Orthodontics is an aesthetic dental treatment that aims to restore the morphological and functional balance of the mouth and face. Orthodontics not only serves to straighten and align teeth, but is also used to prevent and correct developmental disorders, the face, the position of the jaws, the shape of the arches and, above all, functional chewing disorders.

The objective of orthodontic treatment is to achieve normality for each patient. Orthodontics seeks to create a functional and aesthetic balance by adjusting the teeth and jaws of each patient to their growth and development pattern in a natural way.

At what age should braces be put on?

Although it is usually associated with adolescence, there is no fixed age for orthodontic treatment. It will depend on the type of problem, when it appears and how serious it is. What is important is to have orthodontic check-ups for children in order to monitor their dental health and to be able to carry out preventive treatments that avoid more serious problems in the future.

It is recommended that the first check-up by the orthodontist be done at approximately six years of age, since it is at that age that the first permanent molars erupt. At that time, the orthodontic specialist must ensure that later, when the second permanent molars erupt, all the teeth will fit exactly where and how they should.

A child completes his or her permanent teeth between the ages of twelve and fourteen (with the exception of the “wisdom teeth”), although for different reasons and circumstances, the eruption of the permanent teeth may vary. Although these advances and delays should not be a cause for concern, it is recommended to also consult with the orthodontist to prevent possible future problems.

Malocclusion: classification

A malocclusion is an anomaly or deformity of the teeth and/or jaw bones. In orthodontics, malocclusions must be assessed based on the relationships between the teeth and the nature of the deformity.

Malocclusions can be classified according to the type of relationship between the jaws and the teeth. Each type of malocclusion requires a different treatment, which can be more or less complex depending on whether the problem is only in the dental structure or also in the jaws. An orthodontic diagnosis can be very complex, which is why it is very important that orthodontic treatments are carried out by a specialized orthodontist.

The following image shows some of the types of occlusion in relation to the position of the jaws and teeth:

Treatments

In orthodontics there are two types of treatments:

1. Interceptive treatments: Aimed at correcting incipient alterations, that is, to correct abnormal habits that may interfere with the regular growth pattern of the face and jaws, such as thumb sucking. These treatments are normally performed during the milk or mixed dentition.

2. Corrective treatments: Aimed at correcting consolidated malocclusions. Although it is advisable to begin these treatments between the ages of 10 and 12, more and more cases are being treated in adults.

Devices for corrective treatments

To carry out a corrective treatment, the most common is to use one of these three types of devices:

1. Functional devices:

These are those that, as their name indicates, make changes in the functionality of the system, correcting dental or maxillary displacements. They are orthopedic appliances that the patient can remove and that are used during temporary or mixed dentition.

Within orthopedic orthodontics, in addition to functional appliances, there are other types of appliances, extraoral appliances, which are used when it is necessary to direct the growth of the face and jaws with forces that cannot be achieved with other types of appliances. These are the extraoral anchorage and the chin guard. For them to be effective, it is necessary to use them the number of hours per day indicated by the orthodontist.

2. Removable appliances:

They are devices that, although the patient can remove them, are attached to the teeth, applying controlled pressure on the teeth to move them. They are mainly used for the expansion of the jaws, the correction of crossbites and in some cases of crowding and tooth movement.

3. Fixed appliances or brackets:

In terms of quality, they are the best option since they allow all kinds of movements for orthodontic correction. They are the only ones that can move each of the teeth, individually, in any direction. Although they are commonly called brackets, they are still one of the elements that make up this type of device.

Fixed appliances or brackets

A fixed appliance is made up of brackets, which are cemented onto each tooth and connected with ligatures to a wire arch. The position of the bracket and the shape of the arch are controlled by the orthodontist, so that controlled pressure is applied to each tooth to bring it to the desired position. Sometimes it is necessary to use intermaxillary elastics or rubber bands to perform tooth movement or move the jaws. The brackets can be metal or ceramic.

Ceramic or aesthetic brackets are the color of tooth enamel, which makes the orthodontic treatment more imperceptible.

Corrections made by fixed appliances

• Dental malposition: in horizontal or vertical displacements of teeth, when the crown or root of the tooth is displaced.
• Rotated teeth: this is the only type of device that can perform rotation movements. – Space closure: interdental spaces are closed by moving the entire tooth (crown and root) and placing it parallel to the adjacent teeth.
• Incisor relationship: they allow angular corrections to be made to the position of the incisors.
• Multiple movements: they allow the position of several teeth or groups of teeth to be controlled at the same time and in both jaws. They also allow all types of movements to be performed at the same time (rotation, inclination, apical) and the application of intermaxillary or extraoral forces.

The retention

Once treatment with fixed braces is finished, it is necessary to use retainers to prevent the teeth from returning to their previous position. With retainers, the teeth are kept in place until the jawbones and gums adapt to the change that has occurred in the mouth.

There are two types of retainer appliances: fixed and removable.

Fixed retainers are glued to the back of the teeth, so they are not visible. Since they are fixed, the patient cannot remove them, so they are the best option to use after finishing orthodontic treatment.

Removable retainers are splints (plastic plates) with the shape of the teeth. They are made from a mold of the mouth after removing fixed orthodontics. The orthodontist decides how long the patient should wear this type of retainer, although it is normal to put it on every night before sleeping, reducing its use over time.

If the patient stops using the retainer, it is possible that the teeth will end up moving over time, so it is advisable to use them for life.

Medical recommendation

Between the ages of six and twelve, the baby teeth are replaced by permanent teeth. It is important to visit an orthodontic specialist at this stage, as these are the ages when the most significant changes in the mouth occur and should be supervised by an orthodontist. Early treatment can prevent malocclusions (deformities in the bite).

Although the most common treatment is for aesthetic reasons, these are necessary to correct other cases such as a bad bite or overloading of the jaw joint.