Phase I Treatment (Early Intervention Braces) and Costs

Phase Treatment (Early Intervention/Early braces) and Costs

 

There are many different types of malocclusion in the developing dentition.  Kids may present with mild spacing to severe crowding, missing teeth to extra teeth and even impacted teeth (present but turned at an angle and unable to erupt).  Baby teeth may be in too long or lost too early allowing space to be lost.  Growth may be irregular, unfavorable or disproportionate with the patient’s face or between upper and lower arches.

 

“The most qualified doctor to ascertain this will be an Orthodontist so it is important for patient to get to an Orthodontist for a screening exam early, usually around age 7.”

 

Whatever the malocclusion may be, there is almost always a “Best Time” to treat.  The most qualified doctor to ascertain this will be an Orthodontist so it is important for patient to get to an Orthodontist for a screening exam early, usually around age 7.  Keep in mind also that this may not always mean the entire correction can be done at the same time as some problems are best treated at different ages.  It also doesn’t completely mandate that you treat every aspect of the bite at different times just because you see one problem early however when the benefit outweighs the cost and risks, then it is best to separate treatment into two “Phases”. 

“Whatever the malocclusion may be, there is almost always a “Best Time” to treat.”

 

I recently had a consult between Phases (after Phase I but before Phase II full braces) where the parents felt slighted that we asked for a new fee to progress into Phase II braces.  They swore up and down that I had promised them to treat at the sibling’s same fee from 7 years past.  So imagine their surprise and disgust when I told them I was discounting a full 50% of the Phase I cost toward the Phase II braces (bringing the fee less than the seven year old fee).  In doing so, I gave up all my profit and then some toward the full braces (I can do this because we prevented removal of permanent teeth, corrected an impacted cuspid and brought her mandible forward a half tooth (Class II to Class I). Unfortunately there was still enough crowding and the original angle of the cuspids allowed them to erupt too far forward and out of the arch so braces were needed to finish alignment.

 

So we all knew that full braces would be needed, this was not in dispute.  Neither was the fact that I informed them before Phase I that a second Phase was likely and would be at additional cost.  But they still could not understand an additional fee beyond the total single-Phase treatments (from 7 years ago!). 

 

In truth, this does not happen to me very often but after 2 to 3 years, parents do forget the details and since we have no idea how much work may be remaining, there is really no way to give a good estimated future cost.  We do document in the consult and the parents get copies however these are forgotten and/or lost by the parents over the years.  So I wanted to put a quick post out so the public has a better understanding of Phase treatment.

 

First, a typical Phase I may cost anywhere from $450 to hold minor space to $1500 to $1800 for an expander or more extensive space maintenance and retention thereafter to $3000 for limited braces or even up to $4400 for extensive Phase I efforts/appliances to avoid surgery or expose an impacted tooth and force its eruption early/on time.  Many times these Phase I treatments will prevent removal of permanent teeth, prevent impaction of teeth and ultimately lay the foundation for a much more stable and more esthetic overall outcome.

So let’s go over some more common questions:

 

Can I avoid braces later by treating with a Phase I now?

The answer is, sometimes.  Holding space allows teeth to erupt straighter (teeth take the path of least resistance,

they will tend to erupt straight up into the space provided).  Even a case with a large skeletal discrepancy may be treated fully in a Phase I if the skeletal discrepancy is corrected and then the teeth erupt correctly.  I have corrected many early underbites that need minimal to no later treatments, same with overjets due to narrow palates, but it is never completely predictable and there are factors to consider such as compliance, oral hygiene and size of teeth.

For a perfect dentition (if there is such a thing), it is likely that there will be some form of Phase II; this can be from small rotations/size discrepancies in teeth or just a really tough case that is not fully corrected.  Just as I have prevented cases from needing Phase II at all, there are many cases where I recommended minor

 

If I treat early can I avoid removal of permanent teeth?

Most of the time, cases that would go to extraction treatment are somewhat borderline; but removing teeth may produce too much space making stability difficult later.  If the crowding is minimal and the upper jaw is narrow, it is likely that correcting the width of the upper jaw with expansion will restore space for teeth and alleviate future crowding to the point  This also helps alleviate crowding in the lower by removing the constriction from a narrow upper arch.  It can prevent braces and certainly can lead us away from removal of permanent teeth later but usually there is some rotation or persistent crowding or deepbite that still warrants a second Phase later.  I will almost always discount my regular price for patients I treated with a Phase I by 25% to 50% of the Phase I fee charged.  This is not a standard practice with all offices and there are circumstances that still warrant a significant fee for Phase II (number of appointments/actual cost of Phase I/severity of initial and current malocclusions) but generally I try to reward parents for making a decision that provides an easier correction without removal of teeth/impaction of teeth.

