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Questions and answers - orthodontic treatment in Chennai

Dr. Nazeer Ahmed Meeran is a specialist orthodontist in Dubai. Get your doubts about braces and orthodontic treatment clarified here! Find out the answers to everything right from metal braces, ceramic braces, self-ligation braces, lingual braces, invisible braces, retainers  and the reasons for orthodontic problems as well as the solution.

 

Why is Invisalign so expensive?

Should I remove my good teeth for braces treatment?

Do braces hurt?

Why Should I wear Retainers after finishing my braces treatment?

Your orthodontic treatment is NOT finished once your braces are removed! Your teeth needs to time to adapt to their new position and this usually takes anywhere between 12–18 months, for the surrounding tissues around your teeth, the bone and periodontal ligament to remodel. This is called as “retention phase”.

The teeth can easily move (Relapse) during this retention period, as the supporting bone is still a little “soft” and not yet completely calcified. Remember, your teeth was moved by braces by a physiological process known as bone remodelling. This remodelled bone needs enough time to become hard and strong.

It is therefore mandatory to have retainers to prevent relapse. You have invested your valuable time and money in your orthodontic treatment. Your orthodontist has put valuable effort and expertise in treating your malocclusion. The effort must not go waste!

Studies have shown that teeth are highly prone to relapse during the first 3 months after removal of braces. After 12 months, the risk of relapse reduces significantly, but NEVER becomes zero!

It is highly recommend to wear the retainers night-time while sleeping, for the first one year after the braces removal. Some advice full time wear, to ensure good patient compliance, as many patients tend to forget them easily. However, 12–14 hours of retainer usage is adequate in most cases.

After this retention phase (12–18 months) is completed, you don’t have to wear the retainers every night. The bone is completely reorganized by this time and your teeth will be in a more stable position.

Unfortunately, you can still expect some mild relapse, if you discard your retainers completely. It is advisable to continue wearing them for at least two nights a week, for the rest of your life, to prevent this risk.

Some orthodontist will place or cement a permanent retention wire on the back side of your teeth. However, the risk of bacteremia due to inadequate cleaning of the “permanent retainer” and the potential risk of dental caries, makes removable retainers as a better choice compared to fixed retainers.

Removable retainers are more hygienic and you must replace them at least every 3–4 years.

Yes. Retainers are meant for life time! The reason is that teeth always respond to force from your lips and tongue and are always ready to shift position. Once or twice a week retainer use for the rest of your life essentially serve as an “insurance” against relapse!

How do braces work?

Orthodontic appliances like braces and aligners apply continuous pressure to a patient’s teeth. This gentle pressure slowly shifts the teeth into a better, straighter position. There are two options for patients who seek to have a healthier smile.

The traditional option uses brackets which are fixed and can only be removed by the orthodontist. The other option involves removable aligners which can be taken out. Orthodontists offer both of these options. They may recommend one method over the other.

How long does it take to get used to braces?

When you get your braces, it may take some time for you to get used to them. Most of the patients get used to them within a few days or maximum a week. Braces may cause mild discomfort or soreness for the first few weeks. The new generation fixed appliances and aligners are more comfortable than before. The duration of the orthodontic treatment likely depends on the teeth alignment and the severity of a patient’s bite.  The treatment duration takes anywhere from one to three years depending on the malocclusion.

 

What Causes Crooked Teeth?

Crooked or irregular teeth can be caused by a number of factors. The main cause of crooked teeth is unwanted bad habits like finger or thumb sucking. Other habits like lip biting, nail biting and chronic mouth breathing can also cause dental malocclusion.  Genetics, heredity, diet and environmental factors can also play a minor role in causing crooked teeth.

Small jaw size with large sized teeth can cause crowding while large sized jaw coupled with small size teeth can cause spacing between your teeth. Untreated mouth breathing habit can cause severe narrowing of your upper jaw which in turn can result in crowded dentition. It is always advisable to have a consultation with your orthodontist as early as 7 years to identify any problems early!

What causes spacing between teeth?

Dental spacing is caused mainly caused by tongue thrusting habit. The continuous pressure of the tongue on your teeth will cause flaring of the teeth. Breaking this deleterious habit at an early age is extremely important to prevent dental spacing in teenagers. Your orthodontist will give your child an habit breaking functional appliance to solve the problem, if identified at an early stage. Consult your orthodontist immediately, if you suspect your kid has tongue thrust habit.

