Tag: braces

If considering orthodontic treatment using Invisalign clear aligners, there are ten important facts that will assist you when making a treatment decision.  These facts fall into three categories; (1) the orthodontist’s role in successful Invisalign aligner treatment, (2) your or your child’s role in successful Invisalign aligner treatment, and (3) the alternative “invisible” appliance to Invisalign aligners, including its advantages and limitations.
 

1.  Invisalign is a powerful and effective tool for orthodontists, not a technological orthodontic treatment. 

What does this mean and why is it so important?

Invisalign’s technological aspect is found in the dashboard available to orthodontists (specialists who have completed post-doctoral orthodontic degrees and residencies) that allows them to create comprehensive, custom treatment plans for their patients using their own directions and inputs through that dashboard.  It is from these custom treatment plans that the clear aligners are produced.  What are clear aligners?  Aligners are transparent, plastic trays that completely cover the upper and lower teeth, moving them in incremental steps toward the final bite (occlusion). 

2.  Invisalign software does not replace or replicate the comprehensive treatment plan of an orthodontist.

An orthodontist plans the Invisalign treatment from the first to the last movement while considering a multitude of factors not “recognized” by Invisalign photographic scanning.  These include, but are not limited to:

  • facial structure, including relative positions of the upper and lower jaws (maxilla and mandible)
  • relationship of the facial bones and soft tissue and the effect of treatment on facial appearance
  • relative size of teeth to bones
  • current position of the teeth in the bones
  • inherited facial form and the corresponding changes likely with aging, whether for a growing child or an adult
  • periodontal (gum and bone) health and the likely safety and stability of tooth movements
  • actions necessary, including involvement of other specialists, to bring the teeth together into a stable occlusion/bite while enhancing facial appearance.

After considering the above, an orthodontist specifies the sequencing of tooth movements; the location and timing of attachments, which are placed on the teeth and engaged by the plastic aligner to direct force; and the specific movements to be made to place the teeth in the correct position for intermediate work by another practitioner or for the final occlusion. 
 

3.  Invisalign/aligner treatment may require coordinated work with other specialists.

Orthodontists providing Invisalign will discern the need for other specialists and will coordinate treatment with them and your general dentist to effect a safe and healthy orthodontic journey and successful arrival at the most stable and attractive destination for your or your child’s smile and face.

4.  Treatment plans using Invisalign aligners that do not address skeletal imbalances fail. 

Skeletal imbalances are one of the principal causes of crowded or spaced teeth.  An orthodontist is trained to both discern those imbalances and plan treatments to correct the imbalance through growth guidance for children or collaboration with an oral surgeon or periodontist for adults.  If these options are ruled out, either physically or by your choice, the orthodontist will compensate for the skeletal imbalance with non-intuitive, complex adjustment to the dentition, which requires awareness of the most stable occlusion possible, given the imbalance, and the impact of treatment on facial aesthetics.   The expertise acquired through the specialized schooling and experience of an orthodontist is required.

5.  Invisalign aligners do not move the roots of teeth well, especially molars. 

Root movements with Invisalign present complex challenges for the orthodontist that must be addressed through comprehensive planning, or the treatment will fail.  General dentists offering Invisalign most often use Invisalign Go, which intentionally prevents the practitioner from attempting to move molars due to the potential for poor outcomes due to lack of knowledge and experience, which is wise.  The ability to safely and effectively move roots is a requirement for successful treatment, however, and falls under an orthodontist’s purview. 

6.  Invisalign aligners require a high level of consistent wear.

Orthodontic tooth movement is a physiological response.  Six hours of force are required to begin tooth movement, with only two hours of removal of that force resulting in regression.  Interestingly and importantly, this regression does not mirror the original movement but leaves teeth in a new position, causing the current aligner to no longer fit or work properly. 

Also, Invisalign aligners must fit every tooth throughout treatment very intimately to avoid failure of tooth movement sequencing. 

