Rapid smiles, rapid braces, 6 month braces – can it be true?
“6 month braces” is the latest buzz word in orthodontic marketing . Six months braces – speedy braces – rapid smiles – straight teeth in no time at all – its what everybody wants but is this just marketing hype? Not every case can be treated in 6 months but with the right strategy it is possible to streamline many cases to make this hope a reality. In almost all brace treatments the initial 6 months is when the most tooth movement occurs because usually very light and springy wires are used which have a long range and minimal resistance.
What type of cases are suitable for 6 month braces?
Simple cases requiring only small tooth movements should be amenable to short term treatment. Mild crowding cases with proportional jaw growth are the most common type of orthodontic problem and are also usually suitable for ‘ 6 months braces ‘ . If your teeth and jaws do not fit into this category it may still be possible to ‘straighten the teeth’ in 6 months but it may be necessary to accept some amount of compromise in the bite position. Usually this is acceptable to most patients and compatible with normal health and function. Sometimes apparently complex and severe malocclusions can be improved substantially in a short period of time by choosing unusual extraction patterns or incorporating some cosmetic dentistry. The key to success is in the treatment planning – and we have over 15 years experience planning and solving orthodontic problems. The type of case which is not likely to complete in 6 months involves any treatment in which an (extraction) space of more than 5mm needs to be closed, or a jaw size discrepancy is to be corrected.
How can teeth be straightened in 6 months? – Using a custom appliance to improve the accuracy of the appliance
About 30 years ago orthodontic fixed appliances were relatively crude or difficult to control, making treatment slow and not always ideal. In the mid 1970s a new appliance concept (‘straight wire’) was introduced which programmed much of the tooth position into the shape of the bracket (the bit attached to the tooth) – and for the majority of cases a good result is achievable simply by correct bracket placement and working through the wire progression. Most good orthodontists use this technique. However the straight wire appliance rarely delivers the teeth directly to the desired position straight out of the box, because of small errors in bracket positioning and variation in skeletal and tooth anatomy from person to person. The orthodontist accounts for this by customizing the braces by bending corrections in the final archwires over a number of appointments until the desired result is achieved – and this can be slow. At North Sydney Orthodontics we use Suresmile – the most advanced orthodontic technology available to reduce treatment time. Dr Daniels develops an ideal tooth alignment from a digital model of your teeth and bracket positions, and this information controls amazing wire bending robots that produce the custom arch wires. Suresmile avoids undesirable diversions on the road from crooked teeth to straight teeth. Not only is this custom alignment fast, its also biologically better for the teeth and allows much better control of tooth position than can be achieved using traditional braces or other so called 6 months braces.
Making teeth move faster – Overcoming the resistance to alignment from tightly contacting adjacent teeth
If you find difficulty passing floss between your teeth because it is so tight it is likely that you have high contact point resistance. High contact point resistance slows down tooth alignment. As an adult it is also likely that triangular spaces will appear when overlapped teeth are aligned. The solution to both of these problems is to slim down the contacting surfaces of the adjacent teeth- a process called interproximal stripping. If you have spacing between the teeth- this does not apply to you!
Making teeth move faster – the application of forces
It seems obvious that if we could make the teeth move faster treatment would be quicker. There are many factors which govern the speed of tooth movement in orthodontics most of which are intrinsic to the patients metabolism and arrangement of teeth. There are a number of possible interventions: Acceledent is a device which generates vibrations which are passed to the teeth and provide stimulation to the bone through an as yet unidentified mechanism. It has been available for 2-3 years and there is currently limited but encouraging evidence for its efficacy. Acceledent is currently only available through specialist orthodontic practices and we supply the acceledent device to our patients on request at cost price.
Surgically accelerated tooth movement
The regional acceleratory phenomenon arises following traumatic bone event such as tooth extraction or surgery (decortication) which causes a 6-10 week boost to tooth movement. There have been a variety of proposed surgical insults to initiate this phenomenon, which range from minor denting of the bone right through to wholesale removal of the outer shell of the bone between the teeth. We can arrange this procedure through a jaw surgeon or periodontist but the overall effectiveness of this process has recently been brought into question.
Drug therapy has not been shown to be effective in accelerating tooth movement but certain analgesics may slow down tooth movement.
Orthodontic tooth movement is intermittent with periods of initial movement following appliance activation, then rest once the appliance becomes deactivated. Using higher forces or reactivating the appliance more often seems like a possible strategy to increase the speed of tooth movement but runs the risk of damaging the teeth as shown in these x-ray images .
The x-rays show the patient’s initial presentation and the resulting damage to the roots and nerves of the teeth following incompetent orthodontic treatment by a general dentist (who claimed to be an expert in orthodontics). The patient reported having frequent appointments over a period of 3 years. Notice many of the roots are short and blunted and the black stripe of the nerve has disappeared from the middle of several teeth indicating the teeth have been injured.
Magic orthodontic braces – Can teeth move faster with self ligating brackets?
Manufacturers have claimed treatment advantages for competing bracket designs over recent decades particularly for self ligating brackets. The claim for shorter treatment times was first made by the original self ligating system the Damon system, and many lookalikes have appeared making similar claims. Unfortunately the science has now caught up with the ‘bracketeers’ and comprehensively disproved all of the claimed “patient benefits”. But some orthodontists will still promote these claims because the adjustment time for a self ligating bracket is quicker – which means more patients can be treated per hour using self ligating brackets.
Glam Smile or veneers
This is probably one option your orthodontist will not discuss with you because it is not orthodontics. Once you have had your 6 months of braces assuming things have gone well some improvement should have occurred. Whatever irregularity remains can be cut out and concealed using careful recontouring of the teeth with cosmetic filling material and selective grinding of enamel. While it is cosmetically effective in the short term it potentially damages the teeth by creating bacterial plaque retention areas, potential nerve injury to the teeth, and a lifetime commitment to repairing the cosmetic dentistry as it wears and stains. It may be appropriate however if the front teeth are already heavily repaired due to previous injuries or decay.
Why are dentists so keen to promote 6 month braces?
It is simple – there is insufficient work to maintain a general dental practice in metropolitan Australia without diversifying into the fringes of clinical practice, and a six month braces implies acceptance that the standard of care is subordinate to the treatment duration.
Why don’t orthodontists flog this type of treatment?
For very simple cases we can already achieve alignment in 6 months with no special tricks. For other cases it is possible to undertake the measures listed above and obtain a great result in 6-9 months that is a great benefit to both patient and a credit to the orthodontist. Under many circumstances however 6 months braces = compromise , and while this can be masked using cosmetic procedures, that is not a natural instinct for an orthodontist. No orthodontist can hope to build a reputation as an expert provider (for referrals) based on compromised treatments. Orthodontists tend to be perfectionists and strive to attain the highest level of result within the demands of the patient. Occasionally tooth movement is very slow no matter how the treatment was marketed or designed- because tooth movement is mostly determined by the patient’s bone metabolism, and all orthodontists have had patients who have confounded their expectations for treatment duration.