Chula vista orthodontic braces logo


Home
First Visit
Directions
Dr. Fuller
Braces
Diagnosis
Retainers
What age?
Patient Forms
Contact Us

Links
Newsletters
Try a new Smile

Clayton Fuller, D.D.S.- Orthodontist

312 I Street. Chula Vista, CA 91910     (619) 422-3223


Braces

Introduction
Archwire
Band
Braces
Clear Braces
Elastics(rubber bands)
Extraction
Functional Appliances
Headgear
Impressions
Interceptive treatment (Phase I)
Invisible Braces
Jaw Surgery (orthognathic)
Ligature tie (color & steel)
Limited Treatment
Lingual Braces
Lingual Holding Arch
Lip Bumper
Molar Distalizer
Nance
Orthognathic(jaw surgery)
Palatal Expander
Phase I (interceptive treatment)
Power Chain
Rapid Palatal Expander
Recall
Removable appliances (Invisalign)
Retainers
Reverse Pull Headgear (facemask)
Separator
Serial Extraction
Space Age wires
Spacer
Spring Retainer
Tongue Crib (habit device)
Trans-Palatal Arch

Braces

Introduction
Orthodontists use several different appliances in their profession. Braces are one of the appliances they use to move the teeth themselves, while other appliances are used to move the jaws. Having straight teeth is not the only goal of orthodontics. You also want to have the jaws aligned and the face in balance, in addition to having straight teeth. Several different appliances can be used at the same time to achieve this optimal result
Braces straighten teeth by holding onto a wire as it returns to its original, straight shape. When this wire is first tied into a brace, you have to bend it slightly to get it to fit in. As it returns to its original shape, it applies pressure to the tooth. This pressure is felt by the bone, which switches on signals to call in new cells that allow the tooth to move through the bone.

TOP

Archwire
The archwire is the wire that connects each brace together. It does the actual work of aligning the braces, which will line up the teeth. It is made from a very resilient material that allows it to spring back to it's original shape, after you bend it. Not like a paper clip that will stay bent.

The wires come in different sizes, shapes, and composition of materials. The size of the wire is measured by the thickness of the cross-section in thousandths of an inch. A common round wire size is 0.016-inch, whereas a common rectangular wire is 0.017 by 0.025-inch. All of them are made from stainless steel materials. The various combination of materials like chromium, cobalt, nickel, titanium, and copper will greatly influence the bending properties of the wire.

TOP

Band
A band is a metal ring that fits around the tooth. It will have a brace welded to it and is held onto the tooth with dental cement. They are only used on back teeth, because they do not look very nice with all that metal showing. In years past, all of the teeth had bands on them; which is where the term "metal mouth" comes from. But with the invention of bonding (gluing) a brace directly to the tooth, you do not have to use bands on the front teeth anymore.

Holding a brace onto a tooth with a band is much more durable than bonding it directly to the tooth. This durability is very important when you have people exerting hundreds of pounds of pressure to their teeth when they chew. They can easily break a bonded brace loose from a tooth, but not a banded one. This is why bands are still used today and why the orthodontists ask their patients not to chew hard or crunchy food.

TOP

Braces
Braces are the tiny brackets that are attached to the teeth. They act like handles that allow you to grab onto the teeth to move them. They are usually bonded (glued) directly to the enamel of the tooth. Except on a back tooth, where it is first welded to a band of metal and the band is then held onto the tooth with dental cement.

There are different types of braces: metal, clear, and gold. Metal braces are the most popular with orthodontists, because they are the most durable. They are made from stainless steel materials like chromium, zinc, nickel, or titanium. The braces today are much smaller than they were several decades ago. Clear braces are made from a ceramic material, aluminum oxide. They are more fragile and are bulkier. As a consequence, they are more irritating to the lips. You have to be very close to someone to be able to see them, which is why they are so popular with adult patients. Gold braces are stainless steel braces that are coated with a gold material. They have the strength of metal and blend in with the color of the teeth and gums much better than the plain metal ones.

TOP

Clear Braces
These are braces that are clear or opaque. They match the tooth color very well. Almost all of them are made from a ceramic material, aluminum oxide. A few of them are made from plastic, which is not as durable. When the ceramic ones were invented in 1987, almost everyone stopped using the plastic ones and the lingual braces. Ceramic braces are more fragile than the metal ones and are actually bulkier. As a consequence, they are more irritating to the lips. They work the same as metal braces, but have a little more friction and can prolong the treatment time. You have to be very close to someone to be able to see them, which is why they are so popular with adult patients.