To both prevent regression and keep aligners married to the teeth, aligners must be worn at all times except during meals when they are removed for eating.  After eating, the teeth are cleaned before the aligner is reinserted.  This becomes routine for most, with the side benefit of weight loss for those who consequently cut down on between-meal snacks. 😊

For some patients, the daily care and use of aligners such as Invisalign is an inconvenience.  If you think that might be true for you or your child, alternative, advanced orthodontic treatment tools, such as the invisible Brava appliance, which is attached to the back of the teeth, or braces with clear or tooth-color, custom-fit brackets, might be better options, particularly given their advantages in treatment efficiency and root movement. 

Note that “clear braces” are not clear aligners.  Clear braces are clear brackets applied to the front of the teeth that are engaged by an archwire running through those brackets.  The composition and tension of the wire exert a constant force that moves the teeth in a sweeping, rather than incremental, fashion.  Clear braces are an example of a fixed appliance, which is not removed by the patient during treatment.  Another fixed appliance is Brava, explored in fact #10, which is invisible to others.

7.  During aligner treatment, regular monitoring and periodic intervention by the orthodontist are required for success. 

Because teeth movement is a physiological process, all orthodontic methods require monitoring for potential adjustment due to the organic, non-linear nature of treatment.  If the orthodontist uses remote dental monitoring, as in my practice, you will simply be asked to submit periodic photographic scans of your teeth using your phone and will be prompted for an office visit when necessary.  Remote monitoring can significantly reduce the number of onsite appointments you must attend.  If your practitioner does not offer remote monitoring or if you are inconsistent in its use, you will need to schedule and keep regular in-office appointments.  Skipping self-scanning or scheduled appointments will lengthen treatment time and compromise your treatment result.  To have the result you desire, aligners must be worn, and monitoring of some type must occur regularly.
 

8.  Each Invisalign aligner has only a small range of motion.

Because of the small range of motion initiated by each aligner, significant movements take more time than when using fixed appliances, such as braces or the lingual (tongue-side) Brava, which generate more force and have larger, sweeping ranges of motion and correction.  Invisalign aligners do work, however!  Unless contraindicated, treatment with Invisalign will be effective given thorough treatment planning by the orthodontist and consistent wear on your or your child’s part.   
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9.  Combination-appliance treatment can hasten and improve outcomes.

Due to the limitations of aligners in tooth movement, many orthodontic cases would finish more quickly and ideally if Invisalign aligners were used in conjunction with other orthodontic tools, such as limited braces on a few teeth for a short time, or if another appliance were used throughout.  As noted above, fixed appliances such as precision braces using LightForce brackets or the lingual Brava appliance can exert more force over a longer range of movement than incremental, plastic aligners, allowing the orthodontist to move teeth more efficiently when needed or when desired by the patient.
 

10.  Invisalign is not the only “invisible” orthodontic appliance available:  Invisalign versus Brava.

 Invisalign is a powerful tool in the hands of an experienced orthodontist, who can treat you or your child discretely using clear aligners and tooth-colored attachments that are engaged by the aligners to exert force in specific directions. Treatment is well tolerated by patients and is a welcome alternative to traditional, wire-and-bracket braces for those who don’t want their orthodontics to be readily noticed.  In my practice, the majority of patients seek Invisalign, and I complete hundreds of cases per year using this innovative tool.  

There are, however, other options for invisible orthodontic treatment, such as the Brava fixed appliance, a fully discrete tool that is attached to the back of the teeth, completely unseen by onlookers.  Like braces and Invisalign, the orthodontist directs all tooth movements when using the Brava appliance. 