The other reason for dental spacing could be due to small size teeth in an adult with large size jaw. This can be corrected by cosmetically increasing the size of the teeth by composite veneers or ceramic veneers. This procedure is popularly called as “Hollywood Smile”, where the size of the teeth is made proportionate to your facial structure to improve your Smile!

What Are The Different Kinds of Braces Available?

There are several kinds of orthodontic fixed appliances available and your orthodontist will usually advise you to choose the one which best works in your case. Most malocclusions can be treated by almost all types of braces.  The patient can choose the one he prefers, if approved by their orthodontist. The most popular orthodontic appliances are Metal braces, Ceramic braces, Self-Ligation braces [Damon, Smartclip,etc], Lingual braces and Clear aligners like INVISALIGN.

Does Invisalign really work?

“Can a small piece of clear plastic, move my teeth?” This is the first question arising in the mind of any patient who hears about invisalign invisible braces for the first time! “Three of my friends did invisalign, one was very happy with the final smile and the other two did not get great results. Why? How can I be sure that it work in my case?” This is another question asked by a few and is a very valid one. And remember, these are all highly educated, top professionals in their respective field and tech savvy patients, who have done their research on Google before meeting the orthodontist.

Is Invisalign treatment really unpredictable in terms of results? It is a very good question! There has been so much hype about clear aligners all over the world and Invisalign has grown to be the biggest and most trusted brand in the aligner world. The hype has grown in the last 2 years, as the technology becomes more recognized among dentists and orthodontists. In 2019, almost all the orthodontic patients in India and the rest of the world, want to get their smile correction done by Invisalign clear aligners.

The millions of dollars spent in research and continuous updating of the product makes Invisalign more precise in moving your teeth in the desired way. Choosing the right invisalign specialist is the key to your treatment success. Here is the fact! Invisalign works perfectly every single time and gives excellent clinical results, if you choose the right Orthodontist! An orthodontist who got his invisalign certification 10 years back and another orthodontist who has just got recently certified, are NOT equal in terms of expertise with the product. This is the reason why Invisalign awards, rates and certifies doctors according to the number of patients they have actually treated with Invisalign, to help the patients find an experienced provider in their locality!

The establishment of good functional occlusion and balance is important to prevent future TMJ problems. Your orthodontist will work on your clin-check software and try to get the best possible treatment finish and functional occlusion. It is not a secret that with experience, the orthodontist will be able to give better and better results with Invisalign & you simply have to find the right one for your treatment!

Can Any Dentist Do Orthodontic Treatment?

No! Orthodontic treatment must always be done by a highly trained and qualified Specialist Orthodontist, who has done an additional 3 years of specialization in the field of orthodontics after his graduation as a dentist. Dr Nazeer Ahmed is one of the top ranking orthodontist with more than 12 years experience in the field of orthodontics. He has a proven track record and has lot of international publications and research papers in reputed international journals like the Journal of clinical orthodontics and the World Journal of Orthodontics. You may rest assured that you are in the best hands when you decide to do your orthodontic treatment with us.

Why is Invisalign becoming popular in UAE?

It is simply due to the fact that they are almost invisible and highly comfortable. Nobody will be able to know that you are actually getting your teeth aligned by orthodontic treatment! Invisalign can correct your crooked teeth in a precise way, using the 3D software with minimal pressure and faster tooth movement. Freedom from poking wires and no unsightly metal to show others! No restrictions about which food you can eat. Simply remove them while eating. The best part is that there is no chance for food particles to get stuck on your aligners unlike regular braces. Maintaining oral hygiene is easy! No doubt why invisalign is so popular in Dubai.

What Are The Foods I Must Avoid When Having Braces?

When you are using removable aligners like Invisalign, you can simply remove them while eating. There are NO dietary restrictions when you have your teeth aligned with invisalign braces! You can eat all your favorite foods.

When you have fixed appliance, you must avoid hard food stuff and sticky foods. Hard seed or nuts can easily debond your brackets. Sticky food stuff like chocolates and chewing gum are better avoided while undergoing orthodontic treatment. Always cut your food into small pieces especially when you want to eat apples, raw carrot or cucumber. Always try to chew them with your back teeth.

Try not to bite into burgers and pull them with your front teeth as the braces might get damaged or the wire might bend out of shape. You can have soft foods like cheese, milk, yoghurt, cooked or steamed vegetables, fruit juice, cut fruits and cooked tender meat.

