Orthodontics FAQ

An orthodontist is a dentist, who completet an examination after at least three years of specialized training. He deals with the detection, prevention and treatment of malpositions of teeth or the jawbone.

Specialized physician in orthodontics

The training for specialized physician in orthodontics is a post graduate  course which starts after succesfull dental education. The course  can be completed either at an university hospital or in an established office for orthodontics. The training takes 3-4 years and is completed after a final examination.

Master of Sience in orthodontics

The Master of Science in othodontics is a 3-year university course. It trains approbated dentists in the theory of orthodontics. Furthermore the student will treat patients in the office of an established orthodontist under the supervision of the university. The study course is completed with a master-thesis.

Dentist

An approbated dentist can take advanced training courses in orthodontics. After completion he is allowed to perfom orthodontic treatment. Some dentists choose orthodontics as their main area.

Stainless steel brackets

Stainless steel brackets are sturdy and of a steel colour. The wires are fastened by coloured rubber-ligatures. The costs for this variant are covered by the health insurance.

Ceramic brackets

Ceramic brackets are of a natural teeth-colour. Compared to the stainless steel brackets they break easier as the ceramic is more brittle. Another disadvantage is that they can damage the dental enamel of the opposite jaw due to their hardness. Furthermore they can break during removal what complicates the process of removal. These brackets are not covered by the health insurance.

Self-ligating brackets

Self-ligating brackets can be made of metall or ceramic. The wires are not fastened by rubber-ligatures but small metall clips. This minimizes the friction resistance between bracket and arch. In result the dentist can use softer wires which may speed up the treatment process.

We use self-ligating brackets with highly elastic wires. Through their tension the wires can operate with less force over a longer time thus beeing easier on the tissue around the tooth.

Under healthy conditions the teeth can be moved the whole lifetime.

Orthodontists distinguish between fixed and removable devices.

The intended teeth-movement (tilting or shifting) determines the device used (fixed or removable).

• Cheilognathoschisis
• Big anterior tooth step (the underjaw is too far back/or the upperjaw is too far in front)
• Crossbite (the lower teeth stand in front of the upper teeth )
• Open bite
• Deep bite (the lower incisor teeth are to far covered by the upper incisor teeth and potentially bite into the palatal mucosa)
• Displaced and impacted teeth, that don’t have enough room to grow from the jaw to the designated place
• Nonformed teeth
• Tight and gap stands

For patients who are still in adolescence usually the permanent canines should already be present at the beginning of the treatment. These are the third set of teeth viewed from the middle of the dental arch. This is usually the case at an age of 11-13 years. In most cases it is not advisable to start earlier because the treatment will take too long otherwise. All existing permanent teeth (with the exeption of the wisdom teeth) must be established before the treatment can be completed. If started too early, patients eventually lose the motivation and neglect the essential participation needed for the orthodontic treatment.

Of course there are exceptional cases where it is crucial to counteract unwanted growth as early as possible. This includes all forms of reverse overjet. Here, the lower incisors stand erroneously in front of the upper incisors, caused for example by the fact that the lower jaw stands too far forward and / or the upper jaw stands too far back. In such cases, the treatment can be started already from the age of about 6 years. To be on the safe side an orthodontist should examine a child at the age of 7 years.

Yes. Often misaligned teeth can be corrected even in adulthood. However, it is not possible, to benefit from growth of the patient like it would be the case with children or teenagers. Some jaw anomalies must therefore be operated in addition. An orthodontic-surgical combination therapy is necessary for example in cases where the upper or lower jaw needs to be moved forward or backward.

For private patients, this depends on the enclosed tariff. Please look for it in your insurance documents.

Patients in the statutory health insurance:

For patients whose treatment started before they turned 18 the statutory health insurance covers all the costs. However, it is mandatory that the insured pays a contribution of 20% and 10% of each quarterly bill in advance, which he gets refunded by the health insurance after successful completion of orthodontic treatment. If the treatment has to be discontinued on reasons of insufficient cooperation or frequent no-show of the patient the insurance company can refuse to pay back the initial contribution.

For adults the costs will only be coverd, if a combined orthodontic-surgical combination therapy is needed.

That depends on several factors. Among other things, the age of the patients at the beginning of the treatment, the process of the dentition and to a large extent on the cooperation of the patient. With typical biological reactivity and good cooperation of the patient, the treatment duration is about 2-4 years.

