Dental Braces - Brace Choices
Dental Braces and Orthodontic dental brace choices that can move teeth plus straighten smiles, now gently with no tooth extractions in as little as 3 months to a year, including increasingly popular new choices with 3D straightening from day 1 systems like Fast Braces® UK
Tooth Brace Choices:
There are a number of different types of dentist braces, but they generally fall into two broad kinds, Removable braces, or fixed braces with rectangular brackets on each tooth and a wire, often on the outsides of teeth to avoid the tongue, though there are lingual bracket options too. Braces brackets are often all metal (like train tracks) but can be done so they are tooth-coloured and look less obvious, like the picture below. That was perhaps more critical when one had to wear traditional fixed braces often for years, but now many brace treatments can be done in months, so the cheaper metal braces are more acceptable and a bit more robust to the bashing and chewing forces they receive too:
So why have Tooth Braces?
For the vast majority, it is purely a Cosmetic/Psychological choice, not an Oral Health one. In general, most published evidence in the scientific literature cannot show ANY credible benefit to Oral Health from Orthodontic treatment, for the majority of cases. No benefit in reduced decay rates, no benefit in gum disease rates and no benefits to longer term oral health in any credible way. Indeed some studies that have looked at specific orthodontic cases even when multiple published control trials exist, show overall NO better health gains for typical class 2 division 2 cases, with the Cochrane review concluding doing absolutely nothing can be just as good!
There are though some other Orthodontic studies that show slight gain or risk reduction for Trauma, in those that have very large discrepancies, such as 9mm overjets, but cases like these are the minority of all Orthodontic cases treated in the UK.
Read below what Cochrane has to say about 'traditional' orthodontic approaches for deep bites with retroclined incisor cases:
Sadly much of the published Orthodontic published evidence is also inconclusive, poor or contradictory and thus, cannot be relied upon for MOST Routine Braces clinically informed decisions, even now in 2017 :(
If NO TREATMENT is really 'evidently' as good as traditional brace treatment options, as stated above in a major Cochrane review of ALL the published peer-reviewed literature, then why would so many Orthodontists be extracting healthy teeth commonly in such patients today???
So we have to be publicly honest and admit for the majority of routine Orthodontic braces cases, there is no credible proven Oral Health gain - the majority of crowded or spacing cases are therefore Cosmetic, Psychologically pleasing and Arbitrary and the ASA are very clear if that is what the published evidence says OR that it cannot support proven oral health gain overall, then the public must be told on advertising and websites that BRACES DO NOT generally improve Oral Health !!!
Such very narrow ASA views could basically risk ENDING the majority of NHS Orthodontics in the UK for children and as clinicians and patients, we'd have to say that is not in the public interest and is clearly a very limiting, blinkered or inappropriate view for clinical dentistry services. But the ASA own's recent policy changes do seem adamant that they will not consider any other measure of evidence, despite having been told how such intransigence puts clinicians in an unnecessarily difficult position who wish to explain ALL the possible options publicly on websites like this one. Indeed the ASA will not even consider actual/factual cases treated in say months with before and after pictures, as evidence (despite real cases being actual and not just theoretical research) and worse, it seems the ASA doesn't want us to tell the public about any such alternatives or FAST possibilities, which would always be subject to an individual clinical examination and discussion first anyway.
However, fortunately for patients, clinicians and COMMON SENSE there is a credible alternative known as BEST Evidence Based Medicine, as promoted by the Cochrane Collaboration to overcome the above typical research-biased limitations, which states that the BEST outcomes are achieved by EQUALLY and FULLY considering a combination of 3 major factors - The Clinician's Experience/Opinion + The Patient's Wishes + any Published Research Evidence. See the diagram below which even the published scientific evidence agrees with, for clinical options, in contrast to the current ASA limiting arbitrary position:
Thus if the published evidence aspect is of poor quality, lacking or where it exists it's inconclusive or not credible, then overall BEST Evidence-based Medicine and Dentistry is dominated by the remaining two factors of Clinician's Experience/Expertise and the Patient's Choice/wishes !!!
