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FIXED APPLIANCE MBT


FIXED APPLIANCE MBT

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FIXED APPLIANCE MBT


FIXED APPLIANCE MBT

MBT system

This system is the most commonly used straight wire bracket system because of its better control of tooth movements and ease of treatment. This system allows for better finish than the Begg’s system. 

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FUNCTIONAL APPLIANCE


FUNCTIONAL APPLIANCES

FUNCTIONAL APPLIANCE


FUNCTIONAL APPLIANCES

Functional appliances

A functional appliance is an appliance that helps to correct jaw deformities in growing individuals. These appliances use the forces of the muscles to control and redirect the growth and hence are also known as ‘Myofunctional Appliances’. These appliances work only if the patient is still growing and they do not work if the growth is completed in the patient.

Removable functional appliances:

These are most commonly used functional appliances. These are used when the patient is in earlier stages of growth. They can be used to improve the growth in the jaws where the growth is deficient or control and limit the growth in over developed jaws. They can also be used to redirect the direction of growth of the jaws.

The most commonly used removable functional appliances are

1)    Twin block

2)    Frankel functional regulator appliance

3)    Activator

4)    Bionator

The functional appliances help to correct only the skeletal problems and the patient may require a follow up with fixed appliances to treat the malocclusion in the dentition. These appliances are worn by the patient for a particular number of hours daily as advised by the orthodontist depending on the type of appliance.  The duration of the entire functional appliance treatment lasts for 8 months to 1 year and is follower by fixed appliance therapy.

Fixed functional appliances:

These are functional appliances that are given when the patient is at the later stages of growth. These appliances are fixed and cannot be removed by the patient. Most of these appliances are given along with fixed braces in place. Like the removable functional appliances, they help in altering the growth of the jaws although to a lesser extent than the removable functional appliance, since these appliances are given at the end stages of growth. There are a wide variety of fixed functional appliances available; some among them are Forsus, Herbst appliance, Jasper Jumper, Power-scope etc.

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CERAMIC BRACKETS


CERAMIC BRACKETS

CERAMIC BRACKETS


CERAMIC BRACKETS

Ceramic braces

Ceramic braces can be a beautiful alternative to metal braces. Ceramic braces are the same size and shape as metal braces, except that they have tooth-coloured or clear brackets that blend in to teeth.Tooth coloured wires can be used with these braces for better aestheticsas they become less noticeable. The main edge of ceramic braces is their aesthetic and cosmetic appeal. 

Benefits of Ceramic Braces

  • Ceramic braces are available as semi-translucent ceramic brackets, which are better for very white teeth, or tooth-coloured ceramic, which is better for slightly darker teeth. Either way, they blend in well.
  • Ceramic braces are strong, especially if they are high-quality. They usually don’t chip or break unless they are badly abused.

Drawbacks of Ceramic Braces

  • Ceramic brackets are more expensive than metal brackets. They are also bigger, but they blend in with teeth so this isn’t an issue for most patients.
  • Like traditional metal braces, ceramic braces use clear or white ligatures to hold the archwire in place. The ligatures are little rubber bands, so they can stain because they’re porous. They’re changed at every adjustment. As an alternative self-ligating ceramic braces can be used which do not require ligatures and thus, are more aesthetic.
  • Metal wires are used, which will be visible, but this can be overcome bycoated wires which are tooth coloured and are thus less visible.
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SELF LIGATING BRACKETS


SELF LIGATING BRACKETS

SELF LIGATING BRACKETS


SELF LIGATING BRACKETS

Self-ligating brackets

Self-Ligating braces eliminate the need for elastic or metal ties, and instead use a permanently installed moveable component to entrap the wire. Self-Ligating braces offer a number of benefits compared to traditional braces. Self-ligating brackets produce lower friction compared with conventional brackets. Through elimination of the ligature ties, these braces reduce the friction and allow free movement of the teeth with less force. As a result, the treatment is quicker and also more comfortable than the conventional braces. They also require less chair side time during appointments for changing the wire. They are also more hygienic as the amount of food deposits on the teeth is less when using self-ligating brackets than conventional braces. The self-ligating brackets are available as metal self-ligating brackets and ceramic self-ligating braces. The ceramic self-ligating brackets offer better aesthetics as they are tooth coloured and also eliminate the need for ligature ties.

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LINGUAL BRACES


LINGUAL BRACKETS

LINGUAL BRACES


LINGUAL BRACKETS

Lingual orthodontics:

Lingual braces (also known as invisible braces) are attached to the inside surfaces of the teeth that face the tongue. There they are practically invisible from the outside, even up-close.

