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Orthodontic Treatment

The art and science of straightening teeth is called Orthodontia

Before Orthodontic treatment, Orthodontist diagnose each cases

1) Orthodontist access the types of faces

Orthodontist access the type of faces

2) Profile of Patient

Orthodontist access the type of faces

3) Skeletal Problem

4) Competency of lips at rest

5) Incompetency of lips at rest

6) Competency and Incompetency

7) Visibility of gum while smiling

8) High Frenum

9) Smile Line

10) Lip Line

11) Naso labial angle



12) Mento labial Sulucus



13) Everted Lower Lip

14) Deviation of jaw while opening


15) Anterior Facial Height

16) Posterior Facial Height

17) High Angle

18) Symmetry of Face

Symmetrical Face

Asymmetrical Face

19) Deep Bite

20) Overjet

21) Midline shift of upper teeth in relation to lower Arch


22) Crowding

23) Malplaced tooth

24) Impacted tooth (canine)

25) Rotation

26) Tilting

27) Cross Bite


28) Molar Relation

29) Canine Relation

30) Missing Permanent teeth

31) Arch shape

32) Open Bite

Anterior Open Bite

Posterior Open Bite

33) Over Retained deciduous tooth

34) Check for habits - Thumb Sucking, Tongue Thrust, Lip Sucking, Mouth Breathing, Bruxism

Orthodontist also diagnose each cases by

IOPA ( Intra Oral Periapical X-Ray)

Checking OPG X-Ray

Lateral Cephalogram

Hand Wrist X-Ray

Orthodontist makes treatment plan

  • Skeletal problem if noticed at growing period will plan to give extra oral &functional appliance for correction
  • Skeletal Problem noticed at later stage will be advised surgical correction after 18 yrs when growth is completed.
  • If patient not willing for surgical correction of jaws, a Chemoflagic approach suggested
  • Arch collapsed given arch expansion appliances
  • Habits noticed will be given appropriate appliance along with Fixed Orthodontic Appliance.
  • Dental correction done by Fixed Orthodontic Appliance
  • Pleasing soft tissue relations achieved by skeleton and dental correction.

Orthodontic treatments can be by

Removable Orthodontic Plate

  • Made of Acrylic with SS wire of different sizes for holding
  • Activation is done by springs for minor correction

Problems are

  • Difficult to ware
  • Poor Patient Co-operation
  • Talking difficult
  • Excessive salivation
  • Can be used only for minor correction cases
  • When not used must to put in water
  • Relapse common

By Fixed Orthodontia:

Time to do fixed orthodontic treatment is 11 to 12 yrs when all canines have erupted

Metal Bracket

Poor esthetic value Cheaper

Ceramic Bracket

Invisible Brackets

Lingual Orthodontic

Lingual Orthodontic

Lingual Orthodontic

  • Brackets are fixed from behind teeth
  • Not visible while smiling or while opening mouth
  • Lingual Brackets can be custom made with help of CAD by milling
  • Standard size brackets also available

Precaution while undergoing fixed Orthodontic treatment

  • Must maintain good oral hygiene while with braces.
  • Plaque can accumulates around and under wires.
  • Daily cleaning prevent cavities, gummy inflammatory and bad breath.

Using Inter dental Brushes to clean under and between brackets and teeth

Inter Dental Brushes

Clear Aligner

Before | After

  • Made of clear acrylic sheet and custom made with computer program and with help vacuum former
  • who does not like to expose brackets.
  • DHelps well for working class, who does not get time during day time
  • Who stays far from Orthodontic Clinic
  • Disadvantage is expensive

Surgical Correction Cases

  • Surgical correction by Orthognathic surgery
  • Fixed Orthodontic treatment will be combine with surgical correction for treating skeletal problem.
  • Done after 18yrs because growth is completed by that time

Before | After

Before | After

Before | After

Chin Cap with Headgear

  • If child face looks abnormal and detected 7-10 years
  • Corrected by non surgical approach is done between age of 9-14 yrs.
  • Appliance is Worm at night for 14 hours
  • Taking advantage of growth hormone released at night time
  • Cases where child having prognanthisam mandible (lower jaw) with normal maxillary (Upper jaw) growth are given Chin cap with Head gear

High pull Headgear

Chin cap with Head gear

Reverse Pull Head Gear

In cases where deficient maxillary growth (Upper Jaw) and normal mandibular growth (lower jaw) is give Reverse Pull Head gear

Reverse Pull Head gear

Reverse Pull Head gear

For collapsed arch are given by expansion plate

Collapsed arch

Expansive Screw

How Space are obtained for fixed orthodontic treatment

1. Utilize the existing space

2. Use of Expansion plate

If child is during growing period

3. Proximal Stripping

4. Extraction of premolars.

5. Rapid molar distalisation

  • Used in Orthodontic relapse cases where premolar have already extracted.
  • Space gaining by distalisation of molars for space gaining by extraction of all wisdom molars.
  • 10mm space can be gained

6. Micro Dental Implant

Micro Implant

  • Micro implant widely used in orthodontic as Anchorage when back teeth (molar) are missing
  • Used to gain spaces by distal movement of molars
  • For forced eruption of impacted canines


After Orthodontic treatments must retain teeth, which have moved to new position.

