As nowadays more and more emphasis is placed on the exterior, most people want a perfect, straight and beautiful teeth.

People who are not naturally given the opportunity to undergo orthodontic treatment and have irregularly grown teeth positioned correctly.

A brace is an appliance that is used in dentistry to remedy jaw and tooth malpositions, thus improving the aesthetics and functionality of the jaw.

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

Especially in the case of severe malpositions and / or especially late-stage orthodontic treatments, it makes sense to use a fixed brace .
A fixed brace is understood to mean a dental device which serves to correct jaw and tooth malpositions but can not be removed from the mouth by the patient himself.
It lingers in the mouth for the entire duration of treatment and must be adjusted at regular intervals by the orthodontist.

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

A brace placed inside the mouth is a so-called multi-band or multi-strap device, which is glued directly to the tooth.
These devices can be made of titanium, plastic or, in some cases, transparent ceramics. In the middle of each bracket there is a small opening through which a wire that triggers the tooth movement is threaded. The strength of the wire increases steadily in the course of treatment, so that more force can act on the teeth to be moved.

Fixed braces have the advantage that they stay 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, in older patients, they are usually the only effective way to correct dental and jaw deformity.

Indications for braces

The indications for braces are very diverse. In most cases, there is a deviation from a healthy, the so-called " eugenic " dentition, which indicates that there is a misalignment of the teeth. The word deformity is interpretable in many ways.

One reason may be a variation in the number of teeth where either too many teeth are present and the jaw is too small, or too few teeth are present to cause a jagged dentition. If teeth are missing and if they are not genetically created, the specialist speaks of non-equipment . Furthermore, the teeth can also vary in shape, so that a malposition of the bite arises and the person concerned gets difficulties in biting, talking and eating. Another indication for a fixed braces are gaps. With the braces, the teeth can be moved so that an existing gap is closed or a gap is created. The orthodontist consciously allows a gap to become larger or arise, so that an implant can be placed there, if there is not enough space or if the gap is too narrow. Further malpositions as an indication for a fixed brace are Fehlbisslagen such as the cross bite, the open bite or the deep bite. Also malformations of the jaw, the lower or upper jaw can be too small, are indications for a fixed braces. In addition, for more and more adults, the indication for a fixed braces is already given for aesthetic reasons, which are solved almost invisibly by the lingual technique. In the lingual technique, the brackets are attached to the inside of the teeth, these move the teeth almost invisibly for the environment. Due to the modern possibilities in orthodontics, the number of adult patients who wish to shift their teeth for aesthetic reasons is increasing. Also, patients who have missed it in adolescence, or have stopped a therapy begun, just want to have beautiful teeth in adulthood.

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

When does an adult need a fixed brace?

The trend that adults want to get their teeth fixed again or for the first time, is increasing more and more and now every third patient has grown up with an orthodontist. In most cases this is for aesthetic reasons. Patients want to have their own teeth as beautiful as possible and that includes a straight position. This is primarily true for patients whose orthodontic treatment in childhood has not achieved the desired success or whose teeth have subsequently shifted.

Patients who have never received orthodontic treatment develop a different level of medical awareness in adulthood, when teeth become relevant. Consequently, the orthodontic treatment is subsequently introduced. A solid braces is necessary for adults, as long as teeth not only have to be moved horizontally or vertically, but also rotates. Rotational movements are often possible only with a fixed apparatus.

Another cause of a fixed brace in the permanent dentition of an adult is producing or closing a gap. For example, if a tooth is lost and needs to be removed, most patients will want implants as a treatment option. However, if the existing gap is too narrow due to tilting of the adjacent teeth to insert an implant, the gap must first be enlarged. For it fixed devices are used.

How long do you have to wear a fixed brace?

The duration of wearing a fixed brace varies depending on the severity of the application and condition of the patient's dentition. Many factors play a role here.

Some medications affect the sliding speed of the teeth. This is especially important in adult treatment. Medications such as bisphosphonates in osteoporosis accelerate the displacement of teeth while others slow them down.

The average gestation time of a confined is about one to three years, but can also run faster or slower depending on the attacks of the therapy. The duration of therapy is planned by the practitioner, so that the patient has an overview and can estimate how long the treatment will last in the individual case. But there is no guarantee for this planning time, so it is a rough framework.

What are the costs for a fixed brace?

