Orthodontic Treatment for Underbites (Class III relationships)

This is the second of a two part blog addressing the most current research and options for the treatment of underbites, or what orthodontists and dentists refer to as Class III relatioships. This facial type is one of the most difficult to treat in orthodontics, and the earlier it is identified and diagnosed, the higher the chance of arriving at a succesful outcome.

The first consideration is what age do we start treating anterior crossbites that are skeletal in nature (lower jaw growing too much, upper not enough, or a combination of both)? Most research continues to support treating at an early age for mild and moderate underbites, ideally prior to 8 years old. However, new research indicates that favorable changes can occur with treatment in older children, even well into the adolescent growth spurt. The positive changes appear not to be as dramatic compared to starting treatment earlier, but can still be significant.
reverse-pull-headgear (1)In the early 1980’s a protocol for early treatment of underbites became the standard of care that has remained until this day (with some new modifications and options that I will discuss). Treatment usually consists of upper jaw expansion (using an “expander”), followed by facemask therapy. A facemask is a device that has rests on the patient’s forehead and chin, and elastics attach from this facemask to “arms” on the expander that place a forward directed force on the upper jaw. Studies have shown the correction comes from foreward movement of the upper jaw, usually accompanied by downward growth, which makes the lower jaw rotate downward (resulting in a chin position that is further back). This rotation of the lower jaw can also be a negative side effect, and must be monitored closely by the orthodontist.
It is imperative for parents and the child to understand that the success of treatment is dependent on the number of hours a day that the facemask is worn, and the number of months that it is worn. The highest success rates occur when it is worn all day and night, however, most orthodontists are understanding of the social issues of wearing a facemask to school. We ask that it be worn every hour that the child is not in school or sports, which usually is about 16 hours per day, including while they are sleeping. Studies have shown the greatest sucess rates occur when the facemask is worn upwars of 10-12 months, and an over correction is observed where the upper teeth are a ahead of the lower tclass-iii-elasticseeth by at least several millimeters.
A very important thing to keep in mind with the treatment of Class III cases is that after early treatment is stopped, the patient will continue to grow like a Class III patient until growth is complete. Since the growth of the lower jaw will continue to be more pronounced, a second phase of treatment is almost always needed, with full braces, rubber bands, and possibly more time with the facemask.
miniplatesIn the last several decades studies have increased our knowledge in treating underbites, and there have been several modifications to the basic protocol. First, the use of a palatal expander has been shown to be useful only if needed for other reasons such as gaining space or correcting a crossbite that exists along with the underbite. A large number of underbite patients have a hyposplastic maxilla (smaller upper jaw), so many continue to have an expander included with their treatment. Second, another viable option to the facemask has emerged that has demonstrated excellent, or even improved results. Skeletal anchorage in the form of surgically placed miniplates can now be placed, which allow the patient to wear elastics entirely within the mouth, and 24 hours a day. The downside is an increased cost due to two surgical proceedures needed to place and remove these miniplates after treatment. This option has been shown to be optimally successful between the ages of 10-12 years of age due to the need for higher bone density to hold these devices secure.
For more severe cases where a very pronounced underbite is detected early, and especially if there is a strong lower jaw component, it may be decided early on that jaw surgery will be needed to obtain a succesful result. These more severe cases cannot be corrected enough by orthodontics alone, but your orthodontist will continue to monitor facial growth, and work in conjunction with an oral surgeon to determine the optimal time to start preparing for a surgical correction. Jaw surgery to correct underbites are usually not performed until the patient’s jaws have completed growing. The best way to determine when this has occured is by taking a series of radiographs called serial lateral cephalograms, and measuring the size of the upper and lower jaws over time. Surgery performed prematurely while the jaws are still growingwill usually result in an unstable result with return of the underbite.
After treatment with full braces is completed, retainers are placed like any other case. However, I do monitor patients with Class III patterns for a longer period of time, as the underbite pattern sometimes returns to varying degrees due to small growth changes that occur throughout life. Yet another challenging aspect to this type of facial growth!
A summary of modern treatment for Class III cases (underbites):
1) Timing is important, with higher sucess rates occuring with early treatment prior to the age of eight. However, later treatment (just before or during puberty) has been shown to be more sucessful than previously believed.
2) Treatment with a facemask and elastics remain the most common forms of treatment. New advancements with surgically placed miniplates have provided another effective option.
3) Success with any treatment option is dependent on number of hours the device is activated, and how many months they are worn. Consistency is the key!
4) This facial growth pattern persists and is often accelerates during the adolescent growth spurt. This must be kept in mind regarding the length of treatment, and is the reason two phases of treatment are usually needed for this facial type.
5) Severe cases detected early usually will need a a surgical correction, usually done in the late teen/early 20’s, and no amount of orthodontic treatment alone can achieve an acceptable result. The earlier parents are informed of these cases, the earlier appropriate plans can be set in place to manage this issue.

