Fixed braces

Fixed braces are a dental device used to correct jaw and tooth misalignments, but cannot be removed from the oral cavity by the patient himself. It remains in the mouth for the entire duration of treatment. A basic distinction is made between appliances that are placed entirely inside the mouth (intraoral appliances) and those that are placed partially outside the oral cavity (extraoral appliances).

The purely intraoral braces are multiband or multibracket devices that are glued directly onto the tooth. These appliances 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 is threaded that triggers the tooth movement.

Fixed braces have the advantage that they remain permanently in the oral cavity, which usually shortens the wearing time.In addition, they are usually the only effective way of correcting tooth and jaw malpositions in older patients. At the beginning of treatment with fixed braces, patients usually feel slight or even moderate pain for several days or weeks. This pain is due to the loosening of the teeth in the jawbone.

Older patients in particular want orthodontic treatment to be as unobtrusive as possible. For this reason, ceramic brackets are increasingly being used. The so-called lingual technique (lingua of tongue) offers a further possibility to perform inconspicuous tooth and jaw correction.

The brackets are not applied to the front of the teeth as usual, but are attached to the side of the teeth facing the tongue. The braces are therefore absolutely invisible from the outside. Since, in contrast to the outside of the tooth, the inside of the teeth is not shaped the same for every person, the brackets must be individually and elaborately shaped for every single tooth.

For this reason an orthodontic treatment via lingual technology is much more expensive than a normal correction. Moreover, this procedure is not covered by health insurance companies. The cleaning of fixed braces is done just like the cleaning of teeth – with a toothbrush.

It does not matter whether you brush with a manual toothbrush or electrically, in both cases brushing achieves the careful removal of most areas. However, the three-minute tooth brushing is not enough to clean every part of the fixed orthodontic appliance sufficiently. Special brushes and dental floss must be used for the areas below the wire, the areas in the interdental spaces or directly at the brackets to remove food debris and bacterial plaque.

There are special brushes for cleaning braces for this purpose, but small interdental brushes are also suitable for use on braces. The area under the wire can be reached with dental floss, which is also used for bridge links. It has a reinforced end to facilitate threading underneath the wire and a fluffy part in the middle where food debris gets stuck.

If desired, regular mouth rinsing with a mouthwash solution can strengthen the oral flora, but cannot replace the toothbrush, braces brushes and dental floss. Daily oral hygiene also includes fluoridation of the teeth, which are difficult to access through the braces, once a week. Applying fluoride gels can permanently reduce the risk of tooth decay, which is very important for the treatment of braces.

It is difficult to limit the costs of a fixed appliance, because the more extensive, longer and more complex the treatment, the more expensive the braces. Treatment with fixed braces is significantly more expensive than with loose braces. The costs are several thousand euros, which to a certain extent must be borne by the patient.

Depending on the equipment and materials, a total amount of 3000 to 9000 Euros can be expected. With fixed braces, wax can be used to buffer metal elements or to cover wire ends to make them more comfortable to wear. This is primarily necessary during the acclimatization period, when the braces are newly 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, must get used to the new space requirement of the braces, which can lead to irritations at the beginning. For this reason, wax is applied to the areas where the soft tissues “chafe along” and thus lead to injuries. The constant contact without the wax can provoke wound pain and be unpleasant without treatment.

Therefore, the wax may cover the sharp wire ends somewhat until the soft tissues of the oral cavity have become accustomed to the new condition. Brace rubbers in orthodontics are necessary for fixed appliances, on the one hand to serve as an anchoring aid of the wire arch into the brackets, on the other hand they also allow tooth movement and stimulate jaw growth. A distinction is made between Alastics and Elastics for braces.

Alastics are the 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 the wearers due to their colorful selection. Elastics are hooked either over groups of teeth or between both jaws to trigger tooth movement.

The elastics are also anchored to special wings of the brackets and their positioning allows groups of teeth to move towards each other.The patient can insert and remove these rubbers independently. They are worn throughout the day and are only removed for meals or oral hygiene. Because both elastics and alastics are made of latex or other rubber-like materials, they wear out and have only limited dimensional stability. After a certain period of wear, they are replaced in order to ensure that the necessary force is still applied to the teeth.