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All Posts in Category: Perfect Smile

Tips for Keeping a Healthy Mouth While Wearing Adult Braces

Wearing braces as an adult is an important step towards achieving a beautiful, healthy smile. However, many patients don’t realize that maintaining good oral hygiene during adult orthodontic treatment can be challenging. Food particles and plaque can easily get trapped in braces, making it essential to keep your mouth as clean as possible. Here are five essential tips to help you keep a healthy mouth while wearing braces, especially if you’re under the care of a Boston orthodontist.

1. Brush Thoroughly and Frequently

Brushing your teeth becomes even more crucial after you get adult braces. Aim to brush after every meal using a soft-bristled toothbrush and fluoride toothpaste. Make sure to clean all surfaces of your teeth and braces, including around the brackets and wires. An electric toothbrush can also be very effective at removing plaque and debris.

2. Floss Daily

Flossing with braces can be tricky, but it’s essential for preventing gum disease and cavities. Use floss threaders or orthodontic floss to navigate around wires and brackets. Alternatively, water flossers can be a convenient and effective tool for cleaning between teeth and along the gumline.

3. Use Interdental Brushes

Interdental brushes, also known as proxy brushes, are small brushes designed to clean between teeth and around braces. These brushes can reach areas that regular toothbrushes might miss, ensuring a more thorough clean.

4. Rinse with Mouthwash

Incorporate an antibacterial mouthwash into your daily routine to help reduce plaque and bacteria. Look for a mouthwash that is free of alcohol to avoid irritation. Rinsing can also help remove food particles left after brushing and flossing.

5. Avoid Certain Foods

Some foods can damage your braces or make it harder to keep your teeth clean. Avoid sticky, chewy, and hard foods like caramel, chewing gum, popcorn, and nuts. Instead, opt for softer foods that are easier to clean off your braces.

Bonus Tip: Regular Dental Checkups

In addition to your orthodontic visits, continue seeing your dentist for regular checkups and cleanings. Your dentist can help monitor your oral health and address any issues that arise during your orthodontic treatment.

Maintaining a healthy mouth while wearing braces requires diligence and the right tools. By following these tips and staying committed to your oral hygiene routine, you can ensure your teeth stay healthy and your braces work effectively. If you need personalized advice or have concerns about your braces, don’t hesitate to reach out to the Boston 6 Month Braces team at Rapid Braces for guidance.

Remember, taking care of your teeth during orthodontic treatment not only helps you achieve the best possible results but also sets the foundation for a lifetime of good oral health. Contact us to learn more about different adult braces options available.

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Top 9 Qualities for Dentists Who Put Their Patients First

A great Boston Area Dentist is more than just a skilled professional; they are compassionate caregivers dedicated to the overall well-being of their patients. Here are the top nine qualities that set exceptional dentists apart, making them true patient advocates:

Comfortable with Close Personal Interaction:

  • A great dentist understands the intimacy of their work and remains composed and professional, ensuring a comfortable environment even during close personal interactions.

Easy to Talk To:

  • Effective communication is at the heart of dentistry. Exceptional dentists go beyond dental concerns, building rapport with patients, making them feel heard, and creating a positive and open dialogue.

Trustworthiness:

  • Operating in a sensitive area, dentists must instill trust in their patients. Demonstrating reliability and prioritizing patient safety are crucial for building confidence and well-being.

Detail-Oriented:

  • The intricate nature of dental work demands meticulous attention to detail. Exceptional dentists focus on precision, ensuring that every treatment contributes to optimal oral health.

Artistic Skill:

  • Dentistry is an art as much as it is a science. Exceptional dentists possess artistic skills, combining technical expertise with an eye for aesthetics to create beautiful smiles while maintaining oral health.

Leadership Abilities:

  • Dentists often lead dental practices, requiring effective leadership. Successful dentists manage teams, make sound business decisions, and create a positive work environment, all contributing to excellent patient care.

Passion for Dentistry:

  • Beyond technical proficiency, great dentists harbor a genuine passion for their work. This enthusiasm fuels their commitment to patient care, continuous learning, and professional growth.

Compassion and Community Service:

  • Exceptional dentists extend their skills beyond the clinic, engaging in community service. They provide oral care to those in need, reflecting compassion and a commitment to improving overall oral health.

