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 (2^nd 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.

Markham Invisalign and Richmond Hill Invisalign Teen Day a Great Success!

It seems like a lot of people out there are getting the message that we are one of the top Greater Toronto Invisalign practices, with a reasonable cost of Invisalign, excellent results, and fantastic service. Markham Centre Orthodontics always works to provide the best treatment possible, and in this case, straight teeth with invisible braces :). Remember that Invisalign is a technique, not a product, so not all Invisalign certified doctors are the same.



On November 19th, Markham Centre Orthodontics hosted Invisalign Day, a day with special promos for those interested in Invisalign and Invisalign Teen. We had a full schedule of consultations and tried to accommodate the walk-ins as well. Ages ranged between 12 to 72 coming locally from Markham, Unionville, as well as Toronto. Our office has far exceeded the annual Invisalign proficiency requirements, but we would have met these numbers on Invisalign Day alone!

Click here if you would like to schedule your complimentary orthodontic assessment and get on your way to a beautiful, straight smile!

Markham Braces Holiday Food Drive and Candy Cane Contest

Your Markham braces orthodontist encourages TeamMCO to bring in 1-2 non-perishable food items for our holiday food drive. At this time of year it is important to remember those less forunate than ourselves. To encourage you, we will be giving out 5-10 TeamMCO points to those who wish to contribute.

Also, at your next visit, make sure you swing by the front desk and count the candy canes. Closest guess wins. Good luck!

Invisalign Braces in Toronto... Dr. Tam Lectures at George Brown College

Successful before and after Invisalign braces in Richmond Hill requires an experienced doctor and a well-trained team. Invisalign is not magic and should not be viewed as a product. It is simply another orthodontic technique to move teeth, just like braces or other appliances. Our patients at Markham Centre Orthodontics benefit from a highly knowledgeable team, including a few who have had Invisalign treatment themselves!

Saturday, it was Dr. Tam's turn to provide a lecture on Invisalign as a part of the dental hygiene orthodontic module at George Brown College. Dental hygienists from all over Ontario came for this informative session, learning tips from a high quality and high volume Invisalign practice. Dr. Tam also provided a hands on demo on impression taking.


If you're looking for braces or Invisalign treatment in the 905 area, look to your Markham Invisalign orthodontist. Send us an email to book your complimentary assessment today!

Richmond Hill Braces Orthodontist Answers: Do I/ How long do I need retainers?

Your Markham braces specialist answers another common question about retainers.

Question: How long do I need to wear my retainer?

Answer: As long as you want your teeth to stay straight :).

Scientific articles published in the "American Journal of Orthodontics and Dentofacial Orthopedics" show an enormous variation in how long you need to wear your retainers. These articles indicate that there is no way to predict how teeth may move without retainers. About half of the undesired tooth movement takes place in the first two years after you stop wearing your retainer.

The literature has conflicting information on the influence on wisdom teeth on crowding of teeth. Generally, orthodontists do not believe that wisdom teeth will be the cause or sole cause of malalignment after treatment. Still, it is generally recommended to have wisdom teeth taken out, as we have more than enough teeth for proper function, and this minimizes the possibility of complications from partially impacted teeth, such as acute gum infections, pain, and swelling.

Some crowding of the lower front teeth may be part of the natural aging process similar to greying hair and wrinkled skin. There are still pressures on the teeth after treatment, such as food, the tongue, grinding, and muscle tone. Unfortunately, everything in the world has a tendency towards disorder. Teeth are not an exception. As such, the only way to ensure continued satisfactory alignment is by the use of retainers to some degree, for life.

When it comes time to take braces off, our team of orthodontic professionals will discuss various retainer options with you. Generally, we place a fixed lingual retainer in the lower arch, and provide a removable retainer for the upper jaw. We also offer essix (clear-style mouthguard) retainers. Each option has its inherent and disadvantages, and we will try to find the options that best suit your individual situation.

Our Markham braces patients start off on a full time schedule of wearing retainers for the first few months. They then taper wear down about an hour per month until wearing aligners only at night. We advise our patients to wear retainers to sleep indefinitely. Many of our patients become accustomed to wearing retainers and feel that it is awkward if they go to bed without them! Let it be known that those who maintain straight teeth have a secret... they still wear their retainer!

