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Specialist Dentistry in Chichester, West Sussex

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Orthodontics

Orthodontics aims to create an attractive smile and improve or maintain dental health. This is achieved with 'appliances' (braces) which correct the position of the teeth and the fit of the bite.In the growing child, orthodontists also aim to modify growth to improve the bite and facial appearance.

Treatment varies enormously. This can take as little as four months or as long as two years but, for most patients, this takes 8 to 18 months with visits every five to eight weeks. After this, the teeth usually need to be held in their new positions with retainers.

Successful treatment depends on many things. Of course, specialist training and qualifications are important - but so is commitment as well as your commitment to the treatment process. Patients (and their parents) are not just passengers on a journey, they are active participants.

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Orthodontist - Adult Braces

It's never too late and adults are increasingly seeking treatment for that perfect smile. This is usually for one of four reasons.

  • Treatment was not undertaken as a child.
  • There has been previous treatment but there has been some relapse.
  • The teeth were previously fine but have started to move.
  • The general dentist plans to carry out restorative treatment but some orthodontic correction is necessary first.
Adult v Child differences

There are differences when comparing the treatment of children and adults. Essentially, adults don't grow (growth is a helpful factor in children), the teeth move more slowly in the first few months and some older patients have gums and teeth that are in poor condition. These differences impose certain limitations but successful treatment is nevertheless possible in the great majority of cases. 

Treatment

When planning treatment, we recognise that adult orthodontic patients are all different with varying needs and priorities. The aims of treatment are then established by mutual agreement. The majority of adult patients wear upper and lower ceramic fixed braces followed by fixed retainers on a permanent basis after completion of treatment. The invisible lingual braces bonded to the tongue side of the teeth are suitable for a number of adult patients. More information is presented on the invisible braces page. In our experience, adult patients are highly motivated, take great interest in the progress of treatment and are a joy to treat.

Orthodontist - Advice on getting the right results

 

Taking a close interest in what is happening makes a real difference to the quality of the end result.

Things to do
  • Keep appointments. Best progress is achieved when visits take place every 6 weeks. Longer time intervals result in longer treatment overall. If this happens regularly, the quality of treatment also suffers. If you are unable to keep an appointment please let us know as soon as possible so that a new time slot can be found with minimal delay.
  • Keep your teeth clean. Apart from being good manners towards the orthodontist and nurses, a clean healthy mouth does not have swollen or bleeding gums and looks nicer to your friends. Of course, this is more difficult when wearing fixed braces but we will give all necessary instructions and brushes.
  • We ask patients to use a fluoride mouthwash as this help to prevent permanent staining.
  • We provide an oral hygeine care pack at the beginning of treatment to ensure all patients have the correct products to maintain a healthy mouth whilst wearing braces.  
  • We expect any removable appliances we provide to be worn as instructed.
  • The same goes for elastic bands. These are often used near the end of treatment to correct the bite. At this time, you need to think of the braces as an engine and the elastics as fuel. No fuel - no progress!
  • Let us know if anything goes wrong. Depending on the problem, we may say it's OK to leave it until the next scheduled visit or we may ask you to come in to have it fixed.
  • It is important you continue regular check-up visits with your general dentist.
Things to avoid
  • Avoid eating certain types of food - those that are very hard and might cause brackets to come unstuck and those that are sweet and sticky and might start a decay process.
  • Avoid acidic drinks. Coke, lemonade etc are lethal to teeth. The 'diet' versions contain no sugar but are very acidic and also cause permanent loss of protective enamel due to acid erosion, as do fruit juices. It's boring but the best drink for healthy teeth is tap or bottled water.
  • Don't brush the teeth straight after consuming sweet or acidic drinks. In fact, this makes matters worse as the top layer of enamel is brushed away whilst it is in a vulnerable state. It is better to wait at least one hour before brushing the teeth.
  • Avoid abusing the braces. Don't 'click' removable braces in and out (the wires will break eventually) and don't pick at fixed brace brackets.
  • Avoid biting on pens and pencils.
  • Stop habits such as thumb sucking. If this is a known problem before treatment starts, we will often fit a dissuasion appliance to help you break the habit.
Orthodontist - Crowding

The word crowding is used to describe the very common problem of irregular or overlapping teeth due to shortage of space.

Why do teeth become crowded?

We don't really know although there are plenty of theories.

