Invisible Braces

Invisible Aligners for Teeth

Everybody wants a great smile, but a lot of us need help getting there. More and more people are having success with clear orthodontic devices called aligners.

Braces use brackets connected by wires to encourage teeth to move. Aligners are a series of tight-fitting custom-made retainers that slip over the teeth. Invisalign is the largest producer of clear aligners, but it’s not the only brand. Others include Clear Correct, Inman Aligner, and Smart Moves.

Clear (or “invisible”) aligners aren’t for everyone. Biermann Orthodontics can help you decide what’s best for you.

Can anyone get invisible teeth aligners?

Because the invisible aligners are custom-built for a tight fit, they are best for adults or teens. Straightening a child’s teeth is more complicated. Young people, and their mouths, are still growing and developing; the doctor must think about this when setting up treatment.

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What is SMARTCLIP™

What are the benefits of SMARTCLIP™?

Standard braces use rubber bands to hold the wire onto your braces. Advancements in technology now bring self-ligating braces onto the scene. Instead of rubber bands, 3M™ Self-Ligating Braces use a unique clip or movable door to hold the wire in place. Which braces you choose is between you and your orthodontist, based on your treatment needs and aesthetic preferences. With SmartClip™, your teeth can stay cleaner and you can spend less time in your orthodontist’s chair.

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Halitosis

Tongue Scrapers Offer An Option For Halitosis

Article Featured on OralB

How Tongue Scrapers Work

If you suffer from halitosis, or chronic bad breath, you’re probably looking for ways to help manage the problem. If so, consider a tongue scraper. They’re relatively inexpensive and available at most pharmacies. Tongue scrapers are often touted as the way to improve bad breath, but there is very little research to show that they are any more effective than simply brushing the tongue with your toothbrush as part of your toothbrushing routine.

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Diabetes doubles tooth loss for US adults

Diabetes Dentistry Diabetes Doubles Tooth Loss for US Adults

Although tooth loss has decreased over the last four decades, U.S. adults with diabetes lose twice as many teeth as adults without diabetes. Black Americans with diabetes are at greater risk of experiencing tooth loss as they age than white or Mexican Americans with diabetes, Duke University researchers report.

The study assessed National Health and Nutrition Examination Survey (NHANES) trends in tooth loss from 1971-2012. While overall tooth loss declined over the 40-year study period, tooth loss remained more common in people with diabetes. Black Americans with diabetes lost more teeth than white and Mexican Americans with diabetes. The researchers suggest this difference could be a result of historical challenges non-Hispanic blacks faced in obtaining proper dental care because of a lack of dental services and dental knowledge.

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Dentistry Nutrition / Diet Soda and fruit juice are 'biggest culprits in dental erosion'

Diet Soda and fruit juice are ‘biggest culprits in dental erosion’

Article by David McNamee | Featured on Medical News Today

Soft drinks are the most significant factor in severity of dental erosion, according to a new study published in the Journal of Public Health Dentistry.

Dental erosion is when enamel – the hard, protective coating of the tooth – is worn away by exposure to acid. The erosion of the enamel can result in pain – particularly when consuming hot or cold food – as it leaves the sensitive dentine area of the tooth exposed.

The enamel on the tooth becomes softer and loses mineral content when we eat or drink anything acidic. However, this acidity is cancelled out by saliva, which slowly restores the natural balance within the mouth. But if the mouth is not given enough time to repair itself – because these acid attacks are happening too often – the surface of the teeth is worn away.

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Keeping Your Smile Pretty

How to Keep Your Smile Pretty and Healthy

by Jeannie Kim | From Health magazine

These days, it seems like everyone’s obsessed with getting a blindingly white grill. But there’s more to taking good care of your mouth than having a soap-star smile.

The condition of your teeth and gums is associated with a host of other health issues that involve your hormones and your heart, and your dental needs can change from decade to decade. Here’s how to keep smiling strong at any age.

Your 30’s: Heed Your Hormones

If you’re pregnant, you might not feel like dragging yourself to the dentist, but you should do it. Higher levels of estrogen and particularly progesterone can result in puffy, tender gums that are vulnerable to minor infection.

Flossing is especially important, experts say, because it helps cut the risk of periodontitis, a more serious gum infection that can endanger more than your teeth: some studies have linked untreated periodontal disease to preterm and low-birth-weight babies.

Perfect Your Stroke

Many adults never learned how to brush and floss properly, says Irwin Smigel, DDS, president of the American Society for Dental Aesthetics. Use a soft brush that has rounded nylon bristles and make gentle circular motions at a 45-degree angle to your gum line.

If flossing hurts or makes your gums bleed, keep working at it. “The more you floss, the tougher your gums become,” explains Paula Jones, DDS, immediate past president of the Academy of General Dentistry.

