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All Posts Tagged: boston braces

boston orthodontics

Get the Perfect Smile You Deserve in Just 6 Months

Let’s face it – having crooked teeth can really impact your self-confidence. It can affect the way you smile, the way you speak, and even the way you eat. Traditional braces can take years to straighten teeth, not to mention the discomfort and inconvenience they can cause. Luckily, there is a revolutionary 6 Month Braces technique that was originated in Boston by Dr. Georgaklis that can give you the perfect smile you deserve fast. In this blog, we’ll discuss everything you need to know about Rapid Braces and how it can help you achieve your dream smile.

 

What are 6 Month Braces?

 

Rapid Braces, also known as Rapid Orthodontics or Rapid Smiles, is a technique that uses high-performance braces and wires to move teeth quickly and effectively. Unlike traditional braces which can take years to accomplish the desired result, Rapid Braces works in just 6 months. This technique is perfect for people who want to straighten their teeth in a short amount of time without the hassle of long-term orthodontic treatment.

 

How does it work?

 

The Rapid Braces technique uses a customized approach to aligning teeth. This targeted pressure is what allows the teeth to move quickly and efficiently. Each patient’s treatment plan is customized to their unique needs, ensuring the best possible outcome.

 

Benefits of 6 Month Braces

 

The most obvious benefit of Rapid Braces is the shortened treatment time. You can achieve your dream smile in just 6 months, which is significantly less time than traditional braces. Other benefits include less discomfort, fewer office visits, and less time spent in the dental chair. Patients also report feeling more confident during their treatment since the brackets and wires are less noticeable than traditional braces.

 

Is it right for you?

 

Rapid Braces is a great option for people with mild to moderate misalignment issues. If you have more severe orthodontic issues, you may still be a candidate for Rapid Braces, but it depends on the severity of the issue. The best way to determine if Rapid Braces is right for you is to schedule a consultation with an experienced orthodontist who specializes in the technique.

 

Having crooked teeth can have a major impact on your self-confidence, but traditional braces can be a hassle and take years to straighten teeth. Rapid Braces, the revolutionary technique originated in Boston by Dr. Georgaklis, can give you the perfect smile you deserve in just 6 months. If you’re interested in Rapid Braces, schedule a consultation with an experienced orthodontist to determine if it’s the right option for you. Say goodbye to traditional braces and hello to the perfect smile you’ve always wanted, thanks to Rapid Braces!

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Transform Your Smile

Transform Your Smile with Rapid Braces in Boston

Are you looking for an easy, effective way to transform your smile? If you live in the Boston area, Rapid Braces can help you achieve perfect teeth in as little as six months! With this revolutionary orthodontic technology, straightening your teeth has never been easier or faster. Let’s take a look at why you should consider getting Rapid Braces.

 

What are Rapid Braces?

Rapid Braces is a new type of braces that utilizes a series of small brackets and wires to straighten your teeth. Unlike traditional braces, which require frequent adjustments over the course of several years, Rapid Braces works quickly and efficiently to get your teeth into their desired alignment. This is because the brackets and wires used in Rapid Braces are constantly exerting pressure on your teeth, which causes them to move faster than with traditional braces. The end result is a beautiful smile in less time!

 

Benefits of Rapid Braces

One major benefit of using Rapid Braces is that it is much more comfortable than traditional braces. Since the brackets and wires used in this system are smaller than those used in regular braces, they cause less irritation and discomfort. Additionally, since the treatment time is much shorter than with regular braces, there is less risk of gum damage or mouth sores. Plus, the results of Rapid Braces are permanent; once your teeth have been moved into their correct positions, they will stay that way forever!

 

If you’re looking for a fast and efficient way to improve your smile then look no further than Rapid Braces! This revolutionary orthodontic technology uses small brackets and wires to straighten your teeth quickly and comfortably – all within six months! And with its numerous benefits such as comfortability and cost-effectiveness – it’s no wonder why so many people are turning to this innovative solution for their dental needs. So if you’re ready to transform your smile today—consider visiting an experienced orthodontist near Boston who offers rapid braces treatment! You won’t regret it!

 

Contact us today to schedule an initial consultation with Dr. Georgaklis. Dr. G will examine your mouth to see how your teeth are aligned to determine the best options for straightening them for a better smile. He can present the best available options and go over any questions you have about 6 Month Braces after seeing your smile.

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invisible braces

Cosmetic Dentistry: Look Your Best for Big Events

Whether you’re getting married, walking across the stage to receive your diploma, or interviewing for a job, big events can make you want to look your absolute best. If you’ve been hesitant to smile due to imperfections in your teeth, cosmetic dentistry could be the answer. In this blog post, we’ll explore how cosmetic dentistry can help Boston-area working professionals look their best for special occasions.

What is Cosmetic Dentistry?

Cosmetic dentistry is a type of dental care that focuses on improving the aesthetics of a person’s teeth, gums, and smile. It involves various dental procedures that help enhance the overall appearance of a person’s smile and oral health. Common cosmetic dental treatments include teeth whitening, dental bonding, porcelain veneers, dental implants, and orthodontic treatments such as braces or clear aligners. These procedures can help improve teeth’ color, shape, size, alignment, and spacing, resulting in a more attractive and confident smile.

