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Updates in Orthodontics (fact or fiction)

Orthodontic treatment is always changing and progressing. The promises of new orthodontic products and treatment, however, can often be exaggerated much like the latest weight loss drug or diet. Sometimes old technology is rebranded as new and the multitude of names given to similar modes of treatment confuses the picture. The point of this area of updates is to help inform prospective orthodontic patients of what is out there such that you are able to make educated treatment choices.

This section is a work in progress and will be updated as time permits (remember I have four kids, a wife who works, two dogs, a horse, a saltwater fish tank, I clean my pool myself- you get the picture). Anyway, if you have any questions about what I have written below or have questions about something else that you may have heard of, please ask me. Am I always right-no, my kids will tell you that. I do, however, attempt to give an unbiased review of what I see and know as I continue to learn.

Dr. “B”

Topics:

A. Digital Orthodontics
B. Accelerated Orthodontic Treatment
C. Early Orthodontic Treatment
D. Growth Modification

A. Digital Orthodontics: Digital orthodontics is computer guided orthodontic movement. This means that the final positions of your teeth are predicted prior to treatment by virtual reality alignment of your teeth. Pretty cool because you can get an idea of what your teeth will look like when treatment is finished. True digital orthodontics utilize the predicted virtual reality model of your teeth to fabricate the appliances (braces and/or wires or clear aligners) that are to move your teeth. The pros- customized appliances may increase the predictability of your final result and treatment time may be shorter. The cons- generally costs more and what you can achieve on a computer does not necessarily correlate to what actually occurs in your mouth (this is especially true of clear aligner treatment with significant rotations and vertical movements).

Most clear aligners are digitally fabricated (e.g. Invisalign and ClearCorrect). Digital orthodontics can be used for traditional and clear braces, but for most cases I do not believe that the additional cost makes sense at this point as treatment with labial braces (braces in front of the teeth) is fairly predictable and treatment times with a digital approach may not be reduced. Nevertheless, the concept is sound and I offer you the choice of going digital if you prefer.  Lingual braces (braces behind the teeth), however, have made significant advances with digital orthodontics. The anatomy of the back side of the teeth is considerably more variable from person to person than the front of the teeth. As such, custom wires and/or braces has transformed lingual orthodontics. I am very excited about INBRACE, a new lingual system with custom, robot bent, multi-loop wires that not only allows for traditional flossing, but may make for significantly shortened treatment times and less frequent office visits, at a reduced cost relative to my current go to custom lingual brace system, Harmony. It is hard to explain the potential advantages in print, but I would be happy to show you on a model and explain the INBRACE system in person. More information is available at www.myinbrace.com.

B. Accelerating Orthodontic Treatment: Everyone wants to get through treatment faster. More pain in orthodontic treatment, however, does not correlate with a shorter treatment time (probably a good thing, right?). We know through controlled research that too much orthodontic force compresses the ligaments surrounding the teeth to the extent that tooth movement stalls out. So, if we can’t force the teeth to move faster, what are our options?

Propel®- Propel claims to expedite orthodontic treatment by means of microperforations made in the bone with a specialized instrument adjacent to the teeth that you desire to move. This results in a mild inflammatory response that is believed to expedite bone turnover adjacent to the teeth and thus expedite tooth movement. Sounds painful, right? Actually, I had a colleague try it out on me with topical anesthetic (no shots) and there was no pain, only a little pressure. How much faster? Possibly twice as fast- two years of treatment in one year? Maybe. Interested? Ask me about it and I will let you know if I feel that it will make a significant difference in your treatment time.

9-2017 update: Maybe less effective than initially thought. New research suggests that accelerated tooth movement may only occur very close to the microperforations and only lasts for weeks rather than months. Not likely to cut treatment time in half, but may be beneficial in areas of difficult movements. A lot of debate going on in this area with many active research studies.

Accelerodent®- Accelerodent claims to accelerate orthodontic treatment by means of ultrasonic vibration stimulating tooth movement. You bite into a vibrating mouthpiece for twenty minutes or so every day- while watching TV, driving, whatever. Pretty simple and minimal discomfort. Unfortunately the research is iffy and the units are expensive and not reusable- they are designed to last a specific number of uses and then stop working. If microperforatoions make you uneasy and cost is not an issue, you may want to give it a try. Accelerodent may be used with any type of braces or Invisalign. Ask me about it if you have questions or contact my staff if you would like to order a unit.

9-2017 update- the market has been flooded with Accelerodent type devices and cost has decreased. I currently use one made by Propel and it seems to help with Invisalign, but as no two treatments are the same, it is difficult to know for sure. Lots of debate and research going on here as well. Some are concerned that over utilization of the device could actually slow down movement as the technology was initially utilized to speed healing of broken bones. If using, follow the instructions as over utilization may potentially extend treatment.

Damon System® and Speed System®- traditional braces utilize elastomerics (small rubber bands) to hold the wire that applies force to the brace and tooth in place. Self-ligating braces, braces that mechanically lock on to the wire, have actually been around for a long time but have become much more popular in recent years primarily due to heavy advertising by Damon and because they have become more refined and easier to use. There are dozens of manufacturers of self-ligating braces. I offer Damon and Speed because people ask for Damon by name and I was introduced to Speed when I was a resident at the Mayo Clinic and appreciate their unique and small design.
Theoretically self-ligating braces make sense as the force that elastomerics produce decreases over time (i.e. they lose their stretchiness), especially when immersed in saliva. As self-ligating braces do away with elastomerics for the most part, more consistent forces should exist throughout treatment. But, does this result in quicker treatment? Independent studies have yet to show this to be the case with any statistical significance. Regardless, they may allow for longer intervals between appointments and shorter appointment times with less discomfort.