Patient-Centric Approach:

  • Putting patient comfort at the forefront, outstanding dentists ensure a positive experience during procedures. Effective communication and a patient-centric approach minimize anxiety and contribute to overall well-being.

In conclusion, the mark of a great dentist goes beyond technical proficiency. It encompasses a holistic dental treatment approach, combining technical expertise with empathy, effective communication, and a genuine commitment to patient well-being. These qualities not only contribute to maintaining optimal oral health but also result in the creation of beautiful and confident smiles. Choosing a dentist with these qualities ensures a positive and fulfilling dental experience for patients.

Dr. Georgaklis and the entire staff at Rapid Braces understand the importance of creating a positive relationship with patients visiting our office. Contact our office today to learn more about becoming a patient at our Boston Area Dental Practice.

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The Benefits of Adult Orthodontics: Exploring Options Beyond Traditional Braces

Gone are the days when braces were exclusively associated with teenagers. Today, an increasing number of adults are exploring the remarkable benefits of adult orthodontics to achieve a beautiful and healthy smile. As advancements in dental technology continue to progress, traditional braces are no longer the only option.

Enhanced Aesthetics and Confidence

A straight and radiant smile can do wonders for self-esteem and overall appearance. Adult orthodontics offers discreet options that are practically invisible, allowing individuals to undergo treatment without feeling self-conscious about their smiles. Clear aligners, like Invisalign, are a popular choice for adults seeking a more discreet way to align their teeth.

Improved Oral Health

Beyond aesthetics, adult orthodontics plays a vital role in promoting better oral health. Misaligned teeth can lead to various dental issues, including difficulty cleaning properly, an increased risk of gum disease, and even teeth grinding.

Diverse Treatment Options

Adult orthodontics offers a wide range of treatment options to cater to individual needs and preferences. In addition to clear aligners, there are alternatives like lingual braces and invisible braces. Lingual braces are attached to the back of the teeth, offering a more discreet option for those requiring more extensive orthodontic correction.

Comfort and Convenience

Modern adult orthodontic treatments prioritize comfort and convenience. Unlike traditional braces with sharp metal edges and painful adjustments, contemporary orthodontic options incorporate advanced technology and materials for improved comfort and faster treatment times. 6 Month Braces can be taken off in 6 months or less as long as treatment goes according to schedule so you won’t need to wear adult braces for long.

Long-Term Financial Benefits

Investing in adult orthodontics goes beyond improving one’s smile; it is a wise investment in long-term dental health. Correcting misalignments can prevent the need for extensive dental work, such as crowns or implants, which may arise from untreated issues. Furthermore, dental problems associated with misalignment can lead to more severe complications in the future, potentially resulting in higher healthcare costs.

Positive Impact on Overall Health and Confidence

A confident smile not only enhances self-esteem but also has a positive impact on overall well-being. Studies have shown that people who feel good about their smiles tend to be more self-assured and outgoing in social situations. Improved confidence can also lead to better communication, more successful relationships, and increased success in personal and professional endeavors.

Adult orthodontics has emerged as a transformative solution for adults seeking a straighter, healthier smile. The benefits go beyond aesthetics, positively impacting oral health, comfort, and confidence. With a wide range of treatment options available, adults can choose the approach that best suits their needs and lifestyles. Whether it’s clear aligners, lingual braces, or ceramic braces, adult orthodontics allows individuals to embrace modern options for a confident and radiant smile. So, if you’ve been considering getting straight teeth as an adult, take the first step towards a beautiful smile and explore the possibilities with Rapid Braces! Contact us today to learn more about our 6 Month Braces treatment option.

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Get Ready for a Big Event Fast with 6 Month Braces

If you have an upcoming event – perhaps a wedding, reunion, or vacation – and you want to look your best, then Six Month Braces may be just what you need. Six Month Braces offer many advantages over traditional braces, including faster results, less discomfort, and more discreet appearance. In this blog post, we will explain why Six Month Braces are such a great option for anyone looking to straighten their teeth quickly and effectively, and show you how you can get ready for your big event in no time.

What are Six Month Braces and how do they work?

Six Month Braces are an adult braces option that focuses on the cosmetic aspects of treatment so you can get your braces off fast. The treatment typically takes six months or less, which is significantly faster than traditional braces. We offer a number of different options including invisible braces which use clear bands and brackets. The discreet look makes them a popular choice for adults and teenagers who want to improve their smiles without drawing attention to their orthodontic treatment.

