Orthodontics is the specialty of dentistry that addresses malocclusions, or improper bite. It deals with studying and treating growing and mature dentofacial structures and the relationships between teeth and facial bone. In the past, nearly all the people receiving orthodontic treatments were pre-teens and teens having malocclusion problems. More recently, adult orthodontic treatment has become more prevalent. Nearly 30 percent of orthodontic patients in the United States are adults. The American Dental Association recommends that children go for an orthodontic evaluation by the age of seven, since orthodontic treatment is most effective when started early in life.

A Type of Restorative and Cosmetic Dentistry

Orthodontics may be classified as a type of restorative as well as cosmetic dentistry. It is restorative because malocclusion may interfere with eating and speaking. Malocclusion may also inhibit the development of an attractive, well-aligned smile or facial jaw line, and therefore may be seen as an esthetic or cosmetic issue.

Typically, a visit to the dentist for a single filling or crown does not indicate the need to adjust your occlusion. If you have not experienced any pain or symptoms of malocclusion, it is expected that your dentist will just work according to your current occlusion, maintaining it and managing it as it was before the restoration was placed on your tooth. However, if you or your dentist notice jaw pain, tooth movement or wear, or other problems related to malocclusion, then your bite may need to be adjusted.

Occlusion is usually a significant component of cosmetic dentistry. Comprehensive cosmetic dental treatment ensures that you have an aligned and even bite. An even occlusion is crucial to oral health and the long-term durability and functionality of the dental veneers or crowns on your teeth. During the planning and treatment phases, your occlusion needs to be properly managed in order to avoid failure in the early stages of your cosmetic dentistry procedures.

Orthodontic Treatment

Orthodontic treatment includes supervising and correcting your bite (occlusion) and increasing the effectiveness of your teeth in carrying out their functions. It may additionally deal with repositioning your teeth and the underlying roots, so that the crowns of the teeth have better support. Orthodontic treatment is suitable for any age and can produce increased comfort and greater esthetic appeal. Orthodontics also contributes to jaw, neck, and lip reshaping that revives facial appearance and creates a well-aligned smile. Another advantage of well-aligned teeth is that you will find it easier to maintain oral hygiene.

Usually your general dentist will refer you to an orthodontist for evaluation of your bite. Orthodontists go through an additional two to three years of post-dental school education before becoming a certified practitioner of orthodontics. If malocclusion is indeed the cause of your dental problems, your dentist will come up with a treatment plan to adjust your occlusion.

Selecting an Orthodontist

It is usually the case that your general dentist will refer you to a qualified orthodontist if the need for orthodontic evaluation arises. However, the choice of orthodontist may be a more complex one as more and more procedures are available to align teeth, and a greater number of practitioners offer these treatments.

These are some things to consider when selecting an orthodontist:

  • Keep your general dentist’s recommendation in mind. Usually your dentist will have worked with orthodontists in managing patient care, and will have observed the results of alignment procedures that have been done. Your dentist is a good resource for evaluations and recommendations.
  • Ask your friends, relatives, co-workers, and neighbors whom they recommend. If you are seeking orthodontic treatment for your child, the teachers’ and parents’ associations at your child’s school are an excellent source of information.
  • Get in touch with a local dental school and ask its orthodontics department to recommend practitioners in the area.
  • Upon initial contact with an orthodontist, make sure he or she is a licensed member of the American Association of Orthodontists.

Members of this organization are required to conform to rigorous training and ethical standards, and have completed two to three years of post-dental school education and clinical training. Members are also strongly encouraged to have current knowledge of research and technological advances.

