Buying Braces in The Unites States
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How braces work
The application of braces moves the teeth as a result of force and pressure on the teeth. There are four basic elements that are needed in order to help move the teeth. In the case of traditional metal or wire braces, one uses brackets, bonding material, arch wire, and ligature elastic, also called an “O-ring”[2] to help align the teeth. The teeth move when the arch wire puts pressure on the brackets and teeth. Sometimes springs or rubber bands are used to put more force in a specific direction. Braces have constant pressure, which over time, move teeth into their proper positions. Occasionally adults may need to wear headgear to keep certain teeth from moving. When braces put pressure on your teeth, the periodontal membrane stretches on one side and is compressed on the other. This movement needs to be done slowly otherwise the patient risks losing his or her teeth. This is why braces are commonly worn for approximately two and a half years and adjustments are only made every three or four weeks. This process loosens the tooth and then new bone grows in to support the tooth in its new position which is technically called bone remodeling. Bone remodeling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoclasts and osteoblasts. Two different kinds of bone resorption are possible which are called direct resorption, starting from the lining cells of the alveolar bone, and indirect or retrograde resorption, which takes place when the periodontal ligament has become subjected to an excessive amount and duration of compressive stress.[3] Another important factor associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament and without bone deposition, the tooth will loosen and voids will occur distal to the direction of tooth movement.[4] A tooth will usually move about a millimeter per month during orthodontic movement, but there is high individual variability. Orthodontic mechanics can vary in efficiency, which partly explains the wide range of response to orthodontic treatment.
Types of braces
Traditional metal-wired braces are stainless steel, sometimes in combination with titanium, and are the most widely used. These include conventional braces, which require ties to hold the archwire in place, and newer self-tying (or self-ligating) brackets. Self-ligating brackets may reduce friction between the wire and the slot of the bracket, which in turn might be of therapeutic benefit.[5]
"Clear" braces serve as a cosmetic alternative to traditional metal braces by blending in more with the natural color of the teeth or having a less conspicuous or hidden appearance. Typically, these brackets are made of ceramic[6] or plastic materials and function in a similar manner to traditional metal brackets. Clear elastic ties and white metal ties are available to be used with these clear braces to help keep the appliances less conspicuous. Clear braces have a higher component of friction and tend to be more brittle than metal braces. This can make removing the appliances at the end of treatment more difficult and time consuming.
Gold-plated stainless steel braces are often employed for patients allergic to nickel (a basic and important component of stainless steel), but may also be chosen because some people simply prefer the look of gold over the traditional silver-colored braces.
Lingual braces (examples of which are SureSmile QT [7], Incognito Braces) are custom made fixed braces bonded to the back of the teeth making them invisible to other people. In lingual braces the brackets are cemented onto the backside of the teeth making them invisible while in standard braces the brackets are cemented onto the front side of the teeth. Hence, lingual braces are a cosmetic alternative to those who do not wish the braces to be visible.
Titanium braces resemble stainless steel braces but are lighter and just as strong. People with allergies to the nickel in steel often choose titanium braces, but they are more expensive than stainless steel braces.
Traditional braces are mostly used in treating children, as well as adults. They consist of a small bracket that is glued to the front of each tooth and the molars are adjusted with a band that encircles the tooth. An advantage is one can eat and drink while wearing the brace but a disadvantage is that one must give up certain foods and eating habits while wearing them, such as, chewing gum and potato chips. Another disadvantage is they have to be periodically tightened by your orthodontist causing increased amounts of discomfort.
Customized Orthodontic Treatment Systems (an example of which is Suresmile) combine high-technology including 3-D imaging, treatment planning software and a robot to custom bend the wire. Customized systems such as this offer faster treatment times and more efficient results. [8] Treatment can be more expensive and is not available at all orthodontists.
Progressive, clear removable aligners (examples of which are Invisalign, Originator, ClearCorrect) may be used to gradually move teeth into their final positions. Aligners are generally not used for complex orthodontic cases, such as when extractions, jaw surgery, or palate expansion are necessary. These braces are the most recent type of braces. Many orthodontists do not use these braces because they feel they do not produce the best corrective results compared to traditional braces, but opinions vary from person to person. The braces are hardly noticeable on the teeth and work to gradually move the teeth into their right position without the need for wires or tightening. Like traditional braces, they do require an improvement in the amount of oral hygiene because they have to be removed to eat and one must brush and floss after every meal.
For less difficult cases, spring aligners are also an option that can cost much less than braces or Invisalign (one example is NightShiftOrtho) and still align primarily the front six top and bottom teeth.[citation needed]
Smart brackets are the latest concept under investigation. The smart bracket contains a microchip that measures the forces that act on the bracket and subsequently, the tooth interface . The aim of these braces is to reduce the duration of orthodontic therapy and the related expenses and discomfort to the individual.
A-braces [9] are another new concept in dental appliances. In the shape of a capital letter A, A-braces are applied, adjusted, removed and completely controlled by the user. At the ends of the A's arms are angled knobbed bits that the user bites down over. The width between the bits is adjusted by turning the crossbar, housed across the arms. A user never has to experience pain because the pressure is so easy to control. A-braces may serve as self-adjustable retainers and palate expanders.[citation needed]
Procedure
A patient's teeth are prepared for application of braces.
