Informative Brochure for Patients

Dear patients, dear parents:

Your general dentist recommended that you or your child should have orthodontic treatment. Or you have decided that you would like an orthodontic consultation for yourself or your child, because you or your child are suffering from various complaints (wrong bite, jaw joint problems). Today is the first time you and/or your child are coming to our practice – a thrilling day for us all! We are very much looking forward to getting to know you. Whether private patient or socially insured – every patient can benefit from our modern and gentle treatment modalities.

We wish you to have this booklet as a kind of guidebook, to give you thorough information on what is to be expected and how diagnostics and treatment generally function, if treatment should be necessary. This should eliminate insecurities that you might have, for one is no longer afraid of something one has come to know. Relaxed and confident, you and your child can go ahead and start working together with us!

If you have any questions, please do not hesitate to ask them. We are always glad to help.

Yours,

Douglas E. Toll, D.D.S.

Dr. Nenad Popovic

Before we start:

Modern dentistry has made it its asset not only to treat diseases of the teeth and the periodontium when they have occurred, but to prevent caries, periodontitis and the like from occurring at all. Prophylaxis has grown ever more important in the recent years. Perhaps, you are already seeing your dentist on a regular basis for professional tooth cleaning? Maybe you are already using tooth floss and/or interdental brushes. You are also very thorough in supervising your child’s oral hygiene? On that we can only congratulate you! You are already making an invaluable contribution to keeping your and your child’s teeth healthy.

During orthodontic treatment it is particularly important to „stay on the ball“ with your oral hygiene. Depending on what is required you might have to shorten the interval between two professional tooth cleaning sessions to stop caries and periodontitis from developing. At home, also, daily tooth cleaning requires additional attention from you or your child. Our staff is very happy to show you hints and knacks for a more efficient tooth cleaning technique, especially when there are orthodontic appliances in the mouth.

The consultation

You are - or your child is - now sitting in our treatment chair. Prior to that, you have filled in the registration form we sent you.First, we will have a close look at your facial profile. We will also study your body posture and your facial symmetry. Often, one can already see at that early stage, if treatment is really necessary or not. Next, we will look into your mouth and evaluate the condition and the position of the teeth.

Simultaneously, we will discuss with you your medical history and ask you if there are any previous dental records that you could bring next time, if you haven’t already done so.

When we have gained our first impression, we will decide if orthodontic treatment is indicated. We will tell you which kind of jaw malrelation or dental malpositioning is present in yourself or your child and which treatment options are in question.

Orthodontic diagnostics is what will happen next. They consist of dental x-rays, impressions/moulds and photos. In adolescents and adults with jaw-related problems, also magnetic resonance imaging (MRI)of the jaw-joints may be necessary.

Should you have records from any previous dentist or orthodontist, please bring them to your consultation appointment.

Diagnostic records

As previously mentioned, diagnostic records include primarily x-rays. More precisely, those are basically a panoramic x-ray (orthopantomogram, OPG) and a so-called lateral headplate or lateral cephalogram. Also, impressions for tooth models and photos will be taken.

In an OPG, the clinician can see all teeth in the upper and lower jaw. In children and adolescents, the status of the dentition can be evaluated, in adults above all the health of their teeth and periodontium. Also, the amount of space available in the mouth forthe teeth can be assessed. In addition, the paranasal sinuses, the nasal cavity and the nasal conchae are visible.

The lateral cephalogram is an x-ray of the skull taken from the side, showing the facial profile. The size relation of upper and lower jaw and their relative position can be seen, also the spatial relation between the jaw and the teeth. In addition, the upper air passage can be viewed and obstructions due to adenoids and tonsils can be recognised.

In growing patients, sometimes x-rays of the hand skeleton are taken. These images show the growth cartilage in the hand bones and allow an extrapolation of the remaining growth potential to be expected.

Our staff will take impressions of both jaws. These impressions will then be processed to obtain a 3-dimensional plaster model of your teeth.

Digital photos will be taken of your facial profile and of the inside of your oral cavity.

Also, a clinical functional analysis of your jaw joints may be performed to test them for any sign of problems.

Should you have any jaw-related problems, it may become necessary for us to refer you to certain radiologists in Frankfurt. They will take MRI scans of your jaw joint.These scans do not involve any kind of radiation, because the underlying principle is magnetism. The scans are taken in precisely predefined bite positions. To allow that, silicone bite registrations will be made in our practice prior to the MRI examination.

Treatment planning

After all records have been evaluated we will inform you about the best treatment options, what the treatment goal is and which treatment methods will be applied. You will also be told what the expected length of treatment is.

The cost and cure plan

The cost and cure plan will be sent to you after completion of all diagnostic records and after treatment options have been discussed with you. The plan contains all diagnostic material and the treatment plan. You may want to send the cost and cure plan to your healthcare provider. Please bring a signed copy to your next appointment. Only then can treatment be started.

Treatment begins

All clinical examinations are complete, the diagnosis stated and your healthcare provider has given consent to cover treatment? Great! Let’s get started!

The cost and cure plan sets the course and can serve you as a guideline what will happen next and when. The treatment that you or your child will undergo is the optimal, individualised way to reach our goal: healthy teeth and a healthy jaw-joint.

