What are self-ligating braces, and are there advantages in using them?

self-ligationThe last several decades have seen an increase in popularity (and marketing) of what are called self ligating braces (brackets). Not unique to one manufacturer, self ligating braces include Empower (American Orthodontics), Damon (Ormco), Smart Clip (3M Unitek), and In-Ovation (GAC Dentsply) among many others. Basically, self ligating brackets use a permanently installed, moveable component to hold the archwire in place instead of removable elastics or steel ties.

The manufacturers of these braces have made many claims regarding the advantages of using these braces, including increased comfort during treatment, increased efficiency, shorter treatment times, and improved oral hygiene. When presented with products with such heavily marketed claims (and which are inevitably more expensive for the orthodontist and our patients), I have to examine the evidence carefully when deciding if I want to offer them to my patients here at Meadows Orthodontics. For ethical reasons, I personally try to make as many decisions as possible using an evidence-based approach. This approach certainly applies to how these braces are presented.

A recent article in the American Journal of Orthodontics and Dentofacial Orthopedics addressed the major claims to these brackets. The findings by the American Association of Orthodontists’ Council on Scientific Affairs (COSA) are very useful in determining the merits to these claims. First and foremost, the article reviews the tenants for an evidence-based orthodontics practice, and states, “Adherence to the tenants of evidence-based orthodontic practice requires that, for any orthodontic intervention applied to a patient, 3 factors must be integrated: the relevant scientific evidence, the clinicians expertise, and the patient’s needs and preferences.” (Note that manufacturers claims and marketing are not among these factors!).

Let’s take a look at what COSA determined (the complete article can be found here). “ 9 of the 14 claims regarding self ligation bracket systems have some peer-reviewed data, but the evidence does not indicate clear differences at this time for reduced friction between arch wire and bracket, reduced clinical forces, reduced treatment time, faster alignment, faster space closure, different arch dimensions, better alignment and occlusal (bite) outcomes, less patient pain, and more hygienic. Three of the 14 claims- lateral expansion leading to bone growth, lateral expansion is comparable to expansion using RPE (expander) and conventional brackets, and stability of lateral expansion long term- have no supporting peer-reviewed data currently. Only two of the 14 claims- mandibular incisor inclination, and time in “untying” the braces, were found to have significant differences.

What does this mean for an orthodontic patient of mine? First, most of these self-ligating braces are great products, and I can achieve great results by choosing to use them. But I treat the vast majority of my patients without self ligating braces, due to the fact that 1) the scientific evidence to support the “marketed” advantages of these braces is lacking, 2) I have used these braces extensively, and have found no clinical advantage for my patients (although they did finish equal to traditional braces), and 3) the vast majority of my patients do not prefer these systems, even though they are presented as an option. What it comes down to is two things: 1) Kids and teens love the color ties that are the “ligation”  in traditional braces (and that self ligation braces eliminate), and 2)  these systems are significantly more expensive, and most of my patients prefer not to pay more for a product with no real or perceived  added value. For patients with esthetic concerns, ceramic braces (traditional and self ligating) with clear ties and Invisalign are the treatment of choice for adults and older teens -you don’t need to have bright colors!

I hope this helps clarify questions that you may have had regarding this issue. I will be posting a series of articles that examine a number of orthodontic topics, and how the current scientific evidence shapes my decisions at Meadows Orthodontics.

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

Owner, Meadows Orthodontics

How long do I need to wear my retainers?

When you think about it, the ability to move teeth within your jaw bones is an amazing and unique thing. While teeth are being moved by braces or Invisalign, the surrounding bone is remodeling to the new position that the teeth are in. It would seem that after this remodeling is complete, or “set”, that this new aligned position of the teeth would be permanent. Most adults that had braces as teens remember being told by their orthodontist to wear retainers to keep their teeth straight, but usually for only several years after their braces were removed. The belief was that when teeth were  aligned and stable, and retainers have been worn for a few years, they would stay this way for life without continued wear of their retainers. Fast forward 5, 10, 20… years later, and many adults notice that their teeth are starting to shift and are crowding again. What happened?