Orthodontic services may be provided by any licensed dentist trained in orthodontics. In North America most orthodontic treatment is done by orthodontists, dentists in diagnosis and treatment of malocclusions—malalignments of the teeth, jaws, or both. A dentist must complete 2–3 years of additional post-doctoral training to earn a specialty certificate in orthodontics. There are many general practitioners who also provide orthodontic services.
The first step is to determine whether braces are suitable for the patient. The doctor consults with the patient and inspects the teeth visually. If braces are appropriate, a records appointment is set up where X-rays, molds, and impressions are made. These records are analyzed to determine the problems and proper course of action. Typical treatment times vary from six months to two and a half years depending on the complexity and types of problems. Orthognathic surgery may be required in extreme cases. About 2 weeks before the braces are applied, orthodontic spacers are required to spread apart back teeth in order confirm enough space for the bands.
Teeth to be braced will have an adhesive applied to help the cement bond to the surface of the tooth. In most cases the teeth will be banded and then brackets will be added. A bracket will be applied with dental cement, and then cured with light until hardened. This process usually takes a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utilized when dental fillings or other dental work make securing a bracket to a tooth infeasible.
An archwire will be threaded between the brackets and affixed with elastic or metal ligatures. Elastics are available in a wide variety of colors. Archwires are bent, shaped, and tightened frequently to achieve the desired results. Brackets with hooks can be placed, or hooks can be created and affixed to the archwire to affix the elastic to. The placement and configuration of the elastics will depend on the course of treatment and the individual patient. Elastics are made in different diameters, colors, sizes, and strengths.
Modern orthodontics makes frequent use of nickel-titanium archwires and temperature-sensitive materials. When cold, the archwire is limp and flexible, easily threaded between brackets of any configuration. Once heated to body temperature, the archwire will stiffen and seek to retain its shape, creating constant light force on the teeth.
When applying another type of dental brace, such as Invisalign, the process is quite different but there are similarities like the initial steps of molding the teeth before application. With Invisalign, impressions of the patient's teeth are sent for evaluation. After viewing and determining the best course of action for the patient, their series of trays are created. The patients dentist or orthodontist receives the trays which fit to the patients mouth almost like a protective mouthpiece.
There are some forms of braces in which the brackets are placed in a special form which are customized to the patients mouth. This reduces the application time for the traditional type of braces. The form contains the metal brackets which are placed in the patients mouth like a mouth guard, drastically reducing the application time.
Dental braces, with a transparent power chain, removed after completion of treatment.
In many cases there is insufficient space in the mouth for all the teeth to fit properly. There are two main procedures to make room in these cases. One is extraction: teeth are removed to create more space. The second is expansion: the palate or arch is made larger by using a palatal expander. Expanders can be used with both children and adults. Since the bones of adults are already fused, expanding the palate is not possible without surgery to unfuse them. An expander can be used on an adult without surgery, but to expand the dental arch, and not the palate.
Each month or two, the braces must be adjusted. This helps shift the teeth into the correct position. When they get adjusted the orthodontist takes off the colored rubber bands keeping the wire in place. The wire is then taken out, and may be replaced or modified. When the wire has been placed back into the mouth, the patient may choose a color for the new rubber bands, which are then fixed to the metal brackets. The adjusting process may cause some discomfort, which is normal.
Post-treatment
In order to avoid the teeth moving back to their original position, retainers may be worn once the treatment with braces is complete.
Patients may need post-orthodontic surgery, such as a fiberotomy or alternatively a gum lift, to prepare their teeth for retainer use and improve the gumline contours after the braces come off.
Retainers
Main article: Retainer (orthodontic device)
In order to prevent the teeth moving back to their original position, retainers may be worn once the treatment with braces is complete for the patient depending on their specific needs. If the patient does not wear the braces appropriately for the right amount of time, the teeth may move towards their previous position. For regular traditional braces Hawley retainers are used. They are made of metal hooks that surround the teeth and are enclosed by an acrylic plate shaped to fit the patient’s palate. For invisalign braces an Essix retainer is used. They are similar to the regular invisalign braces and is a clear plastic tray that is form fitted to the teeth that stays in place. There is also a bonded retainer where a wire is permanently bonded to the lingual side of the teeth, usually the lower teeth only. Doctors will sometimes refuse to remove this retainer, and it may require a special orthodontic appointment to have it removed.
Pre-finisher
The pre-finisher is molded to the patient's teeth by use of extreme pressure to the appliance by the person's jaw. The product is then worn a certain amount of time with the user applying force to the appliance in their mouth for 10 to 15 seconds at a time. The goal of the process is to increase the exercise time in applying the force to the appliance. If a person's teeth are not ready for a proper retainer the orthodontist may prescribe the use of a preformed finishing appliance such as the pre-finisher. This appliance fixes gaps between the teeth, small spaces between the upper and lower jaw, and other minor smaller problems.
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