General Questions

Who is a Specialist in Orthodontics in Israel?
An Orthodontist in Israel is a dentist in possession of a valid working license, who completed a specialization program in Israel or overseas at an institution recognized by the Scientific Council of the Israel Dental Association and who passed the specialization examinations of the Ministry of Health.
Each specialist holds a certificate verifying his being a specialist and bearing his specialist's license number. In spite of the fact that any dentist, who is not a specialist, is permitted to perform orthodontic treatments, he is not permitted (by law) to call himself an orthodontist, or a doctor who straightens teeth, or any similar name that may mislead the public.
The list of orthodontists in Israel appears in the website of the Israel Orthodontic Society, in the category IOS Members – Specialists in Orthodontics.
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Why is orthodontic treatment necessary?
 
One of the most common treatments nowadays, mainly amongst youth, is "teeth straightening", or, to use its professional title, orthodontic treatment. Orthodontic treatment is mistakenly considered as used only for esthetic needs. The truth is that in many cases treatment is required due to some malfunction of the teeth, such as, improper closure (malocclusion), teeth not erupting, crowding or teeth, jaw deviation or "opposite bite". Lack of treatment may cause long-term problems manifesting in pain in the jaw joint, gum problems, plaque and accelerated tooth abrasion due to an imbalanced load on them.

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When is the desired time to begin orthodontic treatment?

What age is the recommended age for orthodontic treatment?
 
What are the factors influencing the choice of timing of the desired orthodontic treatment?
In principle, orthodontic treatment is possible at any age, as long as teeth are in a secured position. However, the influence on jaw growth is only possible when the patient has grown. The stages of jaw development generally follow the stages of development of the whole skeleton. It is important to note that adolescence and the end of growth is earlier in girls (around 14) than boys (around 17). Furthermore, psychological factors such as maturity, motivation, etc., are important in achieving the patient's cooperation and will therefore contribute to deciding when to perform the treatment.
 
Below is a summary of the stages of tooth development and options of orthodontic intervention. Please bear in mind that the ages mentioned are average ages and do not take into consideration the natural variants that exist among the patients.
 
  1. Primary dentition (ages 3 – 5.5) includes only milk teeth that fall out. At these young ages, treatment is performed when problems occur that may become complicated with time, defective functioning, habits, etc., for example, an off-center deviation of the lower jaw when closing the mouth. The orthodontic treatment at this early age is subject to the cooperation of the patient, often difficult to achieve at this time. If treatment is performed, it usually becomes the first stage of a two-stage treatment, the second of which will be at 11-13 years of age. 
     
  2. Transitional dentition(5.5 – 11) includes milk- and permanent teeth. At this age, it becomes possible to intervene in situations of the above-mentioned lower jaw deviation, serious protrusion of the upper teeth rendering them breakable, relative protrusion of the lower jaw that is not too serious and does not require future surgical intervention, impacted incisors, etc. Growth occurring during this period usually benefits the treatment process. Treatments at this stage also usually comprise the first of a two-stage treatment. 
     
  3. Young permanent dentition (12-14) includes permanent teeth (excepting wisdom teeth).
    During this period body and teeth growth are relatively accelerated (especially in males, while in females this growth usually occurs earlier), and therefore, it is possible to affect the growth of the jaws as well as to correctly determine the permanent place of the teeth. Most orthodontic treatments are carried out at these ages. 
     
  4. Mature dentition (after 17) is when growth is complete. At this stage, conditions that are treated should have been treated earlier, but for some reason were not. Ifthe jaws are also not mal-positioned, treatment will involve jaw surgery. Other combined treatments may also be administered, such as reconstruction, gum treatment, etc.
In special cases, treatment is performed by an orthodontist at other periods than mentioned above. For example, babies born with a cleft palate receive a plate to facilitate eating, which is a form of pre-operative treatment. Occasionally, enhancement of correct tooth eruption is required or treatment by sequential extractions during the transitional dentition period.
At what age should one have the first orthodontic examination?
It is advisable to have the first orthodontic examination, when the permanent incisors erupt, namely, between 6-8 years of age.

