Orthodontics is a
dentistry
Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions o ...
specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, and misaligned bite patterns. It may also address the modification of facial growth, known as dentofacial orthopedics.
Abnormal alignment of the teeth and jaws is very common. Nearly 50% of the
developed world
A developed country (or industrialized country, high-income country, more economically developed country (MEDC), advanced country) is a sovereign state that has a high quality of life, developed economy and advanced technological infrastruct ...
's population, according to the American Association of Orthodontics, has
malocclusion
In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-19 ...
s severe enough to benefit from orthodontic treatment: although this figure decreases to less than 10% according to the same AAO statement when referring to medically necessary orthodontics. However, conclusive scientific evidence for the health benefits of orthodontic treatment is lacking, although patients with completed orthodontic treatment have reported a higher quality of life than that of untreated patients undergoing orthodontic treatment. Treatment may require several months to a few years, and entails using
dental braces
Dental braces (also known as braces, orthodontic cases, or cases) are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often ...
and other appliances to gradually adjust tooth position and jaw alignment. In cases where the malocclusion is severe,
jaw surgery
Orthognathic surgery (), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusi ...
may be incorporated in the treatment plan. Treatment usually begins before a person reaches adulthood, insofar as pre-adult bones may be adjusted more easily before adulthood.
History
As a modern science, orthodontics dates to the mid 1800s.
The field's influential contributors include
Norman William Kingsley
Norman William Kingsley (October 26, 1829 – February 20, 1913) was a dentist and an artist in the 19th century. He was a major contributor in the early development of orthodontic treatments and cleft palate therapy. He designed fixed and remova ...
(1829–1913) and
Edward Angle
Edward Hartley Angle (June 1, 1855 – August 11, 1930) was an American dentist, widely regarded as "the father of American orthodontics". He was trained as a dentist, but made orthodontics his speciality and dedicated his life to standardizing ...
(1855–1930). Angle created the first basic system for
classifying malocclusions, a system which remains in use today.
Until the mid-1970s, braces were made by wrapping metal around each tooth.
With advancements in
adhesive
Adhesive, also known as glue, cement, mucilage, or paste, is any non-metallic substance applied to one or both surfaces of two separate items that binds them together and resists their separation.
The use of adhesives offers certain advant ...
s it became possible to instead bond metal brackets to the teeth.
Methods
A typical treatment for incorrectly positioned teeth (
malocclusion
In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-19 ...
) takes from one to two years, with braces being adjusted every four to 10 weeks by specialists called orthodontists, university-trained dental specialists versed in the prevention, diagnosis and treatment of dental and facial irregularities. Orthodontists offer a wide range of treatment options to straighten crooked teeth, fix irregular bites, and align the jaws correctly. There are many ways to adjust malocclusion. In growing patients there are more options to treat skeletal discrepancies, either by promoting or restricting growth using
functional appliances,
orthodontic headgear
Orthodontic headgear is a type of orthodontic appliance typically attached to the patient's head with a strap or number of straps around the patient’s head or neck. From this, a force is transferred to the mouth/jaw(s) of the subject.
Headgear ...
or a
reverse pull facemask. Most orthodontic work begins in the early permanent dentition stage before skeletal growth is completed. If skeletal growth has completed,
jaw surgery
Orthognathic surgery (), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusi ...
is an option. Sometimes
teeth are extracted to aid the orthodontic treatment (teeth are extracted in about half of all the cases, most commonly the
premolar
The premolars, also called premolar teeth, or bicuspids, are transitional teeth located between the canine and molar teeth. In humans, there are two premolars per quadrant in the permanent set of teeth, making eight premolars total in the mouth ...
s).
Orthodontic therapy may include using fixed or removable appliances. Most orthodontic therapy is delivered using appliances that are fixed in place,
for example, with braces that are adhesively bonded to the teeth. Fixed appliances may provide greater mechanical control of the teeth; optimal treatment outcome is improved by using fixed appliances.
Fixed appliances may be used, for example, to rotate teeth if that do not fit the arch shape of the other teeth in the mouth, to adjust multiple teeth to different places, to change tooth angle of teeth, or to change the position of a tooth's
root
In vascular plants, the roots are the organs of a plant that are modified to provide anchorage for the plant and take in water and nutrients into the plant body, which allows plants to grow taller and faster. They are most often below the su ...