Advantages of the Brava appliance:

  • Convenience:  Some patients find the need to handle and clean aligners at every meal more a “hassle” than convenience.  A fixed appliance, such as Brava (or braces), eliminates these extra steps, requiring only a moderate addition to typical oral hygiene practices.  Moreover, since the Brava appliance has individual arms attached to each tooth, flossing between teeth requires no threading; flossing is fully accessible with the appliance in place.
  • Attachment-Free Smile:  The Brava appliance functions completely from behind the teeth.  Unlike Invisalign or braces, there are no attachments on the front of the teeth.
  • Plastic Free:  The Brava appliance itself is plastic free with only a final, finishing plastic aligner used for detailing at the end of treatment.  
  • Speed:  The Brava fixed appliance, like braces, is able to move teeth in a sweeping, continuous motion that shortens treatment length compared to aligners.  In addition, the Brava appliance, unlike braces or aligners such as Invisalign, moves each tooth independently, making it the fastest orthodontic treatment appliance to date.

Brava’s Disadvantage: 

It takes a varying amount of time for the patient to become accustomed to the Brava appliance behind the teeth.  The tongue will be irritated after treatment begins but for a relatively brief time.  The irritation fades over a one-to-three-week period.  Tolerance to the appliance is high and results are fast.

Conclusion

Not a technology-driven treatment, Invisalign is a tool requiring the specialized knowledge and training of an orthodontic specialist for proper use and a successful treatment for anything other than the simplest alignments in an already-stable and balanced bite. 

Successful aligner/Invisalign treatment also requires the ongoing participation of the patient in aligner wear, hygiene, and monitoring, whether remote or on site. 

Alternatives to Invisalign, such as treatment with the invisible Brava appliance or traditional braces, may be recommended or preferred for convenience or speed. 

Your orthodontist will thoroughly examine your or your child’s face, teeth, and bone structure before recommending treatment modalities for your consideration. 

If you should have further questions about Invisalign, Brava, or braces, or wish to schedule a complimentary examination in my Seattle office, please feel free to use the buttons below.

For those considering changes to their smiles, the question to answer is how best to fix crooked teeth or correct one’s occlusion.  Is Invisalign effective?  Are braces required?  Are there any other methods?  And, finally, who should one see, a general dentist or an orthodontist?  

Human teeth have no “natural” pattern of occlusion or appearance that is consistent across individuals.  The appearance of the teeth depends upon idiosyncratic biological relationships of the upper and lower jaws (the maxilla and mandible) to one another and to the shape and size of the teeth erupting from them.  The advent of orthodontics, the first dental specialty to come into existence, created the possibility of arranging teeth in the jaws to enhance the function and stability of teeth over the lifespan and to create a smile that is aesthetically pleasing both to the patient and to others.  Due to the importance of a smile in conveying warmth and creating connections, as well as a greatly lengthened human lifespan, what began as an exciting possibility has evolved to become a standard of care, especially in wealthy nations such as the United States and others.  The methods to provide that care have greatly evolved, also, making orthodontics a sought-after specialty. 

How Orthodontists Straighten Crooked Teeth or Misaligned Bites

The methods available to effect changes to the bite and smile have greatly expanded, with the specialty of orthodontics now able to treat very complex problems through the use of a variety of oral appliances, surgical intervention, and coordination with other specialties such as periodontics, oral surgery, pedodontics, and prosthodontics.  The age range for treatment has also changed since the initial days of the specialty, with orthodontists employing advanced tools and methods that allow them to treat young children, teenagers, young adults, and older adults, including seniors.  Advanced orthodontic appliances that orthodontists employ include plastic aligners such as Invisalign, precision braces such as precision, custom brackets, and the Brava lingual, behind-the-teeth device, among others.  The choice of the appliance is individual to the patient, with the orthodontist presenting the appropriate and best options to achieve the patient’s goals.

Can Invisalign Effectively Straighten Teeth?  Are Braces Required?