Dr. Dan Rejman is the owner of Meadows Orthodontics in his hometown of  Castle Rock, Colorado. Dr. Dan is a Board Certified Diplomate of the American Board of Orthodontics, and is the councilman representing both the Rocky Mountain and Southwest Orthodontic Societies for the College of Diplomates of the American Board of Orthodontics.

Treating Underbites

The treatment of underbites (or anterior crossbites) in orthodontics is in a special category of its own, both in terms of jaw growth, and the challenge and difficulty in treating these cases. It is very important for patients and their parents to be educated as early as possible about the unique pattern of growth that is to be expected, and to set realistic expectations in treating this condition.

underWe are all familiar with the typical appearance of people with underbites (Jay Leno comes to mind for most). This appearance is often first seen at a very young age (often before the age of five), and is usually detected by parents or a dentist noticing that the child’s lower teeth are located ahead of, or even with, the upper teeth (the lower teeth should be located behind the upper teeth). ). In orthodontics we refer to this relationship of the teeth as a Class III relationship, which describes the lower teeth as being too far forward when compared to the upper teeth. The underlying cause of an underbite is most often skeletal in nature, and it is believed that genetics play a prominent role in causing the condition. Parents often recall a grandparent with an underbite, or may even have an underbite themselves. Recent research shows that about 68% of Class III patients have an upper jaw (maxilla) that is deficient, and 70% have a lower jaw (mandible) that is protrusive or growing too much. This means that many have both an upper jaw that is not growing enough, and a lower that is growing too much. The front teeth often, but not always, display a distinctive pattern in which the upper teeth are tipped excessively forward (proclined), while the lower teeth are tipped back (retroclined).

The first thing for parents to know is how this growth pattern will progress. All children undergo an adolescent growth spurt,underbite where the body undergoes a rapid increase in the rate of growth, which includes the maxilla and mandible (upper and lower jaws). This spurt usually occurs earlier in girls (ages 9-12) than in boys (ages 10-14), with considerable individual variation. The intensity and duration of growth is on average greater in boys. After this growth spurt, most skeletal growth usually comes to an end in the mid-teens for females, and late teens to early 20’s for males.

When comparing children with Class III patterns with children with Class I (upper and lower jaws growing in harmony) patterns, research has shown that the maxilla (upper jaw) continues to grow less in Class III patients, while the mandible (lower jaw) continues to grow more in relation to the maxilla. What we have learned from the information in these last two paragraphs can be summarized as:

1) Class III patients will continue to be Class III patients as they develop.

2) The appearance of the underbite usually becomes worse with age into the teens, particularly during the growth spurt. This includes the underbite becoming larger, the lower jaw and chin appearing more protrusive, and the profile becoming more concave.

3) A relatively stable relationship occurs when growth stops, which is mid-teens for girls, and late teens to early 20’s for boys. This is why, in general, we treat girls at an earlier age than boys.

4) The earlier we detect an underbite or Class III, the earlier we can put together a plan to tackle this challenging growth pattern, as often there are considerable concerns regarding appearance, social issues, speech patterns, and proper functioning of the jaws.

In the next blog entry, I will discuss the treatment options for Class III patients, and the challenges and potential complications related to this treatment.

Dr. Dan Rejman is a Board Certified Orthodontist with a private practice in Castle Rock, Colorado. He has treated hundreds of Class III cases, ranging from relatively mild cases treated with braces, to severe surgical cases for teens and adults. He has a particular interest in underbites, as his youngest daughter has had a considerable underbite since her first baby teeth erupted!

Wearing Elastics (“rubber bands”) with Your Braces

Orthodontic-Rubber-BandsWe all have seen kids and adults in who are in orthodontic treatment connecting rubber bands (we call them “elastics”) to their braces. In addition to the wire that runs through the braces, these elastics are a way of placing forces on teeth to make them move (see the previous blog: “How do braces and Invisalign make teeth move?”). At Meadows Orthodontics, we are constantly educating patients about the importance of wearing elastics consistently as directed by Dr. Dan. Here are why these elastics are so important.

