Fake Orthodontics Gaining Ground

Fake Orthodontics (Invisalign) Gaining Ground

(And the Culture of False advertising)

 

As a practicing Orthodontist I meet with dental specialists regularly for continued education, review of difficult cases and overall health of the profession; I have done so regularly for the last 23 years.  Now, at the middle of my career as a Board certified specialist, I feel somewhat qualified to reflect on the state of dentistry, and specifically specialty dentistry, in today’s marketplace.

Although politics has focused on medical insurance and general healthcare (for better or worse) there has been a curious lack of attention to engage the field of dentistry in the negotiations.  This has allowed dental related companies to hide in the shadows as they promote their own profit based treatments directly to the public, many now advertised as not even needing the doctor (and certainly not needing the specialists).  This phenomenon is a result of very large companies combined with social media campaigns that inundated the public with the company’s own agenda, directly to Facebook and other email lists.  Nowhere has this been more harmful than to the field of Orthodontics.

 

 

As the reader, you may ask “how can a company dictate dental care without doctors?”; you may even ask “aren’t there laws to prevent practicing without a license?”

 

In response, it has been a slow but deliberate strategy by certain unethical, profit hungry groups that employ un-ethical dentists and specialists to push them into the range of credibility.  Behind the scenes, there is a battle over standards of care but ultimately dentistry is a business and many succumb to the notion that if you don’t feel you can beat them, you have no other choice but to join them.  This is in fact exactly how Fake Orthodontic Companies like Invisalign (and their subsidiary Smile Club) have become the juggernauts in the room.  Currently there are nearly one hundred lawsuits by national and state dental organizations, boards and individual Orthodontists in the courts against Smile Club and other aligners, but they take time and they get buried by google ads paid for by …. you guessed it, Invisalign.

 

As a history, the idea of clear aligners was not a new one; many of us used clear aligners (made in-house) to hold and correct small rotations or mild relapse after treatment even 35 years ago.  However we all recognized and experienced the extreme limitations of removable plastic trays.  Also at that time, few dentists tried to perform orthodontics without specialty training; in fact family General Dentists would refer complex cases readily to their specialty counterparts/colleagues including surgery to Oral Surgeons, tough root canals to Endodontists, extensive gum disease to Periodontists, kids to Pedodontists and orthodontics to the Orthodontist.  This provided the environment for the General Dentist to become an expert in restorative care as well as the gatekeeper to more advanced treatments that required a higher level of training.

 

“Behind the scenes, there is a battle over standards of care but ultimately dentistry is a business and many succumb to the notion that if you don’t feel you can beat them, you have no other choice but to join them.  This is in fact exactly how … Invisalign [and other “Fake Orthodontic” clear aligner companies] have become the juggernauts in the room.”

 

So what happened?

As competition heated up in larger urban areas, we started to see general dentists pushing the limits to treat more complex issues to avoid losing the income stream from what they perceived as more profitable procedures (more “profitable” because they generally required specialty training to adequately and predictably treat).  Soon, there were whole groups of general dentists claiming specialty status to the public simply because they had seen what they felt like was a significant number of patients.  Of course they were learning on those very patients and were undoubtedly repeating the same mistakes over and over on those same [unsuspecting] patients. 

 

Many would then teach other non-specialized dentists so it became a cycle or grey area in dentistry.  But dentists far outnumber specialist by the definition and specialists had little power to dissuade the American Dental Association (the parent organization of all dentists including specialists) from allowing this progressing breach of standards and ethics.  It is now not uncommon for untrained newly graduated general dentists to see patients already in treatment and then question these cases that they don’t even have the records for and certainly not the training to fully understand.   This sews more discontent and distrust in the public as patients start hearing multiple stories from different doctors and it only serves to confuse patients and leave them open to professional advertising by companies directly.

 

What is the current state of the specialty of Orthodontics?

Today, Orthodontics has become synonymous with Invisalign (by their design, not ours) to new generations through social media and false advertising that would have never been allowed in traditional media.  Add to this a new generation of unethical dentists (and now Orthodontists) driven by pure profit, doctors that know very well they are not offering or providing the best care available (or sometimes even proficient/adequate care without introducing more problems).

