Straight Teeth in Six Months
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All Posts in Category: Adult Braces

How Can Cosmetic Orthodontics Improve My Smile?

Improve Smile with Cosmetic Orthodontics

Getting braces at an older age has become popular than ever, thanks to the advances in cosmetic orthodontics technology. New methods of straightening teeth have been developed that allow for braces to stay hidden and quicker treatment times. Because of this, more and more adults in the Boston area are starting to take advantage of cosmetic orthodontic treatment. Rapid Braces is on the cutting-edge of new treatment methods and one of the best places in Boston to get straight teeth fast.

Cosmetic orthodontic treatment at Rapid Braces can help you get a beautiful smile fast with our 6 month braces treatment. 6 Month Braces are a great way to get a beautiful smile before a big event or if you feel like you missed out on orthodontic treatment when you were younger. Here are a few ways how Boston Cosmetic Orthodontics can improve your smile in 6 months or less.

#1 Get a beautiful smile

Having straight teeth is great no matter how old you are. A beautiful smile will feel good to show off and make it easier to avoid common health issues associated with crowded teeth. Straight teeth will help you feel more comfortable in multiple different ways.

#2 Keep your mouth clean

Properly aligned teeth are much easier to keep clean than crooked teeth. Irregular spacing and position can create spaces in your mouth for plaque and other bacteria to collect that could lead to a bigger problem down the road.

#3 Improve your Self-Esteem

When your smile looks good, you will feel good. A beautiful smile is important for one’s confidence. Aligned teeth can create a great smile that can help you feel comfortable in almost any situation. You will feel more excited and confident going to events with crowds, reunions, parties, and interacting with others.

All these factors can help you improve your smile and are the biggest reasons adult braces are becoming more popular every year. Rapid Braces offers a number of different options so you can find the best choice for you. Lingual braces are one of the most popular choices for new patients because they are placed behind your teeth so you can easily keep your braces hidden. Clear braces are another option that can be kept hidden because they use clear retainers and brackets. Schedule a consultation with Rapid Braces to learn more about the different 6 Month Braces options we offer that could be right for you.

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Are Invisible Braces Right For Me?

Braces are a necessary part of growing up for many people. Visits to the Boston orthodontist were needed to get straight teeth and the patient got a beautiful smile after the braces were taken off. Unfortunately, not everyone is able to get braces when they are younger for a variety of reasons and then feel stuck with teeth that aren’t aligned as well as they could be. Adults are often hesitant to get braces because of the obvious impact on their appearance and put off getting cosmetic orthodontic treatment completely. Today, however, there are a number of different Boston Adult Braces options offered at Rapid Braces that can give you a beautiful smile in 6 months or less.

boston invisible bracesFor many people, the number one concern about getting Adult Braces is how they will affect their appearance. The experts at Rapid Braces understand how wearing braces can make anyone feel socially awkward and have options to help you keep your braces as hidden as possible. Invisible braces are put on the lingual side (behind the teeth) of your mouth so they can’t easily be seen. Once you’re wearing them, invisible braces work the same way that traditional braces do to straighten your teeth but the fact that they’ll be doing their work behind your teeth means that you’ll be the only one who knows you’re wearing braces.

Boston Invisible Braces are a good option for a wide range of patients. They can be custom made to fit your mouth and fix a variety of alignment/spacing issues. Our Invisible Braces option is also popular because you can get straight teeth fast with Rapid Braces 6 Month Braces treatment. The quick 6 month treatment is perfect for adults who don’t have much time for appointments or want an awesome look for a big event coming up. Over 90% of cases treated by Dr. Georgaklis at Rapid Braces have been completed in 6 months or less.

Schedule a consultation at Rapid Braces today to find out more about how we can help you get a beautiful smile with Boston Invisible Braces. We can get a good look at how your teeth are aligned and make recommendations for best adult braces options. Once you decide on a treatment option we’ll schedule the first appointment to get started with adult braces. We strive to make appointments as convenient as possible, it is important that you don’t miss any scheduled appointments if you would like to finish treatment as quickly as possible. Please contact us if you have any questions about Boston 6 Month Braces.

