A smile is a curve that
sets everything straight

ORTHODONTICS (BRACES)

Braces are appliances which are fitted in the mouth to help move teeth. There are many reasons why people choose to have braces: to improve their smile, to chew better, to clean the teeth better, to improve self confidence etc. 

Our consultant orthodontist specialises in the diagnosis, prevention and correction of malpositioned teeth and jaws, for patients of all ages.

Braces for Children
and Teenagers

Braces are most commonly done when patients are in their early teens. However, there are some special situations where braces can be done earlier. Below are some frequently asked questions about braces for children and teenagers.

When should a child first see an orthodontist?

Early orthodontic treatment can be carried out in children between the ages of 7 to 12. Most children start having braces around the age of 12 or when all their permanent teeth (except wisdom teeth) have come through.

What kind of common orthodontic problems can be treated early? 

  • Deep bite – when the upper front teeth overlap the lower front teeth too much.
  • Cross bite – when the upper teeth bite behind/inside the lower teeth
  • Open bite due to oral habits (e.g. finger sucking) – when the upper and lower front teeth do not meet
  • Over-retained milk teeth – when the milk teeth have not fallen out even when the replacement permanent teeth are almost fully formed
  • Supernumerary teeth – extra teeth in the mouth
  • Deficient lower jaw – when the lower jaw is positioned further back compared to the upper jaw
  • How can the problems be treated early?

  • Removable appliances – acrylic/plastic plates with wires designed to move teeth
  • Functional appliances – acrylic/plastic plates designed to modify jaw growth
  • Partial fixed appliance – fixed braces only on a few teeth (2×4 appliance)
  •  

    Removable appliance to correct crossbite of upper front tooth

    Functional appliance to move the lower jaw forward

    Partial braces (partial fixed appliance) to correct crossbite of upper front teeth

    Will a child still need braces after early orthodontic treatment?

    It depends. Some problems can be resolved without further treatment at a later stage. In some other cases, early treatment only reduces the severity of the problem and the child would need comprehensive treatment with braces later.

    Braces for
    Adults

    With greater dental awareness and demand for cosmetic dental procedures, it is not surprising that adults comprise a growing number of patients seeking braces. This demand is further fuelled by the numerous aesthetic options for braces. Below are some information if you are an adult thinking of having braces.

    I’m already in my 50’s. Can I still have braces done?

    Age does not preclude orthodontic treatment as long as the teeth and gums are healthy. So yes, you are never too old for braces.

    I have missing teeth. What can braces do for me?

    Firstly, if there are not many missing teeth, some of the gaps can be closed with braces.

    If a decision has been made to replace the missing teeth with a prosthesis (e.g. denture, bridge, implant), then braces can be done to align the teeth adjacent to the gaps to facilitate the placement of the prosthesis. This is because if a tooth has been missing for quite some time, the adjacent teeth can tilt into the space from the missing tooth/teeth.

    The photos illustrating our before/after clinical cases show consenting persons and the same patients appear, respectively, for the before/after result. These photos have not been retouched. Individual results may vary.

    Types of
    Braces

    There are many types of braces available to suit the individual needs of patients. Each type of braces is custom-fitted  to ensure proper tooth movement and comfort.

    We offer several types of braces:
  • Removable appliance
  • Functional appliance
  • Metal braces
  • Ceramic (clear) braces
  • Lingual braces (braces fitted behind the teeth)
  • Clear aligners (Invisalign®, etc.)
  • Check out this blog for further information regarding types of braces

    BRACES FAQs

    What is an Orthodontist? A degree in Dentistry is typically 5 years long. However, just like doctors, a dental graduate will need to complete at least one year of compulsory service with the government before he or she can become a registered dentist and practise dentistry in Malaysia. After that, there is an option to choose to specialise in fields such as orthodontics, periodontics etc. The process of specialisation is usually 3 years long. In short, it generally takes about 6 years to be a fully registered dentist and another 3 years to become a specialist!
    If you choose to have braces done, required diagnostic information (eg. dental impressions, photographs and X-rays) will be obtained on your first visit. Once all diagnostic information has been obtained, we will discuss all aspects of your orthodontic treatment with you at the subsequent visit.
    • Improve your smile by straightening crooked teeth
    • Facilitate maintenance of oral hygiene as irregular teeth are harder to keep clean
    • Retract/pull back protruding front teeth which reduces the chances of trauma to the teeth
    • Reduce damage to the gums from improper bite.
    • Straighten teeth which have undergone “drifting” in patients with gum disease (periodontitis)
    • Realign teeth to facilitate placement of denture, bridge or implant
    • Improve self-esteem and confidence
    • Clear braces (e.g. ceramic, composite)– these clear brackets are more aesthetically pleasing. They cost more and are more brittle. These brackets are very popular amongst adults as well as some teens.
    • Lingual braces – the brackets are fitted to the back of the teeth. Therefore, they are not visible when smiling. The drawbacks are higher cost and longer chairside adjustment time. Patients might take a longer time to adjust to the braces due to tongue irritation.
    • Clear aligners – these are clear flexible plastic splints which the patient can put on and remove themselves. The most famous brand is Invisalign® but there are other alternative brands as well. They are most suitable for mild to moderate cases. The disadvantages are high cost and high patient compliance as they must be worn for at least 22 hours a day.
    • Brackets are attachments which are glued to the teeth. Brackets can be made of stainless steel, titanium, plastic, ceramic or composite.
    • Archwires are placed on the brackets to move teeth. Archwires can be made of stainless steel, nickel-titanium alloy or titanium-molybdenum alloy (TMA/beta titanium).
    • The archwires are secured to the brackets using coloured elastic modules.
    • Some brackets (ie. Self-ligating brackets) have special clips which hold the archwires in place without the need for elastic modules.
    Here’s a video describing the different parts pf braces:
    Do check out our blog comparing metal braces, clear braces and clear aligner.
    Damon® braces are self-ligating brackets. This means that the brackets have clips to hold the archwires in place and elastic modules are not required. There are many different brands of self-ligating brackets but Damon® is probably the most well-known brand currently. Damon® brackets, and self-ligating brackets in general, have been inaccurately presented as a separate and more superior type of braces. In reality, self-ligating brackets are sub-types of metal or clear brackets. Here’s a video showing self-ligating brackets:
    One of the biggest advantages of self-ligating brackets (e.g. Damon®) is reduced clinical time for the dentists/orthodontists1,2 . This is because there are no elastic modules to replace and therefore wire changes are quicker. Because elastic modules are not required, patients do not have to contend with discoloured elastic modules around the brackets. This is especially obvious with ceramic brackets.