Advantages:

They are places in the inner surface of the teeth which face the tongue, hence are not visible.

They are more efficient than the clear aligner systems for complex tooth movement.

They are more efficient than traditional labial braces in bringing about certain types of tooth movement as a result of their biomechanics.

They require thinner wireswhen compared to traditional labial braces.

Disadvantages:

They are not comfortable as other bracket systems as they constantly in contact with the tongue. It would take quite some time for you to get used to the braces.

The brackets and wires will feel a little rough initially and they may affect your speech for a while.

Lingual braces are also more difficult to keep clean.

Invisible braces may not be possible for patients with short crowns.

The appointments would be more time consuming as the orthodontist has to work in braces that a place lingually.

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CLEAR ALIGNERS


CLEAR ALIGNERS

CLEAR ALIGNERS


CLEAR ALIGNERS

Clear aligners

These are an alternative to traditional braces treatment. This treatment modality offers the best aesthetics during treatment as it involves the use of a series custom made trays that are transparent and can be worn by the patient without anyone noticing them. They act similar to braces and bring about gradual tooth movement by applying forces with the use of metal brackets or wires. Each aligner is worn for three weeks and then followed by the next aligner in the series. Every aligner is designed to bring about a certain degree of tooth movement which is increased by wearing of the subsequent aligner. The aligners are worn for a minimum of 20 hours a day and the duration of treatment varies depending on the degree of malocclusion. They should be removed while eating and should be worn again after eating. 

The significant advantages of clear aligners are

They are removable- hence easy to brush and better oral hygiene.

They are easy to clean and maintain

They are comfortable and do not irritate the gums and cheeks.

They can transparent and hence invisible when worn.

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TEMPORARY ANCHORAGE DEVICES


TEMPORARY ANCHORAGE DEVICE

TEMPORARY ANCHORAGE DEVICES


TEMPORARY ANCHORAGE DEVICE

TAD’s :

Orthodontics deals with moving the teeth into their proper positions. You cannot omit the fact that there will be resistance offered by the teeth to this movement. In some cases these resistances can greatly affect the results of the treatment leading to movement of teeth which were not intended to be moved. To overcome this problem, temporary anchorage devices or TAD’s are used.

Temporary Anchorage Devices (TADs) are devices which are temporarily implanted to the bone in order to enhance orthodontic anchorage by supporting the teeth of the reactive unit. TADs are subsequently removed after the orthodontic treatment. As temporary anchorage devices are fixed to the bone either biochemically or mechanically, TADs can be located subperiosteally, transosteally, or endosteally.

Temporary anchorage devices are known my many names among which are mini-screws, mini-implants, and micro-implants. They are about the size of a small screw (6 to 10 mm long).

 They are made out of biologically inert materials that will not corrode in the mouth or be rejected by the body. They are designed to hold fast in bone and be compatible with the soft tissue through which they pass.

The placement process is very simple. A topical and a very small dose of anaesthetic are placed into the area of soft tissue overlying where the TAD will be placed. The soft tissue is the only part of the mouth that can feel anything as bone itself feels no pain. Since the gums become numb when the local anaesthetic is administered, the procedure will be completely painless. Insertion takes less than a minute.

After a TAD is in place, it provides an immovable object that can be used to push, pull, lift, or intrude teeth that are being straightened. The removal of a TAD is even easier than its insertion. Because the implant is being removed, there is already a breach of the soft tissue and there will be no pain associated with just unscrewing it.

Since TAD’s don’t move, they can be used to move teeth in directions and amounts that previously were not possible. 

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ORTHOGNATHIC SURGERY


ORTHOGNATHIC SURGERY

ORTHOGNATHIC SURGERY


ORTHOGNATHIC SURGERY

Orthognathic surgery:

The term orthognathic comes from the Greek words “orthos” meaning straighten and “gnathic” meaning of or related to the jaw, hence the term orthognathic, meaning “straighten the jaw”. Orthognathic surgery is surgery to correct conditions of the jaw and face related to structure, growth, sleep apnea, TMJ disorders, malocclusion problems owing to skeletal disharmonies, or other orthodontic problems that cannot be easily treated with braces.

Orthognathic surgery can be used to correct;

·         Gross jaw discrepancies (anteroposterior, vertical, or transverse discrepancies)

·   Facial skeletal discrepancies associated with documented sleep apnea, airway defects, and soft tissue discrepancies

As our jaws mature through the course of normal growth and development, it is possible for the growth of the jaws to cease without growing completely or over grow than the normal size leaving a disharmony of function and aesthetics.

Orthognathic surgery helps to correct these jaw deformities. The procedure is an interdisciplinary as it requires the services of an orthodontist and an Oral Surgeon.

