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FAQ's About Orthodontics.

1. What is Orthodontics?
2. What is an Orthodontist?
3. How do I become an orthodontist?
4. Types of orthodontic treatment
5. Dento-facial Orthopaedics
6. How can jaw growth be improved?
7. Why are Hand-Wrist Xrays used?
8. How do teeth move through solid bone?
9. Fixed Appliances
10. How are braces fitted?
11. Fixed Expansion Appliance
12. Orthognathic Surgery
13. Potential risks & limitations of orthodontic treatment.


1. What is Orthodontics?

ORTHODONTICS is the speciality of dentistry dedicated to the straightening of teeth. Often the facial bones also contribute to poorly positioned teeth and treatment is directed to influencing the bone structures. This is called Dento-Facial Orthopaedics.




2. What is an Orthodontist?

Orthodontists are specialist dentists who provide orthodontic and dento-facial orthopaedic care. They have studied and trained in a full time University based and approved programme for at least two years further to their basic dental degree, and have to limit their practice exclusively to Orthodontics in order to be registered as specialists with the State Dental Boards.




3. How does one become an orthodontist?

1. Year 12 : a good Tertiary Entrance ( O.P.) Score
2. First Year Science
3. Dental Course starts in 2nd year at Uni…for 4 further years.
4. Graduate B.D.Sc.
5. Work 2 years in general dental practice
6. Study for Masters degree in Dentistry in Orthodontics : 3 years full-time
7. Graduate M.D.Sc.
8. Restrict practice to Orthodontics
9. Register with state Dental Board as a Dental Specialist (Orthodontist).
10. Enjoy the work! It is very interesting and challenging.



4. Types of orthodontic treatment

Four types of treatments are provided:

1. Dento-Facial Orthopaedic Treatments (functional appliances)
2. Dental Tooth Aligning Treatments ( fixed appliances (braces), and removable appliances.
3. Retention Treatment (invisibles)
4. Orthognathic - Orthodontic Treatment (braces in conjunction with specialist Oral Surgeons)

In my practice I use five main appliance systems:

Removable Appliance

Sagittal

Activator

Twin Block

Fixed Appliances

Part-Braces

Quad Helix

Retainer

5. Retainers (invisibles) Retainers are used for every client at the end of active fixed appliance treatment to assist in the stability of the final result.



5. Dento-facial Orthopaedics

BEFORE (Front)

AFTER (Front)

BEFORE (Side)

AFTER (Side)

Orthopaedic Activator

Twin Block Appliance

RMEA

6. How can jaw growth be improved?
If the lower jaw is "undershot" with growing children it is often possible to encourage more forward growth and positioning of the jaw using Dento-Facial Orthopaedics. The trick is to change the direction of action of the lower jaw muscles so that normal function is carried out in a more normal forward position. Maximum client cooperation is essential for success, and the normal Twin Block appliance used can prove most beneficial.

BEFORE

AFTER

In a non-growing adult, such appliances cannot work, and the orthodontist either accepts the incorrect jaw positions, and aligns the teeth in an attempt to disguise the underlying jaw relationship, or else works in conjunction with an oral surgeon for a combination orthodontic and Orthognathic Surgery treatment approach.






7. Why are Hand-Wrist Xrays used?

As the finger and wrist bones develop in a rather standardized manner, it is possible to tell approximately where a child and adolescent is at with their general growth development.

Of particular interest is being able to determine where an person is in relation to the adolescent growth spurt period , as this often influences the timing of certain orthodontic treatment procedures.





8. How do teeth move through solid bone?

It seems almost a miracle, but when a very gentle constant pressure is applied to a tooth... the tooth moves through the solid bone. Teeth are not attached to the actual bone, but are suspended in a bone socket by gum fibres. When the tooth is pressed on constantly by an orthodontic wire, the gum fibres are compressed on one side and the bone actually disolves.

However, on the other side of the tooth, the gum fibres are stretched and this causes new bone to form... hence the bone socket constantly alters as gentle pressure is applied to the tooth. Our bones need a certain amount of functional pressure in order to be regenerated properly… after all, every few months all our bones are replaced . This is the reason astronauts return from space after weeks of weightlessness with thin, less dense bones. Our bones respond to functional stimulation. See How my Twin Block Works.



