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.

Space Maintainers in Children

by Dr. J. Slaven
When a young child loses a baby tooth prematurely due to decay, infection or accident it creates a situation that requires immediate attention. One of the purposes of the lost baby tooth was to keep space available for the permanent tooth developing in the jaw underneath the baby tooth to have enough room to properly erupt into the child’s developing jaw. When teeth are lost the teeth on either side of the now empty space will quickly begin to drift into the space and effectively block the permanent tooth from properly erupting. If this is allowed to progress without intervention the permanent tooth can become impacted which will then require a surgery to uncover it to allow orthodontic movement of the tooth into proper position.

The simple solution to this is to fabricate and place a space maintainer. A space maintainer is either a passive space holding appliance or an active space opening appliance that is cemented to the tooth or teeth next to the space to assure that the permanent tooth can erupt into its’ proper position. The space maintainer consists of one or more bands that encircle the tooth next to the space with a stiff wire loop that touches the tooth on the other side of the space and keeps it open. If front teeth are lost early the space maintainer can have artificial teeth attached to the wire to create a cosmetic result allowing the child to have their self esteem intact and avoid being teased by other children.

Once the space maintainer has been placed it is important that the child be checked regularly, so that the appliance can be removed at the appropriate time. The space maintainer itself could prevent the final eruption of the permanent tooth, so monitoring is essential.

Benefits of Orthodontic Treatment

by Dr. Karnakova, DDS
A lot of our patients ask about benefits of having orthodontic treatment. The benefits are not only cosmetic, although who can argue the deep social impact of a good healthy smile. What happens clinically, and what are the health benefits with braces? First of all, crowding and overlapping teeth trap food and bacteria. It is very difficult to clean the teeth that are overlapping and over time, people become more prone to developing cavities. In addition, infection in the gums eventually spread to the bone and destroys the supporting structure that holds the teeth. This leads to loosing teeth and abscess formation.

A poor bite affects temporalmandibular joints and causes the degenerate process of the cartilage between the joints. This process is irreversible the cartilage does not regenerate. With time, damaged joints will cause difficulties opening the mouth for speech, and most importantly making eating difficult and sometimes impossible.

In my late 30’s, I was affected with temporalmandibular joint disorder and would sometimes wake up with my teeth only closing on one side. I would experience pain while opening and closing my mouth and often would experience clicking and soreness in my temporalmandibular joints. Besides ruining the dream of having a perfect Hollywood smile, I had to mend through difficult years of trying to prevent cavities and bone loss in the areas where the teeth were misaligned. All these complications motivated me to go through orthodontic treatment and I never regretted my two years of treatment.

My temporalmandibular joints no longer hurt and I can look in the mirror and smile with confidence. I wish this for all my patients; to have a beautiful smile and promote healthy living. Don’t shy away from braces. It is almost never too late. And for the parents of my young patients, I recommend having their first consultation as early as 6 or 7 years old. Sometimes an early approach helps for a more conservative treatment and easier on the child. It allows us to avoid or minimize possible surgery in the future which is a great thing.

One of the benefits of doing orthodontic treatment in our office is that we have our own orthodontic specialist doctor which minimizes prices and makes treatment affordable. Dr. Miller is a wonderful and great specialist who is loved by all our patients. Our office is very fortunate to have someone as special as her providing treatment to the patients.

The role of orthodontics in Implant dentistry.

by Dr. Nadia Abazarnia, DDS

Orthodontics can be used to develop the peri-implant site prior to implant placement. Orthodontic treatment for children and adults can involve management of teeth missing due to agenesis, trauma, or extraction following dental disease or malformation.

An interdisciplinary approach between the dentist and orthodontist, and often the implant surgeon and prosthodontist, is usually  required to formulate the most appropriate treatment plan for the patient. A decision usually needs to be made as to whether the space or spaces should be closed orthodontically, or maintained for eventual prosthetic replacement.

Over the last decade the reliability, predictability and long term success rate of implants has made them the prosthetic replacement  of choice, especially when the teeth adjacent to the space are well formed and unrestored. When it is planned to incorporate  implants into the orthodontic and restorative treatment plan, growth considerations, implant space requirements and implant site development are three of a number of treatment planning factors that need to be considered.

