Popular posts: Let’s talk about…..Fastbraces
I started this blog in October 2013, and it is now entering its tenth year. We have published 911 posts that have been read a total of 3.3 million times. I am aware that the current readers may not have seen the most popular, perhaps controversial, posts. As a result, I will be revisiting and republishing a selection of these posts over the next few weeks. I have selected them based on the number of reads and comments. The first of these is from 2016, and it is about Fastbraces.
Let’s talk about…. Fastbraces
Wouldn’t it be great if someone developed an orthodontic appliance that could be used by General Dental Practitioners with 1-2 days of training? Better still, this appliance would allow them to complete treatment quicker than other braces without taking teeth out. Welcome to Fastbraces!
I have spent some time looking at this appliance. I thought that I should give my academic opinion based on advertising and any clinical research that I could find.
The underlying premise behind this system is that the triangular-shaped Fastbraces bracket increases the inter bracket span, resulting in light archwire forces. Furthermore, as only one flexible rectangular wire is used, the system achieves 3D tooth movement. So the treatment is really fast.
Another claim is that Fastbraces are a
“Patented Method for Restoring Improper Morphology of the Alveolar Bone”.
I have taken this to mean that moving the teeth results in the development of alveolar bone. As a result, we can treat most cases on a non-extraction basis. There is nothing new here. This theory was first proposed by Edward Angle and has been resurrected many times. The most recent reincarnation of this was claims made for self-ligation. The wheel keeps turning.
Importantly, the company provides support to practitioners so they can be taken through the treatment of their own patients by expert Fastbrace advisors.
Dr. Viazis developed the Fastbraces bracket, and they list many publications on the website. Most of the recent publications on this link are in predatory journals. Viaziz published his first papers on his bracket in 1995. Shortly after, he left academia to concentrate on his new brace system. The company has expanded, and currently, Fastbraces are available on all continents.
The Viazis system is now heavily marketed as an orthodontic appliance and philosophy that provides treatment faster than traditional orthodontics.
Importantly, the system is directed at general dentists who attend short courses, some of which are run by the Fastbraces university. They provide full case support. Fastbraces experts and advocates run free courses. Non-extraction treatment is heavily promoted.
The advertising is professional and includes an extensive website that links to Youtube movies in which dentists describe the advantages of this system and how this has changed their practicing lives. The most recent that I could find is here. I particularly enjoyed this one.
They have also published a paper on a new disease called orthodontitis in one of the free-to-access predatory dental journals. Interestingly, orthodontitis appears to be cured by Fastbraces.
What do I think?
My academic opinion is that Fastbraces can be described as Short Term Orthodontics and is mostly treatment directed at improving the appearance of the “social six.” I appreciate that this form of treatment has a clear role in orthodontic treatment provision, providing that the patient is aware that this may be a compromise treatment and the practitioner is sufficiently competent to identify the compromise.
There are completed cases published on the website. Nevertheless, it is unclear what has been achieved without overproclination of the incisors. Some are also relatively straightforward, so it is no surprise that the treatment was fast.
It also appears that Fastbraces may be used to treat more complex malocclusions and to treat teenagers. This concerns me because the practitioners may be inexperienced.
I have also looked at the published literature on Fastbraces, and I could not find any clinical trials that supported the claims for faster treatment, maintaining the bite, less root resorption, and the effectiveness of non-extraction treatment with Fastbraces.
I have contributed to some discussions about Fastbraces on discussion boards. Whenever I have tried to learn more about the system, I have been told to attend one of the courses. I even asked to buy some Fastbraces brackets to try them, but again I was told to attend a course to fully understand the Fastbraces system. My overwhelming impression is that there is little information available about the system. Unless you attend a course.
You can see in the comments below that I have also asked to see clinical case reports. These are not forthcoming.
In summary, I have three main concerns.
My first is with the competence of practitioners. I am not sure that general dental practitioners can gain sufficient competence in orthodontic care from a 1-2 day course to enable them to treat patients, particularly teenagers. These patients would normally be referred to a specialist.
It could be suggested that the support systems may provide the practitioner with detailed advice. But I am unclear what happens if a patient comes to harm or raises a complaint. Nevertheless, I am certain that the treating practitioner should take full clinical responsibility and not the remote prescriber.