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Six Month Smile

The Best and Worst Foods For Your Teeth

So you just got your new Rapid Braces and you’re now ready to enjoy your six-month smile! Did you know that there are some great foods for your teeth along with some pretty bad ones? Here is a list of the best and words foods that you can eat with your new Six Month Smile!

Cheese – We all know how much everyone loves cheese, but now it comes with added benefits! It’s great for your teeth! Cheese is high in calcium which protects your bones, and your new smile will thank you for eating extra cheese. Cheese also raises the PH balance in your mouth which sounds a little odd but studies have shown that it reduces your risk of tooth decay significantly – so eat up!

Greens – As with most healthy food list greens usually find their way on there somehow. Not only are greens great for your overall health but they’re fantastic for your smile! They are high in calcium, folic acid and vitamin B which is the perfect combination of a strong and glowing six-month smile!

Yogurt – The cousin of cheese, yogurt is extremely high in protein and calcium which is essential for a healthy and glowing smile. Yogurt is actually very high in bacteria but it’s healthy bacteria! Called probiotics the healthy bacteria destroys the bad bacteria and helps protect against gum disease and tooth decay.

Ice – A lot of us are guilty of chewing on ice, but this is one of the worst things that you can do and your new six-month smile will not thank you for it. Chewing on hard objects such as ice can make it very easy for dental injury and the need for emergency room visits.

Citrus – We all love citrus as it’s full of Vitamin C and the sourness of citrus is enjoyed on many different foods and in drinks but too much citrus can be a really bad thing for your new six-month smile. The acidity in the citrus can actually wear away at your enamel and leave you with very sensitive teeth. So eat and drink your citrus in moderation!

Alcohol – Alcohol should always be used responsibly and in moderation but did you know that it can actually be very harmful to your smile? Drinking too much alcohol causes dehydration which leads to dry mouth which leads to a very unpleasant time for your smile! Being dehydrated and adding dry mouth on top of it can have very harmful effects on your smile such as gum disease, tooth decay, oral infections and potentially mouth cancer if the alcohol is drank excessively.

Taking care of your new six-month smile is easy if you eat healthily and eat bad things in moderation. Your smile will last you a lifetime if you put in the proper care and have regular dental check-ups with Rapid Braces! Remember to eat healthily and be aware of what you’re putting inside of your body!

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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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Choosing the Right Type of Braces

6 Month Braces Options

Getting braces as an adult is becoming more and more common as people come to realize that your teeth never stop adjusting. It is becoming more and more common for adults to get braces as they realize it’s never too late to get a beautiful smile. There is no shame in having to get braces to get your teeth straightened. In fact, 20% of orthodontic patients are over 18 years old.  If you would like to detract from showing your braces, there are multiple solutions that we can help you resolve this problem.

Options For Straighter Teeth

The braces in the orthodontic industry today have been developed to be more comfortable and less obtrusive than those of the past. The evolution of braces has created many more options for you to chose your preference on how to adjust your smile. Invisalign is a popular option for adults. Invisalign is an invisible set of braces that are not noticeable as long as good oral hygiene is maintained. Invisalign is easily removable as it made from SmartTrack material that predicts controlled tooth movements and adapts accordingly. Lingual braces are another alternative to traditional metal braces. Lingual braces are braces that are on the tongue side of your mouth, and invisible from the outside. These are more costly because of the specialized tools required to attach and adjust the braces on your teeth. If you want quicker results and a less expensive option, then clear braces are the way to go. Clear braces use more force than an Invisalign retainer, are tough to notice, and the highly recommended option of Dr. Georgaklis.

How To Schedule An Appointment

Dr. Georgaklis can set up an appointment with you, once you contact him on our contact page. A date will be set for you to visit our Brookline office for an initial consultation. Once we are able to see how your teeth are aligned we can recommend treatment options and you can choose the best adult braces treatment for you. Our 6 Month Braces can give you a great smile in a short amount of time, as Dr. Georgaklis completes 90% of cases in as little as six months. Dr. Georgaklis’ attention to detail and extended personalized service to each individual patient are other reasons patients love 6 Month Braces treatment.

