Dental Team Luzern - Clinic Dr. Schulte

Orthodontics:
Treatment with Orthodontic Appliances for Children and Adults

Orthodontic Appliances

Straight, regular teeth are attributes for life. Unfortunately nature is not always that kind: over 50% of children have malocclusion (dysgnathia), which require orthodontic treatment with dental braces. There are also many adults who suffer from malocclusion, as in the past orthodontic treatment was not used to correct tooth alignment or treatment was not carried out properly.

Our practice focuses on aesthetics and function, which makes orthodontics an ideal addition to the treatment we offer.

We are fortunate to have experienced orthodontists, who works closely with Dr. Schulte, and the other specialists of our team in providing orthodontic treatment for children and adults.

Modern orthodontics has developed into an independent, extensive specialised area - the information provided here is also extensive. You can read through all the information or select specific areas of special interest to you by clicking on the following headings.

Why Dental Braces?

Aesthetics

Nowadays attractive, straight teeth and a charming smile play an important role socially. They represent youthfulness, dynamism and success, increase self-esteem and confidence and are a kind of optical calling card that creates an initial impression when meeting people. On the other hand misaligned, unsightly teeth can make people inhibited and shy and even contribute to depression in those predisposed to the condition.

Prophylaxis of caries and periodontitis

Crowded, misaligned teeth often form hidden corners for bacterial deposits like plaque and tartar; these areas are difficult to clean. The result is that the risk of caries or periodontal disease is greatly increased in comparison with correctly aligned teeth.

Mouth breathing

Certain types of malocclusion (open bite) cause mouth breathing because the lips do not close correctly. This increases the risk of illnesses of the respiratory tract and often results in caries and periodontitis.

Speech defects

Malpositioned upper front teeth can contribute to speech defects such as a lisp.

Reduced masticatory function and incorrect loading

A poor occlusion impairs masticatory function, which can cause problems with the alimentary tract and damage to the teeth (abrasion, loosening) and temporomandibular joints due to overloading. Incorrect loading of the masticatory muscles and temporomandibular joints can result in facial pain and headaches, noise in the ears (tinnitus) as well as stresses and incorrect posture of the spinal column.

Common Types of Malocclusion (Dysgnathia):

Source: Association of Austrian Orthodontists (VÖK)

Gaps
Gaps
Open bite
Open bite
Lateral crossbite
Lateral crossbite
Centric slide
Centric slide
Pronounced overjet
Pronounced overjet
Overcrowding
Overcrowding (too little space)
Negative overjet
Negative overjet (prognathism)
Negative overjet
Negative overjet (prognathism)
Deep bite
Deep bite

Dental Braces for Children

Fortunately not all children require a dental brace. Children should be examined by an orthodontist to determine whether and when treatment is required.

When should the examination take place?

  • First examination at 4 years (milk teeth)
  • Second examination at 8 years (early transitional dentition)
  • Third examination at 12 years (late transitional dentition)

When should treatment begin?

Generally treatment begins between the ages of 7 and 12. An earlier start to treatment in the deciduous dentition is only required in difficult cases.

Removable orthodontic apparatus (expansion plate)

Removable dental braces

Removable dental braces are the standard tooth correction appliances for children and young adults. The appliance uses the natural growth of the jaws during this period to guide the teeth and bony structures gently into the correct position. There are various types of removable appliances for different areas of application, e.g. orthodontic expansion plates, activators and bionators. They all have one thing in common; they must be worn regularly for about 15 hours a day to produce good results. A check-up is required about every 4 weeks with the orthodontist; if required the expansion screws in the appliance are then reactivated to maintain the pressure on the teeth and jaws.

Important:

  • Success depends on wearing the appliance regularly! This means that parents have to keep their children motivated.
  • Do not wear removable appliances when eating and always keep the teeth and dental braces clean to prevent caries!
  • When the brace is not in use, it should be kept in a sturdy box to ensure it is not accidentally damaged or lost.

Fixed dental braces

Fixed dental braces

Removable dental braces cannot be used in complex cases with severe malalignment of the teeth and jaw bones. In these cases modern orthodontics increasingly uses fixed appliances, also known as multi-band appliances, for children and young adults: small attachments called brackets made from metal, plastic or porcelain are bonded to the teeth with adhesive and connected with custom bent flexible wire arches, which are changed at regular intervals. The force applied by the arches moves the teeth very precisely into the required position. Tooth correction with fixed dental braces is generally completed in 2 - 3 years and therefore requires less time on average than treatment with a removable appliance.

Treatment does not depend on the discipline of the child or parents, as the appliance functions 24 hours a day. Fixed dental braces are effective regardless of age - they function just as well for adults as for children.

