Invisalign

by Dr. O. Karnakova

Invisalign is a clear orthodontic aligner tray made to replace traditional braces. Unlike braces, they do not contain any metal, are constructed out of a smooth comfortable plastic, and are removable. They are used to correct moderate under bites, open bites, crowding, cross bites, and gaps between teeth (diastema).

Invisalign should be worn a minimum of twenty-two hours per day and should only be taken off when eating or brushing. A new set of custom aligners are to be worn approximately every two weeks.

Invisalign offers many advantages over traditional braces. They are virtually invisible and are more esthetically pleasing. The aligners are much more comfortable to wear as compared to the metal brackets and wires. Braces also make it more difficult to maintain optimum oral hygiene. The brackets can trap food debris and plaque, resulting in gum infection.

Invisalign trays can be removed to perform oral hygiene and do not have any food restrictions. Studies have shown that Invisalign can align teeth faster than braces when used correctly.

A disadvantage of Invisalign is that they are not designed to correct severe malocclusions. Teeth that are overly rotated, severely misaligned, or have large gaps over 6mm are not candidates. Invisalign treatment also has the potential for higher costs than traditional braces. Another potential disadvantage with Invisalign treatment is noncompliance. Patients who do not wear their trays for at least twenty-two hours per day may slow the progress of treatment. Not wearing the aligners for long extended periods of time may relapse the progress and require additional costs with mid-course correction.

Malocclusion

A malocclusion is a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close. Edward Angle, who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the permanent MAXILLARY FIRST MOLAR. Angle believed that the anteroposterior dental base relationship could be assessed reliably from first permanent molar relationship, as its position remained constant following eruption. In case where the first molars were missing, CANINE relationship is used.

CLASSIFICATION OF MALOCCLUSION

NORMAL OCCLUSION
Molar Relationship: According to Angle, the mesiobuccal cusp of the maxillary first molar aligns with the buccal groove of the mandibular first molar.

Canine Relationship: The maxillary canine occludes with the distal half of the mandibular canine and the mesial half of the mandibular first premolar.

Line of Occlusion: The teeth all fit on a line of occlusion which, in the upper arch, is a smooth curve through the central fossae of the posterior teeth and cingulum of the canines and incisors, and in the lower arch, is a smooth curve through the buccal cusps of the posterior teeth and incisal edges of the anterior teeth. There is alignment of the teeth, normal overbite and overjet and coincident maxillary and mandibular midlines.

ANGLE Class I: NEUTROOCCLUSION
Molar Relationship:
 The mesiobuccal cusp of the maxillary first permanent molar occludes with the mesiobuccal groove of the mandibular first permanent molar.

Canine Relationship:
- The mesial incline of the maxillary canine occludes with the distal incline of the mandibular canine. The distal incline of the maxillary canine occludes with the mesial incline of the mandibular first premolar
.

Line of Occlusion: ALTERED in the maxillary and mandibular arches
.
– Individual tooth irregularities (crowding/spacing/other localized tooth problems).

– Inter-arch problems (open bite/deep bite/cross bite)
.

Mesognathic: normal, straight face profile with flat facial appearance.

ANGLE Class II: DISTOOCCLUSION (overjet)
Molar relationship: The molar relationship shows the mesiobuccal groove of the mandibular first molar is DISTALLY (posteriorly) positioned when in occlusion with the mesiobuccal cusp of the maxillary first molar. Usually the mesiobuccal cusp of maxillary first molar rests in between the first mandibular molar and second premolar.

Canine Relationship:
 The mesial incline of the maxillary canine occludes ANTERIORLY with the distal incline of the mandibular canine. 
The distal surface of the mandibular canine is POSTERIOR to the mesial surface of the maxillary canine by at least the width of a premolar.

Line of occlusion is not specified but irregular, depending on facial pattern, overcrowded teeth and space needs.

Retrognatic: convex face profile resulting from a mandible that is too small or maxilla that is too large.

Class II Malocclusion has 2 subtypes to describe the position of anterior teeth:

  • Class II Division 1: The molar relationships are like that of Class II and the maxillary anterior teeth are protruded. Teeth are proclaimed and a large overjet is present.

 

  • Class II Division 2: The molar relationships are Class II where the maxillary central incisors are retroclined. The maxillary lateral incisor teeth may be proclaimed or normally inclined. Retroclined and a deep overbite exists.

ANGLE Class III: MESIOOCCLUSION (negative overjet)

Molar relationship: The mesiobuccal cusp of the maxillary first permanent molar occludes DISTALLY (posteriorly) to the mesiobuccal groove of the mandibular first molar.

Canine Relationship: Distal surface of the mandibular canines are mesial to the mesial surface of the maxillary canines by at least the width of a premolar
. Mandibular incisors are in complete crossbite.