During the Initial Consultation

At your consultation with an orthodontist, there are some points worth bearing in mind during your personal evaluation:

  • Experience: How many years has the orthodontist been practicing? How extensive is the orthodontist’s practice? How do you like his or her previous work? (See before-and-after photos of previous patients.)
  • Environment and rapport: Do you (or your child) feel comfortable in the office and in conversation with the orthodontist? How well does the orthodontist and the staff address your concerns? Orthodontic treatment takes an average of two years, with regular visits every six to eight weeks. The more comfortable you (or your child) feel with the orthodontist, the more likely you will follow treatment instructions at home and take good care of your teeth.
  • Treatment: Do you clearly understand the orthodontist’s diagnosis and treatment plan for your teeth? Did the orthodontist offer alternative treatments? Do you find that the treatment plan meets your personal, business and social needs?
  • Technology: How diverse and advanced are the treatments offered? Some new technologies to consider include temporary mini-implants, translucent aligners (eg. Invisalign), arch-wires that are adjusted by computer and fit behind the teeth (eg. SureSmile), and clear brackets and bands that make appliances less noticeable and more comfortable. Another piece of technology to look out for is whether the orthodontist uses a laser to remove the build up of gum tissue around the braces.
  • Practice: Is the location of the orthodontic practice convenient? What provisions does this practice offer in the case of emergencies?
  • Financing: What are the financing options? Consult the American Association of Orthodontics and dental loan providers to get an idea of the financing options available. Cost of orthodontic treatment is lower at a dental school, and some orthodontists may offer pro bono treatment.

Orthodontic Evaluation and Treatment

During your first visit to your orthodontist, an individualized treatment plan will be developed for you after examination using different methods. These include an oral, facial, and functional evaluation, and examination of your intraoral and facial photographs. Your orthodontist may also perform panoramic and cephalometric X-rays of your mouth and develop impressions for models of the teeth and bite. You may also need to have a CT image done of your tempromandibular joint (TMJ).

Your orthodontist will review your dental records and study the results of the evaluation in order to formulate the best orthodontic treatment plan. He or she will determine what needs to be done to adjust your teeth to improve your occlusion. Some of the ways may involve reshaping your teeth, restoring teeth using dental crowns or veneers, for example, or repositioning teeth. In critical situations, surgery to reposition the jaw may be required.

During the second visit, your orthodontist will normally review your treatment plan and approximate the length of time required for the active phase of treatment. The standard treatment phase is two years, after which the orthodontist may recommend that you wear a retainer for a period of time.

The duration of orthodontic treatment differs depending on your age and how closely you follow your treatment plan. Younger patients tend to respond more quickly to treatment than older patients because the bones supporting young teeth are more malleable than those supporting older teeth. On the other hand, pre-teens are generally less consistent with following treatment instructions compared to adults. Duration of treatment is also affected by how long or complicated the treatment is, for instance, if oral surgery and recovery is needed in the course of orthodontic treatment.

Advances in Dental Braces

Braces today are much improved from several years ago. They are more comfortable and look better on your teeth, and may require a shorter treatment period compared to older dental brace treatment.

In the past, dental braces were often stiff and uncomfortable and required headgear to keep them in place. Dental brace wires are now made of materials that make it easier for dentists to treat and reposition the teeth and underlying roots. Titanium implants can be placed in the bone on the side of the mouth and palate to help move the front teeth back and make more room if needed. Magnets can be attached to the molars in order to help lift and reposition them. On the whole, technology has resulted in braces producing less discomfort than before.

Clear dental braces or tooth-colored braces have become more popular recently for those whose teeth need to be mildly shifted. They are virtually indistinguishable in the mouth. These braces or aligners are made of a clear and thin material that fits flexibly and firmly over the teeth. Every two to three weeks this material is replaced to allow gradual movement of the teeth. Your orthodontist will likely require that you return for a checkup every six to eight weeks in order to monitor the movement of the teeth.

In addition to these advantages, orthodonists are now able to shape braces such that they are positioned ideally on the teeth, using computer-aided technology. It has been observed that in some cases the use of this technology significantly reduces treatment time.

Invisalign: Clear Tooth Aligners

To treat malocclusion and adjust the positioning of the teeth, dental patients have the option of wearing braces or clear tooth aligners known as Invisalign. Invisalign is a popular alternative to the metal braces and brackets that some find unattractive.