                                                                                                                                     

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“Quick” teeth straightening – myth or reality?

"Quick" teeth straightening is the dream of every patient and doctor. Moving teeth is a biological process requiring bone absorption in the area to which the tooth is being moved and bone building in the area from which the tooth has been removed. This process takes time and can last from a number of months to a number of years – depending on the required extent of movement required and the bone structure. In adults the bones is denser and the processes of building and absorbing are slower and longer. Where there are receding gums, bone-support of the teeth is less and the orthodontic movement must be performed carefully and very slowly, adhering to frequents visits to the dentist and periodontist. Orthodontic treatment of 6 months to one year is commonly considered the shortest treatment and can also be performed with transparent brackets, invisible brackets or transparent archwires in the event that the patient does not want a visible metal device.  Long-term fixation is unrelated to the length of treatment; it is resultant to the need to sustain the end result and to the tendency of the incisors (esp. the lower) to move over the years (it is sometimes advisable to retain the archwire throughout the patient's life and not only for 10 years).
During recent years, enduring wires and brackets (braces) have been introduced, with minimal abrasion– which significantly shortens the length of treatment and reduces the number of visits required by the orthodontist (check-ups at the orthodontist have decreased from monthly to once every two months on average).
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 How to improve your look during orthodontic treatment?
The last few years have witnessed a rise in the awareness of orthodontic treatment for adults. Traditional orthodontic treatment, with metal braces affixed to teeth for months on end, and even years, discourages many who wish to improve the esthetics of their teeth and smile.
This increased awareness has resulted in a demand for an esthetic alternative to the conventional orthodontic brackets.

Today there are a number of innovative techniques of teeth straightening, developed due to the recognition by orthodontics of the importance of esthetics during the treatment, also especially suited to adults.                                                                                                         
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Transparent Brackets:

There are various kinds of transparent brackets, some of plastic or silicone and others of ceramic materials – hard porcelain, also serving a number of additional medical applications. The porcelain brackets are placed in the same way as the metal ones on the front of the teeth; they do not change color, although the rubber bands used to join the orthodontic wire to the brackets may become colored from food or drinks, such as coffee, tea, wine, mustard and various food coloring. These bands are replaceable by the orthodontist. 
The time of orthodontic treatment depends on many factors. Some treatments with transparent brackets are slightly prolonged due to the greater abrasion that is created between them and the orthodontic wire.
Treatment with transparent brackets is available at any orthodontic practice and its cost is somewhat higher than treatment with regular metal brackets.                                                                                                                     

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Lingual brackets:

This is a new treatment for teeth straightening, where the brackets are invisible: they are affixed to the inside of the teeth instead of the front. This technique, begun in the USA and Japan during the seventies, is now popular mainly in Europe and the Far East. It allows utmost esthetics during the treatment period.
The lingual orthodontic device comprises brackets that are attached to the inside of the teeth and a flexible wire that passes through the brackets and applies pressure to the teeth. During treatment, the lingual appliance is adjusted by the orthodontist every 5-6 weeks. Oral hygiene is particularly important.
This treatment provides a solution for the most varied orthodontic problems, from simple ones to the most complicated.

A period of about one week to ten days is required to adapt to the lingual appliance. During the initial period, slight disruptions may occur in diction of whistling letters, tongue discomfort and difficulty in chewing. These pass within a few days.
Duration of treatment with lingual orthodontics is the same as with metal brackets and depends on the patient's kind of orthodontic problems. The end result is no different to that of traditional treatment, although there are some orthodontic difficulties that are more easily solved with lingual brackets.

Lingual orthodontic treatment is more expensive than regular orthodontic treatment, because the appliance is more costly and because it is prepared in the laboratory individually for each patient, thus incurring higher costs. This treatment requires special training of the orthodontist as well as vast experience. In Israel there are many private dental surgeries that specialize in this field, providing lingual treatment for some years.

