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Wheeler Orthodontics • 4568 Feather River Drive Suite D • Stockton, CA 95219 • Phone: (209) 951-0151 • Fax: (209) 951-1235 • www.wheelerortho.com

Tuesday, May 14, 2013

Dr. Wheeler’s Formula for Successful Orthodontic Treatment

Getting your braces on is exciting, but getting them off is the best day ever!!! So you may be asking yourself, “How can I help my orthodontist help me get to that ‘best day ever,’ with the best result possible in the most efficient way available”? 
The answer is simple... 
Consistency and compliance.      
Let me elaborate…

You (the patient) are a significant variable that affects your treatment time. Your orthodontist may have the perfect diagnosis and treatment plan designed and prepared for you, but he cannot succeed without your cooperation. Some things you might be doing can sabotage your own treatment time.  These include 1) Missing, changing, or spreading out your appointments, 2) Arriving late to appointments so the chair-side technicians do not have sufficient time to perform all planned procedures, 3) Not getting other necessary procedures done in a timely manner (surgeries, extractions, restorative work, etc.), 4) Breaking or bending your wires or brackets between visits, or 5) Not following instructions regarding rubber band wearing, aligners, and oral hygiene. Consistently doing your part will not only help keep your treatment on schedule, it will give you the best final results too.
At the start of treatment, we gave you an estimated time of how long your braces would be on. This estimated time considers and assumes that you as a patient are being 100% consistent and compliant with what we have recommended for you to do. 
The intervals for adjustment visits we set up range from 3 to 8 weeks—although typically it’s every 6 weeks.  This interval is determined by the goals we have for that particular interval, and considers the bio-mechanical properties of the particular wires and ties we have selected for use.  We set up the following visit to coincide when the previous adjustment’s activation is about to “run out of gas”.  It has been proven scientifically that teeth move most efficiently under light, steady, and continuous forces.  If that application of a continuous force is ever interrupted, it takes a bit of time to get back into the “sweet spot” of efficient tooth movement.  We just don’t want an activation to ever “run out of gas”.  In fact, even just rescheduling an appointment just 1 week longer than ideal can easily add 3-4 weeks to your treatment time.  If you have been given rubber bands to wear—wearing them only 80% of the time causes the job to be done in twice the time, and wearing them only 50% of the time causes them to take 8 times as long for the treatment to be done.

Let me give you analogy.  Have you ever had to push a stalled car?  You might have noticed that it takes a little bit of strength and effort to get the car to start rolling; however, once it is rolling it is so much easier to push.  This is true with tooth movement as well.  All of what I am talking about occurs on the biological/physiological level within the supportive tissue around the roots of the teeth.  Once orthodontic treatment starts, special cells are recruited by the body to migrate around the root of the teeth and respond only to the stimuli of pressure…some remove old bone (osteoclasts), some make new bone (osteoblasts). When forces are added to the teeth in a consistent manner, this process works smoothly.  However, if these forces are interrupted by missing appointments, poor compliance with rubber band wear, or having broken appliances that need to be constantly repaired, then these cells get confused by the mixed signals they receive.  This, at a minimum causes a stop in the tooth movement (which takes a while to “get back up to speed”), but worse tends to cause the patient to experience an elevated level of tooth discomfort.  In rare cases, these cells get so confused they can actually start resorbing other hard tissue like tooth root structure, instead of remodeling bone.

Another important factor is to be consistent and compliant with your oral hygiene.  Keeping your teeth and gums free of bacteria-laden plaque keeps the supportive gum tissue strong and healthy.  If plaque is allowed to accumulate, then the gum tissues can get rather inflamed as they try to fight off the infection of the bacterial plaque.  Teeth simply do not move in areas of active inflammation.  To combat this you must be vigilant and consistent with your hygiene including, brushing and flossing twice or more times daily, and in seeing your family dentist regularly for thorough check-ups and cleanings (at least every 6 months or sooner, if advised to do so by your family dentist).  It’s a war against plaque!!

If you are in treatment now and are concerned by your prolonged treatment time, consider these three factors: Are you really doing your part and is there any room for improvement? Have you discussed your treatment progress with your orthodontist to see if anything has changed from his perspective? If you’re confident that both of you are doing your best, it may be that your body’s response to treatment is just slow.  Sometimes, it’s the individual’s biology that limits tooth movement to a slow pace. 
Also consider this as well…Not all orthodontists are the same.  Some are really focused and invested personally on making sure your treatment is complete.  Isn’t it comforting to know your orthodontist Dr. Wheeler has the integrity to finish the job he started, as opposed to one cutting corners just to say he finished “on time”?  Any treatment less that completed is unsuccessful treatment in my mind.

So to help your orthodontist help you get the most out of your treatment …be consistent and compliant with…
      1)     Making all your scheduled appointments

      2)     Making it to your appointments on time

      3)     Following all of our instructions regarding rubber band wear, aligner or appliance wear, and in following through with referrals for any adjunctive procedures (extractions, surgeries, etc)

      4)     Keeping your teeth clean through good oral hygiene practices

      5)     Making your treatment a team approach—having both the parent and patient—be active participants in the treatment.  Ask questions, be engaged in your investment of orthodontic care--come into the office, sit chairside for your child’s visit and not just sit in the car.


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