There are many things that affect the outcome of an orthodontic treatment program. By carefully choosing the most appropriate treatment plan, coordinating this plan with the optimum treatment timing and employing long-term retention, a more predictable and stable long-standing result can be achieved. 

Treatment Timing

The Best Time
One of the most frequently asked questions we hear is, “when is the best time to do orthodontic treatment?” Orthodontists generally agree the optimum time to treat a case is during the adolescent growth spurt. In girls this is typically seen from ages 9 to 12 and in the boys from 10 to 14. There are exceptions due to individual variation in growth. We recommend seeing a case about a year prior to these ages to see if that individual may be one of these exceptions.

Why do we recommend treatment during the growth spurt? The reason is we can use the growth of the individual’s facial bones to aid in the correction of the orthodontic problem. Often times malaligned teeth are due in part to a discrepancy in the relationship of the facial bones. If we are able to use growth, we can lessen these skeletal imbalances. Proper balance of the facial bones will lead to a more stable orthodontic result and a better cosmetic appearance.

Early Treatment
Can a case be started too early? In our opinion, yes. There are some treatment options that require two or even three “phases” of treatment. These plans often require a patient start at a very early age (5-7 years). In general, we prefer treatment plans that call for a single phase of treatment. Single-phase treatments have been shown to be equal to or superior to multiple phase treatments. The advantages of a single-phase treatment include less time in appliances, less incidence of patient “burnout,” and less cost.

Non-Growing Patients
What if I miss the adolescent growth spurt? Cases can be successfully treated during periods of little or no growth. As a matter of fact adult treatment represents the fastest growing component of our practice. The treatment options for a non-growing patient may be different. For example, if an imbalance exists in the facial bones of a growing patient, we may choose to modify growth to bring the facial bones into a better balance. In a non-growing adult patient we would either accept the existing facial balance or if the patient wishes to correct an imbalance, surgery would be considered.

It takes special training and experience to match the best treatment options to the individual.

Many people “do braces.” Unfortunately, not everybody who does has had the extensive training of an orthodontic specialist! Some practitioners may have taken a weekend course on orthodontics and have decided to “give it a try.”

Which Plan?
An important key to long stability is choosing the most appropriate treatment for an individual. There is no such thing as a “one size fits all” treatment plan. No two individual cases are alike. There are many variables that contribute to an orthodontic problem. Unless these variables are incorporated into the treatment plan, long-term stability may be disappointing.

Not all treatment plans are created equal. For example, a common orthodontic problem is the protrusion of the upper teeth (buck teeth). Often this problem is due to an imbalance in jaw growth. The upper jaw may grow too much or the lower jaw may not grow enough. If there is an imbalance in jaw growth, in a growing individual, our preferred treatment is to use a nightbrace. A nightbrace is worn in the privacy of the home and works by slowing the forward growth of the upper jaw and teeth. This allows the lower jaw and teeth to grow forward and “catch up.” The advantage of this approach is that it corrects both the dental and facial imbalances. The disadvantage is that it requires the use of the nightbrace 10 to12 hours per day.

Another option to treat protruded (buck) teeth is to accept the facial imbalance and remove two upper side teeth. The space gained by removing the teeth is used to move the upper front teeth back into contact with the lower teeth. The advantage of this approach is that it does not require the use of a nightbrace and it can be used in a non-growing patient. The disadvantages are that it requires the removal of two teeth and does not resolve the underlying facial imbalance, if one exists.

In a growing patient, with a facial imbalance, we prefer the use of a nightbrace because it results in a more complete treatment. Many orthodontists do not use a nightbrace because they do not want to rely on patient compliance. Our philosophy is to present both options to the patient and parents or guardian and explain the advantages and disadvantages and let them decide.

Surgery
Most often surgery in conjunction with orthodontic treatment is done in non-growing (adult) patient cases. Surgery is typically used to correct an underlying imbalance in the growth of the facial bones. Occasionally, minor surgeries are done to uncover unerupted teeth or place dental implants.

If a case could benefit from a combination of orthodontics and surgery the patient will be made aware. Unfortunately, certain surgeries are not covered by major medical insurance. The insurance companies frequently consider these procedures “cosmetic.” Due to cost considerations, it may not be feasible to do surgery. As a result, both surgical and non-surgical options will be explored.

New Techniques
New treatment options and products are constantly being introduced into the orthodontic profession. Some of these represent a definite improvement over existing techniques. Others do not. Our philosophy at Haas Orthodontic Arts is to investigate these new options. If a new technique represents an improvement over an existing technique, it will be adopted. If the new technique represents an inferior choice, we will not offer it. Following is an example of each.

Dental/Orthodontic Implants: Recently, the use of small titanium posts placed into the bone, called implants, has been introduced. The use of implants to replace missing teeth and the use of implants to aid orthodontic tooth movements is a truly revolutionary and exciting advancement. As a result, we are incorporating the use of implants, especially in the adult patient, in ever expanding numbers.

Invisalign®: This recently introduced technique involves the use of multiple “aligners,” which have the appearance of a clear plastic mouthguard. The technology to produce the aligners is very cool, cutting edge and expensive. However, in our opinion, the tooth movements typically produced are questionable in terms of long-term stability. Due to this concern and the fact that many other techniques are available to duplicate these movements in less time and at far less expense, we have chosen not to incorporate Invisalign® into our practice.

Retention refers to the period of time after the braces are removed and appliances called “retainers” are used. The purpose of the retainers is to minimize shifting of the teeth back toward their original positions. This shift is termed “relapse."

As the field of orthodontics has evolved, the concept of retention has changed. In the early days of orthodontics, retainers were not used. The theory was, if a case was properly treated, nature would cooperate and maintain the result. Unfortunately, this was not the case. The teeth tended to relapse. As a result, appliances called retainers were developed to maintain the alignment. The use of retainers has lessened this relapse.

Why Long-Term Retention?
At first, it was thought that a year or two of retainers would be sufficient to prevent relapse. Unfortunately, this was not the case. The use of retainers for a year or two was found to be inadequate for certain stubborn relapse tendencies, especially the alignment of the lower front teeth. Studies of the stability of orthodontic treatment done at the University of Washington found unacceptable relapse in about 70% of their sample. These cases had one to two years of retention.

Realizing this reality, our senior partner, now retired, started to use long-term retention in the early 1970s. The use of long-term retention has significantly reduced the amount of relapse. When we repeated the University of Washington study, noted above, using our patients treated with long-term retention, the amount of unacceptable relapse was reduced to less than 10%.

Over Correction
There are certain orthodontic movements that will relapse even years after the retainers are removed. These orthodontic movements require “overcorrection” to allow for these inevitable long-term changes. Many orthodontists prefer not to place overcorrections. They want the teeth to look “perfect” the day the braces are removed. While this looks nice the day the braces are removed, a year or two later the teeth start to appear crooked again.

We will often remark to our patients we are not overly concerned with the appearance of the teeth the day the braces come off. We care how they look next year or ten years down the road.

We at Haas Orthodontic Arts have the experience to match the optimum treatment plan to individual needs. We are committed to working with our patients to produce a result that they will be proud of in the years to come.