Removable InvisalignAs a profession in general, most orthodontists now agree that to keep teeth straight for life, retention is needed for life (I often joke that just like the rest of our bodies, teeth “wrinkle” as we age!).  I let my patients know that although this may sound daunting, the benefits are great compared to the effort required to keeping their teeth aligned and healthy. Every bite is unique, but most patients only need to wear their retainers at night while they are sleeping, and are free to go to school, play sports, eat, play and go to work without wearing retainers. This is often a huge relief to patients who expect that they will have to wear retainers 24/7 after their braces are removed!

There are several choices of retainers that I match to patient’s lifestyles and preferences. We offer traditional (Hawley) plastic and wire retainers, clear trays (that look like Invisalign trays), and bonded semi-permanent retainers (small wires bonded to the back of the front teeth). At first, we ask that retainers be worn every evening and night for several years. After this, retainers should continue to be worn (for life!), but how often is unique for each person. Most people can keep their teeth aligned wearing them several nights a week, while others may need to wear them every night (these people may prefer bonded retainers). How often depends on several factors, such as how misaligned the teeth were prior to treatment, facial and soft tissue structure, and whether the patient feels the teeth shifting when the retainers are not in place. To ensure that your teeth remain attractive and healthy as long as possible, I will monitor your teeth long after your braces or Invisalign treatment is complete. You will receive guidance as to the ideal retention protocol for your individual needs!

Written by Dr. Dan Rejman
Meadows Orthodontics
Castle Rock, Colorado

Dr. Rejman has been voted a TOP ORTHODONTIST in 5280 magazine in 2012, 2013, and 2014.  He is a Board Certified Diplomate of the American Board of Orthodontics.  

Everything you need to know about your child’s palatal expander!

One of the most common treatments in orthodontics is the use of a rapid palatal expander, often referred to as an “RPE”. An RPE is used to widen the upper jaw (maxilla), and is usually used to correct crossbites, and to create more space for crowded teeth. The following are the questions that we are asked most frequently by kids and their parents here at Meadows Orthodontics.

“Is the expander going to hurt?”

The most common description by kids is a “tight” or “pressure” feeling. Pain is relatively uncommon, and if sensitivity is reported, it usually only lasts several minutes, or even seconds. We generally have parents activate the expander once or twice a day, which is only 1/4mm to 1/2mm. The vast majority of kids feel very little discomfort and adapt very quickly!

“Am I going to sound different when I talk?”

I always inform my patients that “S” sounds will be a bit slurred at first due to the positioning of the tongue on the palate and the new obstacle for the air producing this sound. Most patients overcome this and adapt within a couple days, returning to normal enunciation. I tell kids to practice reading a book or magazine out loud after the expander is placed to help speech return to normal the fastest.

“My child has a hard time breathing through his/her nose, and snores. Will the expander help with this?”

Studies hace shown that there is a reduction in nasal resistance after expansion, and it has been shown to help with obstructive sleep apnea in some children. However, I do not use expansion for the sole purpose of treating these problems, as treatment for airway obstruction should be interdisciplinary (treated along with your physician, who may precribe medications, or recomend proceedures such as an adenotonsillectomy). Personally, my son had his tonsils and adenoids removed, which helped with his airway and snoring for several years before returning recently (he is 10). I started treatment for his crossbite and crowding with an RPE recently, and within 2 weeks his LOUD snoring (I think all of Castle Rock could hear him!) has disappeared. So, yes, it can help, but every patient is an individual and has different results with airway issues.

“My child has a gap forming between her front teeth!! Is this normal?”

Yes, this is to be expected! The gap is the result of widening of the mid palatal suture of the maxilla. Sutural expansion is usually the goal of expansion treatment, as opposed to mearly tipping the back teeth outward towards the cheeks (which usually occurs also, but we try to minimize this tipping). After active expansion has stopped, you may notice the gap narrowing  spontaneously. The suture not closing, rather the fibers in the gums have been “stretched”, and sometimes pull the teeth back together a bit after expansion. Again, this is usually a good thing.