 

As these general dentists stopped referring patients to the Orthodontists, the very Orthodontists began to move toward Invialign based practices.  They have done this despite the research that clearly and unequivocally proves Invisalign and the other dozen aligner systems far inferior to traditional braces.  But the public continues to be bombarded by advertising to the point now that Invisalign has purchased other companies like Smile Club that push aligner treatment with no dentist at all.  Ironically, now the general dentists are trying to fight the doctorless trend even though it is they themselves that are funding the company via their own Invisalign cases.

 

Clear aligner treatment; straight teeth but with no posterior contact; good luck chewing that steak!

“Straight” teeth from clear aligners with little to no contact and recession across the arch.

Teeth “straightened” by Invisalign but left protruding forward and out of the bone.

 

 

 

 

What is the Result for the Public?

By normalizing inferior treatment as the new acceptable standard, by accepting that Orthodontics is only used to line up the front six teeth (you will notice there is no mention of function on the many Invisalign commercials/testimonials), doctors and the public alike are rapidly turning a very scientific and complex profession into nothing more than a nail salon or mall kiosk (and there are no cliff notes to treat a patient).  In fact, these companies are not even attempting to hide this as they push to put kiosks in malls and drug stores.  Forget that it takes two to three years of post-doctorate study to even be remotely capable to treat moderate orthodontic cases.  Forget that poor function of your bite can lead to severe headaches, Chronic TMD, severe wear of teeth and early loss of teeth.  Forget about the airways, facial proportions and the chewing efficacy, forget about sleep apnea and periodontal disease.  According to these companies, if the front teeth are straight, then the job must be good/acceptable.

 

Determining Facial esthetics when treatment planning; moving teeth can affect the facial height and smile line relative to lips; but not with aligners like Invisalign or other Fake Orthodontics.

 

 

 

 

 

 

Typical forces figured in moving teeth.

 

 

 

 

 

 

Physics mixed with Biology: A key component in Orthodontics.

 

Is there any case that can be treated better or faster with Invisalign (Fake Orthodontics) v. traditional braces?

I cannot think of a single case that is treated better or even remotely as quickly as traditional braces and research bears this out over and over (see research cited in my other blogs on Does Invisalign work?) In fact there are inherent disadvantages including compliance, weak material that fatigues, trays that loosen and cannot move certain longer teeth, lack of root movement and even opening of the bite in many cases.  There are certainly mild cases that can be treated  (which is why Invisalign was accepted early on) but today, aligner trays are pushed on everyone as “invisible orthodontics” because doctors can run four or even five locations and just give out trays instead of monitoring patients and actually treating them. And if the standard of care is just to straighten the front six teeth, well that really is simple.  Lucky for these snake-oil doctors, you may well not get the joint pain, recession, tooth loss or damage for years so they will be long-gone and past the statutes of limitation for any recourse.

 

Does my Dentist Care about the Best for Me and My Family?

If your doctor is not a specialist, then they do not have the knowledge to be the best.  It could be a poor diagnosis, an inability to see problems, a lack of collecting the correct data or lack of interpreting data correctly; it could be the unethical approach of treating to a lesser standard or allowing a computer tech to design and move the teeth for them with no doctor or experience at all.  Either way, only the Specialist has the complete knowledge, experience and skill to give you the best.  Do you need the best?  Maybe not; but can the untrained spot the difference between those cases? My experience is they cannot.

 

 

“If all you are being told is what the doctor thinks you want to hear (or what your kid thinks is popular), then you may as well head to the kiosk and save yourself some money.”