. This treatment course is not preferred where a patient has poor
oral hygiene
Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems (e.g. bad breath) by regular brushing of the teeth (dental hygiene) and cleaning between the teeth. It is important that oral hygiene be carried out ...
, (as
decalcification Bone decalcification is the softening of bones due to the removal of calcium ions, and can be performed as a histological technique to study bones and extract DNA. This process also occurs naturally during bone development and growth, and when uninh ...
, tooth decay or other complications may result. If a patient is unmotivated (insofar as treatment takes several months and requires commitment to oral hygiene), or if malocclusions are mild.
Biology of tooth movement and how advances in gene therapy and molecular biology technology may shape the future of orthodontic treatment.
Braces
Braces are usually placed on the front side of the teeth, but they may also be placed on the side facing the tongue (called
lingual braces Lingual braces are one of the many types of the fixed orthodontic treatment appliances available to patients needing orthodontics. They involve attaching the orthodontic brackets on the inner (lingual vs. buccal) sides of the teeth. The main advant ...
). Brackets made out of
stainless steel
Stainless steel is an alloy of iron that is resistant to rusting and corrosion. It contains at least 11% chromium and may contain elements such as carbon, other nonmetals and metals to obtain other desired properties. Stainless steel's corros ...
or
porcelain
Porcelain () is a ceramic material made by heating substances, generally including materials such as kaolinite, in a kiln to temperatures between . The strength and translucence of porcelain, relative to other types of pottery, arises mainl ...
are bonded to the center of the teeth using an
adhesive
Adhesive, also known as glue, cement, mucilage, or paste, is any non-metallic substance applied to one or both surfaces of two separate items that binds them together and resists their separation.
The use of adhesives offers certain advant ...
.
Wires are placed in a slot in the brackets which allows for controlled movement in all three dimensions.
Apart from wires, forces can be applied using
elastic bands, and springs may be used to push teeth apart or to close a gap. Several teeth may be tied together with ligatures and different kinds of hooks can be placed to allow for connecting an elastic band.
Clear aligners
Clear aligners are orthodontic devices that are a transparent, plastic form of dental braces used to adjust teeth.
Clear aligners have undergone changes, making assessment of effectiveness difficult. A 2014 systematic review concluded that publi ...
are an alternative to braces, but insufficient evidence exists to determine their effectiveness.
Treatment Duration
The time required for braces varies from person to person as it depends on the severity of the problem, the amount of room available, the distance the teeth must travel, the health of the teeth, gums, and supporting bone, and how closely the patient follows instructions. On average, however, once the braces are put on, they usually remain in place for one to three years. After braces are removed, most patients will need to wear a retainer all the time for the first six months, then only during sleep for many years.
Headgear
Orthodontic headgear—sometimes referred to as an "extra-oral appliance"—is a treatment approach that requires the patient to have a device strapped onto his or her head to help correct malocclusion—typically used when the teeth do not align properly. Headgear is most often used along with braces or other orthodontic appliances. While braces correct the position of teeth, orthodontic headgear—which as the name suggests is worn on or is strapped onto the patient's head—is most often added to orthodontic treatment to help alter the alignment of the jaw, although there are some situations in which such an appliance can help move teeth, particularly molars.
Whatever the purpose, orthodontic headgear works by exerting tension on the braces via hooks, a facebow, coils, elastic bands, metal orthodontic bands, and other attachable appliances directly into the patient's mouth. It is most effective for children and teenagers because their jaws are still developing and can be easily manipulated. (If an adult is fitted with headgear, it is usually to help correct the position of teeth that have shifted after other teeth have been extracted.) Thus
Headgear is typically used to treat a number of jaw alignment or bite problems such as
overbite
Overbite is the extent of vertical ( superior-inferior) overlap of the maxillary central incisors over the mandibular central incisors, measured relative to the incisal ridges.
The term overbite does not refer to a specific condition, nor i ...
and underbite.
Palatal expansion
Palatal expansion
A palatal expander is a device in the field of orthodontics which is used to widen the upper jaw (maxilla) so that the bottom and upper teeth will fit together better. This is a common orthodontic procedure. Although the use of an expander is mo ...
can be best achieved using a fixed tissue born appliance. Removable appliances can push teeth outwards but is less effective at maxillary sutural expansion. The effects of a removable expander may look the same as they push teeth outwards but should not be confused with actually expanding the palate. Proper palate expansion can create more space for teeth as well as improve both oral and nasal airflow.
itation needed
Jaw surgery
Jaw surgery
Orthognathic surgery (), also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusi ...
may be required to fix severe malocclusions. The bone is broken during surgery and is stabilized with titanium (or
bioresorbable) plates and screws to allow for healing to take place. After surgery, regular orthodontic treatment is used to move the teeth into their final position.
