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Orthodontic advances result in improved braces (1-25-00)

When Dr. White began practicing orthodontics in the 1960s, he said, brackets and individual metal bands were made from scratch for each patient and placed around each tooth. Not only was this extremely labor intensive for the orthodontist, but it also was quite uncomfortable for the patient.

These days brackets are still used, but they are applied differently, Dr. White said. They are cemented directly to the teeth, and light-force titanium wires are fitted inside the brackets. The orthodontist then adjusts the wires as needed to correct the three-dimensional position of the teeth.

Dr. White expects computerization to further advance the field. Fairly soon, new technology will be available to scan a person’s mouth in three dimensions, then make custom-fitted appliances based on that scan. "It will change orthodontics quite a bit," he

said. "We will see customized wires bent by robots and entirely new bracket designs."

Lingual ("hidden") braces, which are placed on the inside of the teeth, will be more prevalent in coming years, predicted Dr. White. About 10 years ago lingual braces were used on a limited basis in the United States, but they were introduced before the profession was technically prepared to apply and fit them properly, Dr. White said. They fell out of use shortly after they were introduced.

Now there has been a resurgence of interest in Europe and Asia, and Dr. White expects revived use of lingual braces in the United States. "We’ll be training our new residents in lingual braces, to make sure they are prepared for the public’s desire to have a less conspicuous orthodontic appliance," Dr. White said.

Braces can be applied at virtually any age. Dr. White’s youngest patient was a 2-day-old who needed a plate to compensate for a cleft palate. His oldest was an 83-year-old woman who had always wanted her teeth straightened.

Youngsters should be referred to an orthodontist by the time they have all their permanent incisors. "The orthodontist will not necessarily treat them vigorously at this age, but at least the child won’t slip through the cracks," Dr. White said. If problems exist, such as cross-bites, finger-sucking habits or protruding teeth, orthodontic solutions can be prescribed before serious damage is done to the mouth.

Growth modification procedures, such as making a palate wider or advancing a lower jaw, are better done before a child has finished growing. "There are some general rules of thumb for therapy, but every case needs to be considered individually," Dr. White said.

Contact: Will Sansom or Jennifer Lorenzo