Custom Orthodontics: All Smiles Are Not the Same

 

A common practice in orthodontic offices is to use a “standard” preformed nickel titanium arch wire, “one size fits all.” An upper and lower archwire of this “standard” type is pictured above. The trouble is that no individual mouth is “standard.” The reason for using an archwire like this is that the orthodontist’s tech support team may be doing most of the work. What you want is a “hands-on” highly trained and experienced orthodontist bending wires specifically for your particular teeth.

When you are considering orthodontic treatment, always ask who will be doing the adjustments. If the answer is that it will usually be a technician, that means that the arch wire is “one size fits all.” These nickel titanium wires cannot be custom bent, and technicians are not capable of bending wires properly.

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The way to get a personalized treatment is to be sure that the orthodontist uses a stainless steel arch wire that he or she bends specifically for your best smile. You can see the intricate bends in the stainless steel archwires above, created for a specific patient. Only an orthodontist who uses these custom bent wires will give you the personalized results you need.

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At Dr. Droel’s office, he personally bends all the treatment wires and personally does all the adjustments. Pictured above are some of the specialized tools he uses on each patient. His staff only assists him and always works under his direct hands-on supervision. Come into our office for a free exam and learn what is the best specific treatment to give you or your child the best and most natural smile.

Posted in American Association of Orthodontists, Dr. Rodger Droel, Droel Orthodontics, Natural Smiles through Orthodontic Specialists, Orthodonitic Specialist, Orthodontic Adjustments, Quality of Care in Orthodontics, Questions and Answers about Orthodontic Care | Tagged , , , | Leave a comment

Does Your Child Need an Orthodontic Expander?

At Droel Orthodontics, the answer is probably “No.”  This article will explain why.

The face and teeth exist in 3 dimensions:

  • Side to Side (lateral)
  • Front to Back (horizontal)
  • Top to Bottom (vertical)

An orthodontic expander works in only one of these three dimensions:  Side to Side. Most orthodontic issues involve all three dimensions to some degree. Very often an expander actually worsens the problems in the other two dimensions.

If you are told that your child needs an expander at age 7-10, before all the permanent teeth have erupted, you will be told the expander is needed for two reasons:

  1. To grow the upper arch wider before the palatal sutures fuse. What are palatal sutures? These are the spaces between the bones on the roof of the mouth which are somewhat open before the age of 11 to 12 years.
  2. To see if the extra space created by the expander will make the upper arch “bigger” in hopes that teeth will not be crowded and possibly have to be removed.

I do not recommend Phase I orthodontic expanders because:

  1. An expander only addresses the Side to Side dimension and ignores the Front to Back and Top to Bottom dimensions. The lateral expansion by an expander can make any problems in the other two dimensions worse, and more difficult to treat later.
  2. Problems in the other two dimensions will have to be resolved later. This will require a Phase II treatment when all of the permanent teeth have erupted, at age approximately 12 years. Therefore, the child will have braces twice and the parents will have to pay twice.

In almost all cases, I recommend doing one treatment beginning at approximately 12 years and taking about 24 months or less.  The timing of upper arch expansion is not age critical. It can be accomplished perfectly well at age 12 or later.

Before

Before

After

After

The photos above show a treatment that was begun when the child was 13 years old and completed when the child was 15 years old. Looking at the “Before” photo, it might seem that the teeth were very crowded and an expander might have been used.  But an expander was absolutely not necessary to achieve the attractive and functional smile in the “After” photo.

Looking at the “Before” photo above, some parents would say that they would like a more attractive smile for their child during the growth period before age 12 or so.  In that case, I can devise a short treatment plan for about 1/3 of the cost of the typical “Phase I Expander Treatment,” without the use of an expander.

Is an expander ever necessary?  Yes, I use one  in the case of a child with a cleft palate.

Since every patient is unique, I recommend that you bring your child in for a free orthodontic exam around age 7 or 8.  I will advise you on the optimal time to begin treatment for your child’s particular case.  Treatment can almost always be done just once, for one all-inclusive reasonable fee. In the meantime, your child will be scheduled for free periodic “wait and see” appointments so that we can monitor growth.

Posted in American Association of Orthodontists, Braces and Expanders in Orthodontic Care, Dr. Rodger Droel, Droel Orthodontics, Phase One Orthodontic Treatment, Questions and Answers about Orthodontic Care | Tagged , , , , , , | Leave a comment

Orthodontic Phase 1: What About 12 Year Molars?

Have you been told that your 7, 8 or 9-year-old child needs a Phase 1 treatment?  Before you go ahead, there is one important question you should ask the orthodontist:  What are you going to do about the 12-year molars?

The 12-year molars are also called 2nd molars.  They erupt at about age 12.  Most orthodontists who do Phase 1 treatments on young children never work on the 12 year molars, because they are not present until about age 12.

