Orthodontics

3 Methods

Orthodontia, also known as orthodontics and dentofacial orthopedics, was the rst specialty created in the
eld of dentistry. An orthodontist is a specialist who has
undergone special training in a dental school or college
after he/she has graduated in dentistry. It was established
by the eorts of pioneering orthodontists such as Edward
Angle and Norman William Kingsley. The specialty deals
primarily with the diagnosis, prevention and correction of
malpositioned teeth and the jaws.

For comprehensive orthodontic treatment, metal wires

are inserted into orthodontic brackets (braces), which can
be made from stainless steel or a more aesthetic ceramic
material. The wires interact with the brackets to move
teeth into the desired positions. Invisalign or other aligner
trays consist of clear plastic trays that move teeth. Functional appliances are often used to redirect jaw growth.

Nomenclature

Orthodontia derived from the Greek words orthos (correct, straight) and dontia (teeth) AJODO Volume
, p. 176-183

History

The history of orthodontics has been intimately linked

with the history of dentistry for more than 2000 years.[1]
Dentistry had its origins as a part of medicine. According
to the AAO (American Association of Orthodontists),
archaeologists have discovered mummied ancients with
metal bands wrapped around individual teeth.[2] Malocclusion is not a disease, but abnormal alignment of the
teeth and the way the upper and lower teeth t together.
The prevalence of malocclusion varies,[3][4] but using orthodontic treatment indices,[5][6] which categorize malocclusions in terms of severity, it can be said that nearly
30% of the population present with malocclusions severe
enough to benet from orthodontic treatment.[7]

Dental braces, with a powerchain, removed after completion of

treatment.

Additional componentsincluding removable appliances (plates), headgear, expansion appliances, and

many other devicesmay also be used to move teeth and
jaw bones. Functional appliances, for example, are used
in growing patients (age 5 to 14) with the aim of modifying the jaw dimensions and relationship if these are
altered. This therapy, termed Dentofacial Orthopedics, is
frequently followed by xed multibracket therapy (full
braces") to align the teeth and rene the occlusion.

Orthodontic treatment can focus on dental displacement

only, or deal with the control and modication of facial
growth. In the latter case it is better dened as dentofacial orthopedics. In severe malocclusions that can be
a part of Craniofacial anomalies, management often requires a combination of Orthodontics and Jaw Surgery or
Orthognathic Surgery.[8][9] This often requires additional
training, in addition to the formal 3 year specialty training. For instance, in the USA, orthodontists get at least
another year of training in a form of fellowship, the socalled 'Craniofacial Orthodontics, to receive additional
training in the orthodontic management of Craniofacial Hawley retainers are the most common type of retainers. This
picture shows retainers for the top and bottom of the mouth.
anomalies.[10][11]
1

Orthodontia is the specialty of dentistry that is concerned

with the treatment of improper bites and crooked teeth.
Orthodontic treatment can help x the patients teeth and
set them in the right place. Orthodontists usually use
braces and clear aligners to set the patients teeth.[12] Orthodontists work on reconstructing the entire face rather
than focusing only on teeth. After a course of active orthodontic treatment, patients will typically wear retainers
(orthodontic devices), which help to maintain the teeth in
their improved positions while surrounding bone reforms
around them. The retainers are generally worn full-time
for a period, anywhere from just a few days to a year,
then part-time (typically, nightly during sleep) for as long
as the orthodontist recommends. It is possible for the
teeth to stay aligned without regular retainer wear. However, there are many reasons teeth will crowd as a person
ages, whether or not the individual ever experienced orthodontic treatment; thus there is no guarantee that teeth
will stay aligned without retention. For this reason, many
orthodontists prescribe night-time or part-time retainer
wear for many years after orthodontic treatment (potentially for life). Adult orthodontic patients are more likely
to need lifetime retention.

