Why Do I Need Attachments Glued to My Teeth for Invisalign? 

January 7, 2019

Why Do I Need Attachments Glued to My Teeth for Invisalign?

Clear aligners are the rage in orthodontics today. You can’t watch a TV show, view social media, or listen to the radio without being exposed to an advertisement for some type of plastic aligner system that offers you a new smile. The biggest company in this market is Align Technology who produces Invisalign. They have a huge advertising budget and their aligners have become a household name like Kleenex and Band-Aids. New patients come to my office every day asking for me to straighten their teeth with Invisalign because they don’t want anything glued to their teeth. Many are surprised when I explain that although Invisalign doesn’t use brackets and wires, there are still tooth-colored “attachments” that must be glued to the teeth to achieve a successful outcome. What are attachments and why are they necessary?

Plastic aligners use a series of clear plastic shells that are shaped so that they sequentially guide the teeth into their desired positions. Two fundamental principles must be remembered about aligners. First, plastic can only push, it cannot pull. For a tooth to move in any desired direction, there must be a surface against which the aligner can push. Second, for a tooth to remain engaged in the aligner (to “track”), there must be an undercut or purchase point that allows the plastic to grip the tooth. Some teeth have natural undercuts because they are round or bulbous in shape (primarily the back ones). Other teeth are more triangular or pyramidal in shape (the front ones). For all movements except intrusion (pushing the teeth towards the gums), attachments are necessary to create the required pushing surfaces and undercuts. These movements include tipping, rotating, and lengthening the teeth.

To create pushing surfaces and undercuts, orthodontists construct “attachments” or bumps on the teeth using tooth-colored composite (the same material used to repair chipped teeth). The size, shape, number, and location of these attachments is determined by the anatomy of the teeth and the desired movements. Although visible up close, most attachments are invisible to the naked eye at normal conversational distances (about 3 feet). Orthodontic attachments provide the same function for clear aligners as brackets do with conventional braces. They are just handles on the teeth. I tell my patients to think of their attachments as the brackets and the plastic aligners as their wires.

Some patients are adamant that they don’t want to have anything glued to their teeth. Unfortunately, trying to make certain movements without attachments is scientifically impossible. Imagine an upper lateral (second tooth from the center) that needs to be longer to look straight. Without an attachment to provide an undercut, the tooth will remain its original length no matter how well the aligner is designed or worn. Additionally, making the aligners tighter on a tooth in hopes that it will move with the plastic actually causes the opposite effect (the tooth will actually move up rather than down). Think of how a watermelon seed squirts through your fingers when you squeeze it to pick it up. Similarly, if the plastic aligners are programmed to tip a pyramidal shaped tooth without an undercut, the tooth will actually slide UP the aligner rather than move with it.

Attachments glued to the teeth are necessary for accurate, predictable orthodontic movements. I wish there was a way to move teeth successfully without them using aligners, but as of 2018 one does not exist.

Adult Orthodontics Treated with Invisalign or Braces

September 13, 2018

Adult Orthodontics Treated with Invisalign or Braces:

We love our adult patients. They are typically better informed, more motivated, follow instructions better, and usually have better oral hygiene than adolescents. With the availability of information on the Internet, most adult patients have a better understanding of their own condition and the possible treatment options than younger patients. Unlike teenagers who are many times compelled by their parents, adult patients usually pursue treatment because they want it or because they have been referred by their dentist. These differences usually result in better compliance.

Adult patients do face some challenges not faced by younger patients however. First, they are no longer growing. Growth can be a helpful in correcting many types of malocclusion (the exception being underbites). Examples of this include expanding the palate, opening the bite (by changing the direction of growth), and reducing the “overbite” (by restricting the forward growth of the upper jaw). Additionally, because their metabolism is slower than in growing patients, tooth movement in adults is usually slower and therefore their treatment times longer. Finally, adults tend to have more missing and compromised teeth (worn, misshaped, restored, etc.). This sometimes limits the options that are available to them.

