Check out that smile

Hi-tech advances in the correction of dental irregularities reduce the need for costly, time consuming, uncomfortable procedures and help keep teeth healthy.

By DEBRA KATZ
IT IS recommended every child get a check-up with an orthodontist (photo credit: MCT)
IT IS recommended every child get a check-up with an orthodontist
(photo credit: MCT)
‘And thou shalt do that which is straight and good… that it may be well with thee” (Deuteronomy 6:18) When this commandment was given to the Israelites, God may not have been referring to straightening teeth! But it is well-documented in the scientific literature that there are numerous benefits to orthodontics, the correction of irregularities in the alignment of the teeth and jaws.
Crooked and crowded teeth are hard to clean and maintain, contributing to tooth decay and gum disease.
A malocclusion, or bad bite, can cause tooth enamel to wear abnormally or teeth to chip. There may be excess stress on supporting bone and gum tissues, leading to their deterioration. In addition, a bad bite may contribute to chewing and/or speaking difficulties, and joint-related problems. By aligning teeth and improving the bite many of these problems can be prevented or corrected, often reducing the need for other more costly, time-consuming and uncomfortable dental procedures. And, of course, who doesn’t want a beautiful smile? Parents always want the best for their children, which should include healthy teeth and a pleasing smile. It is recommended that every child get a checkup with an orthodontist at the first recognition of the existence of an orthodontic problem, but no later than age seven. By that age, permanent teeth have begun to erupt and it is possible to determine whether an orthodontic problem exists or is developing.
While this does not mean treatment will be recommended at such a young age, an exam by age seven gives the orthodontist the opportunity to monitor the child’s tooth and jaw development – and to recommend the appropriate treatment or intervention at the appropriate time. Delaying a check-up with an orthodontist until a child has lost all of their baby teeth could be a disservice, since some orthodontic problems are easier to correct if they are identified early. In this manner, results may be achieved more efficiently and more comfortably for the child, which otherwise may have been impossible once the face and jaws have finished growing.
But the good news is it’s never too late! Today, one in five orthodontic patients in the US is an adult, as reported by the American Association of Orthodontists.
Although there are no similar statistic available in Israel, it is most likely a similar number.
HEALTHY TEETH can be moved at any age. Thanks to the variety of “appliances” used by orthodontists today, adults may be able to less conspicuously achieve the great smile they want. Many of today’s treatment options are designed to minimize the appearance of the appliance, and office visits can better conform to an adult lifestyle.
So what advances in orthodontic technology have contributed to faster and more comfortable treatment? Orthodontics, like any medical procedure, begins with a proper diagnosis of the problem. This requires a thorough clinical examination and often an analysis of various X-rays, photographs, and plaster casts of the mouth.
Today orthodontic records can be prepared digitally, facilitating the analysis, storage, transferring and sharing of high-quality diagnostic information. Also becoming available are 3D printers, which can use a digital scan of a patient’s mouth to produce a computer image, while 3D Computer-Aided Design/Computer- Aided Manufacturing (CAD/CAM) technology can “print” an orthodontic model and even various orthodontic appliances. Imagine no more uncomfortable bulky impression materials in a patient’s mouth in order to reproduce a model rendition of their teeth.
Another advancement has been the introduction of cone beam CT scanning. The eD images they produce of the entire skull, jaws and teeth provide a much clearer picture of a patient’s complete dentition and other facial structures that allow, when necessary, for more accurate and thorough evaluation than that provided by 2D conventional X-rays.
Much has also improved in the actual “hardware” that orthodontists use to correct malocclusions. There are a variety of types of “braces” available, including more aesthetic options made from clear or tooth-colored materials, or brackets that are designed to be attached to the inside surface of the teeth (lingual orthodontics).
There are also braces with a built-in clip mechanism supposedly allowing for shorter adjustment visits and shorter treatment time.