During treatment
To reduce pain during the orthodontic treatment, low-level laser therapy (LLLT), vibratory devices, chewing adjuncts, brainwave music, or cognitive behavioral therapy can be used. However, the supporting evidence is of low quality, and the results are inconclusive.
Post treatment
After orthodontic treatment has completed, there is a tendency for teeth to return, or relapse, back to their pre-treatment positions. Over 50% of patients have some reversion to pre-treatment positions within 10 years following treatment.
To prevent relapse, the majority of patients will be offered a
retainer
Retainer may refer to:
* Retainer (orthodontics), devices for teeth
* RFA ''Retainer'' (A329), a ship
* Retainers in early China, a social group in early China
Employment
* Retainer agreement, a contract in which an employer pays in advance for w ...
once treatment has completed and will benefit from wearing their retainers. Retainers can be either fixed or removable.
Removable retainers
Removable retainers are made from a clear plastic, and they are custom-fitted for the patient's mouth. It has a tight fit and holds all of the teeth in position. There are many types of brands for clear retainers including Zendura Retainer,
Essix Retainer, and Vivera Retainer.
Hawley retainer
Orthodontic retainers are custom-made devices, usually made of wires or clear plastic, that hold teeth in position after surgery or any method of realigning teeth. Once a phase of orthodontic treatment has been completed to straighten teeth, the ...
is also a removable orthodontic appliance made from a combination of plastic and metal that is molded custom to fit the patient's mouth. Removable retainers will be worn for different periods of time depending on patient need to stabilise the dentition.
Fixed retainers
Fixed retainers are a simple wire fixed to the tongue-facing part of the
incisor
Incisors (from Latin ''incidere'', "to cut") are the front teeth present in most mammals. They are located in the premaxilla above and on the mandible below. Humans have a total of eight (two on each side, top and bottom). Opossums have 18, wher ...
s using dental adhesive and can be specifically useful to prevent rotation in incisors. Other types of fixed retainers can include labial or lingual braces, with brackets fixed to the teeth.
File:Hyrax rapid palatal expander.png, Palatal expander
A palatal expander is a device in the field of orthodontics which is used to widen the upper jaw (maxilla) so that the bottom and upper teeth will fit together better. This is a common orthodontic procedure. Although the use of an expander is mo ...
File:Full orthodontic headgear with headcap and fitting straps.jpg, Orthodontic headgear
Orthodontic headgear is a type of orthodontic appliance typically attached to the patient's head with a strap or number of straps around the patient’s head or neck. From this, a force is transferred to the mouth/jaw(s) of the subject.
Headgear ...
File:Cephalometric radiograph.JPG, An X-ray
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...
taken for skull analysis
File:Retainer.jpg, Top (left) and bottom retainers
Retainer may refer to:
* Retainer (orthodontics), devices for teeth
* RFA ''Retainer'' (A329), a ship
* Retainers in early China, a social group in early China
Employment
* Retainer agreement, a contract in which an employer pays in advance for w ...
Clear Aligners (Invisalign)
Invisalign is another form of orthodontics that is commonly used today. Many patients do not like the appearance of traditional metal braces, so they opt for clear removable aligners. There was a lot of controversy about the effectiveness of Invisalign, but with years of advancements, Invisalign's results can now be closely compared to traditional braces but with a lot more freedom and faster results.
Process
After booking an appointment with a dentist, the patient sets up a consultation. During the consultation the dentist or the dental assistant will scan the individual's teeth with a machine called iTero. The iTero machine digitally scans the structure of the teeth and gums. The dentist is able to see a 3D model of the patient's teeth on the screen. Unlike traditional braces, with Invisalign one is able to see the entire process from start to finish during consultation. Being that aligners are used, there is a lot of flexibility in fixing the smile. The dentist is able to make any changes that one wants to their treatment.
Traditional braces require metal brackets; with Invisalign, depending on the case, a patient will have "attachments" on the teeth. They are clear little buttons that help move teeth. Also, depending on the case, an individual might need interproximal reduction, also known as IPR. The dentist will take a little tool and "shave" off in-between the teeth, to help with overcrowded teeth. The reduction is very minimal, at most 0.3mm.
