Questions and answers

Why is it necessary to do an orthodontic treatment?
Although the fundamental reason why an orthodontic treatment is demanded is usually aesthetic, and although having a nice smile with well aligned teeth is associated with a positive status at all social levels, especially in this era in which the aesthetics is given a great value, there are other reasons to perform an orthodontic treatment, and they are all related to health.
For example, in case of dental crowding to avoid having less susceptibility to caries, in case of protruded teeth to avoid trauma, avoid aggravating periodontal problems, avoid digestive problems by not being able to perform a good chewing and swallowing in case of important maloclusions and so that joint or muscle problems are not generated or perpetuated in the temporomandibular joint.

At what age can orthodontic treatment be carried out?
The biological process involved in moving the teeth is the same for any age. Both children and adults can benefit from orthodontic treatments. It is recommended that all children receive an orthodontic evaluation when they are around seven years old. There are cases where a pre-orthodontic treatment should be done at these ages, and others where it is more convenient to start when all the permanent teeth are in the mouth (at 11 - 13 years).
As the bones of adults no longer grow, certain corrections sometimes cannot be made only by using orthodontic braces.

What´s a pre-orthodontic treatment?
It is a treatment that must be performed at an early age when certain problems are identified in the deciduous dentition, such as, for example, a crossbite or other occlusal problems that justify acting on them to prevent further future problems.
In these cases a tretment has to be performed to guide in the best way the biting. Once the eruption of the permanent teeth has completed, and in a second phase, conventional orthodontics would be done.

Is there any limitation for doing an orthodontic treatment?
Yes. Just as the implantologist needs a certain quantity and quality of bone, the orthodontist also needs adequate proportions of the maxillary bones in the three planes of space. The upper and lower jaw should have proportions within certain parameters. In orthodontics we not only have to look at the teeth. The bones where the roots settle are fundamental.

What happens if this proportions are not addecuate?
When these bone proportions are clearly out of the norm, the orthodontist can align the teeth but then cannot get a good bite. The orthodontist will not be able to perfectly mesh mandible and maxilla with each other. In these cases, to solve the problem adequately, a multidisciplinary treatment will be needed. Prior diagnosis of the orthodontist and combined treatment with the maxillofacial surgeon, the necessary orthognathic surgery will be performed in each case, with the aim of matching both jaws, giving the orthodontist the final adjustments to that occlusion.

Nowadays more orthodontic treatments for adults are demanded. Is there any contraindication?
Basically, the treatment is the same, although there may be more limitations, especially because there may be an absence of parts or more or less established periodontal disease, which implies the correction of periodontal disease. Also, additional treatments such as dental implants or fixed prostheses may be necessary so that the occlusal rehabilitation treatment, which is the ultimate goal of good orthodontics, is optimal.

Which is then the goal of an orthodontic treatment?
The most important thing is to get a correct occlusion. Contrary to what is generally demanded, in an orthodontic consultation aesthetics is not the fundamental objective for the orthodontist, but to achieve good functionality. In any case, if good occlusion is achieved, aesthetics generally go together. Let's find a good occlusion and we'll find a nice smile.

What are the causes of orthodontic problems?
An orthodontic problem is a "lack of adequate occlusion." Some examples of causes of this lack of occlusion can be missing teeth, having more teeth than normal, non-aligned jaws, or teeth that do not grow straight.
Most occlusal problems are inherited, although they can also be acquired. Acquired occlusion problems can be caused by accidents, early or late loss of baby teeth, or finger sucking for a long time.

How are orthodontic problems corrected?
First, pre-treatment annotations are made. These annotations are important tools for the orthodontist to make a safe diagnosis. They should include the patient's medical and dental history, a clinical examination, photographs, x-rays of the mouth and teeth, and a virtual mouth scan. This information will be used to decide the best treatment.
A treatment adapted to each case is always drawn up and the appropriate device or apparatus is prepared. There are many types of devices that can be used.
When the orthodontic appliance is placed, the "active treatment" phase begins. The appliances are adjusted periodically to ensure that the teeth move in the correct direction and efficiently.
The time required for orthodontic treatment varies for each person. An important factor for the duration of the treatment is how well the patient cooperates during the treatment, that is, if he/she follows all the instructions given by the orthodontist.

Are there orthodontic appliances that are less noticeable?
The orthodontic appliances of today are noticed, as a rule, much less than those of a few years ago. The brackets (the part of the device that holds the wires) are glued to the front of the tooth.
The wires are currently made of advanced materials that exert a constant pressure on the tooth, achieving a process of movement faster and more comfortable for patients.

How long does an orthodontic treatment take?
Although the average treatment time is 12-18 months, this varies for each patient. Other factors to consider are the seriousness of the problem, the health of the tooth, gums and bones, and how the patient follows the indications of the orthodontist.
Although orthodontic treatment requires a temporary commitment, most patients believe that the benefits outweigh the time invested.

How to brush teeth when wearing the orthodontic appliance?
Brushing will require a little more time and expertise because when wearing braces there are more nooks and crannies where dental plaque accumulates more easily.

Can orthodontics be placed if teeth are missing?
Yes, it is totally possible, but it makes the treatment more complex, either because of the difficulty in mounting the orthodontic apparatus in certain regions, or because of the difficulty of stabilizing some teeth to move others, the so-called orthodontic anchor. One of the solutions we have worked at the Pardiñas Dental Medical Clinic is precisely the use of skeletal anchors, especially miniplates, to control tooth movements and cancel out the side effects, making the mechanics more efficient compensating for the lack of some teeth. In addition, we have worked with high technology to perform simulations of the treatments in last generation software and to be able to define the positioning of some implants, even before starting the orthodontic treatment, what is known as Reverse Planning in Orthodontics.

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