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Healthy Foods For Teeth

Eat And Drink Your Way To A Whiter Smile

Article Featured on MSNBC

Stars like Jessica Alba and Scarlett Johansson need killer smiles for their livelihood, but for us mere mortals, a whiter, brighter smile can do wonders for our appearance and self-confidence. Plus, surveys reveal that one of the first things that people notice about others is their smile, and as that old saw goes, you only get one chance to make a first impression.

Dr. Timothy Chase, a 15-year veteran of cosmetic dentistry in New York City says white teeth and healthy gums can take 10 years off your appearance. And while professional dental products work best for whitening,  what you eat and don’t eat can play a huge role in how white your teeth are.  It seems certain fruits, vegetables and other foods can aid in your quest for whiter teeth. Here’s what you should know about the white smile diet:

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Orthodontic Case Study

Maxillary expansion or bicuspid extraction: A case study in orthodontics

By By Tyler Pritchard, DDS | Featured on DentistryIQ

To pull or not to pull? . . . the decision to extract permanent teeth in an adult patient is not always an easy one. When an adult patient presents with severe crowding and a posterior crossbite, will dental and skeletal expansion create sufficient space to resolve the crowding, or will teeth need to be extracted as well? This question can be answered by predicting the amount of space that can be gained with dental and skeletal expansion, keeping in mind the desired esthetic outcome and overall oral health of the patient. A study performed by Adkins et al., found that the amount of arch length created by first premolar expansion can be calculated by multiplying the amount of expansion to be preformed by a factor of 0.7. (1) How do we determine how much expansion is appropriate so that we can calculate the amount of space to be gained?

Maxillary expansion or bicuspid extraction: A case study in orthodontics by Tyler Pritchard, DDS - Figure 1
Figure 1: Frontal cephalogram showing the patient’s narrow maxillary arch and lingual tipping of the mandibular posterior teeth.

By using a frontal cephalogram (figure 1), we can determine the amount of skeletal expansion that is required for the maxillary arch to achieve the proper width to match the mandibular arch. To calculate the increase in space, however, we need to calculate the removal of any dental tipping in addition to the skeletal expansion. There are two processes that often occur simultaneously when correcting a posterior crossbite. One process is to remove all dental tipping so that each tooth is centered over the supporting bone. The other process is to correct any transverse maxillary skeletal deficiency. Haas noted that expansion of the maxilla can result in making upright, lingually tipped, lower-arch teeth without lower fixed appliances. (2) It is important to note that it is easy to misdiagnose a skeletal posterior crossbite when the maxillary posterior teeth are tipped facially and the mandibular posterior teeth are tipped lingually—when evaluating a crossbite by dental relationships only. Once the posterior teeth are upright, the maxillary transverse skeletal deficiency can be visualized and match the diagnosis provided by a frontal cephalogram. Let us explore the process of evaluating a patient for dental extractions, using a case study that demonstrates severe crowding and transverse skeletal discrepancy.

A 28-year-old male presented with a chief complaint that he avoided smiling due to his canines that “stick out” (figure 2).

Maxillary expansion or bicuspid extraction: A case study in orthodontics by Tyler Pritchard, DDS - Figure 2
Figure 2: Pretreatment smiling photograph.

Rickett’s Analysis showed a mesio-facial face type and skeletal Class I relationship. His interincisal angle was 132 degrees, which is ideal. His mandibular arch demonstrated a severe curve of Wilson, while the maxillary arch demonstrated a left side posterior crossbite. The left side occlusion was full Class II at the molars and Class I on the right side. Total maxillary crowding was calculated at 12 mm and mandibular at 7 mm. No missing teeth were observed. Mandibular arch width from first molar central groove to central groove was 39 mm. From lingual cusp to lingual cusp of the maxillary first molars, the arch width was 32 mm. Due to the crowding and narrow maxillary arch, the smile arc was uneven (figures 3 and 4).

Maxillary expansion or bicuspid extraction: A case study in orthodontics by Tyler Pritchard, DDS - Figure 3
Figure 3: Intraoral pretreatment biting photographs. Note the extreme lingual tipping of the lower left posterior teeth. CLICK TO ENLARGE PHOTO.
Maxillary expansion or bicuspid extraction: A case study in orthodontics by Tyler Pritchard, DDS - Figure 4
Figure 4: Maxillary and mandibular occlusal pretreatment photographs.CLICK TO ENLARGE PHOTO.

