What’s New with Braces?
How do we actually produce the lighter forces that we know move teeth more efficiently, though?
Fortunately, technology is on our side; we’ve come a long way when it comes to how we manufacture braces and wires. Back in the day, the only type of braces we had available to us was the type that orthodontists refer to as twin brackets. If you had braces as a child, chances are good that this is the type of orthodontic bracket you had.
They were given the moniker of “twin” because of the two sets of wings the bracket used to hold the wire in place. Dentists most commonly used little rubber bands, the colours that the patients used to pick out to act as the fastener holding the wires into the bracket. Think about that: every tooth had a tiny rubber band that tightly held the wire in the bracket.
That was a lot of friction being generated on the wire, and friction slows everything down in life, including tooth movement. In fact, sometimes friction actually brings tooth movement to a screeching halt.
What if, instead of little rubber bands, we had tiny little doors on the braces that allowed us to lock the wire in but decrease the friction? Well, we have those now; we call them self-ligating braces, and we simply don’t need those little elastics anymore. Self-ligation has been a game changer for me and thousands of orthodontists around the world. I now have the ability to gain the precious space I need in crowded mouths without extractions in most cases.
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Because of the light, physiologic forces that I’m able to use, we can now do things we never dreamed of a decade ago. When we have a moderately crowded case, or even a severely crowded case in some instances, we don’t have to rely on extractions to gain the necessary space.
Through gentle adaptation of the jawbones, I am able to reshape the anatomy of the jaws, allowing for all of the teeth to erupt or align into their proper positions. The particular braces that I currently use are called the Damon System, but there are others out there.
I’m certainly not saying that if other dentists use another bracket or system then they are behind the times. What I am saying is that in a decade, I haven’t found a system that does more for me in my hands.
Clear brackets have allowed dentists the benefits of wires and braces but with a cosmetic advantage. This, of course, would be meaningless if we still had the metal bands around the teeth that we needed to use in the decades prior to the 1970s.
Modern bonding technology has allowed dentists the great benefit of bonding the brackets directly to each tooth instead of having a bracket soldered to a band of metal that was cemented around each tooth.
Bonding technology has moved light years beyond the first materials used to bond brackets to teeth. Cosmetic dentistry has been the engine driving this technology, and in my opinion, a tooth should have a band around it extraordinarily rarely and only for very specific reasons. Bands are horrible for hygiene, and they leave little gaps between the teeth when they are removed at the end of a case. Sometimes these little gaps close; other times they don’t.
By the way, it’s not just the brackets that have changed with technology; the wires have changed too. I’m often asked how those little wires move teeth. The answer lies in their chemistry. Wires can be generally broken down into two camps: adjustable and nonadjustable.
Adjustable wires are just that: wires that can be bent with pliers in the hands of an orthodontist. These wires are typically of two types: stainless steel or an alloy called beta titanium. Nonadjustable wires have the fascinating property of recoil, or springback, which allows them to be deformed when putting them in the brackets, after which the heat inside the mouth returns them to their original shape. Wires like this are made of elements like copper, nickel, titanium, and chromium. Dentists will typically work our way through a progression of wires until we get to our final, adjustable wires, at which point we add any necessary bends to optimize the position of the teeth.