This is perhaps better represented proportionately, by the informed-funnel diagram below:
For most routine Orthodontic Braces cases, despite the plethora of Orthodontic articles churned out, the published evidence is regularly inconclusive, poor quality and/or simply fails to demonstrate clear Oral Health benefit. Thus in the joint DECISION funnel above, Clinical Experience in specific approaches and Patient wishes/expectations dominate the BEST evidence-based dentistry outcomes, in the real World of individual choices and personalised care.
PATIENT CHOICE and AUTONOMY must not be impaired by blocking information publicly about valid possibilities that MAY have benefits patients wish to prioritise or Clinicians have delivered for others successfully and repeatedly. This 'Human Rights' principle is, of course, is also true not just for most Routine Orthodontics, but also Restorative Dentistry, Oral Surgery, Children's Dentistry etc, etc.
At the SmileSpecialist Centre you'll be pleased to hear we practise BEST Evidence-based Dentistry and consider all 3 aspects equally and fully before making any JOINT treatment decisions with patients, which is why the Examination, discussion and exploration visit with Dr.Kilcoyne is SO important, to reach a Co-decision between us as to what best meets your needs overall and evidently at best practise EBD levels for 2017 onwards.
So which is the best TYPE of Braces for most cases?
Whilst we agree the scientific evidence-base is poor generally for Orthodontics, most Clinicians agree the best 'aims' of treatment is to correct the position of the roots, so that they are relatively parallel to each other and thus more stable after treatment - this is usually best achieved with fixed brackets glued to the Crown of the tooth; it having a rectangular slot across it and a rectangular arch wire running through this slot, so it can apply 3D forces including torque/twisting/uprighting control of Roots. Think of it like TWO steering wheels attached to each crown at 90 degrees to each other, twisting (torque) the root from front to back AND left to right controllably.
Learn more about how FastBraces® is revolutionising this aspect of fixed Orthodontics in the USA and Worldwide for many patients from day 1.
The second type of Braces tend to use pushing + tipping forces mostly - these tend to be mainly 1D or 2D with very little, none, or even NEGATIVE 3D root apex position movements, but can be useful overall for the simpler cases. These type of appliances tend to be Removable Aligners, removable plastic plates with wires and springs, or STO (short-term orthodontics) fixed rectangular brackets but just using round wire through their rectangular bracket slots, thus not getting sufficient root-torque 3D from the round wire, because it's twisting freely in one of the dimensions within the rectangular slot and may still not fit snugly etc.
The third type of Braces tends to be used as an additional stage, before full fixed Braces, such as Functional Appliances or Arch expanders.
In general, Fixed Braces work the quickest and produce better results, because they link all the teeth together and are active all the time, even when you are asleep and of course, compliance is good because you cannot take them out and give up too easily, on a whim.
Dr. Kilcoyne's most commonly requested Brace are the fixed brace options like the FastBraces® latest options to teeth, to improve the root positions and produce the desired Cosmetic improvement in Smiles in a matter of Months for most, often without extractions of healthy teeth, rather than the alternative common option of textbook traditional 2 or 3 years of Brace Treatment, where even today some 30% still have multiple healthy teeth extracted - that is NOT what most people seeking out Dr.Kilcoyne's expertise and experience, wish. If this sounds like you, why not give us a call?
Currently, under the NHS in England, children younger than 18 years can get Orthodontic treatment free IF it is assessed as being a worse score than 36 on a 1-50 scale, but waiting lists to be seen/assessed can be long, before any Treatment even starts, which could then be years on top too. There could also be requests to have healthy teeth extracted to make room for Traditional Brace approaches too, something Dentists are getting less happy to do when other options exist for many.
Adults cannot get NHS Braces (unless linked to other medical needs/operations) and so must pay Privately anyway. If children want the latest technology like FastBraces® from the USA, then they must pay Privately too as the NHS doesn't fund specific systems like that.
Many expect the NHS dental services will receive further cuts ( or higher scores needed to treat) as the whole service becomes over-stretched, including Braces services too, which some argue are mainly cosmetic anyway. However that is not our system and we don't control it and it's worsening waiting times, despite the good people within it trying their best etc. Discuss with your Dentist and ask what waiting times are like in your area for your children. Alternatively, you could be finished before even starting elsewhere !!!!!!