Using the patient’s lower-arch model, it was determined that the true lower arch width at the first molars was 46 mm by visualizing the lower posterior teeth fully centered over the alveolus. Using Rickett’s Analysis on the patient’s frontal cephalogram, the lower molars were tipped too lingually by three standard deviations. The mandibular width according to Rickett’s measurements, was initially 84.5 mm and ideally would be 91.6 mm. Both manners of measuring the lower arch width showed the need to expand the lower posterior teeth by 7 mm. Thus, it was determined that the lower molars needed to be expanded from a width of 39 mm to 46 mm, and the maxillary arch needed to be expanded dentally and then skeletally from 32 mm to 46 mm. The lower arch acted as the template to which the maxillary arch should be expanded to match (figures 5 and 6).

Maxillary expansion or bicuspid extraction: A case study in orthodontics by Tyler Pritchard, DDS - Figure 5
Figure 5: Mandibular arch-width measurements. CLICK TO ENLARGE PHOTO.

As noted above, using the factor determined by Adkins et al., 0.7 times 14 mm of maxillary dental and skeletal expansion provides approximately 10 mm of space to aid with resolving the 12 mm of maxillary arch length deficiency. Distalizing the left side maxillary posterior teeth to correct the occlusion provided an additional 4 mm of space. Considering the space gain from expansion and distalizing the upper left quadrant to correct the occlusion, it becomes clear that extractions are not mandatory to resolve this patient’s crowding, and a nonextraction treatment option is available.

Maxillary expansion or bicuspid extraction: A case study in orthodontics by Tyler Pritchard, DDS - Figure 6
Figure 6: Note the maxillary and mandibular skeletal-width measurements. CLICK TO ENLARGE PHOTO.

Even though the calculations determine sufficient space can be created to resolve this patient’s crowding with expansion of the posterior teeth, the question remains: Is nonextraction treatment the ideal treatment for this patient? Without removing teeth, it could be argued that there is an increased risk that the patient may require gingival grafting, which ended up being a reality in this case. Also, to achieve this level of expansion, the patient must go through a surgical procedure to attain the desired amount of expansion. The final decision should then be brought back to the patient. When the option of teeth extraction versus expansion were provided, discussing the advantages and disadvantages of both options, the patient preferred to go through the surgical procedure rather than have teeth extracted. The benefit of this course of treatment is a fuller smile that fits the patient’s true lower arch width.

Maxillary expansion or bicuspid extraction: A case study in orthodontics by Tyler Pritchard, DDS - Figure 7
Figure 7: Maxillary occlusal photo of rapid palatal expander (RPE) and trans-palatal arch (TPA), prior to removal of the RPE.

Surgically assisted rapid maxillary expansion (SARPE) is a procedure whereby an oral surgeon performs a maxillary Le-Fort I osteotomy minus the down fracture of the maxilla. This frees the two segments of the maxilla for minimally restricted expansion. Suri and Taneja report that for cases with maxillary transverse deficiency (MTD), “the incidence of MTD in the adult population or in skeletally mature people could not be elucidated from the literature.” (3) The authors do provide guidance that in a skeletally mature patient, “when the MTD is greater than 5 mm, surgical assistance is essential.” (3) In this case the MTD was 9 mm, indicating the need for SARPE. Rapid maxillary expansion, surgically assisted or not, is notoriously unstable—making retention of the expansion movements essential. In a study by Petrick et al., patients who underwent SARPE treatment did not have sufficient bone density of the midpalatal suture up to seven months postsurgical procedure to maintain the surgical expansion. (4) Applying this information in this case, a transpalatal arch was used throughout treatment to assure maintenance of the achieved transverse expansion. When transitioning from the expander to the transpalatal arch, the expander was left in place on the maxillary first molars, while the TPA was fabricated for the maxillary second molars. Thus, arch width retention was present during active treatment with fixed appliances until finishing mechanics were applied (figure 7).

Maxillary expansion or bicuspid extraction: A case study in orthodontics by Tyler Pritchard, DDS - Figure 8
Figure 8: Treatment results. CLICK TO ENLARGE PHOTO.

Extracting teeth in this patient would have collapsed the dental arches to a significant degree and simply compensated for the true skeletal discrepancy. It is reasonable to assess that crossbite correction may not have been achievable with extraction treatment alone, even with dental tipping. Additionally, there is a growing awareness of the effects of orthodontic treatment on a patient’s risk for sleep apnea. Wertz reported finding an increase in the nasal airway when a patient’s maxillary arch was expanded. (5) When the opportunity to increase a patient’s airway presents, it should be considered carefully. Moreover, extracting teeth can reduce the space for a patient’s tongue. This can affect the stability of the orthodontic result as well as encourage a more posterior tongue placement encroaching on the airway. Measuring dental and skeletal archwidth is necessary for proper diagnosis and may avoid unnecessary need of dental extractions. Even in cases demonstrating less dental crowding and mildly narrow maxillary arches, expansion allows for ideal vertical contact of posterior teeth without any lingual or buccal tipping of the posterior teeth as compensation (figure 8).