Align Technologies launched Invisalign in 1999, and its popularity has since steadily grown such that it is now a leading brand of orthodontic appliance. Invisalign features a series of clear plastic aligners that fit invisibly and comfortably over your teeth. The aligners are designed to gradually shift the teeth into the desired position, correcting your occlusion. The aligners are less than one millimeter thick and agreeably more esthetically pleasing than the conventional wire-and-bracket dental braces. Invisalign is used in the treatment of teeth that are slightly misaligned.

The Invisalign Method

The Invisalign approach is based on an idea that was first introduced in the 1940’s and revisited in the 1970’s, that made use of a series of dental impressions to establish the most favorable position of the teeth. The process of treatment with Invisalign begins with an initial consultation, during which a set of impressions and photographs of your teeth is taken. These impressions are used to produce a three-dimensional computer projection of how the teeth could be shifted step by step. The projections form the foundation for producing a series of custom-made aligners intended to achieve this shifting.

Computer-aided design/computer-aided manufacturing (CAD/CAM) processes are used in the manufacturing of Invisalign aligners. The aligners are sent to your dentist from the Align Technologies dental laboratory. Your dentist will dispense them to you in sets of one or two at a time. Most people require 20 to 30 aligners for both the upper and lower teeth.

Each aligner must be worn according to its specific order at least 20 hours daily, for a period of approximately two weeks. While they are worn, the aligners shift the teeth in slight increments of about .25 to .33 millimeters. The aligners are removable when necessary for eating, drinking certain beverages, and tooth brushing. Usually you will need to go for regular check-up appointments every four to six weeks so that your dentist can supervise your occlusion treatment. While treatment time reasonably depends on the specific alignment problem, for the majority of adults using Invisalign, treatment is completed in less than a year.

Problems Treated With Invisalign

Treatment with Invisalign is best for adults and teenagers with completely erupted permanent teeth. It is important that Invisalign users closely follow the directions for treatment, such as the length of time they would have to wear the aligners daily, when to return for follow-up appointments, and instructions on eating, drinking, and cleaning. For example, it is recommended that while you wear Invisalign trays, to drink only water and avoid beverages that might stain the plastic. Treatment success may be

As indicated by researchers and Align Technologies, Invisalign may be a helpful treatment for these types of mild dental problems:

* In instances where there is lack of room in the jaw, such that teeth are overly crowded and cannot fit comfortably.
* In instances of missing teeth, where abnormal growth of the jaw or movement of the teeth result in too wide a space in between teeth. Spaces should be between one to five millimeters in length.
* In the case of overbite or Class II malocclusion, when the upper teeth are positioned over the lower teeth when biting down.
* In the case of Crossbite or Class III malocclusion, when the upper and lower jaws are misaligned.
* If mild relapse of tooth movement has happened after traditional braces have been removed.
* In instances of other simple malocclusions or irregularities in the bite.

The cost for orthodontic treatment can range from $3,000 to $6,000. The cost depends on several factors including the orthodontist, the type and duration of treatment, and any other restorative work that needs be done prior to or throughout treatment.

When Invisalign May Not Be Helpful

To address certain problems in misalignment or for more complicated occlusion problems, Invisalign may not be an appropriate treatment. Such problems include crowded teeth or teeth that are more than five millimeters apart, teeth that are severely rotated or tipped, jaws with multiple missing teeth, and skeletal malocclusions. In addition, discrepancies involving centric-relation/centric-occlusion (how the upper and lower jaw joints and jaw muscles close together) are usually too complex to be treated with Invisalign.

In these cases of complex malocclusions, fixed orthodontic appliances (conventional wire and bracket braces) can be used. Although they may not look as attractive compared to clear aligners like Invisalign, dental braces have undergone advances in technology such that they are smaller, less visible, and more efficient. They may also help to correct malocclusion much faster than before.

Discuss your needs and concerns with your dentist to determine which treatment option works best for you. In addition, an orthodontist will be able to inform you about orthodontic treatment alternatives.