My second is with the marketing and the claims that are made by the Fastbraces providers. At present, I could not find any clinical trials that support the claims, but I may have missed them.
Don’t throw stones in glasshouses.
Nevertheless, the orthodontic specialty must be careful not to “throw stones in glasshouses.” For example, we are all aware of the claims on self-ligating brackets, vibratory devices, and MOP, which appear on many specialists’ websites, that are not supported by good quality clinical research findings. Importantly, the claims for self-ligating brackets are not markedly different from those made about Fastbraces.
Follow the philosophy
My final point is that I find it very interesting that practitioners follow a system and philosophy that flies in the face of some orthodontic research evidence. There may be many reasons for this. One may be a lack of orthodontic training that enables general practitioners to treat the more simple cases using conventional brackets and understand their own clinical limitations. This is a complex area, but I wonder if it is time that the orthodontic specialty should engage more in educating interested practitioners so that they can increase their knowledge and gain a better understanding of orthodontics.
I hope that I have raised sufficient points to start a discussion. Let the comments begin!
Emeritus Professor of Orthodontics, University of Manchester, UK.
Have your say!
What is your opinion on GDPs attending mini residency programme organised by orthodontic Guru? That is not a 1-2 days course, but rather like 6 sessions over 6 months (each session would be like 6 hours of onsite lecture or lecture through teleconference, a session of 3h chair side observation and model practice etc)… I see that these GDPs are super confident after attended the course and are treating very complicated cases rather than just simple orthodontic cases or something fast!
ORTHOTROPICS IS ETHICALLY SUPERIOR to any fast method because orthotropics focuses on correcting the causes of malocclusion so that orhtodontics is not needed. Orthotropics trains children to posture themselves correctly to grow the skeletal structure so that teeth will erupt in alignment.
Orthodontics ignores skeletal growth, and only corrects teeth when they are negatively impacted by sub-optimal skeletal growth. Fast methods don’t address the need for children to chew correctly and posture their tongue correctly to grow the maxilla and mandible in synchrony. The public preferres orthotropics because it’s natural and pleasant for children to do with preventive results.
In the spirit of the return of Game of Thrones to the TV, I fear that this new blog will inevitably “wake the dragon”
Although I very much enjoyed your favorite FastBraces video it is not quite as informative as my favorite (https://www.youtube.com/watch?v=QICiXAq9oSI). If you watch this video it will explain how orthodontists have been missing out for decades on this incredible technology including such unimaginable components as light NiTi wires (I think that was what the wires were made of although I cannot find anything about them on the internet to verify it). They even have their own bracket with only three tie wings! Imagine how light their mouths must feel with one less tie wing per bracket!
I wish I had been told about all of this back in my residency days as it would have been so useful over the past 26 years I have had to practice. I nearly went to my grave practicing orthodontics in the dark ages.
Fortunately, if I am timely and a bit lucky, I may be accepted into the local FastBraces course given by the world’s leading FastBraces orthodentist (more than 100 cases treated!!) nearby my home town. Then I can finally learn how to do it right.
Thanks for alerting all of us to this really useful information. I will certainly sleep better tonight!
A usual, this is another well worded non-incendiary commentary. An evidenced based discussion on “Fastbraces” was long overdue. I agree even about the glass house theory in that orthodontists should be careful not to become hypocrites that appear to be merely protecting their turf. However, stones should be thrown in any direction where evidence does not support the claims.
Hi Kevin. I’ve just had a look at the FastBraces website, in particular the “Very Difficult Cases” page, and could not help noticing the severe gingival recession labially around the lower incisors in Case Example #1. Now, obviously the patient would have been warned about this as part of the consent process, but I wonder if this is an issue which would happen often with such FastBraces? I know it can happen with “Old Traditional Braces” (sic) too, but it isn’t mentioned in the table you took from their website.
Just asking, because I’m not an specialist orthodontist; just a Dentist with a Special Interest in Orthodontics.
Succinct, to the point and balanced. A wonderful read from an insightful professional.
I guess this will help boost the number of hits your blog will get – you are welcome lol
Yes there are a small group of ‘Haters’ who seem to think GDPs shouldn’t do routine Orthodontic cases routinely, because it’s not ‘routine-dentistry’ and so which alternative Ortho. system empowering others do they then ‘hate’ most – FastBraces it seems because it’s proper 3D Ortho. made simple and safe using patented technology!
