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All Posts in Category: Perfect Smile

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

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

Originally posted on Dentistry Today.

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

CASE REPORT

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

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

DISCUSSION

Figure 7a and 7b. Before and After.

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

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

CONTACT RAPID BRACES


References

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

6 Month Braces: How Is It Possible?

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

rapid braces Boston

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

How does Dr. Georgaklis do it?

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

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

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

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

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

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

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

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

Clear or Invisible braces for adults.

Originally posted on Dentistry Today.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Reference

  1. Bishara SE, Jakobsen JR, Treder J, et al. Arch width changes from 6 weeks to 45 years of age. Am J Orthod Dentofacial Orthop. 1997;111:401-409.
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Difficult Case Types, Part 1: A Discussion of Adult Short-Term Orthodontics

Difficult Case Types, Part 1: A Discussion of Adult Short-Term Orthodontics

Six Month Braces for adults.

Originally posted on Dentistry Today.

INTRODUCTION
Short-term orthodontics (STO) has exploded in popularity during the past 10 years. Adults are discovering that they are able to straighten their anterior teeth cosmetically without undergoing 2 years of bite-changing orthodontics, and are enthusiastically seeking out this treatment.
Since I first wrote about “Adult 6-Month Orthodontics” in 1999 for Dentistry Today,1 Ryan Swain (Six Month Smiles) and other general dentists and some orthodontists, have been teaching STO in the United States, Europe, and Australia to enthusiastic audiences. There is good reason for this—orthodontists have not supported a strong case for routinely prescribing 2-year orthodontics with a Class I molar occlusion as its focus. Moreover, the evidence in the literature for the benefits of moving molars already in functional occlusion (except, for example, correction of a posterior edge-edge bite causing attrition) is underwhelming.
Adults do not generally seek orthodontic treatment and wear braces mainly for their molars, and 2-year treatment for profile change is not generally possible nonsurgically in the adult patient. When it is done, profile changes are difficult to retain. Although visits must be longer for STO and retention protocol more stringent, it is a great new service that is bringing many back to dentistry. As Dr. Gordon Christensen stated, “I feel certain that may more people would have orthodontic therapy if it could be simplified and made more acceptable to them as adults….I congratulate you for your innovative and thoughtful approach to the subject” (Dr. Gordon Christensen, personal correspondence in writing, January 4, 2000 and January 29, 2004). A general practice performing this treatment will experience a boon to its periodontic, endodontic, and restorative services, in addition to its bleaching and veneer offerings, as a healthy mouth precedes the healthy smile in treatment planning. This is truly a valuable service to the public.

Orthodontist Jack Sheridan2 pioneered interproximal reduction in the 1970s and promoted chief complaint orthodontics for years. His criteria was: (a) the occlusion is functional and the patient eats comfortably; (b) the patient’s chief complaint is crowded anterior teeth; (c) the crowding can be resolved without expansion and usually air-rotor stripping; (d) treatment time should be minimal, preferably about 6 months; (e) patients understand nighttime retainer wear may be permanent; and (f) patients understand that treatment is aesthetic only in nature (Dr. Jack Sheridan, personal correspondence in writing, June 5, 1997).

The cosmetic dentistry revolution has brought STO to the forefront, and it has become a field all its own. A wide array of problems can be dealt with in a different way when the focus is cosmetic. “Camouflage treatment” can be performed on Class III skeletal patients who decline orthognathic surgery by tipping mandibular incisors into a Class I incisor relation. Slight tipping of maxillary molars can be done in lieu of palatal surgery for the posterior edge to edge bite. Anterior crossbites can be corrected through lower incisor extractions if the patient’s profile is acceptable. As with many difficult cases, there often exist various solutions. With any new treatment approach, though, there also exist certain caveats, areas to watch out for, and pitfalls to avoid.

This article will be a review some of the most difficult cases I have seen during the past 20 years of performing STO on a wide variety of case types. Although there are traditional orthodontists and general dentists who would see this as an opportunity to categorically criticize STO, it is my hope instead that they seek to better understand the treatment, and to realize that it has a place in an array of cosmetic treatment options. Someday, they too may want to consider offering accelerated orthodontic treatment in adult cases that are strictly cosmetic, as it can be a superior and less invasive service than crowning or veneering crowded teeth. It should also be noted that many of the difficulties in the cases presented might have occurred with a longer treatment period.