 

Why do I have to pay again; why not just wait and treat at one time?

Phase I treatment is to re-establish normal development, crate space for future eruptions to prevent removal of teeth and/or impaction of teeth, to improve the growth of the jaws and possibly even prevent surgery.  The goal of course is to reduce needs later and improve overall stability of any correction but it is still likely there will may be full braces recommended as a second phase of treatment, Phase II.  Money paid for the Phase I covers appliances, time and expertise to set the foundation for good development and a better eruption of teeth.  Phase II braces will have their own expenses, time and overhead to correct; they will still carry a fee for braces though it may be less than normal since the idea is the doctor now has an easier case to finish.  Any discount or reduction in the normal fee for braces is subjective and up to the provider because he/she will be the one estimating time remaining and judging previous compliance/oral hygiene/growth to make the recommendation.

The answer to the second part is dependent on the reason for the Phase I.  If extraction of teeth was prevented by an early correction of jaw size, then Phase I saved @$1000 of dental work and provided a more stable dentition with better lip support and a full profile; even if a patient opts out of a recommended Phase II later, the benefits of the Phase I will likely remain.

If a tooth (typically a canine) was impacted and is now erupted after expansion or other Phase I treatment, then surgical exposure could have been prevented saving $2500 to $3000 in dental surgery as well as another $2000 or more in added orthodontic treatment to assist the eruption after any surgery.  Consider the following patient:

 

Age 9y 8mo presenting with a narrow upper jaw and crowding, the panograph (X-Ray) revealed even more severe crowding with impacted canines crossing the incisors and lying at 45 degree angles

 

Panograph taken during expansion with limited braces (4 months into treatment); note the space now opening.

 

Now 10mo into treatment, the expander has been removed and limited upper braces have moved the roots of adjacent teeth away from the erupting canines.

 

 

 

This Panograph taken at 15mo now shows the canines both erupting relatively straight and now into the correct position (not transposed with adjacent roots as in the initial films)

 

 

One year after removal of the Phase I limited braces at age 12y 0mo, you can see the previously impacted canines are now erupting normal and straight; impaction has been prevented as well as any need to remove permanent teeth; there is some minor crowding to correct in the lower arch and a few rotated teeth into the upper arch but now Phase II braces will be more optional, less costly, less time and more stable if employed to finish the correction.

If severe overbite/overjet or an underbite was corrected with the Phase I treatment, then the profile may be restored and surgery of the jaw(s) prevented saving upwards of $40,000 in dental surgery plus another $2000+ in added Orthodontic treatment as surgery cases are more expensive than regular braces. Consider the following cases with changes in their respective jawlines/profile simply from early intervention and no later braces or Phase II treatment.

 

PATIENT 1.

This 7y 6mo young lady presented with a developing underbite and midface deficiency in profile, all from an under-developed upper jaw.

 

 

After 15mo of Early treatment, note the change in her face as well as the restored overjet in the X-Ray.

 

PATIENT 2

This 9 year old developed a very severe underbite leaving no upper lip support and teeth at risk of fracture.

 

At age 10, just one year later, you can see the changes in the lip support and correction of the underbite with Early Phase I limited treatment.

PATIENT 3

 

Patient started Phase I at age 7y 7mo and finished at age 9; note the facial change in the pictures taken one year after removal of Phase I appliances.

  

PATIENT 4

This patient presented at age 7 with a very severe overjet, over 12mm.  Phase I was planned with the objective of simply reducing the amount of any future work and maybe reducing the need for surgery though we still expected some overjet and full braces.

 

 

This same patient after an aggressive Phase I course of treatment for 24mo; note the jaw is forward and the previous 12mm overjet has been fully corrected.  We then placed a type of retainer that helps “settle” the remaining teeth as they erupt (see results below).

The same patient at age 12y, a full 2 years following retention with a positioner to settle teeth.  No braces were ever used on this patient; this demonstrates how much of her original malocclusion was due to skeletal (Orthopedic) discrepancies and not actual dental issues.  Once the jaws were aligned and the geometry of the arch returned to normal, it was relatively simple to get the teeth to erupt straight and in good occlusion.