Benefits of Cosmetic Dentistry

The most obvious benefit of cosmetic dentistry is that it can give you a more attractive smile. Studies have shown that people with straight white teeth are seen as more attractive and successful than those with crooked or discolored teeth. Additionally, cosmetic dentists can improve the overall health of your mouth by removing plaque buildup, reducing cavities and gum disease, and correcting bite issues that may have caused pain or other oral health problems. Overall, cosmetic dentistry offers many benefits beyond just improving the appearance of your smile. It can also help improve the health of your mouth, alleviate pain, boost your confidence, and promote better oral hygiene habits for the long term.

How Can it Help You Look Your Best for Big Events?

If you have an important event coming up—such as a wedding or job interview—cosmetic dentistry could be just what you need to feel confident in your smile when the time comes. With professional whitening treatments, porcelain veneers, and other aesthetic procedures available at our office in Boston, we can help restore dull looking teeth back to their natural color while also fixing any chipped or broken teeth so they look like new again. Plus, we offer same-day treatments so if you’re short on time before an event we can provide quick solutions that will make sure you look your best when the day arrives!

A beautiful smile has the power to boost your confidence when it matters most—and when it comes time for an important event such as a wedding or job interview, having a great-looking set of pearly whites makes all the difference. Fortunately, Rapid Braces offers plenty of options for restoring dull or worn teeth and our 6 Month Braces treatment option so you can get straight teeth in 6 months or less. So if you’re looking for ways to look your best at upcoming special events in Boston area don’t forget about how cosmetic dentistry can transform your smile and boost your self-esteem–it could be just what you need!

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Invisalign Alternative Boston

9 Reasons an Invisalign Alternative Could Be Right For You

Invisalign straightens teeth without the use of metal braces. Clear braces like Invisalign use a series of custom clear plastic retainers to slowly push and pull your teeth into the proper position over time. Less noticeable than traditional braces, Invisalign can be easily taken on and off. 

Traditional metal braces are not the only option when it comes to improving your smile. When undergoing treatment with clear braces, there are no metal brackets or wire. Invisalign offers an effective and discreet solution to a misaligned smile. Many adults who get braces opt for the 6 Month Braces treatment option at Rapid Braces so they can get their braces off fast.

Who can wear them?

Invisalign Alternatives like Clear Braces can be worn by both teenagers and adults. Closing gaps between teeth, treating overbite, underbite, open bite, crossbite, and an overcrowded mouth is all something that adult orthodontics treatment can help with. We can discuss whether an Invisalign Alternative is the right orthodontic treatment for you after an examination of X-rays of your teeth. 

How does the Adult Braces process work?

Examination, X-rays, and a 3D model of your teeth are all used to develop a personalized treatment plan for your Invisalign journey. How your teeth need to shift, and how long it will take all play into how your treatment plan will work. Your custom retainers are crafted after we take X-rays and complete a close examination of your teeth. You can also see how Clear Braces progressively corrects orthodontic issues when you visit the office for regular checkups. 

How Does Wearing Clear Braces Work?

Firstly, we check the fit of your Invisalign Alternative in our office to check for any necessary adjustments.  

Clear Braces fit smoothly into a normal day and is easy to wear. Simply place the clear braces over the teeth once you receive your aligners. For the first part, your aligners may fit tightly as your teeth are pulled into place.

How do Adult Braces feel?

Adult Braces are designed to be discreet and as comfortable as possible. Some mild discomfort may appear as your teeth start to move into position. The pressure applied from your braces will gradually fade over time. Please give us a call if you encounter any significant discomfort or pain. We will schedule an appointment with you to take a look at your teeth, gums, and braces to make sure no adjustments need to be made. 

How long will treatment take?

Treatment time for many orthodontists who offer Invisalign is often 1-2 years, but Dr. Georgaklis can get your braces off faster with his 6 Month Braces treatment. Over 90% of cases at Rapid Braces are finished in 6 months or less. Schedule an appointment to learn more about how you can get a beautiful smile fast at Rapid Braces.

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Benefits of a Great Smile

Benefits of a Great Smile

There is no secret that when you smile more, you just simply feel better. Smiling has many documented social benefits. A Genuine smile can make you seem more likable, attractive, intelligent, and even trustworthy. Perhaps the biggest surprise to benefits of smiling, however, is that it can improve your health & even help you live longer. Here are some of the surprising health benefits of smiling.

  • Everyone feels down sometimes and smiling is the most simple, and the best way to improve your mood. So if you are having a bad day try smiling, improve your thoughts, and it may just lead to a genuine smile to lift your spirits.
  • Smiling and general laughter appears to help lower peoples’ blood pressure, and all around heart health. The reason is that laughter causes an initial increase in heart rate, followed by a period of muscle relaxation. The decrease in heart rate and blood pressure helps you reduce your risk of developing heart disease.
  • When you are in a stressful situation, try smiling! Smiling helps your body deal with stressful situations more effectively. Smiling results in a lower heart rate, telling your body that you have full control of the situation. Stress is generally caused by increases in heart rate and blood pressure. Maintaining a smile will provide you with both psychological and physical health benefits.
  • Have you noticed that you are drawn towards people who smile a lot? This is because people who smile are perceived as being more likable than those who don’t. Being likable makes it easier to build and maintain a better relationship with other people. This is important for overall health, well-being, more stable marriages, and better interpersonal skills than people with negative emotions. Keeping a smile on your face truly helps create healthier and stronger social bonding.
  • An incredible discovery is that laughing and smiling helps boost your body’s immune system. Laughter and positive thoughts release chemicals in your brain that fight stress and illness. Laughter therapy has even shown to increase immune responses in women who have just had babies. Positive thoughts really do have a physical presence in the health of the body, so always keep positive.
  • It turns out that the fountain of youth has been within you all along. It has been discovered that smiling and positive emotions are associated with increased lifespans. Now that is a reason to keep smiling.

