Orthodontic treatment step by step….

Orthodontics is a speciality field of dentistry which deals with diagnosis, prevention and treatment of orthodontic anomalies – irregularities in the position of teeth, dental arches and jaws. These irregularities are not ordinarily a consequence of a disease but rather of disrupted development. From this point of view the orthodontic treatment is voluntary, its alternative is keeping the malocclusion. On the other hand, orthodontic treatment leads to right function of teeth and jaws and to the improvement of the aesthetics of teeth and face, by which it can prevent further health problems and contribute to psychical comfort.

1st Step – Initial Examination And Diagnosis Determination

The orthodontic treatment itself is preceded by a diagnostic process consisting of an initial examination, consultation with the doctor, filling-in a questionnaire, scanning of teeth, taking X-rays and photos of teeth and face. The collected data are at the same time becoming a part of the obligatory health documentation.

2nd Step – Treatment Plan

On basis of the analysis of all accessible information making of a treatment plan follows. It is a key process of treatment consisting of series of logical steps leading to the best outcome regarding the utmost benefit of the patient. To achieve it, a possible part of the treament plan may be some interproximal enamel reduction or extractions of temporary or permanent teeth, prosthetic treatment or surgeries. The healing treatment may complicate depending on individual differences. In those cases, the physician reserves the right to adjust or extend the treatment plan. The patient is always duly informed about potential changes.

3rd Step – Active treatment and retention phase

At our workplace, we perform treatment by removable and fixed appliances. In case of removables, it is possible to take them out and put them aside (for instance while eating, in society, while doing a sport). Classical removable appliances are used in case of minor anomalies , as preliminary treatment before fixed appliances treatment or for maintaining the result of fixed applance treatment.

For a complex orthodontic therapy, fixed appliances, which are tightly fixed on the teeth, are used. We offer fixed appliances in various forms: from basic metallic ones, over less visible transparent braces to lingual technique, i.e. braces fixed at the inner side of teeth (so called “invisible braces”). Due to the fact, that accuracy is very important in orthodontics, we use solely products by renowned companies. Treatment plan in indicated cases involves usage of special appliances and supplementary orthodontic devices (e.g. palatal arch, miniscrews, jumping appliance , etc.). If we count with their usage you will be informed about them in detail while consulting the treatment plan.

An alternative to fixed appliance are special transparent foils (aligners) – Invisalign system.
Those are removable almost invisible braces which are as well as fixed appliances appropriate for treatment of complex defects.

Process Of the Treatment

Orthodontic treatment itself begins with the bonding of appliance. Check-ups of fixed appliances take place once a month, removable braces are checked less often. During the check-ups the appliance is activated and inactive components are replaced. Up to date photos or X-rays are made continuously. Some operations are carried out by our trained orthodontic assistants, always under a physician’s supervision. If we reach the required result by the means of active treatment, removal of the appliance and documentation of the state follows. Straightened teeth are prone to move back to the original position after the removal so it is necessary to maintain the final result for some time. This time necessary for complete reorganizing of tissues and adaptation for the new position is called retention period or stabilizing phase. For its purposes, we usually use removable appliances and small wires attached to the inner side of teeth. Insufficient retention period may cauce so called relapse, i.e. a partial return of the teeth to the initial position.

Duration Of the Treatment

Duration of the orthodontic treatment depends mainly on seriousness of the malocclusion. An average length of treatment is in case of most anomalies from 1 to 3 years, following retention period lasts minimally the same time. If the result of the treatment is unstable the retention period is long-term or permanent. In case of the same defects the length of the active treatment and retention period may vary, it very much depends on individual physiological response of the individual. It is thus unreal to determine a completely precise time of the orthodontic treatment duration. The length of the treatment can be also influenced by the cooperation of the patient. In case of inappropriate cooperation and unfollowing physician´s instructions, its prolongation occurs (see cooperation of the patient).

Price Of the Treatment

A price depends on the strenuousness of the treatment, the type of the apparatus, length of the therapy and amount of used material. You will be informed about an approximate price of the orthodontic treatment during the initial examination and a more precise budget will be designed in the framework of determination of the treatment plan. We accept payments in cash, by card and by the account transfer. The payment usually takes place in three instalments evenly distributed during the duration of the active treatment. We provide 5 percent discount in case of lump sum payment.

Cooperation Of the Patient

An appropriate cooperation of the patient and following of instructions of the physician is the basic premise of a successful orthodontic treatment.

