Straight Teeth in Six Months
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All Posts in Category: Clear Braces Treatment

Best Ways to Keep Clear Braces Sparkling Clean

Choosing Clear Braces for your 6 Month Braces treatment is one of the best ways to get your teeth straightened fast. Clear Braces us clear bands and wiring so your braces can stay hidden while they transform your smile. Many people are used to having to wear braces for much longer but recent advancements in cosmetic orthodontics has made getting a beautiful smile much easier.

Getting your braces off and seeing your beautiful smile is something that all of our patients can’t wait for when they get their braces on but there is still some work to do. It’s important to keep your teeth and braces clean while you’re wearing your braces to make sure your smile looks as good as you’ve imagined. Here are some tips that will help you keep your teeth clean while wearing clear 6 Month Braces.

Brush Your Teeth Often

Brushing your teeth regularly is important but it’s even more important when you’re wearing braces. Clear braces may be almost invisible but they still offer a number of places for food to get stuck and cause a problem. Quickly brushing your teeth after every meal and making sure to take the time to brush thoroughly in the morning and at night is the best way to keep your teeth clean with braces.

Floss Regularly

Like brushing, flossing is a great way to keep your mouth clean. Flossing can help you get to some hard to reach places that a toothbrush can’t with the fine thread. It’s important not to pull too hard on your floss to avoid damaging your braces.

Stay Away from Specific Foods

Everyone who’s ever had braces knows you need to avoid hard, sticky foods like candy, popcorn, Peanuts, etc. but there are some others that can cause problems with clear braces. Due to the transparent nature, clear braces can get stained so staying away from foods or drinks that can stain your teeth like blueberries or red wine is a good idea.

Visit Dentist for Regular Cleanings

Getting 6 Month Braces is a big step towards getting a beautiful smile that you can show off to the world but that smile still needs to be cared for. Visiting your Dentist for regular cleanings and Cosmetic Orthodontist for regular checkups while undergoing 6 Month Braces treatment in Boston is essential. Contact Rapid Braces to schedule an initial consultation so you can learn more about how you can get straight teeth in 6 months or less.

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How to Care for Lingual Braces

One of the concerns that we hear about from patients on a regular basis is how to care for their braces. Cosmetic Orthodontic patients that are getting lingual braces often think that the care routine will be much different than that of traditional braces. As far as your daily routine goes there will be some differences. You will have to take special care to make sure that you don’t damage your brackets and wires. 

Lingual braces are on the inside of your teeth

Due to the fact that lingual braces are on the inside of your teeth, you will have to use more caution when eating than you would with traditional braces. Hard and crunchy foods are some of the easiest ones to damage your braces. You should try to avoid hard foods whenever possible. If you have an overbite it is very easy to add excess pressure to the brackets when you are chewing. This excess pressure can lead to the brackets and wires loosening and or breaking. You should also avoid foods that can easily become caught in the lingual braces. Having to pick sticky or messy foods out of your braces will cause you to have to put unnecessary pressure on them. 

You should always brush and floss after every meal

It is important to make sure that no food particles are stuck in your braces. Mouth wash is also a great tool for helping you to remove anything that may become stuck in your mouth. It is best to floss with a combination of regular dental floss and an inter-dental flosser. It’s best to use a combination so that you are sure to be able to get all of the possible places food particles could be hiding. While it is not as useful as flossing a Waterpik can also be used to help clean your lingual braces. Traditional floss will do a much better job of getting into tight places, but a Waterpik works great for light general cleanup and is a bit more gentle on sore teeth. 

 

Unlike traditional braces, any soreness or small abrasions caused by new braces won’t happen on the inside of your lip. It will happen to your tongue, but there is a solution. Just like traditional braces, you can use wax to cover the brackets to provide temporary relief. Most patients see relief from the discomfort associated with first getting their lingual braces on within the first couple of weeks.

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clear braces orthodontic treatment

What You Need to Know About Clear Braces

The days of having to deal with unsightly braces are long gone. With his Rapid Braces technique of treatment, Dr. Georgaklis has changed the way orthodontics is practiced in the United States and around the world. Most patients can have their braces removed in six months or less with the Rapid Braces treatment. Dr. Georgaklis’ Brookline, MA dentistry office has a track record of treating 90% of his patients in just six months. The rapid braces treatment paired with clear braces means that your procedure will be as discrete as it can possibly be. 

How do clear braces work?

Clear braces work in the same manner as traditional metal braces do to straighten teeth. Each tooth is fitted with a bracket in metal braces. A metal wire ties all of the brackets together after an elastic ligature (very small rubber band) is wrapped around each one. The archwire is held in place on each bracket by the elastic. The cross wire is tightened or modified at each cosmetic orthodontist appointment, putting gentle pressure on the brackets and gradually moving your teeth into the desired position. Clear braces are great for adults who want an alternative to traditional metal brackets, but teenagers can get clear braces as well. 

