Orthodontics

ORTHODONTIC CONSULTATION

First and foremost: talking to the patient

At the time of the first appointment, the orthodontist decides if orthodontic treatment is required and takes a detailed medical history from the patient in order to fully understand the reasons for the patient’s visit, as well as to find out their expectations. This allows an individual treatment plan to be drawn up, which is the first step to achieving results that are satisfactory for both the patient and the doctor.

The further steps of the diagnostic process necessary for planning the treatment are:         

• detailed examination of the occlusion and muscle functions,
• taking impressions for plaster diagnostic models of the patient’s teeth,
• photos of the dentition, which are added to the patient’s digital record,
• X-ray imaging (panoramic X-ray and remote side X-ray of the skull), which may be performed on the spot in our X-ray laboratory.

PRESENTATION OF THE TREATMENT PLAN

At the time of the second appointment, the orthodontist talks to the patient about the results of the examinations and analyses of the occlusion, bone conditions and face profile, and then presents a treatment plan.After the patient accepts the plan, the date of commencing the actual treatment is agreed.

COMMENCEMENT OF THE ACTUAL TREATMENT

Depending on the kind of treatment planned, the actual treatment stage begins with providing the patient with removable braces or the application of permanent ones, which is a painless procedure.The dentist then provides the patient with any recommendations and necessary advice, both orally and on paper.

At the commencement of the orthodontic treatment the teeth must be healthy, free of any deposit and tartar, and the gums free of inflammation symptoms.

Patients of the Villa Nova Dental Cliniccan enjoy comprehensive dental care. Should it be necessary to perform additional procedures preparing theteeth for putting on the permanent braces, the patient will be led through them professionally until the actual treatment begins.

CHECK-UPS

Check-ups take place at various intervals, depending on the chosen treatment method, its phase and the patient’s individual needs:

• Removable braces – every 2-4 months
• Permanent braces – every 4-10 weeks

The aim of these obligatory visits is effective monitoring of the course of the treatment and the activation of the braces.

Treatment with the use of permanent braces lasts 18-24 months on average. Treatment duration depends mainly on the system used and the severity of the treated occlusal abnormality.

RETENTION PHASE

This is the last, yet an incredibly important stage of treatment, whose aim is to maintain the obtained results and to prevent the recurrence of the defect.

• If the treatment involved wearing a removable appliance, the retention appliance will be the same orthodontic appliance used to date, but without activation.
• If the treatment involved a permanent appliance, after removing the appliance, the patient is provided with a thin wire stuck on the internal,lingual surface of the lower front teeth (in some cases also the upper teeth).The patient also receives a removable acrylic retention plate or clear, transparent braces for the upper teeth.

Throughout the retention phase, the patient undergoes free check-ups in accordance with the doctor’s recommendations.

What does orthodontic prevention involve?

Most occlusal abnormalities in children are acquired and occur in the first few years of life.Orthodontic prevention consists in eliminating the factors that have a detrimental effect on regular development and mutual relationships between the teeth and bones of the jaws in children, as well as in early orthodontic treatment aimed at preventing the development of an occlusal abnormality or its complete elimination. In the case of any abnormalities, the orthodontist recommends appropriate exercises or treatment with simple appliances.

We can list certain symptoms in children that point to the need for orthodontic consultation:

• face asymmetry– apparent changes in the child’s appearance
• reverse teeth overlapping (the lower front teeth overlap the upper ones)
• excessive inclination of front teeth (front teeth are “lying” on the lower lip – co-called liptrap)
• crowding and spacing teeth
• harmful habits (biting nails, pencils, pens, sucking on fingers or dummies)
• late loss of milk teeth
• no permanent teeth developing despite the loss of their milk predecessors
• early loss of milk teeth (mostly resulting from carious complications)
• teeth growing in wrong spots
• speech impediments
• breathing through the mouth (mouth permanently open)
• tongue dysfunction (swallowing like a baby)

It is advised to see an orthodontist when the child turns 6. The doctor will establish if there are any abnormalities in the shape of the jaw and mandible.

Removable appliances are devices that can be inserted and removed from the mouth by the patient. They are used in children and youth, as their bones are still growing, and are therefore susceptible to modifications, even with the application of intermittent forces.

