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.

--- DocW

Content used with permission by Dr. Greg Jorgensen

http://www.gregjorgensen.com/blog

Esthetic Orthodontic Appliances: What To Do When Invisalign Is Not An Option

 Many people who want straight teeth never go through with treatment because they just do not like the way braces look. In 1998, Align Technology introduced Invisalign tooth positioning aligners. Up until that time, the only cosmetic alternatives to traditional metal braces on the teeth were clear (ceramic) or lingual (inside) braces. Why do orthodontists still use clear braces when Invisalign seems so much better?

Align Technology’s introduction of Invisalign changed the field of orthodontics forever. First, for appropriate cases, Invisalign does provide the esthetic alternative to metal braces that many patients are seeking. Second, because Align bypassed professional providers and marketed directly to the public (think Nexium—“Little Purple Pill” and Viagra), they created a demand for their product and an expectation that teeth can now be straightened without wires and brackets glued to the teeth. Third, because the Invisalign system seems so much easier to use than conventional braces, more than 300,000 non-specialist general dentists are now also offering orthodontic services in their practices. Although these changes have encouraged more patients to seek treatment...Invisalign is not a replacement for braces in all cases.  

Here's why...

First, although clear aligners are appropriate for many orthodontic problems, they are still biomechanically inferior to conventional braces in many situations. Because it is more difficult for plastic shells to create some of the forces required for complex tooth movements like turning round teeth, making teeth longer, and paralleling roots in extraction cases, most orthodontists still prefer to use brackets and wires for moderate to severe cases—where underlying skeletal discrepancies may exist in addition to dental issues.

Second, by taking Invisalign directly to the public without explaining its limitations, Align forces orthodontists to be “the bad guys” who more often than not have to give disappointing news to overly optimistic prospective patients. My practice statistics indicated that only one out of eight patients who come in hoping for Invisalign actually have problems that qualify for aligner therapy. The other seven would be treated to a better result with braces.

Third, because Invisalign appears easier to use than braces, dentists with little or no orthodontic training are now also offering orthodontic services to their patients. Since most of us trust the advice of our family dentist, rarely do we question when he or she recommends a new service. The results obtained by any doctor however are determined by his skills and experience. Eliminating brackets and wires does not eliminate the need for accurate diagnosis, treatment planning, and case management. Invisalign is simply a tool. Just because I can buy the same golf clubs as Tiger Woods does not mean that I can shoot the same scores as he does!

I use Invisalign in my orthodontic office. It is effective for mild and some moderate crowding and alignment cases. It is especially good for patients who have had previous orthodontic treatment but did not wear their retainers and have experienced some relapse. I like the fact that my patients can take out their aligners to eat and brush. Patients like it because it looks so much better than braces. So in many cases, Invisalign is actually my treatment tool of choice.

If Invisalign isn’t appropriate for your particular problem, what other options do you have? The most tried and true, economical alternative is clear braces. They have been around a long time and are now better than ever! Modern manufacturing techniques have overcome practically all of the long-standing weaknesses that have plagued previous generations of clear brackets. Today’s appliances are stronger, smaller, and do not stain like previous models. They can be used for the exact same complex movements as metal brackets and move the teeth just as efficiently. The only drawback is they still cost your orthodontist more to purchase (which he must pass on to you).

So if you are dead set against metal braces, you now have three options. Invisalign might be perfect for you if your problems are only mild. If you want the ultimate invisible treatment, you should consider lingual braces—which we use the Incognito system. If you want the most cost-effective esthetic alternative to “railroad tracks” that can actually move your teeth like metal however, ask your orthodontist to show you today’s clear braces. I think you’ll be impressed!

--- Doc W

Content used with permission by Dr. Greg Jorgensen

http://www.gregjorgensen.com/blog