“How long does the expander need to stay in?”

I usually keep the expander in place 6-9 months after the last turns were completed. Removing the expander too early without retention often results in the teeth relapsing back towards the original width. Have patience! Keeping the expander in while your upper jaw remodels will be worth it, so you wont have to wear one again in the future!

“I was told that I was to old for an expander to fix my crossbite. Is this true?”

The answer to this depends on the individual. As a person ages, the mid-palatal suture fuses into one, solid piece of bone. At this point the maxilla cannot be expanded without a surgical procedure. There is significant individual variation as to when this happens, but generally fusion can happen from 11-12 years old to mid teens for females, and mid-teens to late teens for males. On the other hand, I don’t like expanding children at too young of an age (eg: 6 or 7 years old) if there is no downside to waiting for one comprehensive phase of treatment when they are ready for their full braces. Again, there are individual exceptions for severe early problems.

“Does my diet need to change with the expander in?”

We will discuss avoiding very sticky foods and candy, but unless braces are on your teeth also, your meals do not need to change significantly!

 

I hope this helps! If you have further questions, I am always available to discuss them.

Dr. Dan Rejman

Castle Rock, Colorado

How to navigate an orthodontic consult:

If you’re getting ready to call an orthodontist, you might have some questions about how the process works.  Here is a step-by-step guide for you from Meadows Orthodontics in Castle Rock, Colorado (located next to Einstein Bagels):

1.  RESEARCH FIRST!  Before calling an orthodontist that you’re interested in, be sure and research them online.

– Do they have the hours you want?

-Are they Board Certified?  (www.americanboardortho.com)

-Are they located in a convenient location (appointments are generally spaced out every 5-7 weeks, however, don’t forget about emergency appointments or extra appointments if your child is in need of an appliance, such as an expander)?

-Did the doctor specialize in orthodontics for 2-3 years after dental school?

These are just a few of the important questions to ask yourself before calling.

PROBABLY MOST IMPORTANTLY, IF YOU HAVE ORTHODONTIC INSURANCE, find out if the orthodontist you’re interested in PARTICIPATES in your dental plan.  This means that the price will be capped on the top IN ADDITION to getting a benefit!  This could save your thousands of dollars!  Most everyone will “take” your insurance, but few actually participate.  

2.  WHEN YOU CALL be sure and find a good time for BOTH parents to attend, if at all possible.  An investment in your or your child’s smile is FOREVER, and you are truly paying for the expertise of the orthodontist.  It is virtually impossible to recreate a conversation when you return home and show your spouse an estimate, but having both parents at the consultation can help prevent confusion and help with the decision process.  Most offices have things for your younger children to do, so do not hesitate to bring them alone!

ALSO – confirm that the appointment is complimentary and whether or not your child will need a panoramic x-ray.  In addition, it is VERY important to give the office your dental insurance information because the office can call and confirm what your benefits are prior to you arriving.  THIS IS CRITICAL IN RECEIVING AN ACCURATE ESTIMATE DURING YOUR VISIT.  If you do not have orthodontic coverage, take heart… only about 35% of families do!

3.  THE FORMS ARE ONLINE!  If you want to save time, most offices have forms that you can print and fill out prior to arriving.  If you don’t have the time to do this, the paperwork you’ll need to fill out at the time your arrive is minimal (less than 10 minutes).

4.  ONCE YOU ARRIVE, your child will most likely have a panoramic x-ray unless you’ve arranged to have your dentist send a recent panoramic film to the orthodontist.  The x-ray takes about 2 minutes to complete and you should go home with a copy at the end of the visit.  Your child will also have pictures taken that assist the orthodontist in creating a treatment plan.  You will get to take these home as well.