 

The benefits long-term may include a more stable bite with less relapse, a more esthetic and full smile, a more favorable chin and jaw line, less wear on teeth by restoring the conditions for better function and less risk of joint pain/TMD; some of these improvements can literally be priceless.

Summary

Early Intervention or Early braces for children can be beneficial and may prevent much more severe malocclusions from developing  This can lead to a much better correction including better function, a more full smile and preventing of extractions or even surgery.  Because of the nature of the eruption of teeth and specific growth of individual children, there is no definite time to start Phase I or make a decision when it is too late; every patient is different.  The American Dental Association, the American Association of Orthodontists and the American Board of Orthodontics all recommend young patients be screened by an accredited Orthodontist by age 7 (when the permanent 1^st molars are erupted) to determine if early treatment would be beneficial.
 

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 20 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. 

 

 

 

 

Airway Obstruction and the Developing Dentition

Airway Obstruction and the Developing Dentition

 

There has been research around for years demonstrating that soft-tissue airway obstruction in a developing child leads to under-development of their upper jaw and constriction of dental arches; this in turn leads to crowding and many times a backward shift of their lower jaw.  The obstruction can be from chronic inflammation, swollen tonsils and adenoids, adverse tongue posturing or just anatomical thick tissue. If severe enough, it can lead us to recommend removal of permanent teeth or even surgery to re-position one or both jaws. We are also seeing that over time, this constriction affects the tongue space and can ultimately lead to Chronic Snoring and Sleep Apnea.

 

As a practicing Board Certified Orthodontist, I have treated thousands of patients with varying malocclusions that could be traced back partially if not wholly to airway obstructions.  Recently however there is a trend in our medical community to address these airway obstructions early to reduce the prevalence of Sleep Apnea and improve the long-term health of young patients before the symptoms of the airway restriction become severe.  Several local ENT’s in my community have become very proactive and I believe the research is continuing to demonstrate early removal of soft tissue obstructions in the nasal airway is absolutely warranted and helps in overall development and later quality of life.

Anatomy of the Nasal Airway with computerized imaging of airway space.

What we are really seeing in the literature is a merging of medicine and dental; perhaps something that is less common than it should be but nonetheless this sharing of data is now helping educate providers and push for better patient care and more successful outcomes.  From my practice, experience shows that by the time a patient sees the Orthodontist by General Dental referral, much of the damage is already done.  That is because most dentists gauge the need for braces by the crowding of the teeth and they tend to want to wait until most or all baby teeth are lost (which is entirely too late for more severe problems).  In these now adolescent cases, we use traditional braces (with or without expansion/removal of permanent teeth/surgical repositioning) to undo what we can and work to establish a new arch form with alignment of teeth while providing the best esthetics and function possible.  

 

“… experience shows that by the time a patient sees the Orthodontist by General Dental referral, much of the damage is already done.”

 

This adolescent was referred only after once all permanent teeth erupted; patient had a history of breathing problems and chronic airway obstruction that went untreated.

 

 
Following extensive Orthodontic treatment including Rapid Palatal (Maxillary) Expansion and removal of the upper right 2nd bicuspid; although the teeth are corrected and arches restored, stability will never be possible without long-term nightly retainer wear; following treatment, the patient was referred to an ENT for removal of excessive soft tissue for added stability.

Correcting a narrow maxilla or a smaller (retrusive) lower jaw due to an airway issue can be time consuming and expensive to correct later in life; stability is sometimes based not only on early intervention and good dental correction but also on alleviating any airway construction before or after the orthodontic correction.  Patients and parents of patients should understand that the development of the dental arches are usually only a reflection of the forces in the mouth; whatever causes a severe malocclusion will still be affecting the teeth following the correction.  Therefore it is important to consider the airways when determining if a correction can be maintained without long-term appliances/retainers.

 

 

At 7 years old, this young patient was identified as having large tonsils and an obstructed airway with under-developed upper jaw and retrusive lower jaw.

Following expansion of her upper  jaw, you can see the lower jaw has come forward; patient reports improved breathing and parents report correction of snoring.

 

At this point, patient is referred to an ENT for possible removal of tonsils and will be monitor as we await the remaining permanent teeth. 