  • Elastics move teeth in the direction that is needed to correct your bite. Each patient is instructed to wear elastics according to their individual needs, and we will teach you which teeth to attach the elastics to. These patterns will often change as your treatment progresses, and your teeth have changing needs as you get closer to an ideal bite. Forward and back, side to side, and up and down…where we ask you to hook your elastics determines where your teeth go!
  • Wearing your elastics as directed by Dr. Dan makes you finish treatment faster! The number of hours you wear elastics each day is usually the biggest factor in how quickly you get your braces removed. It is currently believed that six hours of constant wear is the minimum time required to initiate the biologic mechanisms that allow teeth to move. But the difference in wearing rubber bands 6 or 12 hours a day vs. 20-24 hours a day could be well over a year extra in braces (or more)! This is so important for patients to understand, and they need to be aware of this from the start. Consistency, consistency, consistency! Also, never “double up” your elastics without being directed to do so- this can damage your teeth or cause unwanted delays.
  • Often later in treatment, the braces (after they have initially aligned and leveled your teeth), themselves are just what their name implies, a brace. They are merely holding your teeth in place while elastics are what causes 100% of the desired movement. Sometimes kids will skip several days or weeks thinking that the braces are continuing to move them closer to the goal of getting the braces taken off. The truth is, when the elastics are removed, everything often comes to a screeching halt, or even worse, starts to reverse itself! Don’t let this happen- be consistent. Notice a theme here?

Now that you know how critical it is to wear your elastics, I’ll give you some tips to make wearing them easier and more successful.

-When you first start wearing elastics, your teeth often become sore for a day or two. Your instinct will be to take them off to give your teeth a break, but don’t do this! If they are off too long, all the work you have started can be reversed, and the discomfort will start up again when they are put back on. Instead, keep the elastics on, take Ibuprophen as directed by your orthodontist, and the sensitivity will go away within a day or two. Taking long breaks can cause a cycle of discomfort that never goes away- you are essentially hitting the reset button all the time.

-Keep elastics with you at all times. Place a bag in your backpack for school, have them in your purse or pocket, and have a backup at home or with your parents. Dr. Rejman will gladly provide enough to keep all your bases covered. And if you lose them or run out, call us that day or stop by Meadows Orthodontics and we will give you more!

 

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. Dr. Dan is a Board Certified Diplomate of the American Board of Orthodontics, and is the councilman representing the Rocky Mountain and Southwest Orthodontic Societies for the College of Diplomates of the American Board of Orthodontics.

Do Braces Hurt?

When the time comes to get your braces put on, and the big day is getting closer, many kids (and adults!) get nervous about what it will feel like. Concerns that I hear often at Meadows Orthodontics include:

Will it hurt getting braces put on? Once they are on, what will it feel like? Will it hurt when I come in for adjustments? And, what is it like to get braces removed?  I will take you through each of these questions, and I think that most children and adults will be relieved… braces have come a long way since I was a teen (the 80’s, yes I am old!).

First of all, there are NO SHOTS involved with getting braces! Things just never hurt to the point that an injection of anesthetic is needed. If there ever is an abnormally sensitive area, I have a very strong topical anesthetics jelly to rub on your gums.

Will it hurt getting braces put on?  Believe it or not, placing the braces put on (bonded) is one of the more gentle parts of your treatment. It literally feels like gently touching the back of your hand with your finger. Now, there are other sensations going on at the same time: Using suction “Mr. Thirsty” to keep your teeth dry can be a bit noisy, and we have to rinse your teeth with water to help prepare them for the braces. We also use a bright blue light that makes the braces stick to your teeth. Sometimes we fit bands around back teeth, and this often feels tight, like there is food caught in between your teeth.

Other than these sensations, there is absolutely nothing to worry about. In fact, what used to be considered the most uncomfortable or annoying part of getting braces – having goopy impressions taken – has been largely eliminated. Digital impressions using our iTero scanner have taken the place of traditional impressions, eliminating that gooey, hard to breath sensation.

©Blue Moon Studio, Inc.Once braces are on, what will it feel like?  This is where I do not mislead my patients. On average, there will be about four days of soreness. I tell patients that the teeth will feel like your muscles feel the day after exercising hard. Most people describe it as a dull soreness, not a sharp pain. Then after several days, things go back to normal! Usually, there is also several days where the cheeks and lips get used to the feeling of having braces on the teeth. Ninety nine percent of the time, getting used to braces is so much better than what they are imagining or have heard about. The new materials and technologies that we use have come a long way to greatly improve comfort!

Will it hurt when I come in for adjustments?  A common misconception is that an orthodontist “tightens” braces, where patients usually imagine us cranking or twisting at the back of the wires. Things often do feel “tighter” after your adjustment visits, but this is usually from getting a new, often larger, wire placed in your braces. A tight feeling can come from me placed new curves or small bends in the wire to move teeth, or from starting new elastics (or “rubber bands”) for the first time. The good news is that this new sensation goes away quickly, and is usually only a fraction of what was felt the first couple days after your braces were first placed.

What is it like to get braces removed?  Getting your braces taken off is usually a very quick experience- usually one minute or less! We use a special tool that squeezes the braces one by one, and you may hear a little “pop” as they release from your teeth. After the braces are off, it usually takes longer to completely remove the adhesive that may still be attached to your teeth. We use a hand piece that sounds like a drill, but is actually a gentle polisher that makes the teeth nice and shiny. This polishing is usually not painful at all (most patients think it tickles!), it may just be the sound that causes some nervousness.

