Vivera Retainers in Toronto 2013: An Update from your Top Invisalign Specialist

As discussed in a previous blog entry on Vivera and retainers, one of the most important parts of orthodontic treatment is how to maintain the beautiful results that were achieved using braces or Invisalign.  There are many different types of retainers, and one of the popular types is Vivera retainers from Invisalign.

Here are some of the important points to understand about Vivera:

1.  You receive 4 sets.  The first is fit at the office and three more are sent to you about 1 month later.  Prior to this year, the additional 3 were sent at 3 month intervals, but this is no longer the case.  Part of it is likely to help Align reduce shipping costs, but from a patient standpoint, it is also to realize that they do not need to be changed every three months, but as needed.

2.  Our patients are finding that each Vivera retainer is lasting at least one year, with many keeping them quite a while longer.  To draw a parallel with Essix retainers which also can last several years, the Vivera retainers are much stronger and can last longer than that.  Therefore, your subscription for Vivera can last you many, many years if cared for properly.

3. The cost for Vivera is often not included in your original financial plan (we do, include it as part of the treatment for our Invisalign patients at MCO Orthodontics).  The range of fees for the subscription can go from about $400 to $1600.  If you consider a fee to be around $800, that would be $200 per set, or $100 per retainer, so there is quite a lot of value there.  Other factors to consider are whether a scan/impression needs to be taken, and the cost of the visit to insert the retainer.

4.  Vivera retainers can be created with a new scan, new impression, or from any stage of your ClinCheck.  If you have attachments on your teeth prior to your original scan (as in refinement, mid-course correction, or custom attachments placed by your doctor), you may be better off having a new scan than asking Align to virtually remove those attachments.  If you have braces on, the brackets can be much more easily removed virtually, and it is possible to get a scan with your brackets on.

5.  Vivera retainers can be used in combination with fixed lingual retainers.  They are not always a substitute for them and in some cases, both may  be required.

Acceledent in Toronto : Faster Invisalign, Shorter Time in Braces, More Comfortable Orthodontics

Your Markham and Stouffville Orthodontist knows that two of the largest barriers to treatment are the duration of treatment, and the potential for pain or discomfort.  As an industry, we have always worked to change the various appliances and techniques that we use instead of trying to actually change the physiological process in our bodies.  Orthodontics has adapted long known principles of bone remodelling from orthopedics now with Acceledent.

Before Acceledent, there have been a few techniques that have been used to accelerate orthodontics such as Wilckodontics and Propel.  The principle of tooth movement is that there is a need for bone remodelling via osteoclasts (removing bone from surfaces of the teeth where they need to move) and osteoblasts (cells that build bone behind the tooth where it has moved from.)  Wilckodontics is a periodontial procedure whereby the the gums are retracted and the bone around the teeth is purposefully scored, whereby causing bleeding.  Teeth do move faster with this procedure, but the comfort aspect takes a backwards step, since it is quite painful.  Propel works on a similar principle.

1st generation of Acceledent

Acceledent is a product that has been used in Australia for about 4 years, in the USA for a bit over a year, and was just cleared for use in Canada in the spring of 2013.  It is FDA approved as a Class 2 medical device.  The claims are that treatment can be reduced by about 38-50%, based upon studies at two universities in Texas.  It works by providing a pulsating vibration at a key frequency (30Hz) which has been shown to stimulate the bone remodelling process.  Patients use it for just 20 minutes per day.

There is a possibility for faster treatment with braces and Invisalign aligners to be changed every 4-7 days, significantly decreasing the amount of treatment time required.  Best of all, over the study of 1000s of patients, there have been no adverse effects, including no significant root resorption.  Note that there are no longer term studies of this application in orthodontics, but similar principles have been in place in other medical fields for many years.

This is a very exciting possibility for patients at MCO Orthodontics who would like to have straight teeth with less discomfort and for a shorter amount of time.  Look to MCO Orthodontics as your leader for fast Invisalign in Toronto.

Stouffville Orthodontist Celebrates 10th Anniversary for Study Club of Top Elite Orthodontists

There are many aspects to running successful orthodontics offices that produce both excellent results and provide excellent customer service.  To this end, Dr. Tam and his team at MCO Orthodontics look to be at the forefront of the orthodontic industry, at times working with consultants in the field of orthodontics, those outside of our field, as well as with orthodontists around the world.  It is the only way we can continue to be your choice for orthodontist in Stouffville and Markham.

One such group of orthodontists is a hand-picked group by one of the top orthodontic consultants, Karen Moawad, founder of Hummingbird Associates.  Karen is a pioneer in her field and has shown consistent results of helping orthodontic practices reach their potential.  This year marked the 10th year of the study club and orthodontists flew in from all over the country to meet at the Public Hotel in Chicago.  The group acknowledged Karen with the appropriate gift of an "apple" from Tiffany's as well as some jewelry.  There was also a donation made to Karen's charity in India on her behalf.

Most Recent Evidence About Self-Ligating Braces as of 2013 Are Self-Ligating brackets better?

At MCO Orthodontics, we still do not use self-ligating brackets because there is not enough evidence regarding their superiority.  Recently, the AJODO, our association journal, had both sides in a point and counterpoint.  At this time, the evidence in the strongest studies shows no difference in self-ligating brackets such as Damon, Empower, and SmartClip compared to traditional braces.