It really is that simple………. some really Hate how good and fast it is for most routine Ortho. cases!
Orthodontics isn’t brain surgery, indeed the actual evidence base for most of what is done with Traditional ‘Slow-Braces’ is very poor indeed or non-existent at the highest level of evidence – why aren’t the haters shouting about that or informing patients there’s little good evidence to back up most Orthodontics, so it’s mainly just clinical experience and cosmetic wishes/conformity frankly ???
Sadly we seem to have a Myopic trend in UK Ortho. recently, where our undergrads. gradually learn little/no practical Ortho, deliberately, yet they teach increasing numbers of dental nurses how to do this instead 🙁
At the same time, After qualifying there is a vacuum of formal training pathways, so basically more and more entrants to Specialist training in Ortho, have almost ZERO practical experience – that also can only dumb-down Specialist training qualitatively too!
Imagine starting Oral Surgery or Endodontic Specialist training with Zero-clinical experiences 2 or 3 years postgrad!!!
Fortunately other Dental Specialities haven’t given up on Undergrads. or after they qualify and it is normal in Oral Surgery, Perio, Endo, C+B, Paedodontics and other specialities to HELP ALL GDP colleagues learn more, do more and NOT slag them off publicly as though they were ‘unfit’ to be treating patients because they DARED to better themselves and give more choices to patients, going against the Haters who prefer the Specialist Orthodontic MONOPOLISTIC trend 😮
Yes FastBraces is rectangular wire from day 1 and light forces and completes the majority of ROUTINE Orthodontic cases in just 3-12 months.
It’s not short term ortho. or round wire systems (there are no round wires!) it’s based upon torquing the roots from day 1 and paralleling them – you know, proper Orthodontic goals.
Yes it’s established and safe and satisfies patients in the most demanding USA and now in the UK orthodontically, as well as the rest of the world – it has a GREAT track record over decades too.
I’m sorry you refused past offers to come to FastBraces courses and learn Kevin, even a Professor doesn’t know everything and yes sometimes one needs to learn different ways for a different system – it was your choice to refuse Kevin but there are courses for Orthodontists here and worldwide and separate courses for GDPs too, just like ANY other progressive dentistry discipline.
Those people don’t have to ‘Hate’ from ignorance or zero clinical experience, they have been properly trained and continually supported.
In an ERA where dental students now pay £9000 a year and rarely do ANY hands-on Ortho, that must seem like bad value for money and frankly deskills the profession. It need be no more !!!
If any dental school would like to be the first to offer fixed Orthodontics using the FastBraces system, they can complete several routine Orthodontic cases upon qualifying, safely, competently and evidently within a year on their courses too!
Please do let me know, it would be a great USP for your Dental School as others turn their backs on this aspect, it seems 🙁
Who knows it may help raise the standards and enthusiasm of those considering Orthodontics as a career – certainly compared to doing NO hands on and just learning to do IOTN assessments and write referral letters, like it was Brain Surgery lol
Yes Kevin, it’s time orthodontic leaders stopped minimising undergraduate and gdp opportunities – some in powerful positions speak/blog like Orthodontics is Brain Surgery and so only Specialists should do it etc. – GET REAL !!!!!!!!!!!!
It’s Dentistry and like ALL Dentistry one simply needs to know which cases to refer, or not and be supported to work within one’s competency – We need Specialists for the more complex cases, certainly not the routine ones or Specialists hogging ‘all’ Ortho. cases frankly.
Again, be like EVERY other dental speciality in patients’ best interests !!!
Only UK Specialist Orthodontic Teachers seem to say 5 years +2 days can’t be starting competent; do they really think THEY screwed up the 5 years Ortho. teaching experience so badly first , that even simple cases with PG support and courses are dangerous? Or maybe it’s just SCAREMONGERING again and not dreadful undergraduate provision?!?
Most Orthodontic Specialists I know & meet are lovely, helpful people, but it seems as soon as a FEW of those in POWERFUL positions get a sniff of GDPs doing more Ortho, they get all Scaremongering, trying to undermine individuals as well as the results WHEN THEY HAVEN’T EVEN DONE A CASE or COURSE THEMSELVES and frankly, they actually end up bringing UK Orthodontics into disrepute with most GDPs – do I even have to mention that BOS Specialist advert in the papers denigrating all GDPs publicly again, still with no public apology – really ???
