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The Canadian Association of Orthodontists (CAO) and the American Association of Orthodontists (AAO) recommend a first orthodontic consultation as early as 7 years of age.
In some cases, problems can be identified in preschool children (kindergarden). Of course, not all young children necessarily need dental appliances as early in their life, but some will benefit from them whereas others will not be eligible to receive their treatment until they become a teenager.
The goal of a first consultation visit is:
• to evaluate your dental situation or your child’s.
• to identify existing dental problems.
• to give you all the information that you need to make an informed decision about your orthodontic treatment.
In young patients with mixed dentition (still having deciduous teeth), it is sometimes necessary to take a panoramic X-ray. It is an X-ray of the whole mouth on one film. It is used to identify, in one glance, the presence of all the teeth or the absence of some of them, dental ectopias (impacted canine), etc.
We will be able to make recommendations to:
• Prevent some problems from appearing.
• Intercept or correct existing dental problems.
• Reassure you on the evolution of your child’s dentition or your dentition if you are an adult.
• Suggest to you the appropriate treatment based on your orthodontic condition.
During this visit, you will thus be able to talk to us about your concerns.
The first question that I ask a patient who comes to see me is the following:
“Tell me in your own words the reason why you are consulting me.”
The answer to this question will be carefully noted and it is your main complaint. You are thus expressing your need and the success of the orthodontic treatment that you will receive depends on satisfying this need that you will have expressed.
You will be informed, through this consultation, of the duration of treatment, the costs, the payment modalities. For more details, see the “Finances” tab of our site.
A consultation visit lasts about 30 to 45 minutes.
You will receive a consultation report summarizing the discussions that we had together.
A one-pager (in French) representing different orthodontic problems will be handled out to you before you leave. It includes typical images of some problems. This will help you visualize what we talked about.
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Second visit: the complete examination or diagnostic evaluation
When you decide to start a treatment, we need to perform a complete examination to establish the diagnosis and the treatment plan adapted to your situation.
In addition to the intrabuccal examination, the diagnostic material includes:
• Intraoral pictures.
• To evaluate the color of the gums, the teeth, the relationships between the teeth. It is also a good way to remember the starting point of the treatment and the reasons why a treatment was started.
• Extraoral pictures.
• To evaluate the profile, facial proportions and symmetry, etc.
• Panoramic X-ray.
• This X-ray makes it possible to visualize, on a single image, the whole dentition, the state of dental development, the quality and density of the bone supporting the teeth, the presence of all the teeth and consequently, congenital absences, dental mutilations, pathologies, etc.
• Cephalometric X-ray, lateral view.
• This X-ray allows the evaluation of the anteroposterior (front-back) and vertical relationship of the jaws and the face regarding the bone tissues, as well as soft tissues (skin), etc.
• A cephalometric X-ray, posteroanterior (front) view, if needed.
• The front view is useful to evaluate the relative width of the upper jaw compared to the lower jaw, asymmetries, obstructions or shift of the nasal septum.
• Study models.
• Models are a 3D representation of the dentition. They enable us to evaluate precisely the size of the teeth, the relationship between the arches. Work models are necessary when appliances need to be made in a dental laboratory.
Orthodontic study models are casted in a white plaster stone and carved according to very precise angles. The height of both occlusal models is standardized.
Each malocclusion is different. After meticulously analyzing diagnostic data, we will be able to determine an adequate treatment plan to improve your smile.
The duration of this appointment is about 30 minutes.
Third visit: presenting the treatment plan and installing the appliances in the mouth
The first part of this appointment is used to review the diagnosis of the malocclusion, present the treatment plan, review the risks associated with an orthodontic treatment, review the duration of treatment, review the financial agreement previously established and review the benefits of treatment. You will be able to consent to the treatment that you or your child will receive with all the information at hand.
The second part of the appointment is dedicated to the installation of the fixed appliances. We use a direct bonding technique on the chair, which explains why there is a blue plate on the patient.
