The fixed braces

introduction

Since more and more importance is attached to the appearance nowadays, most people want perfect, straight and beautiful teeth.

People who do not naturally have this have the option of one orthodontic treatment and have irregularly grown teeth brought into the correct position.

Braces are appliances that are used in dentistry to correct misaligned jaws and teeth and thus improve the aesthetics and functionality of the jaw.

Braces are available in different variations, one speaks of fixed braces, loose braces and even "invisible" braces.

Especially in the case of severe misalignments and / or orthodontic treatments that started late, it makes sense to have a fixed braces to use.
Fixed braces are a Dental device that is used to correct jaw and tooth misalignments, but cannot be removed from the oral cavity by the patient himself.
It remains in the mouth for the entire duration of the treatment and must be adjusted by the orthodontist at regular intervals.

Basically, a distinction is made between appliances that lie entirely within the mouth (intraoral appliances), of those that are partially outside the oral cavity (extraoral appliances) must be attached.

Braces located purely within the mouth are so-called multiband or multibracket devices that are glued directly onto the tooth.
These appliances can be made of titanium, plastic, or, in some cases, clear ceramic. In the middle of each bracket there is a narrow opening through which a wire that triggers tooth movement is threaded. The strength of the wire increases steadily in the course of the treatment, so that more force can act on the teeth to be moved.

Fixed braces have the advantage that they remain permanently in the oral cavity and thus the wearing time can usually be shortened. Especially with children, this treatment method is a lot less stressful. In addition, they are usually the only effective way of correcting misaligned teeth and jaws in older patients.

Indications for braces

The indications for braces are very diverse. In most cases a deviation from a healthy one, the so-called "eugnathes“Denture present, which describes that there is a misalignment of the teeth. The word misalignment can be interpreted in many ways.

One reason could be a variation in the number of teeth, either with too many teeth and too small a jaw, or with too few teeth that create gaps in the teeth. If teeth are missing and they are not genetically created, the specialist speaks of Non-investments. Furthermore, the teeth can also vary in shape, so that the bite is misaligned and the person affected has difficulties biting, speaking and eating. Another indication for fixed braces are gaps. With the braces, the teeth can be moved in such a way that an existing gap is closed or a gap is created. The orthodontist deliberately allows a gap to be larger or created so that an implant can be placed there if there is not enough space or the gap is too narrow. Other misalignments as an indication for fixed braces are malocclusions like this Crossbite, of the open bite or the deep bite. Malformations of the jaws that make the lower or upper jaw too small are also indications for fixed braces. In addition, for more and more adults the indication for fixed braces is already given for aesthetic reasons, which are caused by the Lingual technique can be solved almost invisibly. With the lingual technique, the brackets are attached to the inside of the teeth; these move the teeth almost invisibly to the surroundings. Thanks to the modern possibilities in orthodontics, the number of adult patients who only want their teeth to be shifted for aesthetic reasons is increasing. Even patients who failed to do so in their youth or who abandoned a therapy that had already started want to have straight, beautiful teeth in adulthood.

The severity of the misalignment is determined by the orthodontic indication groups.

When does an adult need fixed braces?

The trend that adults want to have their teeth straightened again or for the first time is increasing and meanwhile every third patient with an orthodontist is an adult. In most cases it is about aesthetic reasons. Patients want their own teeth to be as beautiful as possible and that includes a straight position. This applies primarily to patients whose orthodontic treatment in childhood did not bring the desired success or whose teeth have subsequently shifted.

Patients who have never received orthodontic treatment develop a different medical awareness in adulthood, in which the teeth only then become relevant. As a result, orthodontic treatment is initiated after the fact. A fixed Braces are necessary for adults if teeth not only have to be moved horizontally or vertically, but also rotated. Rotational movements are often only possible with a fixed appliance.

Another cause of fixed braces in an adult's permanent set of teeth is the creation or closing of a gap. For example, if a tooth is lost and has to be removed, most patients want implants as a treatment option. However, if the existing gap is too narrow to insert an implant due to tilting of the neighboring teeth, the gap must first be enlarged. Fixed appliances are used for this.

You might also be interested in that: Braces for adults

How long do you have to wear fixed braces?

The length of time it takes to wear fixed braces varies depending on the severity of the application and the condition of the patient's teeth. Many factors play a role here.

Some medications affect the speed of teeth sliding. This is particularly important in adult treatment. Medication like Bisphosphonates in osteoporosis, teeth move faster while others slow it down.

The average wearing time of a fixed one is around one to three years, but it can also be faster or slower depending on the impact of the therapy. The duration of the therapy is planned by the practitioner so that the patient has an overview and can assess how long the treatment will last in the individual case. However, there is no guarantee for this planning time, so it represents a rough framework.

What are the costs for fixed braces?

