Free NHS Orthodontic Braces & Treatments
We provide a range of NHS treatments free of charge at Purely Orthodontics to eligible children and teenagers under 18 years old. Kindly note that we are only given funding to treat a fixed number of children each year so there may be a waiting list for treatment.
Also, under NHS rules we are only able to provide NHS treatment to children with the most serious problems with their teeth. If your child is not eligible for NHS treatment we can stll achieve a perfect smile for them on a private treatment plan.
Removable appliances
Are usually used in children to:
- Widen the upper arch
- Push incisors forwards to correct an anterior cross bite
- To improve deep bites (where the front teeth overlap too much)
- To push teeth backwards if they stick out, or push individual teeth backwards etc.
They are very helpful to make approximate useful movements especially in children who are not yet ready for fixed appliances. They are often followed by fixed braces which are used for more precise tooth movements.
A removable appliance with midline screws to widen the upper teeth
Functional appliances
Braces which are used in growing children and they help correct protrusion of the upper front teeth ('treat teeth which stick out'). These can produce dramatic improvements if worn correctly and you will see a fantastic rapid change in your child's face especially if the teeth really stick out a lot. Functional appliances are simply removable braces which work by holding the lower jaw in a more forward position. The muscles of the jaws then help push the teeth and jaws in the right directions.
At Purely orthodontics we tend to use 3 main varieties of these braces:
Twin Blocks
The most commonly used functional appliances and consist of an upper and separate lower removable component. When the patient bites together, they need to bring the lower jaw forwards for the blocks to fit correctly.
Teuscher appliance
A removable brace which come as one large piece of acrylic. This is fitted on the upper teeth and then the lower teeth need to be held forwards to engage into the patient's teeth imprints on the lower part of the brace. This brace is also comes with a high pull headgear and this must be worn at the same time. The head gear is simply a small black strap which fits on the head and then is attached to a face bow which is fixed to the brace. The headgear enables the patient to grow in the right direction and also prevents the patient's lower jaw from growing downwards. This brace is used in patients with longer faces and prevents any further lengthening of the face.
Medium Opening Activator
A functional appliance which is a one piece appliance made of acrylic and is fitted on the upper teeth and there is an imprint of the patient's teeth for the lower teeth to fit into. When this brace is worn there is separation of the back teeth and this allows them to grow together and encourages lengthening of the face. This is therefore used in people with smaller faces and squarer jaws and who have deep bite tendencies.
Quadhelix appliance
This is a fixed expansion appliance usually used in the upper arch. This consists of a thin metal framework which sits close to the palate and widens the upper premolar and molar teeth. The orthodontist will activate this to produce a widening affect of the upper teeth.
What a quadhelix looks like on a model of teeth.
Trans Palatal Arch (TPA)
This is simply a metal bar which crosses the palate and follows it closely and links the upper first molars together. These are used to hold the back teeth where they are as front teeth are moved back and they are also used to hold expansion which has been achieved by an earlier expansion device.
A TPA on a model of teeth.
Lingual arch
This is similar to the TPA above and this brace links the two lower molars together and prevents the forward movement of the lower molars. These are used to increase anchorage and sometimes are useful to hold space which may help avoid extractions.
A lingual arch on a model of teeth
A lingual arch holding the lower back teeth back - when the baby teeth fall out there is extra space (“leeway space”) left behind which can be used to align the lower adult teeth.
Rapid Maxillary Expanders
These are used in the upper arch and consist of a metal framework which is linked to upper first premolars and the upper first molar teeth by bands. There is a screw mechanism and this is turned on a daily basis by the parent. These are very effective in widening very narrow jaws and can sometimes help avoid extractions. There are reports that this can even help breathing difficulties as the nasal passages are also widened.
Fixed Braces ("train tracks")
These are the most common type of braces we use. They consist of small metal pieces stuck onto each tooth (brackets) and then an archwire which moves the teeth. A thin flexible wire (Ni Ti wires) is first used to align the teeth gently. Once the teeth are aligned we progress into thicker wires called stainless steel wires and then we close any gaps in the thicker wires. Fixed braces are precise and can be used to move teeth in any direction and these braces give you that perfect smile at the end of the treatment.