 

 

 

 

For younger patients, an Orthodontist can identify the early signs of damage from an airway obstruction

and they can take records to confirm and quantify such narrowing in the airways.  If seen early enough, the effects of the airway obstruction can easily be corrected by expanding the upper jaw and freeing the lower jaw to come forward as well as referring the patient to a knowledgeable ENT for closer evaluation and possible removal of soft tissue.  Along with expansion, the Orthodontist may even choose to set upper front teeth (which erupt around age 6 to 8) into an ideal arch form while clearing a path and opening space for future eruption of commonly impacted teeth due to this problem.  We know from the literature and from experience that many impacted canines that would require surgical exposure can be prevented by simply restoring a narrow upper arch with a fixed (not removable) palatal expander.

 

Consider the following case with a severely impacted and transposed tooth.  Already late getting to us, it took expansion with limited braces in the early mixed dentition to correct the impaction and save the adjacent tooth from more damage.

 

 

Note the narrow upper arch secondary to chronic airway Obstruction and Allergies.

 

 

Panograph X-Ray shows the impaction of the canine (on the upper left side in the film)

which is erupting on the wrong side of the adjacent lateral incisor.  The following films
show the sequential movements to correct the impacted and transposed canine.

Review of sequential X-Rays shows the correction of the impacted cuspid following expansion and opening space for the blocked out teeth; the photograph shows the new smile as we now await the remaining teeth.  Airways have n=been increased from the process and we expect a stable long-term correction.

In a Februrary 2013 study published in the Journal of the American Association of Orthodontics (AJODO) (http://dx.doi.org/10.1016/j.ajodo.2012.09.014 ) entitled Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: A cone-beam computed tomography study, investigators using computer tomography imaging on patients treated with palatal expansion measured the before and after airways and tongue posturing known to affect development and contribute to sleep apnea.

 

In this study, researchers pointed out that  “Rapid maxillary expansion (RME) is known to improve nasal airway ventilation. Recent evidence suggests that RME is an effective treatment for obstructive sleep apnea in children with maxillary constriction.”

 

 

  Yellow arrows show the nasal airway space in four patients each with varying

amounts of resistance from soft tissue.

 

 

This study wanted to confirm these findings but also investigate the effects of Expansion on tongue position which have also been shown to cause sleep apnea.

In their conclusion, the authors stated that “In children with nasal obstruction, RME not only reduces nasal obstruction but also raises tongue posture and enlarges the pharyngeal airway.” 

 

 

Yellow arrows show the varying size of tonsils and how they affect the airway space

in five different patients.

In other words, expansion opened air ways and improved tongue posturing in children.  Of course it also increases the arch length and regains space for future teeth thereby reducing crowding and risks of impactions.

 

A more recent study published this month in the AJODO, (http://dx.doi.org/10.1016/j.ajodo.2016.10.027) was undertaken to clarify the relationships between upper airway factors (nasal resistance, adenoids, tonsils and tongue posture) and certain facial patterns seen when treating patients with Orthodontics, specifically patients with small lower jaws (Class II) v. those with excessive growth of the lower jaw or underbite tendencies (Class III).  The findings revealed that the relationship of upper airway factors are different between different facial types.  The data suggested that patients with small lower jaws (Class II) had significantly more nasal obstruction/resistance and that decreased width of the upper jaw measured at the molars related to an increase in nasal airway resistance/obstruction and a less favorable tongue position.

Imaging showing molar widths, measured and compared to obstructive airways.

Combining the results of these two papers, Orthodontists can now show definitively that not only does a narrow upper jaw cause crowding and increased risks of impaction of teeth, but it also is correlated with reduced airflow, poor tongue posturing and an increased risk of sleep apnea.

 

What does this mean to parents?

First, it means all kids should be screened early by someone who is knowledgeable (Certified Orthodontist) and can see the signs of airway obstructions before problems become too severe; General Dentists are not trained to specifically identify this problem in developing children.

 

Second, Orthodontists must not only treat the symptoms of airway obstructions but they should also include their ENT colleagues in consultation to determine if soft tissue removal may be necessary either before or after palatal expansion.

 

Third, expansion is not just about the teeth.  If an upper jaw is narrow, it can lead to a smaller lower jaw, it can lead to further airway resistance and can even contribute to Sleep Apnea later in life. Expansion, when necessary, increases airway space and improves airflow in children.

