Shortly after my braces were removed, most orthodontists were converting to metal brackets on the front teeth. Brackets are much smaller than metal bands, so they were a great cosmetic improvement at the time. Instead of cementing a band around a tooth, the bracket is simply bonded (or glued) to the front surface of the tooth.

Another major advancement in orthodontics was the introduction of alloy wires. For many years, the only material that was used in the fabrication of orthodontic wires was stainless steel. These wires are still used today, but they are very rigid and thus they can cause quite a bit of discomfort when adjustments are made to them by the orthodontist.

Nickel-titanium is an alloy wire (a mixture of nickel and titanium metal), and they are very flexible. These wires are typically used in the beginning of treatment when the teeth are crooked because, unlike stainless steel, they can easily be bent into the brackets on the misaligned teeth. Another feature of these alloy wires is that they have “shape memory”. When they are manufactured, they are created in the ideal curvature of the dental arch as if all of the teeth are perfectly straight. When left in place within the braces over a period of time, these wires slowly and gently move the teeth into proper alignment with much less discomfort than stainless steel.

Clear or ceramic brackets were developed in the 1980’s. They are very similar to metal brackets, but they are more esthetic because they are even less conspicuous to the eye. They also are more expensive to manufacture and thus they are more expensive for the patient too. Most orthodontists offer clear brackets for a slightly increased fee for those patients who are interested in them.

Self-ligating brackets were the next innovation in orthodontics. They became commonplace in most orthodontic offices in the 1990’s because they do not require an elastic or wire ligature to be placed around the bracket. Instead, they have a small metal door built into the face of the bracket that can easily be opened and closed to secure the archwire in place. Self-ligating brackets are more hygienic than traditional brackets and they cause less friction between the bracket and the archwire, so treatment typically is slightly more efficient and takes less time overall.

Dental x-rays dramatically improved in the 1990’s as well with the advent of digital radiography. Originally, all x-rays used film to produce the images. Like the film you use in a camera, it had to be treated properly and images had to be developed in a darkroom or a large darkbox. As technology developed, digital x-rays were introduced, using digital sensors rather than film, to produce excellent quality images that are available immediately and need no development. Diagnostic x-rays can now be viewed within seconds, manipulated as needed for better resolution or contrast, instantly stored in a computer database and even emailed immediately afterward to the patient or other dental specialists so that they too can view them. This is all done now without the use of environmentally damaging chemicals, expensive film and the need to store the processed film. Furthermore, the radiation exposure is a fraction of what it was with conventional x-rays.

By the year 2000, an entirely different method of straightening teeth was being developed. A graduate student at Stanford University in California had completed his orthodontic treatment and he was given thin, clear retainers that fit over his straight teeth. At times he wasn’t very compliant in wearing the retainers, so his teeth would shift a little bit. Once he started wearing his retainers again, he noticed that his teeth would magically realign. The light bulb went off, and he and another graduate student created Align Technology, the maker of Invisalign aligners.

Invisalign works by wearing a series of custom made aligners 20 to 22 hours each day over a period of two weeks. After two weeks, the patient changes to the next set of aligners in the series and the teeth are slowly and gradually moved into their proper positions. The aligners are removable and virtually invisible, which means you can straighten your teeth without anyone knowing; and you can still eat and drink what you want. For obvious reasons, Invisalign has become very popular with both adults and teens.

Most people have experienced having impressions taken of their teeth with a mouthful of gooey putty. It can be uncomfortable and a major hassle. Fortunately, digital scanners were introduced within the last decade as a means of digitally capturing an image of your teeth. Digital scanners are far more accurate than any impression that could be taken with the old method of a mouth full of impression material. This technology allows us to capture three-dimensional images of a patient’s teeth with amazing accuracy and visually see the result on the computer in real-time as we are scanning the teeth. The scanner head fits in the mouth easily and we are basically taking digital photos of the teeth and sending them directly to the computer. The digital data can even be sent directly to Invisalign to get Invisalign treatment started sooner. The Invisalign aligners that are made from the digital scan fit up to 7 times better than those made from a conventional impression.