The 12-year molars are too far back in the mouth to be seen when the patient smiles. Why does it matter whether they come in crooked?  Why does it matter if they are never straightened?

It matters because if the 12-year molars are left crooked, they often cause TMJ problems. If they are left crooked, they can interfere with proper occlusion of all the teeth. Bad occlusion results in TMJ pain.

If the orthodontist starts a Phase 1 treatment at age 7, 8 or 9 and finishes it before the 12-year molars are in, there are only 3 options open:

1. Do another full treatment, including the 12-year molars.

2. Add more braces and keep the child in continuous treatment for about 5 years total.

3. Leave the 12-year molars crooked.

When interviewing an orthodontist who is recommending a Phase 1 treatment, ask this question:  What are you going to do about the 12-year molars?  If the 12-year molars need straightening, will that be a separate treatment with an additional fee?

It is a good idea to bring your child in for a free orthodontic exam at age 7, 8 or 9. In most cases, I will put the child on “recall” and schedule free “wait and see” appointments until the 12-year molars are in and treatment can be done all at once, for a single fee.

Posted in Droel Orthodontics, Natural Smiles through Orthodontic Specialists, Orthodonitic Specialist, Phase One Orthodontic Treatment, Planning the Cost of Braces, Questions and Answers about Orthodontic Care | Tagged , , , | Leave a comment

How Much Do Braces Cost?

When you choose an orthodontist, cost is always a factor.  Dr. Droel’s fees are reasonable and competitive.  They are also ALL-INCLUSIVE. The fee quoted will include records, diagnosis, placing of braces, all adjustments (which are always done personally by Dr. Droel), all repairs, and retainers when treatment is finished.

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Dr. Droel will match fees from other orthodontists who have the same advanced training he has received.  All you need is a written estimate which includes the cost of their add-on fees.

Some patients come in with proposed contracts which have add-on fees for “poor patient cooperation.” This would include patients who fail to wear their elastics or to brush properly. In Dr. Droel’s office, we work with all our patients to encourage cooperation as part of the regular treatment plan.  If we have to schedule additional consultations with parents or patients for poor cooperation, there is never an additional charge.

Other add-on fees that may appear on contracts from other orthodontists include:

  • Records
  • Repair of loose braces
  • Missed appointments
  • Extended treatment time (In Dr. Droel’s office, if treatment takes longer than the original estimate, for whatever reason, there is never an additional charge).
  • Retainers
  • Re-gluing of glued-on retainers that come loose. Charges of $250.00 for this are typical.  In our office, we rarely use glued-on retainers because they are not the best retainers.  If we do use them in rare cases, there is no charge for maintaining them in good order.

Dr. Droel encourages patients to get second and even third opinions before starting orthodontic treatment. Come in to our office for your free exam and consultation!

Posted in Broken Orthodontic Retainer, Dr. Rodger Droel, Droel Orthodontics, Orthodontic Retainer, Orthodontic Specialist, Planning the Cost of Braces, Quality of Care in Orthodontics, Questions and Answers about Orthodontic Care | Tagged , , | Leave a comment

All You Need to Know About Orthodontic Retainers

When you or your child have an orthodontic exam, you are mainly thinking about how to get your teeth straight. At the exam, you should also take time to ask how the orthodontist plans to KEEP your teeth straight. You need to RETAIN the beautiful smile achieved for you or your child.

When treatment is finished at my office, the patient is carefully fitted for pink plastic retainers, upper and lower. THE RETAINERS ARE INCLUDED IN THE QUOTED FEE AT THE BEGINNING OF TREATMENT.

Upper Retainer made in Dr. Droel's office

Upper Retainer made in Dr. Droel’s office

Lower Retainer made in Dr. Droel's office

Lower Retainer made in Dr. Droel’s office

These retainers are hand-made in my office to fit the patient’s teeth perfectly. A patient who wears these retainers nightly should never need orthodontic treatment again.  A patient who wears the retainers inconsistently or does not wear them at all will most likely need orthodontic treatment again in the future.

What about glued-in retainers?

Glued In Retainer

Glued In Retainer

 

This kind of retainer is better than nothing, but if the patient started with an overbite, the overbite will come back. This kind of retainer is likely to break and need replacement. It is very hard to keep this retainer clean, so tooth and gum disease are likely. Finally, this kind of retainer does not even cover most of the teeth. So the teeth will drift back into the malocclusion that was treated.

What about clear plastic retainers that fit over the teeth?

Clear Plastic Retainers

Clear Plastic Retainers

This is not an effective retainer. It is the same as the bleaching trays used for whitening teeth.  It can be made cheaply in any lab, but it is not strong. It does not hold the teeth precisely in the correct position. It will wear out quickly.