Invisalign Day at Markham Centre Orthodontics

Dr. Tam and the team at Markham Centre Orthodontics, your Premier Provider of Invisalign in Markham, Richmond Hill, Scarborough, Toronto, Stouffville, Pickering, Ajax, Thornhill and North York present:

Invisalign Day at Markham Centre Orthodontics

Thursday, November 19th, 2009 from 1PM-6:00PM

**Special Promotions**

-Complimentary exam

-$380 discounted from your treatment fee

-Complimentary whitening to first 20 new Invisalign patients

Ever thought about straight teeth without traditional braces? Now is your chance to take advantage of this limited offer with one of Greater Toronto's top Invisalign Offices. Call us at 905-477-7750 to reserve your visit as appointments are limited!

Note that this day is for those who wish to start treatment on this day. We ask that you confirm your insurance coverage prior this visit. Should you wish to find out more information, please visit our website or schedule a consultation with us before November 19th.

Toronto Invisalign Braces Specialist Provides Trip Report from Costa Rica Study Club

Outside Align Technologies in Costa Rica

At Markham Centre Orthodontics, we strive to be at the forefront of all aspects of care for our patients. As a Premier Provider of Richmond Hill Invisalign braces and Markham Invisalign Teen, Dr. Tam was fortunate to be invited to attend the Invisalign Study Club in Costa Rica for Top Invisalign doctors. This experience included a tour of the Invisalign tech centre, special lectures about Invsalign 1.5, details of the manufacturing and ClinCheck process, as well as clinical discussions with some of the top Invisalign providers in Canada and America. This entry will detail Dr. Tam's trip to the Invisalign centre.

Invisalign Reception Area

Prior to going into the facility, Dr. Tam was asked to sign a non-disclosure regarding proprietary information. Therefore, as much detail will be provided as possible, without infringing upon this agreement.

The tour began with an informational session about Invisalign in their impressive 63,000 sq ft facility, housing around 730 employees, including 543 different techs, 49 team leaders, 65 customer service reps, 48 in finance and IT, as well as 26 doctors, of which 6 are orthodontists. Any patient information is sent digitally from Mexico, and there is no physical data present in Costa Rica. All employees are eligible for complimentary Invisalign treatment in the Invisalign clinic, allowing them to straighten their teeth, while gaining a deeper understanding of the product they work with.

Invisalign on-site employee clinic

Invisalign has chosen Heredia, Costa Rica for its tech plant because of its political stability, solid IT infrastructure, high literacy rate of 96%, high level of education, and quality of dental schools. With no army, the country is able to provide free medical care, basic dental care, and college education for its citizens. Techs are selected from a large pool of applicants and if chosen, undergo 15 weeks of training before being allowed to work on patient cases. This training is known as “Treat University”, and involves using the “Treat” software, developed in Russia, to learn how to receive data, segment the teeth, set the bite, produce a tooth set up, and figure out the location of the gingival margins. There is some training about basic orthodontic principles and the new techs work with new Invisalign doctors, with the assumption that their cases are less complicated. This becomes a problem when these new doctors send in cases that are beyond the scope of a less experienced provider, and has lead to the development of Invisalign proficiency requirements.

One of the two rooms of Invisalign Techs

There is also a team of experienced techs who work with Premier Providers. They work with fewer different doctors, but tend to work with a higher volume of more challenging cases. These techs are supervised by a team leader, who has previously worked as a tech. Dr. Tam’s particular team leader works with with the top doctors from Canada, New York, and Texas. The team leaders are in turn supervised by a staff dentist who may or may not be an orthodontist. Important to note is that the techs have an understanding of basic English, but may rely on their team leaders to provide further clarification. This makes it even more important that the tech understand the preferences of the doctor.

Our Invisalign Technician Auxi working on one of our ClinChecks

Dr. Tam was very excited to meet his dedicated Invisalign technician, Auxi, and her team leader, Alex. They were able to sit down to talk about his preferences, facilitating a better understanding of Dr. Tam’s Invisalign treatment goals. This minimizes the amount of time required to approve a ClinCheck, provides more optimum treatment, and leads to an expedited production of the aligners. Together, they spent a few hours working with Dr. Tam on some new and existing ClinCheck simulations.

L-R: Team leader Alex, Dr. Tam, Invisalign Tech Auxi

Both Auxi and Alex are extremely talented at their work and were extremely friendly. However, they made a point to state that they are not allowed to make treatment decisions, and rely on the doctor’s expertise, prescription, and modifications to produce optimal treatment. This reinforces the concept that successful treatment requires an experienced provider who understands how to move teeth with Invisalign.

Overall, it was an extremely valuable experience to see how Invisalign works behind the scenes. Their software is constantly being developed, the employees are hard-working, and are in a world-class facility. Dr. Tam would like to thank Align Technology for selecting him for this elite Invisalign meeting.

Please feel free to contact us if you are interested in getting started on the way to a straighter smile without braces.