Different treatment options and appliances are indicated, depending on the diagnosis. Someappliances will be introduced shortly here:

The lip bumper

The lip bumper keeps the lips and cheeks away from the teeth. This allows a jaw that is too narrow to broaden (children) or the orthodontist to expand it carefully and non-invasively (adults).

Brackets, fixed braces, multiband

All these terms mean the same thing: the classical „fixed brace“.Metal rings or „bands“ are cemented mainly on the first molars as anchorage for the archwire.One metal or ceramic bracket is usually glued to every tooth. A piece of wire, called „archwire“, connects the teeth over the whole dental arch and thus produces the desired tooth movement. There are brackets that are fixed to the outer surfaces of the teeth and brackets for the inner surfaces of the teeth (lingual).

The Mandibular Anterior Repositioning Appliance (MARA)

If the lower jaw is seated too far back, a MARA can be fixed to the teeth. In most cases, this appliance is used together with brackets: the lower jaw is advanced gradually. The MARA produces a muscular reprogramming, during which the musclesof mastication adapt actively to the new position of the lower jaw.

Headgear andchin cap

To control growth in the upper and lower jaw (if they are overdeveloping), headgears or chin caps are sometimes still in use today. Owing to the fact that these appliances are very visible, they are rarely used, however.

Orthodontic treatment is basically split into two phases: active treatment and passive treatment.

The major part of the tooth and jaw movement takes place during the active treatment phase. It is necessary to come to check-up appointments every 4-6 weeks in that phase. Treatment progress will be monitored and documented on these appointments. The condition of the teeth and the periodontium will also be checked on that occasion. If it is necessary, hints and suggestions will be given for more efficient tooth cleaning or we may recommend shortening the interval between professional tooth cleaning sessions. In addition – and not least of all – the archwires will be “tightened” or they may be replaced with new, stronger specimen. In patients wearing the MARA, we generally check if it is still in working condition. If indicated, we will “build in” some further advancement of the lower jaw. Patients wearing removable appliances should see us every 6 – 10 weeks for a check-up.

When the active treatment phase has been finished and tooth and jaw alignment is complete, it is not enough, however, simply to remove all appliances from the mouth. All tissues, including bone, ligaments and the periodontium, have elastic properties. Failure to stabilise the treatment result quickly leads to the teeth assuming their original, undesired position. This is the very thing we must avoid and the reason why we will take impressions of your teeth on the day your braces are taken off. From these impressions our lab technicians make what is called a “positioner”. A positioner is a clear plastic splint that holds the teeth in the desired position. There is also the possibility to use a positioner for minor final corrections.Positioners should be worn 24 hours a day at the beginning. After two weeks, the time of daily wear can be reduced gradually. Your treating doctor will give you detailed instructions on that.He will also advise you about the required intervals for the next check-ups.

Hints for orthodontic patients:

Please eat only soft foods for 24 hours after bands and brackets were put on your teeth (“banding and bonding”)!
We will call you a few days after insertion of orthodontic appliances or banding and bonding to see how you are faring or your child is faring and if everything is proceeding to your satisfaction. Your well-being is your concern.It is normal to feel some slight soreness or some irritation of the inner side of the cheeks in the very beginning of treatment. These minor inconveniences will pass very soon, just bear with us a little while.You will be fine! To help you, we are glad to provide you with some dental wax temporarily to cover prominent parts of the appliance that may cause some soreness of the inner sides of the cheeks.
The materials used in our practice can be tolerated very well and the brackets are glued very tightly and securely on the teeth. It may happen very occasionally, though, that a band or a bracket becomes loose after certain foods (hard, sticky foods). This is partly why you should avoid eating them – apart from their cariogenic effect. If you should discover that something belonging to your braces or your appliance becomes damaged, bent or dislodged (loose archwire, loose brackets, loose bands), please give us a call. We are always glad to assist you.If necessary, we will schedule an appointment for repair.
Please be very thorough with your oral hygiene. As already mentioned, it is particularly important now, during orthodontic treatment. Any questions about oral hygiene in general or brushing techniques? Please feel free to ask us and we are happy to help. Our staff is trained in professional tooth cleaning, i.e. you can either have your tooth cleaning session done at your general dentist’s or you can have it done here, in our practice, if you wish.
For oral hygiene you need a good toothbrush with a small head. Electrical toothbrushes with special brushheads produce the best result.In addition, it is recommendable to have tooth floss (Superfloss) and/or so-called interdental brushes in the size best suited for your teeth. Mouthwashes are important as optimal complement for optimal oral health. All of these articles can be obtained from pharmacies or drugstores.If you have any questions we are there to help.

Advantages of orthodontic treatment in children, adolescents and adults

Children and early treatment

Improves chances of keeping all teeth in the mouth.

Corrects the relation between upper and lower jaw

Improves lip closure

Prevents extraction of permanent teeth

Adult treatment

Up-rights tipped teeth(e.g. for later prosthodontic tooth replacement)

Improves condition of the periodontium

Jaw-joint oriented bite alignment

Improves condition of the jaw-joints

Corrects and levels axial tooth load

Avoids the necessity of having to grind down teeth extensively

No necessity of extensive prosthodontic measures, such as

crowns, dentures, bridges, etc.

Improves aesthetics

Improveschewing function