  

Now if you go to a specialist and they only offer aligner trays claiming they are superior/faster or more reliable to traditional braces, then you are being a fed a tall tale from someone who definitely knows better.  If you have a simple alignment case/relapse or if you are offered aligner trays with the disclaimer of expecting less of a result on more moderate cases, then that is a decision you can make (but it is you making an informed decision).  If all you are being told is what the doctor thinks you want to hear (or what your kid thinks is popular), then you may as well head to the kiosk and save yourself some money.  Ultimately, it is the public that will determine the fate of Orthodontics in the US; laws are driven by public desires (just look at legalized drugs).  There will be those of us that adhere to a higher standard, those Orthodontists that won’t put their name on inferior treatment even if it costs them those patients and families.   But we/they will be a dying breed and if you or your family present with a moderate to severe malocclusion, you may certainly be out of luck.

Central Austin Location, 1814 35th St.

 

 

 Steiner Ranch Location, 4302 N. Quinlan Park, Austin

 

 

 

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 Summa Cum Laude graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Hospital 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. He is a Diplomate of the American Board of Orthodontics and member of the College of Diplomates of the ABO.  Dr. Waters has been honored as one of “Texas Best” Orthodontists by his peers in the Texas Monthly magazine focusing on Texas healthcare providers for 14 years straight.  Dr. Waters and his wife of 23 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 www.BracesAustin.com .

 

 

 

 

 

 

 

 

Alzheimer's and Periodontial Disease

Chronic Periodontitis (gum disease) may have connection to Alzheimer’s disease

  

There is an unsettling trend to view dentistry as a simple cosmetic procedure with little to no focus on the well-established link of dental health to overall systemic health of the body and mind.  Social media, commercialization of dentistry, overstressing new technologies and a general erosion of ethics may all be somewhat to blame.  I don’t recall seeing anything on my Facebook come up on the dangers of Chronic Periodontitis or its relationship to life altering diseases but I certainly see many ads about Invisalign and tooth whitening.  However now and then there is a study that really is worthy of informing the public, even if it is very preliminary.

 

So how can dental health affect your body?

 

Already researchers have linked Chronic Periodontitis (Gum disease) to Cardiovascular Disease (CVD), Chronic Obstructive Pulmonary Disease (COPD) and recently to Rheumatoid Arthritis (RA), the later by promoting the onset and even the severity of RA.  In particular, bacteria that causes gum disease actually increases the severity of RA with increased bone and cartilage destruction.
 

P. gingivalis attacking bone in Rheumatoid Arthritis

But a new study recently published in the peer-reviewed journal of the Pubic Library of Science (PLOS One*, Oct. 3, 2018) was designed to investigate if there is a correlation between bacteria normally seen in periodontal disease (Porphyromonas gingivalis or P. gingivalis for short) and that same bacteria seen sometimes in the brain tissue of Alzheimer’s patients. 

 



P. gingivalis

This bacteria, P. gingivalis, is a known pathogen in the oral cavity associated with Chronic Periodontitis (the very same bacteria linked to CVD, COPD and RA), the chronic infection of gum tissue that causes people to lose alveolar bone and eventually teeth. The article was presented by Keiko Watanabe, DDS, PhD, a Periodontology professor at the University of Illinois at Chicago who focuses her research on systemic effects of specific oral bacteria known to cause Chronic Periodontal Disease in humans.

 

 

Dr. Watanabe’s prospective study took 20 mice and injected half with regular doses of the bacteria P. gingivalis while the other half received a saline injection.  After 22 weeks, the mice were sacrificed and the brain tissues compared.  As expected, the mice that received the saline injections had normal brain tissue however the mice receiving the bacterial suspension revealed brains with signs of degeneration, inflammation and senile plaque typically characteristic of Alzheimer’s disease in humans.  Dr. Watanabe points out that it is the chronic nature of the infection that related to the changes in the brain tissue, the same chronic exposure any patient would be receiving from years of chronic periodontitis.      

Brain tissue showing degeneration with plaques

It is possible there is a direct effect from the bacteria on increasing beta amyloid production (a major constituent of senile plaque and widely believed to cause Alzheimer’s) or, as Dr. Watanabe postulates, it may be an effect of neuroinflammation caused by the chronic presence of the bacteria. 
 