In my office, retaining the beautiful natural smile we have achieved is just as important as completing the proper treatment. As my patient, you or your child will receive the finest retainers available. With proper care, these retainers will last for many years–and so will the beautiful personalized smile!

Best Kind of Retainer

Best Kind of Retainer

Posted in American Association of Orthodontists, Dr. Rodger Droel, Droel Orthodontics, Natural Smiles through Orthodontic Specialists, Orthodonitic Specialist, Orthodontic Retainer | Leave a comment

Gap in Teeth of 7-Year-Old: Are Braces Needed?

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I am frequently asked whether a gap in a child’s front teeth means that braces are always needed. My answer is, “Not necessarily.”

Two years ago, a mother brought a 7-year-old girl into my office for an exam.  The mother’s concern was that the child had a gap between her new permanent upper central incisors. Baby teeth and permanent teeth were growing in normally. Everything else looked normal. I told the mother that a gap between front teeth is normal at this age. I scheduled a free recall or “wait and see” appointment for 6 months later.

When I next saw the patient, 6 months later, the upper central incisors had erupted further. The gap was the same as before. But I noticed two bumps on the roof of the girl’s mouth. These bumps were the new upper lateral incisors, the teeth on either side of the two teeth in the center. They were beginning to grow in. To help those new lateral incisors erupt forward into their proper positions, I recommended that the family dentist remove the upper cuspid baby teeth: the pointed teeth just to either side of the upper lateral incisors. I scheduled another free recall or “wait and see” appointment in 6 months.

When I next saw the patient, at age 8 1/2, the new lateral central incisors had grown in, moving forward. However, I noticed that they could not move all the way forward to the correct position because the opposing lower baby teeth, the cuspids, were interfering with them.  Again, I sent the patient back to her family dentist.  I recommended removal of the lower baby teeth cuspids.

At the next recall appointment, when the patient was 9 years old, all four permanent upper incisors, central and lateral, were in their correct positions. The gap is now nearly closed. We are now waiting for other teeth to continue growing in.

Some orthodontists would have recommended a Phase I treatment for this patient. I prefer to avoid Phase I treatments if possible, because of the added cost and time the patient has to spend in treatment. In the case of this patient, removal of baby teeth that would fall out anyway allowed the permanent teeth to move into their proper positions without any further intervention.

I will continue to schedule free “wait and see” appointments for this patient. It is quite possible that no orthodontic treatment will be necessary. If treatment does become necessary, it  can be done when she is older and growth is more complete.

If you are concerned about a gap or other issue in your young child’s teeth, call our office to schedule a free exam! We are always glad to see patients for second or third opinions. Exams are always free, and recall or “wait and see” appointments are also free.

Posted in American Association of Orthodontists, Braces and Expanders, Braces and Expanders in Orthodontic Care, Dr. Rodger Droel, Droel Orthodontics, Natural Smiles through Orthodontic Specialists, Orthodonitic Specialist, Phase One Orthodontic Treatment, Questions and Answers about Orthodontic Care, Snowboarding Dentists | Tagged , , , , , , | Leave a comment

Best Time to Get Braces

Last week in my office, I saw two different 12 1/2 year old boys for their free initial orthodontic exams.  Because every individual is unique in growth, occlusion and tooth eruption, I gave them completely different recommendations.

One boy would be best treated by starting his braces very soon, probably within 3 months. The other boy would be best treated in about 18 months.  I will continue to see him every 6 months for no-charge “recall” or “wait and see” appointments to monitor his growth.

Why the difference? It’s all about personal growth patterns.

The boy who should start treatment soon is already 5 feet 8 inches tall.  His father and uncles are 6 feet 4 inches.  He is rapidly growing now.  He needs his overbite growth pattern corrected now while he is rapidly growing. I will treat him with braces, wearing of rubber band elastics, and NO headgear in a 2-year treatment time. (In my office, I have not used a headgear in many years).

The boy who is not ready for treatment is 5 feet 2 inches.  His family history of growth patterns is that growth comes later.  He has not entered his peak growth time.  According to his pediatrician, he is not expected to grow taller than about 5 feet 11 inches.  This boy does not have excess overbite growth.  He will need a 2-year treatment, but the best time to start is in about 18 months.

If your child needs braces, what is the optimal time to start treatment? Come in for your free exam.  With my years of experience, I can give you good personalized advice.  Usually  there is no need for any special records at the free initial exam.  I welcome patients who are looking for first, second or even third opinions. You deserve to make the most informed decisions possible on orthodontic treatment.

Posted in Droel Orthodontics, Natural Smiles through Orthodontic Specialists, Questions and Answers about Orthodontic Care | Tagged , , , , , | Leave a comment