November 17, 2017

Accelerated Orthodontics

CAN WE SPEED THIS UP?

Many orthodontic patients start their journey excited for the changes ahead.  They quickly adapt to their appliance routine and revel in their dramatic smile transformation.  Soon thereafter, a new question arises.  "Hey doc, when can we be done?"  The truth is, most patients tolerate orthodontic appliances just fine but if they had their way the treatment would be over soon after it starts.  We remind our patients that teeth can move only as fast as the bone around them accommodates their tooth movement (aka remodeling).  We remind them that children and adolescents seem to have bone that turns over faster (or remodels faster) than their adult counterparts.  This is in part due to the higher density of adult bone.  We always encourage our patients to do their own "homework" to make sure they finish as fast as possible; to  show up for their appointments (moving their treatment forward), to watch what they eat (so they can avoid emergency appointments), and to comply with treatment instructions (to avoid unwanted side-effects and to provide the necessary force for needed tooth movement).  Some patients will do all of that work and still ask, "Okay but what el se can I do?"  

For those patients that want to push the envelope further we have a few other tools in our toolbox.  For clear aligner patients, vibrating mouthguards may help fit aligners a bit better and contribute to better "tracking" (or teeth following the tooth movement plan).  Those vibrating mouthpieces also seem to lessen discomfort (theoretically by increasing blood flow to the ligament surrounding individual teeth).  

For patients with very difficult tooth movements we can consider TADs (Temporary Anchorage Devices) to hold certain teeth steady or alternatively push and pull other teeth while avoiding unwanted tooth movements (combating Newton's third law that "for every action there is an equal and opposite reaction").  Some clinical scenarios benefit from this treatment auxiliary better than others.

 

For patients that won't to "peg" the speedometer on the biologic process and increase the bone-turnover we can provide a temporary decrease in bone-density that will allow teeth to move faster than normal (e.g. an adult's tooth to move as fast as a child's tooth through bone).  This procedure requires dental anesthetic (like getting numb for a filling) and a patient may be sore for 2-3 days after but it's usually well-tolerated and may speed up tooth movement for about 2-3 months.  This process can be repeated as needed during treatment.  For clear aligner patients, this may allow for reducing aligner changes from once every 7 days to once every 3 days.  This could theoretically shorten treatment by almost half the expected duration.  In general we only expect treatment to be reduced by 1/3rd of the expected length but some patients may find this procedure appealing.

Finally, when patients may benefit from added bony-support around their teeth (e.g. they have a very narrow arch as an adult or they have very thin bone over the roots of their teeth), we can partner with a periodontist or oral surgeon to provide a globalized bone-graft around a certain region.  Once the teeth move into the region of the bone-graft (or osseous augmentation), the new tooth position stimulates the new bone to turn over and this in turn supports the bone itself.  With this procedure, we find that very difficult treatment is accomplished in relatively short time-periods.  This affect seems to last from 3-6 months.

As you can see, there are many ways to increase your treatment speed.  Some methods are very simple and others are extensive, costly, and somewhat invasive.  Contact us to learn more about these options!