 

No matter the direct causation/mechanism, the study definitely suggests there is a link and there needs to be more research on chronic bacterial infections as they relate to Alzheimer’s.  Periodontal disease is a common ailment for humans even in the developed world making this potentially a landmark study.  And any advancement in the understanding and/or treatment of Alzheimer’s disease is certainly of unmeasurable value to society as a whole.  I am always quick to point out to patients the multi-faceted nature of diseases; that there can be many factors and/or triggers for what we perceive as a single disease or ailment.  Sometimes just reducing these factors is enough to keep the disease at bay or prevent expression of certain symptoms.  This is why I feel strongly that anytime you can reduce the risks, you should make that effort (and of course good oral health is in itself its own reward).
 

 

Most people reading this will have been touched one way or another with the terrible effects of Alzheimer’s disease; and Periodontitis will affect many more of us if left untreated.  This study demonstrates how even preliminary research can be employed to possibly reduce risks of potentially severe diseases simply by strengthening our individual resolves to maintain something we should already be maintaining.

 

Health as a game of Chess?

 

 

I believe we should view our individual health like a chess game (as opposed to a single faceted approach like checkers) visualizing cause and effect many moves ahead.  The sooner we realize we are in the game, the better we will fare many moves later.  Therefore I would be amiss not to point out that dental crowding is a factor in chronic Adult Periodontitis due to difficulty cleaning, approximation of roots and plaque accumulation.  Which is another reason for this article in my Blog as a Board Certified Orthodontist; just as we chase down every known factor correlating to Alzheimer’s, it is wise to also look at the predisposing factors for known antagonists.  By straightening teeth, we reduce the risk of Periodontitis which then reduces the risk (or possibly severity) of such diseases as CVD (the leading cause of death in men AND women in the US making up some 25% of all deaths each year; not including the many diseases CVD may also lead to such as stroke and heart disease.), COPD (irreversible chronic disease that ultimately leads to death), and RA (can lead to lung disease, nerve damage and osteoporosis).  And now, another piece of the puzzle, Alzheimer’s disease for which there is currently little treatment and no cure. 

 

“I think we should view our individual health like a chess game ... so I would be amiss not to point out that dental crowding is a factor in chronic Adult Periodontitis due to difficulty cleaning, approximation of roots and plaque accumulation.”

  

*PLOS One is a peer-reviewed open access scientific journal published by the Public Library of Science since 2006. The journal covers primary research from any discipline within science and medicine. The Public Library of Science began in 2000 with an online petition initiative by Nobel Prize winner Harold Varmus, formerly director of the National Institutes of Health and at that time director of Memorial Sloan–Kettering Cancer Center; Patrick O. Brown, a biochemist at Stanford University...

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 and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 22 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. 

 

 

 

 



(In)Accuracy of Invisalign spotlighted in recent study.

New Study Continues to Confirm Invisalign Inferior despite Claims by Advertisers and Dentists

 



 

 

Once again, the most recent study published in the American Journal of Orthodontics & Dentofacial Orthopedics (https://doi.org/10.1016/j.ajodo.2017.11.028) confirms Invisalign along with the other clear aligner systems are inferior to braces and lead to insufficient movements, inability to correct teeth, inaccurate predictions and excessive relapse after the partial corrections (see excerpts of the article below).

 

“In recent years, researchers have used several methods including the American Board of Orthodontics objective grading system, Peer Assessment Rating scores, and other objective occlusal criteria to assess the quality of Invisalign treatment.1-12  The most notable conclusions were that Invisalign is not as effective as fixed appliances [Braces] for expansion,6 it seems to cause more relapse,5 and it is not very effective in controlling buccolingual inclination,4,10,11 occlusal contacts,4,10,11 occlusal relationships,4,11 overjet,4 and overbite.7

 

It should also be noted that results of this study are based on hand-picked cases that were deemed successful but still had to be refined due to failures in movement and inability to achieve predicted results.  In other words, these were patients that wore aligners, were compliant with wearing the aligners AND were chosen as good candidates with minimal movements by expert Orthodontists and they still failed.

 “All achieved rotations were significantly smaller than the predicted ones by different amounts.”

“ …the achieved rotations and vertical movements were significantly different than predicted.”

