What is orthodontics?

Orthodontics is a branch of dentistry concerned with facial growth, development of dentition and occlusion (the way that the upper and lower teeth close over each other), and the diagnosis, interception and treatment of occlusal anomalies (problems that result in an abnormal occlusion which is described as malocclusion).

Orthodontics is divided into two subgroups

Preventive orthodontics is a branch of orthodontics that is concerned with patient and parent education, observation and monitoring of the growth and development of the patient's dentition and cranio-facial structure, and its procedures aim to prevent the development of malocclusion before it happens.¹

Interceptive orthodontics is concerned with the recognition and elimination of the irregularities and discrepancies in the dentofacial complex.¹

Why do we need brackets?

Both preventive and orthodontic treatment have unique importance regarding the patients’ conditions, they help prevent the occurrence of occlusal problems or prevent it from becoming worse.¹ Removing or minimising the risk and the etiological factors and correcting the obvious problems. All of this results in restoration of the normal occlusion so restoration of the patient’s normal function (mastication and speech) and satisfactory appearance and esthetics.

With this article, I aim to provide you with an overview of the innovations that developed in the field of orthodontics.

Orthodontic innovations: beyond traditional braces to accelerate treatment and improve aesthetics

How did it start?

Traditional braces

Traditional braces are small metallic pieces that are used to realign teeth with malposition and misalignment problems, but many people don’t enjoy the traditional metal anaesthetic appearance and simply do not feel comfortable with its shape and colour, this is one of the main reasons that the patients may experience specific anxiety especially those who have great concern with their appearance and need superior esthetic options.²

But now, orthodontists are providing better experiences through their new discoveries and advancement which result in providing the patients with a wide range of treatment options that are suitable for most of them.

It has remained a challenge to create appliances that meet both aesthetic and technical performance but several approaches have been tried to meet this criterion including modifying stainless steel brackets' complexion or lowering their size, shifting the appliance toward the lingual sides of teeth, and modifying components used for creating the bracket.²

After the introduction of modified stainless steel braces, lingual brackets are made, which are aesthetically superior but there is a reduction In their performance which makes them demand more time and have more practical challenges.² Then an initial ceramic-based bracket became available which is more aesthetic than stainless steel ceramic and it also met the orthodontist's technical performance requirements.

Emergence of self-ligating braces

Self-ligating is a system that contains ligatureless brackets that have mechanical devices built into the bracket. It places enough force on the tooth to stimulate its movement without disturbing its blood supply which results in more effective movement that doesn't result in adverse effects like ischemia.³

Beyond traditional braces

Digital orthodontics

For years there have been only 2D modalities for orthodontic imaging like panoramic, cephalometric radiography, and dental photography, but there are some cases that require 3D imaging modalities like the impaction of canine and TMJ problems and there is no option other than the computed tomography which has a radiation dose that is so high to justify its use by orthodontists.

The advancement in orthodontic technology resulted in the invention of Cone Beam Computed Tomography (CBCT) which provided a great alternative to CT by having a relatively lower radiation dose and cost, a significantly smaller footprint, and the acquisition and reconstruction time is lesser which made it an effective replacement to 2D imaging especially in certain cases.⁴

Also the development of 3D facial photography, 4D facial photography, extraoral scanner and intraoral scanner resulted in several advantages over traditional technologies such as:

• More accurate and simple procedures of diagnosis and treatment planning, and ease of defect detection and correction hence less time consumption
• More patient comfort (if we took the impression-making procedure as an example, minimal gag reflex, unpleasant taste so less discomfort)
• Minimise the cross-infection
• Elimination of material problems like storage and maintenance
• Ease of sharing worldwide with better and faster communication and consultation
• Immediate viewing and analysis and results construction⁴

Effect of micro-osteo perforations on orthodontic treatment

What is a micro-perforation procedure?

Tiny holes and perforations are done on alveolar bone during orthodontic tooth movement which can stimulate the expression of inflammatory markers, leading to increases in osteoclast activity and the rate of tooth movement.

Role of micro-perforation in the advancement of orthodontic procedures?

