At a time when more and more value is placed on the outside, most people want a flawless, straight one denture. If this is not the case by nature, orthodontic treatment can be used.
Braces are available in different variations, one speaks of fixed, loose and even "invisible“Braces.
Orthodontic treatment is covered by the statutory and / or private health insurances up to the age of eighteen, but in certain cases it is also possible that the insurances bear at least part of the costs after the age of eighteen.
This is possible if additional surgical therapy has to be carried out in addition to the actual treatment.
Braces are appliances that are used in the Dentistry is used to correct jaw and tooth misalignments and thus the aesthetics and functionality of the Jaws to improve.
Time of treatment
Basically, braces can be used at any age, but since the dentist or orthodontist can make use of the natural growth spurts of their young patients between the ages of nine and fourteen, this is the ideal time to perform orthodontic treatment.
On average, straightening teeth and jaws with braces takes around two to three years, but the duration of treatment depends heavily on various factors.
On the one hand, the initial condition of the dentition plays an important role and, on the other hand, the cooperation of the patient can extremely extend or shorten the wearing time of the braces.
It is advisable to see an orthodontic specialist very early on; for children who have a so-called crossbite, treatment from the age of four can be useful in these cases.
The severity of the misalignment is determined by the orthodontic indications groups.
With orthodontic treatment there are generally relatively few risks, but problems can arise in exceptional cases.
Some patients have an allergic reaction to the materials used; a change of material can help in this context.
There is an increased risk of tooth decay and / or inflammation of the gums, especially when using fixed braces (Gingivitis) to develop. A conscientious and thorough oral hygiene is absolutely necessary in order not to damage the tooth substance, the gums and the jawbone lastingly.
In addition to the toothbrush, it is advisable to use dental floss and / or interdental brushes and to clean the edges of the glued brackets particularly carefully.
Furthermore, incorrectly attached brackets can lead to incorrect tooth movements, but these can be corrected again by realigning the brackets correctly.
In addition, patients repeatedly report pain caused by braces. In principle, this is not a cause for concern, as the symptoms usually subside on their own in a few days. Read more about this at: Braces Pain - What To Do?
Loose braces are dental appliances that are used to straighten the jaw and teeth.
In contrast to the fixed braces, the loose braces can be removed from the oral cavity and reinserted by the patient.
For this reason, loose braces are often referred to as removable braces.
Loose, removable braces are made in the dental laboratory using a jaw and tooth model. Before the devices are made, a so-called dental impression (actually impression) of the upper and lower jaw. On the basis of these impressions, a plaster model can then be poured in the laboratory.
A distinction is made between active plates for the upper and lower jaw and functional orthodontic devices (short: FKO devices).
Active plates are particularly suitable for children between the ages of 9 and 14, as the young patients are still changing teeth at precisely this time.
They can be made in the dental laboratory in different colors or with individual motifs.
With the help of these removable braces, sufficient space in the jaw can be created before the teeth erupt and gaps in the teeth that are too narrow can be expanded.
Functional orthodontic devices (FKO devices), on the other hand, are used to influence the growth of the jaw so that a normal bite position is created (neutral occlusion).
They are therefore used to correct so-called deep bites (Teeth lie too deeply on top of one another; the incisors of the lower jaw are usually no longer visible when biting) or open bites.
Once such loose, removable braces are used, it is of the utmost importance that patients adhere closely to the treatment plan.
The exact wearing time of braces per day and every check-up appointment should be strictly adhered to, because this is the only way to guarantee the success of the treatment and keep the wearing time as short as possible.
Read more on the topic: The loose braces
How do you clean loose braces?
Loose braces are removed from the oral cavity for cleaning. It can be cleaned with a conventional toothbrush and a little soap. It is sufficient to brush the braces and then rinse them with water. Toothpaste is not recommended because the plastic of the braces is sensitive and can be damaged, literally sanded off, by the abrasive particles of the toothpaste.
In the event of discoloration or hard deposits, the braces can be soaked in a bath of dissolved braces cleaner or a solution of diluted acetic acid and water about once a week to loosen the deposits. If used too often, however, the plastic can also be damaged, which is why it is only recommended to use it once a week. However, the intended frequency of use is stated on the packaging of the cleaning tablets and can be found there.
The gentlest form of cleaning is in an ultrasound device, in which the loose braces are placed for three to five minutes. This type of cleaning can be used daily without damaging plastic or brackets.
