All About Retainers and Orthodontics

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Our bodies do not like pressure!

You know the phenomenon: Press your thumb onto your skin and the area around it turns white. The reason is that by applying pressure you are compressing the skin blood vessels – the blood is pushed out of the area and the skin turns pale. For a short period of time, this little experiment does not pose a problem, because as soon as you let go, the skin is resupplied with blood. However, the same mechanism may lead to a necrosis of tissue if a person is confined to bed for a long period. In such a case, the pressure is not applied by the thumb, but the person’s own body weight; physicians call this a bedsore. Bedsores are often observed in elderly, bedridden persons and are always a sign of incorrect positioning.

So pressure is bad for our tissue. With regard to our periodontium, the body “suspends” the teeth with a connective tissue mechanism, the so-called, “periodontal ligament.” The periodontal ligament consists of small fibers that stretch between the root and the bone. The periodontal ligament transforms the chewing pressure into tensile stress. In other words, pressing down your teeth results in a tension in the bone.

Teeth drift!

Teeth are not anchored in a fixed manner in the bone, but are “flexible.” Therefore, if pressure is applied to a tooth – for example, by means of a retainer – the periodontal ligament is able to adapt and a tooth drift occurs. That is the principle used for retainers or braces.

Retainer

Retainer

The position of our teeth results from a balance of tongue and cheek pressures because our tongue and facial muscles apply pressure to the teeth as well. For example, the teeth of people with large tongues usually show a slightly spread out positioning, whereas the teeth of people with strong chewing muscles are often convoluted or tilted inwardly. While teeth tend to move closer together between the first and the second decade of life and develop crowding (tertiary crowding) due to lip pressure and the pressures applied by continuously strengthening facial muscles, teeth behave exactly the opposite way from the fifth decade of life onward.

Due to the facial musculature becoming flabbier, the declining tissue tone, and the constant tongue pressure, the teeth tend to drift apart. Also, lip pressure is decreasing, as is the tone of the facial muscles (primarily that of the cheek or buccinator muscle), while the tongue controls the pressure applied to the teeth from inside the mouth. On top of that, a natural or perhaps abnormal recession of the gums (periodontitis) and the associated bone loss mean that the teeth are not stabilized as firmly in the jaw as they used to be.

In the end, all of this leads to a very slow, insidious spreading of the anterior teeth. The teeth drift toward the front, creating gaps in the process. The more this process advances, the faster the teeth drift – until the patient takes notice and asks for advice. Such malocclusions can be treated very easily and efficiently with aligners, for example!

Does it matter what type of retainer I get to correct my malocclusion?

Fixed Braces

Fixed Braces

No, because each retainer has its advantages and disadvantages. Removable retainers only make sense during the early growth period, i.e. during childhood – and even then, only in carefully selected cases. In the past, almost every malocclusion was treated with a removable retainer.

Today, it is known that in most cases, a removable retainer during childhood will have to be followed up with fixed braces and so, for the children’s sake, the removable one is skipped more and more frequently.

Tooth rotations, particularly those of the canines, are either difficult or impossible to treat with so-called aligners. However, the advantage of aligners is that they are almost invisible – as is the case with lingual therapy. The lingual therapy is very time-consuming and is regarded as rather unpleasant by patients. The question as to which therapy is the most reasonable can be answered by your orthodontist (a dentist specialized in retainers).

A “true” orthodontist has completed an additional four-year training course (in most cases) and only provides “retainers.” Even tooth extractions are done by somebody else. So let yourself be treated by an orthodontist! He will also be able to answer your questions, for example, whether your malocclusion poses a risk for your health, i.e. has a negative effect on your health. Some malocclusions can damage teeth, the jaw joint, and the periodontium. Such cases constitute not just an esthetic, but a medical indication as well! Unfortunately though, a “regular” dentist, i.e. one without the respective additional training, may perform orthodontic treatments as well. You can recognize such doctors by the fact that they offer other services besides orthodontics.

The simplest way to go about it is to ask your therapist whether he has completed the respective additional training. So the trend nowadays is not just toward white teeth – no, people want to have teeth that are as straight as a picket fence. Retainers are not harmful and, if used correctly, may make a positive contribution to maintaining the health of your teeth by correcting your malocclusion!