  • Our modern diet is less abrasive than in the past and this means we don't wear the enamel down as much as we used to in between the teeth, which made the teeth significantly less wide and therefore less crowded.
  • The softness of our modern diet causes the jaw muscles to be lacking in sufficient exercise for the jaws to develop properly.
  • Air pollution is said to cause inflammation of the lining of the nasal cavity leading to mouth breathing. This requires the jaw and tongue to drop a little to allow air to pass which, in time, leads the upper jaw to become narrow and crowded.
  • The combination of big teeth and small jaws. It is a fact that people with small teeth are less likely to have crowding.

The first three theories are environmental or blame modern man's life style. Only the last theory has a genetic component. There are good arguments against all these theories, indicating that crowding is likely to have more than one cause and be based on various combinations of genetic and environmental influences.

Methods of treatment
 
There are five ways in which crowding can be relieved.
  • Extraction of teeth - This usually involves the removal of two or four permanent teeth halfway back in the mouth and is very effective at relieving crowding when it is severe (see photos).
  • Enamel reduction - This entails reducing the thickness of enamel from between the teeth which creates a series of tiny spaces that then close up. This technique, which can be used in children, is more often used for adults to relieve mild to moderate crowding. The process is painless and does not weaken the teeth or make them more vulnerable to decay.
  • Widening the dental arches - This is suitable in specific cases (see photos) but is otherwise prone to relapse with a return of crowding at a later date.
  • Moving the front teeth forward - The lower and sometimes upper front teeth can be guided forward in specific cases. This is effective at creating space but is also prone to relapse with a return of crowding.
  • Moving the back teeth further back in the mouth - This requires the wearing of headgear at night and is suitable only for the upper teeth in growing children. However, this transfers crowding to the back of the mouth which may necessitate extractions at a later date.

These options are frequently used in combination. In borderline cases, there may be more than one treatment option. It is not possible to generalise, hence the need for individual assessment.
What is the logical approach to extractions?

Clearly, each patient needs to be assessed individually. This is why we apply a process known as space planning which identifies all aspects of the dentition before treatment begins and the effects that corrective measures will have. This process determines which cases need extractions and which don't, and when various options are possible.

We are aware that the extraction of teeth is an issue that can arouse strong emotional feelings. However, we pursue evidence-based clinical practice and recommend the extraction of teeth only when absolutely necessary. The large majority of patients are treated without extractions. These are undertaken only when failure to extract would result in a poor appearance due to the teeth being too far forward or in the teeth being in unstable positions.

Orthodontist - Fixed Braces

Fixed braces consist of a series of small square attachments cemented to the teeth. These are known as brackets. It is simplest to think of each bracket as a handle with which it is possible to control each tooth individually. The brackets are highly sophisticated as every tooth has its own bracket design engineered to achieve the correct position and angle of axis.

We have very successfully used ceramic braces for many years as well as mini metal braces. The cosmetic ceramic brackets blend in with the colour of the teeth and are used routinely in adults and when appropriate for young patients. Occasionally, ceramic brackets cannot be used on the lower teeth (when the bite is deep) but the mini metal braces are not usually obvious in these cases.

How are the brackets controlled?

In the early part of treatment, a flexible but springy wire is fitted to link up all brackets. Because the teeth are irregular, the wire has to bend up and down or in and out between the teeth. This is the clever bit: the wire has perfect shape memory and will gradually return to its original shape, bringing the teeth with it. 
As treatment progresses, stiffer wires are fitted and these act as a monorail. At this time, the teeth are guided by tiny springs and elastics.

What are the advantages?
  • Speech is unaffected
  • The temptation of not wearing the appliance does not arise Fixed braces are supreme at fine tuning the way the teeth line up and bite together. Research has shown that patients are happier with their smiles after fixed brace treatment than after other forms of treatment
What about playing sport or musical wind instruments?
  • It is essential to wear a mouthguard when playing sports such as rugby or hockey, whether wearing a brace or not. We provide custom made mouthguards that fit over fixed braces.
  • The problem area for players of wind instruments is the inner surface of the lower lip. We provide low profile brackets for the lower front teeth in such cases with good success, even for professional musicians.
Orthodontist - Growth Modification

Arch development (widening) techniques

The technique of widening the dental arches (orthodontists call it expansion) was already in use a hundred years ago so that crowded teeth could be accommodated without any extractions. However, properly conducted scientific research has shown that indiscriminate use of this form of treatment leads to relapse in many cases with a return of crowding.  Nevertheless, expansion can be very successful in carefully selected cases.

