Techniques & Appliances

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  1. Fixed Appliances (Braces)
    equipment.jpgRegular braces (silver colored)
    Damon braces
    Clear braces (tooth-colored)
  2. Auxiliary Appliances
    Maxillary Expansion Appliance
    Headgear
    Herbst
  3. Removable Appliances
    Retainers
    Functional Appliances
  4. Invisible Appliances
    Invisalign
    Lingual Appliance (braces behind the teeth)

Fixed Appliances (Braces):

Consists of cemented bands (rings) on the molars and small metal or plastic brackets which are bonded on the front surface of teeth. Braces are available in the following variations:

a) Regular braces (stainless steel – silver colored):

These are the most common type of appliances in the United States.

  • Advantages:
    o Highly effective – the quickest method of straightening teeth.
    o Can incorporate colored elastics that can be customized by the patient at each visit.

  • Disadvantages:
    o Metallic appearance

b) Damon braces:

damon.pngBraces use gentle pressure to encourage teeth to move along a prescribed path into a new alignment.

  • First, a bracket is bonded to the tooth. The bracket is simply a handle that is used to attach an archwire.
  • The archwire that is attached to the bracket is what actually does the work of moving your teeth. The wire is bent in a prescribed form designed to shift your teeth to where they need to be. The wire places pressure on the bracket and the tooth and causes the teeth to move.

The traditional way of tying a wire to a bracket creates tremendous friction between the brackets and wires. Dr. Dwight Damon created a new way to attach wires to brackets that allows the wire to slide freely, eliminating the friction.

With the Damon system, the traditional steel and rubber band ties have been eliminated, and a sliding mechanism ‘garage door’ assembly replaces the traditional handle on the front of the bracket. Wires can be secured to the bracket without the need for ties and their added friction and forces. These improvements make Damon system brackets friction-free. The advantages of a friction-free system are:

  • Fewer office visits, up to 12 weeks apart
  • Shorter appointments
  • More comfort for wearers
  • Shorter time in braces
  • Less root resorption

The low forces of the Damon system work in conjunction with the muscles of the face and tongue, bone and tissue to shift teeth. The low forces mean that discomfort is minimized and more types of cases can be treated.

Damon brackets are beneficial for many different types of patients. Adult patients benefit because of the faster treatment and increased comfort. Patients with periodontal (gum) problems can receive treatment because the lower friction of Damon brackets puts less force on their gums. For more information visit the Damon website.

c) Clear braces (tooth-colored):

They are made of a hard acrylic (crystalline).

  • Advantages:
    o Less noticeable. The wires used are steel and can be seen from close distance.

  • Disadvantages:
    o Treatment time can be longer due to reduced efficiency.

Auxiliary Appliances

a) Maxillary Expansion Appliance (MEA):

This appliance is also called the rapid palatal expansion appliance or palatal expander. It widens an otherwise narrowed upper jaw by spreading the bony suture in the palate. It is highly effective in correction of crowding during preadolescence. In post-adolescent patients the sagittal suture system becomes less adaptive with a tendency for the expanded jaw to relapse.

b) Headgear:

An orthopedic appliance which reduces forward growth of the upper jaw, and therefore corrects the overbite (bucked teeth). It is made of two components, a face bow which is attached to the braces inside the mouth, and a traction mechanism which sits on top of the head or behind the neck. Headgear is usually worn at night.

c) Herbst:

A fix-functional appliance; it holds the lower jaw forward causing stimulation of growth in a forward direction. It is used for severe overbites when the lower jaw is underdeveloped.

Removable Appliances

Hawley Retainera) Retainers:

They are commonly used after the braces to safeguard the alignment of teeth and prevent their relapse. They are also used for correction of minor problems in adults.

  • Advantages:
    o Being removable, they do not infringe upon patients’ social life.
    o More hygienic by giving patients the ability to take them out during brushing.

  • Disadvantages:
    o They move teeth minimally and by tipping motion only.
    o They are only effective when worn; therefore they work best for highly disciplined patients.

b) Functional Appliances:

They were originally developed in Europe during the 50s and were introduced to US orthodontists in the 70s. They are primarily used on young patients with large overbites (bucked teeth). Functional appliances stimulate growth of the lower jaw by holding it in a forward position. They are most appropriate for patients with small lower jaws.

  • Advantages:
    o More hygienic than braces.

  • Disadvantages:
    o Being removable, their effects are less predictable. They are appropriate for highly motivated children who wear them at least 12 hours per day.

Invisible Appliances

a) Invisalign® (A new method):

invisalign_1.jpgThe Invisalign system consists of clear customized sets of trays used to move the teeth in small increments. They were developed in 1999 by Align Technology, a high-tech company located in Santa Clara. For more information visit the Invisalign website.

  • Advantages:
    o Practically invisible
    o Comfortable
    o New, exciting technology
    o Has anchorage advantage over other removable appliances by using the entire arch to move a few teeth, i.e. molars.
    o Disarticulation of the teeth may be advantageous for patients with TMJ problems.

  • Disadvantages:
    o Not applicable for growing children and for severe orthodontic problems.
    o Somewhat experimental with short track record of completed cases.

b) Lingual Appliances:

  • Advantages:
    o Lingual braces are placed behind the upper and/or lower teeth, making them virtually undetectable.
    o They allow you to retain your normal appearance for the duration of your treatment.

  • Disadvantages:
    o It takes the tongue 1-2 weeks to acclimate to these braces.