Orthodontics | Braces
in Petaling Jaya

Orthodontic treatment is considered for crowded or overlapping teeth, gaps, front teeth that protrude, teeth that have drifted after an extraction, and bites where the upper and lower teeth do not meet properly. Teenagers are usually treated once most of the adult teeth are through, at around twelve or thirteen. Adults can be treated at any age provided the gums and the bone around the teeth are healthy.

The four bite problems we look for are an overbite, where the upper front teeth cover too much of the lower, an underbite, where the lower teeth sit in front, a crossbite, where upper and lower teeth meet on the wrong side of each other, and an open bite, where the front teeth do not touch at all when the back teeth are closed. Each of these affects how the teeth wear and how well you can bite, not only how the smile looks.

Anything active in the mouth is dealt with before the teeth start moving. Decay is filled, gum disease is treated and brought under control, and any tooth with a doubtful long-term outlook is assessed, because moving teeth through inflamed gums accelerates bone loss. If you have crowns, bridges, veneers or implants already, tell us at the consultation. Brackets bond to crowns and veneers with a different adhesive, and an implant cannot be moved at all, so it becomes a fixed point that the plan has to work around.

There is a limit to what moving teeth can achieve. Where the underlying problem is the size or position of the jaws rather than the teeth, a growing teenager can sometimes be treated with an appliance that guides growth. In an adult, growth has finished, so the choice is between camouflaging the discrepancy by moving the teeth within the bone they have, and correcting the jaws themselves with orthognathic surgery in a hospital setting. We tell you which of these your case is at the consultation rather than starting treatment and finding out later.

Conventional braces, self-ligating braces and Invisalign clear aligners all move teeth using the same biology. What differs is how the force is delivered, how visible the appliance is, and how much of the result depends on you rather than on the appointment schedule. Ceramic brackets are a variation on the two fixed systems rather than a fourth one, and Carriere Motion is a short preliminary phase that sometimes comes before any of them.

• Conventional braces: brackets bonded to the front of each tooth, with a wire held in place by small elastic rings that are replaced at every visit. The rings come in clear or in colours, which teenagers usually choose to change each time. This system handles the widest range of movements, including the ones the other two struggle with.
• Self-ligating braces: the same bonded brackets, but the wire is held by a small built-in clip instead of an elastic ring. Because there is no elastic to perish and stretch, the wire keeps working between visits and appointments can often be spaced further apart. Published trials have not shown a consistent reduction in overall treatment time, so we present this as fewer visits rather than a faster result.
• Invisalign clear aligners: a series of removable transparent trays, each worn for one to two weeks. Small tooth-coloured attachments are bonded to some teeth to give the tray something to grip, and a fraction of a millimetre of enamel is sometimes polished between contacts to create space. Nothing moves while a tray is out of the mouth, so the plan depends on twenty to twenty two hours of wear a day.
• Ceramic brackets: the same fixed treatment as either metal system, with tooth-coloured ceramic brackets instead of metal ones. They are noticeably more discreet at conversational distance, they cost more, and they are slightly bulkier, so we discuss them where appearance during treatment is a concern.
• Carriere Motion: not a full appliance but a preliminary one. A small bar is bonded from the canine to the back molar on each side and worn with elastics for roughly three to six months before the braces or aligners go on, to correct the way the upper and lower arches meet. Getting that relationship right first can shorten what the main appliance has to do afterwards, and it depends entirely on the elastics being worn.

Teeth can only be aligned if there is room for them. Where there is not enough, the space has to come from somewhere, and there are three ways to find it. Which one applies is decided from your X-rays and models, not from a preference for avoiding extractions.

Temporary anchorage devices, often called TADs or mini screws, are small titanium screws placed in the bone under local anaesthesia and removed at the end of treatment. They give the wire something immovable to push against, which makes it possible to move a specific group of teeth without the rest drifting the other way. They are used selectively, and where one is planned you will be told at the quote stage rather than mid treatment.

• Arch expansion: the arch is widened slightly to gain room. This works where the upper arch is genuinely narrow, and it is more effective in a growing teenager than in an adult.
• Interproximal reduction: a fraction of a millimetre of enamel is polished from between the contact points of the teeth. It is painless, it does not weaken the tooth at the amounts used, and it can recover a few millimetres across an arch.
• Extractions: usually the first premolars, occasionally others. This is reserved for severe crowding or protrusion where the other two cannot produce enough room, because closing an extraction space properly adds time to the treatment.

Orthodontic treatment is safe and predictable, and it still carries risks that you are entitled to hear before you commit to eighteen months of it. None of these is a reason to avoid treatment. They are reasons to clean properly, attend reviews and wear retainers.

• White marks on the enamel. Plaque left around a bracket demineralises the surface underneath it and leaves a permanent white scar when the bracket comes off. This is the most common complication of braces and it is almost entirely preventable by cleaning.
• Root shortening. The tips of the roots remodel slightly during treatment in most patients. It is usually a fraction of a millimetre and of no consequence, and in a small number of people it is more pronounced, which is why we take a check X-ray during longer courses.
• Gum recession. Moving a tooth beyond the envelope of bone that surrounds it can thin the gum over the root. Planning within the bone, and treating any gum disease first, is what keeps this in check.
• Relapse. Teeth drift throughout life whether or not you have had braces. Without retainers the front teeth crowd again, often within the first year, and the treatment is effectively undone.
• Longer than planned. Broken brackets, missed appointments and inconsistent aligner wear all extend the treatment. The timeline in your plan assumes the appliance is intact and worn as instructed.

The fibres that attach each tooth to the bone are stretched by orthodontic movement and they take far longer to reorganise than the bone does. Add the natural forward drift that happens to everyone with age, and the position achieved by braces is not self sustaining. Retainers are not an optional accessory at the end of treatment, they are the part that makes the previous eighteen months permanent.

The usual protocol is full time wear for the first few months, then nights only, and then nights indefinitely. Many patients settle into a few nights a week long term. We do not tell patients that retention ends after a year, because it does not. Replacement retainers are quoted separately and are worth keeping a spare of, since the common cause of relapse is a retainer that broke and was never replaced.

• Clear Essix retainers: a thin transparent tray moulded to the finished position, worn at night. Invisible in the mouth, easy to wear, and they wear thin over a few years and need replacing.
• Hawley retainers: an acrylic plate with a wire across the front teeth. Bulkier and visible, more durable than a clear retainer, and adjustable if a tooth needs a small correction.
• Fixed bonded retainers: a thin wire bonded behind the front teeth, out of sight and working permanently without anything to remember. It needs floss threaders or a superfloss to clean under, and it needs checking, because a bond that fails silently lets that tooth move while the rest stay put.

• Brush after every meal with a soft brush, angling the bristles above and below the bracket, and finish with an interdental brush along the wire. This takes about three minutes and it is what prevents white marks.
• Use floss threaders or a superfloss to get between the teeth under the wire, once a day. A water flosser is a useful addition and not a replacement.
• Keep six monthly scaling and check-ups during treatment. Gums swell around brackets and a hygienist visit keeps that under control.
• Rinse aligners in cool water each time they come out and brush them gently. Hot water distorts them and coloured drinks stain them.
• Wear a mouthguard made to fit over the appliance for contact sports. A shop-bought guard does not fit over brackets and can be dangerous.
• Keep the clinic number for breakages. A loose bracket or a poking wire is not an emergency but it should be seen within a few days, and wax over the sharp end in the meantime.