Looking your best during treament

An obvious goal of orthodontics is straight teeth, however,  some of the other positives kickbacks of treatment include a fuller, more beautiful smile, better general smile esthetics (potentially less gummy smile) and in some cases a more balanced face. 

While all these positives sound great, I often address the question of esthetics during treatment. After all, sometimes just the idea of having big bulky brackets on our pearly whites make us regress into crappy childhood memories. So in an attempt to enhance elements of your smile and mitigate some of the effects of the aging process on the maturing face what can we do to remain confident during the process? Here's the one thing I tell my patients, not only has there been significant advancements in the field but you now have options of how you want to design your treatment. Take comfort in knowing that the evolution of modern orthodontic bracketing and wire technology has opened up avenues to help make comfort and confidence a reality.

For patients to understand the differences in technologies we must first realize that all bracketing systems or “braces” are not alike. These differences are indeed important as some carry greater limitations than others and it is by this vehicle that forces which move teeth are transferred. As well, recent wire technologies are more effective in some of the bracketing systems. Together the bracket and wire assembly will largely contribute to the final result. Originally the common bracket was soldered to an orthodontic ring or band that was temporarily cemented to a tooth. With the advent of bonding these brackets were able to be bonded directly to the tooth surface beginning in the late 1970s. This assembly is still used today and appears as square brackets ,metal or clear, to which the wire is held using an elastic ligature tie or “donut”. These ties being either grey, clear or coloured, act like “bungee cords” causing friction and binding to build up in the system. This results in the need for more force to be applied to teeth causing increased discomfort and may limit some of the movements needed to allow for arch expansion and thus facial treatment considerations.

As an alternative to this, there are bracketing systems that are self-locking or self-ligating and require no elastic ligature to capture the wire. Instead a door at the front of the bracket holds the wire in place. In general, the efficiencies of these products require less force to move teeth providing for considerably less friction and discomfort during tooth movement. These technologies came into prominence in the 1980s and have evolved to their current state in this last decade.

Two variations of this technology exist. Active self-ligation, where the bracket latch places pressure on the wire while engaging it and passive self-ligation, where the door places little or no pressure on the wire. The later causes the least amount of friction and is the most comfortable for the patient. The lighter forces invite the most biologically compatible force levels. This often yields the “Face First” results which everyone is looking for.

Orthodontically yours,

Dr Joel Schacher