Smiles

Perhaps a shallow dive into the research on retention will shed a little more light as to what has been discovered about tooth movement following orthodontic treatment:

• There is not a direct correlation between impacting wisdom teeth and the crowding of lower incisors.

• Malocclusions that started with spacing between the teeth have just as much chance to relapse (i.e. spaces returning) as teeth that were crowded.

• Expansion or flaring of front teeth during orthodontics showed a greater chance of relapsing after the completion of treatment

• Unwanted tooth movement also occurs as a result of the normal aging process. These changes include the deterioration of the alignment of the anterior teeth

• It is difficult to predict which orthodontic cases will exhibit relapse therefore every case should be treated on the basis that relapse will occur and that life-long retention is required

• Even with the best of retention protocols, most orthodontic cases will exhibit some movement (5 to 10%) of the teeth

If you have questions about the benefits of Invisalign treatment, please call Visage Orthodontics to schedule a visit with Dr. Tanner, your Santa Fe Invisalign specialist. Dr. Tanner will review everything in detail and develop a customized treatment plan to fit your lifestyle and budget.

A confident and beautiful smile is right around the corner!

So, why do most of us experience crowding of our teeth at some point in our lives?
The answer to this question can be both simple and complex – intertwining evolution, heredity, and environment.

The prevalence of dental crowding in the US population is estimated at 66%. Interestingly, an analysis of human skulls from 10,000+ years ago shows almost no evidence of crowding or impacted teeth – including those pesky wisdom teeth. Why the difference between then and now? The reason for these ideal prehistoric arches is due to the diet of the cavemen.

Early humans needed powerful jaw muscles and consequently large jaws to masticate their raw food. Also, the course diet caused teeth (in their respective arches) to wear against one another thus negating crowding with age. Over the millennia, tools were introduced, hunter-gathers shifted toward an agrarian society and diets became softer. The need for powerful jaw muscles diminished and jaw size shrank – unfortunately, tooth size stayed about the same. As a result, the prevalence of crowding began to increase. This trend continues today with our modern society and our processed food.

No wonder most of us don’t have enough room for our wisdom teeth!

In addition to this evolutionary trend, a large factor that plays into whether we as individuals have crowded teeth is the role of genetics. Both tooth size and jaw size are inheritable traits. Our parents contribute genetic material that influences how large our teeth will be and the size of our jaws. In the worst-case scenario, one parent passes along the gene for large teeth while the other parent passes along the gene for small jaws. The result: Lots and lots of crowding! In a situation like this, the normal complement of 32 teeth must be reduced to 24 teeth (by extracting the first bicuspids and third molars) to accommodate the remaining teeth.

Thank goodness for orthodontics!

One question that always comes up in regards to crowding is the role of third molars. Especially since many of us have perfectly straight teeth until our late teens or early twenties. A significant number of studies have been done on the correlation between wisdom teeth and crowding. A systematic review of the literature published in The Scientific World Journal showed that third molars are not the culprit in lower anterior crowding. So what is going on? Over time, there are subtle changes that occur which collectively result in a breakdown of the alignment of the teeth. Most changes begin in the lower arch and ultimately show up in the upper arch since the lower arch can act as a mold or “retainer” for the upper arch. Typically what happens with age is that the lower arch narrows especially by the canines, the lower molars slowly move forward and the arch length decreases. With these movements, something has to give and it usually starts with crowding of the lower incisors.

All hope is not lost! If you are a parent of a young child, be proactive and have the dentist monitor your child’s dental development. Don’t be afraid to seek an orthodontic evaluation if you have concerns. You don’t need a referral and exams are complimentary. If you have already been through orthodontic treatment – keep wearing your retainers. Remember, it is a lifetime commitment if you want to keep your teeth straight. If you are an adult and experiencing shifting of your teeth, don’t wait – the crowding will only worsen with time.