Once the individual receives their aligners, they will have to wear them every day for 20–22 hours. One is supposed to remove them when eating and drinking. Unlike traditional metal braces, the person is able to eat anything when the aligners are removed; there are no restrictions.
After the treatment is complete, the individual will have to wear clear removable retainers.
Training
There are several
specialty areas in dentistry, but the specialty of orthodontics was the first to be recognized within dentistry.
Specifically, the
American Dental Association recognized orthodontics as a specialty in the 1950s.
Each country has their own system for training and registering orthodontic specialists. It is an effective and efficient alternative to fixed appliance procedures with brackets for the effective and efficient treatment of all dentoalveolar malocclusions, as well as a viable orthodontic therapy for preparation prior to Orthognathic Surgery.
Australia
In
Australia
Australia, officially the Commonwealth of Australia, is a Sovereign state, sovereign country comprising the mainland of the Australia (continent), Australian continent, the island of Tasmania, and numerous List of islands of Australia, sma ...
, to obtain an accredited three-year full-time university degree in orthodontics, one will need to be a qualified dentist (complete an AHPRA registered general dental degree) with a minimum of two years of clinical experience. There are several universities in Australia that offer orthodontic programs:
University of Adelaide
The University of Adelaide (informally Adelaide University) is a public research university located in Adelaide, South Australia. Established in 1874, it is the third-oldest university in Australia. The university's main campus is located on N ...
,
University of Melbourne
The University of Melbourne is a public research university located in Melbourne, Australia. Founded in 1853, it is Australia's second oldest university and the oldest in Victoria. Its main campus is located in Parkville, an inner suburb nor ...
,
University of Sydney
The University of Sydney (USYD), also known as Sydney University, or informally Sydney Uni, is a public research university located in Sydney, Australia. Founded in 1850, it is the oldest university in Australia and is one of the country's si ...
,
University of Queensland
, mottoeng = By means of knowledge and hard work
, established =
, endowment = A$224.3 million
, budget = A$2.1 billion
, type = Public research university
, chancellor = Peter Varghese
, vice_chancellor = Deborah Terry
, city = B ...
,
University of Western Australia
The University of Western Australia (UWA) is a public research university in the Australian state of Western Australia. The university's main campus is in Perth, the state capital, with a secondary campus in Albany, Western Australia, Albany an ...
,
University of Otago
, image_name = University of Otago Registry Building2.jpg
, image_size =
, caption = University clock tower
, motto = la, Sapere aude
, mottoeng = Dare to be wise
, established = 1869; 152 years ago
, type = Public research collegiate u ...
. Orthodontic Courses are accredited by the Australian Dental Council and reviewed by the
Australian Society of Orthodontists
Australian(s) may refer to:
Australia
* Australia, a country
* Australians, citizens of the Commonwealth of Australia
** European Australians
** Anglo-Celtic Australians, Australians descended principally from British colonists
** Aboriginal Au ...
(ASO). Prospective applicants should obtain information from the relevant institution before applying for admission. After completing a degree in orthodontics, specialists are required to be registered with the
Australian Health Practitioner Regulation Agency
The Australian Health Practitioner Regulation Agency (AHPRA), infrequently spelt as the Australian Health Practitioners Regulation Agency is a statutory authority founded in 2010 which is responsible, in collaboration with the ''Medical Board of ...
(AHPRA) in order to practice.
Bangladesh
Dhaka Dental College in
Bangladesh
Bangladesh (}, ), officially the People's Republic of Bangladesh, is a country in South Asia. It is the eighth-most populous country in the world, with a population exceeding 165 million people in an area of . Bangladesh is among the mos ...
is one of the many schools recognized by the Bangladesh Medical and Dental Council (BM&DC) that offer post-graduation orthodontic courses.
Before applying to any post-graduation training courses, an applicant must have completed the Bachelor of Dental Surgery (BDS) examination from any dental college.
After application, the applicant must take an admissions test held by the specific college.
When successful, selected candidates undergo training for six months.
Canada
In
Canada
Canada is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by tot ...
, obtaining a dental degree, such as a Doctor of Dental Surgery (DDS) or Doctor of Medical Dentistry (DMD), would be required before being accepted by a school for orthodontic training.