 

In summary, only an expert in development (i.e. a Certified Orthodontist) is going to be able to determine when expansion may be necessary for restoring restricted airways.  Even without crossbite, an upper jaw can be significantly narrow as the lower jaw is pushed backward or the lower teeth fold inward to stay within the upper jaw arch form.  Waiting on a referral from someone who is not fully trained or experienced can lead to severe crowding, impactions and even Sleep Apnea.



 

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 21 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. 

 

 

 

 

New 2017 Study shows Invisalign only 50% effective v. Braces

 

New 2017 Study shows Invisalign only 50% effective v. Braces

I have previously reviewed several articles concerning Invisalign and other clear aligner systems used to move teeth and there is a fair amount of debate at the specialty level of Orthodontics as to how much we should be using these aligners and how they are abused in so many inexperienced dental offices.  In fact, previous studies have shown Invisalign to have a dismal 41% mean accuracy of tooth movement with a range from 18% to 47.1% (j.ajodo.2007.05.018;www.ajodo.org) and mean percentage of single tooth movement goal of only 57% (j.ajodo.2013.10.022). 

 

When results from Invisalign were compared to traditional braces using American Board of Orthodontic standards, the Passing rate of cases treated with Invisalign were 27% lower (j.ajodo.2005.06.002).  Even worse, another more complete study (j.ajodo.2004.07.016) actually concluded that there was a “minimal improvement in occlusal score based on Board standards from 47 to 36.4 [0 being ideal] and there was a negative change (2.5x worse AFTER treatment) in posterior occlusion contacts with Invisalign.”  

 

This last investigator summarized Invisalign treatment by stating “According to the OGS [Objective Grading System used for the American Board of Orthodontics], Invisalign did not treat malocclusions as well as braces … Invisalign was especially deficient in its ability to correct large anteroposterior discrepancies [overjet] and occlusal contacts.”

 

Last month (April of 2017), a new article was published in the Journal of the American Association of Orthodontics that confirmed previous findings.

The finding s of the new article from April 2017 (http://dx.doi.org/10.1016/j.ajodo.2016.09.022) , are summarized below.  

Management of overbite with the Invisalign appliance

Roozbeh Khosravi

x

“Our results suggested that about 1.5 mm of overbite improvement can be expected when the Invisalign appliance is used in deepbite patients. A previous systematic review on the stability of deepbite correction reported an average of 3 mm overbite correction with fixed appliances [traditional braces].¹³ Our result of a 1.5-mm median correction in open-bite patients is half of the reported average open-bite correction with a nonsurgical fixed appliance approach.²⁵ These comparisons may indicate that aligners can usually improve deepbites and open bites, but they might not accomplish as much correction as fixed appliances.”

Two things to draw from this study:

1. Overbite was corrected on mild cases an average of 1.5mm
2. Overbite corrected by traditional braces for mild cases averages 3mm
3. Traditional braces correct 100% more of the overbite than Invisalign on average.
4. Invisalign is only 50% as effective as traditional braces in correcting overbite.

So relative to braces, Invisalign is half as effective and therefore not clinically sound method to treat when we can treat 100% more with traditional braces.  And this is only one part of a malocclusion a patient may have.

Another area of malocclusion was also evaluated; mild anterior openbites.  This study only looked at patients from three Invisalign offices that had already filtered out the moderate cases for surgery (the author does not state if these discounted cases could have been treated with traditional braces or what those patients did for treatment).

Even with these more moderate to severe cases not included, this study shows that Invisalign cannot intrude or push teeth back into the bone as braces can, in fact all of the bite closure for even these mild cases was through folding the incisors back and down; no mention was made as to the effects on the gingival display (gumminess) and no long-term information was gathered to evaluate for relapse.  This is especially a weak point since these cases (and extrusion of teeth in particular) has been shown in Orthodontic literature to relapse over and over.

In fact when it came to evaluating the post-Invisalign cases, the author simply states the following:

“The second limitation of this study was that almost 50% of screened patients were not included because of the absence of posttreatment cephalometric radiographs. It is unknown whether this might have introduced selection bias to this study.”

 

In other words, if the doctors didn’t take post-Inivisalign records (for instance the results were not good and they didn’t want to have them in the study), they were simply not included in the study.  So we can safely assume this study is full of the best cases only with any failures filtered out of the averages.