The lesson here is, the next time you feel down, try wearing a smile even if it is uncomfortable. Your fake smile will turn into a genuine one, all while gaining benefits for your mind, body, and overall well-being. Set up an appointment with us to get your best smile, and wreak the benefits while looking great doing it.

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Adult Invisalign Alternatives

Invisalign Alternatives for Adults

Invisalign is one of the most popular choices to get braces for adults. Patients of all ages have welcomed Invisalign because of its discreet treatment method. The Clear Plastic trays are perfect for adults who would like to keep their braces hidden from co-workers or friends. The Invisalign plastic slowly adjusts your teeth. Every couple of weeks, a new set of Invisalign trays are set to replace the old set. Invisalign is so popular, not only because of its discreet appearance but because of its discrete adjustments to your teeth with no pain.

Adult Invisalign Alternatives

For Adults that never got the Orthodontic attention they needed as a teenager, cosmetic orthodontic treatment with methods like Invisalign are becoming popular. Because so many adults are looking for discreet treatment options, we offer Invisalign alternatives at Rapid Braces that can get you a beautiful smile.

Incognito Braces

Incognito braces are the latest orthodontic trend for alternatives for adult braces. Incognito braces are hidden from your smile as they are affixed to the back of the teeth. This technique allows the braces to be virtually invisible. The Incognito braces also eliminate the concern of braces damaging the front of the teeth. Your white smile cannot be damaged with this orthodontic treatment.

Clear Braces

Getting Clear Braces is another way to avoid unattractive metal braces during 6 Month Cosmetic Orthodontic Treatment. Clear Braces use clear bands so they can’t be seen easily and are more affordable than lingual braces put behind the teeth. Clear Braces are perfect for adults who don’t want the attention that orthodontic treatment can bring. Fixing your smile as an adult is easier than you can imagine. Schedule an appointment at Rapid Braces and we can take a look at your teeth and see which Invisalign Alternatives would be best for you.

clear braces orthodontic treatment

Why Rapid Braces?

Here at Rapid Braces, we understand the importance of giving each patient enough time to make sure all questions are answered. Patients have specific needs and we make sure to develop a personalized plan for everyone we see at Rapid Braces. Rapid Braces provides a relaxed environment so our patients can be as comfortable as possible when visiting for an appointment. Our team loves to welcome in any new patients and help them get straight teeth fast with our 6-month braces treatment.

To learn more about the alternatives to braces for adults offered by Rapid Braces, visit our office, or reach out to us through our Contact Form.

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Braces for Adults in Boston

Braces for Adults in Boston

Braces aren’t just for kids anymore — now there are options for braces for adults! More and more adults are looking into their options to get straight teeth. Dr. Georgaklis has revolutionized the way adults get straight teeth with his Rapid Braces method. He combines his dentistry expertise with orthodontic practices to give each patient a unique experience and perfect smile.

clear braces orthodontic treatment

People who need braces in the Boston area can benefit from Dr. Georgaklis’ expert treatment and get straight teeth in six months! Adults can choose from clear braces or behind the teeth braces. Both of these options give you straight teeth while “hiding” your braces. Many people might turn to other treatments like Invisalign, but Dr. G’s method can give you straight teeth in half the time!

Clear braces can be considered invisible braces. They mount to the front of your teeth like typical braces, but use clear brackets and wiring for that see-through effect. Learn more about clear braces here!  Lingual braces, or behind the teeth braces, mount to the back of your teeth. These braces are hidden and can only be seen if you tilt your head back! Dr. Georgaklis is able to use a combination of these braces and retainers to give you a perfect smile. Learn more about lingual braces here.

Getting straight teeth as an adult doesn’t need to be a hassle or an embarrassment. It just takes six months to fix your teeth and have you loving your smile! Contact us for a free consultation!

 

 

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Difficult Case Types: Part 2, A Discussion of Adult Short-Term Orthodontics

Difficult Case Types: Part 2, A Discussion of Adult Short-Term Orthodontics

Clear or Invisible braces for adults.

Originally posted on Dentistry Today.

INTRODUCTION 
In part 1 of this article, I discussed the evolution and rationale of short-term orthodontics (STO); and how it dovetails with aesthetic dentistry and other disciplines to provide treatment by one provider in a coordinated and timely manner. I briefly discussed issues involving treating patients who present with bruxism, patients who have unrealistic cosmetic demands or obsessive-compulsive disorder, and those personality types who wish to alter or control their treatment plan. Though STO is oriented toward the patient’s aesthetic chief complaint, we must still limit the patient’s involvement in the treatment planning and smile design to meet “real world” expectations.
At the initial consult, it is helpful to provide cosmetic orthodontic patients with before and after pictures of what they may expect, along with a list of what can and cannot be achieved. All common significant questions should be addressed on one’s Web site, in addition to a consultation photo book given to new patients before seating. Actual pictures of one’s own work can be a fair representation of what to expect, providing an honest and direct dialogue that can be very beneficial to both the patient and the provider.
The case types discussed in the second part of this article include interesting aspects of transfer cases, the judicious use of enamel reproximation, cases with particular retention needs, cases with temporomandibular disorders (TMD), large tongues, profile problems, and a complex multidisciplinary case. These difficult case types offer an opportunity to present pearls that can enhance treatment for both STO and conventional orthodontics alike. The greater focus and time per visit required for STO (I prefer one-hour visits) also bring greater reward and satisfaction for both the patient and the provider.

