Straight Teeth in Six Months
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All Posts in Category: Boston 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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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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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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Occlusal Change Through Orthodontics in TMD Patients

Occlusal Change Through Orthodontics in TMD Patients

Originally posted on Dentistry Today.

Although some claim that occlusion has little effect on a healthy TMJ and is not generally a causal factor in TMD,1,2 many have made emphatic claims to the contrary.3 Many orthodontic practices are positioned in the marketplace as providing proven treatment for TMD, yet some patients seem to experience TMD as a consequence of orthodontic treatment.
While existing literature reports that orthodontics can both helpand worsen TMD, this paper describes 2 cases where TMD relief was successfully achieved through orthodontic therapy. More specifically, these cases lend credence to the theory that increasing the vertical dimension5 and removing retrusive forces on the mandible may help recapture the disc that can be displaced by over-closure of the mandible.

CASE 1

Figure 1. Photos of patient when she presented for fixed orthodontic treatment. She had been wearing a removable splint and was asymptomatic but splint dependent.

Case 1 describes treatment that utilized a hard acrylic, flat-planed splint to alleviate TMD symptoms of pain, popping, and clicking by advancing the mandible and increasing vertical dimension. The patient was “splint dependent” but symptom-free at the stage she was transferred for orthodontic treatment (Figure 1). The pain returned whenever she was not wearing her splint for consecutive days because she returned to an “over-closed” position. Once orthodontic treatment commenced, the splint was reduced incrementally, allowing teeth to supra-erupt. This was done sequentially until the natural occlusion mimicked the patientís occlusion with the splint. It was reduced from the posterior forward, allowing the second molars to supra-erupt in a controlled fashion. It was also sequentially reduced in thickness. Mobility from the orthodontics facilitated this occlusal setting. Three distinct aspects of the patientís occlusion were changed, which helped provide TMD relief:

(1) The maxillary incisors were flared labially with treatment. Lingually inclined  lower incisors translate occlusal force into a retrusive direction as the patient closes, especially during protrusion. This was eliminated as labially inclined upper and lower incisors deliver chewing force in a more vertical direction into the alveolar bone, decreasing the tendency of the mandible to be pushed backward and minimizing disc trauma.

(2) Similarly, the incisors had greater vertical overlap initially. This compounded the problem caused by the retroclined position, as the entire facial surface of the lower incisors was acting as a receiving surface for ìpoundingî by the maxillary incisors. The posterior dentition better tolerates this vertical chewing force.

Figure 2. Cross-arch vertical elastics used to bring posterior extrusion without tipping. The splint was reduced incrementally.

(3) The molar extrusion and improved interdigitation, in conjunction with occlusal adjustment, provided a more stable posterior occlusion. This offers better protection against retrusive slides in centric and during mastication, which can further exacerbate TMD. Molar extrusion achieved using cross-arch elastics (Figure 2) from the buccal of the upper teeth to the lingual of the lowers as well as lingual of the upper teeth to the buccal of the lowers served to extrude the posteriors with greater control and no buccal-lingual tipping.

Figure 3. Occlusion after removal of braces.

Although the causal factors of TMD are often a mystery, this case demonstrates that eliminating obvious and severe occlusal abnormalities through splint therapy and gradually through or-thodontics may provide TMD relief and minimize occlusal wear as the traumatic occlusion is eliminated (Figure 3). Two years after treatment, the patient was orthodontically stable and symptom-free.

CASE 2

Figure 4. Patient’s occlusion before treatment. Figure 5. Progress at 5 months.
Figure 6. “After” photo with upper and lower teeth splinted and incisals restored. Figure 7. Eleven-month recall.

