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Health Matters

Fast Track to a Gorgeous Smile

February 23rd, 2014

By Dr. Saleh Al-Daghreer

We are on the fast track when it comes to accomplishing most jobs in our world...especially compared to where we were 50 years ago; everything has to be fast and efficient now. But why do we still have to spend a year or more in braces to get straight teeth? Are the science and technological advances in orthodontics lagging behind that much? What about these claims of “fast braces”--fast treatment, six-months or even less with braces? Is it real? Does it deliver optimum results? Do these appliances or the professionals behind them make teeth move faster?

To answer all these questions, we have to understand how an orthodontist moves teeth. The diagram is a very simplified way to explain it. Teeth are embedded in our jawbone (white) and attached to it with a tough ligament (yellow) in a very thin layer; that is why they feel rigid. When an orthodontist starts pushing the tooth (Fig. B) using braces and wires, they push the tooth root against the bone of the jaw compressing the ligament on the side of the force’s direction (left side of B). This will start a cascade of events in the bone to start breaking down (left side of C). The space created is where the tooth moves, but what about the opposite side (right side of B)? The ligament there is under tension because the tooth is being pushed away. This will result in forming new bone to keep the bone tightly against the tooth (right side of C). These two events, of bone breakdown and buildup, are called "remodelling".  This is how teeth move.

The factors that affect remodelling are: bone health, anything that affects bone metabolism, and the presence of a mechanical factor. In orthodontics, the suitable force to move teeth has to be light and continuous. This is the mechanical factor under our control, and research has brought us close to ideal appliances and materials.

The new advances in orthodontics have taken a big leap in the last three decades in the following ways: making appliances smaller, tougher, less retentive for bacteria, continuous light force delivery (closer to ideal), more esthetically appealing and less noticeable.

What about modifying the remodelling process? There was attempts which were successful but to some extent not practical because of the cost or the incurring trauma. One of the most successful methods was invented by the two brothers Wilcko. "Wilckodontics", is where they do gum surgery to expose the underlying bone. This led to some perforations and grooves which were found to induce some bleeding and bone trauma leading to more bone turnover (i.e: remodelling) during the treatment with braces. Another modification of this technique was used without exposing the bone and directly making holes in the bone between the teeth. Another method was using vibrations on the teeth while in treatment (Acceledent). All of the previous options will cost you more and the surgical options will introduce some form of trauma and discomfort.

Finally, average orthodontic treatment ranges from 14-18 months. So, none of these techniques will reduce treatment time more the 20-30 per cent at the most. There are some cases that can be treated in less than six months, however. These cases are usually patients with very mild problems or had previous treatment that relapsed a little bit, and usually they are not seeking orthodontic treatment.

The take-home message here is: Faster orthodontic treatment won’t happen without modifying the bone’s ability to remodel. Anything commercially available, which makes big claims without scientific support by research is probably too good to be true. Always seek professional advice from a specialist in the field. 

Tips to finish your orthodontic treatment in the shortest time possible:

Keep your appointments and try not to cancel

Follow instructions

Take care of your teeth

Take care of your appliance

Don't break any of your brackets

Wear your appliance or elastics

Saleh Al-Daghreer is a specialist in orthodontics and dentofacial orthopedics, member of the Canadian Dental association, Canadian Association of Orthodontics and American Association of Orthodontics. Dr. Al-Daghreer is a Clinical Instructor at the dental school at the University of Alberta, and a private practitioner at City Orthodontics and Central Alberta Orthodontics.

Tags: health

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