The costs for fixed braces can quickly exceed a thousand euros and private and statutory health insurances do not always pay a portion of the treatment costs or even the full amount.

Until the age of eighteen, orthodontic treatment with fixed braces is usually covered by the statutory and / or private health insurance companies, but in certain cases it is also possible that the insurance companies bear at least part of the treatment costs for fixed braces after the age of eighteen .
This is particularly possible if an accompanying surgical therapy has to be carried out in addition to the actual treatment.

The statutory health insurance only pays for the basic equipment, i.e. the simplest and largest brackets made of metal and steel arches. Since the standard brackets are relatively large, they are undesirable for many patients, as there are more delicate models that are not so noticeable.Every special request for other variants and models involves additional costs. Flatter, smaller brackets with rubbers or self-alloying without fastening aid are more expensive, and other materials such as ceramic or gold also cost more. The following applies the more inconspicuous braces should be, the more expensive will she. The lingual technique is almost the most expensive because here the brackets are individually manufactured and attached to the back of the teeth. This makes these fixed braces almost invisible to the environment.

Read about it too: Braces behind the teeth

In general, adults do not assume anything for orthodontics, it is a purely private service - unless the misalignment is so serious that orthodontic therapy alone is not sufficient and orthodontic and orthodontic surgery has to be carried out. In such cases, the costs are usually borne by the health insurance companies.

For example, the contribution to the total treatment for the treatment of children is 100-500 euros, while adults have to pay 3000-6000 euros.

What does the statutory health insurance fund?

The statutory health insurance only partially pays for orthodontic treatments. It either pays the entire cost or a portion of it. The guidelines are strict. For example, with an enlarged front tooth step, the so-called overjet, the statutory health insurance only pays something from a distance of 7mm; all smaller front tooth steps are not subsidized. The insured person should contact his or her health insurance company in advance and consult the orthodontist so that all costs are clarified in the personal, individual case.

What does the private health insurance fund?

Depending on the insurance conditions, it is very different what and how much private health insurance in orthodontic treatment. In the case of patients who have completely removed their teeth from insurance, for example, nothing is covered by private health insurance. Depending on the contribution and contract, the private health insurance company can cover some of the costs or even reimburse the entire orthodontic treatment.

However, it is customary for the insured to advance the amount and the health insurance to reimburse it later.

Pain due to the tight brace

At the beginning of treatment with fixed braces, patients usually feel slight or even moderate pain for several days to weeks. Biting down can be particularly unpleasant, so it is advisable to avoid overly solid food for a while.
Read on under: Braces Pain - What To Do?

This pain is due to the loosening of the teeth in the jawbone. In the first few days after the fixed braces have been fixed, the oral cavity has to adapt to the new situation. The braces exert a force on the teeth to move them, which can lead to discomfort in the first 1-2 days. The braces create a strong pressure and pull force that is supposed to move the teeth into the target position. Since the teeth are anchored to the bone by a comprehensive ligamentous apparatus, loosening the individual ligaments can be very painful. However, this pain disappears completely after a few days.

With each new wire insertion, in which a different wire size is used and thus new or greater force acts on the teeth, these complaints can briefly recur. During this familiarization phase, not only the teeth but also the soft tissues have to adapt. The cheek and vestibule have much less space as the braces take up space. The brackets and wires can irritate the inside of the cheek when the mouth is moved. The tissues must first reform themselves, which is why the adaptation phase can trigger redness and slight discomfort.

The inside of the lip is also restricted by the limited space available and has to adapt. The tongue only has to get used to the lingual technique, where wire and brackets are attached to the inside of the teeth, which can lead to irritation. She can no longer take up the original space and becomes irritated. During this phase, which can last about one to two weeks, there is increased salivation, as the soft tissue is touching the wire and the brackets more and more and the body first has to classify this new condition. The most common contributing factor to pain is the wire.

The protruding wire ends can cause injuries to the soft tissues, which are very uncomfortable. The ends of the wire must be rounded to avoid injuries to the oral mucosa. The end of the wire pokes repeatedly into the same part of the mucous membrane and wounds it. If the patient feels an annoying end of the wire, this should promptly inform the treating person See an orthodontistso that the mucous membrane can regenerate quickly.

Another factor that can cause pain is tooth decay. Since the fixed braces restrict the cleaning of the teeth and bacteria can more easily attach themselves to the brackets, caries can often spread unhindered. This can lead to pulling discomfort. If the patient is in pain, they should go to the orthodontist or dentist directly to treat the affected tooth.

Read on under: Braces Pain - What To Do?

Who needs a retainer?

