There are many variations in the design and types of braces, each of which has specific attributes and purposes in dental orthodontics. At Sax Dearing Orthodontics we recognize that no one system of mouth braces will suit every patient’s treatment requirements. So rather than using just one type of orthodontic device we choose the system or combination of systems that will best address each patient’s unique bite problem. Some require top teeth braces and others lower teeth braces or both. Each patient can therefore be assured of personalized orthodontic health care managed according to his or her own custom-designed plan of braces for their teeth.
TP Pre-Finishers® and Tooth-Positioners®
The Pre-Finisher is a soft, resilient finishing appliance in which the tooth positions are in perfect positions. As you exercise (bite) into it, it stretches and pushes back against your teeth like multiple little springs. The pressures applied are in just the right directions to help finish treatment to the highest possible standards. Patients exercise into these appliances by clenching and un-clenching their teeth (isometric) 3-4 hours daily and then sleeping in them at night. Pre-Finishers are a stock item and are used to finish cases and act as an unbreakable retainer. Tooth-Positioners are custom made and used to treat mild orthodontic cases.
Clear Aligners “Invisalign”®
Invisalign® treatment, which uses clear Invisalign® aligners, is a rigid, resilient treatment system that employs a series of clear polycarbonate overlay templates. Although Invisalign® teeth straightening is the most widely advertised there are now actually many brands of clear brackets or transparent braces available. 3-D computer technology is employed to translate the orthodontist’s detailed treatment plan into a series of these aligners, each of which is designed to produce a finite amount of sequential tooth movement. Clear aligners are most effective when chosen for correction of relatively minor malocclusions or those of moderate complexity. Generally, the physical attributes of clear aligners limit their ability to detail tooth-positions precisely.
In a recent article, Djeu et al, found that cases treated with Invisalign failed the American Board of Orthodontics objective grading system 27% more often than cases treated with conventional braces. Thus, in more more complicated cases, clear aligners may be combined with conventional fixed appliances in order to take advantage of the best attributes of both systems.
Sax Dearing Orthodontics have extensive experience with this approach to orthodontic treatment. We would be pleased to evaluate your particular needs to determine if this orthodontic appliance system is an appropriate option for you to consider. See: Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Djeu,G., Shelton,C., and Maganzini. A. American Journal of Orthodontics and Dentofacial Orthopaedics 292-298, September 2005.
Functional or Dentofacial Orthopaedic Appliances
These appliances, either removable or fixed, are typically used in younger patients and are often combined with partial or full braces attached to the teeth. They are employed to modify growth of the facial structures in order to create balance between upper and lower jaw size and position. Since their effectiveness is growth dependent, their use is limited to children and young adolescents. However, they are bulky and uncomfortable and are largely ineffective in about 80% of cases.
In cases where they are effective, the extent of corrections are highly variable between patients. Corrections are achieved by a combination of tooth-tipping and growth modification in varying amounts and both are subject to significant relapse. Interestingly, it has now been proven that conventional braces are able to elicit similar growth modifications rendering the use of such appliances largely obsolete. Furthermore, a recent twin study from Japan showed that one of a pair of identical twin girls who had her upper jaw (Maxilla) expanded by a functional appliance between the ages of 9 and 13, actually ended up with a measurably smaller upper jaw than her sister at the age of 16. See: One-Phase vs 2-Phase treatment for developing Class III malocclussion: A comparison of identical twins. Sagawara J, Aymuch Z and Nanda R. American Journal Of Orthodontics and Dentofacial Orthopaedics. January 2012, Vol 141, Issue 1, pages e11-e22.
Conventional Stock Braces
Orthodontic appliances usually consist of brackets attached to the surfaces of the teeth and a series of flexible wires that are adjusted periodically to gradually and gently move the teeth toward their intended positions. The brackets most commonly are made of metal. For some patients clear or tooth-coloured ceramic brackets may be recommended.
Metal brackets have the advantage of being sturdier, thus resisting breakage and permitting adjustments to be made with a high degree of precision. Ceramic brackets have the advantage of being less visually obvious especially Ormco Inspire Ice® brackets which are made of industrial sapphire and never, ever discolour.
At Sax Dearing Orthodontics we use both types of brackets and will be pleased to discuss with you which design is most likely to meet your personal needs. Experience has taught us at Sax Dearing Orthodontics to fit Ormco Inspire Ice® brackets on the upper incisors and metal brackets and tubes elsewhere to provide the best compromise of aesthetics and efficient tooth-movement.
It seems logical that a bracket design minimizing friction between the brackets and the arch wires would be most efficient in accomplishing tooth movements. Damon brackets and Innovation brackets are two examples of self-ligating bracket designs. However, the most recent scientific evidence available confirms there is no difference in treatment times between cases treated with conventional brackets and self-ligating brackets. See: Self ligating brackets vs conventional brackets in the treatment of mandibular crowding: A prospective clinical trial of treatment duration and dental effects. Pandis, N., Polychronpoulou,A., and Eliades, T. American Journal of Orthodontics & Dentofacial Orthopedics 208-215, August 2007.
“Insignia”® by Ormco – the “Rolls Royce” of braces
Traditionally, fitting a patient with orthodontic appliances, or braces, has not been an exact science. Like shoes, braces are designed for a statistically average person, although few orthodontic patients can be described as “average.” The orthodontist must also position the braces using only hand-eye coordination, and then make adjustments based on experience and initial results—a process called “Therapeutic Diagnosis” that can take up to two years or more.
Ormco’s process scans impressions of the patient’s mouth and with their unique 3-D computer technology designs a set of brackets, arch-wires and bracket-positioning jigs to provide orthodontic devices that are fitted exactly to individual patient’s teeth. It also enables the orthodontist to physically visualize the course of treatment. Such up-front visualization is key to guaranteeing a smooth progress of treatment because changes don’t need to be made down the road. Patients will be more comfortable, spend less time in the orthodontist’s chair, and get a smile tailored to the shape of their jaw and face. While the technology benefits all patients, it is most effective for the simplest and most complex cases.It will also get results much faster.
There are three parts to the Insignia system: jigs, brackets and wires. Jigs are made from digital impressions of the patient’s teeth and act as mini stencils or road maps for precisely positioning the brackets, which attach to the teeth and receive the wires. The only thing that matters about the bracket is its slot. It’s specifically made to receive a customized wire that moves the patients’ teeth to the middle of the jaw bone, based on data taken from the original impressions, so wires are perfectly shaped and sized to match each patient individually. Like traditional orthodontic appliances, Insignia’s super-elastic wires begin moving the teeth. As the teeth get straighter, the wires don’t pull with their original force and must be changed for wires with a heavier cross-section that will continue moving the teeth toward the desired result.
Habit Control Appliances
Finger sucking, thumb sucking, tongue thrust, and lip biting are oral habits that may cause a bite problem or may make an under-lying bite problem more complicated. Habit control appliances of different types are used as a means of assisting children with habit cessation. In addition habit control may be augmented by myofunctional/speech therapy directed at retraining altered oral muscle (tongue, lips, cheeks) posture and function.
At Sax Dearing Orthodontics we work closely with patients, parents, and when required, speech therapists to ensure that persistent oral habits will have as little impact as possible on the achievement of a healthy bite and an attractive smile.