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One of the most frequent doubts that patients face, before starting an Orthodontic treatment, is knowing what type of appliances they should use.
There are basically 2 types: fixed appliances and removable appliances.
The fixed ones are cemented to the patient’s teeth, while the removable ones can be inserted and removed by the person. Among the fixed appliances we can find brackets, anchor arches, expanders and habit breakers; and within the removable ones the aligners, retainers, active plates and functional orthopedic appliances of the jaws.
Among so many available options, it is normal to get confused and have great doubts about it. The intention of this post is to detail the function of each type of device, as well as its indications and limitations; so that you as a patient can actively participate in the selection of the most convenient treatment for your case, and on some occasions, avoid iatrogenias or erroneous procedures.
For Perfection: Brackets!
When it comes to straightening and aligning teeth, braces are the only devices capable of accurately moving them in all 3 planes of space.
So far, there is no other device that even comes close to the effectiveness of these devices. So if you are looking for perfection, show off a really attractive smile with your teeth precisely aligned; braces are for you.
The possibility of cementing appliances in each and every one of the teeth, the biomechanical control offered by their slots and the feasibility of making small bends in the wire arches; allow unique and precise control of tooth movement. Any other appliance will only offer the possibility of tilt movements, without greater control over the alignment and the final position of the teeth.
Regardless of the material with which they are manufactured (stainless steel, porcelain or sapphire crystals), all brackets offer the same advantages, except for some limitations inherent to lingual Orthodontics.
The other types of fixed appliances (anchoring arches, expanders and devices for the control of habits) do not serve to straighten teeth, and are only used as auxiliary resources during the course of treatment.
Aligners
The so-called “invisible orthodontics without brackets” is based on the use of a programmed sequence of transparent splints (removable), which little by little, are moving and displacing the teeth to the desired position.
This type of appliance is excellent for treating simple cases, without much crowding and without any major skeletal compromise. However, it offers great limitations when facing more complex cases or those that require dental extractions.
Orthodontics with Active Plates
Active plates are removable acrylic and stainless steel sheets or appliances that rest on the teeth and mucous membranes to move the teeth. They are similar to the removable retainers of a lifetime, but with other special wires and springs to push teeth.
These appliances have great limitations and very precise indications, so they do not allow large dental movements. Their usefulness is usually limited to correcting individual malpositions or small tilts.
Functional Jaw Orthopedics
Functional jaw orthopedics is a Dental Specialty of European origin that in theory diagnoses, prevents, controls and treats growth and development problems of our face and jaws; that is, skeletal malocclusions, eliminating any interference or alteration that prevents achieving a correct morphological balance of the craniofacial massif.
Although historically there has been great controversy between both specialties (Orthodontics and Functional Orthopedics), and it is not the purpose of this post to enter into it, it is important to clarify certain concepts that cause great confusion between patients and professionals.
Regardless of our professional criteria, functional jaw orthopedics is nothing more than the European version of Dentofacial Orthopedics, the branch of American Orthodontics that aims to modify growth patterns in children and adolescents with skeletal malocclusion.
But beyond the discrepancy of concepts, its philosophy is based on the use of removable appliances to modify the activity of the chewing muscles and make them favorably stimulate the growth of the jawbones. Within this Specialty, there are countless removable appliances made with acrylic and high-caliber wires, which are often installed with the promise that they will also straighten teeth.
Removable appliances of this type DO NOT straighten teeth, they have NO way of doing it, they CANNOT control tooth movement and their possibilities are clearly orthopedic; therefore, never expect them to offer you a definitive solution for your smile.
Similarly, their use in adult patients makes no sense, since there is no growth potential there will be no significant change. Adult patients need braces, and in some cases, Orthognathic Surgery, depending on the type and severity of the problem.
Retainers
As their name implies, they are devices to retain or maintain the teeth in a certain position.
There are fixed and removable retainers, and although small movements can be achieved with them, it is not desirable. Their function must be completely passive.
What Are Removable Appliances Good For?
For many things! Removable appliances often act as adjuvants or complements to the treatment with brackets. Among their most frequent indications we can found:
- Modification Craniofacial Growth and Development Through the various functional and Dentofacial Orthopedics devices, essential in the presence of skeletal alterations or malocclusions.
- Space Maintainers In cases of premature loss of deciduous teeth.
- Space Regainers To allow proper eruption of permanent teeth.
- Bite Planes To guide tooth eruption and/or allow correct placement of braces.
- Retainers To keep the teeth in their new position, avoid recurrence and guarantee the stability of the Orthodontic treatment.
- Expanders To increase the perimeter of the maxillary arch, increase the space available for dental alignment and correct crossbites.
- Habits Control To avoid the deforming effects of finger sucking, tongue thrusting, and other aberrant behaviors.
The fact that it can be inserted and removed by the patient himself, makes any removable device a system of intermittent or interrupted forces; very ineffective for moving teeth.
“Many Parents Place Removable Appliances on Their Children in the Hope that They Will Straighten Their Teeth, Without Knowing that the Use of Brackets Is Essential for This”.
DENTAL TIP
Trust Only Your Orthodontist!
Seeking the help of a true Orthodontic Specialist is the best decision you can make before starting your treatment.
The Orthodontist will be able to diagnose and explain you the dental problem in detail. Furthermore, he will surely converse with you and convince you that in most cases the choice of the device is not due to personal preferences, but to professional indications.
If your case is simple or your malocclusion is localized, probably an aligner or a removable appliance with springs will be able to solve it. If not, multibrackets therapy will be the indicated alternative.
Any removable appliance is capable of generating forces and tilting teeth, but none is capable of controlling movements and guaranteeing results. The displacement of a tooth in body or mass, is an exclusive power of braces.
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