Orthodontics and Dentofacial Orthopaedics in Germany

Orthodontics — a comparatively young field of dentistry — developed in the 1970s and 1980s. German aesthetic orthopaedic dentistry is a rapidly developing branch of medicine that offers innovative treatment methods, outstanding service and quality guarantees.

Orthodontists treat developmental defects of the teeth and of the maxillofacial skeleton. Because of crooked teeth and a misaligned dental arch, teeth are sometimes difficult to keep clean, are at greater risk of early caries and periodontitis, and can place additional strain on the maxillofacial muscles during chewing, which in turn leads to headaches, temporomandibular joint (TMJ) syndrome and pain in the neck, shoulder and back. Crooked teeth and a misaligned dental arch can also have a negative effect on a person's appearance and lead to psychological problems.

High-quality orthodontic treatment does more than improve your oral health and appearance — it also gives you a wonderful smile.

Only a dentist or an orthodontist can determine whether orthodontic treatment is indicated. They make the diagnosis on the basis of a clinical examination and special dynamic radiography or dynamic MRI, and then decide whether orthodontic treatment is required and draw up a plan for it.

Orthodontic treatment is indicated for the following conditions:

• distal occlusion, in which the upper front teeth sit far ahead of the lower ones;
• mesial occlusion, in which the lower jaw protrudes forward while the upper jaw is far less developed;
• crossbite, which is characterised by poor development of one side of either jaw, so that the upper teeth do not close slightly in front of the lower ones as they do in a normal bite;
• open bite - a gap that forms between the upper and lower rows of teeth when the jaws are closed;
• tooth dystopia — a bite anomaly in which teeth of the upper and lower rows are not in their proper place in the dental arch and are displaced sideways from their normal position;
• dental arch defects — gaps and unfilled spaces in the dental arch that arise from tooth loss or from the teeth "filling" the oral cavity incorrectly;
• crowding — the presence of more teeth than can be accommodated in the dental arch with a normal bite.

How is orthodontic treatment carried out?

Special orthodontic appliances change the position of the teeth in the dental arch, while also normalising the function of the facial muscles and the development of the jawbone. These appliances exert moderate pressure on the teeth and jaws. Guided by the complexity of the case, the doctor prescribes the most effective course of orthodontic treatment. The treatment plan is always tailored to the individual case.

Fixed appliances

Braces are the most common of the fixed orthodontic appliances. They consist of the brackets themselves, archwires, ligatures and elastics. The brackets are attached to the teeth with a special adhesive, and the elastics are fastened to hooks on the brackets. The archwire is inserted into the slots of the brackets, and the ligature holds the wire in the slot. Through the brackets the archwire transfers pressure to the teeth, also allowing the dental arches to be moved towards each other until they close completely. Braces are usually adjusted once a month, and reaching the treatment goals can take from several months to several years. In recent years braces have become lighter and less noticeable, with far fewer metal parts. They are made in colours for children, or almost transparent for adults.

Types of braces:

• metal braces: these systems are considered the most popular among patients, because they work faster and cost less; despite the obvious advantages of this material, it does have one significant drawback: metal braces are far more noticeable than appliances made of other materials;
• ceramic braces: these braces are less noticeable thanks to their white colour; however, the natural shade of tooth enamel is darker, so whitening can be carried out before the orthodontic system is fitted, while professional cleaning is a mandatory requirement before treatment begins;
• sapphire braces: the sapphire is produced specially in the laboratory by dental technicians and has a semi-transparent colour, but it is not as strong as metal, for example; certain precautions should therefore be observed while wearing such braces;
• polymer braces: this material is made of a special plastic and is considered the least noticeable, but over time it may become stained by strongly coloured food and drink.

Space maintainers are used when milk teeth are lost early, in order to preserve free space for the permanent tooth to erupt. A loop is attached to the tooth that remains on one side of the space, and a wire arch is fitted onto the tooth on the opposite side of the space.

Removable appliances:

These take the form of a plate for the upper or lower jaw and have become an alternative to traditional braces for adults; they are practically invisible and can be taken out for eating and for brushing the teeth.

