Damon - Wires Question

[pcm001]

Hi! New here.

I have had Damon braces on for about 3 months. I just had my second appointment a couple weeks ago, and I have a question about it. I'm not sure why (whether it was from reading online or speaking to my ortho) but I thought the second appointment and second set of wires were to be rectangular and thicker than the initial ones. However, when I went to my appointment, they took the old small round wires out and replaced them - with ones that look EXACTLY the same. They didn't say anything like my plan had changed or anything. I'm just wondering if anyone else had the same round wires for both their first and second set. I'm worried that this means my treatment will be longer than expected, and if so, I'm kind of upset they didn't mention this to me.

I planned this out so that when I will have them off by the time I am done school and start my career. If for some reason they're not finished by then, has anyone ever heard of switching to invisalign to finish the job?

Thanks.

[Zoso]

The precise sequence of wires can vary from one patient to another. Generally the first few months of treatment will be in round wires, whilst the orthodontist works on the initial alignment and levelling of the teeth. Once those tasks are largely complete is when rectangular wires are usually introduced, as the ortho moves on to tasks such as correcting the relationship between the two arches, closing up large gaps, and ensuring that the roots of the teeth are angled and positioned correctly. Depending how crooked the teeth are at the start, it'snot uncommon to use more than one different strength/stiffness of round wire, one after the other.

With regard to the length of treatment, please do remember that treatment times we are given at consultation are estimates, albeit estimates based on education and experience. But they are not exact, nor are they promises. That said, there's no reason, at this early stage, to presume that you will run long.

It's definitely not impossible to finish up treatment that was started in fixed braces, using Invisalign. But doing so would most likely prolong the overall treatment, since you would need to wait for the treatment plan to be created and approved, then the aligners manufactured and delivered - a process that takes some weeks. Speaking as someone who wore fixed braces in the workplace, I can assure you that doing so is no big deal. But, in any case, there's no sense worrying about this now - cross that bridge when/if you come to it

[pcm001]

Thank you so much for that useful information. I'm guessing that I probably do have a different kind of wire - strength/stiffness - than the last one. And it's good to know there is no standard progression of wires, and that each patient varies. I will just have to wait and see!

Thanks again for clearing that up.

[Zoso]

Good luck! Hopefully you'll be done in the timeline you're shooting for

[Sunny]

Pcm my case appears different, but in fact it's not. I've had round wires from day one of my treatment, and quite possibly will finish my treatment with only having round wires. I've also only had three wire size changes. My ortho hasn't gone up one size at a time, but my case shows a different way of doing things. To date I've had major alignment work, one large gap closed (over a first molar), space made for a rotated teeth and then the rotated tooth moved into the space. My open bite is being closed and my class III is now a class I on my left side ... possibly the most exciting part of my journey so far.

I now work for my orthodontist and with some patients he changes wire sizes and types frequently and with others he doesn't. It depends on the what he's working to achieve ... and the best part, I've seen the amazing results his work achieves.

Good luck with your treatment working well and you being finished as soon as your teeth are biting the best way that can be achieved for them!

[Zoso]

Yes, Sunny - your ortho certainly does seem to do things rather differently than many, at least based on every patient account I've ever seen Not just the wires, but leaving the same ligs in place for months at a time, and asking that you not change an elastic until it breaks! It's definitely worth bearing in mind that some orthodontists do things differently, or perhaps particular cases might require unusual management, but I believe that the response I gave above represents more the norm or the average experience, and is more apt to correspond to what the majority here can expect; but, at the very least, it corresponds with what is being taught at at least one major US dental school. It's hard to visualise how round archwires could produce the counterbalancing couple necessary to induce the controlled tipping that is required to facilitate the proper angulation and positioning of the roots.

[Sunny]

Your response reminds me of a patient we had move to our practise earlier this year. After his first adjustment, his mother was upset that he'd not had an archwire change. His previous orthodontist had changed his archwire at every appointment and our patients mother believed that without this being done, his progress would be delayed and his treatment time affected. The orthodontist who worked on her son, talked to her about our company's policy regarding unnecessary 'waste' and reminded her of the contract she'd signed that states we're an environmental friendly company etc. She left, looking not totally convinced, and with the option to change orthodontist's if she so chose.