 

CASE TYPE I: BRUXERS
Severe bruxers who do not wear their nightguard often experience relapse after orthodontics. The patient in Figure 1 underwent STO for anterior space closure and achieved a nice aesthetic and occlusal result. However, retention for bruxers hinges on strict adherence to retainer wear as well as diligent nightguard use. As new abfractions are evident in the recall photo, he did not comply.

Throughout a period of 14 years post-treatment, the patient’s vertical dimension of occlusion (VDO) decreased. Two crowns were done to cover fluorosis. Although the protrusion and diastema did not significantly relapse, the deep bite returned (Figure 2). Though this may also occur in 2-year orthodontic cases, I more thoroughly emphasize strict adherence to nightguard use indefinitely in these cases. I inform bruxers that orthodontics is of minimal or no benefit if they are not prepared for a lifelong commitment to retention. Despite some relapse, he is still a satisfied patient in our practice 14 years later and fully understands the responsibility of retention lies with him through wearing his nightguard-Hawley combination at night.

Figure 1. Preoperative: Before with diastema and deep bite from bruxing. Figure 2. Postoperative: The 14-year recall after 6-month short-term orthodontics (STO). The patient did not wear his nightguard.
Figure 3. Preoperative: Clencher before STO. Figure 4. Postoperative: Clencher, splinted.

Similar to case 1, this patient was splinted and still experienced some relapse of her VDO at recall because of bruxism and limited nightguard wear. However, her alignment was maintained (Figures 3 and 4).

Figure 5 shows another patient who is a severe bruxer with flat plane occlusion. He experienced buccal migration of his upper first bicuspids post completion due to no nightguard wear. This occurred before postorthodontic settling took place, and articulating paper showed these bicuspids more heavily in occlusion than his molars. When he bruxed laterally, the buccal bone (which had not yet solidified) did not resist buccal tipping from the lateral forces on these teeth during parafunction.
Rarely is every tooth in complete occlusion postorthodontics, even with comprehensive treatment. Bruxers and clenchers usually experience more rapid post-treatment settling with more complete interdigitation than nonbruxers. But when the patient is a severe bruxer, selective migration may occur, especially if this is a flat plane occlusion with no cusps. This patient was rebracketed for 2 months before having a complete occlusion equilibration at the day of debracketing. Nightguard wear was strictly emphasized and the final result was stable.

 

CASE TYPE II: OBSESSIVE COMPULSIVE DISORDER TYPE COSMETIC PATIENTS
Another case type to watch for is the cosmetic patient who wants to dictate the treatment plan. While it is tempting to want to “please” a cosmetic patient, as it is an elective procedure after all, forging into a new area or performing a procedure with which you have less experience means less predictability in the final result. Doing this on patients who have exacting personalities and have a specific end result in mind further increases the risks involved. As with the bruxer category, patients like this can be red flags in cosmetic dentistry. These patients often start out with enthusiasm and seem to grasp the nuances of cosmetic dentistry, understanding the details of smile design. We may feel on the same page as these individuals who share our love for cosmetic excellence, and this makes dentistry fun. But when enthusiasm morphs into unrealistic expectations of perfection, and the patient cannot fully understand that there are limitations, difficulties may arise. Do we always know exactly what end result can and cannot be achieved? Are computer simulations really honest predictors of the end result, and should we depend on them to be accurate in every case? In a perfect world, we could predict all contingencies as well as the final result. But unless one has done every possible case type on every possible personality type with the various biologic limitations, there is no way anyone can predict the myriad of possibilities which may arise in every cosmetic case.

 

Case 1
This first case involves a simple level and alignment type orthodontic case with a slight open bite (Figure 6). Toward the end of treatment, though, the patient decided she also wanted anterior bonding to change her basic tooth shape from round to square. She brought in close-up photos of a famous American supermodel, and wanted her teeth to resemble this model’s smile. These teeth are square, slightly flared forward, and appear wider at the incisal than at the height of contour, usually the widest part of the tooth. When the patient presented for treatment, there was no indication her preferences were so specific. At this point in treatment, we are “married” to our patient, and separation is unfulfilling for both patient and dentist. After treatment, retention and incisal bonding were combined with a composite-Ribbond splint (Figure 7).3

Figure 5. Preoperative: Bruxer with flat plane
occlusion.
Figure 6. Preoperative: STO with open bite.
Figure 7. Postoperative (after STO): Patient requested long square teeth like a famous supermodel she admired. Figure 8. Preoperative (before STO): Patient recently completed Invisalign treatment in another office.
Figure 9. Postoperative to short-term lingual orthodontics with custom requests. Patient wanted his centrals to be longer and a bit more protrusive and brought in a photograph of a famous actor’s teeth to copy. Figure 10. Preoperative: before STO.

