Contemporary Orthodontics & Dentofacial Orthopedics
James
R. Waters,
DDS, MSD , PA
Board Certified Treatment for Children, Teens and
Adults
DIY Orthodontics?
It seems the new buzz in the dental community is the notion
of “do it yourself” orthodontics with various techniques passed around on YouTube. I even have had a dentist calling me asking
for supplies because she had seen someone moving a tooth on YouTube and she
wanted to set up a tooth for a crown in a better position.
To be honest, I never really took the notion seriously until
the American Association of Orthodontics issued reports to us in private
practice (and went national with advertising against such efforts) following
the posting of a DIY case by a student who claimed a correction for $60 of
materials.
The idea of permanently moving teeth which must fit in all
three dimensions with opposing and adjacent teeth (during rest and function), without planning/records
and without a care of how the final bite will fit … I mean it seems common
sense would tell even the most simple or value-minded people that there would
be unforeseen risks and problems. After
all, scalpels can be purchased privately but you don’t see people performing
surgery at home, right? Does the public
really see Orthodontics so simple as if any un-trained individual can move the
teeth successfully and without repercussions; and what has led to this
erroneous and dangerous perception? I
think sadly the answer is “maybe”.
“…scalpels can be purchased
privately but you don’t see people performing surgery at home”
First of all I must state clearly and unequivocally: Orthodontics is the most complex specialty
in dentistry, hands-down. It
requires significant knowledge of biology, bone physiology, physics, anatomy
and no small amount of artistic perceptional ability. Moving teeth to a functional and esthetic
relationship requires experience and a knowledge based on 100+ years of
research and development; and it requires constant continued education of new
technologies, new techniques and new research.
In short, it requires a trained specialist with years of specialty
training beyond Dental School.
Orthodontics is not quick, it is not cheap and it many times requires
fixed braces for a full correction; if there was a short/cheap/dependable
shortcut, your Orthodontist would be using it!
“Orthodontics is not quick, it is
not cheap and it sometimes requires fixed braces; if there was a
short/cheap/dependable shortcut, your Orthodontist would be using it!”
Some of the force diagramming
used when planning orthodontic movements illustrating the physics employed by
Orthodontic specialists in every case. The
diagram on the lower right illustrates the different properties/stored energy
potential for various wires regularly used (clear aligner trays only come in
one size for every movement) v. the elasticity of healthy bone. Note these don’t even take into consideration
the fit between upper and lower teeth OR the fit when the jaw is moving side to
side.
So from where is this simplified view of tooth movement emanating?
First, there has
been a rising trend of Clear Aligner treatment pushed by general dentists that
can now leave your tooth movements (I don’t consider this Orthodontics) up to a
lab; in essence it allows a general dentist with little to no orthodontic
training to take impressions/scans and send them off to a lab for clear
aligners to deliver similar to a mouth-guard, bite splint or retainer. I leave the efficacy of these aligner systems
for another day but will say these aligners are aimed at esthetics over
function and they remain VERY limited in any ability to move roots. Aligner trays end up pushing teeth outward
and can tip teeth completely out of the bone leading to relapse and recession
that can be difficult or impossible to fix.
 |
| Relapse with recession following dental arch expansion. |
In conjunction with this, we have public companies funded by
share-holders (and millions of dollars) which advertise directly to the public
through television and magazines, pushing clear aligners that magically do all
the work (simplifying tooth movement to a lab procedure) as equivalent to
traditional braces. General dentists push
it because it is all they can do and they want the money/patients unfortunately
this can lead to a dentist placing profit above the needs and well-being of the
patients). In fact, any Orthodontist
will tell you that once a General Dentist starts providing Invisalign, all
referrals stop including the most complex cases that would be difficult even for
the specialist; even the younger kids that require early interceptive treatment
are not referred because the Dentist wants to offer teen-Invisalign later and
it cannot be performed until all molars are erupted (after growth and after
many problems are set and un-correctible).
In turn, many Orthodontists feel the pressure and have begun offering
Invisalign rather than lose patients to their general dental colleagues (they
feel at least they will be able to fix problems with braces at the end which
they usually have to do) but the effect is a watering down of the quality and a
false equivocation of Invisalign to true Orthodontics.
Second, technology
used by clear aligner labs is partially available to the public; people with
some tech-knowledge can scan their teeth and produce models with 3D
printers. In Austin where I live, I have
seen middle school kids using 3D printers in their science projects! Although crude to dental standards, it can
appear similar to the trays used by doctors and some have placed videos online
suggesting they “fixed” their own teeth enticing others with a cheap short-cut.
Finally, the push
to find discount alternatives (over quality) and a habit of googling our own
common sense away has allowed ignorance to persist as knowledge; consider
people placing rubber-bands around two adjacent teeth with the simplified idea
of closing a gap (only to open another on the back side, tipping one or both
teeth and having the rubber-band slide up the root and destroy the supporting
bone). I even see patients following online advice and travelling to 3rd
world countries to “save” a few dollars only to learn they have condemned their
teeth and now require implants or worse.
We now see foreign sources advertising do-it-yourself impressions to
send in and receive do-it-yourself aligners online.
 |
| Rubber band placed over front two teeth. |
 |
| Damage from rubber band sliding up the teeth |
This is really what our medical and dental system is
evolving toward; a google/Internet based pseudo-knowledge driving patient
treatments over the advice and recommendations of highly trained specialists. As a specialty, we have failed the public we
serve by keeping our heads in the sand as these false treatments have grown
into the storm we see now. Unfortunately
we do not have the time or money to combat both the Internet and national advertising
by big corporate entities such as Invisalign so we work within our regions to
offer what we know is good treatment and, as long as we have patients enough to
keep afloat, we just ignore the growing malignancy outside our door.
Orthodontists may eventually have to take a more active role
against this DIY value/ignorance-based mentality for their own sakes but for
now all I can say is “if it sounds too good to be true”, or if you are being
told what you want to hear at your urging, buyer beware. The most expensive Orthodontic correction is the
one requiring re-treatment or even restoration due to damaged/lost teeth. If it were as easy as a scan or impression to
fix the teeth, no dentist would spend another 2 to 3 years in specialized
Orthodontic training (and dig into another $200K debt). Until a sharp Lawyer brings a class action
suit or two against these aligner companies for false advertising and against
some of the dentists for poor treatment, we will continue to see a devolving of
this highly specialized field known as Orthodontics and an increase in DIY
gimmicks.
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 35th street and MoPac.
Central Austin
1814 W. 35th
Street
Austin, TX 78703
(512) 451-6457
Steiner Ranch
4302 N. Quinlan Park
Austin, TX 78732
(512) 266-8585
BracesAustin.com