A couple of months ago, her son was totally delighted when he got his braces removed nearly five months ahead of schedule and his mother told us that more had been achieved with his teeth than the first orthodontist had said was possible. She said she was even more amazed, as only one archwire change had occurred during his treatment time with us.

I know I'm lucky to work for orthodontist's who're trained in Australia and are invited to speak in countries like the US about the work being achieved here.

[mariahfromchicago]

That's interesting Sunny.

[Sunny]

I find it interesting having discussions about different practises when we have training with staff from other practices. It's important to be open to what other's in the field are doing and to realise that there's many ways of getting the desired results. I guess this is a reminder of why it's important to find an orthodontist you feel comfortable with, as you can almost be certain that if you do discuss your treatment with another person having (or recently had) treatment, some practises will be different.

Remember all the doubts you've had during your treatment ... and now look at your amazing results! It's great to know that your orthodontist did know the correct way to treat your bite!

[Zoso]

I am sure there are differences from one country to another. For example, Inman Aligners seem to be offered by a good number of practitioners in the UK, but seem uncommon elsewhere. However, I should think there are some things that would be universal, since the laws of physics tend to transcend national boundaries

It's interesting though: some people really do get concerned about how progress can be possible if the wires are not being changed frequently - I think in many cases it is a holdover from the olden days of orthodontia, when the wires had to be tightened at each appointment; without that happening, it is hard for many to believe (deep down) that progress can be happening unless at least the wire is changed every time. Materials science has (for most of us) got ahead of our ability to understand at an instinctive level how this can all possibly work.

[coconut]

The orthodontist who worked on her son, talked to her about our company's policy regarding unnecessary 'waste' and reminded her of the contract she'd signed that states we're an environmental friendly company etc.

[Sunny]

Our company has an policy to not waste product and to be environmentally aware. This affects what we do and the procedures we write and follow. If we consider introducing new products into the work areas, they are looked at to see what affect they have on the environment. For example we only use plant based products to clean our work areas. Water used is recycled to the gardens areas around the building ... and stuff like that.

It used to be quite common for orthodontists to waste archwires, rather than educate patients (parents/guardians etc) about why there's no need to change archwires at every appointment. The same goes for wearing elastics ... often they don't need to be changed during the day, or removed and replaced after eating. Plus many other things. Some of these issues were related to the lack of chairside communication skills of the orthodontist, and other times it was due to the 'superior' attitude some orthodontist's had. Many (hopefully most) orthodontist's have worked hard to change these practises and now communicate in 'every day' language with their patients. We are regularly involved in training about how we communicate with patients, and this is mostly about how we say things, and making sure we don't use technical language, ortho slang etc. With these improvements, orthodontist's should be more in control to explain why things are done the way they are, and also to include what they're doing with regard to the environment.

[Zoso]

It's very cool being environmentally conscious, and beyond that, not discarding consumables that can still be used makes sound business sense as well. (Though I cannot say that I am overly fond of the notion of recycled brackets - even though I know, where this service is offered, that they are properly sterilised, there remains the question of whether, after being bonded, used in treatment, then debonded, they truly do perform as well as new ones; certain studies claim that they can, but I still remain a little skeptical. Tell me, Sunny: does your practice recycle brackets, or buy them from a service that does so?)

But taking the mantra of recycling to the extreme, where the most minor consumables, like elastics, are not changed more frequently, merely for the sake of the environment is simply ludicrous. Elastics lose a very significant percentage of their force in the first few hours of use, making the very typical pattern of changing them after meals (breakfast, lunch and dinner) and last thing at night very sensible in terms of remaining as close as possible to the desired force. This is bad enough problem with latex elastics (particularly the lower force ones) but is more extreme for the latex-free elastics. Frankly, I think it is a ludicrous proposition even to make environmental concern an issue when deciding how often elastics should be changed (the only concern here should be what is clinically appropriate) given that this makes a significant impact on the efficacy of those elastics, but at the same time, over a typical course of treatment perhaps saves less latex than is discarded with so much as a single glove, or at best a pair of gloves; I trust that gloves are not being reused, of course! And, if both the ortho and an assistant are hands-on with a patient at each appointment, that would mean a typical course of treatment would see, let's say 24 pairs of gloves discarded (working on a basis of an 18 - 24 month course of treatment, with appointments every six to eight weeks)

[coconut]

Sunny, surely the particulars of each case are paramount in dictating the treatment plan, including frequency of wire changes, replacement of elastics, etc.?