The second case shows a patient who had bilateral TMJ clicking and tinnitus. He had second molar occlusion only, a constricted maxillary arch, occlusal trauma, and wear (Figure 4).
The patient wore posterior cross-arch elastics from the lingual of the maxillary posteriors to the buccal of the mandibular posteriors to achieve proper intercuspation and bilateral, evenly distributed tooth contacts, as a posterior cross-bite has been associated with TMD.6 The upper posteriors were stabilized with a Hawley retainer. The upper and lower anteriors were stabilized with lingual Ribbond splints (Ribbond) canine to canine.
This effectively stabilized rotated teeth (in conjunction with a fiberotomy) and provided proper resistance form to the restored incisal composites, necessary because of the previous occlusal trauma (Figures 5 and 6). The incisal edges became much more durable once connected to the splint because of increased thickness. The TMJ, occlusion, and restored incisal surfaces were all stable at recall (Figure 7).

CONCLUSION

While TMD is often a mystery and is even seen in many normal occlusions, frequently other factors7 exist, such as a history of trauma, bruxism, or degenerative joint disease of a systemic nature. However, these 2 cases show at least one obvious and proximate cause for their TMD, which is an unstable occlusion.
Acute inflammation can be mitigated through ice, NSAIDS, and splint therapy until subsequent inevitable exacerbations occur. Definitive treatment through permanent occlusal change sometimes is the only hope for these patients, and is still not a panacea if disc damage has occurred or if occlusal abnormalities are not corrected.
While all aspects of orthodontic TMD treatment have not been substantiated in the literature, providing the patient with a stable, evenly distributed occlusion with correct buccal-lingual molar and nonretrusive incisor relationship, as well as providing an increased vertical dimension, may be a good place to focus in treating this elusive problem.

References

  1. Gesch D, Bernhardt O, Kirbschus A. Association of malocclusion and functional occlusion with temporomandibular disorders (TMD) in adults: a systematic review of population-based studies. Quintessence Int. 2004;35:211-221.
  2. Gesch D, Bernhardt O, Mack F, et al. Association of malocclusion and functional occlusion with subjective symptoms of TMD in adults: results of the Study of Health in Pomerania (SHIP). Angle Orthod. 2005;75:183-190.
  3. Reinhardt R, Tremel T, Wehrbein H, et al. The unilateral chewing phenomenon, occlusion, and TMD. Cranio. 2006;24:166-170.
  4. Henrikson T, Nilner M, Kurol J. Signs of temporomandibular disorders in girls receiving orthodontic treatment. A prospective and longitudinal comparison with untreated Class II malocclusions and normal occlusion subjects. Eur J Orthod. 2000;22:271-281.
  5. Hisano M, Ohtsubo K, Chung CJ, et al. Vertical control by combining a monoblock appliance in adult class III overclosure treatment. Angle Orthod. 2006;76:226-235.
  6. Thilander B, Rubio G, Pena L, et al. Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development. Angle Orthod. 2002;72:146-154.
  7. Clark GT. Etiologic theory and the prevention of temporomandibular disorders. Adv Dent Res. 1991;5:60-66.
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A Six-Month Orthodontic Solution to Space Closure and Bite Collapse

A Six-Month Orthodontic Solution to Space Closure and Bite Collapse

Originally posted on Dentistry Today.

For patients who exhibit missing posterior teeth, bruxism, and a concomitant loss of vertical dimension often commonly occurring with anterior flaring and spacing1 (Figures 1 to 3); mainstream treatment consists of 1.5 to 2 years of orthodontic treatment to retract the anteriors and re-establish the collapsed vertical dimension. This is usually followed by removable retainer wear. It is important to restore the missing posterior support,2 and the patient should be given implants or bridges afterward.

CASE REPORT

Figures 1 and 2. Note palatal occlusion.
Figure 3. Note attrition.
Figures 4 and 5. Composite bite plane on teeth Nos. 6, 8, 9, and 11 intruded the anteriors and allowed passive eruption of posteriors.
Figure 6. After bridge cementation. Additional whitening procedures were recommended.

