What is orthodontics?
Orthodontics is a dental specialty that studies, prevents and treats all dental and facial development alterations and the dental arches and the position of the jaw, , in order to restore the morphological and functional balance of the mouth and face, also improving facial aesthetics.
ORTHODONTICS; MORE THAN MOVING TEETH
Orthodontics faces problems that go far beyond the individual and detailed placement of dental pieces, and faces the correction of jaw alterations and, above all, of the functional disorders of mastication.
At birth, jaws are separated. There is no adjustment relationship between them, as the occlusion has not yet developed. The dental eruption, that is, the appearance of teeth through the gums, begins at different ages and may have a variable sequence, as we have seen. As the temporary teeth erupt, the maxillary bones also develop vertically.
When the first baby molars emerge in the back, there comes a time when the superiors meet the lower teeth, and they come into contact – making a “gear adjustment” that did not exist before: Occlusion has been achieved. The Mixed Dentition begins around 6 years old with the eruption of the first upper and lower permanent molars.
After some years, these permanent molars, when they contact with each other, like they had done before. The eruption of these first permanent molars is of great importance, because, in addition to being permanent pieces, they serve as a guide for the correct placement of each one of the other teeth still to come out. Therefore, its protection and proper conservation is essential, as can be deduced from the illustrations. Temporary molars and canines save the space that, later, will occupy the permanent canines and premolars.
Given that the size of the deciduous teeth is wider than that of the permanent ones yet to sprout, this difference provides a space that must be conserved, which is essential for most treatments. Hence the importance (and the need) to keep healthy the first definitive molars that erupt at approximately at 6 years old!
CLASSIFICATION OF OCCLUSION
In modern orthodontics, it is not enough to assess malocclusions based only on a classification of dental relationships. You must dig deeper to find out the nature of the malocclusion. We will see some examples among the many variables.
CLASS I or as we call it, a normal jaw relationship.
- Malocclusion in which both jaws are in correct relation. The problem centers on the advanced position of the dental pieces (with or without crowding) respecting their bony bases. This case, sometimes, requires extractions for correction.
CLASS II We designate those who have a relationship that cause prognathism of the upper jaw, with or without delayed position of the jaw.
- This malocclusion has the maxillary dental structures (with crowding or not) advanced respecting the maxillary bone base. Its treatment is simpler, even though it may need extractions. They would be avoided with the early treatment of the case.
CLASS III are those malocclusions characterized by a situation of mandibular predominance, in relation to a situation of delayed upper jaw. They represent 5% of all malocclusions.
- Malocclusion is characterized by a normal relationship of bone bases, but with the lower dental structures forward respecting the mandibular bone base. The patient usually needs extractions for his treatment. As it can be seen, the diagnosis in modern orthodontics is much more complex than one might think.
Orthodontic treatments can be INTERCEPTIVE or CORRECTIVE. The first one tries to avoid major alterations, while the latter reaches definitive results.
It usually starts and ends during temporary or mixed dentition. They do not rule out the possibility of a later correction, before the appearance of another similar or different anomaly. This type of treatment is used regularly to correct abnormal habits, which can interfere with the regular growth pattern of the face and jaws. Some malocclusions that appear from habits such as thumb sucking can correct themselves when the habit ceases.
Unfortunately, on many other occasions, malocclusions that require orthodontic treatment occur, even if it is with simple devices. The interceptive treatments are oriented, therefore, to the correction of any incipient alteration, given that, if no measures are taken, the malocclusion would get worse. The orthodontist has been trained in growth and development to accurately determine the complexity of the situation.
When the interceptive treatment has not been performed, or has not been successful due to the nature of the malocclusion, then corrective treatment is necessary. In this case, aimed at correcting a consolidated malocclusion. For the corrective treatments, two types of devices are mainly used:
• Functional devices
• Removable appliances
It is advisable to start these treatments around 10 or 12 years old. Approximately they last between one year and half and three years, and usually they conclude when the permanent dentition has been completed, except for the third molars. Referring to an ideal age to begin corrective treatments, does not mean that they cannot start later in adolescence, or in adulthood.
But, depending on the age, orthodontic treatments will have different objectives and results. Although the importance of early or adolescent treatment is emphasized, more and more adult irregularities are being treated successfully. Treatments in adult patients are usually carried out also in collaboration with the general dentist and other specialist dentists.
There is no reason for an adult to give up considering the possibility of orthodontic treatment at a time of advanced techniques and with a social environment that is giving great importance to personal presence. However, we must be aware that orthodontic treatments have limitations, of which we must be aware, and that they must be identified and compensated in the most effective way. It is in this context and for the last reasons that it is said that in Orthodontics each case is a different case and, practically, it has no equal. Hence the individualized concept that must apply to each corrective treatment.
In cases of extreme deformity, it is necessary to combine orthodontics with surgery. The orthodontist will then recommend a buccal or maxillofacial surgeon to jointly develop the appropriate treatment plan. When the need for corrective treatment becomes evident, it is important to select an orthodontist. The general dentist will suggest the one who believes more qualified, and whose technique and results warrant a guarantee.