Extraction of teeth as part of orthodontic treatment
Extractions of teeth are sometimes necessary to produce more space for the alignment of crowded teeth or sometimes to enable the front teeth to be moved back in the mouth, so that they look better.
At Purely Orthodontics we always will aim to produce a great smile without extracting teeth. However, this is not always possible. In moderate to severe crowded cases, extractions may be necessary. Which teeth or combination of teeth are extracted will depend on the degree of crowding and the patients bite. We always prefer to extract the minimum number of teeth possible to get the best result. We will carefully discuss the options with our patients before proceeding.
Examples of different extraction cases:
Non-extraction and orthodontic treatment
Wherever possible we will always try to treat patients by taking no teeth out. This is possible when there is no significant shortage of space. Also space can be gained by expanding the dental arches and also by interdental stripping of teeth (removal of enamel from between the teeth- to gain space).
Demonstrates simple alignment of teeth
Intermaxillary elastics (removable elastics used to move teeth and improve bites)
During the course of many orthodontic treatments we will give our patients a bag of small elastics called intermaxillary elastics and these are warn between the upper and lower jaws. These elastics are used to move the teeth in order to: close spaces, improve bites, pull teeth forwards or backwards, bring teeth in the different arches together and correct midlines. The orthodontist will teach the patient how to wear these and the patient will practice before leaving the practice and show the orthodontist that they are able to wear these correctly for the right tooth movements to occur.
Class 2 elastics on models of teeth (used to pull the upper front teeth back and the lower back teeth forwards)
Natural gaps in teeth
Most patients do not like gappy teeth. The most common gap we see is a midline diastema (a gap between your upper central incisors). Gaps can be closed by fixed appliances and sometimes by aligners.
Demonstrates the space closure of a gap between the upper central incisors
Missing teeth leading to gaps
We do sometimes see that some patients have missing teeth (adult teeth which never develop). The teeth most often missing are the upper lateral incisors or the lower second premolars. We generally will always aim to close spaces where possible in these instances. Sometimes it is necessary to open the spaces with fixed braces and then your dentist will place a bridge or an implant to fill the space.
Ectopic (misplaced) canines
The upper canine teeth sometimes get impacted or stuck in the wrong position and they have to be moved long distances to correct their positions. This will also involve a surgical exposure, where a surgeon will uncover the tooth (teeth) and the orthodontist will then move these teeth into the right position.
An ectopic canine being moved by fixed braces into the right position
Retainers
Once the teeth have been perfectly positioned they need to be held there by retainers. We tend to use 4 types of these retainers:
Essix retainers
The most commonly used retainers. They are thin clear plastic retainers which cover the teeth. As these are clear they are not too visible and well accepted by most patients. There life span is approximately 2-3 years. The first set is given free on the NHS and future ones must be bought to keep your teeth straight. We recommend that they are worn full time for a period of time and then every night for life, if you wish to keep your teeth straight permanently. They are easy to take out to clean and eat food.
Hawley retainers
Hard plastic retainers with a wire in front of the front 6 teeth to keep then straight. Studies have shown that these are effective in keeping the upper teeth straight, but Essix retainers are better at keeping the lower teeth straight. As Hawley retainers don't fully surround the teeth, they can sometimes let the teeth lengthen which may be undesirable. They are useful to allow the back teeth to settle as the teeth at the back can erupt a little to improve the bite after the fixed brace is removed.
Begg retainers
Similar to Hawleys, and are made of hard plastic with a wire on the outside of all the teeth. They are useful where you want the bite to continue to improve after the fixed braces are removed, as well as keeping the front teeth straight.
Fixed retainers
These are thin wires stuck behind the upper or lower anterior teeth. They are usually held in place by a small amount of white dental glue. The advantages are that they are fixed and not removed. The disadvantage is that they are harder to clean. Also these do sometimes break and need replacing or maintaining. We usually recommend that you should also wear an Essix retainer as a back-up to something going wrong with your fixed retainer.
