Orthodontist

Retainers!

January 23rd, 2018

Retainers in Orthodontics:

“How long do I have to wear these things?!”

by Jeff Wing DDS MS

Perhaps the question I get asked most often (other than “when do I get my braces off?” and “why do you ride a hoverboard around your office?”), is…”how long do I have to wear my retainers?”  There is nothing more frustrating than going through 18-24 months of braces, only to wake up one morning and see a lower incisor going rogue and breaking away from the nicely aligned team.  This phenomenon is called “orthodontic relapse,” and it is one of the most common reasons that adults and older teens come into our office seeking treatment.  Before I answer the question of how long retainers need to be worn, let’s first take a look at why teeth want to move after the braces come off in the first place.

 

Reasons for Orthodontic Relapse:

  • Contraction of Periodontal Ligament        As teeth are moved with braces, the fibers of the periodontal ligament are stretched (these ligaments attach the roots of the teeth to the bony tooth sockets…basically they’re what hold the teeth in the jaw).  When braces are removed, these fibers can act like little rubber bands, springing back to their original position and bringing the tooth with them.

 

  • Late Growth of Jaw - As with every other physical feature of the human body, some people are luckier than others when it comes to the genetics of their teeth and jaws.  The unlucky ones have genes that tell the lower jaw to continue to grow well past the normal age of growth completion.  This can gradually turn a perfect bite into…well, a less than perfect bite (such as an underbite).

 

 

  • Newly Remodeled Bone Not Fully Calcified - As the roots of the teeth are moving, the bone surrounding these roots remodels to accommodate for the new position of the root.  If this bone hasn’t had a chance to fully calcify, it can’t stabilize the root well enough to keep the tooth from moving.

 

  • Facial Muscles or Tongue - The forces from facial muscles and any habits with the cheeks or lips can put pressure on the teeth and cause them to move.  The habit I see cause the most unwanted movement of teeth is the dreaded tongue thrust.  Instead of swallowing with the tongue pressing against the roof of the mouth, it pushes forward against the back of the teeth.  This can lead to flared front teeth (“buck teeth”) and the vertical separation of the upper and lower teeth (“open bite”).

 

  • Wisdom teeth - These infamous teeth commonly grow in at a forward angle, which puts pressure on the teeth in front of them and causes the front teeth to shift out of alignment.  Normal 6-year and 12-year molars also have a tendency of drifting forward with time, but this is usually a slower and less drastic effect than wisdom teeth.

 

So…as you can see, retainers after braces are critical!  Now, back to the original question…”how long do I have to endure the shame and embarrassment of taking these things out in a restaurant with a string of saliva hanging from my mouth?” 

Full time wear (22 hours/day) is necessary for a certain amount of time after the braces are removed.  This recommended time varies among orthodontists from 6 weeks to 6 months.  After this initial period of full time wear, it is then recommended that the retainers are worn only while sleeping.  And if you happen to be a major party animal or Netflix binge watcher who only sleeps for 3-4 hours, this doesn’t cut it — we’re looking for more like 7-8 hours each night. 

After a year (give or take) of wearing the retainers each night, patients can then test the tooth stability waters by dropping down to wearing them every other night.  At this point, it is recommended that personal best judgment is used — if the retainers feel unusually tight after not wearing them for 48 hours, it would be wise to stick with the "every night” routine for a while longer.  If they slide right in with minimal pressure, you might be one of the lucky ones who only needs to wear them long term for 1-2 nights per week.

The moral of this slobbery retainer story is that the best answer to the question of “how long do I have to wear my retainers?” is…as long as you want your teeth to stay straight!

Invisalign

August 15th, 2017

Invisalign - The Plastic That Dreams Are Made Of

by Jeffrey D. Wing  DDS MS

Allow me to paint a picture for you today -- there you are seated at the finest table of that famous 5-star restaurant, surrounded by rich leather booths and real mahogany walls.  Across from you sits the love of your life, and as the candle burns down to the bottom of its glass, you realize now is the perfect time to express your love for this special person in your life.  As you utter those three soul-bearing words and you flash that perfect smile you’ve practiced in the mirror for hours, the look you get in return is not exactly what you were expecting.  Instead of a warm smile and a whispered “I love you” in return, you get a look of disgust and ultimate horror aimed at your upper front teeth.  As you watch your soulmate get up and run away from the table and out of your life forever, you look at the reflection of your teeth in the knife and see a large green leaf of parsley and a half kernel of corn stuck between your two front braces.  Game over.

Luckily, this situation can easily be avoided, and instead of a long and lonely life of walking around in a tattered bath robe and soiled slippers mumbling “parsley and corn, corn and parsley,” you can have the future you always dreamed of, and that includes the smile you’ve always dreamed of.  That dream is made possible by Invisalign.  Imagine the same dinner situation above, but instead of having braces to straighten your teeth, you have removed your clear Invisalign trays to enjoy this romantic dinner with 100% confidence.  Suddenly, your solitary future has transformed into a rich full life with a loving family and a white picket fence.

Invisalign has been around for almost 20 years now, and in this time they have made several advancements including the plastic material of the aligners, the software used to design smiles, and the efficiency of moving teeth, just to name a few. Today, Invisalign is capable of treating almost every orthodontic problem that braces can in the same amount of time.

So how exactly does it work?  We start with a quick and easy scan of your teeth (no more goopy, gooey, gaggy impressions!), and within minutes we can show you what your smile could look like after treatment with Invisalign.  After submitting your case to Invisalign, I instruct the technicians how to fine tune your set-up in order to move each and every tooth into the perfect position.  Within a couple of weeks, your set of aligners (anywhere from 5 to 50 of them) arrives in our office and your journey to that perfect smile begins!