Who is a good candidate for Six Month Braces?

Six Month Braces can be a great option for anyone who wants to straighten their teeth quickly and effectively. The treatment is suitable for adults and teenagers with mild to moderate orthodontic issues, such as crooked or overlapping teeth, gaps between teeth, and misaligned bites. Schedule a consultation with Dr. Georgaklis so he can get a closer look at your teeth and recommend the best treatment option for your smile.

How can you get ready for your big event with Six Month Braces?

If you have a big event coming up and want to improve your smile quickly, Six Month Braces may be the perfect solution. To get started, schedule a consultation at the Rapid Braces Brookline Office so we can assess your needs and recommend the best treatment options. If Six Month Braces are right for you, the treatment can begin right away, with visible results in just a few months. By the time your big event arrives, you will have a straighter, more beautiful smile that will make you feel confident and happy.

Six Month Braces are a great option for anyone who wants to straighten their teeth quickly and discreetly. Whether you have a wedding, reunion, or vacation coming up, Six Month Braces can help you get ready for your big event in no time. So don’t wait – schedule a consultation today and discover how Six Month Braces can transform your smile and boost your confidence.

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invisible braces

Cosmetic Dentistry: Look Your Best for Big Events

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

What is Cosmetic Dentistry?

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

Benefits of Cosmetic Dentistry

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

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

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

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

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The Benefits of Cosmetic Dentistry

Everyone knows that healthy teeth have an extremely positive impact on one’s overall health as well as mental health. A smile is something that you use everyday, but if you’re not comfortable with your own smile you might do it less. Cosmetic Dentistry can actually have a lot of benefits, that don’t involve just getting a better smile for adults in the Cambridge area. Here are some of the benefits of cosmetic dentistry.

1. Get a younger look – Though everyone ages with grace, we all want to look younger in the end. Common effects of aging are dental erosion and discoloration. However, by going to a professional cosmetic dentist you can reverse these signs of aging. For example, if you have a missing tooth or need gum reshaping those may be factors that may make you look older. Teeth whitening is another popular option among adults in the Boston area preparing for a big event. Getting dental work done with an experienced Cosmetic Dentist can clean up your smile and give you a more youthful appearance.

2. Prevents future dental damage – A professional cosmetic dentist can ensure that when you choose to get cosmetic dental work done it can prevent future dental damage associated with the issues you may have prior to the dental work. Going to a trusted cosmetic dentist is an essential part in making sure that your work lasts for a long time and is done well.

Teeth bonding and gum reshaping procedures will help make your mouth easier to clean by removing any abnormalities that can make certain areas tough to clean. Many adults in Cambridge have come to Rapid Braces for gum and tooth repair procedures and left with a smile that’s easier to keep healthy and looking good.

3. Builds confidence – If you’re feeling unconfident about your smile it may be hindering your life a lot more than you think. Being able to smile is one of life’s simple pleasures and a natural reaction for when you laugh or you’re happy. Not feeling comfortable to be yourself when these natural emotions happen can leave your self-esteem in bad shape. Cosmetic dentistry can help adults in Cambridge and the Greater Boston area the chance to show their smiles to the world. You can get an awesome new look that you feel comfortable with by repairing broken teeth and whitening your smile.

4. Strengthen your teeth – A cosmetic dentistry professional will do their job right so it actually strengthens your teeth. You may think that by getting your teeth worked on you’re weakening them but you’re actually setting them up to be stronger in the long run. Strengthening your teeth is a very smart investment to make as it’s an investment that will keep your smile looking great for longer.

5. Corrects Aesthetic Flaws – These may be just small things that only you notice like a cracked tooth, or a mis-shaped gum, or it could be something more severe like an entire tooth is missing. A cosmetic dentistry professional will fix these aesthetic flaws so you can feel like yourself again. Contact us to learn more about gum reshaping, teeth whitening and tooth replacement procedures today.

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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 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 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.

 

 

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

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

Conclusion

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

References

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

Alternative Orthodontic Treatment for Adult Crossbites and Overbites

Contact Rapid Braces

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

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

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

Originally posted on Dentistry Today.

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

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

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

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

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

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

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

SPLINTING STEPS

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

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

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

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

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

SUMMARY

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

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


References

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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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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