Fixed dental braces
Fixed dental braces
Before and after multi-band
treatment in the upper and
lower jaw

One disadvantage is that fixed appliances with brackets and arches make it difficult to clean the teeth, increasing the risk of caries. Particularly thorough and precise oral hygiene with special toothbrushes is therefore required. Our dental hygienists provide special instructions for dental brace wearers. Not every patient is comfortable with the "silver smile" of a fixed dental brace, though the aesthetics of dental braces has been improved in the past few years: transparent brackets made from porcelain or plastic are hardly visible. The latest type uses the lingual technique to bond the appliance onto the inner surface of the teeth and is therefore completely invisible. Further details can be found at Adult treatment.

Preventing a relapse: After correction, teeth have a tendency to return to their original position. The risk of relapse used to be underestimated. Consequently, after spending a lot of time and effort obtaining initially good results, many patients (and orthodontists) felt frustrated that the teeth returned to their original malposition over several years.

Lower wire retainer
Lower wire retainer

This problem is now solved by fitting a retainer after completion of treatment, which fixes the teeth in their new position. A thin wire, which is bonded with adhesive onto the inner surfaces of the teeth and remains fitted for many years, is generally used as a retainer.


thumb sucking
Open Bite
Open bite
Caries in milk teeth
Caries in milk teeth

Prophylaxis: Parents' responsibilities

Baby
  • About half of tooth and jaw anomalies are not inherited or congenital, but are acquired through bad habits, e.g. thumb sucking, or due to the premature loss of milk teeth.
  • Prolonged thumb sucking can cause the anterior section of the upper jaw including the incisal teeth to protrude. At the same time the lower jaw is pushed back. The result is an open bite due to thumb sucking, in which the incisal teeth can no longer be closed. This can also cause speech defects and mouth breathing.
  • All small children need something to suck on. It is much better for the child to suck a dummy rather than a thumb. From an orthodontic point of view there is nothing wrong with moderate use of a dummy up to the age of three.
  • Milk teeth have an important function as space maintainers, i.e. they keep the correct amount of space free for the permanent teeth. Premature loss of the posterior milk teeth due to caries can therefore cause severe malocclusion in the permanent dentition. Optimum oral hygiene from early childhood and healthy nutrition are therefore important for maintaining the milk teeth until eruption of the permanent teeth.
  • Our paediatric dentist is happy to offer advice on orthodontic prophylaxis

Orthodontic Treatment for Adults

teeth can be moved - at any age
It is never too late: teeth can
be moved - at any age.

The mouth is not only used for taking in nutrition and breathing, it is also used for communication and other people automatically focus on it. It is therefore no surprise that beautiful, regular, healthy teeth are a kind of "calling card" for an attractive, well-groomed person.

While it is common to see children and young adults wearing dental braces, it is still relatively rare for adults to wear orthodontic appliances, even though there has been a high increase in the past few years. One reason for this was that in the past there was a lack of information about the options for adult treatment. With the modern techniques that are now available it is possible to correct malocclusions in adults of any age.

Generally tooth correction in adults is carried out using fixed appliances, which have to be worn over a period of 6 - 24 months. Many people are deterred by the idea of having to wear this type of dental brace in the mouth for a long time. They overlook the fact that thanks to new techniques dental braces are now much more comfortable to wear than in the past. From an aesthetic point of view there have also been major advances: dental braces that are not visible or only partially visible - wishful thinking in the past - have now become a reality for all patients.

Multi-band appliances

The "classic" fixed dental brace comprises brackets, anchorage points bonded onto the teeth with adhesive, which are connected with special flexible wire arches. This proven technique moves teeth, even in adults, gently, effectively and precisely into the correct position.

Until a few years ago the unsightly appearance of these types of orthodontic appliances acted as a deterrent. Now brackets made from tooth-coloured porcelain or transparent plastic are available, which almost make the dental brace look like of a piece of dental jewellery.

Lingual Technique

Lingual technique
Lingual technique:
viewed from inside the mouth...
Lingual technique
...and from outside
Lingual technique
Before treatment
Lingual technique
After treatment

The lingual technique really is a revolutionary innovation. In the lingual technique brackets and arches are not bonded onto the outer surfaces of the teeth but onto the lingual surface, i.e. onto the inner surfaces, of the teeth and are therefore completely invisible. The "camouflaged" dental braces function just as effectively as conventional appliances.

The disadvantages of lingual dental braces up to now have been uncomfortable irritation of the tongue by the lingually fitted appliance and speech problems, especially in the first weeks of treatment. A completely new development provides a solution to these problems: Incognito brackets are customised CAD/CAM brackets, which lie flat on the surface of the teeth and protrude much less into the mouth than conventional lingual brackets.

Incognito Lingual brackets
A comparison: left a normal
bracket, right an ultra flat
Incognito lingual bracket

As soon as three weeks after starting treatment the patient has generally become perfectly accustomed to the lingual dental brace and no longer experiences discomfort.

Lingual brackets
Incognito lingual brackets
in the lower jaw

The lingual technique is very demanding technically and is mastered by only a few, highly specialised orthodontists. Operators must also acquire special certification for using Incognito brackets. We are pleased that we are able to provide these innovative treatment options in our practice.

