Dr. Kapil Uttamchandani

A generation ago, we would not see so many adolescents with braces as we do currently. Orthodontics, the branch of dentistry involved in the use of braces to align and move teeth to form that perfect arch, has seen rapid advancements in the past few decades and continues to grow at a rapid pace.
The fundamental principle is that the teeth is held in place by surrounding elastic tissues, and minor constant forces can be applied to align them better. Small metal brackets are applied on the teeth and a wire is passed through them so that there is a constant force on the teeth. The amount and direction of force is managed by the doctor. The younger the age, the more elastic the tissue is, the easier it is to move teeth.

There are two main things to understand in terms of your options, relation of age with orthodontic treatment and the choices of braces.

Firstly, correlation with age. Over the years, more people in their 20s and early 30s are choosing to have braces. Though the teeth and more importantly the surrounding periodontium become less elastic with age, the amount of force exerted is increased and therefore tooth movement is enabled. Also, in older patients, tooth removal may be required more frequently to make space for proper alignment.

Secondly, the choices of the braces:

1. In the earlier days, bands were placed around the teeth and a wire was then connecting all these bands to enable tooth movement. Gradually, this made way to small brackets being placed on the front surface of the teeth, and a wire running through it and elastic bands connecting the bracket and the wire. This is the most effective way of moving teeth, though not esthetic. To make it look different, the ligatures could be colored.
2. For people who are constantly in the public eye, the metal braces were a deterrent and so lingual braces became popular. The brackets are applied on the inner surface of the teeth and are not seen easily. The amount of force here varies from the earlier one, and not all conditions can be treated by this method.
3. The next development was the development of ceramic braces, which are also applied to the front surface of the teeth and can be used in most cases. These are more expensive than the metallic braces.
4. Removable aligners is another option, which are trays which need to be worn for close to 18 hours a day to induce tooth movement. This is esthetic and no metal shows during talking or smiling.

So, if you want to improve your smile, visit your dentist and find out how!

Root canal therapy (RCT) followed by a crown is the most common mode of treatment for severely decayed teeth. However, this is not devoid of failure. In another case, if a tooth could not be salvaged by RCT, then extraction followed by a bridge (replacing the removed tooth with support from adjacent healthy teeth) became the next best option.

In both cases, especially latter, healthy teeth are being manipulated to support the tooth being replaced. The next quest was to work without touching the sound tooth. So, instead of taking support from adjacent teeth, thought was given to provide support from within the bone very similar to how a natural tooth stands. The lost root is replaced by a compatible metal, on which a tooth crown is then built. This was the beginning of dental implants, which has gained significant popularity over the last two to three decades.

Advantages:
1. Does not affect adjacent healthy teeth
2. Functionally better, as it has stronger support from the bone
3. More aesthetically appealing
4. Maintain facial bone and soft tissue structure
5. Better for the gum health compared to bridges
6. Easier oral hygiene practices

Mechanism:
A strong, biocompatible material is used to make screws, which are inserted into the bone. Titanium is the most preferred material, and because of its unique property of osseo-integration (fuses with the bone), it fuses with the bone to reduce bone loss after the tooth is gone. In most cases, the titanium screws, which act as the root for the implants are placed into the bone and allowed for some weeks to few months to fuse with the bone. Then, an interim crown may be used until the screw is ready to take on an implant. The screw is periodically monitored and once it is completely accepted, then an abutment is placed on it. This acts like a stump or a root, over which a crown will be placed.

Though most implants are done for replacing single teeth, in many cases, multiple teeth may be replaced using abutments. If the missing teeth are adjacent to each other or in the same quadrant, then a denture might be overlaid over the abutments. Alternately, a partial denture may be used which is screwed over an abutment.

Maintenance:
Regular brushing and flossing, rinsing and mouthwashing assume a greater significance in patients with implants. Also, regular visits to the dentist are a must.

Dental implants are a boon for missing teeth, with the various advantages. However, it is not for all, with excellent bone health being one of the prerequisites. A thorough dental examination will help determine if you are a right candidate. Visit your dentist to find out more.