What do I do if I get a sore spot during braces? All mouths are shaped different, and I use different treatments for different people. Some people go through their entire treatment without getting sore areas, while others develop areas that bother them a bit.  Please read the next Blog that I post, in which I will give tips on addressing this issue.

 

Written by Dan Rejman, D.D.S., M.S. Dr. Dan is a Board Certified Orthodontic Specialist, who is the owner of Meadows Orthodontics in Castle Rock, Colorado.

How do braces and Invisalign make teeth move?

A question that I am often asked by my patients is, “How are braces able to move my teeth?” A very simple answer is that when gentle forces are placed on teeth, the bone around the teeth remodels, or “reshapes” to let the teeth move to a new position. In reality, the physiology of tooth movement is much more complicated, but also more interesting to those who are curious about science and the human body. So for those curious types, here is a more in depth (but still simplified!) explanation as to why teeth are able to be moved by braces.

pdlLet’s start with the players involved. The tooth itself is made of different materials. The part that can be seen in the mouth is covered by a material called enamel, while the root of the tooth (below the gums) is covered with a material called cementum. The cementum of the root is connected to the surrounding bony tooth socket by what is called the periodontal ligament (PDL). The periodontal ligament is made of many bundles of fibers, which in turn are made of a protein called collagen. Many types of cells also reside within the PDL, each with specific functions (more on that below). The main purpose of the PDL is to anchor the teeth to the bone socket (so your teeth do not fall out!), while also allowing slight movement, or “bounce”, to cushion the forces from chewing.

Normal chewing places forces on the teeth, PDL, and bone, and there is constant remodeling (tissue loss and rebuilding) taking place. Under normal conditions, this remodeling is usually in balance, and the teeth do not move. However, if additional forces (or pressure) are placed on teeth (such as with braces), something very interesting happens to the cells that reside within the periodontal ligament. On the side where the PDL is being compressed, or “squished”, cells called osteoclasts start removing, or “eating away” bone. Thus the tooth moves into this new space. On the back side, where the PDL is under tension, or is being “stretched”, cells called osteoblasts start producing bone. Thus bone is added where the tooth root once was. When the forces produced by braces or Invisalign are removed, the osteoclasts and osteoblasts return to their less active roles of maintaining the teeth when they are stationary.

Now that you know the basics of teeth movement, I’ll go over some other questions you might have.

Can I speed up tooth movement by wearing double the rubber bands?  Wearing more rubber bands than asked by Dr. Rejman will likely make your treatment take longer!  In fact, it is thought that the ideal force for orthodontic tooth movement is very light, slightly higher than capillary blood pressure. Excessive pressure can lead to areas around the tooth where cells are not present (hyalanized areas), which results in reduced tooth movement. The take home lesson: wear your rubber bands as directed!

When braces or Invisalign are removed, are the teeth permanently set in place?   No!!! Even though the bony socket has remodeled, and the body finds relative equilibrium (as described above), the PDL fibers are now “stretched”, and want to pull the tooth back towards its original position. Retainers must be worn to keep the teeth in place. Everyone is different, and Dr. Rejman will instruct each patient how long to wear their retainers each day, and which type of retainer will be best for each individual.

So, if placing a light force on a tooth can cause it to move, can I move my teeth with my tongue or my finger? Absolutely! Teeth do not know what is placing a force on it, all it knows is “How much force, and how long does it last?” This is why we are concerned with thumb sucking, which can dramatically tip teeth upwards and outwards. The pressure that the tongue places on a tooth is normally balanced nicely by the opposing pressure the cheeks and lips, and the tooth finds a happy space in the middle of these forces. However, I have seen patients with abnormally large tongues that place a larger outward force on the teeth, which moves them to a non-ideal “wide” position, often causing an open bite. They key is that the force must remain long enough to activate the cells that are responsible to remodel the tissues, as described above.

Why an Orthodontist (What is an Orthodontist?)

 

For those who have had braces, most are familiar with who an orthodontist is. But there are still many people who don’t know exactly what an orthodontist is, and how they differ from their general dentist. Ready for an explanation? Here we go…

An orthodontist is a specialist in the diagnosis, prevention and treatment of dental and facial irregularities (straightening teeth, and aligning the jaws). Being a specialist has two components: 1) Attaining a specialized and ADA accredited education, and 2) real world practice where a specialist’s sole focus is on that specialty alone.

All orthodontists are dentists, but only about six percent of dentists are orthodontists. An orthodontist must complete undergraduate college requirements before starting a three-to five-year graduate program at a dental school accredited by the American Dental Association (ADA).  After dental school, at least two or three academic years of advanced specialty education in an ADA-accredited orthodontic residency program are required to be an orthodontist.  Admission to most orthodontic programs is extremely competitive and selective. The training includes advanced education in bio-medical, behavioral and basic sciences.  The orthodontic student learns the complex skills required to manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics).