If you are over 18 years old and wish to have your teeth straightened, then we can offer clear Aligners for simple cases (treatment times 1 or 2 years and mainly tipping) or STO Brackets and Round Wires for similar results to aligners but treatment times quicker at 6 months to 12 months or so, or Traditional Braces which usually start with STO approaches in year 1 and then swap to rectangular wires to fit better their rectangular slots to the start 3D paralleling of roots later, perhaps in year 2 or 3.
However.... FastBraces® uses rectangular wire in rectangular slots in patented TRIANGULAR brackets, to achieve 3D tooth root corrective movements from day 1, meaning immediate 3D torque allowing many cases to be completed in as little as 3 months to about a Year, with most of Dr. Kilcoyne's FastBraces® cases taking 5-7months, which is very well tolerated by Adults and Teenagers alike!
The unique patented FastBraces® system, that is now available from Dr. Kilcoyne near the Leeds and Bradford area in Yorkshire, uses a clever triangular bracket stuck to teeth (can be metal or clear to match white teeth better) and a special rectangular wire from day 1 which COMBINE to deliver low forces, low friction and great comfort than Dr.Kilcoyne's traditional brace systems. Traditional Brace systems use older rectangular brackets with rectangular slots containing round wires, only changing those round wires gradually and then eventually moving onto the better rectangular wires for proper 3D root correction much later......
Metal braces though can work very well indeed and many children and even adults do decorate these with different coloured elastics around the metal brackets, to personalise these and make them more fun - whether FastBraces® or more Traditional Slow-Braces, one doesn't have to just have clear elastics around the brackets, see the picture below for an example of this:
Why not book a cosmetic Smile Consultation appointment with Dr.Kilcoyne himself, to learn all your options to best meet your specific needs and wishes?
It seems as we all socialise and take photos on our phones more to publish in social media etc, people notice a Smile that isn't as nice as it could be and thus people start behaving differently, maybe without even noticing over time, by being less social, smiling with lips together, not laughing at jokes in case one shows one's teeth etc, etc. It is more common than you may think.
The great news is, at the Smile Specialist Centre we can quickly provide options to improve your smile, utilising techniques & technologies learned from the USA so that YOU can benefit from FastBraces® or other Cosmetic Orthodontic Tooth Braces. You don't need to be a superstar to get Super-Star options and it may well cost less than you think, for this Latest option in the UK. See our Special offer pages here..........
Orthodontic Retention after Brace work!
In ALL forms of Orthodontics now (Slow Traditional or FastBraces or STO) science has shown that moved teeth are prone to "rebound", which means the natural tendency is for teeth is to drift back to their original positions when the braces are stopped being worn.
This means you HAVE TO WEAR A RETAINER for the rest of your life basically or risk relapse and reversal of the improvements made. We can provide FIXED retainers, which are bonded behind your front 6 teeth OR removal retainers that are like thin bleaching trays, or BOTH for extra surety, especially in the early years!
Whilst Fixed tooth retainers placed on the inside (tongue side) of teeth are not normally visible, you can see in the picture above that if you open wide and laugh and someone is viewing you from high above, then with a close-up photo lens they may see some of the thin metal bars that are bonded behind the front six teeth, to make sure they stay in line. Can you recognise who the above person is? Clue = the nose shape and they are famous!
there are a number of different kinds of retainers that can be glued behind your teeth now, which although not normally visible, can be made of more cosmetic materials so they are metal-free and even more unlikely to show than this metal bar hidden behind the teeth.
The above person is 27 years old now (2010) and finished his Ortho Braces 11 years ago, but the standard advice now is if you have had Traditional Ortho Brace Treatment over several years (as above) or Quicker brace options, you will need retention for life to ensure you do not suffer a relapse. Did you guess who it was - well here is the full face picture below to show Braces really can be for everyone!
Prince William photographed recently - did you notice the Family resemblance to Princess Di?
