What happens after Orthodontic Braces Treatment?

Posted on February 4, 2011 in Dental Articles

There is a common misconception that orthodontic (braces) treatment is completed once braces are removed. This is not true because like any other treatment, it requires continued care and maintenance to prevent relapse and to maintain the general health of the teeth and gum.

 
Retention after Braces
 
PictureAfter the completion of orthodontic treatment, it is essential to follow it up with orthodontic retainers to ensure stability of the results. This is because during orthodontic treatment, crooked teeth are straightened by stretching and compressing the fibres around teeth. These fibres essentially hold teeth in position and orthodontic wires manipulate the lengths of fibres, hence altering the teeth position. While it is easy to straighten teeth, it is hard to maintain them in the straightened position as the fibres contain elastic memory and tend to return to their original lengths especially if the teeth were very crooked or needed a lot of movement in the first place. This is where retention plays an important role to hold these teeth in place after treatment. Orthodontic retention allows the fibres to reorganize in their new position and ‘reset’ their memory. This generally takes a year or more, some even recommending a longer period. Hence it is important for clients to comply with their
 
Types of Orthodontic Retainers
 
PictureThere are several types of retainers, in the form of wires, elastic thermo-plastic moulds, acrylic plates or a combination. They can be either fixed or removable. Depending on your condition, your dentist may recommend you to use one or the other or both together to maximize retention. These braces retainers are designed to hold the teeth in place, preventing tooth movement. Generally, for the first 6 months after orthodontic treatment, retainers are generally worn all day except during meal times and brushing. After that, the retainers are worn only at night. The retention period is a minimum of a year but it is highly desirable to continue wearing retainers as teeth can still move. This is especially true in young adults where late lower jaw growth can cause movement of lower front teeth, and also in cases where marked correction of teeth position was done, resulting in crowding or crooked teeth again.
 
Periodontitis or bone loss around teeth
 
Preventing gum disease and tooth decayIt is especially important to continue maintaining good oral hygiene practices to keep the teeth and gums healthy and to prevent decay or gum disease. Accumulation of plaque around tooth close to the gums can cause inflammation of the gum tissues. This can lead to gingivitis where gums become irritated, swollen and bleeds easily. While gingivitis does not compromise the results of orthodontic treatment, in a susceptible individual, gingivitis may progress to periodontitis which affects the supporting structures of the tooth. Periodontitis is associated with loss of soft tissue attachment and bone around the affected teeth.  This leads to the gum recession, and more importantly, the lost of support for the teeth, resulting in  loosening of teeth and they may start to move, therefore compromising the treatment outcome. Continued regular visit to the dentist every 4-6 monthly is important.
 
Prevent trauma impact to the teeth
 
PictureAnother important aspect of post treatment care is to prevent trauma to orthodontically treated teeth due to the increased chance of pulpal death ofthe teeth. Pulpal death means there is no blood to carry nutrition to the teeth, hence causing them  to loose vitality, or become dead. Pupal death will lead to darkening of the teethand possible infection, requiring futher root canal and prosthodontic (crown) treatment for the teeth. It is therefore advisable for patients to wear mouth guard especially if they play contact sports to minimize impact to their teeth.
 
 Prevent Wisdom Tooth Development from affecting Orthodontic Treatment
 
PictureWisdom teeth crown starts forming from 10-18 years old, and the roots complete from 18-25 years old, showing visible eruption in the mouth. Because most of the wisdom teeth do not erupt vertically and there is not enough space for them, when the wisdom tooth erupts, it can produce a mesial (front direction) pressure leading to crowding of the lower front teeth. It is thus advisable to remove wisdom teeth between 15-18 years old before the roots have formed completely. This sometime necessitates removing the wisdom teeth even before the braces are removed. Removing impacted wisdom teeth will help to reduce the chance of relapse