At your first aligner delivery appointment, we bond "attachments" to a few of your teeth.  These attachments are small tooth-colored composite build-ups that help certain teeth move more predictably.  The Invisalign software dictates what teeth are going to need a little extra grip from the aligners, and these attachments fit into small notches in each aligner to provide better control.

I will usually give you 3-4 of your aligners at a time, and each set is worn 1-2 weeks, depending on the complexity of the tooth movement.  At each one of your appointments, I will make sure all the teeth are "tracking" well (a.k.a. following the program) and show you the progress of your treatment.  And since the aligners need to be worn about 22 hours each day, I will occasionally provide a little positive reinforcement to keep you at this level :)

A few of the amazing advantages of Invisalign include:

  • Removable! This means you can eat anything you want, as well as brush and floss without braces and wires getting in the way

    • Clear! These aligners are customized and adapted so precisely to your teeth and gums, they are barely noticeable when you're wearing them

      • Comfortable! No need for orthodontic wax normally used to smooth over rough parts of the braces -- nothing but smooth plastic for the ultimate enjoyment of your cheeks and lips

      • Convenient! Instead of long orthodontic appointments where we change wires and repair broken brackets, we simply give you your next few sets and make sure all your teeth are on track
      • Great for Teens! Invisalign allows them to eat whatever they want, which means less time in the office repairing broken braces.  Also, for those involved with sports, it is much easier to wear a mouthguard and less damaging to cheeks and lips if they get hit

      If you have any questions about Invisalign and whether it's the right choice for you, please email me at wingortho@yahoo.com.

      Welcome to Our Blog

      May 1st, 2017

      Thank you for taking the time to visit our blog. Please check back often for weekly updates on fun and exciting events happening at our office, important and interesting information about our orthodontics, the dental industry, and the latest news about our practice.

      Two Phase (Early) Orthodontics

      May 1st, 2017

      Two-Phase (Early) Orthodontics

      Does My Orthodontist Just Need a New Car?

      By Jeff Wing DDS MS

      So the question that’s on everyone’s mind these days (aside from “when will this flipping water bottle craze ever go away!?"), is “why are all of these 8 and 9 year-old kids walking around with braces on?”  It’s an extremely valid question…after all, most of these kids still have 12 baby teeth in their mouth.  Is it simply a scheme that all orthodontists came up with during their super-secret annual underground meeting so they could all upgrade their daily modes of transportation?  Believe it or not, the short answer is…NO!  Now, here’s the long answer:

      In most cases, children’s mouths are big enough to accommodate all of their adult teeth as they continue to come in until age 12 or 13.  Unfortunately, this doesn’t guarantee that these teeth will come in straight, but that’s OK — the main thing we care about in that 8-12 year age group is that all of the adult teeth do, in fact, come in.  In about 10-15% of children, their mouths are so small that there isn’t enough space for all of the adult teeth to squeeze in, so one or more of them can get “stuck” or “trapped” up in the bone under the gums, or even behind other teeth.  Think of the mouth as a parking lot in this situation — these adult teeth are looking for a place to park when the lot is actually FULL, and no cars/teeth are leaving.

      This is one of the situations when a brief period of early limited orthodontics (usually called Phase 1) is a great idea — we can take advantage of these kids’ developing jaws and create the space needed for these trapped adult teeth to find a parking spot.  By doing so, we can avoid the need to extract permanent teeth down the road…and why settle for 24 teeth when you can have 28?!

      Other situations where an early Phase 1 is recommended include:

      Anterior crossbite (underbite) - where the lower teeth bite in front of the upper teeth. This can wear the enamel down on these teeth and lead to chipping or fractures.  This is also a sign of a skeletal jaw pattern that needs to be corrected early to avoid jaw surgery in the future

      Posterior crossbite - where the upper back teeth bite on the inside of the lower teeth on one side, causing the lower jaw to shift to that side.  This is due to a narrow upper jaw, and expansion or widening of the upper jaw is easily performed at an early age

      Severely protruding upper front teeth - when upper front teeth are angled forward and flared out away from the lower front teeth, these teeth are at an increased risk of trauma from sports, the bottom of swimming pools, and sometimes even walls!

      Anterior Open Bite - when there's an opening between the upper and lower front teeth when biting down, usually caused by a thumb sucking habit or tongue thrust habit

      If your children (or any neighbor kids that don't annoy you) display any of these situations, a visit to an orthodontist is recommended.  A simple x-ray and a quick exam will help the orthodontist determine whether a Phase 1 treatment would be beneficial or if we can wait until all of the permanent teeth are in before considering orthodontic treatment.

      Severe Crowding

      Anterior Open Bite

      Anterior Crossbite

      (underbite)

      Severe Protrusion

      Posterior Crossbite

      Please feel free to email me at wingortho@yahoo.com if you have any questions about Phase 1 orthodontics!

      "We LOVE Wing Orthodontics! I have had 2 children as patients and a 3rd about ready to be a patient. The office is so friendly and organized. They are prompt and always help my children feel at ease."~ Laurie D
      "Dr. Wing and his staff have been taking care of my teeth for the last 16 months. They always treat you like you are their only patient. Dr. Wing is great at spending the extra time with you to answer questions and make sure everything is good."~ Joseph L
      "The staff at Wing is amazingly sweet and helpful, Dr. Wing is a caring and thorough orthodontist, and the way they treat their patients is phenomenal. The movie theater in the office and awesome client parties don't hurt either."~ Sarah G
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