Orthodontics

What is it?

Orthodontics is the branch of dentistry that focuses on correcting tooth positions and the alignment of the jaws. A harmonious and healthy smile is essential for self-esteem at any age. The goal of orthodontic treatment is to achieve a balanced, functional bite and an elegant, expressive smile.

During the first orthodontic consultation, a general evaluation and a cost estimate are performed. The second consultation involves an orthodontic study, with the goal of diagnosing and planning each clinical case. All necessary clinical information is collected for an appropriate treatment plan. Intraoral and extraoral photographs, radiographs, study models, and, in specific cases, a CBCT scan may be required, and an articulator assembly might be necessary. After completing the study, there are two options: either scheduling the appliance placement appointment or a preliminary consultation to explain the treatment plan, at which point the most suitable appliance for the patient in question is chosen.

Treatment duration

It depends on the treatment phase and the specific treatment plan for each patient.

Early treatments with mixed dentition last between 7 to 12 months. Treatments in adults can last between 12 to 30 months, depending on the severity of the case and the technique used.

Importance

In adulthood, treatment becomes more difficult and time-consuming, with more limited results. It may be necessary to resort to dental extractions or jaw surgeries.

Age for orthodontic evaluation

The first orthodontic evaluation should be done around the age of 6. However, the pediatric dentist may refer a child for an earlier evaluation, around 3 or 4 years old, if any functional jaw issues are detected.

There are certain situations that should serve as a warning to parents, such as the use of a pacifier after the age of 4, thumb-sucking after the age of 4, early loss of a baby tooth, or children who breathe through their mouth.

Early diagnosis of situations

There are several situations that can be diagnosed early, including:

Narrow palate
Crossbite
Receding lower jaw
Protruding upper teeth
Lower teeth too far forward
Jaw deviations and asymmetries
Lack of space for teeth

Early loss of baby teeth
Delay in tooth eruption
Anterior open bite
Thumb-sucking or pacifier use
Oral breathing
Sleep apnea
Atypical swallowing

Changes should be made early because they influence the normal and harmonious growth and development of the jaws, as well as their function and physiology. They should be treated early, while growth is still occurring, so that it is possible to stimulate, inhibit, or modify the orofacial structures. In adulthood, treatment becomes more difficult and time-consuming, with more limited results. It may be necessary to resort to dental extractions or jaw surgeries.

Orthopedic and functional orthodontics

They are orthopedic and functional appliances used in children with primary, mixed, or permanent dentition. They serve to restore jaw function, correct their relationship, re-educate parafunctional habits, and balance the orofacial musculature. It is a preliminary treatment, which in most cases requires a subsequent definitive treatment with fixed appliances.

Fixed orthodontics

At The Lisbon Smile Clinic, we use 3 types of vestibular brackets (bonded to the outside of the teeth, in the visible area). These are different techniques, with varying results and treatment speeds.

It is the most classic bracket system. It is the conventional technique for placing braces. In terms of cost for the patient, it is the most affordable appliance. The follow-up appointments are monthly. However, it often requires the use of additional appliances to resolve more complex cases.

It is an innovative technique and treatment philosophy. The braces consist of passive self-ligating brackets, which can be metal or ceramic (aesthetic), making them more effective, faster, and providing better results, with fewer appointments and a shorter treatment time. With the Damon system, we can reduce the number of extractions of healthy teeth, avoid the use of additional appliances, and in severe cases, reduce the likelihood of orthognathic surgery, which with conventional braces is the only way to solve some complex cases. Follow-up appointments are every two months.

The Damon system is an advanced appliance designed and perfected with a straight arch that harmonizes biology and function, using treatment mechanics with gentler forces to achieve exceptional results in a simple, fast, and less invasive way. The Damon system eliminates the need for traditional mechanics that may require more frequent extractions. It uses lighter forces, minimizing friction. As a result, the most efficient treatment modalities are facilitated, offering patients faster and more comfortable treatment with fewer appointments.

It consists of a system of fully customized passive self-ligating brackets, using cutting-edge digital orthodontic technology. In other words, all planning is done by computer, which drastically reduces the margin of error, and the brackets and arches are made and calculated for each patient through next-generation software, ensuring excellent quality. Follow-up appointments are every two months. Its unique innovation provides clinicians with a tool to design and achieve precise and efficient results, with reduced treatment time. An advanced computer algorithm accurately calculates the unique prescription for each tooth, as well as its position and morphology.