Teeth must be cleaned using a rotative cupule and paste to remove the film of saliva or bacterial plaque that could be on the teeth. Special retractors make it possible to keep the lips away and keep teeth dry.
The tooth enamel is treated with a 35% phosphoric acid. This process, called etching of enamel, has been used for more than 40 years in dentistry and allows the tooth enamel to adhere using a composite resin.
A sealant is applied to the base of the bracket which is then coated with adhesive. Each bracket is picked up and individually positioned on teeth at a very precise location.
The tooth will previously have received the same sealant as on the bracket. The bracket is firmly pressed on the tooth to remove the excess of adhesive. This excess is removed with a fine instrument. This sandwich technique (sealant-paste-sealant) allows the products contained in the sealant and the paste to blend and a chemical reaction follows. The adhesive hardens and maintains the bracket firmly on the tooth. The orthodontist has to work not much more than 30 seconds.
The position of the bracket is measured and it is centered on the tooth in width and at a predetermined height from the tip of the tooth. We mainly use the self-ligating SPEED™ system (see the “Appliances” tab on our site).
When all brackets are installed, the patient rinses his/her mouth to remove the bitter tasting of the adhesive. Oh yes! Vanilla or strawberry-flavored adhesive is still not available yet.
The orthodontic wire is installed and the teeth start moving. In fact, the body receives signals that something is happening to the teeth.
After the installation, we give you all the necessary hygiene instructions and recommendations (see the “FAQ>oral hygiene” tab).
The duration of this appointment is about 60 to 75 minutes. It can never be at the end of the day, because this period is reserved for short appointments in order to accommodate the most people possible in late afternoon.
Visits between the beginning and end of treatment
Follow-up appointments during the treatment have variable durations. 15 minutes are generally required to change the wire, 30-minute appointments are required for adjustments that are more complicated, bracket rebonding, taking X-rays, pictures or imprints, the installation of fixed functional appliances, expanders, the installation of surgical arches in patients who undergo orthosurgery treatments, etc.
The frequency of appointments is generally every 6 weeks. It can sometimes be 8 weeks, sometimes 4 or 5. During the finishing phase, I like to see patients every 3 or 4 weeks. Small movements then occur and the patient is involved in the qualitative appreciation of his/her smile. It is a team work between the patient, the parent and the orthodontist. It is a determining phase in the patient’s satisfaction.
Removal of the fixed appliances
It is the big day. The removal of the appliances means the removal of fixed appliances.
This day is a celebration for the patient and the parents.
Imprints, which are used to make the retainers, must have been taken previously. Generally, retainers are wires that are bonded to the lingual side of teeth. Sometimes, a removable retainer will be necessary. The lingual wire bonding procedure is available in the Keynote presentation available online “Bonded lingual retainer”.
Final data must also be taken, including intra and extraoral pictures, panoramic and cephalometric X-rays and a last set of models, the final models. The parent who accompanies the patient is invited to have his/her picture taken with his/her child as a souvenir. It will be our pleasure to send this picture to you via email. It is our way to say thank you to parents who accompanied their child throughout the whole orthodontic treatment.
The patient is seen again about 6 weeks after the fixed appliances are removed. The wires are inspected to ensure that they are perfectly bonded. Before and after pictures of the treatment are put together and handed out to the patient. The subsequent appointments will be every 6 months. There will thus generally be 3 of them.
2 years after the removal, the last appointment makes it possible to perform a final inspection. Often, we check the evolution of the wisdom teeth (the third molars) if they were not already extracted. A last panoramic X-ray could be required.
The retention follow-up is then finished. You can come back if you feel the need to do so after these two years, but consultation fees will then apply.
In addition to improving your appearance and your self-esteem, orthodontics can improve your oral health and thus prevent some oral diseases.
Result: an entire life of good oral health and radiant smiles.
We often say that beauty is in the eye of the beholder. But, since beauty standards may vary, a few characteristics are almost universal: a face with harmonious traits and a brilliant radiant smile.