The duration of treatment with the use of removable appliances and its effectiveness will depend on the type of defect, age of the patient and the level of the patient’s compliance with the dentist’s instructions. To benefit from the positive results of the treatment, the child has to observe the principles of wearing the appliances, i.e. the recommended duration and the manner of use of the device. The orthodontist must continuously monitor the progress and adjust the appliance, i.e. adapt it to the changes taking place in the mouth, such as changes in the position of the teeth and the replacement of milk teeth with permanent teeth.

Depending on the bite abnormality being treated, various types of removable appliances may be used.They comprise an acrylic plate in a colour selected by the patient and, depending on the appliance type, wire elements that fix the orthodontic appliance or elements exerting pressure on the teeth (screws, springs).

PERMANENT APPLIANCES

Permanent appliances are devices comprising catches of various types (brackets and rings) placed permanently on the tooth surface with special adhesives for the entire duration of orthodontic treatment.The catches provide support for springy wires that exert the actual force acting on the teeth. Due to the fact that the appliances exert a constant pressure for the whole period of treatment, they allow an exact effect of the treatment to be obtained,while the aspect of patient compliance in much less significant. This might make easier the life of parents whose children are unwilling to cooperate.

Depending on the patients’ treatment and aesthetic needs, as well as their comfort, different types of orthodontic systems are recommended. Virtually any of these allows the patient to choose between metal and aesthetic (transparent) models.

We use the latest generation systems that let us eliminate all elements that complicate treatment with the use of conventional permanent braces. This lets us achieve treatment results faster, while keeping the patient’s discomfort to a minimum.

Moreover, in the treatment of more complicated cases we use additional solutions (e.g. micro-implants) that make it possible to achieve a perfect bite quickly and safely.

Treatment with the use of permanent appliances can be used in both children and adults, with virtually no age restrictions.

THE DAMON SYSTEM HELPS ACHIEVE A PERFECT, FULL SMILE AFTER A MUCH SHORTER TREATMENT TIME!

It’s a modern, self-ligaturing orthodontic system thatoffers extraordinary possibilities of treating bite abnormalities, owing to a unique design of the brackets and technologically advanced arches, which generate delicate, physiological forces. It also offers the patient more aesthetic looks and shorter treatment duration compared to traditional methods. Most importantly though, in most cases it eliminates the necessity of tooth extraction!

Additional benefits of the Damon system:

• longer intervals between check-ups (even 8-10 weeks)
• quick results (even after just 2-3 visits)
• significant reduction of discomfort that usually comes with orthodontic treatment
• easier maintenance of perfect oral hygiene due to the elimination of discolouring ligatures and the lack of rings on molars
• brackets are smaller and less visible(available in the Damon Q metal and the practically invisible, aesthetic Damon Clear version)
• they guarantee excellent results – full profile, wide smile, better lip support, younger appearance!

The BENEFIT system, consisting of various pillars and connectors, gives the possibility to construct a device that will be extremely effective in:

• molar distalization (one or both sides)
• molar mesialization (one or both sides)
• arc asymmetry correction
• en masse retraction
• lengthening and shortening of molars

In an effort to satisfy the needs of our most demanding patients, particularly those with intense professional lives, Villa Nova Dental Clinic offersthis modern method, i.e.  a fully cosmetic orthodontic system.

Perfect Clear enables a precise, yet completely invisible correction of teeth alignment.

It is a set of perfectly clear dental aligners(positioners) created for each patient individually.

The perfect matching of the splint with the shape of the dental arches and the smile line guarantees comfort of use, with no impact on speech or freedom of smile.

The patients of Villa Nova Dental Clinic praise the Perfect Clear system for the ability to remove the appliance from the mouth. On the one hand, it makes it easier to maintain appropriate hygiene of the oral cavity and teeth, but on the other hand it obligates the patient to cooperate with the dentist in a conscious and responsible manner. Treatment results depend largely on the patient’s full cooperation!

To quickly achieve treatment success, the positioners must be worn almost around the clock, except for meal times, brushing and flossing the teeth. The number of splints that make up the set prepared for a given patient, each of which should be worn for about 2 weeks, translates into the overall treatment duration, and depends on the initial state of the patient’s teeth and the assumed goal of the treatment.

