There is a lot of talk these days about “invisible braces” and for good reason. For selected cases, they work great. They can be removed to eat and to brush and floss. However, these type of “braces” do not work on many cases because of the complexity of the case. The invisible braces do not allow for fine control of tooth movement and some movements such as raising a tooth from it’s socket or doing a lot of rotation cannot be done with that method. Many adults and even some teens avoid orthodontic treatment because of the “metal mouth” stigma. For those who are not candidates for invisible braces, there is still hope to get their teeth straightened without having to wear a silver smile. Clear brackets are placed on the teeth as an alternative to the metal ones. These are made of an extremely hard, ceramic material. A metal wire still needs to be used, however, that is so thin that it is not very perceptible from a conversational distance. The ceramic brackets can be more difficult to work with and some orthodontists will charge more due to that. They can especially be problematic treatment wise when torque is placed on them and they can tend to crack due to their brittle nature. But if the only other acceptable treatment is no treatment, the clear braces are certainly a very acceptable alternative.
Once the gum tissue has been reflected away from the bone, the surgeon can drill on the bone all day without any discomfort, only vibration because there are no nerve endings in the bone. To place an implant, there must be adequate bone to hold the titanium cylinder. Now 3D x-rays are available to accurately measure the amount of bone and to avoid major structures such as nerves and sinuses. An incision is made in the gums, then the gums are pulled back to give the surgeon full visibility of bone. A hole is drilled into the bone and then the titanium implant is screwed right into the bone. The gums are sutured back into place and the implant is left under the gums undisturbed for a number of months. This allows the bone to grow directly around the implant, a process called osseointegration. Finally, once the implant site has fully healed, the implant can be uncovered and restored to a new tooth.
Metal allergies to dental materials can cause the need to change the way different conditions are treated. There are a number of metals used in dentistry: gold, silver, mercury, nickel, titanium, chromium, cobalt. Any one of these metals can cause an allergic reaction in a susceptible individual. The good news is that true metal allergies, except for nickel, are extremely rare. Gold is used in crowns, silver and mercury are used in fillings, titanium in implants, and chromium/cobalt is used in partial dentures. The main symptom of metal allergy is contact dermatitis marked by a localized redness in the area where the metal contacts the mucosal tissue. The solution to the problem is to change out the dental work to a non-metallic alternative. For crowns, there are all porcelain types that can be made. Amalgam fillings can be replaced with composite (tooth colored) filling material. A chromium/cobalt metal framework of a particular denture can be redone in all acrylic (plastic). Titanium implants can be removed and a partial denture constructed to replace teeth. Even though metal allergies are not common, they can be very aggravating if you are one the affected ones. At least there are viable alternatives for restoring and replacing teeth.
We recently added a digital x-ray system to our office. It has been a very welcome addition. With it, we bought a computer for each treatment room. We are now able to take the x-rays and blow them up to the size of the computer screen. No more squinting through a magnifying glass to search for little cavities. The images can also be rotated or enhanced. The images’s contrast can be sharpened to make previously undetected cavities jump out on the screen. With the larger images on the screen, it is much easier to explain to the patient about the need for a particular dental treatment. Although the pages are stored digitally and backed up regularly, we still print a “hard copy”. Having that copy in hand has saved us during times when the server was down. With the x-rays stored on the server, they can be viewed at the touch of a button. They can also be emailed to specialists or to insurance companies. Technology allows life to keep getting easier.
Invisible braces (such as Invisalign®) are a fantastic way to straighten one’s teeth. There is no “metal mouth” look. People can’t even tell that you are having orthodontics done. You can take the aligner out to eat so there are no restrictions of sticky or hard foods. You can also take them out to brush and floss your teeth. Oral hygiene is so much easier to do without all of the nooks and crannies to negotiate around with the brush. No more smiling with a big wad of lettuce hanging from your teeth. The process is started by making precise molds of the person’s teeth. A lab makes a 3-D computer image of the mold and a technician manipulates the teeth in tiny increments until the final result is achieved. A clear, thin, plastic aligner is contructed for every incremental step. As each aligner is worn, the teeth are slowly moved to their intended positions.
Invisible braces are not for everyone. They have a difficult time raising teeth out of the sockets, a movement called extrusion. They will also not be able to treat a tooth that is severly rotated. Teens can be treated with this method, however, all of the 2nd molars (12 year old molars) have to be fully erupted. With all of that being said, for patients who are candidates fo invisible braces, it can be an extremely satisfying experience.