Direct-to-consumer aligners have gained more and more popularity. SmileDirectClub, Byte, NewSmile, AlignerCo are some of the well-known names in the industry. Most of these companies charge a fee that is 50% to 60% less than orthodontic care in a traditional office setting. In addition, these businesses state that treatment takes 6 months or less, patients are “overseen” by a licensed dentist and they offer a “nighttime only” version of their product (though treatment takes longer—up to 10 months). A quick Internet search shows that most patients are pleased with the service and results they receive. SmileDirectClub’s website has over 61,000 5-star reviews (out of 65,000 reviews) and Byte has a 4.6 rating based on 24,000+ reviews. Pretty enticing for someone seeking a simple and inexpensive way to straighten their teeth!!!

A deeper and more thorough Internet search reveals a truer picture about the safety and efficacy of direct-to-consumer aligners. There have been public warnings and litigation from dentists, orthodontists, the American Association of Orthodontists the American Dental Association, State Dental Boards, Congress, the Food and Drug Administration and the Federal Trade Commission regarding this type of orthodontic care. SmileDirectClub, the first company to offer this product, has been involved in multiple lawsuits since their inception in 2014. In addition, there have been thousands of complaints lodged against SmileDirectClub through the Better Business Bureau—issues ranging from customer service to treatment results. Finally, a search on YouTube brings up an abundance of “horror” stories or bad experiences from patients who used direct-to-consumer aligners and ended up with unsatisfactory results and in some cases, serious dental problems.

• There is no pretreatment assessment by a dentist as to the health of the teeth and gums prior to the start of the treatment. It is the patient’s responsibility to make sure their mouth is disease free and in optimal condition before starting treatment.
• There is no radiographic and clinical assessment of the teeth and occlusion by a trained professional which is paramount for the development of an accurate orthodontic treatment plan.
• Unlocking the occlusion with aligners can sometimes lead to unwanted changes to the bite. This cannot be anticipated through a scan or at home impressions of the teeth but can be discovered with an accurate clinical exam.
• Direct to consumer aligner companies state that “a dentist or orthodontist supervises treatment”—the truth is that a quick evaluation is done at the initial assessment as to the viability of the case. Thereafter, there is little oversight during orthodontic treatment. Furthermore, if it is a dentist who is responsible for “overseeing” treatment, dentists do not have the same level of training or experience as an orthodontist.
• Direct to consumer aligner treatment can only correct mild malocclusions (mild crowding and spacing) even though they state that they can correct mild to moderate malocclusions. The more complicated the bite or malaligned the teeth, the less likely treatment will be successful. These systems do not have the sophistication of Invisalign, which is engineered to handle a much greater range of cases.
• Successful orthodontic treatment requires direct supervision by an orthodontist on a regular basis to ensure proper tooth movement, monitor gingival health, assess TMJ function and make necessary adjustments/corrections throughout treatment. This is not possible with at home orthodontic care.

Candid, one of the former industry leaders in direct-to-consumer aligner therapy, recently made a major course change with their business model after recognizing that teledentistry was not in the best interest of their patients. Here is an excerpt from their CEO, Nick Greenfield:

“It was incredibly difficult to close the DTC business and our Studio doors; but, for us to live out our mission of helping as many people as possible access affordable and efficient care, we need to work in partnership, not in competition, with dental professionals.”

Candid now works directly with dental providers as a hybrid remote/in-office model.

On a final note, I reviewed before and after photos on SmileDirectClub’s website—their “success stories”. I looked at over 100 cases and came to the following assessment on their treatment results:

• Insufficient leveling of the front teeth
• Incomplete space closure
• Teeth not fully aligned
• Incomplete correction of crossbite(s)
• Lack of vertical correction of deep bites
• Insufficient correction of open bites
• Increase in the “overbite”
• Teeth moved too quickly

Gambling the health and well-being of your teeth and bite to at home orthodontic care is a risk not worth taking. Straightening teeth should be overseen by a professional—it is a type of medical care and treatment that requires the expertise of an orthodontist.

If you have questions about the benefits of Invisalign treatment, please call Visage Orthodontics to schedule a visit with Dr. Tanner, your Santa Fe Invisalign specialist. Dr. Tanner will review everything in detail and develop a customized treatment plan to fit your lifestyle and budget.

A confident and beautiful smile is right around the corner!