CASE TYPE IV: TRANSFER CASE WITH TIPPED POSTERIOR TEETH
While some believe that they can nonsurgically expand the dental arch through orthodontics in an adult patient, it has been proven that “expansion” (crown tipping in an adult) at past the age of 13 years is not significant, and it is prone to relapse.1Posterior crowns tip to the buccal without significant root translation resulting in an unaesthetic and unstable result also prone to gingival recession.

Figure 1. Patient first came into our office with teeth tipped outward through use of removable expansion appliances. There was sufficient space for alignment, but the roots were in unstable positions with crowns tipped to the buckle. Figure 2. A stable result must maintain arch circumference in an adult patient with the teeth in cortical bone to prevent inward collaspe post-treatment.
Figure 3. Patient presented with narrow incisors due to previous treatment that relied too heavily upon enamel reproximation and scarificed tooth proportion and aesthetic outcome.

Patient in Figure 1 was referred by an orthodontist in Los Angeles for lingual orthodontics. He expanded her for one year with Crozat appliances, leaving sufficient space to align the teeth (Figure 1). At this point, she moved to Boston, where we commenced lingual orthodontic treatment which proceeded smoothly. Brackets were removed with an aesthetic result. However, in the months after completion, the arch form and tooth roots continued to collapse inward. Expansion had spread the teeth laterally into an unstable position outside the cortical bone. The patient needed a brief course of retreatment with enamel reproximation which yielded a far more stable result which has been maintained well (Figure 2).

CASE TYPE V: OVERUSE OF ENAMEL REPROXIMATION
While the previous case showed an under-reliance on enamel reproximation, this case shows overreliance on it. Lack of flexibility and overreliance on any one treatment modality has its perils, though. The patient in Figure 3 was looking for retreatment despite the fact that her teeth were straight. In order to achieve an ideal occlusion nonextraction by the treating orthodontist, the teeth had been interproximally reduced to the point that they were unaesthetic, lacked embrasure space, and were not self-cleansing. This resulted in unaesthetic tooth proportions and perpetually inflamed papillae. Minor alignment was done along with recontouring. The teeth were shortened to establish better proportion, and embrasure spaces were opened to allow better self-cleansing.

CASE TYPE VI: SPECIAL RETENTION NEEDS; ADULT CLASS II, DIVISION 2; LARGE DIASTEMA, SEVERE ROTATION 
The Class II, Division 2 is a common type of crowding where the upper centrals tip palatally and the laterals flare labially (Figure 4). Aesthetically conspicuous, it is usually a simple case to align dentally with enamel reproximation. These patients do not usually have a profile problem needing orthognathic surgery. As they are fully grown adult patients, skeletal change and complete overjet correction is not usually possible nonsurgically, so the upper central incisors will always tend to relapse palatally. Therefore, this is an ideal case for maxillary lingual splinting of teeth Nos. 7 to 10 or teeth Nos. 6 to 11. Slight overjet allows a durable splint to be placed out of occlusion in a case type that would otherwise be very prone to relapse. Recognizing the instability of cases that have a skeletal component is essential, and this patient’s aesthetics are basically identical today to the result (Figure 5), 12 years after completion, with no noticeable relapse due to her upper and lower lingual fiber-reinforced composite splints (Ribbond).

Figure 4. Adult Class II, Division 2 is very prone to relapse. Figure 5. Splinted result maintained well (at 12-year recall).
Figure 6. Large diastema needing fixed retention. Figure 7. After short-term orthodontics (STO) with splinting.
Figure 8. The 3.5-year recall with fiber-reinforced composite (FRC) (Ribbond) splints. Figure 9. Severely rotated incisor.
Figure 10. This rotation could never be maintained without a splint. Figure 11. Four-year recall with maxillary FRC splint.

Large diastema cases (Figures 6 to 8) also have special retention needs (a maxillary splint), as do severely twisted teeth (Figures 9 and 10). Though it requires overjet be left in the final result, the maxillary splint provides excellent retention, though it can require maintenance. Removable retainers would almost surely fail to retain these particular tooth movements. However, with the maxillary splint, the excellent results were well-retained in both cases at the 3- and 4-year recalls (Figures 8 and 11). Few orthodontists finish cases with the overjet needed to allow for placement of a maxillary splint.

CASE TYPE VII: Temporomandibular Disorder 
This patient was a bruxer whose crowding and anterior recession were worsened by bruxing forward, causing anterior displacement of an upper central incisor (Figure 12). As a prominent cosmetic dentist, he came to Boston for rapid cosmetic orthodontics. The alignment proceeded smoothly with one exception: I allowed the likable dentist-colleague to limit my enamel reproximation in the lower arch. Therefore, my ability to retract the lower incisors and establish sufficient overjet also became limited. Parafunction usually ceases at the beginning of orthodontic treatment, but then returns once the teeth are no longer sore. Once the parafunctional bruxing returned, the upper central (that now had been retracted back) caused a more retrusive and limiting anterior guidance on the mandible (Figure 13). The new incisal guidance brought less freedom of the mandible during bruxing, pushing it backward, so disc compression and tinnitus followed.

Figure 12. Bruxer, before STO, with protruded tooth No. 8 from bruxism. Figure 13. Bruxer, after STO, with normal incisor occlusion.