These are all signs and symptoms of a sickness at the top frankly – it’s Shameful, just shameful…….
So in short it’s time for those in power in UK Specialist Orthodontics to take their own blinkers off first, before criticising others actually making progress for 10+ years. FastBraces is listening to and benefitting many many many tens of thousands of patients, giving them straight teeth quickly, comfortably, without extractions or irradiating brains unnecessarily etc – it’s called Evidence Based Medicine = the BEST evidence of all 😉
If undergraduate Ortho. experience and teaching is really that dreadful today, let FastBraces sort this out for UK dentistry!
Thankfully many more Orthodontists and GDPs are liking FastBraces once they experience it for themselves too.
Yours Fast forwardly,
Hi Tony, thanks for the comments. Have you got any cases for me to post up along with their treatment times? This would be really helpful and certainly provide a great illustration for the people who follow this blog.
Regarding 6 sessions at 6 hours a piece, that comes to 36 hours. Orthodontic residencies in the US are two to three years at over 40 hours per week. 36 hours, while a nice start, just seems inadequate when looking at it from that perspective. I teach pediatric dental residents about orthodontics. I think the key is knowing how to protect the patient and stay out of trouble. This is a topic I preach early in their education. Unfortunately, it’s easy to over estimate one’s abilities when these courses say it is so easy.
Do you have any undergraduate cases to post up so we can see?
Or how about those starting Specialist training in their first 3-9months?
There are books full of illustrated cases for FastBraces, literally thousands of them and as you know, cases are peer reviewed at every stage with feedback too.
Are you really asking to see lots of FastBraces cases?
That’s why we do the courses – they are free and one learns and sees – they were at the dentistry show too demonstrating lots of cases and there was courses after the show too.
Furthermore as one progresses with the courses, getting feedback and learning, progressively, one goes on further and further courses too – again they are ALL free !!!
One of the reasons I like FastBraces is they are insistent upon attending courses, reviewing and pre-approving every case to keep people safe, feedback/review at every visit and told when case is finished to a satisfactory standard too.
It’s so good I’m looking at doing something similar restoratively – it’s actually very good educationally and supportively.
As regards posting cases, I’ll look at consents but that might be an issue.
If dental schools are interested in persuing this for undergrads, then I’m sure a special visit and tons of cases, evidence over decades can be shown that would be fast and good teaching cases for even undergrads and those supervising them too, with special online support 24/7 too.
Now THAT really would be Fast Forward educationally!
email : anthony kilcoyne @gmail.com (no gaps)
Thanks, as you know the undergrads in the UK do not complete orthodontic cases as this is not in the curriculum that was designed by the General Dental Council. You will remember that you and I approved this curriculum when we were on the GDC.
As for post graduate cases, these can be easily seen by looking at the cases that are posted in the Journal of Orthodontics.
In any case this is not the issue, I have raised concerns about the claims made on the Fastbraces website by the advocates, which include you, if you cannot post any cases to me, can you let me have some screen shots from the Fastbraces books. Or better still let me know where I can buy one of the books from? I have looked on Amazon and I cannot find any.
I sure don’t remember banning any Orthodontic experiences at undergraduate level – the new curriculum was a bit wooly in parts though, but I assumed that added flexibility.
If that’s how it’s recently been re-interpreted or applied so no Ortho. cases are done, then surely graduate Ortho. training is a must from day 1, or you’ve just killed GDPs doing routine Ortho. cases.
Sounds like my undergraduate offer is more needed than ever !!!
As regards your concerns about FastBraces claims established over decades or their publications, you know the website and email and even postal contacts there, so why not ask them directly – they may even have some ‘permission-cases’ consented for public blogging with the back story of ‘Specialist wanted to extract 4 teeth’ but done extraction-free etc. But that’s an entirely different consent process to private clinical records as I’m sure you’ll understand.
If you’d have done that in a timely manner they could have been sorted legally and ready to go for this blog you’d planned.
So how do you feel about the claim – “orthodontics is 99% cosmetic, no evidence of health-gain” – claim then ???
Yours still Fast Forwardly,
Hi Tony, so it is not possible to see some cases? Can you let me know where I can buy a Fastbraces book?