Never Too Old For Braces

Many people feel they’ve missed their chance to get braces after their teenage years, but this is a common misconception of the truth. The social stigma of braces is that only children and teens can have them. The facts are that more adults need braces than children as our teeth are always adjusting and have no age limitations on treatment. The main issue with adult braces is the “embarrassment” of people knowing you have them. Here at Rabid Braces, we get the job done quickly for you so that your worries don’t last long. We understand our customer’s concerns which is why we implement our multiple strategies to hide braces from covering your smile. We want every last one of our patients to smile confidently, and worry-free after an appointment with us.

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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.

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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Six-Month Adult Aesthetic Orthodontic Treatment

Six-Month Adult Aesthetic Orthodontic Treatment

Straight teeth in just six months.

Posted on Glidewell Laboratories.

While cosmetic dentistry has commanded more attention with recent breakthroughs — such as all-ceramic crowns, veneers, composite materials and intraoral cameras — the demand for adult cosmetic orthodontic treatment has also increased. It has been estimated that in 1970, only 5 percent of adults aged 18 or older sought consultations for comprehensive orthodontic treatment.1 In 1990, four times that number sought consultations for orthodontics.

Currently, adults present with chief complaints about the crowding of their teeth more frequently than anything else.2 Many adult patients want to straighten their teeth, but they are unwilling to wear braces for two or more years. Patients presenting with a physiologic occlusion and a desire for aesthetic improvement can benefit from orthodontic correction that requires only a short treatment time of six months or less. Adults who have their teeth straightened experience a better body self-image and higher self-esteem.3,4 The general public is focused on a noncrowded, aesthetic tooth arrangement more so than orthodontists, who are also concerned with occlusal and skeletal relations.5 A short, six-month treatment can very well enhance periodontal and occlusal aspects of the patient’s dentition. Treatment, therefore, serves as an adjunct to final periodontic and restorative treatment, even though the main focus remains cosmetic.

Simultaneously treatment planning the orthodontics with the cosmetics, crown & bridge, and periodontics in the same office facilitates a well-orchestrated cosmetic result, which can be more difficult to achieve through cross communicating between specialists. In this context, limited cosmetic orthodontic treatment is best done on patients who otherwise may not opt for comprehensive orthodontic treatment.

Method

The first aspect of case selection involves a discussion of the patient’s chief complaint. Patients are given a list of orthodontic and cosmetic problems, and asked to indicate their objective(s) for seeking treatment. In almost 90 percent of adult cases, relieving anterior crowding is the primary concern. This figure is based on 20 to 25 new orthodontic consults per month for six months in my general practice.

When the patient is committed to treatment, a database of information should be obtained: panoramic and full-mouth radiographs, intraoral and extraoral photographs, and models. A problem list is then reviewed with the patient, followed by a comprehensive treatment plan. The orthodontic aspect should be cosmetically oriented, specifically excluding skeletal problems. Because the profile and posterior occlusion are not to be changed significantly, a lateral cephalometric X-ray is not necessary.6

The treatment sequence includes the following:

  • Data collection and records;
  • Prophylaxis, fluoride application, oral hygiene instruction, and endodontic and periodontic disease resolution;
  • Extraction of third molars and a lower incisor when necessary (other teeth may rarely need to be extracted);
  • Cosmetic orthodontics; and
  • Bleaching, crowns and cosmetic bonding when indicated

If the patient prefers not to wear Hawley retainers, teeth can be retained by splinting once settling has occurred.