It takes many years to become an orthodontist and the educational requirements are demanding. Personally, my residency required classes and clinical training, all day, five days a week, with studying and research in the off hours and weekends. I spent about 65-70 hours a week training, treating patients, studying, and preparing for my research. I received my Masters Degree in Orthodontics at the completion of my residency (This is a bit reversed as opposed to other professions. We receive our doctorate first, and then can receive a masters if we become a specialist).

Only dentists who have successfully completed these advanced specialty education programs (accredited by the ADA) may call themselves orthodontists. General dentists can do orthodontics, but may not call themselves orthodontists or an orthodontic specialist. An orthodontist does not do crowns, implants, cleanings, fillings, sealants or veneers. These are services that general dentists excel at, as they perform these skills daily in their practices.

The American Association of Orthodontics has a web site dedicated to educating the public about our specialty, which can be found here:  https://www.braces.org/. A slogan on the site is,

“Your smile deserves a specialist. And orthodontics is all we do.”

This brings us to the second part of being a specialist. Orthodontics is what I do (and all orthodontists do) exclusively. I have been studying and practicing orthodontics only, for nine and a half years. After graduating from my residency specialty program I was well prepared, but was not even near the orthodontist that I am today. Proficiency and expertise comes from experience (in addition to a great education). Even having treated over 5,000 patients with braces and Invisalign, I learn something as a specialist every day, which further enhances and fine tunes my skills. Doing a proper job aligning the teeth and jaws can be very complex, and then comes the artistic part: noticing and detailing the little and not-so-little nuances that really make things beautiful. Speaking for myself, these qualities have only become exceptionally developed through treating thousands of cases, dedicating myself to continuing education, and being open to examination and criticism through the process of Board Certification (only 40% of orthodontist are Board Certified by the American Board of Orthodontics (see below).

As I tell people, braces and Invislalign are only tools, just as a paintbrush is only a tool for painting. Just as works of art come from the artist who is doing the painting, not the brush, exceptional results come from your choice of professional, not the braces themselves.

So how can you be sure you are seeing an orthodontist for your Braces or clear aligners(Invisalign)? Use these resources and links below.

aao_logoThe American Association of Orthodontists (AAO)  Only dentists who have completed an ADA accredited orthodontic residency program (2-3 years) may call themselves “orthodontists,” and only orthodontists are accepted for membership in the AAO. By choosing an AAO member, the public is assured that the doctor truly is an orthodontist.

To find an AAO member, click here:  https://www.braces.org/

aboThe American Board of Orthodontics (ABO)  Orthodontic specialists can become board-certified by the American Board of Orthodontics(ABO). Board-certified orthodontists are known as Diplomates of the American Board of Orthodontics. The American Board of Orthodontics is the only boarding organization for the orthodontic specialty that is recognized by the American Dental Association (Please note that you can be an orthodontist and not be board certified- this is an optional process).

To find a board certified orthodontist, click here:  https://www.americanboardortho.com/public/

 

Information Courtesy of American Association of Orthodotists (AAO), and the American Board of Orthodontics (ABO)

How to Select an Orthodontist

Posted  Sept. 10, 2012 in Dental Life

How to Select an Orthodontist

Thank you to Mommy DDS.com, who wrote this great article (Posted  Sept. 10, 2012 in Dental Lifeabout selecting the best orthodontist for family. We took the original text, and then added how it pertains to Dr. Dan Rejman and Meadows Orthodontics (in the Blue text!)

Stuff that matters when choosing an orthodontist:

 

  • Is the orthodontist board certified?  Most people think board certification is required and that all orthodontists are board certified.  Board certification is voluntary in orthodontics and only a small percentage actually go through the rigorous process.  If your orthodontist is not board certified, it doesn’t mean they don’t do a good job.  But, an orthodontist who is board certified is making a concerted effort to better themselves.  For an updated list of board certified orthodontists in your area, please visit americanboardortho.com.  Unfortunately, some orthodontists misrepresent themselves as board certified when they are not.  If your orthodontist claimabos to be board certified, verify it with the American Board of Orthodontics.

 

Dr. Rejman is currently the only Board Certified orthodontist in Castle Rock and Castle Pines.

 

  • Is the doctor an orthodontist or general dentist who does orthodontics? An orthodontist is a specialist, and has attended a 2-3 year residency program.  During this time they are exclusively treating orthodontic patients and studying tooth movement, jaw growth and development.  This person generally has a master’s degree in orthodontics and usually has done extensive research and defended a thesis on the subject.  A general dentist can take courses in orthodontics and is legally permitted to perform orthodontics, but has not been through an orthodontic residency.  If the person offering to do your braces also does cleanings, fillings and crowns, that doctor is a general dentist not an orthodontist.  I often hear people tell me, “My dentist is also an orthodontist”.  It doesn’t work that way.  Orthodontists ONLY do orthodontics.  They never do cleanings and fillings.