9. Fixed Appliances

Fixed Appliance

1: Small stainless steel brackets
2: Small GOLD brackets
3: CLEAR ceramic brackets
4: INVISIBLE stainless steel brackets placed BEHIND the teeth.

Various combinations of the above can be utilised: eg. Clear ceramic on upper teeth and stainless steel on lower teeth.


10. How are braces fitted?

Braces consist of stainless steel brackets bonded to the teeth, to which are attacked flexible Archwires. The brackets may be direct bonded to the teeth using 21st Century adhesives cured by an ultra-violet light.

Alternately, the whole set can be indirectly bonded as follows. Impressions are taken of the teeth and the braces are placed into the correct positions on the dental cast. This is done in the laboratory between appointments, and takes several hours. When the client returns a week or two later, the braces are sitting in Transfer Trays. The teeth are cleaned and dried, special glue is placed on the teeth and the transfer trays are inserted for several minutes. When the trays are removed, all the brackets are glued to the teeth in the positions Dr Costello arranged in the laboratory.

The Arch Wires are then placed, and the teeth commence moving. The client is seen about once each 6 weeks during the treatment stage.



11. Fixed Expansion Appliance

Up until mid to late teens the upper jaw consists of two separate growing halves separated at the midline. As an adult the two halves fuse into one solid bone. While the two halves are separate, it is possible to orthopaedically move them further apart and thus widen the upper jaw process. The widening can take several months, and the appliance is left in place for support while new bone develops. It is usually removed after a further 6 months.




12. Orthognathic Surgery

Before > After

When an adult has the jaw and facial bones out of alignment , the teeth often cannot be repositioned into correct relations with each other for optimum function and appearance. Some such patients require the assistance of an oral surgeon to improve the overall alignment of the jaws.

The orthodontist aligns the teeth to be in harmony with the overall improved jaw relations. Some jaw alignment problems in growing children, however, can often be corrected with Dento-Facial Orthopaedic treatment.



13. Potential risks & limitations of orthodontic treatment.

The benefits of orthodontic treatment are obvious, from improved self-esteem, from the new radiating dazzle smile, to the rather mundane benefit of having teeth that are much easier to clean and maintain. However there are some potential downsides:

The three most common risks are entirely preventable. They apply to every orthodontic client , with no exceptions:
1. Poor Oral Hygiene can lead to gum infection and to permanent white marks (decalcification) on the teeth.
2. Eating incorrectly almost always causes breakages of appliances. Hard and sticky foods can break the appliances off the teeth. Breakages can cause treatment blowouts adding many extra months unnecessarily to treatment times.
3. Failure to wear Retainers as instructed does not permit the teeth to remain in their treated positions. I suggest you read about Retainers.

There are other problems which can sometimes occur, although in over 30 years of practicing orthodontics I can honestly count their occurrences on the fingers of one hand. I include:

Root Bluntening: fore-shortening of the roots as a pathologic response to tooth movement
Jaw Joint Problems: Most such problems however are stress related, rather than being related to particular tooth positions. It is however important that the teeth and jaws close together in harmony.
Tooth Vitality: Previous trauma sometimes so damages the tooth nerve and blood supply that routine orthodontic movement renders the tooth becoming non-vital. Routine endodontic treatment with one's dentist can rectify any such pathology and possible discoloration.
Atypical Growth: sometimes renders the attainment of a normally relating set of teeth impossible. For this reason, many orthodontists delay treatment for suspected poor growers until growth is almost complete, in an attempt to minimize such surprises.
Ceramic Brackets: Modern translucent clear ceramic brackets are available , and are usually restricted to the upper teeth of older teenagers and adults. ( Tom Cruise was fitted with them in 2002 ).Technically they are more fragile and bulky than routine modern stainless steel. As teenagers often find it difficult to cope with the even more stringent care required to prevent ceramic bracket brackages, Dr Costello tends to recommend them only for mature adult clients. Fees are usually several hundred dollars greater than with regular stainless steel.

Extended Treatment Times: are usually completely under the control of a client. Provided breakages are kept to a minimum, and the teeth and gums are kept perfectly clean and healthy, orthodontic treatment proceeds at maximum speed.

General Medical health problems can affect your orthodontic treatment. Please keep Dr Costello informed about any changes in your medical health.