Video about treatment with lingual dental brackets in the lower jaw (0.7 MB).

Invisalign - the invisible high-tech appliance

Invisalign

For a long time now orthodontists and patients have wanted to correct teeth inconspicuously and without the use of fixed dental braces. New technology has turned this dream into reality: the new type of treatment is called Invisalign (= invisible/ align). A series of virtually invisible, thin, flexible foils made from a special plastic gently move the teeth into the correct position. State-of-the-art computer technology and three-dimensional analysis has made this revolution in orthodontics possible: software specialists in the American company, Align, developed a three-dimensional diagnostic and planning programme in collaboration with the Universities of Indiana, Florida, Washington and the Pacific School of Dentistry.

tooth movement
Computer simulation of the
required tooth movement

Using the latest computer technology it is possible to simulate the desired treatment outcome on the computer. The orthodontists then calculate the number of stages required to move the teeth into the correct position using the relevant number of foils.

Depending on the degree of difficulty, the patient receives 12 - 48 transparent foils from the orthodontist. The patient changes the splint every two weeks.

Invisalign foils
An Invisalign splint compared...
Invisalign comparism
with a fixed multi-band appliance.

The treatment splint is practically invisible in the mouth from as close as 50 cm. It does not interfere with speaking and is only removed for eating and cleaning the teeth.

The Invisalign technique improves patient comfort and can be used for treating adults who refuse to wear metal fixed appliances.

Invisalign cannot, however, be used for treating all types of malocclusion. Our orthodontist completed special training and is certified to use Invisalign and as an experienced operator is familiar with the possibilities and limitations of this fascinating treatment technique.

Cost of Orthodontic Treatment

The cost of orthodontic treatment depends of course on the difficulty of the case as well as on the type and length of treatment. In our clinic, the first orthodontic consultation is free. We only charge the X-rays or plaster models that may be necessary.

We provide a detailed written estimate before each treatment. Treatment costs are distributed over the whole treatment period and are invoiced every quarter. Usually we offer a fixed price that is kept even if the treatment is longer than scheduled.

Average cost range of common treatments

Treatment with Invisalign or fixed braces SFR 4'000 - 12'000
Treatment with lingual braces SFR 7'000 - 15'000
Orthopulse treatment accelerator SFR 1'100

Do you want to convert the CHF prices (Swiss francs) to euros? Use the online currency converter

Tariff / tax points in our practice

In our practice orthodontic services, i.e. treatment with dental braces, are calculated in the same way for all patients with the tax point of 3.10 Fr. (social tariff). This is irrespective of whether we provide private treatment or statutory treatment in accordance with KVG (health insurance law) or disability insurance. Further information about our invoicing.

Insurance

Statutory insurance companies do not generally cover orthodontic treatment. Disability insurance (IV) only covers treatment costs in particularly severe cases, which must fulfil specific, precisely defined criteria.

The majority of medical insurers offer additional insurance, which covers part of the cost of tooth correction for children. This type of policy should be taken out in early childhood when the need for orthodontic treatment is not apparent. With older children the insurance companies usually request an assessment and may omit dental braces from the policy.

Frequently asked questions

FAQ

  • At what age should a child begin tooth correction treatment?
    There is no generally accepted answer. The first examination should be carried out at 4 years as a precautionary measure, though treatment normally only begins at 7 - 12 years.
  • Until what age is orthodontic treatment possible or effective?
    As long as the teeth are healthy and there is adequate bone structure, there is no age limit for orthodontic treatment. Even at the age of 60, treatment can be effective.
  • Is orthodontic treatment painful?
    In the first few days after having the appliance fitted, the feeling of stress on the teeth fluctuates. Initially the oral mucosa of the lips, tongue or cheek may be irritated. Sometimes there are also speech problems. All of these symptoms generally wear off after the first few days and after becoming accustomed to the appliance it can be worn without any problem.
  • Can a fixed appliance cause caries?
    Caries is not caused by the dental brace but by bacterial tooth deposits (plaque), which have not been removed with a toothbrush. With fixed appliances plaque builds up readily at the brackets that are bonded to the teeth. This is why teeth should be thoroughly and regularly cleaned with special brushes to avoid damage to the tooth by caries.
  • Is it possible for the teeth to return to their original malposition after orthodontic treatment?
    Yes, there is that risk. This is why in most cases, after completion of treatment, a fixed or removable retainer is now fitted that fixes the teeth in the correct position.
  • Why do we now see more adults wearing dental braces?
    In childhood many adults did not receive any orthodontic treatment or, according to modern standards, received incorrect orthodontic treatment. Nowadays an increasing number of people attach importance to their outward appearance and want to improve the aesthetics of their teeth. An increasing number of adults therefore decide to make up for lost time in their youth and attain an attractive smile with orthodontic treatment.

Further information about Paediatric Dentistry, Dental Aesthetic and Bleaching.