 

Dr. Rejman attended four years of dental school at The University of Michigan and completed his residency and Masters degree at Marquette University in Milwaukee, WI.  Dr. Rejman is a Board Certified orthodontist.

 

  • Review the qualifications of the doctor.  In the end, you are choosing an orthodontist – not an office, orthodontic technique or particular bracket.  It takes technical skill to produce an optimal result.  Review the doctor’s education (especially dental school and orthodontic school) and experience.  Not all schools are created the same.  Some are excellent, some are good and some are quite poor.  Some of the top programs in the country include: University of Michigan, University of North Carolina, University of Washington and Baylor University

 

Dr. Rejman attended dental school at The University of Michigan and wumas chosen for his residency and Masters at Marquette University.  He won the award for highest academic standing in his graduating class of 100 at Michigan and has received TOP ORTHODONTIST honors by 5280 magazine in 2012, 2013, and 2014 as voted by his peers. He was recently Best of the Bestvoted Best of the Best “Best Orthodontist in Castle Rock, 2014”. Dr. Dan has also received numerous academic awards throughout his career. 

 

 

  • Is the location convenient to school or home? If your child goes to school 30-45 minutes away from your home, an orthodontist closer to school may be a better choice.  You will be driving to and from the orthodontist every 6-8 weeks, not including emergencies.  It needs to be easily accessible to the places your child spends most of his time – school and home.

 

Meadows Orthodontics is conveniently located across from the Castle Rock Adventist Hospital and next to Einstein Bros. Bagels.  There are over ten schools within two miles of our location.

 

  • What are the hours? Some orthodontists have multiple locations.  Find out the hours that the orthodontist is on-site at the location you are planning on visiting the most.  If the orthodontist is only available one day of the week, that office might not be as convenient as you first thought.  If you need a bracket repaired or have a scheduling conflict, you may need to drive 30 minutes to an alternate location.

 

Meadows Orthodontics is open early mornings (6:30 AM), evenings (until 6:30 PM on Mondays and 8:00 PM on Wednesdays), and is open both day time hours and two Saturdays per month.  Visit www.MeadowsOrthodontics.com for a full listing of our hours. 

 

  • Does the doctor have ownership in the practice?  This may sound like an odd question, but there are more and more orthodontists working out of general and pediatric practices.  They are hired by the general practitioner as an associate.  Because they have no ownership, there is no guarantee that they will be there for the entirety of your treatment. In those situations, it isn’t unheard of to have 3-4 different orthodontists working in an office during a logotwo year period.

 Dr. Rejman is the only orthodontist that you or your child will see.  He is the sole owner of Meadows Orthodontics, and Castle Rock is our only location!

 

  • How accessible is the orthodontist? Dr. Rejman meets with every new family for a one-hour consult.  He also does the majority of in-the-mouth work.
  • Do you like the staff? Every team member in our office is from Castle Rock.  In fact, our staff has lived in Castle Rock a total of 47 years!  Julie, the office manager, is Dr. Rejman’s wife- so Meadows Orthodontics is truly a FAMILY ORTHODONTIC PRACTICE – and our middle name is friendly!  

 

Ask who sees patients if there are after hour emergencies.  There are some offices where a staff member is available to take care of your needs.  In other offices, you have access to the doctor and he/she will see you for after-hours care

 

Dr. Rejman sees the majority of emergency patients himself.  He lives right in Castle Rock and is very accessible to is patients. 

 

  • What does the practice charge for additional services? In an effort to make their treatment fees appear lower, some practices will present you with a lower fee and then surprise you with additional fees for required services such as x-rays, models, retainers and emergency appointments.

 

Our office does not charge for additional services.  Dr. Rejman also issues TWO sets of retainers at the end of treatment and these charges are built into the original price.

Top ten things that have improved with braces and orthodontics since I was a kid!

 

Everybody loves a top ten list, so here we go! Many parents of my patients at Meadows Orthodontics had braces themselves in the past. They often wonder how their childrens’ experience with braces will differ from the experience that they had. There have been many positive changes over the years, all of which make braces more comfortable, make treatment more efficient, or increase safety. Here are some of the most significant changes.