Friction that is commonly measured in these self-ligating studies trying to support their superiority is usually a first order friction (force of an elastic on top of the wire) rather than a second order (binding at the corners of the brackets).  For orthodontic purposes, the binding is the important factor, and this has not been studied by proponents of self-ligating brackets.

You might wish to read both of the arguments and make your own decision.

http://journals.elsevierhealth.com/periodicals/ymod/article/PIIS0889540612010256/fulltext

http://journals.elsevierhealth.com/periodicals/ymod/article/PIIS0889540612010268/fulltext

Our office wants to use the best treatment options for our patients and we are at the forefront of modern orthodontics, but as orthodontics is a science, we do need to rely on the strongest evidence when deciding on which options to offer.

Toronto Invisalign Orthodontist Dr. Jason Tam Speaks to Canadian Orthos in Costa Rica

Dr. Jason Tam, your Elite Invisalign orthodontist at MCO Orthodontics, serving Richmond Hill, Markham, Stouffville, and Thornhill, recently took a quick trip down to San Jose, Costa Rica to speak about Invisalign as a technique rather than an as a commodity.  He discussed how orthodontists can become more proficient in this technique, and showed several case examples of how movements that were previously thought impossible with aligners, could actually be achieved.  His talk, closing lecture for the Canadian Orthodontic Invisalign Costa Rica Study Club, was thought provoking and very well-received.  No longer should it be asked if Invisalign can correct something.  The right question to ask the doctor is if he/she can correct something using Invisalign… a subtle but large difference.

Dr. Jason Tam speaking to orthodontists across Canada.

While down in Costa Rica, Dr. Tam visited the Invisalign Treat Facility, for the third time.  It is at this facility where the technicians modify ClinChecks based upon the directions of the doctor.  This type of regular interaction with key members of Dr. Tam’s Invisalign team ensures that the proper treatment plans are being developed, according to his instructions.  As the features of Invisalign change, and more complex malocclusions are corrected, the technician must be updated on how they will impact the desired ClinCheck program.

Dr. Tam at Costa Rica Invisalign Treat Facility with his Territory Manager Craig MacIntyre

To ensure proper continuity, Dr. Tam spoke extensively with the staff dentists at Align, and worked with a second technician to help work with his simulations.  This ensures Invisalign patients at MCO Orthodontics the consistency and level of excellence they deserve.

Dr. Tam with two of his technicians and Align dentist Dr. Guitterez

Dr. Tam would like to thank Align for inviting him to speak again, having spoken across Canada, United States, and now in the town of the Invisalign Headquarters in San Jose, Costa Rica.  He is also grateful to his techs and dentists for their warm congratulations on Dr.Tam’s selection for the 2012 Invisalign Case Competition in Las Vegas.  MCO Orthodontics continues to work hard to stay at the forefront of Invisalign treatment in the world!

Invisalign SmartTrack Material Information from Dr. Jason Tam

There has been a lot of buzz about a new material called SmartTrack from Invisalign.  The following is information from the webinar from Align Technology regarding the release:

EX15 = Template material
EX30 = Original aligner material
EX40 = Vivera material

LD30 = SmartTrack material

As per Align webinar:

-new material started for cases approved after January 14, 2013 with full roll out by January 21, 2013

-thickness will be the same

-no BPA

-some increase in staining/clouding of the aligners

-all new refinements/midcourse corrections will get new material.  Replacement aligners using original EX30.

-easier insertion and removal of aligners

-more flexible and better adaptation to the teeth

-material to start with less initial pressure at start of two weeks but more pressure for a longer period of time

-allergies reported = those with EX30

-gliding sensation when inserting (less force on initial delivery)

-fewer broken/cracked aligners
-works well with SmartForce features

New Enhancements to Invisalign G4 (available Feb 23, 2013)
- root control for upper laterals similar to those for upper centrals/canines.  If lateral incisor is too small, then there is one attachment and up to two pressure points (3 force systems)
- root control for upper premolars similar to those for upper central.  If premolar is small, there will be one attachment and a pressure point
-attachments customized for each tooth based on morphology

Invisalign Outcome Simulator with Toronto Orthodontist

There have been a number of notable advancements in Invisalign care in the past few years.  One of the most recent is the Invisalign Outcome Simulator.  It is a useful tool for patients to get an idea of how their teeth might look after teeth are made straight.

An Invisalign iOC scanner is required to see the before and after simulation.  The scan is completed, and then the long axes of the teeth are marked.  The simulation takes about 5 minutes to complete, and then individual teeth can be adjusted to produce the final outcome.  Items such as extractions, IPR, expansion, etc can also be simulated.

Current dentition and then simulated outcome using Invisalign Simulation Outcome

A couple of very important things to note:

1.  The simulation cannot be saved for the doctor nor for the patient.  It is simply to be used as a tool to show what may happen.  The scanned teeth are good for sending to Align for Invisalign treatment.

2.  It is only a simulation, meaning it may not be a good representation of how teeth may actually end up.  It is also not a ClinCheck plan.

Nevertheless, it is an interesting tool that some patients may be interested in before beginning Invisalign treatment.  If you are in the Toronto area and interested in Invisalign or the Invisalign simulator, please visit our Markham Orthodontist website.