Orthodontic treatment is usually carried out in childhood as the adult dentition develops. It is a good idea for all children to see an orthodontist by the age of 10 years old to check on the development of the permanent teeth as some developmental problems with the teeth can easily be sorted out at this stage and thereby avoiding more complex treatment later, or damage to the teeth.
Orthodontic treatment is carried out for dental health reasons so that a healthy dentition can be functioning all through life, and also for aesthetic or cosmetic reasons. The appearance of the teeth and jaws has a huge influence on psycho-social development and its importance cannot be underestimated.
Very young children under 6 years old
The primary (baby teeth) start to come into the mouth at around 6 months old and usually have all come into the mouth at 2 ½ years old. It is extremely rare that orthodontic treatment would be offered at this stage. At around 6 years old the permanent teeth start to come into the mouth. The four first permanent molars at the back of the mouth and the lower permanent incisors at the front of the mouth are usually seen at around 6 years of age. Although treatment would not be offered at this stage, severe jaw problems may become apparent.
Children 6 - 9 years old
Sometimes it is necessary to start orthodontic treatment in this age group. The types of treatment considered for this age group are for problems such as:
The lower jaw too far forward relative to the upper jaw. This problem is sometimes treated at this stage using a Facemask to encourage the upper jaw to grow forward more.
The lower jaw too far back relative to the upper jaw causing the upper front teeth to protrude in front of the lower lip and become very susceptible to being broken. A Functional Appliance such as a Twin Block is often fitted in these sorts of problems to encourage the lower jaw to grow forward more so that the lower lip comes in front of the upper front teeth.
Early loss of a baby tooth due to decay or trauma may cause problems with the position of the permanent teeth and therefore an orthodontic Space Maintainer may be considered to prevent this problem occurring. If the space where the baby tooth has already been lost then Interceptive Treatment to re-open the space can be carried out in this young age group.
The upper permanent incisors (front teeth) can sometimes come into the mouth behind the lower front teeth into what is described as a crossbite. It is important that this is treated at this stage when it is very easy to do so, rather than waiting until the problem is more complex. A simple Removable Appliance is often used to treat this problem at this age.
Children 10 - 15 years old
At the age of 10 years old it is recommended that the child see an orthodontist and usually have a radiograph (x-ray) taken to check on the development of the permanent teeth. There are some complex problems that can be avoided, such as impacted upper canines, if this is spotted some simple interceptive treatment is begun at around 10 years old.
At the age of 10 years old the child normally has a mixture of baby and permanent teeth in the mouth. By the age of 12-13 years old most children have all their permanent teeth.
Treatments carried out at this age group are:
Functional appliance treatment to encourage a retrusive lower jaw to grow forward.
Facemask (if not started earlier) to encourage a retrusive upper jaw to grow forward or treat protrusive upper teeth.
Headgear treatment to treat protrusive upper teeth or create space to straighten crowded or crooked upper teeth.
Definitive appliance treatment to treat all problems with the position of teeth for dental health reasons or aesthetic concerns. The types of braces for definitive treatment are fixed orthodontic appliances and are listed below.
Children aged 15 years to adulthood
In this age group all permanent teeth apart from the wisdom teeth should be in the mouth and orthodontic treatment with fixed appliances is carried out. It is usually too late for functional appliance treatment to correct the position of the lower jaw as most children have gone through their growth spurt.
In cases where the jaw position is incorrect and jaw surgery is planned (orthognathic surgery) orthodontic treatment is often started at this age.
Types of braces available for this age group:
Functional appliance treatment - Twin Block if the child is still actively growing a functional appliance can still be used although it usually will work better in the younger age groups.
Face mask treatment can be used to move upper teeth forward in this age group but is used to move the upper jaw forward in the younger age groups.
Clear braces placed on the fronts of the teeth i.e. ceramic brackets
Gold braces placed on the front of the teeth
Metal braces placed on the front of the teeth
Ligation-free braces such as SPEED or DAMON
Removable brace treatment
Totally invisible braces placed on the backs of the teeth i.e. lingual appliances - Incognito or WIN
Transparent aligners i.e. Invisalign or custom made positioners
Extraction versus non-extraction treatment (removal of teeth vs. non-removal of teeth):
Occasionally as a part of orthodontic treatment it is necessary to extract a healthy tooth or teeth to get an optimal aesthetic and functionally stable result. Dr. Gibilaro likes to avoid removing healthy teeth if at all possible. Most treatments do not require the removal of healthy teeth and treatments are designed so that this can be avoided. During the initial consultation these issues will be discussed.
At end of orthodontic treatment the teeth are in a different position in the mouth than they were at the start. The bone surrounding the teeth and the gums must adapt to the new tooth position and during this time the teeth may move. Retainers are necessary to keep the teeth in their new position while the bone and gums adapt.
Occasionally a removable retainer is fitted that can be removed by the patient. There are different designs of retainer depending on the initial problem.
A fixed retainer consists of a thin wire bonded to the backs of the front teeth. This type of retainer does not show and the patient will soon forget it is there. It is removed by the orthodontist when it is no longer needed.