The costs of a fixed braces can quickly exceed a thousand euros and the private and statutory health insurance companies do not pay in all cases shares of treatment costs or even the entire sum.

Until the age of eighteen, orthodontic treatment with fixed braces is usually taken over by the statutory and / or private health insurances, but in certain cases it is also possible that the health insurances will pay at least part of the costs of the fixed braces after the age of eighteen,
This is particularly possible if, in addition to the actual treatment, a surgical concomitant therapy must be performed.

The statutory health insurance pays only the basic equipment, ie the simplest and largest brackets made of metal and steel arches. Since the standard brackets are relatively large, they are undesirable in many patients, as there are more delicate models that are not so noticeable. Any special request for other variants and models involves additional costs. Flat, smaller brackets with rubber or self-alloying without fixing aid are more expensive, even other materials such as ceramic or gold cost more. It is true, the less inconspicuous a brace should be, the more expensive it will be. The lingual technique is almost the most expensive, since the brackets are manufactured individually and attached to the back of the teeth. This makes this fixed braces almost invisible to the environment.

In general, nothing is taken over for the orthodontics of adults, it is a pure private service - unless the malposition is so serious that a purely orthodontic therapy is not sufficient and therefore an orthodontic-oral surgery must be performed. In such cases, the costs are usually borne by the health insurance companies.

For example, the own contribution to the overall treatment for child treatment is 100-500 Euro, while adults have to pay 3000-6000 Euro.

What does the statutory health insurance fund?

The statutory health insurance pays only limited in orthodontic treatments. It takes over either the complete costs or shares of them. The guidelines are strict. For example, the statutory health insurance pays for an enlarged anterior tooth stage, the so-called overjet only from a distance of 7mm something, all smaller anterior teeth stages are not subsidized. In this case, the insured person should contact his health insurance company in advance and consult the orthodontist so that all costs have been clarified in the individual, individual case.

What does the private health insurance fund?

Depending on the insurance conditions, it is very different, what and how much the private health insurance takes over in the orthodontic treatment. For example, for patients who have completely taken out their insurance, nothing is covered by the private health insurance. Depending on the contribution and the contract, the private health insurance company can assume a proportion of the costs or even reimburse the entire orthodontic treatment.

However, it is customary that the insured anticipates the amount and the health insurance later reimbursed.

Pain due to the tight clasp

At the beginning of treatment with a fixed brace, patients usually experience mild or even moderate pain for several days to weeks. Just the biting can be particularly uncomfortable, so it is advisable to give up some time on too solid food.

This pain is due to the loosening of the teeth in the jawbone. In the first days after fixing a fixed braces, the oral cavity must adapt to the new situation. The braces work with force on the teeth to move them, which can cause discomfort in the first 1-2 days. The braces cause a strong compressive and tensile force to move the teeth to the target position. Since the teeth are anchored to the bone by a comprehensive ligament apparatus, loosening the individual ligaments can be very painful. However, this pain will disappear completely after a few days.

With every new wire insert, which uses a different wire size and thus new or greater force on the teeth acts, these complaints can re-emerge entertaining. During this familiarization phase, the soft tissues must adapt as well as the teeth. The cheek and the mouth have much less space because the braces take up space. The brackets and wires can irritate the cheeks during oral movements. The tissues must first regroup, which is why the adjustment phase can cause redness and mild discomfort.

The inside of the lip is limited by the smaller space and must adapt. The tongue only needs to get used to the lingual technique, where the wire and brackets are placed on the inside of the teeth, which can cause irritation. She can no longer take the original room and is irritated. In this phase, which can last for about one to two weeks, increased salivation occurs because the soft tissues increasingly touch the wire and the brackets and the body must first classify this new state. The most common factor for pain is the wire.

By protruding wire ends can cause wounds on the soft tissues, which are very uncomfortable. The ends of the wire must be rounded so as not to produce any injuries to the oral mucosa. The end of the wire repeatedly pokes into the same place of the mucous membrane and wounds it. If the patient senses a disturbing end of the wire, they should visit the treating orthodontist promptly so that the mucous membrane can regenerate quickly.

Another factor that can cause pain is tooth decay. Since the fixed braces, the cleaning of the teeth is limited and bacteria can easily attach to the brackets, can often spread unhindered caries. This can lead to drawing complaints. The patient should consult the orthodontist or dentist directly for pain to treat the affected tooth.

Who needs a retainer?