Because of these differences, adult treatment varies from adolescent treatment in the following ways. Adult treatment usually takes longer than the same treatment in younger patients. Because there is no growth, extractions and surgery are more common if full correction is to be achieved. If teeth are missing or compromised, there may be fewer treatment options than with teenage patients. Since many adults don’t want to have teeth removed or have jaw surgery, many are willing to accept a degree of compromise not necessary in their children. On the upside, adult patients are usually more motivated and compliant than adolescents and are therefore better candidates for esthetic options like Invisalign clear aligners.

If you are an adult who is considering treatment for yourself, take heart. Although your treatment may take a little longer and may be more complicated, improved appearance, better function, and healthier teeth are achievable at any age. Make an appointment today to see how an orthodontist can help give you your best smile.

Do Orthodontic Wire Braces Hurt You Mouth?

March 14, 2017

Do Orthodontic Wire Braces Hurt Your Mouth?

One of the most basic and sincere questions that I get asked by potential brace patients is, “Do braces hurt your mouth?” If you’ve read any of my other articles, you know that I’m a straight shooter and I tell it like it is. Here’s what it feels like to get braces on your teeth.

Although the retractors used to hold the tongue and cheeks out of the way may be a little uncomfortable, the process of conditioning, rinsing, drying, and sealing a tooth is completely painless. Neither is there any pain when the orthodontist places a bracket (brace) nor when the technician cures the cement with the blue LED light. Seriously, having brackets glued to your teeth is 100% painless. The next two steps are also painless. The first is placing your initial wire into the slots on the brackets and the second is securing the wire using “ligatures” or ties that hold the braces together. These may be in the form of either colored O-rings or very thin metal wires. Although you may start feeling pressure after the ligatures are in place, it really isn’t painful at that point. That comes a little later as I’ll explain below.

If your orthodontist is going to place metal bands around your teeth for an expander or “overbite” springs, the first step is to create space in your mouth. This is accomplished by placing rubber spacers (separators) between the teeth. Again, although you will feel pressure where the spacers are seated, it is usually not painful until a few hours later.

Just like braces, clear aligners (Invisalign, Clear Correct, etc.) work by putting pressure on the teeth. Instead of the force being created by a wire, however, it is generated by the flexible plastic used to construct the plastic shells that covers your teeth. As I describe how braces move teeth and what makes treatment uncomfortable, please remember that your teeth cannot tell whether the force is coming from a wire or from a plastic shell. Force is force, and if your teeth are going to move, your body must undergo the exact same process. Additionally, it doesn’t matter what kind of a bracket your orthodontist uses or which company manufactures it.

Braces (and aligners) work by creating inflammation around the roots of the teeth. This occurs when the force placed on the crown of the tooth pushes or pulls the tooth slightly and cuts off blood flow to the tissues on one side of that tooth. In so doing, there is a slow build up of lactic acid that creates what feels like a cramp or a “Charlie horse” next to the tooth. Lactic acid is the same thing that makes your muscles sore when you perform strenuous exercise or overexert yourself. With braces, this lactic acid buildup starts to make you feel sore about 3 to 4 hours after your braces are “tightened” or after you start wearing your aligners.

Over the course of the next 24 to 48 hours, your body adapts to the new position of the teeth by dissolving bone in the area where there is pressure. This remodeling of the bone relieves the pressure, makes you feel better, and results in the tooth moving to a different position. Depending upon how crooked your tooth is or how much the wire or plastic is designed to move the tooth after your adjustment, the process may repeat itself and your soreness may continue. Once the force is all used up, the tooth will relax in its new position and your discomfort will finally subside. Remember, the process is the same for wires, plastic aligners, rubber separators, etc. If a tooth is being moved, there will be some discomfort.

In my experience, tolerance to the discomfort associated with orthodontic treatment ranges from patients who tell me they hardly feel anything to those that say their pain was unbearable (very rare). Common over-the-counter analgesics like Advil and Tylenol are usually enough to get through the first 48 hours. Many patients who have new braces, claim that chewing sugarless gum reduces the length of time they are sore. This makes sense as it would be similar to massaging a cramping calf muscle after getting a Charlie Horse.

