How do we proceed?
Diagnostics - Phase 1
After the initial consultation, formal diagnostic procedures have to be entered into involving the taking of study casts, acquiring of x-rays and supporting computerised tracings and the annotation of a formal plan.
Orthopaedics - Phase 2
The first phase 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 unintrusive, children and adults alike become used to their presence very quickly and the changes produced are dramatic and at the same time gentle. There are two elements to the fee: clinical time and laboratory costing.
Functional Therapy - Phase 3
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 fee again consists of two elements, laboratory cost and the maintenance fee. 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.
Fixed Appliances - Phase 4
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. 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. For those who are concerned about aesthetics, we also provide Porcelain Brackets. These are however more expensive.
Retention - Phase 5
Retainers are provided a laboratory cost to the patient. Retention involves a further clinical fee but not at the level of the normal maintenance commitment. 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 6 months full time and 6 months night only. In complex cases it may involve local surgical techniques to individual teeth (‘precision’) and may involve the wearing of retainers over a longer period. Fixed retainers may also be used. 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 date.
Repairs
Repairs to broken braces can be a necessary part of any treatment. The clinical time required to correct a fractured appliance is covered as part of our service to you.
The laboratory element as well as material 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.
Post Treatment Equilibration - Phase 6
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.
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 Temporomandibular Joints have the 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.
Homecare – Oral Hygiene 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 the patient to schedule time to be spent with our hygienists
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