 

 

In fact, many studies published in the dental Journals have repeated similar results from different samples rating the success of aligners v. braces and all have found that aligners are simply inferior to braces (see the list of references at the end of this blog).  The real question is when can aligners be used for acceptable outcomes even if they cannot perform as well as braces.

 

Unfortunately due to advertising, poor public education (if not outright being misled by so-called professionals) and patients’ overall preference to clear aligners over braces, many patients are being offered a treatment that simply will not work.  There will always be improvements in alignment that are noticeable, but when do we as doctors draw the line on what is success versus what is improved but ultimately a failure?

 

 

And who is the public going to go to for advice when the professionals have simply given up trying to overcome the false advertising and just give in to offer what the patients demand?

 

Recently the head of Orthodontics at a prominent New York Dental School outright suggested in a letter to the American Journal of Orthodontics that Orthodontists need to just lower their standards and give the patients what they want even though we know the failure rate and relapse rate are high and the predictability is poor even with mild cases!  His reasoning was that we will be out of business if we do not just give them what they want.  This is an educator that has given up on educating.  No different than a principal at a school telling teachers not to teach algebra, chemistry or physics because parents feel they will never use them (and they are hard subjects for the kids) and kids/parents have been complaining.  Is that the school you want your kids enrolled; or the principal you want running it?

 

 

So I ask the same questions I have every time a study confirms the inferiority of Invisalign (and ever since I stopped using Invisalign 15 years ago when it was clear results were poor); What is the future of Orthodontics?  Are we only about the front six teeth or are we there to improve the function and the bite?  What responsibility do we have as dental specialists to provide care that improves function of the teeth and jaw and what liability do we have for providing a “service” that actually does harm to the bite even if the front six teeth look straight-ish?

Does the public in whole really just want a short-cut even though it may harm their teeth/jaw/ability to chew?

 

 

The public seems to have forgotten that Orthodontics is a specialty in the first place; why it takes two to three years AFTER becoming a dentist to be proficient enough to actually practice as an Orthodontist.  From experience over the last 22 years in practice, I can say there are far too many un-ethical professionals out selling a product they KNOW is inferior under false pretenses and solely for profit without concern of “do no harm”.  I worry about doctors that will push an inferior product on patients, products that can harm patients over time, instead of offering what they KNOW is best (and usually FAR superior); makes me wonder what else they will do for profit.

  

“I worry about doctors that will push an inferior product on patients, products that can harm patients over time, instead of offering what they KNOW is best (and usually FAR superior); makes me wonder what else they will do for profit.”

 

There is far too much money in advertising pumped into social media and TV by Invisalign to counter with a simple blog by this humble practitioner.  For now, it is up to the public to wade through the noise and seek out good advice.  If you are looking for a good Orthodontist you can trust, I suggest reading my earlier blog on selecting a family orthodontist.

 

A full view of the article may be seen at : https://doi.org/10.1016/j.ajodo.2017.11.028

Accuracy of clear aligners: A retrospective study of patients who needed refinement

Orfeas Charalampakis,a Anna Iliadi,b Hiroshi Ueno,a Donald R. Oliver,a and Ki Beom Kima

St Louis, Mo, and Athens, Greece

(ajodo, July 2018)

 

Further information and studies concerning Invisalign can be found listed in several of my other Blogs including, “Braces are Better … and here’s why.” and “Does Invisalign really work as advertised?”.

  

1 Bollen, A.M., Huang, G., King, G., Hujoel, P., Ma, T. Activation time and material stiffness of sequential removable orthodontic appliances. Part 1: ability to complete treatment. Am J Orthod Dentofacial Orthop. 2003;124:496–501.Google Scholar

2 Clements, K.M., Bollen, A.M., Huang, G., King, G., Hujoel, P., Ma, T. Activation time and material stiffness of sequential removable orthodontic appliances. Part 2: dental improvements. Am J Orthod Dentofacial Orthop. 2003;124:502–508.