The splint helps to support more durable lengthening of the incisal edges, often done with porcelain veneers. While the orthodontics went smoothly, the final step of aesthetic bonding and recontouring was tedious and difficult.

Case 2
This patient had not long before completed Invisalign treatment elsewhere with acceptable results, but had very specific requests and a particular mental picture of how he wanted his teeth aligned and shaped. I was hesitant to take the case, as his alignment was already fairly good (Figure 8). A chief complaint list was made at the initial consult and twice reviewed with the patient. He chose lingual braces, the most difficult to control. He was advised that we may need to do some finishing with labial brackets in the final weeks. During treatment, his requests grew even more specific and he brought numerous hand-drawn sketches and a picture of a famous American actor’s smile to copy. More frequent visits were required, but the teeth were aligned in 4 months to his specifications, like this actor’s smile, with the upper centrals slightly protruding and longer (Figure 9). The patient completed treatment very happy with the result, but it is still risky to accept this case type knowing the patient has such a specific result in mind.

Case 3
This patient had become addicted to cosmetic surgery at a young age. At the consult, he expressed his dissatisfaction with his plastic surgeon despite what seemed were good results. Because his occlusion, crowding, and tooth morphology were so unaesthetic, it seemed that significant aesthetic improvement would not be difficult (Figure 10). However, the patient had numerous specific demands, including exact measurements for the lateral incisor veneers done after Figure 11. The final results were excellent but, again, the process difficult due to specific requests.

Figure 11. After STO, but before porcelain veneers on teeth Nos. 7 and 10. Figure 12. The patient had central incisors extracted at a young age, before conventional 2-year orthodontics.
Figure 13. After distalizing lateral incisors. Figure 14. After retreatment with laterals brought back to mesial and 4 splinted crowns.

 

CASE TYPE III: PATIENT ALTERS TREATMENT PLAN
To what extent do we try to please the patient? Figure 12 shows a patient who had orthodontics at age 13 years. Due to protrusive maxillary central incisors, the orthodontist decided to extract them and move laterals into the centrals’ position. With relapse, the spacing and recession is highly conspicuous. A simple treatment plan was given to consolidate the space through space closure and to provide 4 splinted crowns. When treatment began, however, the patient decided he wanted to re-establish the space for the missing central incisors to have a natural complement of teeth. As this was a patient in his 40s, the bone was not malleable. When space was established and a temporary bridge placed (Figure 13), there was slight overjet. Although I have before left overjet to provide space for a maxillary lingual splint without patient objection, this particular patient was not comfortable with his new incisor position forward. He felt that his maxillary incisal edges were noticeable, at times touching on his lower lip, although there was no deep bite. I referred him to a board-certified prosthodontist who felt there was nothing wrong with the bridge and that he could not improve significantly on the result. After a hiatus, the decision was made to retreat the case (at no change) and follow the original plan; consolidate the incisor space, and place splinted crowns. The end result satisfied the patient, and was more aesthetic, but the circuitous route there was difficult and spanned 4.5 years (Figure 14).

Bruxers, patients with obsessive compulsive disorder, and patients who alter their treatment plan represent challenging cases even when one is prepared for them and has treated similar cases previously. This is because no 2 orthodontic cases are ever identical when one considers the complete aesthetic, biologic, and interpersonal picture. We can only diligently try to consider all contingencies.

 

CLOSING COMMENTS
Treating such a variety of cases makes aesthetic orthodontics fascinating. Specialty orthodontic training often has a different focus which does not always encompass the adjunctive cosmetic dimension and adult psychological aspect central to success in some of these adult cosmetic cases. Furthermore, patients do not always afford us the 2 years of treatment time often needed to cross-refer across specialties and follow the traditional channels from decades past. As we listen more to our patients, the future of adult orthodontics is finally evolving, becoming a distinct area and more integrated with cosmetic dentistry.

In part 2 of this article, I will discuss transfer cases, improper use of enamel reproximation, cases with special retention needs, temporomandibular disorder sequelae, large tongues, problem profiles, and multidisciplinary cases that have unique challenges which fall out of the norm of traditional orthodontic cases.


References

  1. Georgaklis CC. Six-month adult aesthetic orthodontic treatment. Dent Today. 1999;18:110-113.
  2. Sheridan JJ, Ledoux PM. Air-rotor stripping and proximal sealants. An SEM evaluation. J Clin Orthod. 1989;23:790-794.
  3. Georgaklis CC. Anterior retention with a reinforced composite resin splint after cosmetic orthodontic treatment.
  4. ‘;. 2002;21:54-57.
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Using Orthodontic Techniques for Straight Teeth

Get Straight Teeth in Six Months with Orthodontic Techniques

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

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

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

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

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

 

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

 

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Straight Teeth Fast with Boston Speed Braces

 

Feeling unconfident with your smile?