Our typical treatment method of leaving overjet avoids any retrusive incisor contact on the mandible, and avoids TMD sequelae. The lack of tight anterior coupling in my finished orthodontic cases accounts for the fact that I rarely see TMD in my patients after STO—a remarkable statistic, especially considering occlusal change is not the primary treatment focus. One must be very cautious when leaving a case with the incisors tightly coupled together in occlusion, as any lower incisor relapse or change in jaw position forward may cause disc compression and the pain that may or may not have been poresent beforehand.

CASE TYPE VIII: LARGE TONGUE 
Patients with a large tongue often have anterior spacing. The patient’s tongue in Figure 14 already fills the space available and goes to the lingual surfaces of the teeth. While the anterior spacing can be reallocated distal to the canines, the incisors cannot be retracted and maintained inside the neutral zone with long-term stability. The tongue pressure will push the teeth forward unless tongue reduction has occurred. In such cases, we always explain to our patients at the initial consult that space will be redistributed distally to maintain an incisor position that is in harmony with the tongue, instead of a retracted incisor position when the tongue will not allow them to be maintained and would cause relaspe.

CASE TYPE IX: PROTRUSION WITH UNAESTHETIC PROFILE
There is no STO solution for cases with an unaesthetic facial profile and lip incompetence. This case needed bicuspid extraction because the amount of upper incisor retraction required cannot be done with enamel reproximation alone (Figures 15 and 16).

Figure 14. Large tongue prohibited the retraction of incisors. Figure 15. Bicuspid extraction case with lip incompetence.
Figure 16. After bicuspid extraction treatment. Figure 17. Surgical case that requires a referral to the surgeon-specialist team.
Figure 18. Canine substitution needed for missing upper lateral incisors. Figure 19. Final result; bonded and splinted upper canines and bicuspids without any bridgework or implants.

Even more involved, the skeletal case in Figure 17 clearly needs orthognathic surgery.

CASE TYPE X: MULTIDISCIPLINARY CASE
This case cannot be done with orthodontics alone (Figures 18 and 19). Treatment involved surgical exposure and bringing down impacted canines throughout one year (still considered STO due to the complexity of the case), as well as splinting with reshaping and bonding. Canine substitution was done for the missing upper laterals incisors. With some creative thinking, this patient avoided any bridgework or implants as this result was achieved solely with orthodontics and bonding. Most patients enjoy a result with greater simplicity, stability, and predictability, while eliminating implant surgery and minimizing treatment time and expense. This type of thinking can bring people back to dentistry, especially adult patients like this with aesthetic problems who have not sought out care sooner due to obstacles inherent in a conventional and more involved treatment plan. Patients opt out of 2-year treatment when there is a shorter plan with proven results.

CONCLUSION
As dentists, we have a myriad of responsibilities that can make dentistry complex as well as rewarding. Diagnosis and treatment planning, patient management, and retention protocol all vary with a need to understand and accommodate each patient’s teeth and character. Comprehensive 2-year orthodontics may better address more complex cases, but there is also a demand for more rapid orthodontic treatment for the typical adult cosmetic cases.
We must always remember that elective cosmetic dentistry of any type often comes with a human dimension of personal preferences that is often distinctive. These preferences must be understood, addressed, and ideally, satisfied, within the parameters of a healthy and stable long-term result.


Reference

  1. Bishara SE, Jakobsen JR, Treder J, et al. Arch width changes from 6 weeks to 45 years of age. Am J Orthod Dentofacial Orthop. 1997;111:401-409.
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Redefining Adult Cosmetic Orthodontics

Redefining Adult Cosmetic Orthodontics

Six Month Rapid Braces treatment.

Originally posted on Symbiosis.

In the early 1900’s, Edward Angle was a pioneer that lead orthodontics into becoming its own speciality. He founded the first school of orthodontics, the American Society of Orthodontia in 1901, and the first orthodontic journal in 1907. As the “father of modern orthodontia”, he heavily influenced treatment towards establishment of an Angle Class I occlusion, classifying malocclusions as Class I, II, and III based on molar occlusion. Yet the meaningfulness of this classification system is often brought into question [1]. There is less disparity among orthodontists when classifying occlusions according to incisal classifications of overjet and overbite, as many do in Britain [2]. There has yet to be definitive evidence in the literature to support lengthening treatment to establish a Class I molar occlusion if it is otherwise functional.

When the popularity of orthodontic treatment surged in the 1950’s, esthetic dentistry had not yet come into its own. America’s dental awareness and cosmetic expectations were low. With the advent of acid etching, cosmetic bonding, and later porcelain veneers, the practice of cosmetic dentistry progressed. Slowly more adults began to undergo orthodontic treatment also. They usually wanted straight teeth and a pretty smile. Over time, orthodontists began to notice that the general public wanted straight teeth and was less concerned with the type of occlusion and cephalometric measurements than they were [3], as long as they functioned without attrition, open bite, periodontal loss, or other health related issues.

Bonding brackets instead of banding made it possible to judiciously make space locally through the interproximal reduction of enamel surfaces, popularized by Dr Jack Sheridan [4]. It has taken decades for enamel reproximation to become more accepted, and now it is widely used over the all or none measure of bicuspid extraction, which requires closing a greater amount of space made far from the crowded incisors. Single lower incisor extraction also came into use in the 1970’s [5] and 1980’s.