According to the doctrine, one should follow each orthodontic treatment Permanent retainer (Wire) on the back of the front teeth of the lower jaw, as the teeth have a tendency to move back to their original position if given the opportunity. This retainer remains attached for a lifetime, as the teeth still show this tendency after years. After a short period of acclimatization after insertion, the retainer is barely noticeable for the person concerned.

However, the permanent retainer is not always possible. The retainer is often not an option for patients with a very deep bite, in which the upper teeth reach far beyond the lower teeth when they merge, as it hinders clenching.

What is the best way to clean fixed braces?

Fixed braces limit the possibilities of cleaning and create difficult-to-reach loopholes in which bacteria can settle well. As this increases the risk of tooth decay, thorough cleaning of the wire elements and teeth is particularly important.

In general, you can use a manual toothbrush or, even more simply, electric brushing to reach most of the surfaces. For the hard-to-reach places between the wire and the bracket, as well as in the interdental spaces, interdental brushes are recommended, with which remaining food particles can be removed.

Since normal dental floss can no longer be used optimally, a floss floss (e.g. SuperFloss) should be used for the interdental spaces. This has a reinforced end and a "fluffy" middle part. The hard end makes it easier for the user to get between the teeth, the soft middle piece removes all food residues and bacteria.

A fluoride-based mouthwash solution is also recommended to suppress demineralization of the hard tooth substance by bacteria.

Brushing with the electric toothbrush

The electric toothbrush is a good way to clean your teeth and braces regularly. The fast vibrations of a sonic toothbrush or the rotational movements of an electric toothbrush break the deposits off the braces and teeth.

For the daily cleaning of the interdental spaces and the hard-to-reach areas between the wire and brackets, however, the electric toothbrush is not sufficient and interdental brushes or reinforced dental floss are essential.

Which materials are used?

The materials of the fixed braces vary. The external brackets are made of gold, plastic, ceramic and titanium, the brackets for the lingual technique, which are on the inside of the teeth, are made of ceramic, steel alloys or gold.

The wires attached to the brackets are made of nickel-titanium alloys and are very biocompatible

Gums with fixed braces

Brace rubbers are fastening elements at Edgewise - Bracketswhich serve to anchor the wire in the lock of the bracket. They serve as so-called ligature and are particularly popular with children because of their color variability.

However, since the rubber wears out due to the constant force and tension exerted by the wire, it must be replaced with new ones at regular intervals. The time frame is around two to three months.

As an alternative to rubbers, there are wire ligatures, which, due to the material used, are much more durable and resistant than braces rubbers. However, because they are metallic in color, they are not very popular for aesthetic reasons.

Find out more in our main article: Braces rubbers

What brackets are there?

The retaining elements of fixed braces, the so-called Brackets differ in shape and form and are used for the respective treatment goal. The standard bracket or also Twin bracket has two wings. However, there are also brackets that only have one wing. These are called single brackets. The wire that is anchored in the bracket is secured by an encryption mechanism and can no longer move. Therefore, the brackets are also differentiated based on their locks.

The three different locking mechanisms name the brackets in Edgewise brackets, light wire brackets and self-ligating brackets. With Edgewise brackets and light wire brackets, the Wire closed with a ligature of thinner wire or a pin. With self-ligating brackets, however, no aids necessary for fastening, which is why this is also the most expensive variant represents.

Furthermore, the different locking mechanisms differ in size, as wires of different strengths are gradually used - for greater or lesser tensile force on the teeth.

Another distinguishing feature is the material of the brackets. Brackets are made of gold, plastic, ceramic and titanium.

These also vary when attaching the brackets. The majority of brackets are attached to the outside of the tooth surfaces and are universal brackets that fit on any tooth surface. With modern lingual technology, the brackets are fixed to the back surface of the teeth and are individually made so that they only fit the patient concerned.

Further information can be found here: Brackets of a brace

How do you correct an overbite?

In the majority of cases, an overbite results from an enlarged anterior tooth step, the so-called Overjet, which describes that the lateral distance between the upper and lower anterior teeth is too great. As a result, the upper jaw teeth appear too big, like "buck teeth" and are usually tilted forward.

Find out more about this at: Jaw misalignment

This malformation is justified by the fact that the upper jaw is too small or the teeth are too big. An overbite is often corrected by pulling two teeth in the upper jaw to create more space. It refers to Premolars (these are the 4th and 5th teeth counted from the middle), one of which is removed from each side. The remaining teeth are then pulled into the gap and the anterior tooth step is reduced so that the overbite disappears.

Treatment is easier for growing patients because the upper jaw can be stimulated to grow with an active plate, or loose braces. In some cases, this procedure combined with a fixed brace that moves all teeth into a straight, gap-free position is sufficient to achieve a satisfactory result.

In adults, growth stimulation is no longer possible because growth has already been completed. In this case, combined orthodontic and maxillofacial surgery or tooth removal is necessary to correct the overbite.