What is the expected cost of clear braces?

Despite the fact that the procedure of straightening teeth is the same, the cost difference between clear braces and standard metal braces can be different. The cost is determined by your dental insurance and the circumstances of your case. When you come in for your cosmetic orthodontic consultation, we’ll assess your case, go through your treatment options, and give you an estimate of how much each option will cost. We’ll work with you every step of the way to make sure you’re happy with the cosmetic orthodontic treatment you’ve selected and the financial commitment that comes with it.

The 6 month clear braces therapy is available to patients who receive clear braces at Rapid Braces. Dr. G has been using the 6 Month Braces treatment for nearly 30 years, and 90% of his patients may finish treatment in 6 months or less. The most common reason patients select braces is to straighten their teeth, and Dr. G understands how vital a flawless smile is. He focuses on dental cosmetics in his treatment and will go to great lengths to ensure that his patients depart with a beautiful smile.

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Clear Braces vs. Lingual Braces: Find Best Option For You

Adults who are interested in getting their teeth straightened have a number of different options that didn’t exist a few years ago. New technologies have allowed cosmetic orthodontic treatment to get faster and easier to keep concealed than ever before. New methods of straightening teeth that differ from traditional ceramic braces have made getting your teeth aligned at an older age faster and more popular than ever before. Clear Braces and Lingual Braces are 2 adult braces options offered at Rapid Braces that have advantages over traditional ceramic braces. Both options can be completed in 6 months or less with 6 Month Braces treatment at our Brookline office.

clear braces for adults

Clear Braces are one of our most popular options because of their affordability and aesthetic advantages. Clear braces use bands and brackets that are transparent so your braces will be difficult for anyone to notice. This option is good for adults looking for a cost-effective way to get straight teeth fast and can be completed in 6 months or less with the 6 Month Braces treatment plan. Please note that patients must be able to attend all scheduled appointments for the fastest possible treatment time.

Another popular choice for patients who want a better smile is lingual braces. Lingual braces are braces that are placed on the insides of your teeth so they will be completely hidden. Patients often let us know that they needed to tell close friends about their braces before they even knew they were there. Lingual braces are custom made to fit in each patient’s mouth and allow for more control of how your teeth are aligned so you can get a beautiful smile fast. Many patients consider clear retainers like Invisalign but ultimately choose lingual braces because of treatment that can take HALF as long.

Rapid Braces offers 6 Month Braces treatment to adults who want to fix crooked teeth and get a beautiful smile fast. Each treatment plan is fully customized to address patient’s needs so they can get their braces of fast with a healthier smile. Our staff has experience working on cases that have been called untreatable by other orthodontists. We understand that each patient we treat has unique needs and provide a number of different adult braces options so you can find what works best for you. Schedule an initial consultation today to learn more about how we can help get you a beautiful smile.

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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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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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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

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

2. Rossouw PE, Preston CB, Lombar CJ, et al. A longitudinal evaluation of the anterior border of the dentition. Am J Orthod Dentofaciai Orthop. 1993;104:146-152.

3. Sinclair PM, Little RM. Maturation of untreated normal occlusions. Am J Orthod. 1983;83:114-123.

4. Bondevik O. Changes in occlusion between 23 and 34 years. Angle Orthod. 1998;68:75-80.

5. Harradine NW, Pearson MH, Toth B. The effect of extraction of third molars on late lower incisor crowding: a randomized controlled trial. Br J Orthod. 1998;25:117-122.

6. Becker A, Goultschin J. The multistrand retainer and splint. Am J Orthod. 1984;85:470-474.

7. Oikarinen K. Comparison of the flexibility of various splinting methods for tooth fixation. Int J Oral Maxillofac Surg. 1988;17:125-127.

8. Rosenberg ES, Garber DA. A temporary-permanent splint. Refuat Hapeh Vehashinayim. 1979;28:27-30,33-37.

9. Ferreira ZA, de Carvalho EK, Mitsudo RS, et al. Bondable reinforcement ribbon: clinical applications. Quintessence Int. 2000;31:547-552.

10. Sheridan JJ. Incremental removal of bonded lingual retainers. J Clin Orthod. 1988;22:116-117.

11.Kuijpers-Jatman AM, Al Yami EA, van’t Hof MA. Long-term stability of orthodontic treatment. Ned Tijdschr Tandheelkd. [in Dutch] 2000;107:178-181.