After the x-ray and pictures are taken, the exam with the orthodontist takes place.  Take special note of how much time the orthodontist is willing to give you.  Does he or she examine your child’s mouth for 5 minutes and then leave, or does he or she spend time with you?  This is an important note to take when deciding how much personal attention you need throughout the treatment process.

Dr. Rejman makes it a priority to spend a great deal of time with a family so that your questions can be answered and the full treatment plan can be explained in great detail.  He gives his personal cell phone to patients, and families are always welcome to call with post-consult questions as well.

5.  Finally, the FINANCES are discussed with the Treatment Coordinator.  This is your opportunity to hear what the cost of the treatment will be, what your insurance discounts or benefits will be, and what your payment options are.  Meadows Orthodontics offers interest free financing and many payment options that will make your life easier over the next 12-24 months!

There!  It’s that simple!  To schedule a complimentary consultation today, call us at 303-660-0112.  We are open from 8:45 AM – 5:00 PM every single day of the week AND we offer before school, evening and Saturday appointments!

Dr. Daniel Rejman is a Board Certified Orthodontic Specialist and treats children, teenagers and adults with traditional braces, Ceramic braces, Invisalign Teen and Adult Invisalign.  He owns Meadows Orthodontics in Castle Rock, Colorado and is the only orthodontist at this practice.  As a Castle Rock resident, he is very accessible for not only appointments, but for emergency appointments in the evening and on the weekends.  Dr. Rejman was voted a TOP ORTHODONTIST by his dental peers as seen in 5280 magazine and has multiple awards and honors that can be seen at our website (www.meadowsorthodontics.c0m).  Most importantly, we offer a warm and fun place for you and your children to receive orthodontic treatment!  WELCOME!

 

Avoiding Staining on Teeth While in Braces

The big day has finally arrived!  Both you and your orthodontist have worked hard to make a beautiful smile, with perfectly straight teeth.  It’s time to have your braces removed!  This is usually an extremely happy day with a reason to celebrate!

When some people have their braces removed, however, white spots that look like a “picture frame” from around the outside of the braces remain.  These white stains can form along the border of the teeth near the gum line.  After all of that beautiful work, the appearance of these stains, which are often permanent, is not something that we at Meadows Orthodontics are happy to see.  These permanent white stains are called decalcification, which is a loss of calcium from the enamel.  Decalcification most often occurs due to the poor removal of dental plaque from the teeth, whether the gum lines, around the braces, or if there are no braces at all!  The bacteria in plaque produce acids that damage tooth enamel by leaching away calcium.  This leads to the often permanent white spots, which is the beginning of a more extensive cavity if habits do not change.

What can be done to prevent these unsightly white spots?  First, the removal of dental plaque, by brushing, flossing or waterpik is vital.  An excellent brusher will rarely aquire stains.  Second, avoid or limit the amount of processed sugars in your diet.  Bacteria in plaque actually feed on sugars, and release acids as a waste product onto your teeth.  Yuck!  Soda and sports drinks are the biggest culprits, as the additional acidity compounds the effect on teeth.  Finally, fluoride rinses can help remineralize teeth, but only to a point.  The public water in and around Castle Rock if fluoridated, so this helps in the development of the enamel but this is not enough to counter the effects of poor plaque removal and high sugar levels.

So, protect that beautiful smile while you are in braces (and after!).  Dr. Rejman will always take the time to educate you and your child about proper dental care and a healthy diet.

 

Dan Rejman is an orthodontist in private practice located in Castle Rock, Colorado.  Meadows Orthodontics provides braces and Invisalign for children, teens and adults and offers before school, day time, evening and Saturday appointments.  Dr. Rejman is a Board Certified orthodontist and has been voted a TOP ORTHODONTIST in 2012 and 2013.  Please go to www.meadowsorthodontics.com to learn more. 

 

Why are so many eight-year-olds in braces these days?

ORTHODONTIC TREATMENT FOR CHILDREN

One of the most commonly asked questions about orthodontics in the Castle Rock community is…

                      “Why do I see so many eight-year-olds in braces these days?