First the orthodontist plans the treatment and aligns the teeth in the jaws and makes it best suited to undergo the surgical procedure.

The Oral surgeon does the required surgical procedure which is either advancement or reduction of the jaws in both the anteroposterior and vertical planes.

This is then followed up by the orthodontist who does the final finishing of the case.

This procedure brings a transformation to how the patient looks and helps to also boost the self-confidence of the patient by improving his/her personal appearance.

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CLEFT CORRECTION


CLEFT LIP AND PALATE CORRECTION

CLEFT CORRECTION


CLEFT LIP AND PALATE CORRECTION

Cleft lip and palate:

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside the mother.

Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly.This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).Cleft lip and cleft palate can occur on one or both sides of the mouth.

The occurrence of clefts, are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.Another potential cause may be related to a medication a mother may have taken during her pregnancy.Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the foetus is developing in the womb.

Problems associated with cleft lip and palate:

  • Eating problems: With a separation or opening in the palate, food and liquids can pass from the mouth back through the nose.
  • Ear infections/hearing loss: Children with cleft palate are at increased risk of ear infections since they are more prone to fluid build-up in the middle ear. If left untreated, ear infections can cause hearing loss.
  • Speech problems: Children with cleft lip or cleft palate may also have trouble speaking. The voice may take on a nasal sound, and the speech may be difficult to understand
  • Dental Problems: Children with cleft palate often have an alveolar ridge defect. A defect in the alveolus can cause improper positioning of teeth, alveolar bone from forming and also can prevent eruption of permanent teeth.

Treatment of cleft lip and palate:

The treatment of cleft palate involves a multidisciplinary approach.  The members of a cleft lip and palate team typically include:

  • Plastic surgeon to evaluate and perform necessary surgeries on the lip and/or palate
  • An otolaryngologist (an ear, nose, and throat doctor) to evaluate hearing problems and consider treatment options for hearing problems
  • An oral surgeon to reposition segments of the upper jaw when needed, to improve function and appearance and to repair the cleft of the gum
  • An orthodontist to straighten and reposition teeth
  • A dentist to perform routine dental care
  • A prosthodontist to make artificial teeth and dental appliances to improve the appearance and to meet functional requirements for eating and speaking
  • A speech therapist to work with the child to improve speech
  • An audiologist (a specialist in communication disorders stemming from a hearing impairment); to assess and monitor hearing

The health care team works together to develop a plan of care to meet the individual needs of each patient. Treatment usually begins in infancy and often continues through early adulthood.

 

·        Surgical care:

A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old.

Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The first surgery to repair the palate usually occurs when the baby is between 6 and 12 months old. Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with  cleft palate require further surgeries to help improve their speech.Once the permanent teeth grow in, braces are often needed to straighten the teeth.Additional surgeries may be performed to improve the appearance of the lip and nose.

  • Orthodontic care

  • A first orthodontic appointment may be scheduled before the child has any teeth. The purpose of this appointment is to assess facial growth, especially jaw development. After teeth erupt, an orthodontist can further assess a child's short and long-term dental needs. After the permanent teeth erupt, orthodontic treatment can be applied to align the teeth.
  • Prosthodontic care:

  •  A prosthodontist is a member of the cleft palate team. He or she may make a dental bridge to replace missing teeth or make special appliances called "speech bulbs" or "palatal lifts" to help close the nose from the mouth so that speech sounds more normal. The prosthodontist coordinates treatment with the oral or plastic surgeon and with the speech pathologist.
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BEGG'S APPLIANCE


BEGG'S APPLIANCE

BEGG'S APPLIANCE


BEGG'S APPLIANCE

Begg’s appliance:

This was the early fixed braces systems that came to existence. It was developed by Dr.Raymond Begg. The appliance used light forces with the help of round thin wires to move teeth.  Begg’s bracket design allowed teeth to freely tip mesially and distally as well as lingually and labially. The appliance works by tipping the teeth to the desired position and then followed by uprighting of the tooth. This type of braces is less used frequently with the advent of the straight wire system.

Advantages:

Light elastic forces are used to move teeth.

Rapid tooth movement the bracket design allows for free movement of the teeth.

All anchorage requirements can be established intra-orally without headgear, without the need for any ancillary appliances.

Less costly than other appliance systems.

Disadvantages:

The system requires the use of auxiliaries such as torqueing auxiliaries and uprighting springs, which increase chair side time at appointments.

Since the teeth are free to move, there is a chance that the tooth would tip more than what is required.

Uprighting the tooth and establishing the required torque is a challenging process.