  1. The development of advanced arch wires used in braces. There has been a massive increase in comfort and efficiency due to the wires (the part that actually aligns the teeth) that we currently use. Beta- titanium, Nitinol (Nickel- Titanium Naval Ordnance Laboratory- an alloy named after its site of discovery), and heat-activated Nitinol wires are widely used, which allows us start with more gentle forces, and offer a large range of flexibility, adjust-ability, and shape-memory properties.
  2. Clear braces, and more esthetic alternatives. New advances in ceramic braces have Braces for Adultsoffered highly esthetic alternatives that were not available before. These new braces are similar in size and shape to metal braces, but are clear! After years of development they no longer stain or change color as some people remember from years ago. They really look beautiful, and are a great option for adults with concerns about their appearance during treatment, and for teens that just want a different look. Of course, Invisalign is an option that I didn’t have in the 80’s, but I am honest about whether Invisalign will be the best option for your individual smile and goals. It is a great for some, not so great for others!
  3. Bonded braces. Most people take this one for granted, but it was not that long ago wearing braces meant full metal bands that totally surrounded every tooth in the mouth. My wife was actually one of the unfortunate last of our generation to wear these bands as the profession migrated to using bonded braces. Bonding technology allowed brackets (the “square” part of braces) to be “stuck” to the surface of the teeth, instead of being welded to the metal ring that surrounded every tooth. Kids, you may groan when parents say, “When I was a kid…”, followed by some tale of childhood hardship. In this case they mean it – the braces of today are so much more comfortable and smaller than they used to be!
  4. Decreased exposure to radiation. The development of digital radiography, which has replaced traditional film, has reduced exposure to radiation my many multiples.
  5. Better long term retention of straight teeth. This is more due to awareness than to any technological advancement. It is rare that a progressive orthodontist does not recommend retention for life these days, which certainly was not the case when I was younger. Whether you have had braces or not, we now know that most people experience tooth movement as they age. After your orthodontic treatment, we will help you choose the most comfortable retention option for your lifestyle.
  6. Options to help prevent permanent tooth staining. The new adhesives we use to make the braces “stick” contains fluoride to help counteract decalcification (the loss of minerals in the teeth, which causes “spots”). For added protection, we also offer a protective, clear glaze that can be placed for more at risk individuals.
  7. No more headgear! Well, sort off. We now have multiple alternative choices to treat Class II cases (or upper teeth that are located too far ahead of the lower teeth), most of which are hard to see, relatively small, and worn within the mouth. Head gear is still a great treatment option for some kids (some actually prefer it over the other options), but we certainly do not ask for it to be worn in public!
  8. Digital impressions. A recent advancement in the last few years, digital scanners (no radiation) are taking the place of the gooey alginate impressions that most consider an uncomfortable part of treatment. The digital scanners use a low- intensity laser that is fast and completely comfortable. At meadows Orthodontics, we use what is called an iTero scanner, which also sends digital impressions directly to Invisalign if this is the treatment of choice.
  9. More fun colors! For patients who choose traditional braces, we offer over 30 colors to mix and match, including glow in the dark colors. Parents are often shocked at the colors we offer compared to when they had braces! A smart friend of mine figured out that there are 435 different combinations of two colors, and 4060 combinations for three colors!
  10. Evidence for ideal treatment. Dr. Rejman uses peer-reviewed evidence to help make treatment decisions whenever possible. The web alone has been a game changer in the ease that professionals can access research and information from respected journals around the world. Clinical experience is very important in practicing orthodontics and making decisions, but Dr. Rejman balances this with being an evidence based practice for the well-being of his patients and the community.

 

Dan Rejman, D.D.S., M.S.

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. He loves discussing treatment alternatives with his patients, and various artistic ways to get a smile to look “just right”! He has been Board Certified by the ABO for seven years, and was recently voted Best of the Best, “Best Orthodontist in Castle Rock, 2014”.

Murals in the Meadows!

How about a break from Orthodontics and teeth? As our patients know, I am really into painting, sculpting and encouraging the arts. Aside from the artistic side that great orthodontics benefits from, I think having an artistic outlet can add a lot of flavor and beauty to life in general. I thought it might be nice to show the progress I am making with the Mural that the Town of Castle Rock asked me to paint. It is located in the tunnel that leads to the Grange in the Meadows, underneath Meadows Parkway. Officer Seth Morrissey is running the program to deter graffiti, and various artists are photopainting murals along the trails, bridges and underpasses throughout Castle Rock. I actually agreed to painting, thinking that it would be the size of your average wall. When we went to see the site, I was met with a NINETY foot wide wall! I had to shift gears, and planned to break down the wall into five sections measuring 18×12 feet. The overall plan is to use a sepia-like effect to unify the five sections, and to blend with the surroundings.

I started two weekends ago, and was lucky to have two very talented volunteers help, Billy and Lela. We started with a simple tree in the middle section of the wall. By simple, I mean the design- we actually painted many thousands of fine branches in three layers to give it a delicate look. I started with a very light tree in the background that took a full day to paint. Although this layer is the least visible at first glance, it gives the final result an overall lush and warm feeling. We spent hours and hours on those small fine braches! The next day we added a medium tone, and then the darkest tone on top of that. We finished with a white ground with a few areas of sparse grasses coming through to give it a wintery feel. Presto- one section done!

photo 3The next weekend we started the Buffalos drinking at the water hole scene. This was painted similarly, in layers and in sepia tones. I sketched the buffaloes on paper, and used an overhead projector to draw it on the wall. For the sky I used a photo on my phone that I took while mountain biking in Buffalo Creek, but ended up changing a large portion of it while we were painting. Now that I’m looking at it, I need to touch up a few areas, but it came out really nice.photo 1

 

What is next? I think we are going to do something fun with frogs. Stay tuned.

