New Technologies Give Orthodontists More Reasons To Smile

By Nancy K. Crevier

In the month best known for going out with a burst of caramel apples, popcorn balls, and every kind of sticky sweet known to humankind, it seems appropriate that October would be National Orthodontic Health Month. Luckily for those who wear braces and for the orthodontists who place them, newer innovations mean braces that can be removed, that are easier to keep clean, and are made of materials that are slightly more forgiving than braces of a decade ago.

Invisalign brand braces have probably made the biggest difference in orthodontics in recent years, said Dr Aaron Gilman, an orthodontic specialist at Dental Associates on Church Hill Road.

“Invisalign has allowed for more adults to do treatment,” he said. The removable and clear active retainer is perfect for adults or responsible teenagers who desire a healthier smile but do not want to be conspicuous. A series of see-through trays made of a thermoplastic material, customized to each individual’s mouth, gently move teeth into proper alignment.

“It is also a great advantage for those patients who may have problems keeping tooth hygiene top-notch,” Dr Gilman said, as the aligner is taken out of the mouth when eating and drinking, and teeth are easily brushed and flossed clean with no implements in the way.

Orthodontic specialist Dr Joshua Baum, whose office is also on Church Hill Road, agreed that Invisalign is probably the biggest innovation in orthodontics in recent years. While Invisalign has been extremely popular with older patients, he is excited that his office was selected to be a pilot office for Invisalign Teen, a form of Invisalign that became available nine months ago and that addresses some of the concerns related to teenagers wearing the removable aligners. His office is the only recognized Invisalign Teen provider in Fairfield County, said Dr Baum.

Using a 3D Invisalign computer program, Dr Baum can view the model of a patient’s teeth to help determine the course of treatment, and whether Invisalign Teen is appropriate.

“The big design change with Invisalign Teen is that now we can use it once baby teeth are out, but before the adult teeth are fully grown,” said Dr Baum. From an orthodontist’s point of view, the big questions with Invisalign have always been whether or not the young person would wear it properly, and would they lose it, though, he said. Invisalign Teen has come up with a solution to the first part of that question.

A blue dot placed on the aligner reacts with saliva — and only human saliva — and turns clear when worn for the appropriate amount of time. Parents and doctors can tell by the color of the dot if the treatment is being adhered to.

With the appliance being removed for eating and drinking, there is no way to completely control an aligner being misplaced, Dr Baum said, but Invisalign Teen offers up to three replacement aligners at no extra charge.

Improved tooth hygiene is possible with Invisalign or Invisalign Teen over traditional metal braces, he said, but wearers must be sure to brush teeth before reinserting the appliance after a meal.

Some cases are too difficult to treat with Invisalign Teen, Dr Baum said, and for the preteen patient, he still feels that the traditional route will give the best results. Even more so than with traditional orthodontics, the success of Invisalign Teen can depend on the skill and knowledge of the doctor treating the patient, he said. The Invisalign computer program aides the doctor, but the training of a doctor allows him or her to determine the nuances of the treatment that may not be suggested by the program.

New Possibilities

What excites Dr Curtis Beck, whose practice is on Mt Pleasant Road, are the advances that have been made concerning imagery and materials science, as well as the use of temporary anchorage devices (TAD). Historically, explained Dr Beck, the orthodontist hitched a group of teeth together as an anchor to pull against. But with this process, the anchor moves some as it pulls.

By using TAD, an assortment of surgical pins and attachments that are inserted directly into the bone, the orthodontist is able to achieve absolute anchorage, revolutionizing the approach to moving teeth. Because this technology is so intertwined with biomechanics, which Dr Beck feels is his forte, having trained in biomechanics at UConn Health Center, he is particularly impressed with this improvement in treatment.

“Pins have been used by orthodontic surgeons for years, but have only in recent years been FDA approved for use by orthodontists,” said Dr Beck. “With the use of TAD, we can move teeth in ways we could not before,” he said. The use of pins has further reduced the need for the extraction of teeth for orthodontic work, he added.

Material science advances mean, for one thing, adhesives that are “better than ever,” Dr Beck said, “allowing us to reduce the size of the braces on the teeth. For the patient, esthetically, that is better.”

More malleable wire materials in which the springiness of the wire in the mouth increases to help move the teeth, also lets the doctor put the wire into the braces more easily, with very little discomfort to the patient.

Looking to the future, Dr Beck sees the increased use of computer robots to bend and heat treat wires.

“The simultaneous bending and heat treating is something orthodontists can’t do right now,” said Dr Beck. “When the robot uses computer information to bend the wire, the prescription bracket will move the tooth to the ideal position. This is where we’re heading, although much of this technology is in its infancy still.”

Going from flat, two-dimensional photographs to 3D X-rays opens a world of possibilities, as well, said Dr Beck, that did not exist before. Three-D ability means the orthodontist can truly see how teeth are functioning with each other and help the doctor to better project the ideal outcome.

“Orthodontics has expanded beyond just lining up teeth and the esthetics,” said Dr Beck. “Today, we try to educate our patients more completely on how the function of the teeth and jaw is important to health. New technology is building on each new discovery for better treatment and outcome.”

Dr Gilman also praised the improvement of materials technology related to orthodontics. The heat activated wires made of nickel titanium have made orthodontics easier and more comfortable for the patient and the doctor, Dr Gilman said. The wire, which can be round, square, or rectangular depending on the stage of orthodontics and the precision needed to move the teeth, bends easily to be threaded through the braces brackets. But at 98 degrees Fahrenheit, body temperature, the wire wants to straighten out. This puts gentle pressure on the teeth, moving them into place with less discomfort than occurred with the older, less flexible wires. Younger and older patients especially benefit from this new wire technology.

Along with the wire technology, brackets have also been improved upon. The bracket is the tiny metal button that is cemented to each tooth and allows the wire to pass through, moving the teeth.

“The newest brackets have self closing ‘doors,’” explained Dr Gilman, eliminating the need for the colored ties formerly used to hold brackets and wire together. “These new braces allow the wire to be more flexible, and create less friction,” he said. More complicated moves are possible, and less friction can mean more biologically safe movement for the teeth.

“What we want to be careful with, when it comes to technology, though,” said Dr Gilman, “is choosing what helps your practice and patients. We have to be sure that technology doesn’t take away from the ‘art’ of orthodontics.”

Ultimately, the goal is to have a positive end result.

“The best gift I can get for National Orthodontic Health Month,” said Dr Gilman, “is having someone thank me for their smile.”