Line of occlusion is not specified but irregular, depending on facial pattern, overcrowded teeth and space needs.

Prognathic: concave face profile with prominent mandible is associated with Class III malocclusion.

CLASS III Malocclusion Class III malocclusion has 2 subdivisions:

  1. TRUE class III malocclusion (SKELETAL) which is genetic in origin due to excessively large mandible or smaller than normal maxilla.

 

  1. PSEUDO Class III malocclusion (FALSE or postural) which occurs when mandible shifts anteriorly during final stages of closure due to premature contact of incisors or the canines. Forward movement of the mandible during jaw closure can also result from premature loss of deciduous posterior teeth.

 

Class III Sub-division: Class III molar relationship exists on one side and the other side as a normal Class I molar relationship.

By Dr. S. Fatahi, DDS

Braces vs. Invisalign

The Healthy Smile

by ADA (American Dental Association)

It’s never too late to perfect your smile.
Ask dental professionals about the health reasons for having a correct bite.

When you have your teeth that are in cross bite, your teeth that are misaligned, and there is a great chance to have food buildup in between your teeth, then plaque buildup which has a trickle-down effect because the more food buildup, the more plaque you get. Therefore, the more concern for periodontal disease.
Improper bite also means you can’t chew food properly, which can lead to gastrointestinal problems.

Orthodontic treatments that use either braces or Invisalign are just few of the many techniques used by dental professionals in straightening the teeth. They straighten teeth to give them an ideal position, improve their look, and promote proper function.  Traditional braces utilze metal wires to get the most ideal movement or position for the teeth.  Invisalign on the other hand, utilizes a set of clear plastic trays to achieve the position.

What is the great thing about orthodontic dental treatments that use braces or Invisalign is that they do more than just straighten the teeth. They also correct bite issues that often require special diagnosis and treatment.

Benefits of dental braces

Dental braces feature brackets that tend to run along a wire. An orthodontist or other trained dental professional is responsible for affixing the dental braces onto the teeth. The wire and brackets that form part of the braces are pressed against the patient’s teeth. This supports slight movements that can help in properly aligning and straightening the teeth.

Dental braces can correct even the most complicated issues in aligning the teeth. The braces are not only esthetically pleasing, but functional as well. These are beneficial in closing gaps and correcting crooked teeth.

Benefits of Invisalign

The use of Invisalign is an efficient method for tooth movements that are not too complicated. A set of clear, computer-generated trays is ideally worn 24 hours a day with change-outs every two weeks. There are certain trays that can last for six months to one year. However, these require some form of retention to prevent the teeth from shifting back. One of its best advantages is that the trays are relatively invisible. Hence the name Invisalign. Some people simply don’t want anyone to know they are wearing braces. They also provide help for people who wish to obtain straight teeth while still feeling comfortable in social situations. Wearing Invisalign offers comfort because it does not affect your speech.

Invisalign treatment can be expected to work more efficiently for esthetic purposes rather than for the purpose of improving the functionality of the teeth. This is why many people, especially those who have complex dental problems, still prefer dental braces.

Dental braces are better for complex cases

There are plenty of reasons why you might choose dental braces over Invisalign. Mainly composed either of colored metal or resin brackets, braces are attached onto the face of the teeth. Braces also come with a wire that runs through them and affixes them in place. One benefit of dental braces over Invisalign is that these are not removable.

Unlike an Invisalign treatment which is extremely useful for esthetic purposes and simple dental issues, braces are functional and work efficiently for fixing complex tooth issues. Braces can also be expected to work faster at closing gaps and aligning the teeth than Invisalign.

According to patients, braces work in moving misaligned teeth within a relatively short period. The use of these dental materials in aligning the teeth is also a huge help in fixing bites and creating an attractive and healthy smile. This plays a significant role in boosting the patient’s self-confidence. Dental braces are also useful in correcting malocclusion (crooked or crowded teeth) and bad bites.

If the patient’s bite is abnormal, then the application of braces can bring out his or her best smile. The immediate correction of this problem can improve the patient’s smile while also boosting his or her oral health. This is beneficial because being unable to correct an abnormal bite, or other dental issues that are treatable using braces, can lead to oral health problems. This proves the usefulness of dental braces in curing various dental problems.

Are braces better than Invisalign? Ultimately it’s going to come down to determining the specific need in each case and deciding which one will meet that need in the best way for your patient.

Lack of Posterior Dentition

It is not uncommon for people to have concerns about the health of their anterior teeth due to concerns of esthetics and a beautiful smile. Equally as important are posterior teeth, which play an important role in chewing, grinding, and crushing food. Anterior teeth are designed for biting and tearing, and are unable to handle the stress of chewing.