The system of positioners can be used to treat most bite abnormalities, but it has proven to be most effective in case of small abnormalities in tooth alignment, e.g. crowding and spacing teeth or shifts in tooth position after removing permanent braces, resulting from the lack of compliance with the dentist’s instructions during the retention phase.

Invisalign jest przezroczystym aparatem prostującym zęby, dzięki któremu na Twojej twarzy zagości wymarzony piękny uśmiech. Wykorzystując zaawansowaną technologię obrazowania 3D, w metodzie Invisalign tworzony jest kompletny plan prostowania zębów, uwzględniający przesunięcie z początkowej do pożądanej pozycji na podstawie zaleceń Lekarza. Następnie przygotowywany jest zestaw alignerów specjalnie dostosowanych do zębów konkretnego pacjenta, które stopniowo przesuwają zęby, są one przezroczyste, więc nikt nawet nie zauważy gładkich aparatów na twoich zębach, dzięki czemu możesz je nosić w każdej sytuacji, każdego dnia. Alignery można zdejmować, więc nie ma żadnych ograniczeń co do produktów, które można jeść i pić. Można je zdjąć również do szczotkowania i czyszczenia zębów nicią dentystyczną, aby zachować dobrą higienę jamy ustnej. W odróżnieniu od klasycznych stałych aparatów, alignery nie mają żadnych zamków ani drutów. Każdy aligner z kompletu nosi się przez około dwa tygodnie i wymienia się je na nowe, aż do uzyskania pożdanego ustawienia zębów. Plan leczenia metodą Invisalign jest przygotowywany przez Lekarza na podstawie indywidualnych potrzeb pacjenta.

A full, beautiful, perfectly shaped “Hollywood” smile is every patient’s dream and every orthodontist’s challenge. The application of modern orthodontic techniques, such as the Damon, Ten Brook, and Incognito systems by the dentist at Villa Nova Dental Clinic brings us closer to this ideal. In order for the results of the orthodontic treatment to be even more spectacular and satisfactory for the patient, our clinic offers a wide range of services that will make the smile truly perfect:

• Whitening
• Lasercorrection of gum tissue
• Aesthetic dentistry procedures (including porcelain veneers and all-ceramic crowns)
• Implant prosthetics (see -> implants for everyone)
• Aesthetic correction of the shape of the lips and the elimination of gummy smile (see -> aesthetic medicine)

Corticotomy is an effective method of supporting orthodontic treatment in adult patients.
This procedure significantly shortens the time of wearing the orthodontic appliance, even up to 1/4 of the time intended for conventional treatment.
It is worth to remember that surgical support of orthodontic treatment helps in accelerating teeth movements to set them correctly in the dental arch.
The fact is, sometimes this technique is indispensable to get the best results of a good bite and smile.
However, it should be remembered that the orthodontist sets the best treatment plan for the Patient.

The corticotomy treatment consists in selective – linear or point – decortication of the bone tissue surrounding the teeth.It triggers a state of transient osteopenia, which is associated with a decrease in the resistance of the cortical layer of bones to the teeth undergoing orthodontic treatment.This procedure is performed under local anesthesia – it is not associated with increased pain.It takes about 40 minutes.As the patients say: “There is nothing to fear”

This sounds extreme, but will be gentle. We know that the screws may be associated with an automobile workshop or furniture installation. Indeed, we also use them in our practice, but in a slightly smaller version. In truth, they are very small.

To understand what the screws are, a small introduction may be needed. Orthodontists live in a world where one group of teeth is opposed to the other. Then, they are pushed or pulled. Choosing the right group of teeth is crucial, since this determines the movement of selected teeth. It’s a bit like a tug-of-war on the beach. Imagine ten people on each side of the rope. On one side –a one hundred kilogram strongman, on the other – a strong orthodontist weighing eighty kilos. It is obvious that even if I had the strength of ten (I am as strong as three men) – this would be a challenge. Usually, large teeth win against small teeth that are pulled, unless we find more small teeth, as if we get more slender orthodontist to our group.

However, it would suffice to tie us to a tree to make us insurmountable.Since the teeth (all of them) move, it is worth having something in your mouth that does not move when pulled. This is called an absolute anchorage, because it is really absolute.