 

Should I remove teeth for orthodontic treatment?

Space requirement is the main criteria for deciding between extraction and non-extraction treatment protocol, when your orthodontist decides your treatment plan. If you already have existing gaps between your teeth, removal of good teeth will not be needed. If your dental crowding or protrusion is minimal, your orthodontist can do your braces treatment by arch expansion. Arch expansion is a way of gaining space by slow expansion of your jaws. If your crowding is too severe, then extraction of a few teeth to make space for the alignment of your remaining teeth might be necessary. Your orthodontist is the right person to take the decision for you after taking into consideration several factors including your skeletal & facial profile, occlusion and lip competence.

How to clean my teeth when wearing braces?

Maintaining good oral hygiene is extremely important to prevent “white spot lesions'” in orthodontic patients. These are decalcification spots in the enamel of your teeth which appear as localized opaque areas in your teeth. This is mostly seen in patients with fixed appliances with poor oral hygiene.

These white spots can progressively become yellow, brown and later black, if left untreated. That means, a white spot lesion has the potential to become a permanent dental caries or tooth cavity.

Luckily, these white spots are reversible! Your orthodontist will give you a fluoride containing mouth wash to prevent or treat these enamel decalcification.

You have a special “orthodontic tooth brush” to help clean your teeth when you have braces. Inter-proximal brushes are also available to clean in between the teeth or remove the food caught on the braces and arch wire. It is advisable to brush your teeth after every meal during the entire duration of your orthodontic treatment.

Removable appliances like Invisalign have an advantage over the fixed appliances mainly due to the ease of cleaning. In addition to that, you discard the old aligner after a few days and start using a new one. This minimizes the risk of cavities to a large extent. They are removable while brushing and eating. In patients who are prone to dental decay, orthodontists mostly recommend removable appliances for aligning the teeth!

What is the best age for braces?

Most of the patients get their braces after the age of 12, as by this time most of the permanent teeth have already erupted in your mouth. Early treatment might be needed in case of developing jaw problems and your orthodontist will give you a functional appliance for correction of the jaw problem.

Will braces make my teeth weak?

No. Braces will not make your teeth weak. You’ll feel that your teeth just a bit mobile after getting your braces, and you should know that it’s perfectly normal. In order to move your teeth gently into the right position, they have to first loosen just a bit. This is a physiological process known as bone remodelling. After your teeth have been positioned and are in the right place, that mobility will go away completely and your bone will become strong once again just like before your braces.

Do braces fix gummy smiles?

Orthodontic treatment can correct gummy smile and reduce the gingival show when smiling. The treatment of gummy smiles depends on the severity of the problem. Mild to moderate gummy smiles can often be treated with braces. Your orthodontist will do selective intrusion of your anterior teeth during the treatment. This reduces the gum show of the smile without shortening the teeth. For severely gummy smiles, your orthodontist may recommend a combination of braces and jaw surgery.

Should I use mouth wash when having braces?

Braces can pose a challenge as food particles can easily stick to your braces. Maintenance of good Oral hygiene is extremely important to prevent white spot lesions, dental caries or teeth cavity.

Fluoride mouth washes are regularly prescribed for orthodontic patients, to minimize the risk of dental caries in orthodontic patient. Chlorhexidine mouthwashes are sometimes recommended for patients having severe gum inflammation. However, understand that mouth washes are not a substitute for proper brushing. Good brushing habit after every meal is important during the entire duration of your orthodontic treatment, to prevent cavities and gingivitis.

What is a deep bite?

Deep bite is a condition where your upper front teeth bite too deeply over the lower front teeth. Your lower teeth might actually be impinging on the upper palatal gum area, causing trauma. This condition is most commonly seen in Class II skeletal condition, where your upper jaw is either normal or too forward and your lower jaw is too backwardly positioned.

Severe skeletal deep bite can even affect your facial profile and will reduce your facial height. It can also cause TMJ pain and discomfort at a later stage, if left untreated.

This skeletal problem can be easily corrected if identified at the growing stage. Your orthodontist might give a functional appliance or a removable appliance with an anterior bite plane to correct this deep bite problem. Deep bite can also be corrected during teenage or adulthood, but the process is more difficult and time consuming. Early intervention is always the best for deep bite correction.

What is an open bite?

Open bite is a condition where there is a gap between the incisal edges of your upper front teeth  and lower front teeth, when you occlude your back teeth. Your tongue will be visible through this gap when you speak or open your mouth. Inadvertent spitting of saliva is seen in these patients.

