  Putting any necessary metal bands into place is the step after the brackets are applied.  Sometimes the bands are needed on teeth that have fillings, because the filling material cannot be used for attaching braces.  On those teeth, the braces can be attached to the molar bands. 

Next, arch wire is threaded through the brackets.  This is the metal wire that actually, eventually, moves your teeth.  Orthodontists prefer to use arch wires manufactured from a nickel-titanium material.  The nickel-titanium remains flexible and easy to work with while it is cool; once your body heats it, it stiffens and takes the shape necessary to exert force on your teeth. You can expect your teeth to move approximately one millimeter per month. 

The arch wires are held into place with elastic ligatures.  Elastics come in many diameters because they perform several purposes.  In some cases they will create a shift in the midline.  They are often used to exert the pressure necessary to close open bites, and to force teeth or even your jawbone into the desired direction.  The orthodontist can add brackets with hooks to your mouth.  Once these additional brackets are fastened to the arch wire, it is simple to attach them to elastic. 

What if there is not enough room in your mouth?  Often the orthodontist resorts to one of two procedures.  In the first one, he simply extracts the teeth that are necessary to provide sufficient space.  The alternative is forcing an expansion. 

To create an expansion, a device called a palatal expander widens your jaw or palate.  It's easier to do this in children, because the bones of their face and jaw are not fused.  Surgery is sometimes necessary for adults, but only to expand the palate.  Expansion of the jaw does not require surgery.

At the End of the Treatment

The day will come when it's time to remove the teeth braces, which is a much quicker process.  The orthodontist gets the elastics and arch wires out of the way with a pin and ligature cutter.  He then uses a special pliers tool to separate each bracket from its tooth.  Once the brackets are out of the way, there is still a coating of cement left on the tooth.  The orthodontist uses a tool that has a curved hook on one end to scale the excess cement.  Finally, he will polish each tooth so it's as beautiful as your new smile!

As a final step, your orthodontist will fit you with a retainer.  As preparation for this he will check to see if a fiberotomy is necessary.  A gingival fiberotomy removes some of the fibers that attach the tooth to the gums, so that the tooth is less likely to return to its former position. 

The retainer itself is a metal wire that usually attaches to the upper teeth.  It helps your teeth to remain in their new position while your jaw bones adjust and harden into place.  The most common type is the Hawley retainer, named after its inventor.  Its base is an acrylic arch that rests against the palate of the mouth, or its lingual walls in the event of palatal malformation.  To this base is attached a wire ring that encircles the new teeth and keeps them in place. 

The Essix retainer is a clip-on PVC piece that goes only from canine tooth to canine tooth and stays on by suction.  They are much less visible in the mouth than Hawley retainers but they aren't well suited for everyone.  The upper and lower teeth cannot touch with an Essix, which is contrary to most orthodontists' recommendations. 

A fixed retainer is completely different.  It is a wire that bonds to the inside of the incisors.  Unlike the other retainers, the patient cannot remove this one himself.  Usually the orthodontist chooses a fixed retainer if the teeth braces have resulted in a huge change and he doesn't want to take a chance that the teeth will relapse to their former positions. 

In one of the next articles, we will talk about "pre-finishers," the complications and risks of teeth braces, and a plaque control program. 


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