The Case for Enamel Reproximation

Because the postextraction health of the temporomandibular joint has been questioned, bicuspid extraction is now done with less frequency than in the past. It provides a result that is not always aesthetic or stable, has been slowly decreasing in popularity (almost 8 percent between 1988 and 1993), and remains controversial, varying widely among practitioners.7-10 Almost one and a half years is required to close the extraction spaces, and nonextraction patients have fuller lip support following treatment.11 Expansion is also a questionable method of treatment because long-term stability is doubtful.12

However, enamel reproximation allows for minimal localized tooth movements, fewer extractions, maintenance of lip support and shorter treatment time. Begg theorized that crowding of most dentitions is actually the result of decreased proximal wear, which our evolutionary predecessors once experienced.13 Therefore, enamel reproximation would seem to be the most natural available remedy for relieving crowding.

Enamel reproximation (air-rotor stripping) can be done for up to a 10 mm arch-length discrepancy. Sheridan recommends limiting reproximation to 1 mm per contact or 0.5 mm per proximal surface.14,15 Frequently, more than this can be done without noticeable change in tooth morphology or sensitivity because it’s done throughout six months in conjunction with fluoride treatments. It has also been theorized that the resultant flat interproximal contacts may actually increase post-treatment stability.16 Anterior lower arch crowding greater than 4 mm should be treated with the extraction of a lower incisor, followed by reproximation to minimize the black triangular space at the gumline. In most cases, a space determination is performed by resetting the teeth on the models with wax to measure the space required. This also allows a preview of the aesthetic result for both patient and doctor.

Appliances

Brackets should be bonded to the first molars using a straight-wire technique and NiTi wires. Posterior brackets with a larger (0.022) bracket slot placed in an ideal, aligned position minimize posterior occlusal changes. Successive reproximation using double-sided fine diamond discs (Brasseler) is followed by the use of fluted carbide burs for finishing and rounding enamel edges. Interproximal over-reduction can rarely cause transient tooth sensitivity.

All teeth should be gradually aligned with local reproximation, progressively heavier wires and chain elastics. The principal tooth movements include rotations, tipping and vertical movements as opposed to translation and root torquing. By minimizing root movement and bone remodeling, treatment time is decreased. Profile change, relapse and root blunting are also minimized, which is significant because root blunting can occur when moving roots greater distances throughout a longer period.

Retainer wear is recommended for six months (full time), six months (at night) and three nights per week until stability is achieved. Post-treatment fiberotomies should be performed for all rotations. Following two months of retainer wear to allow for occlusal settling, cosmetic alterations may be performed, such as cosmetic bonding, bleaching, all-ceramic crowns, enamelplasty and gingivectomies. Teeth deficient in a mesial-distal dimension (peg laterals, enamel erosions or broken teeth) should be built up before treatment to allow for proper final tooth positioning.

Case I

The patient presented with typical Class I crowding with aesthetics as the chief complaint. Rather than expand the arches into an unstable position prone to relapse in the adult patient, or reproximate lower incisors so much that they impinge on the gingival embrasures, it was decided to remove a lower incisor. The uppers were reproximated using a Brassler diamond disc and edges recontoured. The treatment was seven months and the patient was splinted afterward. Some molar supra-eruption occurred because of an anterior composite bite plane that relieved the deep bite and decreased the likelihood of further attrition in the anteriors.

Case 1 - overcrowding teeth

Results after 7 months of treatment

Case II

The patient was referred by a local dentist who had done simple orthodontics, but who was not willing to treat occlusal problems. The patient had crowding with a bilateral crossbite that was causing both anterior and posterior attrition at a young age, requiring orthodontics.

The crossbite was corrected through the use of cross-arch elastics from the lingual of the upper molars and bicuspids to the buccal of the lowers. Enamel reproximation made space to treat the anterior crowding. Upper and lower bonded Ribbond splints served to reinforce the bonded incisal areas caused by attrition. It also provided resistance to fracture, as the splints produce a greater bonded surface area and composite thickness. An upper posterior Hawley retainer prevented relapse of the posterior crossbite.

Case 2 - Patient with crowding and a bilateral crossbite.

Case 2 - The crossbite was corrected through the use of cross-arch elastics.