Let’s Try Something Different

After learning about these two simple less invasive ways of making space, I was instantly hooked. Brainwashed by long term treatment dogma in dental school, I was convinced I was doing something wrong, or just missing something. The potential to shorten treatment was readily apparent as I began my first cases in general private practice in 1991. As the teeth straightened quickly by creating space locally, as well as through nickel titanium wire use, patients were asking why the braces needed to be on longer. As they generally had begun with well functioning occlusions, I had no answer. My orthodontic treatment times were reduced with limited occlusal change (treating crossbites, anterior deep bites, and overjet reduction) to 6 months or less when I wasn’t extracting bicuspids- which was done rarely. Through the use of fixed anterior composite bite planes behind the incisors, deep bites corrected quickly through passive supraeruption of molars, and some intrusion of the incisors. I started treating a wide variety of cases and occlusions in an ethnically diverse city. I found that resolving incisal Class III occlusions and posterior cross-bites usually could also be treated in a short time frame. Although not all of my patients have finished with a Class I molar occlusion over the last 24 years, they function well over time at recalls, just like molar Class I cases. Bruxers experienced attrition with whatever type of occlusal guidance or molar occlusion they had. It was obvious they needed a nightguard, rather than choosing which teeth they would wear down and have abfractions on. I could not discern any differences in stability or attrition at recalls between patients finished with a molar Class I, II, or III. “Less than 15% of the population develops a normal occlusion defined by Angle in the permanent dentition. The term ‘ideal’ may therefore be a more appropriate description, and deviations from this esthetic and functional optimum should not be considered abnormalities in the true sense of the word. Current research indicates that few malocclusions compromise dental, periodontal or temporomandibular health” [6].

Treatment of TMD is another controversial area in which we have used long term bite changing orthodontics. Many claim TMD improvement and the cessation of bruxism during their orthodontic treatment as proof of successful occlusal rehabilitation, and therefore predictive of long term joint health. Given the sparseness of research supporting this, the more likely reason for improvement is teeth are too sore to be clenching during active treatment. Though I never promise TMD resolution in performing orthodontics, I have had remarkable long term success in TMD cases through avoiding retrusive incisor contact. Establishing liberal overjet avoids retrusive anterior contact and disc impingement, even if there is relapse or non-compliance with retention. After numerous studies, comprehensive 2 year orthodontic treatment has not been proven to improve TMD [7].

Those who claim long-term successful resolving TMD through orthodontic treatment would do well to put forth more definitive research supporting it.

So from 1991 – 1999 in my general practice, with a cosmetically focused treatment approach I discovered that the majority of adult cosmetic orthodontic cases could be aligned in 6 months time or less having treated hundreds of cases, and decided to write about it (Georgaklis, 1999). Many of these cases had significant crowding and were finished with a highly cosmetic result that excited the patients and myself.

An example of the typical case we see for adult accelerated orthodontics (AAO) with upper and lower splinting canine to canine for reliable retention. We recommend the splints stay on for a minimum of 5 years before sequential removal.

Many principles of smile design are incorporated into adult accelerated treatment (AAO) beyond alignment such as decreasing gingival display and addressing tooth proportions, shape, and color.

These cases are also stable by avoiding posterior lateral expansion, maintaining arch circumference and functional posterior occlusion. There are very few tooth movements (of erupted anterior teeth) that take greater than 6 months to align if space can be made without bicuspid extraction. I used to think that shorter treatment times would bring more root resorption, based on the assumption that greater force was used. But greater force is not what makes shorter treatment time possible, but that space is made locally near the crowding. There is less tooth movement, less bone remodeling, less inflammation, and less time for the roots to resorb, if the individual is prone to this distinctive hyper inflammatory response. It is longer treatment times using extractions that has been repeatedly and conclusively proven to be the cause of significant root resorption [8].

The Age of Accelerated Adult Orthodontics (AAO)

After practicing AAO for 24 years, I believe that avoiding difficult and lengthy adult molar translational movements that are nearly impossible to retain (in an attempt to obtain a molar Class I) is truly beneficial for the patient. “Minimally invasive cosmetic dentistry” as Maini [9] describes adult aesthetic orthodontics, can be an effective tool for adults with a cosmetic chief complaint. As many practitioners of AAO know, the three most important reasons for treatment are “aesthetics, aesthetics, and aesthetics” [10]. Perhaps the acronym should include ADULT ACCELERATED AESTHETIC ORTHODONTICS and be AAAO. So far everyone has their label. But everyone knows treatment is accelerated for aesthetic reasons, so the word “aesthetic” is redundant. Many patients are coming back to the dentist for this service who has been avoiding us. 2/3 of them in my practice have frank caries and other restorative and periodontal issues. AAO is a more appropriate and conservative treatment than some the most well intentioned restorative dentistry replacing enamel and dentin with porcelain or composite in “restoring smile harmony” [11].

