Monday, February 28, 2011

Extraction with braces vs Non-Extraction Orthodontist in Markham

We see a lot of people for free consultations who are considering braces and Invisalign in Toronto. One of the most common concerns with Richmond Hill braces is to be able to have orthodontic treatment without taking teeth out. The fear is out there. In fact, there are Damon braces, from Ormco, that make the claim that virtually all orthodontic treatment can be done without extraction, as a part of direct marketing to the public.

Some of the biggest reasons for not wanting teeth out are:

-don’t want to take out good teeth
-scared of extractions
-worried spaces won’t close
-possible caved in profile or narrow smile
-won’t have enough teeth to chew with

There are three major reasons for needing teeth out for orthodontics:

1. A non-viable tooth
-Generally, there is no debate from our patients about removing teeth when there is a huge cavity or an abscess.

2. Excessive crowding
-There is a certain amount of space required to align all of the teeth in crowding situations. In order to gain space, the teeth can be expanded out in a lateral direction, proclined in an anterior direction, distalized to the posterior, or we can do some interproximal reduction.

-There may not be enough room to distalize teeth due to the presence of wisdom teeth or lack of ridge of bone, and there may not be enough space between the roots to reduce enamel safely.

-In terms of lateral or anterior movement, the support of the teeth within the bone is important. If the expansion is too great, the teeth will be pushed out of the periodontal complex, leading to problems such as recession, mobility, and an unstable result.

3. Overly full facial profile

There are times when crowding can be alleviated without removal of teeth, but the end result would result in an overly full facial profile. This presents with individuals unable to close their lips without strain, or an appearance of bulging lips. To harmonize the appearance, it is important to retract the anterior teeth, and in order to do that, space is required. Otherwise, there is no room to move the teeth back. Keep in mind that the orthodontist can control the amount of retraction since space can be closed by moving front teeth back, or back teeth forward. This means you do not have to have a “dished-in” profile with extractions.

As seen with Patient #2's Before and After Extractions, there is no problem with closing up space, and as described above, sometimes it is actually healthier and will provide better results when taking teeth out than trying to fit teeth where they will not be stable. In this case, the arch is actually wider after tooth removal than prior. There are a lot of celebs with beautiful smiles, and they have had teeth taken out too!

There are many people who do not have full function of all of their teeth, due to malocclusions, or extractions, and they function well. A proper bite with teeth that are in good occlusion with fewer teeth is better than more teeth that do not fit well together.

Each individual situation is different. At MCO Orthodontics, whenever possible, we do not extract teeth. However, there are instances as described above, when tooth removal is indicated and will produce better long term outcomes. To book your own complimentary evaluation, please visit us here.

Monday, February 7, 2011

Retainers and Vivera: Information from your Markham Orthodontist

One of the most important aspects of your Toronto Invisalign or braces treatment is going to be your retainers. Following any orthodontic care at your Markham Orthodontist, you will need to do something to maintain that beautiful smile. The answer to the amount of time retainers need to be worn is "as long as you want your teeth to stay straight" :).

Our patients have a number of different options for retainers. For our Invisalign patients, we generally recommend Vivera retainers or Invisalign retainers. For our fixed braces patients, we usually recommend a combination of fixed retainers with a removable retainer. Here are some of the options:

Fixed lingual wires
-don't have to think about taking retainers in and out
-teeth attached to intact wires will not move
-no one can see them

-only holds teeth they are attached to
-wires require flossing with a floss threader, ie more difficult to maintain
-cannot bite down on front teeth without risk of breaking retainer; if broken, teeth may shift without knowing
-still need removable retainer nightly to maintain posterior teeth

Invisalign aligner retainers or Essix Style retainers
-excellent aesthetics
-retain all teeth in the arch
-made off your ClinCheck without need for a new impression if you had Invisalign treatment
-no adjustment period since they are the same as all aligners during treatment

-may need to replace every 3-6 months
-must remember to wear nightly

Traditional Hawley or Circumferential retainers
-longevity- can last several years
-ability to make small movements by bending wire in certain situations

-poor aesthetics
-nightly wear required
-cost of replacement if lost or broken

Vivera retainers
-can be made off last Clincheck stage or with new impressions
-superior aesthetics
-minor relapse can be corrected by wearing this retainer full time
-subscriptions can be ordered to defray cost of ordering individual retainers, and after the first retainer, the rest can be mailed to you
-reordering is as simple as a phone call to the orthodontic office as digital impressions are stored

-replacement required after 9-12 months
-need for nightly wear

Take a look at Dr. Tam's video on Vivera for more information.