    Conventional ceramic brackets with transparent elastic modules which have discoloured

    Self-ligating ceramic brackets

    However, contrary to some published claims, self-ligating brackets do not result in faster treatment compared with conventional brackets3,4,5,6,7. The number of braces appointments is also similar between self-ligating and conventional brackets4,8. Self-ligating brackets do not cause less pain than conventional brackets4,9 and they do not reduce the need for extractions8. In conclusion, self-ligating brackets perform just as well as conventional brackets.
    Clear aligners are transparent plastics which cover the teeth. They are almost invisible when worn. A series of clear aligners move the teeth little by little. Below are some videos showing how clear aligners work.
    It depends. Usually extractions of teeth are required to provide space to straighten crooked teeth. Sometimes teeth are extracted so that the protruding front teeth can be pulled back.

    The process of fitting the braces do not hurt. Some discomfort during eating is expected following fitting of the braces. The pain and discomfort normally last for a few days up until a week. Painkillers (e.g. Paracetamol) can be taken if the pain is unbearable.

    Appointments are normally scheduled every 4-6 weeks.
    Treatment duration varies between patients and can take about 2 years to complete. More complex cases can take even longer.
    • Brackets can come off if you bite on something hard. It is advisable to avoid hard and chewy food throughout the duration of treatment.
    • Pain or discomfort. There may be some discomfort in the first few days but the discomfort should go off after a week.
    • Poor oral health. Cavities, white spot lesions (demineralization of the enamel) and gum disease can happen if excellent oral hygiene is not maintained.
    • Multiple appointments. Braces treatment can take up to 2 years or more to complete. If you are planning to move abroad (e.g. for studies) within that time, then it may be advisable to defer treatment.
    Retainers would need to be worn full time initially, and then night time only. There are 3 types of retainers:
    1. Vacuum-formed retainers – these are clear plastic splints which can double as mouth guards if patients grind their teeth during sleep.
    2. Acrylic retainers (e.g. Hawley retainers) – these are made of acrylic/plastic and metal wires.
    3. Bonded or fixed retainer – these are wires glued to the back of teeth. Periodic check-ups are necessary in case the wire detaches from the teeth. Oral hygiene must be excellent to prevent gum problems.
    All the different types of retainers function to maintain the alignment of teeth. Some movement of teeth is to be expected as we age. Therefore, it is important to continue with retainer wear to prevent the teeth from becoming crooked again. Do check out our blog comparing the different types of retainers. Vacuum-formed retainers Hawley retainer Bonded or fixed retainer
    Retainers are needed after braces treatment to prevent orthodontic relapse. Relapse is defined as the return to the original crooked alignment of teeth after braces treatment. Relapse happens due to:
    • Reorganisation of gum (periodontal ligament) fibers around the teeth.
      • After braces are removed, the gum (periodontal ligament) fibers around the teeth will reorganise to accommodate the new tooth positions.
      • The process happens over a 3-4 month period.
      • The retainers function to stabilise the tooth positions.
    • Progressive narrowing of the inter-canine width (dental arch) with age1,2.
      • The constriction of the dental arch with age will result in the lower front teeth becoming crooked again if retainers are not worn.

    Straight teeth after braces

    r2

    Crooked teeth due to relapse from not wearing retainers after braces

    The most common advice is to wear the retainers for as long as you want straight teeth. This would normally mean lifelong retainer wear.

    A study found that 2 out of 3 patients who stopped wearing retainers completely developed crooked lower teeth  (crowding) after about 10 years1.

    Reference:
    1. Stability and relapse of mandibular anterior alignment – first premolar extraction cases treated by traditional edgewise orthodontics (American Journal of Orthodontics)

    It is common belief that buried (impacted) wisdom teeth (third molars) can “push” the front teeth causing them to become crooked (crowding). This is not entirely true as patients who do not have wisdom teeth (congenitally missing) or already had the wisdom teeth removed still developed crowding of the teeth¹.

    Reference:
    1. The role of mandibular third molars on lower anterior teeth crowding and relapse after orthodontic treatment: A systematic review (The Scientific World Journal)

    Should you need any further information, please do not hesitate to contact us.
    We look forward to seeing you!

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