Dan Rejman, D.D.S, M.S.

Dr. Rejman is the owner of Meadows Orthodontics in Castle Rock, CO. He was recently named the “Best Orthodontist in Castle Rock, 2014”, by both “Best of the Best”, and Douglas County Living. Stop by his office to see more of his artwork- both on the walls, and displayed on all his patient’s smiles!

Advice on Relocating when a Family Member is in Braces

Sometimes families need to relocate while one of their family members is in the middle of orthodontic treatment. If the move is a significant distance, they likely will have to find a new orthodontist to continue their treatment. In my experience, the majority of these “transfer” scenarios proceed smoothly. There are times though, that this transition does not go as planned for the family. My goal in writing this article is to educate and inform families about what to expect and what to look for when anticipating a move (whether coming into my practice, or moving away from Castle Rock). These tips can make this transition a much easier process.

skyThere are two areas that I will discuss; 1) What to expect regarding treatment and finding the “right” new orthodontist, and 2) financial concerns and expectations in the transfer. I will tackle the former first. Whether your treatment has just begun, or whether you are close to having your braces removed, make sure to inform your current orthodontist of your move as far in advance as possible. At Meadows Orthodontics (and at most practices), we set up a special final appointment that includes the taking of final records. This includes taking photos, digital impressions, and radiographs as needed. I also prepare a transfer form (created by the American Association of Orthodontists -AAO) to send to your new orthodontist. This informs your new doc of your original concerns, diagnosis, types of braces and appliances used, recommendations for continued care, and an estimate of remaining time left in treatment.
I also assist in finding a new orthodontist if possible. I usually build close relationships with my patients, and I want them to find someone that they can trust, and that provides an exceptional level of care. If I do not know an orthodontist in your new area, the AAO provides a data base of orthodontists with information on their practice preferences, education, years of experience, and Board Certification status. Finally, I want to make sure that your braces are as secure and “trouble-proof” as possible for your move.

We also want the financial aspect of your move to be as stress free as possible. I like having a specific financial transfer meeting with parents, so that we can explain how we prorate or refund a percentage of your investment (if it was paid in full), or when to stop payments if the treatment was financed. Years ago the AAO provided a formula to help determine the fair amount to reimburse patients that are transferring or moving. This formula is no longer published (likely due to individual case variation and differing financial opinions of individual practitioners), but I still use it as a consistent guideline for what is “fair” for the majority of cases (It is important to be aware of this, especially at the start of treatment if you are paying in full). If there is any “grey area”, I tend to err in the patient’s favor, as maintaining great relationships is more important to my business than “nickel and diming” will ever be.

For patients that are moving to the Castle Rock area, we recommend that, as described above, you complete and resolve any financial issues with your current/former orthodontic office before you move. It is important to understand what percentage remains with your or your child’s treatment, and that you are comfortable with the agreed upon financial arrangement. Most orthodontists will gladly discuss your case details with one another (with proper HIPPA compliance) to ensure a smooth transition, but resolving and closing out your previous financial arrangement (and reimbursements if applicable) upon moving are solely between you and your previous office.

On our part, we will do our best to make your transition as easy as possible. When you arrive at our office after your move, we will perform a full examination, and will base our fees to finish your treatment on several factors. The most important factor is how long it will take to complete your case, but may also be influenced by case difficulty, appliances or braces that may need to be replaced, and how fairly we believe you were financially “sent on your way” at your previous location. With the vast majority of cases there is a very similar estimate of remaining treatment goals, and we are on our way to getting you finished! In the rare case that we believe you have considerable more time remaining than your previous orthodontist estimated, I will explain in depth why this is the case, and may recommend a second or third opinion, just so you feel at ease with the treatment that still remains.
Regarding your insurance benefits, be sure to let your original orthodontist and insurance carrier know when you are moving and when your last appointment will be with your original orthodontist. Without this information, your insurance carrier may continue to send payments to an office where you or your child is no longer at! (The above information is applicable to braces, clear braces, and Invisalign)

As always, if you have any questions, please call us at Meadows Orthodontics and we will be glad to help you!

Dan Rejman, D.D.S., M.S.
Owner, Meadows Orthodontics, Castle Rock, CO.

Dr. Dan Rejman is Board Certified by the American Board of Orthodontists, and was recently voted Best Orthodontist in Castle Rock 2014 (Castle Rock News Press), and Douglas County’s finest Orthodontist 2014 (Douglas County Living).