Removable space maintainers perform the same function as fixed ones. They are made of acrylic that covers the dental arch and are fitted with plastic or wire extensions that hold the spaces between particular teeth.

Most people have bite anomalies to some degree. Uneven positioning of the teeth and jaws is determined genetically, so it cannot be prevented. What prompts a visit to an aesthetic dentistry practice is the negative effect an abnormal bite has on the patient's well-being and appearance.

Various methods of bite correction are practised in Germany. For a minor deformity, wearing a removable brace is recommended. This method is suitable for children aged 6-12. In adult patients, jaw defects are more pronounced. In such cases fixed braces are appropriate. No less effective and more aesthetic are the "invisible" appliances — clear aligners and lingual braces.

Dentofacial orthopaedics, bite correction

Prosthetic dental treatment

Treatment of this kind is necessary in cases where more than half of the tooth has been destroyed. Dentofacial orthopaedics uses the following types of fixed prosthesis:

• the stamped crown, made of a stainless alloy or of precious metals; it is fixed with cement and fits the tooth poorly;
• the cast crown fits the tooth better than a stamped one, is less traumatic and highly durable (up to 10-12 years);
• the gold crown is considerably softer and therefore fits the tooth perfectly; it rarely breaks and does not wear down the opposing tooth; as a rule it is placed on the back teeth so as not to spoil the attractiveness of the smile;
• the all-ceramic crown is translucent and therefore looks more aesthetic; the material does not darken over many years; among its disadvantages doctors point to low wear resistance; such a crown is not suitable for the chewing teeth;
• the metal-ceramic crown — a metal framework up to 0.5 mm thick covered with a layer of ceramic; the average service life is about 8-10 years.

About bite correction and ways of straightening teeth

An abnormal bite is an obvious pathology, clearly visible when the dental arches are closed; the upper jaw may be pushed out over the lower one or vice versa; with a deep defect, the upper dental arch is overlapped by the lower one.

With an abnormal bite, the load on the jaw is distributed unevenly. During chewing the teeth wear down severely and become more susceptible to infection. The teeth become mobile, which can lead to periodontitis. In addition, poor chewing overloads and harms the gastrointestinal tract. Food debris that accumulates on uneven teeth leads to the development of caries.

Correction of a distal occlusion (the upper jaw is pushed forward) is recommended because of the various disorders it causes: speech defects, difficulty swallowing, incorrect breathing and destruction of the teeth.

Correction of a malocclusion without surgery is achieved with various orthodontic appliances:

• trainers — silicone appliances worn at night; they are comfortable to wear, easy to care for and inexpensive; they are used for minor deformities of the jaw;
  aligners are made of bioplastic or biosilicone; they solve problems with jaw displacement, speech disorders and nasal breathing;
• braces — the most affordable and popular appliance for straightening teeth; braces are recommended for children over 11 years of age and involve constant wear for 1-1.5 years; the appliance is made of metal, ceramic or plastic.

Surgical bite correction

Surgical bite correction is recommended for speech defects, difficulty swallowing, discomfort when chewing and significant displacement of the jaws. It is strictly contraindicated in patients with diabetes mellitus, impaired blood clotting, and infectious or dental diseases.

Preparation for surgery begins with computer modelling of the facial bones — the creation of a so-called "sketch" of the ideal jaw, which is needed in order to carry out the surgical procedure. The operation comprises the following stages:

• administration of general anaesthesia;
• making incisions inside the mouth;
• placing the jawbones in the ideal position and fixing them with plates and screws;
• applying a splint to fix the jaw for 2 weeks.

The operation lasts from 1 to 6 hours, depending on the degree of jaw displacement.

The rehabilitation period includes:

• taking antibiotics as a preventive measure from the first day after the surgical correction;
• applying a pressure bandage to the cheeks and chin for 24 hours immediately after the operation. While it is worn, you must not eat, blow your nose or open your mouth wide;
• two weeks of monitoring;
• the stitches are removed after 14 days and the screws after 3-4 months.