A majority of patients visiting an orthodontist for an examination inquire about aligner treatment, most commonly known through the Invisalign brand name.  Invisalign is a powerful tool in the hands of a skilled orthodontist who specifies tooth movements from the beginning to the end of treatment within the Invisalign dashboard by using its virtual tools to customize treatment for each patient.  Invisalign’s software generates only a baseline treatment that is insufficient and is overwritten by the orthodontist.  Orthodontic training and expertise are required to address anything more complex than very mild crowding in an otherwise balanced bite (occlusion).  This limitation explains both early failures with Invisalign aligners and the current problems experienced at times by general dentists, who are unfamiliar with comprehensive orthodontic treatment diagnosis and planning.  Invisalign in the experienced hands of an orthodontist can certainly be used in a wide variety of cases to straighten crooked, misaligned teeth and correct bites.

Straightening Teeth with Braces and Other Fixed Appliances

Invisalign is not the only treatment method for straightening crooked teeth and is not always the best choice for every patient. For reasons of treatment efficiency or convenience for the patient, fixed appliances may prove to be a better choice.  A skilled orthodontist can determine the best and appropriate options for each patient and will present those options during the initial examination.  The patient will be given the opportunity to choose from the recommended methods.

Options for fixed-appliance treatment, as mentioned above, included braces—individual brackets placed on each tooth and engaged by an archwire—and, in my own practice, the Brava lingual appliance that sits behind the teeth and is completely invisible to an onlooker.  Custom precision brackets, when used for braces, increase the precision of movement and shorten treatment time.  The Brava appliance moves each tooth individually, unlike either Invisalign aligners or braces, which has great advantages in terms of speed and proper sequencing of tooth movements.  One of these methods, due to the movements required for proper treatment or the patient’s assessment of treatment tolerance or willingness to handle and wear Invisalign aligners consistently, may prove to be a better choice.

Fixed appliances such as braces and Brava can create more force than the incremental plastic aligners of Invisalign and can move teeth in a consistent, sweeping motion, which speeds treatment, especially when large movements are required or when molars must be moved.  Molar movement is complex and is, consequently, not allowed in the Invisalign Go version supplied to general dentists.  An orthodontist, unlike a general dentist, can use Invisalign to move molars, as well as make other complex movements.  The advantages of fixed appliances, therefore, are speed and patient convenience for those who do not wish to handle and clean removable aligners.

Choices for Correcting Crooked Teeth or a Misaligned Bite

Invisalign aligners, custom precision brackets, and lingual appliances such as Brava can all be used to straighten teeth or create a proper occlusion or bite.  An experienced orthodontist will consider many factors, including current occlusion/bite, patient age and the corresponding anticipated facial changes, the present relationship of facial bones and teeth, periodontal conditions, and patient preferences before making recommendations.  In most cases, Invisalign can be used effectively by an experienced orthodontist, even when molars must be moved.  Fixed-appliance options such as precision braces and the behind-the-teeth Brava appliance may also be recommended and may be preferred by some patients. 

If you would like to learn more about options for orthodontic treatment or are ready to schedule a complimentary exam, feel free to reach out to my office below.

In this post, we will explore the principles behind tooth movement and the mechanisms orthodontists use to achieve desired outcomes.  A basic understanding of this process will inform your treatment decisions and aid you in understanding your orthodontist’s recommendations, which may include the following tools:

For instance, while aligner/Invisalign treatment can be very appealing to many orthodontic patients, it may or may not be mechanically appropriate for a given case.  Understanding the biological processes involved in orthodontic tooth movement is helpful in grasping why. 

Teeth are rooted in the alveolar bone within the jaws and are held in place by the periodontal ligament (PDL), a thin layer of connective tissue surrounding the tooth root and attaching it to the bone.  The PDL plays a crucial role in transmitting forces applied to the tooth and facilitating its movement.  Each orthodontic appliance applies force in a unique way, impacting the PDL differently than other appliances.

When orthodontic forces are exerted, the periodontal ligament or PDL undergoes remodeling, leading to changes in the bone surrounding the tooth root.  These changes include bone resorption where the force is applied and bone deposition on the opposite side of the tooth.  This remodeling process allows the tooth to move in the desired direction. 

Did you know?  

