Phase I - Bonding of the Brackets
Bonding of the orthodontic brackets to the teeth is widely used in modern orthodontic treatment. It has many advantages to the patient. It is a painless procedure. Brackets can be placed very quickly and does not require separators and provides positive protection of the tooth under the brackets. However, the patient must be very cooperative while the brackets are placed. A clean dry tooth surface must be present. The patient is requested to take the prescribed tablets for mouth dryness prior to the bracket placement visit. The tongue must be kept still; jaw movement can cause trouble. A sudden force on the bracket can cause the bonding material to separate from the surface of the tooth, releasing the bracket. This force may come from clinching teeth together or trying to crack ice or hard candy or forceful chewing and other unrestrained jaw functions.
Should a bracket be broken from a tooth, please save. if possible, and return to the office.
Should a bracket be broken from the tooth after the arch system is placed DON'T TRY TO REMOVE THE BRACKET - it will stay near its original position. Don't touch or destroy the arch system - fingers MUST be kept out of the mouth.
Active orthodontic treatment starts when the arch systems are placed.
Phase II - Debonding and removable appliance wear
Debonding is done when the patient is ready for the next phase of the orthodontic treatment. This varies greatly with each patient, ranging from a few months to several years. The patient IS NOT finished when the fixed appliance is removed, but MUST wear removable appliances for continued tooth alignment, space closure and to allow for bite settling.
Debonding (when the fixed appliance is removed) requires more time than placing the appliance. Each bracket must be removed individually, while in placement, the brackets of each arch are placed at the same time through the use of a transfer tray. A special removal instrument is used to grip the bonding agent and bracket, causing the bonding material to separate from the tooth. During this procedure, discomfort may be experienced if the teeth are sore. Usually the bracket and bonding material come off together. However, small pieces of bonding material may require individual removal, done at the same visit or later visits. Some gingival (gum) irritation is usually present. The patient should massage the gingiva with a tooth brush each evening to hasten shrinkage and tightening of the gingival tissue.
When debonding has been accomplished the teeth are cleaned and an impression is taken. The impression is used to supply the model for a removable finishing appliance.
During this second phase, complete cooperation of patient is required. Instructions MUST be followed exactly. The removable appliance is worn night and day except while eating. Each visit the appliance will be inspected to determine if adjustment is necessary to continue improvement. Sometimes a removable appliance, called a tooth positioner, may be used at night and up to four hours during the day. A tooth positioned is especially useful to improve the bite relationship and settling all the teeth in good function.
Eventually no further improvement is anticipated and the retainers may be worn at night for several years. However, some severe problems that are subject to reoccurrence, may require night wear, indefinitely.
Phase III - Retention
Holding teeth from rotating, spacing and holding the arch shape is the work of the retainer. A removable appliance may become a retainer when it is no longer producing active movement. A retainer can be removable, fixed or bonded (cemented to certain teeth). Fixed retainers are replaced by removable retainers at some period. Retainers MUST be worn as instructed. Five years of night wear is not unusual and some patients must wear retainers indefinitely. Retainers must not be worn if they accidentally become bent. Additional fees will not be made for retainer adjustments. An additional fee will be required for retainers that are remade due to loss or if broken beyond repair. A fee will be necessary for repairing a broken retainer if the contract period has expired. Also, a fee will be charged when the retainer has to be remade be- cause lack of wear has caused it not to fit.
The years following orthodontic treatment
Some change in tooth position always occurs when the patient no longer wears a retainer. These changes are slight and usually require no further treatment. However, the position of teeth are greatly influenced by breathing, the chewing habits, tongue thrusting and abnormal swallowing. lf objectionable changes occur, the patient should be examined for possible additional treatment. Retainers can be worn, at night, over a long period of time to control recurrence of extreme problems.
During the years following orthodontic treatment, if the retainers don't seem to fit properly, the patient should return to the office for retainer adjustment.