Being environmentally friendly is commendable, but this should never be a key driver in a treatment plan.

In an earlier post you mention that your practice's contract includes reference to your company's environmental policy. I'm not sure how this binds either party or even what it means, but personally I would be disinclined to sign any contract for treatment that included even the slightest prospect of some unrelated company objective subordinating the primary needs of my case.

[Sunny]

Sunny, surely the particulars of each case are paramount in dictating the treatment plan, including frequency of wire changes, replacement of elastics, etc.?

... and that's exactly what our policies are about. Some case require elastics to be changed, others don't. But many people have this out-dated idea that not changing elastics will slow progress, when often changing them too often affects progress. It's a case of studying each case and making the correct decisions for each. Tooth movement is an interesting science and often it's important that the root of the tooth move slowly due to the process that is necessary for this movement. Fast movement is linked with the reabsorption of the roots of teeth, so this has to be factored into the work we do.

Patient care is paramount ... as it should be with all service business.

In an earlier post you mention that your practice's contract includes reference to your company's environmental policy. I'm not sure how this binds either party or even what it means, but personally I would be disinclined to sign any contract for treatment that included even the slightest prospect of some unrelated company objective subordinating the primary needs of my case.

Businesses in this part of the world are leading the way by including environment procedures in their polices and procedures. We're also transparent, and to do this, all our material is available to our clients. Everything a company does is related to the final product in some way ... and for most it's related to the final cost. Our patients and their guardians appreciate knowing as much as possible about our company when it comes to making the decision to spend a large amount of money and time with us.

Zoso the brackets we use are marked 'not for recycling'. We had considerable discussion with regard to whether to continue using these brackets, or to change to a type that can be recycled. Research showed that the brackets we're using are efficient and cost less than the ones that we would consider using, that can be recycled, so we've stayed with the 'not for recycling' brackets.

[coconut]

All I was looking for was a 'yes' or 'no' to my first question. I'm well aware of the risks of moving teeth too quickly.

Regarding my second point, as a consumer, I am less concerned about my orthodontic practice having an environmental policy, but if it does, then all power to it. My primary concern is that the practice has the technical capability to deal with my case and an established reputation in the market place. I don't believe that I'm unusual in this regard.

Furthermore, if my treatment plan involves frequent wire changes and requires me to replace elastics four times a day, then so be it.

[Zoso]

Zoso the brackets we use are marked 'not for recycling'. We had considerable discussion with regard to whether to continue using these brackets, or to change to a type that can be recycled. Research showed that the brackets we're using are efficient and cost less than the ones that we would consider using, that can be recycled, so we've stayed with the 'not for recycling' brackets.

This gambit of tagging their products as "Single Use Only" is but one of the ways (alongside law suits that claim, amongst other things, patent infringement) that the manufacturers of orthodontic brackets have attempted to curtail the recycled bracket market that obviously eats into their profits. It's a red herring. But perhaps as someone whose level of involvement is restricted to minor patient counselling, clerical duties, sterilising, maintaining and laying out instruments, and the like, this is perhaps not something you would be expected to be aware of.

But at a more fundamental level, it doesn't matter one iota if every orthodontist on the globe were willing to allow their brackets to be reused, if none of them were willing to use those recycled brackets in the first place - the circle needs completion to have any impact. I'm surprised that any practice that requires its patients to sign a contract that includes acknowledgement that this is "an environmental [sic] friendly company" would not be looking at working with these recycled materials, given that they offer benefits to the patient and practioner (in terms of lower cost), as well as to the environment. I'd be curious, therefore, to learn what are the objections of the orthodontists in this practice to these recycled materials. (Not a different brand of new bracket that is surprisingly missing the "Single Use Only" label.) As I said, I remain somewhat skeptical, but that is just the opinion of someone who is not a dental professional, so I'd love to read what it is that Con and his partners have to say as to why he will not employ recycled brackets, in keeping with the environmental ethos his practice, you say, boasts.