An excellent article published by the Wall Street Journal discusses the pros and cons. To summarize the article, early or “two phase” treatment is orthodontic treatment before all the permanent teeth have erupted.  This approach is used when waiting to treat would create a significantly more difficult treatment plan or less stable outcome.  The American Association of Orthodontists recommends that all children be evaluated at the age of 7.  With that being said, only a relatively small percentage of those children will need early treatment.  Orthodontists generally agree that the optimum time to treat a case is during the adolescent growth spurt.  In girls this is typically seen from ages 9 to 12, and in boys from ages 10-14.  There are exceptions due to individual variation in growth.

Lysle Johnston, one of the most prominent orthodontic educators of our day, has argued that a lot of early treatment is a “practice management decision” rather than a biologic imperativeIt is his way of kindly stating that much of it is done unnecessarily.

The fundamental questions Dr. Rejman asks when evaluating a patient for early treatment are as follows:

  •  If I don’t treat this patient now, will I miss a window of opportunity that will negatively affect his/her outcome?
  • If I do 2 phases on this patient, will I achieve a better and/or more stable outcome than treating with one phase?
  • Will the patient look/function any differently at 18 if I treat in 1 phase versus 2 phases?

If the answer to any of the above is “yes,” then early treatment may be indicated.  Typical orthodontic problems treated early include cross bites or narrow palates, open bites, and under bites.  Early treatment usually requires a second phase of orthodontic treatment when all the permanent teeth have erupted.  When possible, Dr. Rejman prefers to treat patients in a single phase of treatment.  Advantages of single phase treatment include less time in appliances (braces), less patient “burn out” and significantly less cost for families.

Dr. Rejman offers a complimentary exam to assess your child’s orthodontic needs.  If treatment is indicated, we’ll discuss why and what specifically is needed.  If orthodontic problems are evident but no early treatment is indicated, we will continue to periodically monitor your child’s teeth and jaw development at no fee until the time is appropriate for treatment.

Dr. Rejman is the owner of Meadows Orthodontics, a private practice in Castle Rock, Colorado.  Dr. Rejman is conservative about early or “two phase” treatment.  He is also one of the few Board Certified orthodontists in Douglas County and has treated over 4000 patients.  He has been voted a TOP ORTHODONTIST by 5280 magazine in both 2012 and 2013. 

Advice on entering the Dental/Orthodontic Profession

Have you or your child ever thought about becoming a dentist or orthodontist?  Throughout my years of practicing as both a general dentist and an orthodontist, many patients have expressed an interest in knowing more about my profession.  I thought that I’d write a blog letting readers know more about this fantastic career.

My first bit of advice that I would offer is that if your child expresses interest in dentistry to get them into a dental office as soon as possible.  They could be an intern or shadow a dental professional.  Don’t be afraid to ask a dentist that you know!  I love having young people around our orthodontic office in Castle Rock, especially when they are really interested in orthodontics.  If there is an opportunity to work in the mouth at all, take it.  People often asked me when I knew that I could work in mouths all day.  Well, before dental school I worked as a dental assistant  in Connecticut to make sure that I could work in the mouth.  I cannot emphasize the importance of this enough.  I remember several classmates in dental school who realized after school began that dentistry was not the career for them.

Some basics:

*  Take as many science classes as you can in high school and undergrad.  Math helps, too.

*  Dental School is a four year program and you must have a four-year undergraduate degree prior to applying to a Dental School.

*  In order to get into dental school you must have some basic sciences and you must take the DAT, or Dental Admission Test.  If you purchase  a guide to getting into dental school/the DAT, the book will give you a list of all of the dental schools and their contact information so that you can find out what they require for prerequisite classes.

*  Once you are in dental school, you might decide to specialize.  Specializing can take another several years AFTER dental school, depending on what route you take.  Some specialties include orthodontics (moving teeth, usually using braces and Invisalign), Pediatric Dentistry, Periodontal (gums), Endodontics (root canal specialist) or oral surgery.

