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Braces

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A brace is a dental apparatus used for making corrections to the jaw and repositioning malaligned teeth, and this branch of dentistry is called orthodontics. We differentiate between fixed braces and removable appliances. In the picture, one can see a fixed brace on the inner surfaces of the teeth, called a lingual brace, and here one can see a classical fixed brace on the outer surfaces of the teeth.
Material used for the brackets comprising fixed braces ranges from stainless steel to titanium, plastic, and transparent ceramic. The brackets are glued to the teeth after the enamel has been etched. These brackets serve to anchor a wire that pushes the teeth into the desired position. Metal brackets and wires are clearly visible, whereas ceramic brackets of the same color as the teeth and a teflon-coated wire make their appearance less obvious.
With regard to removable appliances, we differentiate between active appliances for minimal dental movement and functional appliances. Functional appliances are primarily used to support the growth of the jaw as well as correct functionally impaired musculature; tooth movement is only a secondary purpose.
The use of removable appliances only makes sense for children who are in the growing phase. With adults, a permanent working force is important, and this is only possible with fixed braces.
A relatively new product is the aligner, made of transparent plastic. Aligners do not have any adjustable elements, unlike classic braces. After an impression has been made, transparent plastic rails are manufactured and worn in sequence for 2 weeks each. For a treatment timeframe of 9–18 months, up to 36 rails are required. Not all tooth movements are possible with aligners, e.g., tooth rotation. In particular, the position of malaligned teeth such as rotated canines decreases the predictability of treatment with aligners. The advantage of aligners is that they are easy to remove while eating or brushing the teeth. In addition, they are hardly visible and do not affect one’s speech.
Irrespective of the apparatus used, chewing causes pain for approximately 3 days after insertion. It may also cause irritation of the oral mucosa, and in some patients, it may frequently cause aphtous ulcers.
Most malaligned teeth are corrected within 1–2 years or a maximum of 3 years. After treatment is complete, a retainer is sometimes inserted in order to avoid potential movement of the tooth to the original, incorrect position, especially when optimal occlusion (Class 1) has not been achieved.
Alternatives to fixed braces or removable appliances depend on the indications. If incorrect positioning of the tooth is only an esthetic issue, orthodontic treatment should be reconsidered. An alternative in this case could be veneers.
With an experienced practitioner, the risks associated with orthodontic treatment are negligible. Nevertheless, complications occasionally occur, at times necessitating further measures. With every additional measure, there is a further possibility of complications that can even progress to becoming life-threatening. Complications specific to orthodontic treatment are as follows:
root resorption because of excessive forces or excessive tooth movement
calcification stains after removal of brackets
recurrence of tooth movement after removal of braces

Fortunately, because of positive developments in the field of medicine over the last few decades, such complications have become very rare.

Braces