Tyler Pritchard, DDSTyler Pritchard, DDS, earned his DDS degree from Loma Linda University in 2006. After graduating from dental school, he attended a general practice residency at the Loma Linda Veterans Hospital for one year. He completed his orthodontic residency in September 2009, earning a master’s degree from Loma Linda University. Dr. Pritchard is a second-generation orthodontist and a third-generation dentist. He practices orthodontics in Battle Ground, Washington.

References
1. Adkins MD, Nanda RS, Currier GF. Arch perimeter changes on rapid palatal expansion. Am J Orthod Dentofacial Orthop. 1990;97:194–199.
2. Haas AJ. Long-term post-treatment evaluation of rapid palatal expansion. Angle Orthod. 1980;50:189–217.
3. Suri L, Taneja P. Surgically assisted rapid palatal expansion: A literature review. Am J Orthod Dentofacial Orthop.2008;133:290–302.
4. Petrick S, et al. Bone density of the midpalatal suture 7 months after surgically assisted rapid palatal expansion in adults. Am J Orthod Dentofacial Orthop. 2011;139:S109–116.
5. Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod. 1970;58:41–66.


Looking for an orthodontist in Beaverton, Oregon? Biermann Orthodontics is a cutting-edge orthodontic practice that serves Beaverton and Molalla, OR, and focuses on providing world-class customer service and efficient treatment. We strive to create stunning smiles in the shortest amount of time without ever sacrificing quality.

Visit our Locations page to find a clinic near you, or schedule an initial consultation.

Biermann Orthodontics

503-690-0722
17885 NW Evergreen Parkway, Suite 200
Beaverton, OR 97006

Temporary Anchorage Device (TAD) use in the treatment of anterior open bite

Temporary Anchorage Device (TAD) use in the treatment of anterior open bite

Article by Padraig Dennehy, DMD | Featured on Dentistry IQ

This article first appeared in the newsletter, DE’s Breakthrough Clinical with Stacey Simmons, DDS.

While orthognathic surgery is sometimes the only option for treatment of certain skeletal malocclusions, having another tool in the orthodontist’s arsenal is a welcome option for patients and clinicians alike. Anterior open bite, defined as a state in which the maxillary and mandibular molars occlude first in mandibular closure, leaving the anterior teeth out of contact (1), has previously been treated by a variety of means. These treatments include but are not limited to extractions, high-pull headgear, bite blocks, elastics, and functional appliances (2). In more severe cases, the patient may require orthognathic surgery to correct the skeletal malocclusion. In cases of anterior open bite due to overeruption of the maxillary posterior teeth (posterior maxillary vertical excess), the oral surgeon will reposition the posterior maxilla superiorly, allowing autorotation of the mandible upward and forward to close the open bite (2). Orthognathic surgery is a predictable treatment modality for anterior open bite cases, but is sometimes cost prohibitive and has associated risks and recovery time.

ADDITIONAL READING | Treatment considerations for the congenitally missing maxillary lateral incisor

Recently, the minimally invasive placement of TADs (temporary anchorage devices) has allowed orthodontists to treat some of these patients without orthognathic surgery through intrusion of the posterior maxillary molars. While TADs are not a substitute for surgery in all cases, they do provide a treatment alternative for specific mild-to-moderate open bite cases without other skeletal malformations.

TADs are titanium-alloy mini-screws that range from 6–12 mm in length and 1.2–2 mm in diameter (3). The orthodontist or surgeon can insert the TAD directly into the bone through the gingiva with a handheld driver and, most often, with the use of only topical anesthetic (3). The TAD can be loaded immediately as it gains its anchorage through mechanical gripping of bone rather than through osseointegration (3).

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Can Tooth Enamel Grow Back?

Can Tooth Enamel Grow Back?

Article Featured on WebMD

The Rumor: Using certain toothpastes and mouthwashes can regrow lost tooth enamel

You know that the key to a great smile is keeping your pearly whites in top-notch shape. The best way to do that? By taking really good care of your tooth enamel. Enamel is the thin outer covering of teeth that protects the delicate tissues inside. A lifetime of chomping and sipping can stain, chip and wear away that covering, however — and once that happens, your teeth become extremely sensitive to hot and cold. Even your favorite sugary treats can deliver a twinge (if not a bolt) of pain.

While tooth enamel is actually translucent, teeth start to look more yellow as it wears away, because the yellow dentin underneath begins to show through. Which can leave you wondering: What can you do to get your precious enamel back? Today there are lots of products out there (from toothpastes to mouthwashes to dental guards filled with strange, squishy paste) that allegedly help restore lost enamel. But by making that promise, are manufacturers biting off more than they can chew?

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