Your last question appears to have little to do with the current blog post, however, I am not sure where you got this quote from because it is far from correct. This is an area that I am particularly interested in and there are clear dental health gains and socio-psychological benefits from some treatment, but not all. This depends on many factors and it is not always clear. If you are asking does all orthodontic treatment benefit, I would say we are not 100% certain and this is similar to other areas of dentistry that are based on cosmetic improvement. But to say that there is no evidence is not correct
So Kevin, there is ‘some’ presumably weak evidence that Orthodontics may have some health gain, but not ‘indesputable’ evidence of health gain, so let’s be generous and say 95% of all Orthodontics done, is Cosmetic or Cultural then?
Is that reasonable ???
If not ‘readonable’, where may I find this ‘indesputable’ evidence?
Dear Mr. Kilcoyne, it comes to mind (swiftly), the old adage: “the lady doth protest too much”? I seem to have stumbled upon a comedic preamble which attempts to transgress all but the poorest clinical research and development which has been the foundation of those irrefutable mores which have stood fast in all but the most “hotel weekend” Orthodontic quick fix “programmes”: which leave their mentally shell-shocked, brainwashed and consequently vastly impoverished attendees with the mistaken idea that years of orthodontic wisdom, teaching and practise can be lumped into a few hours of talks and slides; with no practical or enduring clinical instruction to boot. Many an “artist” has attempted to convince their gullible audiences too buck the proverbial system and make a fast buck only to be seen disappearing over the horizon, pockets bulging with their “disciples” cash followed of a fast but inexorable pursuit of litigation experts behind the said “disciple”: especially when they have no defending “back up” i.e. research, accredited qualification(s), experience, or long-term case studies with which to fight their ever-diminishing corner? Why, do you surmise that we, at last, have a GDC Specialist List which gives Joe Public and his/her weans something that they can tangibly rely on? Especially when they don’t believe all the b/s trumpet blowing, which they read on the “fast buck” (seemingly professional) internet websites?
I have no problem with the competent and well-
intentioned and patient-centered GDP (which all of us in High Street Practice are, essentially); but the few of those who DO like to do a little simple Orthodontics at “the coal face” and not primarily for financial gain should, in my opimion, be encouraged to link up with a tame Orthodontist in their local Specialist Practice to whom they refer or with an understanding local Hospital Consultant to see what can be agreed between them if the are interested in disseminating some knowledge and instruction which may go some way towards stemming the seemingly fifancially-driven tidal surge towards the mainly non-CPD accredited “certificate” in ” Weekend Hotel-based Kwik-Fix Orthodontia”? I am disgusted that such respected individuals like yourself encourage such untested and potentially litigious-looming, root resorptive and rapidly relapsing practises even WITH the UNADVOCATED 24/7 AND semi-permanent retention which even I humbly envisage, in the non-growing
adult! Does ANY self- respecting Specialist really believe there is really a “Kwik-Fix” for physiologically moving teeth through bone with NO deleterious pathological sequelae and yet, not be related to the Almighty (whatever you believe) Him/Her-self ?!
GDPs doing ortho generally do far less damage to patients than the local traditionally trained specialist , as the inexperienced GDP is very weary of extracting teeth .
With the confidence the speciality badge gives them , the specialists incorrectly extract, extract, and extract again. Current stats are at about 50% of all cases .
Many of these patients are physiologically symptomless are suffer no further effects other than loosing teeth , but many are not. The mandible is distalised and they they suffer postural changes , neck and back ache , voice box changes , increased migraine occurrence , high blood pressure , disrupted thyroid levels , dystonias and loss of hand coordination , depression , a real rag bag of symptoms , that generally put them in the ground 10-15 years early . This research was done in the 60 and 70’s by alred fonder. After 25 years of practising both traditional extraction ortho ,and non extraction ortho , and personally having had a course of traditional treatment reversed , my conclusion is that Fonder was right . I find dentistry is far more important than I was taught at dental school , and the GDP doing ortho generally is far safer than the specialist in the current environment , simply because by default he will try and follow a non extraction protocol , and so inadvertently not further distalise the mandible.
The “evidence” does not recognise these long term problems poor maxillo mandibular relationship creates , and insistance upon RCT’s as the best evidence , does not hold , as real dental physiology is not taught a dental school nor recognised by the profession, nor considered by any of the rcts in the literature .
