tooth alignment
Tooth alignment can play an important role in making restorative treatment more predictable and conservative.
Your teeth do not need to be significantly misaligned to benefit from alignment treatment. Even relatively small changes in the position of your teeth can create or redistribute space, improve how the teeth come together, and provide a more favourable foundation for subsequent restorative treatment.
Teeth can be aligned using fixed braces with brackets and wires, or with removable clear aligners. The most appropriate approach depends on the movements required and the wider goals of your treatment.
What can alignment treatments achieve?
Create or Redistribute Space
Aligning your teeth can help to create space between your top and bottom teeth or between your teeth. This can allow the space needed to provide restorations of appropriate size with better predictability. For example;
If teeth have drifted over time and you require an implant, alignment may allow us to recreate the space needed to position the implant appropriately.
If tooth wear has reduced the space available between your upper and lower teeth, alignment may help create the space needed to restore the teeth to more appropriate proportions.
Close Spaces
Where you have spaces between your teeth (diastemas), alignment can be used to close these spaces, so that the teeth touch. Alternatively, they can be used to redistribute the spaces between teeth to allow them to be restored with better proportions.
Improve the position of individual teeth
In selected cases, a tooth can also be moved slightly further out of the supporting bone. This may be useful when a tooth has fractured and additional tooth structure is needed above the gum to allow it to be restored predictably. It is also possible to improve the gum and bone levels around a tooth which has lost support over time.
Improve how the teeth come together
Alignment can also influence how the teeth come together when you bite. Where appropriate, improving the relationship between the teeth can help distribute biting forces more favourably and reduce excessive loading on individual teeth.
When might they be appropriate?
The decision to align teeth is often determined not simply by how straight they look, but by what we are trying to achieve with the teeth afterwards.
Aligning your teeth can be appropriate in many situations, and is dictated in part by the intended final restoration. They can be appropriate if your teeth are crowded and overlapping, if you have worn teeth, if your teeth have drifted over time or with age, and if you have spaces in your smile. They may also be appropriate if we have another reason to create space to improve the predictability of your care.
When might another approach be better?
In order to move teeth predictably, we need an adequate amount of bone around the tooth, and healthy gums. While gum disease in itself doesn't prevent you from aligning your teeth, active or poorly controlled disease precludes you from this treatment.
In some patients, the position of the teeth is influenced by the underlying relationship between the jaws. Comprehensive correction may then involve more extensive orthodontic treatment and, in some cases, jaw surgery. Where this is not appropriate or not something you wish to pursue, alternative approaches may sometimes be considered to camouflage the underlying discrepancy.
How I approach treatment
When I consider alignment as part of a wider treatment plan, one of the first questions I ask is: where is the space, and where does it need to be?
I assess the space available between and around the teeth, both when the teeth are at rest and as they move during function. This helps determine what movement is required and whether alignment can create the conditions needed for the next stage of treatment.
I also consider the final position and appearance of each tooth. Where restorative treatment is planned afterwards, this allows us to position the teeth with the final restoration in mind.
In some cases, this can allow restorations to be designed more conservatively by creating a more favourable position before restorative treatment begins.
What does treatment involve?
Tooth alignment is a commitment rather than a quick treatment. Whether you have fixed braces or removable aligners, treatment involves a series of appointments to monitor how your teeth are responding and make adjustments where necessary.
If you have fixed braces, brackets and wires are used to guide the movement of your teeth. With clear aligners, a series of removable trays is used, often with small tooth-coloured attachments bonded to selected teeth. In some cases, elastics or other auxiliaries may also be required.
Creating space is often an important part of alignment treatment. Depending on your individual situation, this may involve carefully removing a small amount of enamel between selected teeth (IPR), or, in some cases, removing a tooth to create the space required.
If you are treated with aligners, you will need to wear them for the majority of each day (21+ hours) during active treatment.
Tooth movement is influenced by individual biology, so treatment does not always progress exactly as predicted. I will provide an estimated treatment time, but I cannot guarantee an exact duration. With aligners, additional sets of aligners may sometimes be required to complete the planned movements.
Longevity and maintenance
Alignment isn't finished when the teeth are straight.
Teeth naturally have a tendency to move throughout life, which is why retention is an essential part of maintaining the result of alignment treatment. I will recommend a retainer regime based on your individual circumstances and the position we have achieved. Retainers require ongoing use and will eventually need to be replaced.
In some cases, I may recommend a bonded retainer in addition to a removable retainer, particularly for the front teeth.
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