It maybe you've had previous Traditional brace work that has now reversed without using a retainer and now as an older adult, you simply want your teeth to be straighter/nicer in the smile, WITHOUT going through all the complex and long-drawn-out treatment times of Traditional Orthodontics. At the Smile Specialist Centre, we can certainly help you with Quick Brace options which on average take 3-9 months BUT you will still require a Retainer after treatment to avoid repeat treatment and repeat costs. Because retention is for life now, we would recommend the fixed in retainers which apart from an occasional re-glue every 5-10 years, are far more reliable than removable retainers, not as easy to lose or forget or get fed up of wearing, but we can discuss this further when assessing you at your Cosmetic Smile Consultation. Indeed you may feel you would benefit most by a combination of options such as quick Fast Braces, whitening, the odd bit of re-contouring/shaping/bonding, a cosmetic Veneer etc, etc. We can discuss these and all other aspects after examining you for a Cosmetic Smile Consultation, for Braces or other Smile improvement options.
Click here to make a Cosmetic Smile Consultation with Dr.Kilcoyne himself!
Here at our Smile Specialist Centre, we will not limit your options and choices, but clearly, everyone has different problems and may wish for different solutions, from Traditional Orthodontic Brace treatment over Years to Quicker Brace options taking just Months, to faster but more invasive Restorative Treatments over weeks to maybe no treatments at all ! However we cannot possibly give you ALL the options without examining you first AND take the time for you to ask questions, have a properly written estimate and go through the Pros and Cons for your preferred choices, so we book out the time to do this thoroughly and expertly with you - the realistic cost is £125 for a 45 minute appointment at our Smile Specialist Centre, Haworth, West Yorkshire. Good value for GREAT personal advice!
That is a small price to pay to get a thorough Examination and discussion of your particular wishes, needs and possible options that best meet your needs and budget. We will, of course, give as much info. free on our very informative dental website, but if you need to know more or get a personal opinion as to which options will meet your needs best, then there is NO substitute for a personal examination from someone who can give you ALL the choices!
Are there any side-effects or complications with wearing Braces?
The main problems are usually related to oral hygiene cleaning around the brackets and wires - unless one can already clean teeth well to a high standard without braces in place, then most orthodontists and Dentists will refuse treatment, because there is no point in having straight rotten teeth with lots of decayed holes in them when finished!
Please do visit our other dental health information pages such as Oral Hygiene, Diet, Topical Fluoride and gum diseases too...
Any Braces will inevitably trap more food, plaque and debris around them, making a dirtier mouth prone to tooth decay and gum problems.This will always cause more decay and cavities, especially if treatment takes YEARS, but even wearing FastBraces for Months rather than years, not cleaning these properly can still lead to the enamel weakening in say a 6 month period and gums becoming inflamed and bleeding due to the extra bacteria and food trapping, though the often much shorter time-scale of Treatment for FastBraces patients, does mean the risks to teeth and gums are much lower and even good cleaning habits (rather than ideal 100% cleaning often demanded by some Orthodontists) will still be OK, though we would ALWAYS encourage people doing their best efforts to keep their teeth and gums healthy and reduce the number of Sugar attacks in your daily eating, which is good advice even if you don't wear Braces and you want your teeth to have a good chance of lasting a lifetime - that could be 100 years remember !!!
Other potential problems are some pain and discomfort initially as the teeth start to move - only rarely does this cause treatment to be abandoned and one of the BIGGEST surprises to patients is that unlike the extensive metal Fixed Braces in the picture above, but FastBraces can work by using very LIGHT Forces on teeth (sometimes less is more effective), but like wearing new shoes, there is often some discomfort and just getting used to something new at first, but in the main, 95% of people adapt quickly.
When some teeth are moved long distances through the bone or heavy, prolonged forces are applied for more than a year, then there is a risk some teeth can become shorter (like blunting a pencil nib) or even non-vital (dead nerve) and need root canal treatment later - the roots resorb (dissolve) due to being moved through the bone with heavy forces and/or by tipping forces in effect waving the root ends around too much.
