Contemporary Orthodontics & Dentofacial Orthopedics

James R. Waters, DDS, MSD, PA

Board Certified Treatment for Children, Teens and Adults

Is there such a thing as “Faster” braces?

In today’s inpatient society, we are always looking for a faster way to do something; always looking to save time (and money if possible, but definitely time). So it is no surprise that companies and doctors have begun to advertise a faster way to do things. Of course there are clinical researchers always pushing the technology to improve treatment times but the limiting factor is rarely the physical appliance or brackets themselves.

Bone takes @14 days to remodel and we have learned that light continuous forces allow for the bone to remodel as the teeth move. The older technique with stronger and stiffer wires would place too much pressure on the bone and not allow the living bone to remodel as the teeth moved; this led to necrosis or bone death through a lack of oxygen which in turn would actually slow the movement down. Additionally, because forces were very high, there was an increased tendency for damage to the roots of teeth.

When using the newer super-elastic wires, there is more energy stored in the wire itself allowing for more consistent and continuous forces; the forces are now controlled by the engineering of the wires to allow tooth movement and bone remodeling without leading to necrosis. The movement is not only more comfortable for the patient and healthier for the teeth, but the movement of the teeth in the long run is actually faster and more predictable. This is the true limit of speed when moving teeth and we all must obey the laws of bone physiology.

The other way some practitioners or companies may offer “fast” braces is to allow the teeth to “tip” instead of moving the entire tooth. This may line up the tops of teeth only to relapse later as the roots remain crooked. Tipping also stress the bone around the neck of a tooth and the very tip instead of spreading force out along the entire length of the root; this action places very heavy forces on the leading edge and the bone at the apex of the root tip which can lead to destructive forces affecting the long-term health of the roots and the supporting bone.

So, are there real options to speed up the tooth movement? The answer is yes but generally it is not seen as worth the cost and effort. Probably the best way to drastically increase tooth movement involves using the body’s own physiology to accelerate bone turn-over around the teeth while braces are used to place forces necessary to move the teeth. This is done by “flapping” the gum tissue away from the bone along the dental arches and de-corticating (or perforating) the bone around the teeth where rapid movement is desired (I use this regularly around molars I want moving faster when I send to have Wisdom teeth removed). IF an entire arch is de-corticated, tooth movement can be 50% faster however the procedure is a significant enough surgery that in most cases it is prohibitive. It is probably more common when there is a lack of anchorage or a stubborn tooth and the Orthodontist wants to speed up movement in one area versus another.

Research has also shown that site injections of Prostaglandins and specific Bone Morphologic Proteins can also temporarily speed tooth movement enough to reduce treatment time but again the cost and effort seem to make this not necessary in most cases.

Finally, there are those that claim certain brackets have less friction and therefore move teeth faster however prospective studies just don’t seem to prove this; there have been studies that show friction is different with different types of alloys we use in the wires but again the overall treatment time is not greatly affected when looking at true root movements. Case reports do seem to show some support by practitioners but it seems these practitioners become more of an advocacy for more of an advertising angle so it is difficult to trust this over the prospective and juried research papers seen in the literature. I simply have not seen definitive proof that any type of bracket can move a tooth faster correctly, meaning a true root movement, simply because of some advertised advantageous design (including self-ligating or tipping braces).

Sometimes as a consumer you simply must differentiate between what is true and what someone perceives you want to hear. If there was a faster way to move teeth correctly, we would all be using it! Faster for you means more patients for the orthodontist, cheaper treatment, happier patients and finally more profit. So you can trust that if and when there is a silver-bullet discovered, we will all be using it.

If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35^th street and MoPac.

Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001. He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics. Dr. Waters and his wife of 19 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin. You can learn more about Dr. Waters at BracesAustin.com.

Central Austin

1814 W. 35^th Street

Austin, TX 78703