Here are the most common questions concerning the topic of retainers!

Is it possible to wear a retainer at any age?

In principle, yes; however, with increasing age, the shifting of teeth becomes more difficult. In childhood, removable retainers are often sufficient. The body is still growing and it is enough to give the body an “impulse” in the “right” direction – with a removable retainer, for example! Once the growth has stopped, the teeth can be arranged perfectly with fixed braces and be kept that way for a lifetime.

Whether the result must be maintained, i.e. whether a so-called retainer must be placed, depends on whether an optimal occlusion – the so-called, “Class I” – was achieved or not. Furthermore, it also depends on your musculature, the size of the tongue, and a host of other factors which would determine whether the teeth will exhibit a tendency for drifting after a therapy was performed.

Fixed braces or not?

Due to the continued growth of young people, one can work with removable retainers here. Impulses are sufficient for the movement of the teeth; the retainer does not have to be worn permanently. Once the growth has stopped, one must work with fixed braces, because the force required for the movement of the teeth should act continuously.

Invisible retainers?

Invisible retainers such as, for example, aligners, are also suitable for the correction of malocclusions or the rotation of canines, but a therapy with them is very difficult.

Braces and kissing – a contradiction?

Kissing is always possible, no matter what kind of retainer you wear; so tongue acrobatics are not required! Thanks to modern retainers, eating and laughing are possible without any problems as well.

How much do retainers cost?

In Europe, health insurances often only assume a small portion of the costs, which also depends on the type of malocclusion. In the United States, this is a completely private matter – unless one has supplemental insurance coverage. The exact costs are best discussed with the respective practitioner. Oftentimes, the therapy is charged on an annual basis. That is why some treatments take three, four, or more years. Charging for each therapy individually is a more trustworthy method, because an experienced practitioner can already estimate the labor costs prior to the treatment.

Duration?

As a rule, most malocclusions can be corrected within 2 years; anything taking longer than that should be treated surgically. Such surgeries are not performed on the teeth themselves, but on the correction of the alignment of the jaws toward each other.

Why crooked teeth?

Malocclusions may have different causes. The most common cause is cavities in the milk teeth. That is why milk teeth frequently have to be removed early. However, milk teeth are an important growth stimulus for the jaws. If it is missing, the growth of the jaw slows down and the remaining teeth experience a lack of space in the small jaw, resulting in skew teeth and crowding.

Retainers and periodontitis?

Some malocclusions are associated with an increased risk of periodontitis and/or gum recession. An orthodontic treatment may prevent a periodontitis and thus the loss of teeth. So in some cases, a malocclusion may promote the development of inflammations of our periodontal apparatus. By correcting the malocclusion, this may be prevented – but be careful, wearing a retainer/braces and a lack of oral hygiene may also trigger a periodontitis. If you are to receive fixed braces or already wear them, buy yourself a water pick, because it allows for a more thorough cleaning of the oral cavity.

Is it possible to treat tinnitus with a retainer?

Tinnitus (ringing in the ears) may be triggered by a malocclusion of the jaw; in such cases, correcting the position of the jaw may alleviate the problem. Bad dental work may also have an effect on the occlusion and thus change the position of the jaws. Over the course of many years, the masticatory apparatus may be destabilized to such a degree that the jaw joint head becomes dislocated. If, during the closing of the mouth, the jaw joint head is pushed far into the back in the direction of the middle ear, the pressure applied upon the two nerves lying between them is huge. The middle ear and the jaw joint are positioned very closely and separated only by a thin bone lamella. Phantom noises in the ear, also known as tinnitus, or headaches in the temples may result.

In such cases, the remedy often lies in an extremely thin splint made of clear synthetic material that returns the joint heads to their original position. For at least four weeks, day and night, the patient has to wear a so-called pivot splint in the upper jaw, which is slightly raised in the back to even out the malocclusion. When closing the mouth, the lower jaw turns around this artificial splint and pulls the jaw joint downward. The tailor-made splint is regularly readjusted and cut until the ideal occlusion has been stabilized.

Click here to see the video: Orthodontics

 

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