TOP

Elastics (rubber bands)
Elastics are rubber bands that you hook from one brace to another to provide a force that will move the teeth. They can be used to slide one tooth along an archwire or to move a group of teeth. They come in a variety of sizes and strengths. Not everyone needs to wear these, as they are only needed for specific movements.

TOP

Extraction
An extraction is the removal of a tooth. It is utilized when the teeth are crowded and there is not enough room for all of them. The space from the removal of the tooth provides room for the others to rotate and line up straight. All of the extraction space is completely closed; there are no gaps at the end.

Deciding which tooth to remove is a big deal. You usually take out the side tooth closest to the crowding, but other factors may interfere with this decision. If in taking out a side tooth, you leave in a tooth with a short root, you will have compromised the case. As short roots have a greater long term risk of failure than normal roots. Other features which put a tooth at risk are fillings, crowns, root canals, and bone loss. Having to take out a different tooth will make the case more difficult and cause the treatment time to be extended. But it is of paramount importance that you keep the most important teeth.


TOP


Functional Appliances
These are used to help modify the growth of the jaws in children. The theory behind their action is that if you hold a jaw in a specific position long enough, that it will grow into that position. What you usually get is a combination of a little jaw growth with a lot of tooth movement. These are not universally accepted, as they do not always work.

The first of these appliances were removable and are still very popular. They are made of plastic and wire. Some of their names are Frankel, Bionator, and Twin-block. A different style is actually fixed to the teeth and uses a spring action to hold the jaw into position. These have names like Herbst and Jasper Jumper.

TOP

Headgear
Headgear is an appliance that is worn on the outside of the mouth, with an attachment to connect it to the teeth on the inside. This is used when you have upper teeth that stick out too far in front of the lower teeth, as in buckteeth. It will move the upper teeth and jaw back to match the lowers.

There are several different types: cervical pull, high pull, etc. The type utilized is dependent upon the skeletal growth pattern. It is usually seen as a soft pad that is worn around the back of the neck that attaches to a wire that reaches forward to connect to a brace inside the mouth. It is used for both movement of the teeth and for guiding the growth of the jaws.

TOP

Impressions
Taking an impression involves placing a putty-like material in a mouth tray and positioning the tray over the teeth. It is held in place for about a minute, until the material hardens to the consistency of Jell-O. Your teeth will have then left an impression of themselves in the gel. This is then taken to the lab where a liquid plaster is poured into it. After the plaster hardens, the tray is removed and there is a duplicate of your teeth in the plaster models. This has also been called taking a mold of your teeth.

The plaster study models are used to analyze a lot of features about your mouth: tooth size, relationship of the teeth to each other, amount of available space, how they come together, etc. A lot can be learned from the models that can't be seen by looking directly into the mouth.

TOP

Interceptive treatment (Phase I)
There can be a lot of different types of Interceptive Treatment, but their common goal is to stop a problem early enough so that it does not become a big problem later on. This is done for young children, before they have lost all of their baby teeth. Not many people will need this intervention, as most orthodontic problems can be solved later in adolescence. But for those that do need it, it will make a world of a difference. In addition to intercepting a problem, it can also involve the correction of a jaw discrepancy. As you want to prevent any damage from getting worse over time.

A good example of this is a crossbite. This is where the upper teeth fit inside the lower teeth. Additionally, the upper jaw will be fitting inside the lower jaw. The teeth can be moved at anytime, but the bone can not. If left untreated, the bone will stay this way. You can not orthodontically correct it later. The bone shift will be very subtle at first, but it will continue to grow crooked. Hence, the damage will get worse over time.

Interceptive treatment has also been called Phase I. After the permanent teeth come in, their straightening with braces is called Phase II. If there is an early problem, but it is not severe enough to require intervention, then it can be corrected later during what is called Comprehensive Treatment. This treatment takes into account the entire facial structure as well as the permanent teeth. If the jaws need correction, then the patient will start treatment a little earlier than usual. With Comprehensive Treatment, all of the problems are then corrected in one time frame.

TOP

Invisible Braces
Several different types of braces are called invisible. Clear braces are called this because it is difficult to see them, unless you are very close to the person. Lingual braces are also called this, because they are on the inside of the mouth and you do not see them. Essix and Invisalign removable appliances are also called this because they use clear plastic for the appliance and are very difficult to see.

TOP

Jaw Surgery (orthognathic)
This is used to correct the jaws deformities of non-growing patients, adults. For example, if the lower jaw is too far behind the upper jaw, then the lower teeth are also too far behind the upper teeth. In order to line up the teeth, you need to move the lower jaw forward and the teeth come with it.