Case III

This patient presented with the chief complaint of a large diastema. She had advice from numerous orthodontists who expressed different opinions regarding how to correct this (because of her deep bite and lack of lower spacing), as well as reservations regarding the possibility of successful retention. At our consultation, it was explained to the patient that our plan would include:

  • Upper and lower anterior retraction and possibly lower enamel reproximation because of extra space on the uppers;
  • A fixed composite bite plane on #8 and #9 lingual to relieve the deep bite by causing posterior supra-eruption;
  • Possibly redistributing excess space to the distal of the upper canines to limit the retraction required; and
  • An upper splint, which would be required. Removable retention is unacceptable in these cases. Therefore slight overjet in the final result is planned to make space for the splint.

Case 3 - Patient with large diastema.

Case 3 - Patient after five and a half months of treatment.

Per usual protocol, a prophy, bitewings, panoramic X-rays and restorative work were completed first. The patient’s treatment lasted five and a half months, with splinting and bleaching occurring on the final visit. At recall, the patient’s Ribbond splints were intact as she was not a bruxer. It is unlikely that this case would have succeeded without fixed retention.

It has been estimated that in 1970, only 5 percent of adults aged 18 or older sought consultations for comprehensive orthodontic treatment. In 1990, four times that number sought consultations for orthodontics.

Conclusion

Six-month adult cosmetic orthodontic treatment has a 60 percent acceptance rate among new patient consults in my practice, and post-treatment satisfaction is high. Many adults who undergo treatment have previously declined comprehensive treatment in other offices. Enamel reproximation, extraction of a lower incisor for space and limited occlusal change are among the modalities making this treatment unique and well accepted by patients. Offering clear or lingual appliances increases the patient’s cosmetic options. Treatment planning the orthodontic and restorative phases together facilitates patient understanding and communication, and delivers an outstanding cosmetic service. Patients with TMD, skeletal chief complaints, severe over/underjet, occlusal problems or very deviated midlines may opt for comprehensive treatment by an orthodontist. However, for the majority of adult patients with simply unaesthetic, crowded, spaced, functionally efficient and non-TMD dentitions, dentists should focus on the aesthetic chief complaint by performing conservative attenuated treatment in the general practice.

References

  1. Gottlieb EL. 1990 JCO study of orthodontic diagnosis and treatment procedures: results and trends. J Clin Orthod. 1991;24:145-56.
  2. Nattrass C, Sandy JR. Adult orthodontics—a review. Br J Orthod. 1995 Nov;22(4):331-7.
  3. Varela M, García-Camba JE. Impact of orthodontics on the psychologic profile of adult patients: a prospective study. Am J Orthod Denofacial Orthop. 1995 Aug;108(2):142-8.
  4. Lew KK. Attitudes and perceptions of adults towards orthodontic treatment in an Asian community. Community Dent Oral Epidemiol. 1993 Feb;21(1):31-5.
  5. Cochrane SM, Cunningham SJ, Hunt NP. Perceptions of facial appearance by orthodontists and the general public. J Clin Orthod. 1997 Mar;31(3):164-8.
  6. Proffit WR. Contemporary orthodontics. 2nd ed. St Louis: Mosby; 1993. p. 155.
  7. Little RM, Riedel RA, Engst ED. Serial extraction of first premolars—postretention evaluation of stability and relapse. Angle Orthod. 1990 Winter;60(4):255-62.
  8. McReynolds DC, Little RM. Mandibular second premolar extraction—postretention evaluation of stability and relapse. Angle Orthod. 1991 Summer;61(2):133-44.
  9. Weintraub JA, Vig PS, Brown C, Kowalski CJ. The prevalence of orthodontic extractions. Am J Orthod Dentofacial Orthop. 1989 Dec;96(6):462-6.
  10. O’Connor BM. Contemporary trends in orthodontic practice: a national survey. Am J Orthod Dentofacial Orthop. 1993 Feb;103(2):163-70.
  11. Paquette DE, Beattie JR, Johnston LE Jr. A long-term comparison of nonextraction and premolar extraction edgewise therapy in “borderline” Class II patients. Am J Orthod Dentofacial Orthop. 1992 Jul;102(1):1-14.
  12. Glenn G, Sinclair PM, Alexander RG. Nonextraction orthodontic therapy: posttreatment dental and skeletal stability. Am J Orthod Dentofacial Orthop. 1987 Oct;92(4):321-8.
  13. Begg PR. Stone Age man’s dentition. Am J Orthod. 1954;40:298-312.
  14. Sheridan JJ, Ledoux PM. Air-rotor stripping and proximal sealants. An SEM evaluation. J Clin Orthod. 1989 Dec;23(12):790-4.
  15. Sheridan JJ. The physiologic rationale for air-rotor stripping. J Clin Orthod. 1997;31:609-12.
  16. Peck H, Peck S. An index for assessing tooth shape deviations as applied to the mandibular incisors. Am J Orthod. 1972 Apr;61(4):384-401.
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Alternative Orthodontic Treatment for Adult Crossbites and Overbites