It takes approximately six hours of light, directed force to elicit biochemical responses in the periodontal ligament (PDL) that initiate orthodontic tooth movement, yet it takes only two hours, once the force is removed, for the six-hour-long process to reverse! 

To apply these forces, orthodontists use a variety of orthodontic appliances and techniques, including braces, clear plastic aligners such as Invisalign, and invisible applications to the back of the teeth such as the Brava appliance (see below) or lingual braces (brackets and wires).  Let’s briefly review these methods to illustrate their mechanical differences and why one treatment modality may be superior to another in a particular case.   

Braces:  Orthodontics with Wire and Brackets

An appliance with which most people are familiar is braces, which consist of small metal or clear brackets bonded to the teeth and connected by what are called archwires.  These wires provide a continuous force that acts on the teeth, guiding them into proper alignment.  The orthodontist adjusts the archwires periodically to control the direction and magnitude of the applied forces, facilitating the desired tooth movement.  Archwires vary in material, shape, thickness, and other properties, allowing the orthodontist to customize forces for specific situations.  Archwires may also be hand-bent to further facilitate fine detailing.  

Braces are able to move teeth over relatively long distances in a slow, sweeping motion, applying continuous force to the tooth and PDL.  Interestingly, fixed appliances, such as traditional braces and the Brava appliance, can deliver a stronger continuous force than that of removable appliances such as aligners, and can, therefore, move roots of teeth in the supporting bone much more effectively and efficiently.  Precision appliances such as custom brackets and doctor-customized wires, only increase this efficiency.  This factor becomes more important the greater the required movement of roots, especially that of molars.

The disadvantages of braces include visibility and hygiene.  Some patients, both youth and adult, are comfortable with the appearance of braces, but others are not.  Likewise, some are comfortable brushing around braces and flossing under wires, while others find both challenging. 

Invisalign:  Orthodontics with Clear Aligners

Due to aesthetic concerns with traditional braces, a popular alternative over the last ten years has been and continues to be the use of clear plastic aligners, such as those under the trade name Invisalign.  Aligners are removable trays that are custom-fabricated to the orthodontist’s specifications in order to apply controlled forces to the teeth.  Each aligner in the series is designed to move the teeth incrementally, and patients typically begin a new aligner each week or more frequently.  The aligners combine direct movement, tipping, rotation, and other forces to gradually shift teeth into the desired positions. 

Aligners are made of relatively thin, flexible plastic and move teeth via the forces created by the stretched plastic combined with fixed, tooth-color attachments that are specified and positioned by the orthodontist.  When the attachments are engaged by the plastic aligner, the direction and amount of force is altered according to the orthodontist’s treatment plan.   

Each new aligner must fit the teeth intimately.  If the fit is insufficient, the forces needed to move the teeth will not be produced.  As a result, each new aligner must represent an incremental change in tooth position.  Consequently, the range of motion for an aligner is very limited compared to the sweeping motion of braces or the Brava appliance.  As a result, the length of treatment for moderately complex or highly complex orthodontic cases may be greater with aligner treatment. 

The overriding advantage of aligner/Invisalign treatment for many patients is the freedom, both aesthetically and hygienically, afforded by removable appliances that are less visible than braces.  The disadvantage, however, is that, for some patients, this freedom results in an insufficient wearing of aligners, leading to longer or less successful treatment.  

(Knowing and communicating your likely tendencies and preferences to the orthodontist is important in determining if aligner treatment is right for you, as are the movements that will be required for your teeth and the ability of aligners to create that movement.  I have treated thousands of patients successfully with Invisalign, but it is not always the most effective choice.)    

Brava:  Orthodontics with an Invisible Appliance

The Brava appliance allows for an alternative mode of treatment that offers the mechanical advantages of fixed orthodontic appliances and an even greater aesthetic advantage than that of aligners.  Brava is a plastic-free, fixed orthodontic appliance placed on the tongue side of the teeth, making it invisible.  Treatment with the Brava appliance is not equivalent to lingual (tongue-side) braces, however.  