The Insignia software uses over 40,000 data points per tooth and unique algorithms to design the final treatment outcome and individualized appliances.

Lingual orthodontics

At The Lisbon Smile Clinic, two types of lingual appliances (bonded to the inner portion of the teeth) are used: the Incognito System and the WIN System. These are bracket systems that, for aesthetic reasons, are bonded to the inside of the teeth. They are suitable for all patients who have a strict aesthetic requirement, as both Incognito and WIN are orthodontic appliances placed on the inside of the teeth, making them virtually invisible. The brackets are custom-made for each patient, meaning the treatment is fully personalized.

Invisalign orthodontics

The treatment involves a series of aligners (silicone trays created using a 3D printer, based on the planned design) that are virtually invisible and removable, custom-made for each patient. Its main advantages are convenience—for oral hygiene as well as overall comfort—and reduced sensitivity. It is a highly precise system because the entire treatment plan is computer-generated. It can be used to treat anything from minor to complex alignment issues.

Invisalign clear aligners are custom-made with an exclusive material, Smart Track, fitting comfortably and easily removable for eating, brushing, and flossing. They are trimmed along the gum line for added comfort and are recommended to be worn 22 hours a day, only removed for meals.

This orthodontic treatment combines convenience with aesthetics and effectiveness. You can use the My Invisalign Smile app to track your treatment progress and compare improvements with each aligner.

Retainers

After using any type of orthodontic appliance, the use of a retainer in the upper and lower jaws is recommended. Its purpose is to optimize the stability of the results achieved at the end of orthodontic correction. The duration of this phase varies from patient to patient, depending on the severity of the initial malocclusion, age, and the results achieved at the end of treatment.

Retainers can be fixed or removable and should be monitored by the dentist at varying intervals over time.

Frequently Asked Questions

Yes, treatments at early ages or interceptive treatments are dental or orthopedic treatments, and braces are placed on baby teeth without any harm to them. The goal is to correct or mitigate skeletal problems of the jaws, recover space for permanent teeth, allow for symmetrical jaw growth, and normalize the shape, size, and function of the orofacial structures.

In adulthood, when growth has ceased, treatments become longer and yield more limited results. Treatments at an early age are generally simpler and well-tolerated by children. Issues that are easy to resolve early on, if left untreated, worsen with growth and lead to malocclusions that affect not only bite and function but also facial aesthetics and posture.

The placement and removal of braces do not damage the teeth, and with proper oral hygiene from the patient, the teeth remain intact after the braces are removed. However, if the patient does not maintain good hygiene, as explained on the day the braces are placed, irreversible enamel demineralization stains may occur. These stains, caused by plaque buildup around the brackets, do not disappear.

The placement and removal of braces are painless. After the braces are placed, there is a period of adaptation for the lips, tongue, and, in some cases, speech. The day after placement, some tooth sensitivity is normal, which generally does not require any medication. Depending on the type of braces used, the adaptation period can range from 2 days to a week.

On the day the braces are placed, you will receive a document with all hygiene and dietary instructions. Some mandatory and general care guidelines for all types of braces include avoiding hard and sticky foods (such as gum, gummies, and caramels), carbonated drinks, nail-biting, and brushing your teeth and braces after the three main meals.

Allergies to the components of braces are rare. Metal braces are made of nickel and titanium. For patients allergic to these substances, there are other treatment alternatives, such as the Invisalign system.

Orthodontic treatments can be performed on patients with periodontal or gum issues as long as the condition is not active. A prior consultation with a periodontist is necessary for this.

Fixed braces, due to friction on the oral mucosa, can cause mouth sores or traumatic lesions. In these cases, a healing gel will be prescribed for the sore, and orthodontic wax should be applied to the braces. These lesions are reversible and will disappear once they heal.

Yes, pregnant women can get braces, and if a woman becomes pregnant during treatment, it can continue without any limitations. However, pregnant women need to pay special attention to oral hygiene as they are more prone to gum bleeding, which is common due to pregnancy hormones.

After using any type of orthodontic appliance, wearing a retainer is recommended. The retention period varies depending on the final results of the orthodontic treatment, the patient’s age, and the severity of the initial malocclusion. The retainer’s purpose is to maintain the stability and results achieved. Failure to wear it can result in the regression of the treatment.

Professionals in the field

Dr. Marta Figueiredo

Orthodontics | Neuro-occlusal Rehabilitation | Masticatory and Respiratory Rehabilitation (MRR)

Dr. Ana Ferreira

Orthodontics

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