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Brace yourself: New types feel better
New technology has had a dramatic effect on orthodontic treatment. Latest advances range from "space-age" wires used to more efficiently realign teeth to 3-D diagnostic computer imaging that allows more precision treatment to "clear" braces and removable retainers that address patients' vanity.
Wearing braces has been a painful rite of passage for generations of American teens, but orthodontists say today's treatments are considerably more comfortable both physically and aesthetically.
New technology has had a dramatic effect on orthodontic treatment. Latest advances range from "space-age" wires used to more efficiently realign teeth to 3-D diagnostic computer imaging that allows more precision treatment to "clear" braces and removable retainers that address patients' vanity.

"In orthodontics, everything keeps getting better," says Donald Joondeph, an orthodontist in Bellevue, Wash., and president of the American Association of Orthodontists.

To get his message out about today's better-looking braces, Joondeph in September wrote to the star of Ugly Betty, the new ABC comedy about a plain Queens girl who pushes her way into the fashion world despite her mouthful of large metal braces.

"I want to be the first to congratulate you on joining the growing trend of more than one million adults with braces you are well on your way to a healthy, beautiful smile," Joondeph wrote to America Ferrera, who plays Betty Suarez. "Although most adults today opt for sleeker and less noticeable braces, it looks like you decided on the retro 'railroad tracks' model."

Options for adults, kids

Gone are the days when orthodontists hammered large metal brackets onto the teeth. Today, the brackets that are used to hold the wires bond directly onto the tooth with an adhesive, significantly cutting the time it takes to fit the braces.

In addition, the orthodontist's regular and vital process of adjusting wires around the braces has been made less painful. Wires now are made from more resilient metals that are more flexible and retain a preformed shape. Today's braces are much smaller than those of prior generations, so they are less noticeable and are less likely to rub into the gums and trap food particles, Joondeph says.

Technological advances have eliminated the "railroad tracks" braces, and some patients can be treated with "clear" braces braces with ceramic brackets and clear rubber bands that blend in with teeth. The downside: The clear bands most adults choose to hold in the wires tend to stain from food and cigarette smoke.

Still another option is lingual braces that are attached to the back of teeth so they are nearly invisible. One of the drawbacks of lingual braces is difficult cleaning.

As technology has improved, so has the profession's knowledge of when to start treatment. Now doctors often recommend a first orthodontic checkup at age 7 or 8 rather than waiting until 12 or 13 when the adult teeth have come in, says Robert Vanarsdall, professor and chair of the department of orthodontics at the University of Pennsylvania School of Dental Medicine. The earlier age allows orthodontists to make adjustments before the child's jaw is fully developed.

"Our knowledge base today is so much better that we can do more great things for patients than we could ever do in the past," Vanarsdall says.

Retainers stay on longer

Today, nearly 1 in 5 wearers are adults, many of whom are attracted by the quicker and less noticeable treatment options.

Alexis Anzalone, a 24-year-old marketing executive in San Diego, had braces when she was 8 but still had what she considered a crooked smile. Earlier this year she decided to try again. She first was attracted to the so-called clear braces but finally chose a new type of conventional braces, smaller and more comfortable than she had before. "It's been a totally different experience," she says.

Because of better technology, most patients now wear braces for about 18 months to two years, about six to nine months less than in the 1970s.

In addition, many patients wear removable retainers or aligners at night for several years, which helps the teeth and mouth maintain the proper shape, says Jed Feller, a Las Vegas orthodontist.

"We used to think if we did everything right as orthodontists, a patient would wear a retainer for two years," Feller says. "But now we've learned that people need retainers for many more years, at least to wear every now and then."

3-D imaging

Orthodontists also have several new tools to help choose the best treatment and predict future results. One system, called SureSmile by OraMetrix Inc., uses 3-D diagnostic imaging and computer-aided treatment planning to increase the accuracy with which teeth are moved.

The system uses a digital wand to scan the patient's teeth. A 3-D image is sent to OraMetrix's headquarters near Dallas, where computer software determines a treatment plan and a wire is made to fit the patient's teeth within 1-degree accuracy, according to the company's website.

Some orthodontists also are using 3-D imaging to help predict how a patient's appearance will evolve as the teeth are straightened. "When we can visualize the teeth and root positions precisely rather than guessing based on static images, patients get a better and more stable result," says Orhan Tuncay, professor and chairman of orthodontics at Temple University's School of Dentistry in Philadelphia.

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