Have a wedding or graduation coming up? Want to drastically improve your confidence and self image in under 6 months? Yale Graduate Dr. Clifton Georgaklis, founder of Rapid Braces, is dedicated to every patient to ensure that the process of creating your perfect smile is as smooth and as fast as possible. Many patients are looking for places to get fast orthodontic treatment, and like many Boston Orthodontists, Rapid Braces offers a number of different options custom to your needs. We understand that the concept of adult braces is not ideal, but our treatment for adults surpasses the complexity of traditional adult orthodontic treatment.

Scared to start adult orthodontic treatment due to length of procedure, and uncomfortable and unappealing equipment?

There is no shame in wanting a perfect teeth. Here at Rapid Braces, we treat patients of all ages and are dedicated to giving you the confidence and look that you’ve always wanted. Here at Rapid Braces, our process is neither scary, painful nor unattractive. One of our treatment options  consists of inserting a clear or metallic braces behind your teeth, creating minimal maintenance and clutter that you get from traditional braces. We understand your smile is essential to all aspects of your life, which is why our process is affordable, easy and FAST. Start seeing that smile you have always dreamed of having within the first 6 months of treatment! Wow your co-workers, impress your friends, and get that smile you’ve always wanted with Rapid Braces. Theres no time to waste, get that perfect smile today.

Rapid Braces is your solution to a perfect smile in less than 6 months. Period.

Get in touch for a consultation and take the next steps in controlling your confidence. During a quick appointment, Dr. Georgaklis and our team will get a good look at how your teeth are aligned and provide you with a plan to getting a perfect smile. We hope to see you at our office at 1798 Beacon Street Brookline, MA 02445. Don’t wait, make an appointment today!

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Am I Too Old for Braces?

boston braces for adults

Getting a perfect smile has come a long way since we were kids. At Rapid Braces, we feel that process of straightening teeth with braces should be as fast as possible for individuals of all ages. At Rapid Braces in Brookline, MA we offer a number of different state-of-the-art adult braces solutions. Our modern braces alternatives are designed to get you straight teeth fast without filling your mouth with uncomfortable metal brackets. Dr. Clifton Georgaklis is the inventor of the 6 month Rapid Braces program.

Straightening your teeth as an adult is a great way to boost confidence before a big event. Many adults are embarrassed with how their smile looks but hesitant to get orthodontic treatment. Adult braces from Rapid Braces have helped many adults get the smile they’ve always wanted fast. Feeling confident about your smile can make a huge difference in how you feel at a big event like a graduation or wedding. Not being afraid to show your teeth has also been proven to help in social situation and professional settings.

State-of-the-Art Adult Braces

Our Rapid Braces program has earned international respect from professionals in the field for our unique approach. Over 90% of the cases we have taken on have been completed in 6 months or less with the 6 Month Braces treatment method. Whether you need a drastic change or a mild straightening, we offer various enamel shaping and repair options as well to enhance your smile.

Rapid Braces offers a variety of flexible plans for adult braces patients. Techniques such as invisible braces, clear braces and behind the teeth braces can address even the most severe cases. More and more adults are realizing they can get the smile that they’ve always wanted fast with our 6 Month Braces option. We also understand that many adults have busy schedules and do our best to be accommodating with appointment times. It is important that anyone receiving our 6 Month Braces treatment plan attend all scheduled appointments if they wish to get their braces off as soon as possible.

Dr. G and his team are ready to help you feel great about your smile. Contact us today to schedule a free consultation.

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Get Braces Off in 6 Months or Less

Many adults spend their entire lives wishing that they could have a better smile. Big gaps and crooked teeth can cause individuals to constantly worry about covering up their smile, leading to unwanted anxiety. The thought of getting braces to get a perfect smile is often enough to scare adults away due to the painful treatment and long treatment times. Luckily, today there are a number of adult orthodontic treatment options available that can fit into any adult’s busy lifestyle.

6 month orthodontic treatment

Dr. Georgaklis began developing the 6 month braces technique more than 20 years ago and has received acclaim from fellow orthodontists worldwide. The technique was created because Dr. G realized there was an overwhelming need for fast adult orthodontic treatment. Adults were too often choosing not to get braces because of the demanding appointment schedule and lengthy treatment time. In the past it would regularly take a patient between 1 and 3 years to get straight teeth and a beautiful smile. Using the 6 month braces method that he created, Dr. G is able to finish over 90% of his cases in 6 months or less.