Here we are talking about small (length of approx. 8 mm, diameter of approx. 1 mm), sterile bone screws, abbreviated hereafter as TAD (Temporary Anchorage Devices). The miniscrews are screwed only for some time in the course of orthodontic treatment and their removal leaves no trace. You cannot confuse them with prosthetic implants replacing missing teeth, remaining in the bone for life.

TADs changed the way we look at difficult cases. A few years ago, some of them would be seen as unfit for orthodontic treatment. And now they are routinely treated. We love those little screws and the opportunities they offer.

In many patients who would normally have to undergo general anaesthe-sia and a surgery to correct jaw distortion, we can now use only a few screws and thus avoid surgery.

The screws allow us to pull back the teeth which lengthened themselves due to the lack of opposing teeth. Recently, microimplants on the palate are used more and more often.

The biggest problem with traditional microimplants is a large risk of lo-sing them during treatment (approx. 25%). Their location between the roots of teeth can also hamper their movement. These disadvantages have been eliminated in the case of microimplants on the palate. Their preservation is at the level of almost 100% and there are no roots in their vicinity. As a result, we can finally perform unbelievable teeth movements without the risk of losing our “anchor”. It is important that the treatment is invisible to others for many months.

In the end, we can push back the upper teeth to relieve crowding in the anterior section and straighten the lower inclined molars.

It is possible to close even large gaps after missing teeth by moving back teeth to front.

And in the absence of the upper “seconds”, instead of waiting for the possibility of implantation, we may close the gaps with the patient’s own teeth.

Easy fixing – often only a local anaesthetic gel is needed. After the treatment, the screws are simply removed and the bone regenerates fully and quickly.

1. What are main causes of occlusion defects?

There are numerous causes for the occlusion defects mentioned. Acquired occlusion defects, being the most common, develop within the first years of life of a child. Factors leading to abnormal position of the teeth include the application of inappropriate dummies and teats, breathing through the mouth (instead of the nose), sucking of the thumb or lip and premature loss of a milk tooth/teeth due to injury and, first of all, dental caries. The loss of milk teeth before the time of their natural replacement leads to inhibition in the growth of the jaw, and then irregular position of the permanent teeth due to lack of sufficient space.

2. How and when should I prevent occlusion defects?

Prevention of occlusion defects should be implemented from the first days of the child’s life of the child. You should pay attention to:

• the timing and method of feeding of the baby (bottle or breast-fed);
• the application of appropriate dummies and teats;
• the early introduction of feeding using a teaspoon;
• making the baby accustomed to biting and chewing solid food.

Extremely important, but a difficult and patience-consuming task is to prevent the development of bad habits or getting rid of them (e.g. sucking a thumb or lip, biting pencils, etc.). Due to the significant importance of dental caries in the development of occlusion defects, the milk teeth should be thoroughly cared for from the time of their eruption to natural loss.

3. When should I come with my child to the orthodontist?

There are various circumstances, which should encourage the parent or guardian to take the child to the orthodontist. The most important of them include:

• premature loss of the milk teeth;
• habit of sucking a thumb or dummy in a child over 3 years;
• reluctance of a child over 3 years to bite and chew solid food;
• worrying changes in the appearance of the child’s face (e.g. face asymmetry, apparently retracted or protruding chin);
• reverse tooth overlapping, i.e. a lower tooth overlaps the upper one.

4. Why is the treatment of children so important?

Orthodontic treatment of children in necessary, as occlusion defects do not reverse spontaneously, but become worse with the child’s growth. Also, the fact that crooked teeth may be the cause of complexes in children from their earliest years, and may pose more difficulties in cleaning (increased susceptibility to dental caries and gum diseases), and that abnormal occlusion may promote speech disorders, is also of importance. The orthodontic treatment of children brings results faster than in adults, and commonly allows the removal of permanent teeth to be avoided and prevents complications of occlusion defects, if started at appropriate time.

5. Is there any age limit for orthodontic treatment?

Age provides no limit for orthodontic treatment. The treatment may be commenced at any age, with the appropriate method selected. However, the prerequisite is the presence of bone tissue in sufficient amount and quality, the lack of acute periodontal inflammation, healthy teeth, and the lack of dental deposit and tartar.