Cost of loose braces
The cost of loose braces goes along with the impressions and laboratory costs between 250 and 300 euros. In addition, however, there is the orthodontic fee and the treatment itself, which can take between six months and two years. The orthodontist creates an annual plan in which he plans how quickly he wants to be with which goal of therapy. If the patient is finished with the treatment faster than the calculated time due to the actual displacement of the teeth, the treatment becomes cheaper or more expensive if the therapy lasts longer. For a therapy plan for one year with loose braces, the price is around a thousand euros upwards.
It depends on Which Braces are needed and how extensive the treatment becomes. In some cases, the loose braces are only one step in the therapy until a fixed appliance follows. Then the costs of both treatment steps add up and can reach several thousand euros to reach the therapeutic goal.
Learn more at: Cost of braces
Loose braces are worn for a long time
Loose braces are usually worn during the day and night. Depending on the orthodontist's statement, you should come for at least 16 hours a day to move your teeth. A shorter period of time keeps the teeth in their current position. If the braces are worn too short, the teeth quickly move back into their old position, so that the success of the last few weeks is undone. Once the treatment is complete, the bite is also stable. However, the process to get there is long and unstable.
Loose braces are only useful in childhood, as the existing growth allows teeth and jaws to be moved. With some braces, the child should independently stretch the braces apart by turning a screw, for example to promote the growth of the upper jaw. The application usually takes one to three years, until it is either completely finished or until a fixed appliance is then inserted to continue therapy.
In adulthood, loose braces would not be successful because only fixed appliances can cause movements due to the lack of growth. Loose braces are only used here to be worn at night after therapy during the retention phase.
Fixed braces are dental devices that are used to correct misalignments of the jaw and teeth, but cannot be removed from the oral cavity by the patient himself. It remains in the mouth for the entire duration of the treatment.
Basically, a distinction is made between appliances that lie entirely within the mouth (intraoral appliances), of those that are partially outside the oral cavity (extraoral appliances) must be attached.
The purely intraoral braces are multiband or multibracket devices that are glued directly onto the tooth. These devices are made of titanium, plastic or, in some cases, "invisible“Ceramic brackets. In the middle of each bracket there is a narrow opening through which a wire that triggers tooth movement is threaded.
Fixed braces have the advantage that they remain permanently in the oral cavity and thus the wearing time can usually be shortened. In addition, they are usually the only effective way of correcting misaligned teeth and jaws in older patients.
At the beginning of treatment with fixed braces, patients usually feel slight or even moderate pain for several days to weeks. This pain is due to the loosening of the teeth in the jawbone.
Older patients in particular want orthodontic treatment that is as inconspicuous as possible. For this reason, ceramic brackets are being used more and more frequently.
Read more on the topic: fixed braces
The so-called lingual technique (lingua of the tongue) offers another possibility to carry out an inconspicuous tooth and jaw correction.
In this treatment variant, the brackets are not applied to the front surface of the tooth as usual, but rather attached to the side of the tooth facing the tongue. The braces are therefore absolutely invisible from the outside.
Since, in contrast to the outside of the tooth, the inner surface of the teeth is not shaped the same for every person, the brackets in the lingual technique have to be shaped individually and laboriously for each individual tooth.
For this reason, orthodontic treatment using the lingual technique is much more expensive than a normal correction. In addition, this procedure is not covered by the health insurance companies.
Read more on the topic: Braces behind the teeth
How do you clean fixed braces?
The cleaning of fixed braces is done like cleaning the teeth - with a toothbrush. It does not matter whether you brush with a manual toothbrush or electric, in both cases the brushing achieves the careful removal of most areas. However, brushing your teeth for three minutes is not enough to adequately clean every part of the fixed orthodontic appliance.
Special brushes and dental floss must be used for the areas below the wire, the areas between the teeth or directly on the brackets in order to remove food residues and bacterial deposits. There are special brushes for cleaning braces, but small interdental brushes are also suitable for use on braces.
The area under the wire can be reached with a dental floss that also for pontics is applied. It has a reinforced end to make it easier to thread it underneath the wire and a fluffy part in the middle, on which leftover food can stick.
If desired, regular mouth rinsing with a mouth rinse solution can strengthen the oral flora, however do not replace the toothbrush, brace brushes and dental floss.
Daily oral hygiene also includes fluoridation of teeth once a week, which are difficult to access due to the braces. Applying fluoride gels can sustainably reduce the risk of tooth decay, which is very important for braces treatment.