It is believed that after each orthodontic treatment, a permanent retainer (wire) should be attached to the back of the anterior teeth of the mandible as the teeth tend to move back to their original position, if they can. This retainer remains attached for life, as the teeth still show this tendency for years to come. After a short familiarization period after insertion, the retainer is hardly noticeable to the person affected.

The Dauerretainer is not always possible. In patients with a very deep bite, where the maxillary teeth extend well beyond the mandibular teeth during a fusion, the retainer is often not an option as it interferes with clenching.

How best to clean a fixed brace?

A fixed brace restricts the possibilities of cleaning and produces hard-to-reach loopholes, in which bacteria can nest well. Since the risk of caries is thereby increased, a thorough cleaning of the wire elements and teeth is particularly important.

In general, as usual, it is possible to brush with a manual toothbrush or even more simply electrically to reach the majority of the surfaces. For the hard-to-reach places between wire and bracket, as well as in the interdental spaces between space brushes are recommended, with which remaining food remnants can be removed.

Since normal dental floss can no longer be used optimally, a floss floss (eg Super Float) should be used for the interdental spaces. This has a reinforced end and a "fluffy" middle section. With the hard end, the user can get between the teeth with ease, the soft centerpiece removes all leftovers and bacteria.

Also, a fluoride mouthwash solution is recommended to suppress demineralization of hard tooth substance by bacteria.

Cleaning with the electric toothbrush

The electric toothbrush works well to clean the teeth and braces regularly. The rapid vibrations in a sonic toothbrush or rotational movements of an electric toothbrush blow up the linings of the braces and teeth.

However, for the daily cleaning of the interdental spaces and the hard to reach places between wire and brackets, the electric toothbrush is not enough and interdental brushes or reinforced dental floss is essential.

Which materials are used?

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

The wires fixed in the brackets are made of nickel-titanium alloys and are very biocompatible

Gums with a fixed braces

Braces are fasteners on edgewise brackets that serve to anchor the wire in the bracket of the bracket. They serve as so-called ligature and are particularly popular in children because of their color variability.

However, since the rubber wears out due to the permanent force and tensile exercise of the wire, it must be replaced at regular intervals by new ones. The timeframe covers about two to three months.

As an alternative to the rubbers there are wire ligatures, which are due to the material much more durable and durable than the braces. However, since they are metallic colors, they are therefore not very popular for aesthetic reasons.

Which brackets are there?

The holding elements of a fixed braces, the so-called brackets differ in shape and shape and are used for the respective treatment goal. The standard bracket or twin bracket has two wings. However, there are also brackets that have only one wing. These are called single brackets. The wire anchored in the bracket is secured by an encryption mechanism and can not move. Therefore, the brackets are also distinguished by their locks.

The three different lock mechanisms name the brackets in edgewise brackets, light wire brackets and self - ligating brackets. For edgewise brackets and light wire brackets, the wire is closed with a thinner wire or pin ligature . In self-ligating brackets, however, no tools for attachment is necessary, which is why this is the most expensive variant .

Furthermore, the different closure mechanisms are still different in size, as gradually different strength wires are used - for a greater or lesser traction 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 mounted on the outside of the tooth surfaces and are universal brackets that fit on any tooth surface. In the modern lingual technique, the brackets are fixed to the back surface of the teeth and are custom-made so that they fit only the affected patient.

How to correct an overbite

An overbite results in the majority of cases by an enlarged anterior tooth level, the so-called overjet, which describes that the lateral distance between maxillary and mandibular anterior teeth is too large. The upper jaw teeth seem to be too big, like "roaring teeth" and are usually tilted forward.

The reason for this malformation is that the upper jaw is too small or the teeth too big. An overbite is often corrected by pulling two teeth in the upper jaw to create more space. These are premolars (these are the 4th and 5th teeth counted from the center), one of which is removed on each side. The remaining teeth are then pulled into the gap and thereby reduces the front tooth stage, so that the overbite disappears.

For patients in growth, the treatment is easier, because in advance with an active plate, a loose braces, the upper jaw can be stimulated to grow. In some cases, this intervention, combined with a tight-fitting clasp that places all the teeth in a straight gap position, is already sufficient to achieve a satisfactory result.

In adults, the growth stimulation is no longer possible because the growth is already completed. In this case, combined orthodontic and orthodontic therapy or removal of teeth will be necessary to correct the overbite.

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