Fixed Appliance Treatment

What Is A Fixed Appliance?

A fixed appliance consists of metal or ceramic brackets glued to the teeth. This is very different to a removable appliance in which the brace can be taken out by the person wearing it. A fine wire connects these brackets together and elastics may also be added to move the teeth. Very precise movements may be carried out with this type of appliance and a high quality finish is the usual result. The standard type of bracket is made of stainless steel. These are the sturdiest and also the most comfortable and hygienic. Colours may be added if preferred. Clear brackets are made of a plastic or ceramic material and are less visible than the metal ones, though they tend to be bulkier and more prone to breakage. They are not generally suitable for lower teeth. Lingual braces are fixed to the inside of the teeth and so are invisible. This type of brace takes a bit of getting used to and may affect speech for a short period of time. They have to be custom made and are more expensive to make and adjust than conventional fixed braces. Treatment also takes longer, however the end result is similar to that of a conventional fixed appliance. As both the teeth and gums have to be mature in order to fit this type of brace, it is only suitable for adults. At this clinic we offer:

What are the brackets made of?

Fixed braces are usually made of metal, though plastic and ceramic brackets may be used, especially for adults. You cannot generally get these braces on the NHS.

What is headgear?

As well as an appliance it is sometimes necessary to wear headgear. You usually only need to wear it in the evening or at night. Your orthodontist will discuss whether it is necessary. It is very important to wear it in the way the orthodontist tells you otherwise treatment may not progress correctly.

What are elastics?

It may be necessary to attach delicate elastic bands to a fixed brace to help move the teeth. Your orthodontist will tell you if you need elastics.

What are ‘invisible braces’?

These braces may be used in certain simple cases. They are tough, clear plastic ‘aligners’ (moulds) that are used to straighten teeth. Several sets of specially moulded, slightly different aligners are made for each patient. Each set is worn for a few weeks before being replaced with the next one. They are made from clear plastic, so they are nearly invisible. The aligners should be worn for 22 to 23 hours a day for the best results. They can be easily removed for eating, drinking, brushing and flossing. You need to have all your adult teeth before you can have this treatment.

Can fixed braces damage my teeth?

Braces do not, in themselves, cause damage. However your teeth are  likely to be damaged if they are not properly looked after during treatment. Brackets, wires and braces trap food and cause more plaque than usual to build up. This, together with poor cleaning and too many sugary drinks and snacks can harm the teeth. So the teeth and appliance need to be cleaned very thoroughly in order to keep them healthy. Occasionally, the extreme tip of the tooth root may be smoothed off, particularly if fixed appliance treatment has been prolonged or the teeth have been moved a very long way. This effect is generally so slight as to make no difference to the health of your teeth and is not normally considered to be a problem.

Is orthodontic treatment permanent?

The position of your teeth is determined by the pressure of your lips and cheeks on one side and your tongue on the other. The teeth sit in the balance zone and will respond to changes in the balance between the two sets of muscles. As your face grows and matures, the balance continually changes in a way we do not yet understand. Therefore, even after retention, it is normal for minor tooth movements to happen throughout life, so no permanent guarantee can be given. However, it is unusual for teeth to alter enough to need further treatment. We recommend that you continue to wear your retainer at least two or three nights a week for as long as you want to keep your teeth perfectly straight.

What are microscrews?

Microscrews are sometimes used as an alternative to headgear or elastics. They are tiny screws a few millimeters long and are inserted into the gums, where they attach to the underlying bone. The brace is then attached to these screws, which act as a reinforcement. The procedure is done using a few drops of local anaesthetic. Placing and removing these screws is painless. Occasionally they loosen and have to be replaced or moved to another position.

I don’t want braces on both top and bottom teeth, can I have just one for the top (or bottom)?

In most cases, treatment can be carried out in just one jaw. However there are cases where the way your teeth meet will prevent them from being moved into their correct position and in order to achieve a good result, both jaws will require treatment. The orthodontist will tell you if this is necessary or not. Also, having started treatment in one jaw, some people decide to do the other jaw after a few months as they find that the untreated jaw dosen’t look good and that braces aren’t so bad after all. This may require a change of treatment plan and in some cases may no longer be practical. Treatment will be lengthened as the second jaw will have to catch up with the first before progress can be made. Get the opinion of the orthodontist and think things through properly before starting.

What are elastics?

It may be necessary to attach delicate elastic bands to a fixed brace to help move the teeth. Your orthodontist will tell you if you need elastics.

How do I clean my teeth with braces on?

It is easy to clean your brace but you have to be systematic in order to clean all the surfaces of your teeth. Braces trap food and increase the buildup of debris and bacteria, so you need to take a bit of extra care. The toothbrush must not be too big or it will not be able to reach all the corners of your mouth. The bristles should be medium or soft. Never use hard bristles, they will wear away the teeth. Use a pea-sized piece (you don’t need more) of fluoridated toothpaste on the brush. The most important place to brush is between the brace and the gums. Start at the back of your mouth and use small backwards-and-forwards or small circular movements. If you have an electric toothbrush, it will do these movements for you. Clean all the way from one side to the other. Then clean the inside of your teeth the same way. After that brush the tops or chewing surfaces of your teeth. To clean in between the metal squares (called brackets), use an interproximal toothbrush. This must be of the right size to fit in between, generally 8mm wide. You should floss in order to clean in between the teeth. You will need a floss threader or use Superfloss (floss lengths with a stiff end, to push underneath the brace. It is a good idea to start with your bottom teeth before you mouth fills with saliva and toothpaste foam and then move to the top. Once you’ve finished brushing, rise your mouth with water, take your fluoride mouthwash and move it around your teeth for a minute. If this is the evening/night clean, you should not eat or drink anything after this apart from water. The evening clean is the most important one as most of your mouth’s defences are in your saliva and you produce very little saliva when you are asleep, so it is easy for bacteria to grow in your teeth and mouth.

This is a link to a useful toothbrushing video

This is a link to a flossing video

This one has an electric toothbrush