BRACES: TREATMENT GETS FASTER AND LESS VISIBLE

Nora Davison’s and August Imholtz’s treatment began with braces.

“I went to the orthodontist with my daughter, who had an appointment, and I asked about my teeth,” Davison recalls. “That’s how I got into this.”

Davison was fitted with partial braces: eight on her upper teeth and eight on her lower—16 brackets total, compared with 28 for a full set. “It was a clear ceramic bracket with silver wires,” says McLean orthodontist Deirdre Maull, who treated Davison. “It’s really inconspicuous.”

From years of grinding, Davison’s top front teeth had been worn down and her gums had become lopsided. Braces repositioned her four front top teeth—called incisors—pushing them farther into her gum. The result was a gum line that was more symmetrical. Her teeth, meanwhile, remained too short, but that problem would be addressed later. Braces on her lower teeth alleviated crowding. All of this work was done in six months.

“I did not change Nora’s entire bite, only the alignment of her front teeth,” Maull says. “Since it was a partial treatment, there was less to do, which required less time.” Prosthodontist Benjamin O. Watkins III handled the rest of Davison’s treatment.

The hardest part of braces, Davison says, was cleaning her teeth after meals, because food often got caught in the brackets. “For someone who before had flossed every two months,” she says, “this was a new challenge.”

August Imholtz wore Invisalign—clear, removable aligners that contain no metal and are a popular choice for adults. Except when brushing, flossing, eating, and drinking, patients wear the aligners around the clock as they would braces.

“We’ve had patients on TV with Invisalign, and you can’t see the aligners,” says Andrew Orchin, an orthodontist whose practice in DC’s Friendship Heights specializes in treating adults.

Invisalign was a consideration for Davison, Maull says. But because more than straightening teeth was involved, braces—or “fixed appliances”—offered more control.

Imholtz’s aligners were fitted by his general dentist, Brian Gray, also of Friendship Heights. More dentists are handling simple orthodontic cases, especially those involving Invisalign. There is a bit of controversy surrounding this trend, says Orchin, but most orthodontists are okay with it as long as difficult cases are referred to specialists. Invisalign manufacturers provide a two-day course to certify dentists in its use. The course teaches Invisalign techniques but doesn’t teach the finer points of orthodontics, says Gray, an instructor.

To fit a patient with Invisalign, a dentist uses a material called polyvinyl siloxane to make molds of the teeth. It’s gooey when applied but hardens within minutes. The resulting impressions are sent to a lab where they’re used to make a 3-D computerized model of the teeth. From there, a series of aligners are produced. Each set is worn for two weeks before being replaced by the next in the series. With each successive set, the teeth are gradually straightened.

“The results have been tremendous,” says Imholtz, who wore Invisalign for 12 months, until April of 2009. He now wears a retainer at night—but not the head gear once so common.

“The biggest misconception with orthodontics is that when you’re done, you’re done,” Gray says. “The teeth are always moving.” Imholtz will need to wear some type of nighttime aligner for the rest of his life, says Gray, but the frequency of wear will be decreased over time.

The range of orthodontic options is considerable, with bulky hardware and rubber bands no longer the only choices—although bands are still used on occasion, mostly for children. One new technique is SureSmile, which boasts average treatment times of about a year. Wires that control and move the braces are the key.

Wires have always played a part in orthodontia; SureSmile wires are custom-made with the help of an oral scanner, a tool that resembles a wand and fits inside the mouth to take photos. The photos are translated into a three-dimensional image of a patient’s teeth and bite. A “robot” in a Dallas lab bends the arch wires into the dimensions assigned by the computer, and the wires are mailed to the dentist. This precision gives quicker and more accurate results than bending a wire manually and necessitates fewer follow-up visits.

“The great thing about the wire is that it’s heat-activated,” says Orchin, who started working with the product last year. “If I cool the wire down with ice or cold water, it becomes totally malleable. As soon as the wire is heated up in the patient’s mouth, it goes back to the shape the robot bent it into.”

Patients who experience discomfort following the placement of a new wire can get relief by sipping cold water and allowing the wire to soften.

The technology in SureSmile sounds promising to many, including Maull. Still, she’s waiting for the findings of independent researchers.

“I initially studied mechanical engineering, and I love gadgets,” Maull says. “But I don’t want to be beta-testing on my patients. People should not get too hung up on what type of bracket or gizmo an orthodontist uses. The important thing to remember is that all of these appliances are just tools. Nothing can substitute for good hands and sound judgment.”

Braces can leave white spots on teeth when they’re removed. A product called Icon is working wonders on these spots, called decalcifications, says John Drumm, a dentist in DC’s Foxhall neighborhood: “It gets into the nooks and crannies and seals up the tooth. It picks up the actual color of the tooth and remineralizes the tooth—and there’s no anesthesia necessary."