The Brava appliance differs from braces in that each tooth moves independently (not bound by its neighbor through an archwire).  The site-specific effect on the PDL and resulting movement of each tooth leads to treatment lengths roughly half as long as other methods in many cases.

The Brava appliance does not use an archwire; rather, independent arms are attached to each tooth from a wire band that sits on the gum.  Tooth and gumline hygiene is not inhibited by a wire as with braces. 

The disadvantage of the Brava appliance is that, for some patients, it may be a few weeks before it’s presence becomes completely comfortable to the tongue.  Also, patients with large bony growths on the tongue side of the teeth cannot wear the Brava appliance, which will not fit properly.   

Note:  In addition to aligners, braces, and lingual appliances such as Brava, orthodontists may use auxiliary appliances, such as elastics or springs, to apply additional forces or modify the direction of tooth movement.  Elastics, for example, can be attached to braces, aligners, or Brava to exert force between upper and lower teeth, correcting bite discrepancies.

Remote Monitoring:  Checkups without Appointments

Regardless of the orthodontic appliance used, regular monitoring by an orthodontist is essential, allowing the orthodontist to make necessary adjustments as the treatment proceeds. 

My practice (Keith B. Wong, DDS, MS, Specialist in Orthodontics) uses remote monitoring of the teeth to assess progress and advise patients.  Remote monitoring involves scans made by the patients using their cell phones and a specialized application.  These scans are reviewed by both staff members and myself, with the patient contacted when an office visit is needed.  

Remote monitoring increases care, supervision, and communication while minimizing in-person office visits.  Gone are the days of monthly trips to the orthodontist!  Patients can be seen in our office as infrequently as every four months, and for non-local or international patients, this can be extended even further with adherence to the treatment protocol.  With remote monitoring, the importance of proximity of the orthodontist’s office is greatly reduced, allowing the patient greater choice in choosing a practitioner. 

With remote monitoring, the importance of proximity of the orthodontist’s office is greatly reduced, allowing the patient greater choice in choosing a practitioner.  

Where to Begin:  A Thorough Orthodontic Examination

The patient’s first visit is devoted to a thorough, complimentary examination and a discussion of desires and preferences.  The exam is concluded with an initial treatment recommendation, including choice of appliances, and the anticipated treatment length and its associated fee.  If the patient wishes to proceed at that time, flexible financial arrangements are discussed and, in many cases, treatment can be initiated that day if the patient desires.  If the patient prefers additional time or information, a second consultation may be arranged.    

Treatment recommendations are based upon a multitude of factors, including the presenting facial structure, age/anticipated growth, tooth position and bite, and patient goals and preferences.  Recommendations are informed by the orthodontist’s thorough understanding of tooth movement, which enable him or her to plan and execute treatment effectively, resulting in improved dental aesthetics, function, and overall oral health.  

When considering the options presented to you, recall that appliances differ in their abilities to move teeth, especially roots, and that you or your child’s experience with each appliance will also differ.  An option not previously considered may prove to be the best choice for effective treatment.   

 If you would like to learn more or schedule a consultation, please feel free to contact my office or use our online scheduling application.  

I hope this post has been informative!

If you are interested in orthodontic treatment for yourself or your child and wish to avoid traditional braces, the options have been made more extensive with the recent (2022) addition of the Brava appliance that is currently available from a limited number of orthodontists.

Pro Tip: No longer is treatment with aligners such as Invisalign the only discreet option for adults and teens. The Brava appliance presents significant advantages and is the first true alternative to the use of aligners, whether Invisalign or otherwise.

What is the Brava Orthodontic Appliance

The Brava tool is a lightweight, fixed appliance that sits against the soft tissue beneath and behind the teeth. It is completely invisible to onlookers with no attachments to the visible surface of any tooth. Each tooth is engaged by a curved arm that is shaped to deliver the exact, measured movements (tipping, rotation, retraction, expansion, etc.) prescribed by your orthodontist to be in the proper sequence with the correct results in both crown (visible tooth) and root movement.

