Tag: LightForce

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!