Although AAO is not yet standardized, the simplified approach is growing [12]. The foundational thinking is listening to the patients chief complaint and treating it, suggesting (but not deciding for them) what they must endure to get the smile they came for. Suggesting excessive overjet reduction when it exists is necessary, changing molar occlusion can be very helpful (especially with crossbites), but insisting on both across the board can legitimately be considered overtreatment that I would not want for myself or my children. As Mohlin [13] said on malocclusions and aesthetic treatment, “The mere presence of deviations from the concept of the ideal occlusion should have no influence on orthodontic treatment decisions. According to studies, the influence of malocclusion on periodontal health, speech and chewing is fairly minor. Neither can orthodontic treatment be justified as an effective means of preventing TMD but it may be indicated to reduce the existing signs and symptoms of TMD in certain carefully selected cases. Interceptive or preventive orthodontic treatment may be indicated to reduce the negative influence on growth and occlusal development of functional malocclusions (anterior or lateral forced bite) or ectopic tooth eruption. Similarly, early correction of large overjet may be valuable in order to reduce the risk of traumatic injuries. Such treatment is usually motivated during the primary or mixed dentition periods. From the teenage period onwards, psychosocial or aesthetic reasons for orthodontic treatment are dominating. Decisions to start orthodontic treatment in order to improve aesthetics should usually not be taken before the child has reached sufficient maturity for these decisions, normally after the age of 12 years.” This well summarizes my treatment approach on AAO, pediatric treatment, and TMD orthodontics.

Since the arrival of Invisalign, which was specifically formulated for anterior alignment in the adult cosmetic patient about 15 years ago, the limited treatment concept does not seem so controversial. Perhaps this is because the method of delivery is less invasive with removable appliances. But when I began marketing cosmetic orthodontics in 1991-1992, it was considered radical. With AAO, straight teeth are just a starting point though. There are various other modalities that are incorporated into treatment that haven’t yet been because of the narrow occlusal focus of the past. Teeth can be straight but appear unaesthetic.

Treatment in the above case shows lack of attention to anterior tooth morphology, incisal congruence, stepping, and proportion, gingival display and height, and color- despite proper alignment and open bite closure. The final result also ignores the gingival and anatomical accommodations needed on the right side for canine substitution.
So what is different about AAO?

Accelerated treatment time and lingual orthodontics: We know that long treatment time is one of the greatest barriers to orthodontic treatment. Though thermally activated, nickeltitanium wire use, limited occlusal change, enamel reproximation, lower incisor extraction, and to some extent lingual orthodontics, you would have to live under a rock not to realize that adult orthodontics has undergone a rebirth [14]. Any arch expansion treatment past the age of alveolar growth (usually 12-14 years old) will be more prone to relapse [15], so we avoid expansion and bicuspid extraction when possible. In cases with significant crowding or spacing I suggest canine to canine splinting. Posterior cross bite correction in adults requires permanent removable retainer wear at night. While it is far more difficult to control tooth movements with lingual orthodontics, it is another option that eliminates objections to treatment. It is far easier to perform lingual orthodontics when focusing on the anteriors and the occlusion is maintained.

Fine tuning proportion: In my office, interproximal reduction is performed with Brasseler diamond discs of .15mm thickness, so very little enamel is removed, even if the same contact is disked on multiple visits. After measuring the mesialdistal dimensions of disked anterior teeth on castes before and after treatment in multiple cases, I could not detect the difference because it was so small. When making space on multiple visits, wide teeth are disked to maintain symmetry. Incisal edges can also be adjusted to maintain proportion.

This excellent orthodontic result could have been made better through enamelplasty.

We re-establish proportionate interproximal and incisal embrasures so teeth maintain their shape.

Teeth are “shrunken” in every dimension, not just interproximally. No one should be able to detect where enamel was removed.
The positioning of facial line angles also changes perceived width as shown on the left. Using high magnification we can modify facial-interproximal line angles to change the apparent widths of facial surfaces so they relate to other teeth in the Golden Proportion shown above right.

Although both smiles show the Golden Proportion in widths relative to other teeth in the arch, the length to width ratio on the right simulation is more appealing. Shortening anterior teeth on the left dentition would provide better proportion.

Narrow teeth such as peg lateral incisors are bonded before space closure. I reshape incisal edges noting proper offsets, and facial surfaces to change apparent root angulations. I bond or bleach uneven, chipped, fluorosed, decalcified, or dark teeth, and establish proper gingival display of 0-2mm [16] through gingival surgery. If the deficient dimension of the tooth is on the incisal due to attrition, bonding or porcelain is added. While thin incisal composites normally fracture, the thickness is greater when supported by a lingual splint and remarkably durable.

We can deliver a white, wide, full arch smile that is retained where necessary through splinting, in a timely manner in the vast majority of cases. Thoughtful delivery of finishing procedures according to each patient delivers the ideal result.

Tooth morphology should be custom. Unless the patient specifies otherwise, I prefer the rounded incisor appearance.
While orthodontics leveled the plane of occlusion, corrected the cross bite, and positioned roots, porcelain was needed to address the peg lateral on the right, canine substitution on the left, and replacement of both mobile primary canines which were extracted.
Acid erosion diminished incisor widths and congruence, especially in the incisal third. After orthodontics a composite splint retained the result and added proportion, without extensive removal of enamel for crowns. Thin sections of composite match well and can be hard to detect.

This involved case demonstrates the manipulation of line angles, incisal edges, and gingival contour essential when performing canine substitution for missing upper lateral incisors. After the impacted upper right canine was extruded, both canines were reshaped, bonded, and made into a lateral incisor. Deep bite correction was achieved through a fixed flat composite bite plane lingual to 8 and 9. Moving the canine facial-interproximal line angle to the center of the tooth narrows the facial aspect, turning each canine into a lateral. Shortening the point, flattening the face, and adding incisal corners hides the cylindrical qualities of the canine. Bicuspids were flattened facially on the incisal third to resemble canines- anatomical hybrids of incisors and bicuspids.

