Tuesday, December 1, 2009

Toronto Damon Braces and Richmond Hill Self-Ligating Braces... What does the evidence say?

Markham Invisalign and Unionville braces patients know MCO to be a high-tech, modern clinic offering exceptional patient care. New patients often ask us about the types of braces used to correct improper alignment and bites. In the last several years, many orthodontic companies have pushed self-ligating (SL) brackets including Damon braces, SmartClip Speed, and Innovation R. Patients have referred to them as “braces that don’t require extraction” or “new technology braces” or “painless braces”. These braces do not require an elastic tie to secure the wire as there is generally some sort of sliding door mechanism. The manufacturers make several claims as pulled directly from their websites:

  • Straighten teeth faster due to reduced friction
  • More comfortable/painless treatment
  • Reduce the number of tooth extractions
  • Reduce the number of visits
  • Reduced amount of root resorption

Here are some of the common questions we hear about these braces...

Are self-ligating or Damon braces better than traditional braces?

Do Damon Braces or Self-Ligating braces work faster?

Are Damon Braces or Self-Ligating braces pain-free?

In 2008, Miles published a paper in one of the most highly respected orthodontic journals, Angle Orthodontics, confirming Kusy’s findings in the late 90s, describing friction in conventional vs SL braces. He noted that the friction of the wire against the corners of the brace (2nd order friction for those physicists and engineers out there!) was the major factor in the speed of tooth movement rather than the force of the elastic against the wire. This property is present in every brace. He was unable to validate manufacturer’s conclusions that SL braces move teeth faster.

This year, in 2009, Fleming also published in the same journal. He wrote that “clinical trial data do not support the contention that treatment time is reduced with SL brackets”. He went on to say that, in fact, there may be a greater number of visits due to a greater number of wire changes required. Patients complained of greater discomfort at their visits from the increased pressure required to open and close SL bracket doors. Speed of tooth movement is independent on bracket type and there is no difference in the amount of root resorption. Braces themselves do not hurt, as evidenced by no pain during the time braces are being put on. It is the mobilization of teeth that causes the teeth to be sensitive, and no brace thus far, has been able to change this biological process.

Do Damon Braces or Self-Ligating braces reduce the need for extraction?

The debate of extraction versus non-extraction is extremely controversial. The bottom line is that extractions can be of benefit in certain situations. There are limits as to the amount of jaw expansion that will remain relatively stable and healthy with respect to the gum and bone structure. Various studies have shown that bone does not regenerate around the teeth, despite using Damon braces, as the company asserts. Sometimes, extractions will improve the profile, as in individuals who cannot close their lips without strain, or who have a protrusive profile. Extractions do not need to mean dished in faces. With proper orthodontic movement, the right amount of retraction of anterior teeth, and protraction of posterior teeth will yield excellent results.

So why are many orthodontists offering Damon braces and SL braces?

The amount of chair time may be reduced for the person changing your wire to flip a door closed rather than ask you what coloured elastics you would like followed by securing them to each individual brace. Also, in our ever-demanding consumer world, who wouldn’t go and see the orthodontist who claims to offer painless, faster treatment? Orthodontic suppliers are providing all of this marketing, the general public has adopted their claims, therefore driving up business. Unfortunately, the orthodontic literature shows there is no advantage, and in some cases there are disadvantages, in using SL brackets. As a profession, orthodontists must remember that we are business, but first and foremost, a health care industry based upon science.

So what's the bottom-line?

Despite the aesthetic nature of orthodontics, it is important that health care treatment be evidence-based. In other words, scientific studies should confirm any claims made. There is a significant amount of physics and biology behind the way your teeth move. At Markham Centre Orthodontics, our team strives to stay up to date on the most advance technologies in order to provide the best care possible. We have chosen not to use Damon braces or self-ligating braces since most modern day braces work the same and they can all produce excellent results. The experience and skill of your orthodontist and their team will be the factors that make the difference.

Toronto and Markham braces patients deserve the most scientific, aesthetic, comfortable, cost-effective, and shortest treatment possible. A lot of our patients enjoy the fun of choosing colours to match their schools, teams, and holidays. At Markham Centre Orthodontics, whether it is braces or Invisalign, rest assured that you will receive the most up-to-date, scientifically-based treatment around. Factor in world-class customer service in a contemporary, comfortable environment, and you’ll discover why we are the secret behind some of Markham’s best smiles. Click here if you would like to book your complimentary examination with us today.


r2d2 said...
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r2d2 said...
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Markham Centre Orthodontics said...

Hi r2d2

Your comment is precisely the problem with the "Damon System". The clinical evidence of it being superior is still lacking, yet the company, orthodontists, and some patients laud it as the second coming of orthodontics. 2 million completed cases is not a large number when comparing other brands. In fact it is still a very small number. This entry does not say there is anything wrong with using the Damon system when used properly, however, to imply that the "System" is doing the treatment is not accurate. Orthodontists are the decision-makers, and their ability to treatment plan, diagnose, and do the work clinically are the most important factors in a patient's care. Thanks for your comment!

Anonymous said...

In an April 2009 published study, "In most patients, teeth bonded with SL (self-ligating) attachments had fewer bacteria in plaque than did teeth bonded with E (elastic) brackets. At 1 and 5 weeks after bonding, the means for SL vs E brackets were statistically lower for total bacteria and oral streptococci (P <0.05). ATP bioluminescence values were statistically correlated to the total oral bacteria and oral streptococci, with correlation coefficients of 0.895 and 0.843, respectively." There are strong arguments for as little plaque growing in the mouth as possible for the 18-24 months braces are worn...

Markham Centre Orthodontics said...

This blog is attracting some interesting visitors!

Thanks Dr. Waters for your comment. For those who are unaware, Dr. Waters is the contact for the Damon Implementation Course at the National Workshop in Athens, Georgia. If you could share with us whether there is clinical significance in this study, that would be fantastic, as statistical significance may not have a practical clinical application in some situations.

Also, should you be able to substantiate the claims on the Damon website, it may put an end to this debate. Unfortunately, the orthodontic profession has yet been unable to provide this evidence. Perhaps you have some information at the teaching facility that we are not privy to and can share it with our readers.


staci said...

The AAO Council on Scientific Affairs recently published an scientific evaluation of these claims. In a nutshell, they're unsupported by the evidence. In all fairness, some of the claims haven't been directly DISPROVEN either. Either way, as a profession we shouldn't be buying into them just because a manufacturer tells us they're true. Unfortunately Ormco is a much better marketer than the AAO.