1. Slow rate of tooth movments.

Normally tooth movment should proceed at 1 mm per month in children and less in adults. If progress is slow , check the following.

• Is the patient wearing the appliance full-time? If the appliance is not being worn as much as required, the implications of this need to be discussed with the patient and the parent. If poor cooperation continues, resulting in a lack of progress, consideration will have to be given to abandoning treatmen
• Are the springs correctly positioned? If not, explain again to the patient the purpose of the spring and show them how to insert the appliance correctly.
• Are the springs underactive, overactive, or distorted? If the springs were correctly adjusted at the patient’s last visit, check that the patient is not using them to remove the appliance or putting it in their pocket during meals.
• Is tooth movement obstructed by the acrylic or wires of the appliance? If this is the case, these should be removed or adjusted.
• Is tooth movement prevented by occlusion with the opposing arch? It may be necessary to increase the bite-plane or buccal capping to free the occlusion.

2. Frequent breakage of the appliance.

The main reasons for this are as follows:

• The appliance is not being worn full-time.
• The patient has a habit of clicking the appliance in and out .
• The patient is eating inappropriate foods whilst wearing the appliance. Success lies in dissuading the patient from eating hard and/or sticky foods altogether. Partial success is a patient who removes their appliance to eat hard or sticky foods!

3. Appliance quickly becomes loose fitting

The most common cause of this is a patient who is clicking the appliance in and out. This habit can also lead to intrusion of the teeth, which are clasped by the appliance and to frequent breakages. The patient’s close family are often very grateful if the habit is stopped, as the clicking noise that it generates can be very irritating.

4. Excessive tilting of tooth being moved.

Removable appliances are only capable of tilting movements. However, this is exaggerated by the following:

• The further that the spring is from the centre of resistance of the tooth the greater is the degree of tilting. Therefore a spring should be adjusted so that it is as near the gingival margin as possible without causing gingival trauma.
• Excessive force is being applied to the tooth, as this has the effect of moving the centre of resistance more apically.

5. Anchorage loss.

This can be increased by the following:

• Part-time appliance wear, thus allowing the anchor teeth to drift forwards.
• The forces being applied by the active elements exceed the anchorage resistance of the appliance. Care is required to ensure that the springs, etc. are not being overactivated or that too much active tooth movement is being attempted at a time.

6. Palatal inflammation.

This can occur for two reasons:

• Poor oral hygiene. In the majority of cases the extent of the inflammation exactly matches the coverage of the appliance and is caused by a mixed fungal and bacterial infection . This may occur in conjunction with angular cheilitis. Management of this condition must address the underlying problem, which is usually poor oral hygiene. However, in marked cases it may be wise to supplement this with an antifungal agent (e.g. nystatin, amphotericin, or miconazole gel) which is applied to the fitting surface of the appliance four times daily. If associated with angular cheilitis, miconazole cream may be helpful.
• Entrapment of the gingivae behind the upper incisors during overjet reduction between the incisors themselves and the acrylic of the bite-plane . A mistake commonly made during overjet reduction is to trim away the fitting surface of the appliance to allow for palatal movement of the incisors only, forgetting that space should also be created for retraction of the palatal gingivae. To prevent this from occurring, it is necessary to achieve good over-bite reduction in the initial stages of appliance therapy and trim the acrylic as shown in  during overjet reduction.

7. Lack of overbite reduction.

Lack of progress with overbite reduction can be a problem in patients who are not actively growing vertically, such as adults or those with a horizontal direction of mandibular growth. In these cases it may be necessary to proceed onto fixed appliances. In children, the most common reason for lack of progress with overbite reduction is that the appliance is not being worn during meals. Patients should be advised that their treatment will be quicker and more successful if they wear their appliance for eating, and that adaptation will be enhanced if they start with softer foods.

Image from qdtcorp.com

A Canadian diagnostic device company, revealed its breakthrough technology which detects and monitors the early onset of tooth decay without the need for dental x-rays. It reduces the number of invasive and painful procedures, and encourages better oral health. They introduced  Dental Caries Detection System, as The Canary System.

The Canary System uses a handheld laser that send out a low-power light to examine tooth surfaces. When laser light is shone onto the tooth, the system measures the level of glow (luminescence) and heat released from the tooth. Laser light interacts differently with healthy teeth than with decayed teeth. By varying the pulse of the laser beam, a depth profile of the tooth can be created to permit detection of decay as deep as 5mm from the tooth surface and as small as 50 microns in size (20 times smaller than a millimeter). With The Canary System, the dentist is able to identify areas of decay much earlier than with current methods.