 

But even with the results skewed to the most successful treatments, Invisalign is simply not close to the effectiveness of traditional braces.  They are bound by the limitations of a removable tray that has to be loose enough to be removed and over time, fatigues and becomes essentially inert.  Even Invisalign studies show that any tooth moment occurs the first 48 hours of the tray and the next few weeks really show no movement.  This is a clear sign that tray cannot produce the constant forces necessary to make full tooth movmennts.

 

So if the research is so plain and clear, who is pushing Invisalign to the public?

 

The problem now stems from profit-based corporate companies like Align Technologies (Invisalign) and other brands such as Clear Correct and Smile Club advertising directly to the public as if Orthodontics is no different than a trip to the salon and similar to whitening your teeth.

 

Doctors now invested in Invisalign (such as those in this study), also will make statements suggesting relative success in corrections without telling the public that 50% success means 50% failure when compared to braces.  I wouldn't accept a 50% in a grade from any of my four kids and I certainly wouldn't be bragging about a 50% result v. another Orthodontist's cases but that is exactly what Invisalign and Invisalign doctors are saying and many times it's because they know what the public wants and don't want to lose business even though they know there is a better treatment.

 

In fact, Orthodotics is very complex, so much so that it takes two to three years of specialy traingin After dental school to be called a Specialist or Orthodontist.  Companies will lead you to believe a computed scan with a tech can plan and align your teeth equal to traditional braces and this is simply not the case.

Consider sticking a pencil into a soft wax candle jar.  Now imagine simply pushing the pencil over with finger pressure; the pencil will move but will tip.  Now grab the pencil tight and try to move it completely sideways through the wax.  This will illustrate the difference between Invisalign (tipping) and traditional braces (true root movement).  Without the later, there is no way to correct teeth in all three dimensions and any correction from tipping will likely lead to significantly more relapse.

 

                            So are so many doctors now advertising Invisalign?

 

1. It is all General Dentists can do without training for braces.
2. Orthodontists are losing referrals to General Dentists who now believe they can treat their patients and keep everything “in-house” so they are trying to keep their patients.
3. Advertising by a Billion dollar public company is telling patients that clear aligners can give them a smile (though they neglect to talk about function/health) and that braces are essentially “old technology” and not necessary.
4. Align Technologies threatens lawsuits against criticism of their product; they are protecting their profit by any means.  They also pay doctors to use their product by offering free advertising, referring patients directly to doctors that treat more with Invisalign and they donate to all levels of the dental organizations.

 

So why should you care?

 

There is a reason that all dental offices in the state of Texas must be owned by a licensed dentist; only a dentist can be truly held accountable for dental care.  Companies have only one primary objective: profit.  IF they can get profit from a great product then by all means, good for them.  But if they rely on borderline false advertising or advertising by omission to push their product then the patient gets compromised treatment that will lead to relapse, recession or bigger functional problems years later. 

 

Patients should always ask their doctor: Is this the best treatment?  How would braces be different than aligners?  Patients should also avoid any doctor who only offers Invisalign since we know from the literature that Invisalign is only 50% as effective as braces for even minor movements correctible by traditional braces.

 

If a patient accepts to treating to a lesser standard without having to wear braces (and is aware of any risks of functional disturbances in their occlusion afterward), then there is no problem. I personally would never treat and leave a patient in a functional malocclusion out of pure liability because I plan on practicing for many years but if a patient wants this and goes somewhere and they disclose the limitations then at least it is an inform decision. 

 

How do I know my General Dentist treated me to a Functional Bite?

The best way to check your bite after treatment with Invisalign by a general dentist is to have a certified Orthodontist see you after treatment.  Be up front, let them know that you have treated with aligners but that you just want to make sure there are no big issues functionally.  Usually, a good Orthodontist will just keep to the big stuff; he or she is not looking to re-treat patients or openly criticize someone else’s work, but they will now be responsible for identifying any problems and informing you of potential issues.  Keep in mind, aligners are rarely going to provide ideal occlusion simply due to the plastic between the teeth and due to any jaw shift that changes the bite from before the aligners to after (all trays are made from the initial scan and may only be altered once during the entire treatment).  Regardless, large problems that can lead to recession, damage to teeth and damage to joints will have to be disclosed.  From there, you can decide what path to take but at least you will know.

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 21years 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. 

 

Steiner Ranch Office, Austin, TX

Central Austin office on 35th Street, Austin, TX