The lack of posterior teeth may have many negative consequences on the oral health of an individual. Posterior teeth support the vertical height of the face, and may lead to a posterior bite collapse if missing. The missing of posterior teeth can also lead to the drifting, flaring, or extrusion of remaining dentition. Speech impairment and temporal mandibular disorders can also be a consequence. In addition, unnecessary stress is placed on the remaining dentition, and can lead to fractures or breakage.

Ideally, the best treatment for replacing missing posterior teeth is an implant, which have the greatest long-term prognosis. Bridges or partial dentures may also be used to restore missing teeth. Each method of replacing missing dentition is based on a patient-by-patient case. Please consult with your dentist for available treatment options best suited for your needs.

by Dr. O. Karnakova, DDS

Dental Prosthesis Care

by Dr. O. Karnakova

Among many of the different care approaches for fixed tooth retained bridges and fixed implant bridges, brushing and flossing still remains the most effective and preferred method by dentists. Inadequate oral hygiene will eventually lead to gum disease and the formation of cavities. Ideally, brushing should be performed after every meal, or a minimum of two times daily for at least two minutes.

It is important to brush around the gumline, where plaque is most prone to accumulate. The toothbrush should be held at a forty-five degree angle, using a combination of gentle horizontal strokes and a vertical sweeping stroke towards the occlusal surface of the tooth. Flossing should be performed a minimum of two times daily and is essential at removing plaque where the toothbrush cannot. To floss around the tooth or implant, the floss should be wrapped in a "C" shape to hug the abutment. Gently slide the floss up and down in a vertical motion for a minimum of three to five times. On the downward motion, the floss should slide about two to three millimeters below the gumline. It is also important to floss underneath the bridge by use of a floss threader. Floss threaders feature a stiff plastic end and are effective at inserting the floss under the bridge. Simply use the stiff end to thread the floss under the bridge, and gently slide the floss back and forth parallel to the occlusal plane.

Partial dentures and full dentures can accumulate bacteria and plaque much like natural teeth. Patients should rinse their denture with water after every meal to remove any food particles. Brushing is recommended at least once per day and also prevents staining. It is best to use a brush specifically designed for cleaning dentures or a soft bristled toothbrush. Avoid using hard bristles that can potentially damage the appliance. Special denture cleaning solutions, gels, or pastes are recommended for cleaning the denture because they do not contain abrasive materials. Toothpaste should not be used because they contain abrasive particles that can damage the denture. Polident is a recommended tablet solution by dentist for cleaning or soaking your dentures at night. Please follow the labeled instructions for the length of time the denture should be soaked.

Patients with a removable or fixed prosthesis should visit their dentist for gum treatment every three to four months. The accumulation of plaque over time hardens into a substance called calculus or tartar that can cause many health concerns. Calculus can only be removed by a dental professional. Visiting the dentist regularly ensures that the gums and dental prosthesis are in good health and increases its life span. If a denture breaks or does not fit properly, please take it to your dentist. Do not attempt to adjust or repair the denture yourself as it can cause irreversible damage.

Replacing Missing Teeth with Implant

by Dr. J. Slaven

Implants have become the standard of care for the replacement of missing teeth. Prior to this development, our choices for replacing missing teeth were fixed bridges or removable partial dentures.

Replacing missing teeth with fixed bridges involves preparing the teeth on each side of the missing teeth for crowns, which are attached to the artificial tooth replacement as one piece that is cemented to the prepared teeth. While this is still an acceptable treatment it has the downside of doing a procedure on two good teeth and turning a one tooth problem into a multiple tooth problem.  Every time a tooth is subjected to a procedure that involves removal of tooth structure its living part, the pulp, becomes inflamed, and it never recovers from this 100%, which can lead to problems such as the need for root canal therapy in the future.  The happiest tooth is one that has not been drilled or ground down, which the teeth supporting a bridge have been.

If there are not teeth on either side of the missing tooth or teeth the non implant option is a removable partial denture.  This also has problems associated with it.  The clips or clasps that hold the partial denture to the supporting teeth put unnatural pressures on these teeth because even the best fitting partial denture will move slightly when chewing.  This can damage the gums and bone around the supporting teeth over time.  I liken this to what happens when you rock a fence post.  Partial dentures require meticulous oral hygiene to prevent decay or gum infection of the supporting teeth.  The clasps create what I call the perfect English Muffin full of nooks and crannies that trap food and allow plaque accumulation.  Although a partial denture is  still considered an acceptable option for replacement of missing teeth, the patient must understand its limitations.

The limitations of both fixed bridges and partial dentures that I have explained do not apply to replacement of teeth with implants.  Implants provide permanent tooth replacement that is as close as we can get to your own natural tooth and are the better choice.