3 Baldwin, D.K., King, G., Ramsay, D.S., Huang, G., Bollen, A.M. Activation time and material stiffness of sequential removable orthodontic appliances. Part 3: premolar extraction patients. Am J Orthod Dentofacial Orthop. 2008;133:837–845.

4 Djeu, G., Shelton, C., Maganzini, A. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Am J Orthod Dentofacial Orthop. 2005;128:292–298.

5 Kuncio, D., Maganzini, A., Shelton, C., Freeman, K. Invisalign and traditional orthodontic treatment postretention outcomes compared using the American Board of Orthodontics objective grading system. Angle Orthod. 2007;77:864–869.

6 Pavoni, C., Lione, R., Lagana, G., Cozza, P. Self-ligating versus Invisalign: analysis of dento-alveolar effects. Ann Stomatol (Roma). 2011;2:23–27.

7 Krieger, E., Seiferth, J., Marinello, I., Jung, B.A., Wriedt, S., Jacobs, C. et al, Invisalign® treatment in the anterior region: were the predicted tooth movements achieved?. J Orofac Orthop. 2012;73:365–376.

8 Krieger, E., Seiferth, J., Saric, I., Jung, B.A., Wehrbein, H. Accuracy of Invisalign® treatments in the anterior tooth region. First results. J Orofac Orthop. 2011;72:141–149.

9 Kassas, W., Al-Jewair, T., Preston, C.B., Tabbaa, S. Assessment of Invisalign treatment outcomes using the ABO Model Grading System. J World Fed Orthod. 2013;2:e61–e64.

10 Li, W., Wang, S., Zhang, Y. The effectiveness of the Invisalign appliance in extraction cases using the ABO model grading system: a multicenter randomized controlled trial. Int J Clin Exp Med. 2015;8:8276–8282.

11 Buschang, P.H., Ross, M., Shaw, S.G., Crosby, D., Campbell, P.M. Predicted and actual end-of-treatment occlusion produced with aligner therapy. Angle Orthod. 2015;85:723–727.

12 Grunheid, T., Gaalaas, S., Hamdan, H., Larson, B.E. Effect of clear aligner therapy on the buccolingual inclination of mandibular canines and the intercanine distance. Angle Orthod. 2016;86:10–16.

13 Chisari, J.R., McGorray, S.P., Nair, M., Wheeler, T.T. Variables affecting orthodontic tooth movement with clear aligners. Am J Orthod Dentofacial Orthop. 2014;145:S82–S91.

14 Drake, C.T., McGorray, S.P., Dolce, C., Nair, M., Wheeler, T.T. Orthodontic tooth movement with clear aligners. ISRN Dent. 2012;2012:657973.

15 Kravitz, N.D., Kusnoto, B., Agran, B., Viana, G. Influence of attachments and interproximal reduction on the accuracy of canine rotation with Invisalign. a prospective clinical study. Angle Orthod. 2008;78:682–687.

16 Kravitz, N.D., Kusnoto, B., BeGole, E., Obrez, A., Agran, B. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. Am J Orthod Dentofacial Orthop. 2009;135:27–35.

17 Simon, M., Keilig, L., Schwarze, J., Jung, B.A., Bourauel, C. Treatment outcome and efficacy of an aligner technique—regarding incisor torque, premolar derotation and molar distalization. BMC Oral Health. 2014;14:68.

18 Rossini, G., Parrini, S., Castroflorio, T., Deregibus, A., Debernardi, C.L. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod. 2015;85:881–889.

19 Simon, M., Keilig, L., Schwarze, J., Jung, B.A., Bourauel, C. Forces and moments generated by removable thermoplastic aligners: incisor torque, premolar derotation, and molar distalization. Am J Orthod Dentofacial Orthop. 2014;145:728–736.

 

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. Waters with his family on vacation in Oregon.

 

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 and is a Diplomate of the American Board of Orthodontics and member of the College of Diplomates of the ABO.  Dr. Waters and his wife of 22 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. 

 

 

Contemporary Orthodontics of Austin, Central Austin, TX

 

 

Steiner Ranch Orthodontics, Steiner Ranch (West Austin)