The idea that we should accept a crowded arch form because it is more stable post treatment is incorrect . (imho)
All orthodontic treatment relapses to a greater or lesser degree . If we have extracted teeth , the relapse in class 2 cases further distalises the mandible. Physiological disaster , unnoticed by the patient . ( Incidentally I have an extraction rate of about 5% , usually ectopic teeth , lower class 3 cases , and facially very full protrusive cases , ( very rare in caucasions ) The post extraction mechanics are done with out distalising or entrapping the mandible )
Fast braces , and 2 day ortho training courses keep it simple and do no harm at all , in my opinion . So what if treatment relapses. The patient is back to square one. . This can not be said of the specialists treatment .Yes extraction treatment may relapses perhaps even a little less , but with far more serious consequences . Sorry to be so critical Kevin , but what harm are the GDPS doing ?
I see far more harm coming from the specialist camp . Every day I observed collapsed faces, further compressed joints , migraines galore , neck and back and movement problems , all which need to be treated by a dentist , yet that orthodontic specialty and expertise is not there in the specialist community .
I still would love your opinion Kevin , of Brendon Stack (orthodontist) successfully treating tourettes patients ,and movement disorder patients , amongst other things.
He has about 30-40 medical miracle , clinical cases posted on you tube . Please watch and lets discuss what the hell he is doing and how he is doing it.
We have so much influence over patients physiology with our orthodontics, and dentistry . There is no need for protectionism . The public are in desperate need of pain relieving , health giving treatment , and are not getting it , because most of the profession still hasn’t got over squinting at plaster models , that completely miss the point.
I have tried not to be too cutting , but obviously want to maintain interest to the voyeristic reader . Love the blog , Not before time ,
Best regards Peter
Phew, what a lot of ranting and very little science
The question posed is a simple one. Is their any evidence that Fastbraces treat an equivalent case more quickly than any other type of fixed brace. If I had developed a new type of appliance over 20 years ago and it shortened treatment times by a very significant amount I would have designed a study(s) to prove it and then travelled the world promoting it and then retired early, sleeping well at night, in the knowledge that I had taken orthodontics forward. It seems that the developer of this system is traveling the world but has yet to do the science.
I have shown a video on their site to a few patients. The GDP in one video states that she can treat a complex case in 3-7 months, had she refered the same case to an orthodontist it would have taken 2 1/2 to 3 years for them to treat the case. When the video is over I ask the patients what they thought. All said that the message given by the dentist is that Fastbrace shorten treatment time.
Although I have not been at it that long, (13 yrs post specialty training) I have treated patients with Begg, Tip Edge, Tip Edge + Damon (1,2,3….) and a few other systems. All of them move the crown and root from the beginning of treatment, it is not possible to do anything else. All of them can treat cases non extraction. All of them can align the front few teeth in a few months. The question is – Is any system better than any other.
I am regularly bombarded with manufacturer claims that state their system is the best in terms of treatment time, efficiency, reducing extractions and reducing root resorption. With my enquiring mind and skills to evaluate the literature (which will include meta analysis of RCTs and Cochrane systematic review) I have not found any quality evidence to support any of these claims. And neither has anyone involved in the publication of quality orthodontic literature.
I find it very sad that members of a profession I am proud to be in sell patients hope that is not based on evidence.
Steve . If you care to watch Brendon Stack curing tourettes with orthodontic treatment on you tube I would love your opinion.
first 10 minutes only . Please . I defy anyone dental to watch Stacks videos on you tube and not have a siesmic change in opinion . What is he doing?
That video is fascinating but I’m not sure how it equates to all extractions for orthodontic reasons being a bad thing.
I understand that in the past, a proportion of patients will have been inappropriately treatment planned for extraction based ortho treatment.
But, I’m not sure I get your point about the majority of extraction based therapy resulting in a distalised or trapped mandible.
in class one mod-sev crowded cases, I’d aim to maintain the AP position of the incisors after extractions.
in class two cases id either use functional appliances to reduce the overjet or id extract in the upper arch to camoflague, maintaining or advancing the lower incisors.
Im not using any mechanics to distalise the mandible.
to rule out extractions on the basis that the tmj will be compressed doesn’t seem to make much sense
Hi Nicky , Thanks for responding . To answer your question .