Another recent innovation in orthodontics is the use of temporary anchorage devices (or TADs). A TAD is essentially a very small screw made of titanium metal that can be placed inside a patient’s mouth in bone to provide a rigid point of anchorage. There are many advantages to utilizing TADs during orthodontic treatment. Since TADs don’t move, orthodontists can use them to move teeth in directions and amounts that previously were not possible. TADs are comfortable, they can reduce treatment time, they can help to improve esthetics, they reduce reliance on patient cooperation such as wearing a headgear, they sometimes can eliminate the need for jaw surgery, they enable us to move and place teeth into healthy positions that otherwise would not be possible and they can help close spaces more efficiently.

https://www.youtube.com/watch?feature=player_embedded&v=rA_HBJ660Qc

The most recent development in orthodontics is accelerated tooth movement. Last year, AcceleDent was introduced to orthodontists for the first time. It basically is a hands-free medical device that is worn by a patient 20 minutes every day and it produces light vibrations or micropulses that accelerate tooth movement by up to 50%. It even allows orthodontists to reduce the number of visits for their patients using the appliance. A good example of this is with Invisalign patients. As stated earlier, Invisalign patients wear a set of aligners for two weeks and then advance to the next set for another two weeks. Those aligner patients using the AcceleDent appliance wear their aligners from between 4 days to 7 days and their teeth move beautifully and with minimal discomfort.

Orthodontics has a come a very long way in the last several years. As you can see, there are many new and exciting innovations that make orthodontic treatment more desirable and efficient to both children and adults!

By Dr. Gary Reichhold

The post What’s new in orthodontics? appeared first on Mount Diablo Orthodontics- Dr. Reichhold & Dr. Vargas.

TAD’s are sometimes necessary in cases where a patient’s teeth need to be moved in a certain way to get the results that we want. For example, when a tooth is extracted prior to orthodontic treatment due to crowding in that area of the mouth, the teeth on either side of the extracted tooth move toward each other to close the space. This movement between teeth is based on one of the laws of physics that states that “for every action there is an equal and opposite reaction”. However, if a patient has a severe overbite and an upper tooth is extracted on each side of the mouth to make room to move the upper front teeth back, we need to maximize that backward movement to correct the severe overbite. In order to accomplish this, we need to anchor the upper back teeth so that all of the movement comes from the upper front teeth. That’s where TAD’s come into play!

The placement of a TAD is very simple and painless. We typically place a topical anesthetic on the gum tissue overlying where the TAD will be placed. The gum tissue is the only part of the mouth that can feel anything because there is no innervation within bone itself. As long as the gum tissue is numb, the procedure will be completely painless. A driver that is similar to a screwdriver is used to drive the TAD through the gum and into the bone. Insertion takes less than a minute in most cases. TAD’s are usually placed between the roots of two adjacent teeth. In the rare case of root damage, roots will typically repair themselves without issue. When it is time for the TAD to be removed, anesthesia is rarely even needed. It’s that easy!

After a TAD is in place, it provides an immovable object that can be used to pull, push, intrude or extrude teeth that are being straightened. The only requirement is that patients keep the gum tissue around the TAD clean and healthy. In addition to routine brushing, a mouth rinse such as chlorhexidine should be used on a regular basis until the TAD is removed. As long as the gums are kept healthy, there are very few complications that can arise from a TAD.

There are many advantages to utilizing TAD’s during orthodontic treatment. Since TAD’s don’t move, orthodontists can use them to move teeth in directions and amounts that previously were not possible. TAD’s are comfortable, they can reduce treatment time, they can help to improve esthetics, they reduce reliance on patient cooperation such as wearing a headgear, they sometimes can eliminate the need for jaw surgery, they enable us to move and place teeth into healthy positions that otherwise would not be possible and they can help close spaces more efficiently. Orthodontics has a come a very long way in the last 10 to 20 years. Temporary anchorage devices are one of many new and exciting innovations that make orthodontic treatment more desirable and efficient to both children and adults!

By Dr. Gary Reichhold

The post What are Temporary Anchorage Devices? appeared first on Mount Diablo Orthodontics- Dr. Reichhold & Dr. Vargas.