Fixed braces costs
It is difficult to narrow down the cost of a fixed appliance because: The more extensive, longer and more complex the treatment, the more expensive it is braces. Therapy with fixed braces is significantly more expensive than with loose braces.The costs are several thousand euros, some of which you have to pay yourself. Depending on the equipment and materials, a total of 3000 to 9000 euros can be expected.
Wax for fixed braces
In the case of fixed braces, wax can be used to buffer metal elements or to cover wire ends in order to make them more comfortable to wear. This is primarily necessary during the acclimatization period, when the braces are inserted into the oral cavity or a wire element is changed. The soft tissues in the oral cavity, such as the inside of the cheeks, tongue or lip, have to get used to the new mass of the braces, which can lead to irritation at the beginning. That is why the wax is applied to the places where the soft tissue "scrub along“And thereby lead to wounds. Constant contact without the wax can provoke wound pain and be uncomfortable without treatment. Therefore, the wax can cover the sharp ends of the wire a little until the soft tissues of the oral cavity get used to the new condition.
What are braces rubbers?
Braces rubbers in orthodontics are necessary for fixed appliances, on the one hand to serve as an anchoring aid for the archwire in the brackets, on the other hand they also enable tooth movement and stimulate jaw growth. In the case of braces rubbers, a distinction is made between Alastics and Elastics.
Alastics are those O-shaped Rubber rings that anchor the wire in the brackets and must be replaced approximately every 6 to 8 weeks. They are the counterpart to ligatures made of metal, but are very popular with wearers due to their choice of colors.
Elastics are hooked either over groups of teeth or between both jaws to trigger tooth movement. The elastics are also anchored on special wings of the brackets and their positioning allows groups of teeth to move towards one another. The patient can hang and unhook these rubbers independently. They are worn all day and only taken out for meals or oral hygiene.
Because both elastics and allastics are made of latex or other rubber-like materials, they wear out and are only dimensionally stable to a limited extent. After they have been worn for a certain period of time, they are replaced in order to continue to ensure that the required force is applied to the teeth.
Read on here: Braces rubbers
Who pays for the braces?
Several criteria apply to statutory health insurance. Early treatment, which is treatment from the eruption of a milk posterior tooth, is only accepted in extreme cases. The phase in which the health insurance company pays the most is the second part of the tooth change between the ages of nine and twelve, when the premolars (teeth 4 and 5) of the supporting zone break through. In this case, costs are covered, but only from a certain severity of the malocclusion.
The statutory health insurance therefore has a division of the malposition into the so-called "Orthodontic indication groups"that regulates the extent and participation of the costs in general. The statutory health insurance often only pays the costs for basic braces, while any special requests, such as lingual technology or other materials for brackets, have to be paid for out of pocket. For those with statutory health insurance, it is advisable to take out additional private insurance, as it partially or completely covers orthodontic treatments, depending on the insurance.
Private health insurances have also cut benefits in orthodontic treatments, so it is advisable to first contact the health insurer and discuss the agreed conditions in order to be able to assess the cost coverage. Nevertheless, it is a fact that private health insurance covers more benefits than statutory health insurance does.
For adult treatments, only treatments that are orthodontically and surgically treated are accepted, i.e. only extreme cases.
Braces for adults
Orthodontics is moving more and more into focus due to today's dental awareness for adults and every third patient in orthodontics is now an adult. With the help of splint therapy and lingual technology, it is possible to carry out a treatment almost invisibly to other people, which creates the incentive.
New studies have shown that the head, skull and jaw grow up to the age of forty, which is why it is also possible to move the teeth therapeutically in a short time. This is also possible after growth has ended, but the therapeutic goal can be reached more quickly in the growth phase. Orthodontic treatment can therefore be carried out with a good prognosis for a lifetime. Indications here are crowding and nesting in the front, which can be compensated for by invisible splints. Tooth tilting and gaps that are too narrow are also an indication to open these gaps in order to be able to insert a bridge or an implant. Closing the gap is still possible in old age, which can arise, for example, from periodontal diseases.
For all these treatments, however, only fixed braces or splint therapy come into question; loose braces would not lead to therapeutic success.
More information can be found here: Braces for adults
For whom are braces from the inside suitable?