Diagnosis and treatment planning

TRAINING

5 Training
Orthodontics was the rst recognized specialty eld
within dentistry. Many countries have their own systems for training and registering orthodontic specialists.
A two- to four-year period of full-time post-graduate
study is required for a dentist to qualify as Specialist
Orthodontist.[14]

5.1 United States

In order to be enrolled as a resident an orthodontics
program, the dentist must have graduated with a DDS,
DMD, BDS or equivalent. Entrance into an accredited
orthodontics program is extremely competitive, and generally lasts 23 years. Orthodontic residency programs
can award the Master of Science degree, or Doctor of
Science degree, depending on the individual research requirements. The class size, tuition, stipend and number
of patients seen and treated will all depend on the location
and setting of the program (hospital vs. university). Each
training program has its own goals and treatment philosophy, however, most U.S. orthodontic programs focus on
xed straight wire appliances. All the graduates must also
complete the written portion of the American Board of
Orthodontics (ABO) examinations.
In order to become Board Certied, a practicing orthodontist must present six cases that have been treated
entirely by the orthodontist to the ABO examiners. The
orthodontist then must appear in person in front of a panel
of examiners to defend the clinical decisions regarding
those cases. Once certied, the certicate is renewed every 10 years, and the practitioner can add the title Diplomate, American Board of Orthodontics.
Job outlook as a recent U.S. orthodontics graduate depends on the location of employment. Typically, more
popular destinations (such as California, NYC, Seattle,
Las Vegas and Texas) are heavily saturated with orthodontists. Traditional, practice transition situations
(new orthodontist buying out the seller orthodontist) are
becoming rare as the orthodontic market has been saturated with new and old practitioners, general dentists
performing orthodontics, corporate clinics and older orthodontists delaying retirement.

Lateral cephalometric radiograph, used for skull analysis

In diagnosis and treatment planning, the orthodontist

must (1) recognize the various characteristics of a malocclusion or dentofacial deformity; (2) dene the nature
of the problem, including the etiology if possible; (3) design a treatment strategy based on the specic needs and
desires of the individual; and (4) present the treatment
strategy to the patient in such a way that the patient fully
understands the ramications of his/her decision.[13]

5.2 Europe
In the United Kingdom, the training period lasts three
years. After completion of a membership from a Royal
College, a further two years are then completed to train
to consultant level before a fellowship examination from
the Royal College is sat.[15] In other parts of Europe, a
similar pattern is followed.

5.7

5.3

Pakistan

Canada

A number of dental schools and hospitals oer advanced

education in the specialty of Orthodontics to dentists
seeking postgraduate education. The courses range from
two to three years (with the majority being 3 years) of
full-time classes in the theoretical and practical aspects
of orthodontics together with clinical experience. Generally, admission is based on an application process followed by an extensive interviewing process by the institution, in order to select the best candidates. Candidates
usually have to contact the individual school directly for
the application process.

3
Physician and Surgeons (BCPS). Bangladesh Orthodontic Society (BOS) was formed in 1993.

5.7 Pakistan

In Pakistan to be enrolled as a student or resident in

postgraduation orthodontic course approved by Pakistan
medical and dental council, the dentist must graduate
with a Bachelor of Dental Surgery (BDS) or equivalent
degree. Pakistan Medical & Dental Council (PMDC) has
a recognized program in orthodontics as Master in Dental
Surgery (MDS) orthodontics and FCPS orthodontics as 4
years post graduation degree programs, latter of which is
Similar to the ABO, the Canadian orthodontic specialconducted by CPSP Pakistan.
ist can take a two-part examinations (Written NDSE and
Oral NDSE) oered by the Royal College of Dentists of
Canada (RCDC) in their nal year of the orthodontics
training. Upon completion of the examinations, the or- 6 See also
thodontist is admitted to the RCDC as a Fellow and can
add the following title, FRCD(C).
Accelerated orthodontic treatment
American Association of Orthodontists

5.4

India

In India, many dental colleges aliated to universities

oer orthodontics as specialization in Master of Dental
Surgery (M.D.S) programme.The only required qualication for M.D.S is Bachelor of Dental Surgery ( B.D.S
). The present course for MDS in Orthodontics stands at 3
years in all dental colleges in India which are recognised
by the Dental Council of India.

