This month, we’re focusing on dental health and wondering how orthodontics and the process of straightening the teeth with braces has changed through the years. We talk with Dr. Robert Good II (DMD, MDS) and Dr. Ronald Good (DMD, MDS), who are board certified specialists in orthodontics and facial orthopedics.
How have orthodontics progressed through the years and has technology changed your practice?
There have been great advancements in orthodontics and things continue to progress, which means we are students for life. While technology has greatly enhanced diagnostic capabilities and aided in the delivery of care, certain principles and the goals for treatment remain essentially the same. Overall, technology offers the opportunity for better patient care. Technological advancements include 3D imaging and printers, the evolution of braces from bands to bondable brackets to esthetic clear and self-ligating brackets, enhancing esthetics, comfort and treatment efficiency and space age wires with properties of greater flexibility and memory. Mini magnets placed on the back of the lower anterior teeth are being utilized as retainers to maintain alignment. Advances in technology provide many benefits in terms of diagnosis, treatment efficiency, enhancing the patient experience and achieving treatment goals. Orthodontics is an art and a science. With high-tech, there must also be high-touch. There is no substitute for employing the appropriate personalized treatment for each patient with compassionate care. We treat each child and patient as if they were our family.
Has the process of straightening teeth changed at all? Does it still involve headgear, rubber bands and expanders?
Moving teeth still employs the principles of physiology, bone metabolism, orthopedics and biomechanics. There are various treatment modalities and appliances used, pending the nature and severity of the malocclusion (bad or improper bite) and the age of the patient. Factors that must be evaluated are growth potential, skeletal and facial jaw balance, tooth position, bite relationships, airway and TMJ joint function. When a diagnosis is made, the appropriate appliances are utilized to deliver forces to effect and control the desired tooth movement and direct facial growth. Braces, elastics/rubber bands, headgear, expanders and various other appliances and auxiliaries are employed to achieve the optimal outcome. Palatal expanders, for example, are used in growing patients to orthopedically widen the upper jaw for a skeletal change.
How long does the process take and at what age do you recommend braces for children?
The American Association of Orthodontists recommends that children be seen by age 7 for their first orthodontic checkup. In some cases, treatment may be recommended earlier and one is never too old to benefit from orthodontics. Intervention at an early stage is generally referred to as a Phase I and is often beneficial in addressing habits, speech issues, airway problems, overbites, cross bites, protruded teeth that are prone to be damaged by a facial accident and for self-esteem. Interceptive treatment often utilizes growth in order to obtain favorable changes and also to prevent problems from developing into bigger ones. Orthodontics is not just about straight front teeth. Rather, it involves a dynamic system dealing with the interplay of the TMJ, muscles, teeth, ligaments, cartilage and bone. While our culture is often seeking instant gratification, there are no short cuts to obtaining beautiful, healthy and stable results. Diagnosis is critical and we take the time to initially obtain all the necessary information to do thorough analysis in order to determine all treatment options.
What are the costs associated with braces and have they become more affordable now?
Orthodontics is a wonderful investment for one’s well-being and quality of life. The benefits are health, function, esthetics and self-esteem. The financial investment is based on the complexity; but a beautiful healthy smile is a gift of a lifetime and is truly priceless. When compared to the cost of crowns, root canals, periodontal procedures and implants, etc., that are performed in a few appointments, orthodontics is the best deal going and flexible payment options are available. Over time, the cost has of course escalated, but is very moderate in comparison to most other services and products.
Tell us about Invisalign. Does it work and is it for everyone?
Aligner therapy (i.e. Invisalign) is a treatment modality that utilizes a series of clear removable trays or aligners that have built in correction of tooth positions. They are worn in a progression to align the teeth as they have been programmed digitally. Invisalign can be a great tool, but like any tool, it must be used for the appropriate job. Therefore, diagnosis is critical for proper use and application. The advantages of aligner therapy are comfort and esthetics. Compliance in wearing the aligners is absolutely necessary. There are limitations in terms of what tooth movements and root alignment may be accomplished. Also, treatment time may be longer and control of tooth movement may not be as accurate as conventional fixed appliances (braces). The nature of Invisalign treatment does not take into account jaw joint positions and there are often compromises that patients need to understand. Aligner therapy is often great as an enhancement to manage relapse for someone who had previous orthodontic treatment. Without diagnosis and supervision, a ‘do it yourself’ aligner approach as well as treatment by a provider who takes a weekend course may lead to detrimental and unfavorable results.
What tips do you give patients for caring for their newly straightened teeth after their braces are removed?
We advise our patients to do a good job wearing their retainers and take great care of their teeth to protect their investment. We also advise that patients have their wisdom teeth evaluated and wear mouth guards for sports. Retainers are a lifetime commitment for most patients. Just as our eye sight changes, our teeth move during our lifetime, even if there has been no orthodontic treatment. Lastly, smile!