The Canary System can scan for caries on smooth enamel surfaces, root surfaces, biting surfaces, between teeth, and around existing fillings. Current methods are not as sensitive in detecting early decay in these areas.

Source  www.e-dental.com

According to USC (University of Southern California) School of Dentistry , they have discover a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years. Researchers at USC School of Dentistry have published the first case study of the successful use of a patient’s own bone material for the grafting necessary in the accelerated orthodontic surgical procedure. The report appears in the May 2008 issue of the Compendium of Continuing Education in Dentistry.

USC dentists used a procedure known as PAOO, short for Periodontally Accelerated Osteogenic Orthodontics. With this technique, a periodontist or oral surgeon uses special instruments to score the bone that holds the teeth in place and then applies bone graft material over the grooves. The procedure is done under local anesthetic in the dental office operatory . This procedure allowing teeth to be moved into alignment with dental braces in a matter of months, and the cost for accelerated orthodontics typically ranges from $10,000 to $15,000, depending on the course of treatment.

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Image from inmanpower

Palatal expander is also known as a rapid palatal expander, rapid maxillary expansion appliance, palate expander or orthodontic expander. It’s used to widen the upper jaw so that the lower and upper teeth will occlude together, this can only be done when the patient is still growing. Palatal expander is used for about four to six months on children, this expansion process usually results in a large gap between the patient’s front teeth (which it’s normal) this gap will be visible in a week or two and the teeth may overlap so then orthodontics braces followed to straighten out all the teeth. Chewing and swallowing food may be hard at the beginning, and some discomfort should be expected. It is also important to keep the device clean by brushing it along with your teeth.

Image from kessklaus.de

A removable orthodontic appliance designed to correct functional and skeletal anteroposterior discrepancies between the maxilla and mandible. Bionators initially look like a sort of combined upper and lower Hawley retainer, but they are not bind to the teeth and are not used for post-brace removal treatment. Bionators are held in the mouth within the space that the teeth surround when biting. They are used to expand the palate and create space for incoming teeth. You should wear bionator all times except, when eating, when brushing your teeth or when engaging in active sports. Bionator should be brushed after each meal when the teeth are brushed, also it should be brushed with a toothbrush and a toothpaste.

Image from johnsdental.com

Is an Orthodontic retainer which made of a metal wire and acrylic that surrounds the teeth and keeps them in place. This type of retainer is used to keep teeth straight after the fixed braces is removed, also Hawley retainer is normally worn full time for 3 months after the removal of your braces, then nights only after this period for at least one year following the removal of your braces.You should clean your retainer each night, if you are wearing your retainer around the clock, rinse it with warm water after taking it out of your mouth, and also before putting it back in later! This will help prevent bacterial buildup, also you can brush it with a tiny bit of toothpaste.

2- Crown angulation: All tooth crowns are angulated mesially (mesiodistall tip).

3- Crown inclination: Indication refers to the labiolingual or buccolingual inclination of the crowns of the teeth.

A. Incisors are inclined toward the buccal or labial surface.

B. Upper posterior teeth are inclined lingually similarly from the canine to the premolars. Upper molar crowns are inclined slightly more than the canines and premolars.

C. Lower posterior teeth are inclined lingually , progressively more from canine to molars.

4- Rotations: Rotations are not present.

5- Spaces: Spaces are not present between teeth.

6- Occlusal plane: The plane is either flat or slightly curved.

From Andrews LF: Am J Orthod 62:296-309, 1972.
Figure

Image from www.infalab.com

Orthodontic wax or dental silicone is used to relief from irritation that may be caused by wires and brackets , it’s stop irritation between your braces and your lips, gums and cheeks. You can treat irritaion by placing the wax on the irritated parts ( brackets ) until the irritation stops. Don’t worry If you swallow the wax it is specially made to be digested. Put a small amount of wax on each irritated spot . replace the wax if needed as it flakes away and loses its stick. Orthodontic wax are available in a variety of flavors ( Mint flavor, Cherry flavor) also it can be Unflavoured .

Separators are a small rounded shaped elastics, placed between your teeth before applying orthodontic bands. They create space between teeth so that silver bands will fit easily on the back teeth. These are placed approximately a week before or some time at the same visit when braces are placed. They can come out if they made enough space or if you play with them. Sticky foods and chewing gum may also cause a separator to come out. If you lose a separator you should go back to your doctor to place them again.