Teeth have to be surrounded by bone, for blood supply and nourishment. They can be moved around within the confines of the jawbone, but not outside of it. If more movement is needed, then you have to move the jaw. The braces are used to straighten the teeth within each jaw and then the surgery is used to line up the jaws, which will align the teeth.

Some people that need jaw surgery refuse to do it. Sometimes a compromised treatment can be done to align the teeth, but the jaws and face will remain incorrect. If you decide on doing a compromise, then realize that you will not get an excellent result.

TOP

Ligature tie (color & steel)
The archwire is held to the brace by means of a ligature tie. This tie fits under the corners of the brace, but over the archwire. This is needed to tighten the archwire into the brace. The ligature ties are usually little rubber rings, but narrow steel wires can also be used. The rubber ligature ties are simply stretched around the corners of the brace, whereas the steel ones are twisted into place. This twisting action is where the term "tightening" comes from. The brace is not actually tightened, it's the steel ligature tie that is tightened. The rubber ties are usually gray in color, but they also come in a variety of bright colors. So when you see someone with colors on their teeth, it's the ties that are colored, not the braces.

TOP

Limited Treatment
This means that a very limited amount of treatment is going to occur. It is to correct a specific problem only, even though others may exist. The braces will not be placed on all of the teeth, just the few that are being corrected. This is in contrast to comprehensive treatment, where the entire oral-facial complex is being treated.

One example of limited treatment is called uprighting a molar. This is usually done when someone is missing a back tooth and the molar has leaned forward and blocked off part of the space of the missing tooth. The general dentist can not make a proper bridge because the space is too small and the molar is at an incorrect angle. The treatment will be limited to pushing the molar back and into an upright position.

TOP

Lingual Braces
Lingual braces are placed on the inside of the patient's teeth, so you do not see them. All the wires and brackets are next to the tongue. Which is a problem because it constantly rubs against them and causes more discomfort than standard braces. It will also take some time to adjust your talking. Another problem is that the treatment takes a little longer and is more costly. They are not for correcting all malocclusions and it is extremely difficult to get a perfect result. As a result, many people also get braces on the outside, at the end of treatment, to detail the final result. They were used many years ago, before the advent of clear braces and are rarely used anymore.

TOP

Lingual Holding Arch
A lingual holding arch is a space maintainer for the lower teeth. It maintains the molars where they are, it does not move them. This is fabricated by placing bands on the molars and connecting them to a wire that fits up against the inside of the lower teeth. It keeps the molars from migrating forward and prevents them from blocking off the space of teeth that develop later. This is used when you have the early loss of baby teeth or when you have lower teeth that are slightly crowded in a growing child and you do not want to remove any permanent teeth to correct the crowding

TOP

Lip Bumper
A lip bumper is an appliance that fits between the lower teeth and the lip. It has a plastic shield in the front with wire arms that reach back to fit into a brace on the lower molars. This holds the lower lip out away from the teeth. It is used when you have crowded lower teeth. The theory is that the pressure from the lip, pushing back on the bumper, will push the lower molars back and open up space for the front teeth to uncrowd. A lot of studies have shown that what is actually happening is that the lower front teeth just lean forward into the gap. This does result in gaining space for uncrowding, but the forward lip position can be unsightly in some people. Most of the time the lip will move back later on and the teeth will crowd up again.

TOP

Molar Distalizer
This is an appliance that is used to move the upper molars back towards the rear of the mouth. Its action is similar to that of a headgear, but this will only move teeth, not jaws. This is utilized when the upper molars are too far forward, but the jaw is in the correct position.

There are several variations to this appliance. Some use little coil springs attached to a Nance while others use thick wire extensions in place of the coil springs. A common trait to all of them is that they fit totally inside the mouth, without any extra-oral wires.

TOP

Nance
A Nance is a space maintainer for the upper teeth. It maintains the teeth where they are, it does not move them. It consists of bands on the molars connected to a wire that extends forward to a plastic disc on the roof of the mouth (palate). It keeps the molars from migrating forward and prevents them from blocking off the space of teeth that develop later. This can be used when you have the early loss of baby teeth.

TOP

Orthognathic (jaw surgery)
This is used to correct the jaws deformities of non-growing patients, adults. For example, if the lower jaw is too far behind the upper jaw, then the lower teeth are also too far behind the upper teeth. In order to line up the teeth, you need to move the lower jaw forward and the teeth come with it.