Come visit Rapid Braces in Brookline to learn more about our 6 month braces treatment option. Our expert staff strives to offer the most personalized orthodontic treatment option in the Boston area. With individualized treatment plans in place we are able to closely monitor your teeth’s movement and make any changes that will lead to better end results and a quicker completion time. Each case that we take on will start with a consultation so Dr. G and his trained staff can get a good look at how your teeth are aligned and put together an adult orthodontic plan tailored specifically for your needs.

Get started with 6 month braces treatment at Rapid Braces and you’ll be amazed at how quickly you get fantastic results. A better smile can significantly help with self-confidence. Former patients often drop by to let us know how happy they are with their new smile. Call Rapid Braces today to learn more about how to get started with the fastest and most comfortable adult orthodontic treatment in the Boston area.

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Avoid Delays During Your Cosmetic Orthodontic Treatment

One of the best reasons to get adult cosmetic orthodontic treatment at Rapid Braces in Brookline is the fast treatment times. Dr. G has developed his Rapid Braces technique so he is able to get patients finished with their orthodontic treatment in 6 months or less. By utilizing this method, Rapid Braces is able to complete treatment in 6 months or less with more than 90% of our patients. During treatment our expert staff is able to give patients the highest-quality orthodontic treatment in the Greater Boston area.

fast orthodontic treatment brookline

When you are getting straight teeth with Rapid Braces it is important that you attend all of the appointments that we schedule for you. We like to keep the number of patients we are treating down at any given time so we are able to provide a more personalized service. With our personalized orthodontic service Dr. G. is able to focus on each case individually and make any changes that are necessary to achieve the best results. These individualized orthodontic appointments are a big part of why Rapid Braces has been able to get so many patients perfect smiles fast.

Rapid Braces’ quick treatment times and personalized service are both carefully planned for each patient so they can receive the best possible service. Making sure you don’t miss any of the appointments that we schedule for you at the start of your treatment is essential. At these appointments Dr. G and his staff can make sure you’re taking proper care of your mouth and that your teeth are responding to the orthodontic treatment as expected. It doesn’t happen often but there are times in which we notice something we didn’t catch earlier that will improve results and reduce treatment time.

Don’t hesitate to call Rapid Braces if you are looking to get a perfect smile. Over the past several years the staff Rapid Braces has learned that the only thing preventing most people from getting straight teeth is themselves. A fear of a long and painful treatment is what causes most people to back out of starting treatment but Rapid Braces is here to change the way you think about braces. Our treatment times rarely last longer than 6 months and use modern braces technologies that minimize the amount of pain that comes along with wearing braces.

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How a Perfect Smile can Improve your Life

get perfect smile benefits

Many studies have shown that individuals who like their smiles have better self-esteem. People who feel they have straight teeth and can show off their smile have an easier time in social settings and feel more comfortable interacting with their peers. People who want straight teeth are often afraid to talk to strangers due to fear of exposing their teeth. Even though this problem exists many people won’t even consider getting braces because they’ve heard the treatment can be lengthy and painful.

At Rapid Braces in Brookline we are proud to offer a number of modern braces alternatives that will make the process of getting a perfect smile considerably easier. 75 percent of the American population doesn’t have straight teeth so utilizing our service can help you stand out in a good way. Rapid Braces also offers Dr. G’s signature Rapid Braces technique which has helped 90% of patients finish their orthodontic treatment in 6 months or less. Patients must be able to make all of the appointments that are scheduled during their orthodontic treatment if they expect to be able to be done in 6 months or less.

Getting a perfect smile at Rapid Braces in Brookline has benefits beyond just the cosmetic improvements as well:

  • Individuals with straight teeth chew better.
  • Having a perfect smile will give you a better bite.
  • Straight teeth can help you speak more clearly.
  • No gaps between your teeth will make them easier to clean and contribute to better gum health.

As you can see, there are a number of reasons to get straight teeth at Rapid Braces in Brookline. We understand the fear that accompanies some patients when they are first getting their braces put on and strive to offer a comfortable environment for every appointment. Rapid Braces offers a number of different types of braces so that every patient can choose what is best for them. A perfect smile can be a big part in a more confident you. Get in touch with our office in Brookline and schedule an appointment to learn more about how you can improve your life by getting straight teeth today.

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