• orthodontics
• whitening
• bite splint therapy
• oral cancer screening
• dental implants
• periodontal disease
• preventive dentistry
• pit & fissure sealants
• radiographs (x-rays)
• wisdom teeth

orthodontics

INFORMATION FOR ORTHODONTIC AND ORTHOPAEDIC
TREATMENT 2005/6 - I

Initial consultation - FIRST VISIT

At a first appointment, you can meet the team, and talk with Dr Lister about your concerns and how modern Dento-Facial Orthopaedics and Orthodontics may help you, whether for yourself as an adult or your children.

Our philosophy is essentially to encourage full development of the growing face in a young person. In most cases this allows us to consider avoiding unwanted removal of teeth altogether - indeed, some orthodontists now refer to such extraction as amputation. It should be added that wisdom teeth are separately assessed either as part of the orthodontic treatment or upon arrival in the mouth approaching age 20. Current thinking from the National Institute of Clinical Excellence is that wisdom teeth should only be removed IF there is repeated infection or some other significant problem.

Thus we seek to influence the bones of the face through Orthopaedic Therapy, and later to align the full complement of teeth with Orthodontic Mechanics.

Dr Lister is regularly attending Continuing Education in this field whether in this country or overseas, in an attempt to ensure that the most scientifically sound and clinically up to date techniques are offered at the Private Treatment Centre. Primary training involved completion of the Clinical Foundation of Orthopaedics and Orthodontics educational programme in the UK under Dr J W 'Skip' Truitt, based in Gainesville, Texas. Dr Lister is also a member of the American Academy for Functional Orthodontics.

One such innovation is the use of a tiny, fixed orthopaedic appliance called The ALF - the Applied Lightwire Force system - far less bulky and therefore much easier to wear than the older types of plate. Another innovation is the Delta® system of fixed braces (the so called 'train tracks'). Their revolutionary triangular design has halved the time that the brackets need to be on the teeth - hence the snappy name 'Half Time Braces'! Many of the reasons for efficient fast treatment relate to the use of high technology alignment wires, which are made of heat activated Nickel Titanium which applies different forces in different areas of the mouth.

We would encourage you to make the investment in the self-confidence and inspiration that comes from a confident smile - for life.

(Our understanding is that even in 2003 under the General Dental Services of the National Health Service, any crowding of teeth has to be treated with removal of teeth and the simplest appliance systems to reduce the resultant space.)

After the initial consultation, formal diagnostic procedures have to be entered into. This will involve most of the following stages:

• The taking of mouth impressions
• he pouring of study casts
• Taking external x-ray images to confirm the presence of teeth and absence of extra structures
• Assessment of growth tendencies with computer aided tracings
• The establishment of a formal plan
• The taking of photographic records
• Measurement of the jaw size in the various positions

Collecting this information allows us to assess the changes as they occur. It also allows you to see how much change is occurring, which is of course a very powerful motivator for patient or parent.

Jaw preparation - Phase 1 treatment

First stage- Orthopaedics

The first stage of treatment usually involves the placement of removable appliances. An upper removable plate, for example, constructed of plastic with adjustable gears may be employed while a dentist-adjusted wire appliance in the lower jaw is usually also required.

Increasingly the ALF type wire appliances are used; these are worn full time (including eating and cleaning). Because they are delightfully small, children and adults alike become used to their presence very quickly and the changes produced are dramatic and at the same time gentle.

It is reasonable to expect this stage to last between 6 months and 1 year, very occasionally it will last up to 18 months

Second stage - Lower jaw correction

The aim of this phase of treatment is to position the lower jaw or mandible correctly beneath the upper jaw or maxilla. Often upper front teeth will appear protuberant because of the backward positioning of this particular jawbone.

The appliance is either a 'Bionator' single unit type or a 'Twin Block'® two-part construction. We are also increasingly using an adaptation of the ALF approach - less bulk, with equal effectiveness.