This open bite  condition is most commonly seen in patients with untreated mouth breathing habit, due to enlarged adenoids or airway obstruction. The vertical facial height is increased in these patients with possibility of future TMJ problems. Early intervention at the age of 8 years can correct this problem effectively.

I am 40 years old. Can I get braces?

It is possible to get your teeth aligned at any age. However, your bone support around the teeth must be adequate, for your teeth to with stand the pressure applied for moving your teeth. Your gums must be in good condition with minimum inflammation before starting your orthodontic treatment.

Is mild mobility of my teeth normal during braces treatment?

Braces are meant to slowly move your teeth to the right position to improve your smile. This process is gradual and takes months. It is normal to have shaky teeth while they get pushed or pulled into their new position. In the early days of treatment, some teeth may actually get pushed to a worse position. This shouldn’t be a cause of panic. The teeth are simply moved gradually without causing any periodontal problem.

Mild mobility of the teeth will be there for a few months following treatment, but will become stable after some time. In the final months of orthodontic treatment, the teeth should not move. If this occurs, you need to see your orthodontist quickly. In fact, all changes occurring to your teeth in the final month should be reported to your orthodontist.

Another expected change during treatment is the spacing out or overlapping of teeth. Of course, this shows that the teeth are moving. In the initial stages of braces treatment, it may appear that the treatment is worsening your condition, but that is not the case. The treatment is simply aligning them into a correct form. You have to be patient for the braces to fix your smile to perfection!

Do braces make my teeth yellow?

This is one of the most common doubt in the mind of many orthodontic patients. NO. Braces do not make your teeth yellow. With all the brackets and wires surrounding your teeth, it’s easy for plaque to build up in hard-to-reach places. That’s why it’s especially important for you to brush properly when you have braces. When plaque is left to sit on your teeth, your teeth start to decay, causing them to turn yellow. Good oral hygiene will prevent tooth discoloration during braces treatment.

Do braces leave marks on your teeth?

It can be prevented by good oral hygiene. While the risk of getting white spots is greater during braces, white spots (Initial decalcification) can occur even without orthodontic treatment, in the absence of proper brushing and dental care. However, they are reversible, if treated early. Your orthodontist will prescribe a fluoride containing mouth wash to prevent the white spot lesions.

However, remember that fluoride mouth rinses are NOT a substitute for good oral hygiene maintenance. You need to use your “orthodontic toothbrush” and maintain excellent plaque control. It is better to brush your teeth after every meal during the entire duration of your orthodontic treatment.

What are the parts of fixed appliance?

Brackets: 

The small metal, ceramic, or plastic attachment bonded to each tooth with a tooth-colored adhesive (Composite). The bracket has a slot that the orthodontic wire fits into.

Band: 

A metal ring, usually on a back tooth, that is cemented to a tooth for strength and anchorage. Today, you have freedom form bands after the advent of new generation bondable buccal tubes, which can be glued to the molar teeth.

Arch wire:

The metal wire that is attached to the brackets and used to move the teeth. They are made up of stainless steel. The new-generation arch wires made up of Nickel – Titanium, apply comparatively less forces on your teeth and make the treatment more comfortable for the patient.

Modules:

These are the small round elastics which help in holding the arch wire to the brackets. They come in different colors and can be replaced every visit. Kids love them and like to customize their braces color according to their mood and occasions. It is one of the fun part of your braces treatment.

What is the Angle’s classification of malocclusion?

Class I malocclusion:

A malocclusion in which the back molars meet properly, but the front teeth may appear to be crowded together, spaced apart, there my be an overbite, an openbite, a posterior (back) crossbite or an anterior (front) crossbite.

Class II malocclusion:

A malocclusion where the upper front teeth are protruding, or the lower teeth and/or jaw is positioned back relative to the upper teeth and/or jaw. The upper teeth appears to be protruding severely in this malocclusion along with lip trap or lip biting habit.

Class III malocclusion:

A malocclusion where the lower teeth and/or jaw is positioned ahead relative to the upper teeth and/or jaw. You can see mid face deficiency in a Class III malocclusion.

What is cross bite in orthodontics?

Upper back teeth are in crossbite if they erupt and contact inside or outside of the lower back teeth. Lower front teeth are in crossbite if they erupt in front of the upper front teeth. A crossbite can be a single tooth or groups of teeth. Posterior cross bite can be corrected by dental or skeletal expansion using expanders. You have slow-expansion appliances and rapid palatal expanders (RME). Rapid expansion is quite fast and can be completed with in a few months.