CAD-CAM technology is also being used to produce patient-specific brackets based on the orthodontist’s proposed tooth-moving plan for that particular patient.
There is even a technology to improve bracket placement on the teeth that uses a wand with a builtin miniature video camera that transmits real-time images from the patient’s mouth to a screen. When the software detects a match between the projected image and the predetermined clinician-prescribed bracket position, a signal confirms this and allows the doctor to accurately attach the bracket to the tooth.
In addition to the bracket component of braces, archwires made of various types of metals in a variety of sizes and shapes are seated into the brackets and provide the force necessary to move the teeth. In the 1970s, a very significant advancement was made that has dramatically changed the types of orthodontic archwires used today. Nickel-titanium alloys were developed by the US Naval Laboratory and their typical “shape memory effect” was observed. Orthodontics benefited enormously from this ability of a wire to “remember” its original shape after being distorted. In the 1990s, these archwires were further improved with the additional feature of being activated by changes in mouth temperature. These state-of-the-art archwires generate constant light forces, enabling the clinician to better control tooth movement in a more comfortable manner for the patient.
Today there are treatment options available that are more aesthetically pleasing and comfortable than even the highest-tech braces on the market. Aligner technology involves a series of clear, removable plastic aligners that are custom-made for the patient and sequentially worn over the teeth to gradually move the teeth to the desired position, based on exact movements prescribed by the orthodontist to the manufacturer. The original aligner system was called Invisalign, and today many more such systems are available.
Advancements in the plastics industry have provided orthodontists with plastic aligners that can be “activated” or adjusted by special heated pliers creating divots or bubbles in the plastic, thereby producing a specific amount of force on a specific tooth location in order to gently move the tooth. Aligner treatment has a huge advantage over conventional braces, in that they are a removable type of appliance which allows for improved oral hygiene, critically important to the patient’s dental health (though not all orthodontic problems can be treated with aligner technology).
REGARDLESS OF what type of appliance is used to move teeth, an orthodontist must always design the treatment plan to take into account a basic principle in physics, Newton’s Third Law of Motion, which states that for every force there is an equal and opposite force. That means that when a force is applied to a tooth in order to intentionally move it in a desired direction, another equal force exists that might cause an undesired effect. This is counteracted with what is called “anchorage.” An exciting new modality in orthodontic treatment, it uses small, surgical-grade titanium screws as temporary anchorage devices.
TADs are relatively easy to place and remove and provide a secure anchor point in a patient’s mouth, to allow only for the desired tooth movement and eliminate unwanted movement elsewhere. Once treatment is completed, the TADs are removed.
Some of the more recent research and development in orthodontics relates to the speed of completing orthodontic treatment.
Simply stated, how can orthodontists move teeth faster? A relatively new product that is used in conjunction with conventional braces is a mouthpiece, used for just 20 minutes a day, which generates gentle cyclic pulsing forces on the teeth.
This allows for faster tooth movement by accelerating the jawbone reshaping process that takes place around the roots of moving teeth.
Another available technology employs a custom-made plastic mouthpiece with an underlying inflatable silicon balloon that fits over the patient’s teeth. It is connected to a small machine that provides a programmable pulsating force which moves the teeth towards the desired position; it is intended for use 10 hours a day.
As with any treatment decision, these new technologies should be discussed by patient and doctor so that the patient can fully understand the advantages and disadvantages they offer, and enable the patient to best make educated decisions regarding their treatment. Not all technologies are necessary or beneficial in treating all orthodontic problems.
So what does the future hold for orthodontics? Since most orthodontic problems are inherited, will there ever be technology to prevent a malocclusion from developing? Time will tell! Meanwhile, at least new strides are continuously being made in advancing the treatment of orthodontic problems – making a beautiful and healthy smile available to everyone.
■ The author, a graduate of Columbia University Dental School, New York, and Hadassah Dental School’s orthodontic residency, maintains an orthodontic practice in Jerusalem, servicing children, adolescents and adults.