It has been found that micro-perforation significantly increases the recruitment of cytokines and chemokines (which are molecules that are secreted in response to inflammation, infection, and various other physiological processes, they both influence the activity and differentiation of osteoclasts, which are specialised cells responsible for bone resorption in the body) this result in higher level of bone resorption in comparison with the conventional orthodontic procedure, hence more rate of tooth movement and consequently it reduce the orthodontic treatment time (it’s found that it reduce it by 62%).

It’s also an effective, comfortable, and safe procedure and results in only mild discomfort locally with little to no pain; accordingly, it decreases the avoidance of orthodontic treatment and the seeking of other alternative options like implants or veneers with less than optimal results.⁵ 

Improving aesthetics in orthodontics

Advantages of aesthetic considerations in orthodontic treatment

Aesthetic is one of the significant concerns of the patients seeking an orthodontic treatment not only after it but also during the treatment.

Facial appearance, dental appearance and teeth alignment are the common complaints of the patients looking for an orthodontic treatment.

So lingual orthodontics, clear plastic aligners (Invisalign) and tooth-coloured brackets have been developed and they represent some of the effective solutions that do not impair the patient from an aesthetic point of view and are used as an alternative for conventional metal brackets but of course, these plastic brackets are only suited for clinical application if they have a metal slot to provide the strength and rigidity required for teeth movement in addition to ceramic and fibreglass that are also have been added to the plastic brackets to reinforce it.

Also, ceramic brackets and clear plastic aligners are excellent options for adults and responsible adolescents. They have multiple advantages over the conventional brackets; they are more cosmetic due to their transparent appearance, the removable nature of the device so the food can be consumed easily, less applied forces therefore less root resorption and demineralization.

But naturally, it also has several disadvantages that should be well understood before accepting the treatment; they are expensive and easy to be lost or damaged due to their removable nature so their success depends on patient compliance. Also, there may be cases of allergic and toxic sensitivity reactions to Invisalign.⁶

Lingual orthodontics brackets are placed over the lingual aspect of teeth therefore the appliance is inconspicuous and it has now undergone many years of clinical experience and has been shown to consistently produce satisfactory results.

In addition, we can’t ignore the effect of the advanced digital technologies on the aesthetic aspect of the treatment results, for example, the 3D printing technologies which enhanced them by offering customised, comfortable, and aesthetically pleasing solutions tailored to each patient's unique needs and preferences. It could anticipate the teeth movement, ensure precise recording and fitting and have a higher level of accuracy.

Patient satisfaction

Patient satisfaction after the completion of orthodontic treatment is influenced by multiple factors; first of all, the doctor-patient relationship represents the most important factor in patient satisfaction. Also, the psychological status of the individual is one of the factors that influence satisfaction besides age, duration of treatment⁷ and compliance. Compliance can be defined as the extent to which a patient obeys healthcare worker’s guidelines⁸ and dentofacial improvement.

Results show that, overall, patients are more satisfied with their orthodontic treatment than patients were a decade ago. This may result from the fact that patients’ expectations and attitudes also change with time and also may be due to the improvement of the approaches of the treatment.⁷

Challenges of innovative orthodontics

Despite the recent development and innovation of orthodontic treatment approaches it’s challenging for orthodontists to keep seeking the available technologies and decide the best cost-effective treatment options.

Furthermore; there are several challenges and barriers that may affect the success of orthodontic treatment, the most important of them patient compliance, also the uncomfortable appearance, difficulties of oral hygiene maintenance, length of the treatment, expense and financial issues of the patient (economic status), breathing and speech impairment, patient concerns like teeth extraction, relapses and aesthetic concerns may represent huge barriers to a successful treatment.

Moreover, there are challenges facing the introduction of new orthodontic innovations, such as the lack of technology, training and consensus with respect to the use of innovative technologies, that the desired movements cannot be achieved by using them.⁸

These challenges and barriers can be overcome by patient counselling, motivation and reinforcement before the start of the treatment. Along with that, more training sessions for orthodontists in order to introduce them to new technological paradigms may aid in minimising the challenges.⁸

Summary

The field of orthodontics has undergone an exceptional and impressive revolution and the patients now have diverse options and treatment choices. These innovations offer a new era of orthodontic care and unparalleled opportunities to achieve optimal oral health and aesthetics they want, and with these continuous progression, it promises to further enhance treatment outcomes ensuring that patients receive the highest quality orthodontic care tailored to their individual needs and preferences.