Teeth have to be surrounded by bone, for blood supply and nourishment. They can be moved around within the confines of the jawbone, but not outside of it. If more movement is needed, then you have to move the jaw. The braces are used to straighten the teeth within each jaw and then the surgery is used to line up the jaws, which will align the teeth.

Some people that need jaw surgery refuse to do it. Sometimes a compromised treatment can be done to align the teeth, but the jaws and face will remain incorrect. If you decide on doing a compromise, then realize that you will not get an excellent result.

TOP

Palatal Expander
A Palatal Expander will expand the upper jaw out to the sides. This is the same as a Rapid Palatal Expander. It is used when the upper jaw is too narrow for the lower jaw. The bones of the palate (upper jaw) are actually moved apart and then new bone grows back in the middle, to fill it in. This is one of the few bones in the body in which this can be done.

The expander can be either banded or bonded to the teeth. Banded ones have the expander attached to a band around the tooth. Whereas the bonded ones have a plastic section that is bonded over the back teeth. Your vertical growth pattern will determine which type is utilized. Both types have a screw section that is turned for the expansion

Age can play a big factor in how easily this is accomplished. Up to about age 15, the upper jaw can be moved apart easily. After this age, the two halves of the bone have fused together and you will need to have surgery first, to undo the fusion.

TOP

Phase I (interceptive treatment)
There can be a lot of different types of Phase I treatment, but their common goal is to stop a problem early enough so that it does not become a big problem later on. This is done for young children, before they have lost all of their baby teeth. Not many people will need this intervention, as most orthodontic problems can be solved later in adolescence. But for those that do need it, it will make a world of a difference. In addition to intercepting a problem, it can also involve the correction of a jaw discrepancy. As you want to prevent any damage from getting worse over time.

A good example of this is a crossbite. This is where the upper teeth fit inside the lower teeth. Additionally, the upper jaw will be fitting inside the lower jaw. The teeth can be moved at anytime, but the bone can not. If left untreated, the bone will stay this way. You can not orthodontically correct it later. The bone shift will be very subtle at first, but it will continue to grow crooked. Hence, the damage will get worse over time.

Interceptive treatment has also been called Phase I. After the permanent teeth come in, their straightening with braces is called Phase II. If there is an early problem, but it is not severe enough to require intervention, then it can be corrected later during what is called Comprehensive Treatment. This treatment takes into account the entire facial structure as well as the permanent teeth. If the jaws need correction, then the patient will start treatment a little earlier than usual. With Comprehensive Treatment, all of the problems are then corrected in one time frame.

TOP

Power Chain
Power chain is a row of rubber ligature ties that are connected together. They resemble a chain because each little rubber ring is attached to the next one in the row. The chain is stretched over a group of braces, with each ring going around one brace. As the stretched chain wants to contract, it pulls the braces closer together. This is utilized when closing gaps between adjacent teeth.

TOP

Rapid Palatal Expander
A Rapid Palatal Expander will expand the upper jaw out to the sides. This is the same as a Palatal Expander. It is used when the upper jaw is too narrow for the lower jaw. The bones of the palate (upper jaw) are actually moved apart and then new bone grows back in the middle, to fill it in. This is one of the few bones in the body in which this can be done.

The expander can be either banded or bonded to the teeth. Banded ones have the expander attached to a band around the tooth. Whereas the bonded ones have a plastic section that is bonded over the back teeth. Your vertical growth pattern will determine which type is utilized. Both types have a screw section that is turned for the expansion.

Age can play a big factor in how easily this is accomplished. Up to about age 15, the upper jaw can be moved apart easily. After this age, the two halves of the bone have fused together and you will need to have surgery first, to undo the fusion.

TOP

Recall
Recall is a re-examination of the patient while no actual treatment is being done. This is to monitor the growth and development of the child, before active orthodontic treatment is started. As you want to make sure all of the teeth are erupting correctly and the facial growth process is occurring on schedule. If a problem starts to occur, you want to intervene before it becomes a serious problem. A parent would have no way of knowing if everything was proceeding properly, because orthodontic problems do not cause any pain that would alert you to something being wrong. Orthodontists are not only experts in straightening teeth, they are also experts in the growth and development of your child's mouth, jaws, and face.

TOP

Removable appliances (Invisalign)

These are retainer-like appliances that can move the teeth a little bit. They are only good for rotating or tipping a tooth; which is minor movement. They can not move the roots of the teeth or the jaws, so they can not correct a deep overbite or crowding. They work by tipping the crown part of the tooth. Examples of these are the Spring Retainer (plastic with metal wires), Invisalign (clear plastic), and Essix (clear plastic).