5.5

Iran

Canadian Association of Orthodontists

Indian Orthodontic Society
Orthodontic mechanics
Orthodontic technology
orthognathic surgery

7 References

In Iran, Orthodontics and Dentofacial Orthopedics is

known as a specialty since 1978. General dentists can
begin their postgraduate course after participating in a
comprehensive national exam (which is held once a year)
and fullling good rankings among all participants. After three years of postgraduate academic training, students can participate in a national board exam for nal
evaluation and if they can reach the determined scores,
they will be recognized as board certied specialist orthodontists. Iranian Association of Orthodontists (IAO)
has been established in 1978 and has been contributed
in several national and international congresses since its
establishment.

[1] Milton B. Asbell, Cherry Hill, N. J. (August 1990). A

brief history of orthodontics. American Journal of orthodontics and Dentofacial Orthopedics 98 (2): 176183.

5.6

[5] Borzabadi-Farahani A. (October 2009). An insight into

four orthodontic treatment need indices.. Progress in Orthodontics 12 (2): 132142. PMID 22074838.

Bangladesh

In Bangladesh to be enrolled as a student or resident in post-graduation orthodontic course approved by

Bangladesh Medical and Dental Council (BM&DC), the
dentist must graduate with a Bachelor of Dental Surgery
(BDS) or equivalent. At present BM&DC recognized
program in Ortho[lpl]larded by Bangladesh college of

[2] http://www.archwired.com/HistoryofOrtho.htm
[3] McLain JB, Prott WR. (June 1985). Oral health status in the United States: prevalence of malocclusion..
Journal of Dental Education 49 (6): 386397. PMID
3859517.
[4] Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F. (October 2009). Malocclusion and occlusal
traits in an urban Iranian population. An epidemiological
study of 11- to 14-year-old children.. European Journal
of Orthodontics 31 (5): 477484. PMID 19477970.

[6] Borzabadi-Farahani, A, Borzabadi-Farahani, A (August

2011). Agreement between the index of complexity, outcome, components of the index of orthodontic treatment
need.. Am J Orthod Dentofacial Orthop. 140 (2): 233
238. PMID 21803261.

[7] Borzabadi-Farahani, A. (2011). An overview of selected

orthodontic treatment need indices. In: Naretto, Silvano,
(ed.) Principles in Contemporary Orthodontics. In Tech.
ISBN 9789533076874. doi:10.5772/692.
[8] Akram A, McKnight MM, Bellardie H, Beale V, Evans
RD. (February 2015). Craniofacial malformations and
the orthodontist.. Br Dent J. 140 (2): 233238. PMID
25686430.
[9] Pedro E. Santiago, Barry H. Grayson. (February 2009).
Role of the Craniofacial Orthodontist on the Craniofacial
and Cleft Lip and Palate Team. Seminars in Orthodontics
15 (4): 225243. doi:10.1053/j.sodo.2009.07.004.
[10] Joseph G. McCarthy (February 2009). Development of
Craniofacial Orthodontics as a Subspecialty at New York
University Medical Center. Seminars in Orthodontics 15
(4): 221224. doi:10.1053/j.sodo.2009.07.003.
[11] ADA Accredited programs in Craniofacial and Special
Care Orthodontics, Retrieved March 8, 2015, from
ADA: American Dental Association: https://www.
aaoinfo.org/sites/default/files/community_docs/ADA%
20Accredited%20programs%20in%20Craniofacial%
20and%20Special%20Care%20Orthodontics.pdf
[12] Braces and Orthodontia. (n.d.). Retrieved November 2,
2010, from ADA: American Dental Association: http://
www.ada.org/3061.aspx
[13] T. M. Graber, R.L. Vanarsdall, Orthodontics, Current
Principles and Techniques, Diagnosis and Treatment
Planning in Orthodontics, D. M. Sarver, W.R. Prot,
J. L. Ackerman, Mosby, 2000
[14] Directory of Orthodontics. orthodontist.a5local.
[15] UK teeth straightening. www.sensu.co.uk. Retrieved
14 September 2015.

REFERENCES

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