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Invisalign:

Invisalign is a new orthodontic technique, without any brackets, where teeth are straightened by means of transparent plates that envelope the teeth. These plates are removable and the patient has to wear them for 22 hours a day. Plates are removed for eating, drinking and tooth brushing.
The plates are prepared through special computer technology in an American Laboratory. The impressions of the teeth that are sent to the USA are scanned, making the creation of a computerized model of the teeth possible and enabling simulation of the orthodontic treatment. The teeth are moved on this model and a number of plates are produced that are concomitant with the different stages of the treatment.
The advantage of this treatment is the patient's convenience; the plates are more comfortable for the tongue and lips that the brackets. The only disadvantage of this method is embedded in the fact that the patient can remove the plates: for treatment to succeed the plates must be worn constantly.
This technique is suitable for a wide range of orthodontic problems and the orthodontist should be consulted to ensure that the patient's malocclusion is suited to treatment by this technique.
Because of the high cost of the laboratory process, this technique is more costly than conventional treatments.
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Why is there sometimes a necessity to extract permanent teeth for orthodontic treatment purposes?
When is it necessary to extract permanent teeth during orthodontic treatment?
Tooth extraction is required in some cases of disharmony between the size of the teeth and the size of the jaw.
 
How is this disharmony manifested?
1.   If teeth are not arranged in a uniform row, overlap each other, some teeth are unable to erupt, it is easy for the patient or his/her family to understand the necessity for tooth extraction. However, there is another kind of disharmony that is more difficult to understand:
2. The teeth have successfully arranged themselves despite the disharmony between their size and that of the jaws because they protrude – which can occur in one or both jaws. The uniform appearance is misleading, although on closer examination it will be noticed that the lips protrude, there is a large gap between them and the patient has difficulty in closing them properly.
 
How does extraction solve this problem?
1. When teeth are not uniform extraction creates space for the other teeth. The dentist decides, according to considerations detailed below, whether to extract teeth or to widen the jaw.
2. When teeth protrude, extraction enables them to move back and they are consequently positioned at the correct angle on the jaw, while the lips also move back, enabling them to touch thereby improving the patient's appearance.
 
Why is it not possible to widen the jaw in order to make space for all the teeth?
Indeed, there are cases where it is possible to widen the jaw, although there are cases where this is not possible, and there are also cases where it is not desirable to widen the arch.
 
Is it not a pity to extract healthy teeth?
1       Although healthy teeth are being extracted, their extraction sometimes  enhances the entire mouth, as will be explained in the next section.
2       Extraction is often the only option to improve appearance.
3       Spaces left by extraction close totally, and the whole system functions faultlessly.
 
What are the orthodontist's considerations on reaching a decision to extract teeth?
1.     The patient's facial appearance: if lips protrude and they find difficulty in touching, extraction may solve such a problem, while widening of the jaw may aggravate the condition.
2.     Thickness of the gums surrounding the teeth: when gums are thin, widening of the jaw can cause gum recession, meaning the consideration is the patient's health.
3.    The patient's age: the younger the patient, the greater the possibility to       "exploit" growth processes in order to make space for teeth. The older the patient, the only option is to extract teeth.
 
How does the dentist determine his considerations?
His attitude, previous experience, personal inclination, orthodontics not being an exact science - are part of the complex considerations the dentist takes into account. Dentists have the option to choose various treatment plans, at the same time worthy ones. One should be cognizant of the fact that there are many situations where treatment is administrable with and without extractions.
 
What is the significance of the patient and/or his representative's opinion?
The dentist must is obliged to consider his patient and/or the patient's representative's opinion, (fear of extractions' facial appearance, etc), and to change the treatment plan accordingly.
 
In conclusion:
As decisions are complex, it is advised to listen to the entire web of considerations of the orthodontist, who has had thorough training that helps him ultimately reach the most correct decision.
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