TOP

Retainers
Retainers are used to hold the teeth in place, after treatment is completed. They are needed because the bone has a memory which wants to move your teeth back to where they were. A retainers can not move any teeth, it can only retain them where they are. It is sometimes confused with a Spring Retainer, which can move the teeth a little bit.

Retainers can be made from plastic, wire, or a combination of the two. The standard retainer is the Hawley, which is made of plastic on the inside and wire along the outside of the teeth. This acts to retain the teeth in a narrow groove between the plastic and the wire. The plastic can be ordered in different colors and a sticker can be placed on the inside, if you like. It must be worn to be effective, since it is removable. Another removable type is the clear plastic retainer.

Fixed retainers are made of wire that is bonded (glued) to the inside of the lower front teeth. They are used in cases in which the lower front teeth were crowded to start with and teeth were not removed to correct the crowding. They are also good for the forgetful patient, because they can not be taken out or lost.

TOP

Reverse Pull Headgear (facemask)
This is a very different type of headgear that is used where you have upper front teeth that are in behind the lower front teeth (anterior crossbite). The facemask is designed to pull the upper jaw forward. It is removable and fits in the front of the face. There are soft pads that allow it to rest on the chin and forehead.

It is attached to the upper jaw by means of elastics that connect the facemask to a bonded rapid palatal expander appliance. It is very important that the bonded appliance in the mouth be firmly fixed to the teeth, to anchor them together and to the bone. Otherwise, you will be moving the teeth and not the jaws.

TOP

Separator
A separator is also called a spacer. It is a rubber ring or a metal wire that is used to make space between the teeth. This is utilized on teeth that are going to be getting a band placed around them. The teeth usually fit very tightly next to each other. This tightness is something you notice when you floss. In order to make space for the thickness of the band, you need to place a separator between the teeth for about a week to push them apart.

TOP

Serial Extraction
This is the sequential removal of specific teeth, in children with crowding. The removal allows the remaining teeth to uncrowd by themselves. It involves removing both baby teeth and permanent teeth. This needs to be done in proper order, as the specific teeth come into the mouth over several years. When the remaining permanent teeth grow into the mouth, they will not be crowded and will bring their natural bone height with them. This is a feature that can not be duplicated if you wait until all the permanent teeth are in, before extracting them.

You can tell if a child will be crowded by age 7. If you are sure that the child will need removal of permanent teeth at some point, then it is best to follow this sequential extraction of them. First baby teeth are removed, then the child is reexamined at regular intervals to watch for the correct point at which the specific permanent teeth are removed. They are then monitored on a regular recall basis to decide when the most appropriate time will be to start comprehensive orthodontic treatment.

TOP

Space Age wires
This is a class of wires that have the unique property of being very flexible, without losing the memory of their original shape. The flexibility is important to be able to push the wire into the brace of teeth that are rotated. The memory is important so that the wire straightens out to its original shape and moves the braces with it. The composition of nickel and titanium in the wire is what makes this possible.

TOP

Spacer
A spacer is also called a separator. It is a rubber ring or a metal wire that is used to make space between the teeth. This is utilized on teeth that are going to be getting a band placed around them. The teeth usually fit very tightly next to each other. This tightness is something you notice when you floss. In order to make space for the thickness of the band, you need to place a separator between the teeth for about a week to push them apart.

TOP

Spring Retainer
A spring retainer is more correctly called a removable appliance and can move the teeth a little bit. It is only good for rotating or tipping a tooth; which is minor movement. It can not move the roots of the teeth or the jaws, so it can not correct a deep overbite or crowding. It looks like a retainer with metal levers (springs) on the inside.

TOP

Tongue Crib
This is used when the tongue has a harmful habit of pushing forward between the front teeth when speaking or swallowing. It is also used to stop thumb sucking. Both of these cause an anterior openbite, which is where the front teeth do not touch when the back teeth are together. The tongue crib appliance is made of metal and is usually attached to bands on the upper back teeth. The bands connect to a wire that extends forward to a curved section that rests behind the upper front teeth and drapes down to keep the tongue back where it belongs.

TOP

Trans-Palatal Arch
A Trans-Palatal Arch fits on the inside of the upper molars. It consists of bands on the molars with a thick wire that connects them together. It has several functions, but it is mainly used to rotate molars.



TOP





2001-2010 Drfuller.com. All Rights Reserved.
Site Designed and Hosted by: QualWebDesign