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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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Adult Orthodontics and a Post-Treatment Bonded Splint: A New Cosmetic Subspecialty

Adult Orthodontics and a Post-Treatment Bonded Splint: A New Cosmetic Subspecialty

Originally posted on Dentistry.com

As the field of cosmetic dentistry is still rapidly evolving, we have not yet integrated the various specialties to provide seamless care in a case that requires multiple disciplines. For example, a patient needing orthodontics, crown and bridge or implants, gingival recontouring, orthodontic retention, and bonding will normally be cross-referred between their GP, periodontist, orthodontist, and perhaps an oral surgeon1,2 (4 doctors). While specialists normally provide the highest level of care, there exist certain cases where a “cosmetic subspecialist” may be best suited to create a final result that is harmonized in concept, proportion, and materials.
The following case would often be treated with orthodontics and retainers, and then relapse because of the unusual nature of the case and high tendency to relapse with removable retainers3 regardless of the duration of the orthodontics. The relapse in the anterior segment in adult patients is especially high.4 This patient had 3 missing anterior teeth as well as an impacted canine (Figure 1). Most orthodontists are not accustomed or trained to incorporate significant bonding and reshaping into their treatment plans, so the missing lateral incisors spaces would usually be opened up for implants or 6 units of crown and bridge to provide traditional canine guidance. Yet, there is insufficient bone for an implant for No. 7, and there are alternative treatment options that are simpler, far shorter in duration, and less expensive. Nontraditional thinking is required in this case, especially from an orthodontic perspective, as ideal treatment is most likely impossible.

CASE REPORT (FIGURE 1)

Figure 1. Patient is missing 3 lateral incisors. Tooth No. 6 was fully impacted in bone before surgical exposure, and was used to substitute for the missing tooth No. 7 through extrusion, mesialization, reshaping, and bonding. Figure 2. Bonding and reshaping was also done to the enamel and gingiva of the bicuspids to make them into canines. The front 6 teeth were splinted and bonded. This case has no implants or bridges.

The patient had been to 3 orthodontists and was looking for treatment alternatives, as all 3 offered 2- to 3-year treatment plans with no promise of a satisfactory result because of bone issues surrounding tooth No. 6, among other things. The patient was not willing to crown all his anterior teeth, which had also been proposed. Our treatment plan involved surgical exposure and super-eruption of tooth No. 6, then making teeth Nos. 6 and 11 into lateral incisors through mesial movement and bonding, making teeth Nos. 5 and 12 into canines, minimizing the lower canine cusps, and connecting all anteriors with a Ribbond/composite splint for stability as well as to support the extra bonding that would be necessary (Figure 2).5
Instead of dividing the treatment by “specialty” and fragmenting the plan with 3 providers, in this way the case may be managed by one practitioner who is experienced in performing splinted retention with concurrent bonding. I previously wrote of a porcelain pontic veneer placed over a Ribbond splint used for orthodontics.6 This case shows how the splint can support significant bonding and provide needed fracture resistance to canines, which are made into laterals, and bicuspids which are made into canines. Equally important is the required fixation, as any relapse would reveal their deficient anatomy and ruin the “camouflage” effect of the bonding. Most orthodontic cases have some degree of relapse, and that would be unacceptable in cases such as this.
This treatment reflects a paradigm shift. Instead of providing a traditional orthodontic result by adding prosthetic lateral incisors, other teeth are moved shorter distances and bonded, providing a faster, simpler, and less expensive result. This is preferable for many patients who are more interested in avoiding gaping holes in their smile than committing to a 2-year treatment plan with endosseous implants. While patients are made aware of treatment alternatives, specifically what will not be provided in this plan, they overwhelmingly choose a method that resolves their chief aesthetic complaint. They are generally satisfied years at recall as well. Should they choose to crown or veneer this result in the future when more stability has been achieved, that option is still available to them.

CONCLUSION

 

Reshaping teeth via splinting and bonding is a practical, aesthetic alternative which addresses the high incidence of relapse still seen in orthodontics today. Simultaneously, this can serve to resolve some difficult and unusual aesthetic predicaments.


References

  1. Chadroff B. The interdisciplinary approach to implant dentistry. Gen Dent. 2004;52:321-326.
  2. Spear FM, Kokich VG, Mathews DP. Interdisciplinary management of anterior dental esthetics. J Am Dent Assoc. 2006;137:160-169.
  3. Hirschfelder U, Hertrich K. The treatment of deep bite in adults. Fortschr Kieferorthop. 1990;51:36-43.
  4. Lang G, Alfter G, Goz G, et al. Retention and stability—taking various treatment parameters into account. J Orofac Orthop. 2002;63:26-41.
  5. Kokich VO Jr, Kinzer GA. Managing congenitally missing lateral incisors. Part 1: Canine substitution. J Esthet Restor Dent. 2005;17:5-10.
  6. Georgaklis CC. Anterior retention with a reinforced composite resin splint after cosmetic orthodontic treatment. Dent Today. Jan 2002;21:54-57.
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