Currently, there are 10 schools in the country offering the orthodontic specialty.
Candidates should contact the individual school directly to obtain the most recent pre-requisites before entry.
The Canadian Dental Association expects orthodontists to complete at least two years of post-doctoral, specialty training in orthodontics in an accredited program, after graduating from their dental degree.
Pakistan
In
Pakistan
Pakistan ( ur, ), officially the Islamic Republic of Pakistan ( ur, , label=none), is a country in South Asia. It is the world's List of countries and dependencies by population, fifth-most populous country, with a population of almost 24 ...
to be enrolled as a student or resident in a postgraduation orthodontic course approved by
Pakistan Medical and Dental Council
Pakistan Medical Commission is a statutory regulatory authority that maintains the official register of medical practitioners in Pakistan. Its chief function is to establish uniform minimum standards of basic and higher qualifications in medici ...
, the dentist must graduate with a Bachelor of Dental Surgery (BDS) or equivalent degree. Pakistan Medical & Dental Council (PMDC) has a recognized program in Orthodontics as Master in Dental Surgery (MDS) orthodontics and FCPS orthodontics as 4 years post-graduate degree programs, the latter of which is conducted by CPSP Pakistan.
United States
Similar to Canada, there are several colleges and universities in the
United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
that offer orthodontic programs. Every school has a different enrollment process, but every applicant is required to have graduated with a DDS or DMD from an accredited dental school. Entrance into an accredited orthodontics program is extremely competitive, and begins by passing a national or state licensing exam.
The program generally lasts for two to three years, and by the final year, graduates are to complete the written American Board of Orthodontics (ABO) exam.
This exam is also broken down into two components: a written exam and a clinical exam.
The written exam is a comprehensive exam that tests for the applicant's knowledge of basic sciences and clinical concepts.
The clinical exam, however, consists of a Board Case Oral Examination (BCOE), a Case Report Examination (CRE), and a Case Report Oral Examination (CROE).
Once certified, certification must then be renewed every ten years.
Orthodontic programs can award the Master of Science degree, Doctor of Science degree, or Doctor of Philosophy degree depending on the school and individual research requirements.
[Orthodontics Instruments https://esurgerytool.com/]
United Kingdom
Throughout the
United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and North ...
, there are several Orthodontic Specialty Training Registrar posts available.
[https://www.bos.org.uk/Portals/0/Public/docs/Careers/guidelines-on-orthodontic-specialty-training.pdf "Orthodontic Specialty Training in the UK" (PDF). British Orthodontic Society. British Orthodontic Society. Retrieved 28 October 2017.] The program is full-time for three years, and upon completion, trainees graduate with a degree at the Masters or Doctorate level.
Training may take place within hospital departments that are linked to recognized dental schools.
Obtaining a Certificate of Completion of Specialty Training (CCST) allows an orthodontic specialist to be registered under the General Dental Council (GDC).
An orthodontic specialist can provide care within a primary care setting, but to work at a hospital as an orthodontic consultant, higher-level training is further required as a post-CCST trainee.
To work within a university setting, as an academic consultant, completing research toward obtaining a Ph.D. is also required.
See also
*
Orthodontic technology
Orthodontic technology is a specialty of dental technology that is concerned with the design and fabrication of dental appliances for the treatment of malocclusions, which may be a result of tooth irregularity, disproportionate jaw relationships ...
*
Orthodontic indices
*
List of orthodontic functional appliances
This is a comprehensive list of functional appliances that are used in the field of orthodontics. The functional appliances can be divided into fixed and removable. The fixed functional appliances have to be bonded to the teeth by an orthodontist. ...
*
Molar distalization Molar distalization is a process in the field of Orthodontics which is used to move molar teeth, especially permanent first molars, distally (backwards) in an arch. This procedure is often used in treatment of patients who have Class 2 malocclusi ...
*
Mouth breathing
Mouth breathing, medically known as chronic oral ventilation, is long-term breathing through the mouth. It often is caused by an obstruction to breathing through the nose, the innate breathing organ in the human body. Chronic mouth breathing ma ...
*
Obligate nasal breathing
Obligate nasal breathing describes a physiological necessity to breathe through the nose (or other forms of external nares, depending on the species) as opposed to breathing through the mouth.
Definition
The term may be misleading, as it implie ...
Orthodontic Tooth Movement: Gene Therapy and Molecular Biology Aspect
Notes
References
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