Growth Considerations: It is not usually appropriate to place an implant until completion of dento-alveolar development and skeletal growth. Throughout active growth the implant responds like an ankylosed tooth while the adjacent teeth continue to erupt, creating a discrepancy between the gingival margin of the implant and the natural teeth. Particularly in a patient with a high lip line, this will produce a poor aesthetic result unless implant treatment is delayed until growth has been completed. Chronological age alone is not accurate in determining whether growth has been completed for an individual. We expect that most girls will have completed the majority of their active facial growth by 16 years of age and boys by 19 years of age. However, boys in particular can show significant late facial growth. Radiographic examination can help to determine whether active facial growth has been completed.

Although active facial growth may be considered to have been completed in the late teens or early twenties, continued facial maturation and changes, including in the vertical dimension, continue throughout the individual’s life. The space required for implant and crown replacement will be determined by a number of factors including the size and shape of the contralateral tooth, the size of adjacent and opposing teeth, aesthetics, the occlusion and by the size of the implant to be used.

In some situations the orthodontist may be forced to create more or less than the ideal space required for the implant due not only to the size of the teeth but also in order to establish normal overjet and overbite. Options to be considered, in consultation with the restorative dentist or prosthodontist, are whether adjacent teeth need to be increased in width using adhesive restorations, veneers or crowns, or whether the width of the teeth needs to be reduced by interproximal stripping and crown recontouring.

The incorporation of orthodontic therapy into comprehensive treatment planning is a valuable adjunct which can enhance aesthetic and functional outcomes in restorative dentistry.

Reference ; Australian society of orthodontists

Orthodontic Treatment


by Dr. H. Kopel
Phase one orthodontic treatment is sometimes referred to as interceptive orthodontics.
Some orthodontic conditions are simply easier to correct if they’re corrected early. Leaving orthodontic conditions untreated until all the baby teeth fall out can cause damage to the surrounding permanent teeth, trap permanent teeth in the jaw and other problems.
Interceptive orthodontic treatment is all about preventing more severe problems later on. It provides the opportunity for an orthodontist to have control over where the permanent teeth come in by addressing the structure of the jaw and teeth while the primary teeth are still in the mouth.
By age seven, your child’s mouth has grown enough and has enough sound structure to know how it will develop as the permanent teeth start to emerge.
In addition, common problems such as thumb sucking and tongue thrusting can be addressed.
If your Zak Dental diagnostic dentist detects any abnormalities your child will be referred to our in house orthodontist for a consultation.

Orthodontics for Children


It can be a common misconception that oral care is simply a luxury, and as adults with completely developed teeth this may be true. However, at a young age tooth care is extremely important for insuring healthy, functioning teeth. So, the important question is when should children begin to visit an Orthodontist? This question can be answered by observing the development of teeth. Between the ages of 6 and 12, when the facial structure and teeth further grow and develop, an Orthodontist is able to best correct any incorrect growth that might be occurring in the child’s permanent set of teeth.

Tooth development occurs in two stages; the first set of teeth, called primary teeth, and the final, permanent adult tooth set. The early stages of oral development are a crucial time for the teeth of children. Primary teeth begin to break through the gums around six months of age, typically emerging in a pattern of front teeth to back teeth (1). A disruption of this order is one of the main causes of child dental problems; leading to the growth of teeth in the spaces of other teeth, infections, and crowding in the mouth.

Even though the primary teeth may appear to be straight and orderly, the underlying adult teeth are experiencing a number of changes that could potentially lead to malformed permanent teeth. By the age of 3 the primary set will be completed and the growth of the jaw and facial bones will begin to increase. It is important to remember that during this period of growth a child’s teeth will go through a lot of normal changes, such as the seemingly crooked appearance of the front permanent teeth. This is a problem that will simply correct itself as the rest of the permanent teeth come in, filling in spaces and providing the pressure needed to move each tooth into its proper position (1). However, not all mouth oddities are normal and therefore it is important to consider early Orthodontic visits.

Recognizing the signs of primary tooth trouble is essential to good health in a child’s teeth. Children who are experiencing even slight discomfort caused by tooth abnormalities will engage in actions intended to relieve the
irritation, such as sucking on the thumb, grinding their teeth, or biting of the cheeks and roof of the mouth (2). Such actions tend to appear more frequently around the age of 7, when the progression from primary to permanent teeth is in motion. Your Dentist will examine and will discuss early orthodontic intervention to correct and guide musculoskeletal
discrepancies. Give us a call and bring your son or daughter for your early orthodontic intervention exam.


1. “Your Child’s Teeth: Development Chart and Eruption Schedule.” WebMD. WebMD, 26 June 2015. Web. 26 June 2015. teeth>.

2. “A Child’s First Orthodontist Visit.” A Child’s First Orthodontist Visit. N.p., 26 June 2015. Web. 26 June 2015. orthodontist-visit/>.