It is reasonable to expect this phase to last between 3 and 12 months - each person is different.

Final alignment of teeth - Phase 2 Treatment

The first two phases are aimed at developing the jaw and facial bones correctly in order to allow the teeth to be accommodated to the best of their ability. This final phase is the subtle alignment and angulation of the teeth, which can only be achieved with fixed appliances. In addition, the bite is properly established whereby all the teeth meet in their best manner. Although outwardly this may appear to be unnecessary, at the outset we strongly recommend this as the only way to be sure of establishing a stable bite for the long term.

It is also the treatment which establishes that confident, attractive smile for life. This is surely the best investment you can offer your children.

Retention - Holding it all when its over!

During the retention phase, occasional review may be necessary. Retention is absolutely essential to allow the teeth to settle into their new positions. It is, as a minimum, 12 months full time and 12 months at night only. In complex cases it may involve local surgical techniques to individual teeth ('pericision') and may involve the wearing of retainers over a longer period. Fixed retainers may also be used where possible in the lower jaw.

Failure to wear retainers, which allow the newly established bite to stabilise, will result in unwanted relapse to an unpredictable extent, and may result in a need for re-treatment at a later age.

Repairs

Repairs to broken braces can be a necessary part of any treatment. The clinical time that is required to correct a fractured appliance is covered as part of our service to you under the quoted fee.

The laboratory element qualifies as a cost to an outside agency and will be passed on at cost to you. You may wish to examine the feasibility of having your child's appliances covered against loss or damage under your household insurance policy.

Homecare - Dental Health Educational (DHE) support

Looking after the mouth with removable appliances and particularly fixed braces in place can be a tiresome and difficult problem. We routinely find that children adapt their techniques very well. But some patients do benefit from professional input from our dental hygienists. This will include proper prophylaxis, or in-depth cleaning, and demonstration and monitoring of home cleaning techniques. We have a professional responsibility to ensure that the mouth remains as healthy as possible and will therefore routinely expect to schedule time to be spent with our hygienists

Post Treatment - Making the Bite as healthy as possible- "Equilibration"

Although orthodontic finishing can be expected to place the teeth in an ideal relationship with each other, the bite will 'settle' over a longer period of time. Even after Functional Jaw Orthodontics, where the structures are in large part already functioning in harmony, the individual tooth contacts require careful analysis. We expect the face to continue growing until the late teenage years and the muscle forces upon tooth positioning mean that often the teeth are only 'nearly' in their ideal relationships.

So it is likely that at a detailed level of analysis the individual bite contacts will not be quite correct. The result of this is that the heavy forces of biting or mastication are distributed along an inclined axis to the tooth rather than the preferred long axis of the root.

We strongly commend a process of post orthodontic equilibration to occur at approximately age 21 in the teenage case, or 1-year post finishing in the adult. The process involves usually 2 or 3 visits to carefully adjust the biting contacts to so that ideal biting function is obtained.

The benefit of this procedure can be to reduce the tendency to night grinding or clenching, to reduce any predisposition to headaches of dental origin. It is also designed to ensure that the Tempero-Mandibular Joints have a best opportunity for long-term healthy function. This is achieved by ensuring that the dynamic tooth contacts allow the protective reflexes of the jaws to become fully operational.

Cross referral to SOT [Sacro Occipital Technique] Chiropractors or other Cranial Therapists

Many children we see exhibit a history of trauma during childhood, sometime minor, or sometimes a major fall from a bike etc. There may be a history of a difficult birth, or known neonatal feeding problems. Eve a routine birth can be more traumatic than imagined! In adults, often we are trying to influence bony relationships, which have been in place for many years.

It is our experience that many for of tension can exist in the system of complex cranial and facial bones. With this in mind you are commend you to seek the specialist opinions of a chiropractor or similarly understanding therapist who understands cranial manipulation, at the least; We can recommend the name of a chiropractor of the Sacro Occipital Therapy group of practitioners.

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