The Brava appliance is the next generation in orthodontic tools, not only in aesthetics but also in tooth movement.  The technological aspect of this tool resides in the associated software that converts the orthodontist’s comprehensive, detailed instructions into the exact arm shape that is required for each tooth.

As with Invisalign and braces, the orthodontist applies extensive, specialized knowledge to direct tooth movements from the beginning to the end of treatment when using the Brava invisible appliance.

Like Invisalign and braces, the Brava appliance is NOT a treatment, rather, it is a tool for orthodontists to use to quickly and correctly reposition teeth for a stable, healthy, and attractive smile and face.

The Brava Appliance versus Invisalign Aligners: Five Facts to Know

1. Unlike Invisalign, the Brava appliance is completely invisible to the onlooker.

The Brava appliance neither covers the teeth like an aligner nor does it require any attachments to the front of the teeth. Treatment with aligners, if properly prescribed, most often requires tooth-color attachments to the fronts of a limited number of teeth to enable the aligner to exert the required force in the required direction.

2. Unlike Invisalign aligners, the Brava appliance is fixed to the teeth with no parts to handle or remove when eating or for cleaning.

During treatment with aligners, the plastic aligner trays must stay seated on the teeth, i.e., fit very intimately, for the aligners to exert the necessary forces in the correct sequence. For this to occur, the aligners must remain on the teeth for at least 22 hours per day and be removed for short periods only. Removal must occur for eating, and the teeth and aligners must be cleaned before reinsertion to protect the teeth and gums from bacterial and tartar build-up on the teeth under the aligner and at the gum line.

The Brava appliance is not removed. It remains in place throughout treatment and is cleaned when brushing the teeth. Also, because the lightweight bar from which the curved arms extend sits below the teeth, the space between the teeth and beneath the gumline can be flossed in a normal manner with the appliance in place, unlike with braces.

3. A distinguishing feature of the Brava appliance compared to Invisalign aligners is that it is free of plastic.

The active appliance is composed of a thin, specialty metal, with metal attachments on the back of each tooth to which the curved arms are anchored. The only plastic used throughout treatment is the finishing aligner used by the orthodontist to make detailing adjustments at the treatment’s conclusion.

4. With each tooth engaged by an independent arm on a fixed appliance, the Brava tool exerts a very specific force for each tooth in a long, sweeping motion that creates fast movement.

This is in contrast to aligners, which move each tooth incrementally due to the manner in which the aligner must stretch over the teeth to effect change. The greater flexibility in tooth movement of the Brava tool means that the orthodontist’s treatment plan is executed more quickly.  The result is a substantially reduced treatment time.

5. The only disadvantage: Unlike Invisalign aligners, the location of the Brava appliance creates temporary (two- to four-week) irritation to the tongue, which brushes against the curved arms and metal anchoring attachments on the back of the teeth.

Fortunately, this irritation fades and eventually resolves over a period of two to four weeks. The Brava appliance is well tolerated by patients. A comfort kit is supplied in my practice to aid patients during this adjustment period.

Conclusion

The Brava appliance is lightweight, flexible, and sits below and behind the teeth.  Each tooth is moved by an independent arm, and the treatment proceeds without any outward sign. 

Your smile is never compromised, and treatment is fast and effective. 

The position of the appliance, with no wire to preclude flossing, also means full hygiene access without the removal of an aligner or wire.

There is no plastic and nothing to remove and replace.

See Brava in action: Your treatment plan executed using the Brava appliance results in efficient, invisible alignment, as illustrated in the video below.

The Invisible Brava Orthodontic Appliance in Action

As one of the pioneer Brava users, I would be happy to consult with you about this innovative treatment tool.  If you would like to learn more or explore treatment, contact my Seattle office to schedule a complimentary examination.