Alternative Orthodontic Treatment for Adult Crossbites and Overbites

Contact Rapid Braces

Orthodontic treatment for deep bite cases in adults has traditionally involved either a removable anterior bite plane to supraerupt posterior teeth, or active intrusion of anterior teeth using reverse curve archwires. Headgear and the Nance appliance are also used, but are more appropriate for growing patients. Resolving deep bites may become a necessity in order to bracket lower anterior teeth. As many patients with deep bites exhibit decreased vertical dimension caused by insufficient eruption of posterior teeth appropriate treatment allows their supra-eruption to a normal vertical dimension.  Although bite plane therapy causes some intrusion of anterior teeth, the greater part of deep bite correction results from posterior extrusion and occurs within 6 months, effectively. Increasing vertical dimension has been accomplished to restore lost ver­tical dimension due to enamel ero­sion, and in certain cases it may aid in temporomandibular disorder treat­ment. Removable anterior bite planes can accomplish this, but require con­tinuous patient compliance and are difficult to use while eating, a time when posterior re-intrusion may occur.

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Anterior Retention With a Reinforced Composite Resin Splint After Cosmetic Orthodontic Treatment

Anterior Retention With a Reinforced Composite Resin Splint After Cosmetic Orthodontic Treatment

Originally posted on Dentistry Today.

It has become increasingly clear that making space in the crowded adult dentition by orthodontic expansion of the dental arch is prone to relapse.1,2 Moreover, the intercanine distance has actually been shown to decrease as early as mid-adulthood.1,3 Even cases treated to stability during late adolescence are prone to “late incisor crowding” by 34 years of age,4and the presence of third molars does not significantly contribute to this.5 Even though other skeletal factors and even facial bone dimensions may not significantly decrease until a later age, the influence of naturally decreasing intercanine distance on anterior dental aesthetics has been grossly underestimated. This basic misunderstanding of the early maturation of adult jaw dimensions has enormous repercussions for orthodontic treatment philosophy, as well as implications for the necessity of long-term retention.

Therefore, in cases where one must choose between slight contraction of the intercanine dimension through lower incisor extraction or expansion, the former may prove more stable. Anticipating “intercanine shrinkage” may help prevent future crowding years later when the doctor and patient have presumed stability, and retention has been discontinued. A cosmetic splint anchoring each anterior tooth individually serves to prevent this common and unaesthetic phenomenon of anterior orthodontic relapse.

Traditionally, orthodontists in the 1950s used a prefabricated metal bar fixed to only the canines for lower retention, with the rationale being the effects of arch expansion would be maintained until it was removed. Any incisor relapse would be inconsequential because it would just be an “aesthetic” consideration (Figure 1). Now that dentistry has accepted that the major reason adult patients seek treatment is aesthetics, we can properly address this essential aspect of retention. Some began affixing a customized bar with incisor pads or braided wire bonded to each incisor,6,7 which represented an improvement but still required placing metal in an aesthetic area. It was rationalized that the elastic property of a thin wire allowed physiologic mobility helpful in the periodontic patient.7 This is to be differentiated from the orthodontic patient with healthy periodontium, where the aim is to provide a window for bone and PDL fibers to reorganize with rigid reinforcement.