A patient who came to our general practice was given this treatment plan by 2 previous dentists with specialists in their offices. Eager to seek other alternatives, she presented for attenuated orthodontic and restorative treatment.
Treatment consisted of short-term, 6-month, fixed-orthodontic treatment by retracting the incisors to their original position before they migrated forward. The collapsed vertical dimension was increased through use of an anterior fixed composite bite plane. This is a flat-planed composite bite plane bonded to the lingual of the upper central incisors3 (Figures 4 to 6), prohibiting full closure. Through lack of posterior occlusion, within 3 to 4 months the posterior teeth exhibited significant passive supra-eruption, even without posterior vertical elastic wear (which may be used as an option to accelerate the process). At the same time, the incisor region is intruded through chewing. This occurs throughout the entire anterior region, as the teeth are essentially “splinted” through the orthodontic wire. In this way, even teeth without the composite bite plane are intruded. The ratio of posterior extrusion to anterior intrusion has been shown to be approximately 60:40.4

DISCUSSION

Figure 7a and 7b. Before and After.

Secure retention is an essential aspect of this case. Removable retainers are inadequate, as even slight space relapse will be cosmetically obvious; this is likely in an adult patient with fully formed dental arches and some bone loss.5,6 In addition, our practice occupies a niche in treating adults through short-term cosmetic orthodontics,7 and this demographic desires retention that is aesthetic. Furthermore, treatment is orthodontic in these cases and not orthopedic, so the results are less stable, thus requiring fixed retention. A lingual composite splint (Ribbond [ribbond.com]), where composite covers most of the tooth’s lingual aspect and can overlap onto the buccal aspect, is preferred. This can serve to augment small teeth, change shape and width by enhancing line angles, fill chips, and restore surfaces with attrition.8
In conjunction with the orthodontic space closure, posterior support must be provided, as the splint will fracture without posterior protection and incisor flaring will return.9 The increased vertical dimension would also be lost, since the posteriors would intrude. If implants are part of this plan, they should be placed before or during orthodontic treatment, not after. This case utilized 3 fixed bridges, helping to correct some mesial drift which may be caused by transseptal fiber contraction.10Temporary bridges were inserted the day the braces were removed, and the splints were placed. Permanent impressions were taken one month later to allow for gingival healing and minor occlusal settling (Figures 7a and 7b).

CONCLUSION
This treatment approach shows a rapid, straightforward solution for this common functional and aesthetic dental problem, which is frequently treated with a more complicated long-term plan, often prone to relapse.

CONTACT RAPID BRACES


References

  1. Kelly JT Jr. A multidisciplinary approach to restoring posterior bite collapse. Compend Contin Educ Dent. 1997;18:483-485,488-490.
  2. Reshad M, Jivraj S. The influence of posterior occlusion when restoring anterior teeth. J Calif Dent Assoc. 2008;36:567-574.
  3. Georgaklis CC. Alternative orthodontic treatment for adult crossbites and overbites. Dent Today. 2001;20:60-63.
  4. Lei Y, Zhang S. Clinical study on the orthodontic treatment of deep overbite with bite plane [in Chinese]. Hunan Yi Ke Da Xue Xue Bao. 1998;23:465-466.
  5. Brunsvold MA. Pathologic tooth migration. J Periodontol. 2005;76:859-866.
  6. Martinez-Canut P, Carrasquer A, Magán R, et al. A study on factors associated with pathologic tooth migration. J Clin Periodontol. 1997;24:492-497.
  7. Georgaklis CC. Six-month adult aesthetic orthodontic treatment. Dent Today. 1999;18:110-113.
  8. Georgaklis CC. Anterior retention with a reinforced composite resin splint after cosmetic orthodontic treatment. Dent Today. 2002;21:54-57.
  9. Greenstein G, Cavallaro J, Scharf D, et al. Differential diagnosis and management of flared maxillary anterior teeth. J Am Dent Assoc. 2008;139:715-723.
  10. van Beek H. Dissertation 25 years later. 1. Mesial drift of teeth by occlusal forces [article in Dutch]. Ned Tijdschr Tandheelkd. 2004;111:48-51.
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6 Month Braces: How Is It Possible?