The integrating of fixed and removable appliances is usually painless, but maybe a little uncomfortable. In order to move teeth or groups of teeth, it is necessary to apply certain – low – forces. This manifests itself as a pressure felt on the respective teeth, which different patients feel to varying degrees. Insofar mild pain at the teeth is something that has to be taken into account during the treatment.

Removable braces are made of a custom-made resin matrix, which is typically offered in many different colors and with specially bent wire elements to “hold” the teeth. Normally these devices are accepted by the patients without too many problems. Patients will have to get used to talking with the device installed, but this should not be a reason to remove the braces. Proper oral hygiene can be maintained easily and without extra effort.

The disadvantage of removable devices is that the orthodontist is completely reliant upon the cooperation of the patient. The braces should stay in the mouth at least 14 hours a day, otherwise the effect is gradually restricted. Accordingly, the end result would be less satisfactory than with constant positive cooperation of the patient. To prevent a restriction of the treatment process, the clinician has the option to use fixed devices.

Fixed braces consists of several distinct parts: Firstly, of brackets that are bonded to the front teeth using method known from the filling treatment method, and secondly of bands that are cemented to the back teeth. The informations that are gathered about the position of the teeth by these parts are transformed onto the teeth by different wire archs, that are fastened to the brackets with small rubber bands. These rubber are available in different colours, but also in tooth-colored or transparent design. Normally, steel brackets are used. For adult patients or such patients that are very much set on aesthetics white plastic or ceramic brackets are available. Allergic reactions to the materials are rare.

With the help of bands and brackets teeth can be rotated moved physically, what can not be achieved with removable. Another key advantage of a fixed device is that it stays constantly in the mouth of the patient and thus is effectic 24-hours a day. By this the orthodontist is less dependent on the cooperation of the patient.

The noticable disadvantage is that the tooth cleaning with fixed bracket is considerably more expensive than without. The use of special interdental-brushes and possibly Superfloss dental floss in addition to brushing with regular toothbrush is required. In cases of insufficient oral hygiene, it can happen that the apparatus must be removed prematurely, without the treatment goal beeing achieved.

With optimal oral hygiene the risk is just as low as without wearing the fixed braces. Most currently used luting materials and cements dispense fluoride to the environment – ie to the teeth – which harden the dental enamel and make it more resistant to decay. If however oral hygiene stays insufficient for an extended period of time, carious changes on the teeth can not be excluded. These manifest themselves as white spots, which are mainly located between the gum and the bracket and or around the bracket. These white spots don’t disappear on their own and have to be treated.

It is important that patients who are undergoing orthodontic treatment, still regularly consult a normal dentist for checkups – up to 18-years of age every six months, thereafter once a year.

The last teeth of the dental arch, the so-called “wisdom teeth” should be removed only if there is not enough space available in the jaw, to ensure hassle-free breakthrough into oral cavity. As long as they integrate normally into the dental arch, they don’t have to be removed. A critical situation exists if the wisdom teeth do not grow straight out of the bone, but are pressing at an angle against the neighouring tooth – the second large molar. They are then clamped in this position, so to speak, and dont’t get the chance to be classify themselves correctly into the dental arch. After an orthodontic treatment this can lead to a repeated crowding in the anterior region of the dental arch. In addition, such clamped teeth that have partially broken into the oral cavity welcome bacterias which can cause serious infections and abscesses.

As long as the finger or thumb sucking ceases during the 3rd year of life, no permanent damage must be expected. If the habit persist however position changes of the teeth are possible. The sucking-thumb (or finger) in most cases presses the upper teeth forward and upwards. Not infrequently this results in an open bite. This incorrect position of the teeth will have to be treated, and in case the patient does not stop sucking on the finger or thumb, such deformations can not even be corrected orthodontically.

Similar effects can be observed with patients who – most of the time unintentionaly – press their tongue against the teeth, which usually happens in conjunction with a persistence of the infantile swallow pattern. Again, it often leads to unwanted tilted stands and open bite. In such or similar cases the cooperation of a speech therapist might be needed.

Invisalign is a new hidden method to fix the position of the teeth. Transparent plastic rails, so-called “lnvisaligners” are hardly noticeable and gently create an aestheticaly ideal tooth arrangement.

“Lingual” means “tongue sided” and Lingual technology is the correction of malocclusions with fixed appliances, which are mounted on the backs of the teeth.

Many orthodontists use recycled rather than new brackets for cost reasons. New brackets cost three to five times as much as a recycled brackets. Mrs. Arlt only uses new brackets, as no recycled bracket reaches the quality of a new bracket.