What You Should Know about Orthodontic Treatment

This is an entire specialty of dentistry devoted to straightening misaligned teeth, and improving a person’s dental and facial appearance. There are two major forms of misalignment. In one form the jaw relationship is abnormal and in the other the teeth are misaligned (crooked). Orthodontics deals with them both, and the two forms can be exhibited in one person. There are two main abnormalities of jaw relationship. Teeth are supposed to close with the front upper teeth just in front of, and in contact with and overlapping the bottom ones. In what is referred to as a Class II abnormality, a so-called ‘weak-chin’, the upper teeth protrude too much. A more prominent lower jaw with the lower teeth biting in front of the upper ones is called Class III. This may be the more difficult to treat successfully. Crowded teeth, overlapping teeth, crooked teeth, missing teeth and gaps between teeth are also dealt with. When these are found in a ‘normal’ biting position it is called Class I.


Orthodontic treatment is based on the fact that continuous, light pressure applied to a tooth can move it in the bone, and that the bone itself can be expanded or encouraged to grow – in other words develop to its own genetic potential. Most orthodontic treatment is carried out in the age bracket that spans the start and end of puberty. It can, however, start at ages as young as 5, and there is no upper age limit at all. Indeed, adult treatment is becoming ever more popular. The basic forms of orthodontic treatment are built around various forms of appliances, including the following.


– Functional appliances are removable appliances designed to improve or release the growth potential of the jaws. Examples include appliances with screws that expand the plate to widen the roof of the mouth (palate), or others that counteract muscular forces that may be stopping the lower jaw from growing. Functional appliances are used where there are skeletal difficulties, and they precede other treat­ments. Should treatment be carried out at very young ages it will almost certainly be with this form of appliance.

– Fixed appliances are bonded to the teeth. Typically they look like the miniature railway track seen on so many teenagers. Wires apply pressure to individual teeth to move them into the desired position. A typical treatment time is 21 months. However to stop the teeth ‘relapsing’ into their previous positions a minimum period of 1 year of stabilization with a moveable appliance is required. However, this stabilization might require more time, perhaps until the end of the normal growth period (17 or 18 years of age).

– Removable appliances are most often a plastic plate with wires and/or springs or screws that apply pressure to selected teeth, to move teeth relative to other teeth. This type of appliance is now more often used to maintain changed relationships, rather then changing the relationship in the first instance.


It may be that space has to be made to straighten the teeth; so one or more teeth have to be extracted, often, but not always, before an appliance is made and fitted. The most noticeable functional appliance is one attached to a large metal bow sticking out from either side of the head. It looks like an extra-large pair of electrodes for Frankenstein’s monster. It is capable of exerting large forces on the teeth. Occasionally jaw surgery is needed, in addition to ‘normal’ orthodontic treatment, to correct misplaced teeth and jaw discrepancies. Given patient cooperation and expert treatment planning, there is every reason to believe that nearly 100 per cent of orthodontic treatments will succeed.


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