Soft tissue aesthetics and congruence: Gingival contour and position can often be manipulated because many cases in the younger population undergoing AAO and cosmetic dentistry require removal of gingiva to establish congruence more than addition. Most patients with high smile lines do not have concurrent recession problems due to the thick bone and gingiva, as shown below.

This case was treated through intrusion of the maxillary incisors in conjunction with successive gingivectomies. A periodontal pocket was re-established to maintain biologic width and minimize regrowth of gingiva post treatment. Photo on right was after emax crown cementation on #8 with the lingual splint bonded directly to the tooth.

If the gingival level after surgery does not allow for biologic width defined as the space between alveolar bone attachment and the free gingiva margin, the gingiva will regrow to re-establish a protective zone for the bone. After performing a gingivectomy I use a narrow fluted burr to make a shallow pocket of 1-2 mm severing the crested periodontal attachment (an “augmented gingivectomy”) to prevent regrowth of the gingiva back to its previous level. This limits regrowth of gingival.

After AAO, and 2 days after augmented gingivectomy.

As moving teeth together for space closure can constrict, enlarge, and lengthen the papillae, deficient papillae can be made to fill black triangular spaces. Overgrown swollen papillae should be trimmed as they collect more plaque and are unaesthetic. Triangular shaped teeth can have recession of the papillae because the contact point is more incisal and the bone crest is more apical which results in a flatter papilla [17]. A flatter contact after reproximation usually elongates the papilla so that it is “pinched”, and often able to fill the black triangular space though. This commonly occurs in space closure. Many times I treat black triangular spaces in this way, saving the patient an involved periodontal surgical procedure.

Brandao [18], an orthodontist in one of the most esthetically conscious countries in the world (Brazil) well described finishing procedures in orthodontics; “Treatment quality is directly related to the amount of procedures implemented by the orthodontist, associated with concepts and resources from Periodontics and Dental Prosthesis. Microesthetics cannot be seen in isolation, but rather as the key to establish a pleasant smile (miniesthetics) in addition to a harmonious face (macroesthetics) and a human being with high self esteem (hyper-esthetics).” Occlusion is no longer the sole focus of orthodontics, and that the “attainment of perfect occlusal results does not ensure stability” [19]. Many know that the “ideal posterior occlusion concepts as a general orthodontic treatment goal should be reconsidered” [20]. Patients can tell their type of incisor occlusion, but it does not correlate with molar occlusion. Posterior occlusion is difficult to maintain, and even mandibular incisor relapse has been termed “inevitable” [21]. Any tooth movement when done past the stage of growth and alveolar arch adaptation is more likely to relapse [15], especially expansion of the intercanine width [22].

Fortunately anterior teeth that have been moved can be splinted. Expecting the majority of the adult population to reliably wear removable retainers permanently (as textbooks say) is unrealistic. For any significant anterior tooth movement, upper or lower, I strongly suggest a bonded splint. Anterior fixed retention prevents the “inevitable” incisor rotations while still allowing posterior settling [23]. Once teeth are straight patients focus on other dental imperfections, so identifying aesthetic restorative and periodontal treatments should be part of the plan.

Conclusion

The patient should understand the full scope of the problem and treatment plan at the initial consult to avoid disappointment by undergoing orthodontics alone. Few orthodontic practitioners address comprehensive dental esthetics because of the different skill sets involved. Ultimately we seek to deliver straight, white teeth, with symmetry, proportion, lip support, minimal gingival display, attractive facial embrasures, and a durable result, in an efficient treatment time, that the patient is happy with years later. It is thrilling to hear a patient say it was the best thing they ever did for themselves.

A brilliant smile is a puzzle integrating various small parts. Cosmetic dentistry is long past focusing only on whitening (although some endodontically treated dark incisor roots can still be hard to opaque from light refraction coronally). Putting the pieces together for a spectacular lasting result is within our grasp for the majority of cases, thanks to the evolution of materials, techniques, experience, and creative thinking.

See references here.

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Wearing Braces Back to School

Wearing Braces Back to School

It’s that time of year again when students of all ages are going back to school. Children start a new grade and adults may be beginning a new career path. In either situation, the first day of school can be nerve-wracking. This feeling can intensify if you recently were told you needed braces. But don’t let that stop you from enjoying your first day back to school! Dr. Georgaklis offers many alternative options to help you feel more confident. And he has even revolutionized the practice with his Rapid Braces method — most patients can be treated in just six months.

Here are two options for hiding those braces from your new friends at school:

Clear Braces:

The most cost effective way of hiding your braces is with clear braces. Dr. Georgaklis recommends clear braces to many patients because they are cost effective and provide great results in a short period of time. Some patients would rather consider clear retainers like Invisalign, but these don’t use the same force as real braces do. They sit over your teeth, instead of attached to them, which makes them less effective and require more treatment time.

 

Lingual Braces:

Lingual braces, otherwise known as “invisible braces,” are braces attached to the inside of your tooth (tongue side) — hidden from view! This option is popular amongst adults who want straight teeth but don’t want to deal with braces. Once un place, these braces work just like regular ones. These are a better option than Invisalign because Dr. G will have full control over teeth movement and maintenance. Plus, they don’t need to be replaces like the retainers for Invisalign do.

Dr. G works with every patient on a personal basis. He will meet with you for an initial consultation to hear your concerns, talk about budget and other options. Whether you’re going back to school, starting a new job or just afraid to have braces, Dr. G will make sure you feel confident in his hands! Contact us today to get started on your new smile!

 

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