Orthodontics for children and adolescents
"The mouth may not be everything, but without the mouth, everything is nothing."
Many children need orthodontic treatment because malocclusions occur. The development of the jaw, the teeth and the oral cavity should be given equal attention as other facets of a childís development. This is particularly important because the physical and mental development of a child also depends on the development of her or his oral cavity.
The mouth is constantly in action, even if you donít chew, swallow or speak. It expresses many emotions such as anger, sadness, fear, surprise or joy. "The mouth may not be everything, but without the mouth, everything is nothing."
In our practice we emphasize child-friendly treatment. Our friendly and welcoming practice setting creates a relaxed and safe atmosphere. Beautiful and straight teeth do not only have their price, they also require a lot of hard work. We focus on dental hygiene and a tooth-friendly diet, right from the start. We introduce these concepts in a funny way to the children.
Before each treatment we perform a thorough diagnostic and discuss the outcome with the child and parents. As part of the diagnosis we use modern computer technology. This ensures highly accurate results. Digital, low-radiation X-ray is also part of our standards. After this procedure, we can determine with certainty which therapy ensures the desired results. Treatments are either applied with removable or fixed appliances and usually take several years. Wearing the appliance and proper oral hygiene are key aspects during the treatment period to ensure a successful result. With special programs we support our young patients throughout the duration of the treatment and make sure that determination and drive are not lost.
REMOVABLE ORTHODONTIC APPLIANCES
Removable unimaxillary appliances
These so-called removable appliances consist of an individual, laboratory-made plastic body and stainless steel elements for holding the teeth. Orthodontic screws and individual elements that alter a single tooth, groups of teeth or the entire jaw can also be integrated. The use of these components enables the stretching of the jaw, the opening and closing of gaps, as well as moving teeth in different directions.
Today removable appliances can be produced in various colors, so your child's individual taste can be considered. This also increases acceptance and their motivation for wearing them.
A regulation of the jaw, using removable appliances for children and adolescents during the growth period is, in most cases, a prerequisite for finer corrections with fixed orthodontic appliances later on. Unlike active removable appliances, functional orthodontic appliances use the body's own forces, which are generated by the muscles. With these appliances, both maxilla and mandible can be mutually moved to the correct position. The classic devices include the Bionator, the Activator and the Functional Regulator by Fränkel.
The Bionator by Prof. Balters is worn loose in the mouth and always moves along when the child swallows, breathes, speaks or makes facial movements. Thus correct mouth movements are trained and bad habits are untrained. By wearing the bionator, the functions of the temporomandibular joint, muscles, teeth and spine are perfectly aligned. The appliance is virtually "gymnastics for the mouth" and has positive effects on the body condition of the child (loosening of tissue and muscles, optimisation of metabolism, etc.).
Applying the Functional Regulator (by Prof. Fränkel), the position of the mandible is corrected. Simultaneously the mouth muscles, the tongue and the lips are affected. A good lip closure is trained. After a short settling time, the young patient can speak very well while using the appliance because the plastic components are situated in the fold between the teeth and the cheek.
The activator transfers an increased muscle activity onto the teeth, jawbone and jaw joints. Usually, only the powers that are suitable to correct the bite position get activated.
Functional Appliances are suitable for a holistic treatment. They include posture exercises, a secured mouth closure, a proper tongue position and correct nasal breathing.
FIXED ORTHODONTIC APPLIANCES
In situations with complicated tooth and jaw misalignments, fixed appliances that are glued to the inside or outside of the teeth are usually utilised. Through exact positioning and permanent wearing, a more efficient and often shorter treatment can be achieved (compared with removable fittings). Correction of the teeth is achieved by wire arches which are guided through individual brackets. These are secured with either rubber-made or wire-ligatures or held with clips, in the case of self-ligating brackets. During the treatment period, the wire is adjusted until the desired correction is obtained.
The multi-band technique often uses additional aids, such as anchoring equipment, elastic bands or hinges.
In the main, metal brackets and arches of various metal alloys are used. The wires are fixed with so-called rubber or wire-ligatures to the brackets. For allergy sufferers, brackets made of titanium are available. Today, there is a vast choice of treatment methods and materials available for the multi-band technique.
Ceramic brackets are a high-quality version in the area of multi-band technology. With regard to breaking strength and functionality, the ceramic brackets are equally strong as their metal counterparts. The smooth surfaces facilitate the hygiene and provide a comfortable fit. To outsiders, the dental braces are only visible at close range.
An innovative twist in the multi-band technology is represented by self-ligating brackets, especially in the miniature version. Self-ligating brackets do not only reduce lip and cheek irritation, but also transfer an even, barely perceptible force with their holding springs, resulting in less discomfort during treatment.
Self-ligating brackets are also more hygienic. It is much easier to clean their smaller, rounded surfaces than regular brackets. The greater distances in between brackets and the lack of ligatures also facilitate the cleaning with interdental brushes.
The use of anchoring appliances includes a variety of conventional but also very innovative equipment. The parts are only fixed to a few teeth and either act passively ("hold") or actively ("move"). Some rely on cooperation, others donít. In the maxilla they can run along the palate or in the mandible along the inside under the tongue (e.g Palatal-bar or Lingual Arch). But they can also run outside between the teeth and lips or outside the mouth (e.g., Headgear, Lip bumper).
In modern orthodontics, more and more anchoring appliances are being developed that can be temporarily bolted to an implant in the jaw.
After the active orthodontic treatment it is important to secure the success and consolidate the new position of the teeth.
The moved teeth have the tendency to shift back for a lifetime and this should be, of course, avoided.
This is done with the help of so-called retainers that can be either removable or fixed. The removable retainers are splints, that should be worn at least during the night for a longer period. They are part of the treatment and their position should be checked regularly by the orthodontist.
The fixed retainers are bonded wires which are running behind the front teeth and remain in the mouth after the completed treatment. Good oral hygiene is absolutely necessary to guarantee the success of fixed retainers.
Fixed retainers are usually not covered by the health insurance.
In connection with the "retention", it is also always important to clarify the situation of the wisdom teeth that could jeopardize the outcome of treatment. Usually they should be better removed!
A word on costs
Before 2003, a large percentage of orthodontic treatments for children and adolescents under the age of 18 were covered by health insurance policies in Germany. Since 2003 however, the "Orthodontic Indication Groups" (KIG) have been applied, which define the severity of an existing denture or jaw malformation. This grouping defines which patients can be treated under health insurance cover.
It is important to note that this is not a classification of medical necessity, but merely an indicator of the economic efficiency of the treatment. This means that certain treatments might still be necessary from a medical point of view, but are not covered by health insurance.
The need for treatment is divided into five levels according to the clinical findings. For levels 1 and 2, the costs are not covered at all by health insurance policies. Of course, these treatments are desirable medically but must be paid directly by the patient. For levels 3 to 5, health insurance will cover the costs that are "adequate, effective and economical".
In general, the degree of need for treatment is determined during the clinical examination. We advise you and inform you whether or not and to what extent your health insurance will cover the cost of your orthodontic treatment and how much will need to be covered by yourself.
Such restrictions do not exist for privately insured patients. But even here, individual insurance clauses have to be taken into account and need to be clarified with your private health insurance provider.
The same procedure applies for public health insurance patients with additional private insurance policies. Following this advice will avoid problems with the reimbursement of expenses by your health insurance provider.