[Images from www.froehls.de]

This appliance combine the use of upper and lower bite blocks to position the mandible forward for skeletal Class II correction. The appliance was first developed by Scottish Orthodontist William Clark and Orthodontic Technician James Watt in 1977. The Twin Block has become the most popular functional appliance in use in the United Kingdom and is gaining popularity across Europe and the USA. The Twin Block appliance is used to help a receded jaw grow forward and skinny or narrow jaws grow wider to help you keep all of your permanent teeth. Clark Twin Block appliance Indicated for following malocclusions

• Class II Division I
• Class II Division 2
• Class I open bites
• Class I closed bites
• Class III
• Lateral arch constriction
• Anterior/posterior arch length discrepancies
• Can also be used effectively in TMJ therapy

Bad breath or Halitosis

It’s an unpleasant condition that’s cause for embarrassment. Some people with bad breath aren’t even aware there’s a problem. If you’re concerned about bad breath, see your dentist right away.Bad breath is caused by bacteria that hide under the tongue and in the grooves and rough edges of teeth. As bacteria come in contact with food particles they can turn these food particles into sulfur compounds.lack of regular brushing and flossing can encourage the reaction that leads to bad breath, and of course eating foods like garlic and onions.

What are the causes of bad breath?

Most cases of bad breath are nothing to worry about, but bad breath can signal an ongoing health problem such as diabetes, liver or kidney disease, gum disease, dry mouth (xerostomia), infection in the respiratory tract, chronic sinusitis, postnasal drip, chronic bronchitis, gastrointestinal disturbance. Other factors can cause bad breath, such as Tobacco products, alcohol, morning breath, poor oral hygiene, braces and dentures.

Bad Breath Treatments

If the source of bad breath is in the mouth, you should try

* Specially formulated mouth rinses
* Dental restorations if you have old fillings and crowns
* Schedule regular dental visits for a professional cleaning and checkup
* Gum disease treatment
* Plaque removal

It’s important to clean your braces because when your mouth is loaded with bands, brackets, and wires, from your orthodontic braces, brushing them is really hard. Specialized brush tips are available to help get in between the braces and under the wires, also it’s important to brush your teeth after eating anything, and especially after a meal.The goal is to remove plaque from around the teeth and gums. It is the bacteria in plaque that is responsible for causing gum Inflammation (gingivitis), decalcification, tooth decay.Braces don’t cause these problems, but they make cleaning the teeth more difficult.

To watch a video about suresmile click here

Three Steps to a SureSmile

1. Digital imaging with the OraScanner which creates a 3-D digital model of your mouth, showing the exact position of every tooth.
2. Computer modeling with SureSmile Treatment Planning Software allows the orthodontist to manipulate the digital model of your teeth and create a plan for your ultimate smile.
3. Robotic hands, guided by the SureSmile software, precision-bend Shape Memory Alloy archwires that work with your body heat to shorten treatment time.

The average length of SureSmile treatment is 40% less time than conventional techniques. For example, treatments estimated to take two years with traditional orthodontics may take only 12 to 15 months using SureSmile, also this technique doesn’t move the teeth faster? it’s just about efficiency.

Thumb and digit sucking are believed to cause number of changes in the dental arch and the supporting structures. The severity of the malocclusion caused by thumb sucking depends on three factors

A. Duration : The amount of time spent in that habit.

B. Frequency: The number of times the habit is activated in a day.

C. Intensity: The strength with which the habit is performed

Here are some of the effects of thumb sucking

• labial tipping of the maxillary anterior teeth.
• Increased overjet.
• Anterior open bite.
• Cheek muscles contract during thumb sucking.
• Tongue thrust.

In mechanical treatment we can use appliances usually consist of a crib placed palatal to the maxillary incisors , these appliances called ( habit breakers ) and they can be in two types

1. Removable habit breakers
2. fixed habit breakers

In chemical approach we can use bitter tasting or foul smelling preparation placed on the thumb that is sucked, this can make the habit distasteful

According to newscientist there is a new way to encourage your child to brush there teeth , and with this new toothbrush which look like a simple version of a Nintendo Wii remote which turn the toothbrushing into a fun computer game.

Parents or professionals trying to teach young children to brush their teeth are faced with two problems. Many youngsters are not willing to brush their teeth in the first place. Then even if they can , they often lack skill to brush them effectively – for example, the average five-year old brushes only a quarter of their teeth.

Hao-hua Chu and his team at the National Taiwan University have come up with a new solution using a learning through play approach.

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