Also presented for periodontal patients have been reinforced composite splints using TMS pins8 and bondable reinforcement ribbon.9 With the boom in cosmetic dentistry and cosmetic orthodontics, the ribbon is proving useful for the stabilization of adult patients. Unlike the lingual bar this splint can be later removed incrementally as the patient desires.10 As 50% of relapse has been shown to occur in the first 2 years after orthodontic treatment,11 the splint should remain intact for longer than 2 years.

The main purpose of the splint is rigid fixation of the teeth. This immobilization, however, also accelerates the growth of supporting tissues, as the alveolus and PDL fibers can reorganize around the teeth in their new positions without interference from tooth mobility inherent in orthodontic treatment. In addition, this technique enables cosmetic augmentation of the final orthodontic result, as black triangular spaces, incisal discrepancies, or the lengthening of teeth can be achieved with more strength than free-standing incisal composites, which lack the thickness or support of a reinforcement material on the lingual aspect (Figures 2 and 3). Except for those few cases where the patient has a perfect orthodontic result and well-proportioned white teeth without any incisal defects, anterior bonding attached to and reinforced by the splint can greatly enhance the final aesthetic result.

If a maxillary splint is planned and the patient presents with overjet, the overjet should be preserved to allow space for the maxillary splint (Figure 4). This is in contrast to traditional orthodontic philosophy of complete elimination of overjet, even if the overjet represents the natural skeletal position. Skeletal changes cannot be permanently retained without surgery. Adult overjet, such as in a class 2, division 2 case (Figure 5), will be more stable if the overjet is maintained.

Figure 1. Lingual metal bar fixed only to the canines allows incisor relapse, which is not acceptable in cosmetic orthodontic patients. Figure 2. Class 2, division 2 before incisors are tipped forward giving overjet. Note attrition from deep bite on palatally tipped incisors.
Figure 3. After a 6-month treatment time with lingual braces, patient is splinted. Irregular incisors may be lengthened with more durability than with incisal composites not supported by a splint. Figure 4. Slight overjet in final result helps allow the necessary thickness for a durable maxillary splint.
Figure 5. Once completed, an adult class 2, division 2 case will result in overjet without surgery. Figure 6. Etching can include incisals should there be discrepancies that need correction.
Figure 7. Initial layer of composite should be a strong material and kept away from papillae. Figure 8. Splint-It! reinforcement material is placed into composite and cured.
Figure 9. Placement of addtional composite to cover reinforcement fibers. Figure 10. Occlusion is checked before final recontouring and polish.

SPLINTING STEPS

Step one. Complete enamel etching with recontouring on buccal and incisal for aesthetics, and on lingual if necessary to allow splint thickness with occlusion (Figure 6).

Step two. Bonding layer with composite is kept away from gingiva (Figure 7).

Step three. Two strips of Splint It! (Jereric/Pentron) or Ribbond (Ribbond Inc) reinforcement material are pressed into composite. Excess material is placed over reinforcement and cured (Figure 8).

Step four. Addition of final layer of composite (Figure 9).

Step five. Occlusion is checked preceeding recontouring embrasures with a Brasseler No. 8392-31 016F interproximal diamond and polishing bur (Figure 10).

SUMMARY

Even in the most stable types of orthodontic treatment, any relapse at all may be unacceptable cosmetically. Through the placement of a reinforced composite splint, the teeth can be held in position and more significantly recontoured, thus augmenting the final result. Subsquent splint removal can be done incrementally 3 to 5 years after placement as the patient desires.

Author’s Note: I was saddened to hear of the passing of Dr. John Witzig on December 3, 2001. Dr. Witzig was a true innovator who was not afraid to fight the tide of consensus in orthodontics. He brought many  people together in the field (I met my wife at his course). We all owe him a debt of gratitude, and he will be greatly missed. Thank you, John.


References

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