6 Month Braces: How Is It Possible?

Get straight teeth in just six months with Dr. Georgaklis’ Rapid Braces treatment. He specializes in clear braces or invisible braces for adults and promises to give you your best smile.

rapid braces Boston

Adults who need braces shouldn’t have to suffer for a long time period with metal brackets on their teeth — let Rapid Braces be the solution for you! This Brookline dental office is the only office to complete 90% of cases in six months or less. Adults can wear clear braces or invisible braces and see results faster! These also are a better alternative to Invisalign, as they control your teeth with more force and take less the time.

How does Dr. Georgaklis do it?

First, he makes sure that every patient at his Boston area dental office gets personalized treatment the moment they walk through the door. He schedules each patient for longer visits, allowing him to get more done during one appointment. Most orthodontists see their patients for five to fifteen minutes, while Dr. G sees his patients for an hour.

Dr. Georgaklis uses his professional experience to mix cosmetic dental practices with orthodontic techniques to give his patients straight teeth fast.

In order to treat patients within six months, this Boston area dentist uses special techniques like:

  • using special wires that don’t fatigue
  • sanding in between the teeth
  • not removing any teeth
  • reshaping gums and teeth
  • not changing the bite or profile unless needed (although this can often times be done in six months)
  • straightening front teethadult braces

These procedures give you a perfect smile with proportionate and straight teeth! After six month braces, Dr. Georgaklis fits his patients with a fixed retainer behind the teeth. This lingual retainer prevents movement, giving you straight teeth for life!

To learn more about the Six Month Braces treatment, click here. You can book your free consultation today!

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Using Orthodontic Techniques for Straight Teeth

Get Straight Teeth in Six Months with Orthodontic Techniques

Dr. Clifton Georgaklis has revolutionized dentistry with his 6-Month Braces. He uses his own techniques and knowledge combined with orthodontic techniques to create Rapid Braces.

Most orthodontists will tell you that you’ll need at least two years to get straight teeth. Dr. G can make it happen in six months. Orthodonotristry focuses on the treatment of improper bites and misaligned jaws, with straightening teeth as an added visual aesthetic. At Rapid Braces, getting straight teeth is the focus. Typical orthodontists see between 50 and 100 patients per DAY, but Dr. G only sees 8 to 12. He gives each of his patients a personalized experience.

The 6-Month Braces technique has two options: clear braces or invisible braces. Clear braces are done with transparent materials and plastered on your teeth like normal braces; but invisible braces are attached to the back of your tooth so they aren’t visible.

Rapid Braces can fix a number of different problems with the alignment of your teeth to give you the best possible smile. We’ve closed gaps, moved teeth to the right position, straightened crooked teeth and even spaced out crowded teeth. The experts at Rapid Braces are able to complete over 90% of cases in six months. Just read some of our patient testimonials to hear more!

“I will never forget your promise to me that the treatment would take 6 months. I have to admit I did not believe you. My hopes were that the treatment would be completed within a year. You amazed me by finishing in just 5 months!…If there were slogans in orthodontics, yours should be ‘underpromise, then over-deliver.’ Thank you so much for improving my teeth, my smile and my life.” —Hans Brings, Waltham, MA

 

“I have never been happy with my smile because of crooked teeth. I have seen many orthodontists and they have all said 2 years. I met a man who told me this particular dentist could straighten teeth in just 6 months. While sitting in the waiting room, I looked at pictures of previous patients and said to myself, ‘this man is not an orthodontist, he is a miracle worker.’ The day my braces came off, my smile looked so magnificent I could have cried. I felt like a totally changed woman. I would have never have gotten braces if I had to wear them for 2 years. Who says you’re too old to get braces and change your life? Dr. G. You are my hero!” —Dannetta Smith, Boston, MA

 

Schedule your consultation today.

 

 

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