What is ectopic eruption?

Term used to describe a tooth or teeth that erupt in an abnormal position. Orthodontic treatment can move them to the right position in the arch.

What is the Forsus appliance?

It is used for correction of class II malocclusion. An orthodontic appliance made of a fixed spring mechanism that moves the lower jaw forward, usually to correct an overjet (protruding upper teeth). It can also be used as an anchor for other types of movements. The treatment duration with this appliance is around 8-12 months and is used in combination along with your regular fixed appliance or braces.

What is frenum?

Dental mid line spacing (Mid line diastema) is mostly caused by a thick and fleshy frenal attachment. The tissue attachment between the lip and the tongue or the lip and the upper jaw. A large frenum can cause spacing between the front teeth or cause the tongue to be “tied.” A large frenum can also cause the gum tissue on the lower front teeth to be pulled down. the surgical removal of the frenum is known as frenectomy.

How is orthodontics useful in implant patients?

An artificial replacement for a missing tooth/teeth. The process involves placing a metal post in the jawbone.. A crown is placed on the implant so that the patient is able to bite, chew and speak. Implants can be used to anchor a single tooth or multiple teeth. An orthodontist can create space or hold space open in the mouths of patients who may need implants to achieve good dental function. Dental implants cannot be moved by conventional orthodontic forces.

What is IPR in orthodontics?

IPR is also known as inter proximal reduction and is one of the methods of gaining space to align your crowded teeth. Removal of a small amount of enamel from between the teeth to reduce their width. Also known as reproximation, slenderizing, stripping, polishing, enamel reduction or selective reduction. They are one of the alternatives to avoid removing good teeth for orthodontic purpose. The other alternative is dental expanders to create more space with in the arch, to align the teeth.

What is a night guard?

It is a removable appliance worn during sleeping to prevent damage to the occlusal surface of the teeth due to clenching or “bruxism”.

Do you know teeth can move in response to pressure?

Some pressure is beneficial, however, some is harmful. Actions like thumb-sucking or swallowing in an abnormal way generate damaging pressure. Teeth can be pushed out of place; bone can be distorted. This movement is slow and can exist through out your life time. This is the reason why orthodontists advise you to wear your retainers at least once a week, even a few years after your orthodontic treatment is completed. The continuous pressure on the teeth by your tongue and lips apply enough force to move them slowly over a period of time. This must be understood before you decide to align your teeth with braces. The results need to be maintained with good effort on the patient’s part.

What is a customized smile design system?

Today, an orthodontist or dentist can use 3-D planning software to create a custom smile for each patient, using their facial and dental features as a guide. This technology also makes it possible for individuals to see the final results of what their smile will look like after orthodontic treatment, even before you start the treatment.

Using 3-D planning software and impressions of each individual’s teeth, we can create three-dimensional models of their dental structure. Wires and brackets can also be customized based on each patient’s specific needs. This offers better precision and ensures the best treatment result and dental occlusion in dental patients.

What are temporary anchorage devices (TAD’S)?

Temporary anchorage devices (TADs) are surgical-grade titanium miniscrews generally used for oral surgery. Now, orthodontists are also using them to control movement of teeth in the mouth. These devices provide a secure anchor in the jaw bone for molars and other teeth, reducing unwanted movement. They are useful in highly complicated malocclusions which require good anchorage for difficult tooth movements.

The procedure of placing TADs in a patient’s mouth is extremely simple and painless, because it only requires a small amount of topical anesthetic applied to the area. They will be removed by your orthodontist, after the orthodontic treatment is completed.

What is 3-D imaging by CBCT scanning?

Dental technology has improved today compared to a decade before with new advancements. CBCT scanning is one among them. They provide the dentist with a clear picture about the problem in your teeth and bone. Conventional dental X-rays provide only a hazy two-dimensional image which can sometimes be difficult to interpret. This means that the conventional dental X-rays are limited in their ability to view a patient’s dental structure.

With cone beam CT scanners (CBCT), however, an orthodontist can view three-dimensional images of a patient’s entire skull, jaw, and oral bone structure.

CBCT scanning provides clear and detailed images that can be manipulated and viewed from any angle. This makes it easier to pinpoint symptoms of dental problems, reach an accurate diagnosis, and customize orthodontic treatment for each patient.