Hawley’s Plate

Traditional Hawley’s retainer are made of Acrylic plate with staleness steel wire

  • Must use it for 24hrs for one year.
  • Excessive salivation, bulkiness, inconvenient to use it makes patient not to ware during day time
  • Patient may ware only at night time
  • Relapse common with use of this retainer

Invisible Retainer

Made of invisible plastic clear material

  • Custom made with vacuum former
  • Comfortable, not visible, no problem while talking, no excessive salivation. patient will ware day and night time.
  • Patient can eat anything after removing
  • Advised to use first 6 months full time except eating and drinking
  • Next 6 months to use at night time.
  • Must not use Hot water for washing
  • No need to keep in water

Fixed Retainer

Fix a thin arch wire from behind teeth by bonding

Problem is restriction of eating hard food items, can brake the bonding, and tooth is shifted out from the aligned teeth



  • Infant even sucking while in Uterus
  • Thumb sucking normal up to 4 1/2ys.
  • Sucking gives emotional security
  • If sucks after 4 ½ year causes dental problem depending on the intensity, frequency and duration cause protrusion of teeth.
  • Can interfere in pronunciation and effect the roof of the mouth.
  • Child sucks to get attention from parents and their love and care

Infant in Uterus

Thumb Sucking


  • More seen in children whose both parents are working, gets less time to care them and love them.
  • Give attention, so child can discontinue such habit
  • Some mothers use bitter tasting applications on thumb sucking is in order to stop sucking
  • Never punish children, but give love and give more attention.
  • Some children use pacifiers, but never dip pacifiers in sweet solutions.
  • Child sucks to get attention from parents and their love and care

Thumb Sucking can be corrected by using Habit Breaking Appliance

Thumb Sucking

Child with Habit Breaking Appliance

Child with a pacifier

Tongue Thrusting

  • Normal person, swallow 800 times day time and 200 times at night
  • Child during breast feeding thrust tongue to suck the milk from mother’s breast nipple
  • When teeth erupted, child stops breast feeding
  • Due to some irritation, abnormal use of tongue can make habit to come back
  • Tongue Thrust cause open bite in front or back showing some space between teeth when teeth are closed.
  • Can cause protrusion of teeth

Tongue Thrust

Open Bite

Tongue Thrust Correction by:

  • Corrected by tongue exercise in day time
  • Use habit breaking appliance by removable or by Fixed appliance during day time
  • Damage occurred due to tongue thrust while swallowing can be corrected by fixed orthodontic treatment combine with elastic and Habit Breaking Appliance at any age

Habit Breaking

Lip Sucking

  • Holding lower lip beneath the upper front teeth, combine with Thumb sucking
  • Upper teeth will protrude, lower teeth will incline lingualy
  • Child does this to get attention from parents
  • Seen more in children whose both parents are working
  • Parents get less time to care and love them

Sucking lip

Lip Sucking Corrected by

  • Appliance to be worm during day and night
  • Give more attention, care and love the child

Appliance for lip sucking

Mouth Breathing

  • Child with mouth breathing
  • Can be due to bad habit.
  • Due to growth in nose called adenoid.
  • Makes child forced to mouth breathing

Mouth Breathing Corrected by

  • Child must be seen by ENT specialist to remove the adenoids if any
  • Give oral screen appliance to change mouth breathing to normal nose breathing

Appliance for Mouth Breathing Correction


  • Is a neurological disorder where excessive teeth grinding at night
  • It is a unconscious act done at night
  • Causes rapid tooth to wear
  • Main cause can be mental tension

Due to Bruxism teeth worn

Due to Bruxism teeth worn

Bruxism Corrected by

  • Using night guard made of soft acrylic material
  • Comfortable to wear at night prevent teeth getting worn out

Night Guard

If not corrected

  • Using night guard made of soft acrylic material
  • Comfortable to wear at night prevent teeth getting worn out

Patient Bite with strain | Corrected by crowning all teeth to increase vertical height

TMJ dysfunction syndrome

It is a TMJ disorder due to myofunctional problem

  • Patients complaints of pain, aching jaw, clicking, cripitation sound while opening and closing jaw.
  • Pain radiates to bones of skull over ear (called temporal region), neck and to shoulder
  • Cause is due to deviation of jaw while opening and closing
  • Can cause disc to come out protrude which makes bone to rub each other causes pain and abnormal sounds.

TMJ dysfunction treated by

  • Adjust the food habits to prevent wide opening mouth
  • Restrict yawning and laughing
  • Prevent eating raw fruits
  • Use spoons to eat
  • Cut raw fruits and eat
  • Orthodontist give systemic medication, give anti inflammatory gel ask patient to do hot Fermentation, & given TMJ appliance
  • To wear for 3-4 hours per day to get disc to correct position in joint space
  • Stop clicking, cripitation sound and stops the radiating pain
  • Appliance correct TMJ joint and cranio mandibular muscles
  • Correct extra capsular by relaxing facial muscles
  • Correct intra capsular by reducing symptom of jaw joint and bone structure, reduce the sounds

Cross Bite

  • Seen anteriorly (front teeth) or posteriorly (back teeth)
  • Can be due to early loss of milk teeth or delay in shedding of milk teeth
  • Defective of palatal arch growth.


  • If child is below 14 yrs corrected by palatal expansion palates
  • Either removable or fixed expansion by rapid palatal expansion Plate
  • After cross bite correction, child must go to fixed orthodontic treatment for stable occlusion

Types of Expansion plates

Hyrax (Rapid Maxillary Expanding)


Rapid lower expanding

Nance ( Lungal Holding Arch)

Pendulam Appliance with TMA

Quad helix

Fixed Blue Grass Appliance