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Orthodontics

“…When should my child start having braces?”

These are some of the very valid questions we often get from parents and patients interested in treatment. Orthodontic treatment is another service we provide that can be either traditional bonded braces or clear aligners, which includes brands such as Clear Correct and Invisalign. We always aim to have the most aesthetic outcomes possible in dentistry and this can often include orthodontics to move the teeth into the proper positioning first before restoring them.

In children, we do this to alleviate crowding (too many teeth in a small space), over/underbites, molar relationships, etc. In adults, we can accomplish the same things in addition to more frequently trying to gain additional space for definitive restorations such as implants and bridges. To complete treatment properly for some people, orthodontics is necessary and failure to do so can result in compromised quality of care.

“…Traditional braces or removable clear aligners?”

What Can I Expect?

(Click on the topics below to read more)

Diagnosis & Treatment Planning

Perhaps the most important step in having orthodontic treatment is properly diagnosing your condition and having a sound plan moving forward that takes into consideration addressing aesthetic and functional problems, while setting the stage for future work to be done if necessary. We will look at dental, skeletal, facial, and other anomalies to take into consideration while treatment planning. Different types of imaging (x-rays) can also aid in this process. By taking impressions of the teeth we can also analyze how much space is available (or unavailable) to move the teeth.

 

During this stage we also look at the relationship of the upper jaw (maxilla) to the lower jaw ( mandible). Sometimes moving teeth alone is not sufficient to move them into a stable relationship. This is seen in extreme over or underbite cases. This suggests a skeletal problem and not one coming from just the teeth. In those instances, what we call orthognathic surgery is recommended by an oral surgeon. What this does is it will surgically move both jaws into the correct relationship so the braces will be able to do their job and move to the most desired position.  This represents a minority of all cases, but is still necessary when indicated.

 

Some children who are still developing may need different appliances before they are able to have braces. During your consultation and treatment planning we will recommend such treatment if necessary. For any further questions regarding diagnosis and treatment planning your doctor will be able to provide you with assistance.

An example of a panoramic image used to look at a developing dentition

Stone models used to look physically at relationships between the jaws and dentition

Appliance Considerations

A big decision for many patients is whether they will start their treatment with clear aligners (such as Clear Correct or Invisalign) or traditional bonded braces. Ideally, do they both work? The short answer is  yes. There are a multitude of factors that will go into deciding which may be best for you.

Clear Aligners

Clear aligners are best known for treating minor to moderate cases in terms of difficulty, but have also been shown to be effective in some more advanced cases. Clear aligners are clear plastic trays that are removable so they are highly dependent on patient compliance. This means the patient must be wearing them all day and night (other than for basic functions such as eating, brushing, etc) in order for them to be effective. Non-compliant patients will see limited to no results.  However, motivated patients will see great improvement.

Traditional Orthodontics

However, for more difficult cases and more predictable results, traditional bonded braces provide a great service. This is indicated for cases ranging from simple to complex and has been the gold standard against which other appliances perform. This includes recall intervals at approximately six weeks after your initial visit for placement/bonding of the appliance.

Since there are brackets and wires involved, these need to be adjusted regularly to make sure they are doing their job. Elastics such as in the top picture to the right may also be necessary which is another factor that is patient dependent; if they aren’t worn they can’t work to help correct your bite! During your consultation, you will be able to decide which type of appliance might be best for you.

Traditional bonded braces on a child patient showing an underbite which was then corrected by Dr Stephen Dadaian

Mid treatment of a patient wearing clear aligners.

Initial Application

During your initial application and bonding visit, you will receive either your first set of trays or brackets depending on the agreed upon treatment. For some clear aligners, they require pieces of white filling material (composite resin) bonded to the tooth to act like a bracket to help the tooth move easier. These are visible on the clear tray to the right. Not all clear aligners require these and they are also not always required at the first visit but some are. This depends on the agreed upon movement of the treatment between the dentist and lab technicians that help fabricate the trays.

An example of a clear aligner with wells visible that will fit over composite attachments

Recall Visits

Perhaps the most important factor of having orthodontic treatment are the recall visits. Following up regularly with your progress and making the necessary changes to make sure treatment goes smoothly is crucial for your dentist once things have started. Failure to meet regular recall visits will result in delayed treatment, unaddressed corrections that need to be made, periodontal issues from hygiene, and many more. For traditional braces, this may mean changing a bend in the wire or elastics, while for clear aligners this may be making an adjustment to the aligners to better approximate how your teeth are responding.

Outcomes & Assessment

At the end of treatment, which is typically 12-18 months for comprehensive therapy, we will evaluate your pre and post-operative photos to evaluate a multitude of factors to see if everything was successful. Often times clear aligners require additional refinement trays. That is, the anticipated movement was close but not perfect. This is included frequently in the overall cost of treatment, but may just simply add a little more time to get things where they should be. With traditional braces these corrections are often made along the way more easily.

 

Once both we as the doctors and patient are satisfied together with the outcome, we will remove the appliance for traditional type braces, or composite brackets in the case of the clear aligners. Teeth are polished and a retainer is fabricated for the patient. The retainer instructions will be discussed at your time of visit. This is important since all teeth once moved can relapse, usually not as severely as they were before, but to a degree that may be noticeable to the patient. For this reason, we recommend use of a retainer to maintain tooth position of the final result.

An example of the final outcome of a patient having undergone orthodontic treatment using the Tip Edge bracket (metal braces) before and after.

Referrals

For a small percentage of our patients who have very advanced severity of difficulty and may have skeletal issues that complicate treatment, we will refer you to a specialist in your area. This may also be for those requiring surgery to correct jaw relationships followed by orthodontic treatment. Most cases can be completed in our office, but we evaluate each case thoroughly. We have your best interest at heart and if we feel you would best be served by a specialist due to the difficulty of your case, we will work with you to find one to fit your needs.
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