6. When should an adult visit the orthodontist?

Adult patients commonly decide to start orthodontic treatment for aesthetic reasons. This is an important reason indeed, but there are also others:

• attrition of the teeth;
• headache in the forehead, pain in the ears and neck of unknown origin;
• elongation of the crowns of the teeth;
• elongation of the crowns of the teeth;
• crowded teeth (in particular when wisdom teeth are coming through);
• loosening of individual or a group of teeth;
• appearance of rapid ageing of the face around the angles of the mouth.

7. What are the benefits of orthodontic treatment in adults?

Successful orthodontic treatment in adult patients provides:

• an improvement in appearance and the well-being of the patient, and thus more self-confidence;
• easier tooth cleaning, which reduces susceptibility to dental caries, tartar build-up and periodontosis;
• improvement of chewing quality, which has a direct effect on the performance of the alimentary tract;
• delayed ageing of the face;
• elimination of disorders of the temporomandibular joints and related headache;
• an easy, full smile.

8. How should I prepare myself for orthodontic treatment?

Before the commencement of orthodontic treatment, in particular involving permanent appliances, all the teeth have to be healthy, free of dental deposit and tartar, and the gums have to be free of inflammatory symptoms (softening, redness, bleeding, pain).

9. Is orthodontic treatment painful?

If the treatment involves the use of a permanent appliance, just after its application and a few days after (on the second or third day) a feeling of discomfort or even soreness may occur, in particular during biting solid food. However, such symptoms should subside within a week, and the patient should become accustomed do the appliance within a few days. A similar feeling, but less intensive, may occur after the activation of a removable appliance. Protruding elements of the device may irritate the mucous membrane of cheeks and lips, but there is an excellent remedy for the problem, a special wax that adheres to the appliance and allows the mucous membrane to become accustomed quickly to new conditions.

10. Should I change my oral hygiene practices when wearing a permanent appliance?

If you wear a removable appliance, you may apply your normal method of cleaning your teeth. The other problem is to keep the appliance itself clean; it should be cleaned with a separate toothbrush or special brush for prosthetic appliances and toothpaste or liquid soap. On the other hand, cleaning the teeth with a permanent appliance requires more accuracy, more time and additional accessories (interdental toothbrush, special dental floss, dental irrigator). It is recommended that professional tooth cleaning and fluoridation in the surgery be undergone every several months.

11. Can permanent appliances do damage to teeth?

Permanent appliances do not damage the teeth! Only the failure to observe regular principles of hygiene by the patient may, under the new condition, lead to the demineralisation of enamel and development of caries.

12. Does wearing a permanent appliance require a dietary modification?

In the initial period, just after the application of a permanent appliance, it is recommended to eat only soft meals, due to the hypersensitivity of the teeth to biting. During the whole treatment period you should avoid very hard or sticky food (in particular nuts, chewing gum or toffee-like sweets and candies). Such food may hinder tooth cleaning or damage the appliance, which prolongs and complicates the treatment. The selection of aesthetic brackets requires avoiding large amounts of coffee, tea, red wine, certain fruit juices (e.g. blackcurrant one) and meals (e.g. curry), and smoking, as these products promote the build-up of deposit which is difficult to remove.

13. Is it necessary to apply permanent appliances to both dental arches?

The final decision needs to be taken by the orthodontist who, having considered the examination results, the type of occlusion defect and the patient’s opinion, determines whether appliances on both arches are necessary for the satisfactory results of the treatment.

14. Are there any invisible appliances?

There are no completely invisible permanent appliances among the conventional ones currently available. However, there are aesthetic appliances available with brackets matched to the tooth colour (ceramic) or completely transparent (of pure monocrystalline sapphire), as well as arches matched to the tooth colour. In some patients the lingual technique may be applied, in which the brackets are fixed to the internal surfaces of the teeth.

15. What does the effect of orthodontic treatment depend on?

The following factors influence the effect of the treatment:

• type of the occlusion defect;
• age of the patient;
• type of the appliance used;
• level of oral hygiene;
• regular attendance at scheduled check-ups.

16. Is there a risk that the teeth will want to return to their old, wrong positionsafter the completion of orthodontic treatment?

Such risk does exist when the patient does not attend appointments during the so-called retention phase of treatment, which consists in monitoring permanent retention appliances attached to the lingual surface of the upper and lower front teeth, as well as removable appliances, worn in accordance with the dentist’s recommendations.