Functional appliances

There are many types of functional appliances, mainly to treat underdeveloped lower jaws. Some are fixed to the teeth but most are removable by the patient for cleaning. They all work by holding the lower jaw in a forward position for 9 to 12 months.

We use 'Twinblock' functional appliances which are very effective at changing the way the teeth bite together by restraining the upper dental arch and advancing the lower dental arch. It is nearly always necessary to complete treatment with fixed braces to fine tune the bite and straightness of the teeth.

The timing of treatment is an area of controversy. One school of thought is that the Twinblock phase should take place 'early', at age 7 to 9, with a two year interval before the fixed brace phase. However, an early start does not mean that treatment finishes earlier, but usually means a longer overall period of treatment at higher cost.

We prefer to begin treatment in the final year of the mixed dentition (when there is a mixture of primary and permanent teeth). This ensures that the two phases of treatment can take place one after the other, without pause. This shortens the overall duration of treatment, reduces costs and is preferred by patients.

Despite the above, early treatment can be appropriate when the upper front teeth protrude in such a way that the risk of accidental damage is increased or when the young patient is suffering from being teased.

Orthodontist - Invisible Braces

Invisalign

We are an accredited practice for this leading clear aligner system. This type of brace is popular amongst adults because of its discrete appearance and the ability to remove it for eating and cleaning. Patients report these braces are easy to wear and they do not suffer from the braces rubbing.

Lingual Braces

Lingual braces are bonded to the tongue side of the teeth (hence 'lingual'). They are invisible and very effective at straightening irregular front teeth in suitable cases (mainly when the crowding of the teeth is not too severe). The system we use is affordable and provides good quality results, often in as little as four months.

However, we don't offer either lingual braces or Invisalign for the treatment of very complex problems as we are not totally satisfied with the quality of results achieved for this group of patients. For patients with bite problems or more severe crowding, ceramic labial braces offer more predictable and better quality results.

Orthodontist - Removable Braces

Removable braces are rarely the only appliance used. They are mainly used in the early part of treatment, for example to widen the upper dentition or to reduce the depth of the bite between the front teeth. Once their task is completed, treatment continues with fixed braces.

Removable braces can be used successfully on their own in younger children undergoing interceptive treatment. This type of treatment is undertaken for three to twelve months at 7 to 9 years and aims to correct only one or two specific problems present during this phase of development. Further treatment is often necessary at 11 to 13.

An example of interceptive treatment is the correction of an upper incisor that has become trapped behind the lower teeth when closing together. Crossbites such as this can also occur at the back of the mouth and these can also be corrected with removable braces.

Orthodontist - Retainers

After completion of orthodontic treatment, the teeth tend to slip back towards their original positions. This, if allowed to happen, is known as 'relapse'. If teeth are likely to relapse, they are referred to as 'unstable' and the part of treatment that prevents this is called 'retention'. Many orthodontists regard retention and the long term management of stability as one of the most important and difficult parts of orthodontic care.

Certain types of dental problems such as twisted or overlapping front teeth and certain types of treatment such as arch widening or moving the lower incisors forward are more prone to relapse.

Retainers are the opposite of braces as they prevent movement rather than cause it. The main types are:

  • Removable retainers consist of thin plastic in the roof of the mouth and sometimes a wire across the front teeth. They are mostly worn just at night.
  • Vacuum retainers are removable and made of a thin sheet of clear plastic moulded to fit over the upper or lower teeth.
  • Fixed retainers consist of fine wires bonded to the inner surfaces of the upper or lower front teeth. They are invisible and only require inspection every year or two.
Duration of Retention
Sometimes retention is only necessary for a few months but for most young patients, upper removable night time retention lasts 18 months and lower fixed retention lasts until age 22 to 25. For some patients, particularly adults, it is necessary to recommend long term retention to ensure continued enjoyment of the new smile.
 
Teeth move even without orthodontics
The teeth become more crowded and overlapping during the late teens and early twenties in people who have had no orthodontic treatment. This is so common it has to be regarded as normal. The reasons are complex but it is likely that the wisdom teeth are not the cause even though they are frequently blamed for this. In fact, the teeth tend to become more crowded throughout life.

Request a direct referral to our Specialists today

 

 

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