So here’s what you can expect: no pain when the braces are attached, soreness that begins 3 to 4 hours after each adjustment and lasts for 24 to 48 hours, and then very little discomfort for the rest of the time between adjustments as your body rebuilds the bone around the teeth that have been moved. If your discomfort lasts longer than a week (especially if you have something rubbing or there is swelling), you should contact your orthodontic office and let them know what you are feeling. Remember that it will all be worth it in the end with straight teeth and a beautiful smile . Good luck and remember “The Doctor you choose matters!”

What To Expect At Your First Orthodontist Appointment

December 14, 2016

What To Expect At Your First Orthodontist Appointment

It is normal to be nervous anytime you are doing something for the first time. If you’ve never been to see an orthodontist before, it is not surprising that you may be wondering what is going to happen at that visit. Here’s what your first visit will be like in our office for Braces or Invisalign…

As with all visits to any Dental healthcare provider, there will always be some preliminary “paperwork” that will need to be taken care of before we get started. This can take place on our website, by filling out the paperwork that we’ve mailed to your home, or by filling out forms in our reception area when you arrive. The paperwork asks for standard things like your name, address, and phone number, insurance information (so we can verify your benefits for you), your health history, your dental and Orthodontist history, and a brief explanation of what you’d like to accomplish during treatment. If you are under 18 years old, you’ll need to come with a legal guardian.

Once the paperwork is taken care of, a member of our Orthodontics staff will obtain a set of dental diagnostic records to help us decide the most appropriate Orthodontics treatment for you. These records usually include pictures and an x-ray. Some dental problems don’t require x-rays and a few patients bring copies from their dentist or Orthodontist. If there is any question about the need for additional x-rays, I’m the one who will let my staff know what is required. X-rays help me to see the health and position of your teeth, bone, roots, and jaws. There are some decisions that I just can’t make without them. The purpose of the pictures is not only so we have a record of where your teeth are at the beginning of treatment, but also to help me evaluate your profile, lip posture, and facial symmetry.

With your diagnostic records completed, you and I will take a minute to get to know each other and discuss your dental health concerns. I’ll then examine your face, lips, gums, teeth, and bite to help me determine what’s good, what could be better, and the best way to get from here to there. During your dental exam, my treatment coordinator will take notes so that I can communicate with your primary care dentist about the problems I see and how to fix them. Finally, I’ll explain all of your possible treatment options, like Braces or Invisalign, and then recommend the one I feel is the most appropriate for you. There are generally four outcomes after your exam.

First, if I don’t think you need Braces or Invisalign, I’ll let you know. There might be other options that are quicker, easier, or that better address your chief complaint. Additionally, there are times when I just don’t believe that you would benefit by orthodontic treatment. This typically happens when a problem is so minor that the cost and risks associated with Braces or Invisalign outweigh the benefits.

Second, you might need Invisalign or Braces but are not ready for them yet. This most commonly happens when you still have baby teeth to lose, your 12-year-molars are not yet in, or your treatment is dependent upon your jaw growth and we need to observe it for a while. In any of these situations, we’ll schedule you to come back a few months down the road so that we can check on your development. This is called a recall or observation appointment. The length of time until your next visit is usually six months, but that can vary depending upon the reason we’re waiting.

Third, although you may need Invisalign or Braces, you might need to see another dentist first. This can happen if you need to have some routine dental work finished, have some gum or bone issues that need to be addressed, or your treatment will require the help of another dental specialist. If you have unfinished work or just need your teeth cleaned before we can start, I’ll refer you back to your primary care dentist. If your jaw sizes don’t match or if you have impacted teeth, you may need to see an oral surgeon. If you have gum problems, you will be referred to a periodontist. If you need a root canal for any reason, I’ll recommend that you see an endodontist. Orthodontic treatment sometimes requires a team approach and this is best coordinated before your Braces or Invisalign go on.

Finally, the most common result of your initial Orthodontics exam is that you are ready for Braces or Invisalign and can get them on right away. My Ortho treatment coordinators will work with your family to make the best possible financial arrangements and get the necessary informed consent. Once that is done, you are ready to get started! Believe it or not, the majority of patients today actually choose to start the process of getting Braces or Invisalign on the same day as their exam since they have already taken time off from work or school. My staff and I have streamlined the initial exam process to make it as convenient as possible for everyone involved. See you at your first appointment!