The most important condition of success is perfect oral hygiene. It is necessary to clean teeth with fixed orthodontic appliance after every meal, according to instructions of the orthodontic assistant. The outcome of an insufficient hygiene is the decalcification of the tooth (see complications of the treatment) and may be the reason for a premature debonding of the appliance or not starting the orthodontic therapy. After placing of the fixed appliance an instruction about the oral hygiene and tools for its execution is provided for free. If it is found out that the hygiene is insufficient during the treatment a reinstructing paid by the patient is necessary.

Another important factor contributing to the success of the orthodontic therapy is regular attending the check-ups. We will try to comply with you in terms of reservation of dates for appintments, however, due to organization reasons it is impossible to fit all the dates into non-school and non-work time. Due to capacity reasons, we kindly ask you to attend accompanied by one person maximum. Unfollowing of dates of examinations leads to a prolongation of the treatment. In case of failure of the apparatus it is essential to arrange an extra appointment. Repeated absences in the attendance or repeated failures of the apparatus may be penalized, in some cases may be the reason for a premature termination of the treatment. Apart from check-ups at the orthodontics it is necessary to attend also regular preventive examination at the dentist´s.

A minor adjustment of dietary habits is connected to orthodontic treatment. It is appropriate to avoid very hard meals namely (baked bread, nuts, hard fruits and vegetables). From the point of view of the risk of emergence of dental caries food with high sugar content is undesirable.

While using removable appliances, additional devices of fixed appliances and retention tools a closer cooperation of the patient and following instructions of the physician are required. Unless respecting his/her instructions it is impossible to reach planned achievements or there is the risk of the relapse (see Course of the treatment).

Possible Complications of Orthodontic Treatment

Complications of the orthodontic treatment are usually not serious and it is possible to deal with majority of them. Still it is our duty to inform you about them. It is possible to prevent a range of the complications by means of good cooperation during the orthodontic treatment and thorough oral hygiene.

The initial complication after the bonding of appliance is the pressure on teeth or mild tooth pain. Those complications last only several days and gradually fade away. Analgesics for mitigating the pain are necessary only exceptionally. Similar feeling can repeat after every examination but they are of a milder nature. Parts of the orthodontic apparatus may cause minor errosions and pressure sores of the lip, cheek or tongue. In case of patients with fixed appliance who do a contact sport, it is recommended to use a mouth guard to prevent an injury to soft tissues.

Allergic reactions to the orthodontic appliance are rare. They manifest themselves by itching, reddening and swelling of the oral cavity. Most of materials that cause allergy on skin does not present a risk for the oral cavity. In case of proved allergy to specific components contained in the orthodontic appliances we will try to offer an alternative solution.

The most common complications of the orthodontic treatment are decalcification of the tooth enamel and dental caries. Those are caused by the plaque around the braces because of insufficient oral hygiene. It means that the orthodontic appliance itself does not have any harmful influence. The sign of decalcification of the tooth enamel are white marks, those are the first stage of enamel damage. White marks, compared to dental caries, do not require a therapeutic intervention, however, they present an aesthetic problem. In this respect the solution is difficult. The cumulation of the plaque also causes gum inflammation. Orthodontic treatment thus becomes unpleasant for both sides and its prolongation occurs due to the slowing down of tooth movement. Gum inflammation retreats quickly after improvment of dental hygiene. The wrong hygiene may in extreme cases cause damage of periodontal ligaments and loss of the tooth. It is unacceptable to permit devastation of the set of teeth during the orthodontic treatment. First signs of the damage of teeth are the reason for the debonding of the fixed appliance.

In course of tooth movement during the orthodontic treatment so called root resorption, in other words shortening of the tooth root, may occur. This complication is usually unpredictable, it depends on the patient´s tendency to resorptions. Apart from orthodontic treatment, many other causes, e.g. retained teeth, injury, hormonal changes, may participate on this complication. Shortening of the tooth root is in most cases mild and does not have any influence on the functionality and the prognosis of the tooth. Only in exceptional cases the root resorption is of a larger extent and it threatens the prognosis of the tooth. At the same time, rarely may also occur the loss of vitality of the toot- necrosis of the tooth pulp. It is usually the case of teeth after an injury or teeth with larger filling. Loss of vitality manifests itself by change of the colour of the crown. To patients with thin gums may emerge a recess- retreat of the gum. Correction of this state is possible by the means of a periodontal intervention.

A complication of the treatment is also an undesirable response of the patient to the treatment or an unpredictable growth. Under such circumstances the outcome of the treatment may be a compromise, alternatively it is necessary to change the treatment plan.

During the orthodontic therapy, temporomandibular joint disorders may occur. It was proved that correctly performed orthodontic treatment does not cause these problems, they probably develope not depending on the orthodontic therapy.