However, fortunately, these complications are rare and the vast majority of orthodontic braces treatment is successful and of course, the shorter treatment times and light forces involved with FastBraces treatments, lower these risks even further, but nothing in life is risk-free, not even just crossing the road sadly.
We will discuss these and other considerations after we have given you a thorough examination and discussed your particular needs.
How long does Normal Traditional fixed Brace Treatment take and does it Have To Be usually years?
Most textbook Traditional Orthodontic Braces treatment often does take years, partly because of their stiffer designs, their higher force mechanics would be too painful for patients initially, which is often why they can't start with 3D corrections of a well fitting rectangular wire from day 1 like FastBraces® does. Mostly it's year-2 when rectangular wires are fitted in traditional treatments, so the approach is quite different, even from day 1.
Indeed if you do place Traditional brackets and TRIED to put in a snug rectangular wire day 1, that first appointment might go something like this, " Ouch that hurts, OMG the pressure, should the pain be building up like that, Arrgh, stop, get it off me, now, Arrgh, Arrgh Arrgh get it off now you maniac it's killing me....". OK, I exaggerate slightly to make the point and no I don't have a double-blind trial to prove that, which quite rightly would be refused upon ethical grounds from what we already know clinically in the real world of dental practice, where inserting a snug rectangular wire would cause acute pain for traditionally planned rectangular bracket brace cases!
Thus Traditional fixed Braces will commonly do more separate mechanical stages, with tipping mainly mechanics first using loose round wires, then after several visits/months changes with thicker and thicker round wires, they can after some time consider smaller then eventually larger better fitting rectangular wires, often depending upon the discomfort the patient can stand at each stage - sadly a lot of patients don't look forward to a traditional 'wire-change' appointment, due to the discomfort and pain they will normally endure for the next 3-7 days after those traditional visits, typically, even when doing the above multiple stages over 18-30 months traditionally :(
Of course, Traditional Braces may be more 'ideal' in the 11-14-year-old child in some situations, especially where large jaw or skeletal bone-changes are desirable longer term, but what happens if the patient refuses treatment because the timescale of years is not acceptable for some reason OR doesn't want healthy teeth extracted??? Are these patients offered an alternative Orthodontic Brace option like FastBraces routinely? Well for many the answer is likely NO because they didn't have the Clinical experience OR expertise in specific systems like FastBraces - Dr.Kilcoyne has had such training at advanced levels in the USA by the inventor of the FastBraces system himself, Dr.Tony Viazis, Professor of Orthodontics and a highly respected Clinician and researcher who has written textbooks on this subject too.
Clearly, there are a number of options to consider and not everyone is suitable for braces or other alternative treatments.
Your Dentist or Specialist can discuss ALL the options with you, perhaps including Traditional and alternative Quicker Brace options, Restorative, Smile makeovers, Whitening etc.
Fixed FastBraces® or Removable aligners/plates or Traditional textbook train-track Braces - you CAN decide after a full examination and discussion for your particular needs and wishes, in the BEST evidence-based dentistry way, before you decide!
Although the published evidence base is poor in Orthodontics, what it does show to a moderate degree is that IF treatment times take longer than 1 year, then the risks associated with moving roots through bone, such as dead nerves, root resorption, decay on the teeth or gum recession etc, is very low but does increase substantially after 12 months - thus treatments that take less than 12 months are not only more convenient, but relatively 'healthier' as the risks and degree of side-effects are reduced with reduced treatment times, and the opposite of course - everyone should be aware of this aspect too!
All of these aspects need to be considered together when you consider both the Journey and the Result you, the patient, would like to achieve. This can ONLY be determined individually after a bespoke examination and discussion. Thankyou.
You can use the above website menu or just click-a-link here for Specialist or Advanced aspects of Fast Braces , Cosmetic Dentistry, Tooth Veneers, Tooth Whitening, Dental Tooth Implants and smaller Mini-Implants, Dental Ceramic Crowns, Gum Diseases and Bad Breath, Root Canal treatments or Dental CPD Courses, are just some of the subjects you can learn more about here on our award winning dental website www.smilespecialist.co.uk.