All of this education sounds like a lot, but they were some of the best years of my and my family’s life.  My friends in dental and orthodontic school worked hard but had a lot of fun together and our families all became really close.

Don’t underestimate the importance of loving to work with people.  I love working with kids so orthodontics is great for me.  I also have to ease the fears of adults, not to mention educate them about what treatment is needed for their children.  Being good with people is really important in this profession.

Finally, choose to work in a place that you love.  The rest will come.  I love living and working in Castle Rock and going to work each day is a pleasure.  You should really love what you do so just be sure to pick a location that you enjoy, too.

I can’t imagine being anything else besides an orthodontist and I’m so glad that I chose this profession.

 

Dr. Rejman, Meadows Orthodontics, Castle Rock, CO  80109  (303) 660-0112    www.meadowsorthodontics.com

Dr. Rejman is a Board Certified Orthodontist who graduated from The University of Michigan’s School of Dentistry in 2003.  His practice, Meadows Orthodontics, is located in The Meadows in Castle Rock, Colorado.  

Meadows Orthodontics has a state-of-the-art facility to serve you.

Dan Rejman, orthodontist in The Meadows in Castle Rock, Colorado, built his own private orthodontic practice in 2013.

From Where I Sit

Watching Dan Rejman become an orthodontist

It has been a privilege watching Dan Rejman become an orthodontist.

I was 15 when I met him and I knew from the start that there was something really special about him.  He always stood out in a crowd, whether it was because of his practical jokes, unusually strong work ethic, artistic skills, or kindness to absolutely everyone.   It just felt good to be around him.

Nobody was surprised when he did well academically in our little town in Upstate, NY.  It was obvious that he was really smart.  He was from a big dairy farm and we all wondered what he’d end up doing as a career.  We all knew that he could be anything he wanted to be.   He was just that type of guy.

bikeAfter college he studied art at Parsons School of Design but had stopped to pursue something closer to his heart;  Dentistry.  He studied for 18 months.  He took prerequisite classes at 5 am and 10 pm.  He worked long hours for a dentist to make sure he enjoyed working with teeth.  He studied until 2 am every night.  He was warned that many don’t get in their first year, but an envelope arrived and he was accepted into dental school at The University of Michigan.  The Dean at Michigan wrote a handwritten note on his acceptance letter that he was a unique candidate and that she remembered his interview long after it was over.  We’re not sure they ever interviewed a dairy farmer before!

Dan worked harder than he ever had before at dental school.  It quickly became clear that he excelled in the field.  He won scholarships.  He won awards.  He was at the top of his class.  Yet, nobody knew.  He was the normal, down-to-earth guy he had always been.  He never talked about his grades or accomplishments to anyone.  Most people didn’t know how much he had excelled until his name was read over and over again at graduation.  Instead of standing on the stage while his name was read, he quickly walked down the stairs and found a man in the audience who gave him a scholarship so he could shake his hand.

Dan was a general dentist for two years but had fallen in love with orthodontics.  He decided to specialize in the field at Marquette University in Wisconsin.  He continued to work hard both during and after school, but his family was growing and he always made them his priority.  He has always been good at finding balance in his life.  He has always been good at keeping his career in perspective.

Over the years we have watched Dan Rejman use his humor and kindness to ease the worry of children in the dental chair, or gain the respect of parents who desperately crave honest feedback about orthodontics.  We have watched him become friends with such a diversity of human beings by admiring their character above anything else.  Most importantly, we watched him find orthodontics, the career he adores in and out.  He has a smile on his face most every night when he returns from work.

As his high school sweetheart and wife, I can’t help but admire his entire journey.  In fact, I have never admired anyone more.

It has been a privilege watching Dan Rejman become an orthodontist.

 

Julie Rejman has been married to Dr. Rejman for 15 years and is the office manager at Meadows Orthodontics.