Internal fixed braces are the alternative to fixed appliances that are attached to the outside of the teeth. Therefore, every indication of fixed braces such as a gap closure by the so-called Lingual technique can be achieved.
The advantage here is that the orthodontic treatment is invisible to outsiders, which is why the lingual technique is very popular with adults. Furthermore, the tongue, which lies directly on the braces, also offers a natural cleaning function, which simplifies oral hygiene.
However, the lingual technique is unsuitable for bite shapes in which the braces prevent or interfere with clenching or chewing. In these cases, fixed braces on the outside of the teeth must be used.
The so far new form of the lingual technique is associated with more additional payment than an appliance on the outside. This is due to the fact that the brackets in the lingual technique have to be made individually for the patient in order to optimally fit what makes them unique. With fixed braces on the outside, universal, standardized brackets are used. The greater effort therefore justifies the higher costs.
Read more here: Braces behind the teeth
Duration of treatment
Depending on the treatment case and severity The duration of orthodontic therapy is variable for the dentition disorder. In teenagers, the average duration of treatment is one to three years. In serious cases that are treated orthodontically and surgically, a treatment period of more than five years is not uncommon. In the case of severe malformations, an attempt is made to use loose braces in the deciduous dentition to prepare the jaw for a fixed appliance and to move it. In these cases, therapy can start at around 5 years of age and continue from the age of 9, so that in total almost 10 years of treatment are necessary.
The longest duration of therapy is necessary for the clinical picture of a cleft lip and palate. The newborn is then provided with a plastic drinking plate immediately after birth so that food can be consumed at all. Operations and orthodontic appliances are carried out well into adulthood in order to counteract the malformation and to restore normal function and aesthetics.
For adults who undergo orthodontic treatment, the duration of treatment is comparable to the standard duration. It ranges from six months to three years.
Pain from braces
Pain from braces occurs primarily during the acclimatization phase. The braces achieve tooth movement by transmitting tension and force to the teeth, which they first have to get used to. In the first few days after insertion and a change in wire size, pain occurs. After a period of one to two weeks, however, these symptoms should have subsided. Orthodontists recommend taking painkillers after the implantation to contain them. Hard foods should also be avoided during this phase, as excessive chewing can increase the pain.
Further complaints arise from the irritated soft tissue, which also has to get used to the mass of the braces. This includes the tongue in the lingual technique or the inside of the cheek with braces anchored on the outside. Wire ends that protrude or are not rounded also show the potential to cause discomfort, as the soft tissue is constantly coming into contact and thus chafing. This can be remedied by the orthodontist turning the end of the wire or buffering the wires with wax. However, these complaints usually only occur with fixed appliances.
There is hardly any pain with loose braces, usually only if the braces are not worn or adjusted as directed by the orthodontist. However, this pain is not as bad as pain medication.
Read on here: Pain from braces
Corresponding follow-up treatment is important after every orthodontic therapy in order to maintain the success of the treatment with braces.
Since the shape of the jaw can change for a lifetime, a successfully completed tooth correction is no guarantee that the teeth will remain permanently straight.
For this reason, the active treatment phase follows (while the devices are in the mouth), the so-called retention phase. For the first 1-2 years after removal of the braces, patients should wear retention braces at least during the night.
In a sense, these braces fix the end result of the therapy. In addition, often thin wires (Retainer) permanently attached to the tooth side facing the tongue.
Braces cleaners are commercially available in gel or tablet form. The tabs consist of salts such as calcium phosphate or silicates and are dissolved in water. The braces are immersed in the resulting bath for about 2 to 5 minutes, depending on the degree of soiling. If that is not enough, the braces should be cleaned with soap and water to loosen hard deposits.
Braces cleaners in gel form usually consist of diluted citric acid and silicates. The gel is applied to the braces and spread with a soft toothbrush. The coverings are loosened and can be cleaned off. It is important not to use too much pressure, so that the plastic for the braces is not worn away.
After use, the braces must be rinsed thoroughly with water so that no residues can remain on the braces that would otherwise get into the oral cavity.
Which materials are used?
Loose braces are made from a plastic base with brackets made from nickel-titanium alloys. In the case of fixed appliances, the wire also consists of a nickel-titanium alloy and is between 0.1-0.6 mm thin. Modern wires are thermoelastic and can only be deformed when the body heats up. The external brackets are made of gold, plastic, ceramic or titanium. The brackets for the lingual technique that lie on the inside of the teeth are made of ceramic, steel alloys or gold.