1. Crowded and narrow upper arches often have poor mandibular position to start with . ie slightly entrapped, particularly div 2 cases. (40 % of the population have tmj clicks., indicating poor mandibular position .It is v common ) In an upper arch once the upper teeth have been extracted, even with out brace work , the posterior teeth mesialise and the anteriors distalise . Add to that further relapse and upper arch collapse , as the patient ages . That last small bit of extra mandibular distalisation can and will push the patient into symptomology , that will occur as the patient ages . The mandibular movements we are talking about are small but have huge physiological impact.
2 Fact . Alveolar bone grows to accommodate teeth . i.e. development and expansion works . Extractions are usually avoidable, and the clinical end results are aesthetically superior. Fuller, wider smile , a more balanced facial result, better mandibular position AP which equals better head and neck posture.
3. It IS appropriate to extract in certain situations where the mandible is not entrapped to start with and will not be distalised further., but these are a minority 5% of cases .IMHO . Very ectopic teeth , lower arch class 3 extractions and true maxillary prognathism. Very rare in western caucasians. More common in Chinese asian and Afro-caribbean populations .
4. Plently of people lose premolars and have no symptoms at all , and will physiological adapt , but speaking from personal experience having had both extraction treatment and having had it reversed ,I am a different person following correction . I had 25 years of migraines that have now gone. I could not drink alcohol , eat wheat, coffee or chocolate without suffering migraine. If I was not a dentist I would have had no clue. All the ” lunatic fringe stuff ” and outlandish claims I have found to be true. Ie neck and back ache improving, Improved arm function from trapped nerves in the spine . I have witnessed a doctor patient with a 4 year leg dystonia , being able to walk without crutches from improved mandibular position. I have successfully treated severe clinical depression orthdontically . I have personally clinically witnessed all these things improve in my own surgery , with freeing the mandible up .
5 Even if you can’t fully reduce the over jet , I am coming to the opinion that these patients physiologically are still better treated as a failed functional case , with remaining over jet,
than an extracted successful camouflage case . It has long been recognised that class 2 patients posture the mandible forward when they stand up . Even though the occlusion does not allow them to bite in this correct position , they still unconsciously attempt to adopt this position whens standing as this allows better head and neck posture . Camouflage treatment robs the patient of this final physiological release position and traps them in an incorrect head posture .
7 In my career I am guilty as everyone else in incorrectly extracting , collapsing lips , and inducing tmj symptoms in some of my own patients. I have watched it happen over 25 years as a clinician . We only do what we are taught by our elders.
8 Dentistry is king of the body . I want Kevin to look at this subject and a do a good RCT to follow on from Brendon Stack , and Al Fonders work ,
and put the profession where it belongs as massively important to a patients long term health , life expectancy and quality of life.
Sorry to be so lengthy and appear to rant , and thanks for reading . I would love a response as I think this subject is massively important , to us all as a profession .
Hi Nicky Thaks for your question .
Narrow and crowded maxillas often start with a slightly distalised mandible. This is very common , 40% of the population have asymptomatic tmj clicks indicating incorrect mandibular position .The under developed maxilla has stopped the mandible reaching its correct position before we even start orthodontic treatment.
Even without orthodontic appliances after extraction of two 8mm premolars = 16mm of space, from the upper arch , the posterior teeth mesialise , and the anteriors distalise , like it or not. Add space closing mechanics to finally close the space between 5 and 3 and the anteriors distalise further , often entrapping the mandible . To attempt to hold the incisor position after extraction is very difficult The whole 2112 section WILL distalise slightly. Add to that further relapse and arch collapse as the patient ages , and that can be enough to push the patient into synptmology . The distances we are talking are very small less than 1mm but physiologically it is VERY significant . I lived with migraines 3x a week and it was alll caused by camouflage treatment . Having finally reversed it I am a different person , but I see it a lot in the general population post camouflage ortho , and they along with the profession usually have no clue as to what has happened .
It has long been known that class 2 patients often posture the mandible forward , even though the teeth do not allow occlusion in this more correct position . This is because the airway is slightly more patent as the tongue moves forward, and a more upright head and neck position can be obtained . Camouflage treatment with its over jet reduction , and permenant mandibular entrapment or distalisation , robs the patient of this physiological release valve with subsequent physiological postural problems I have previously listed. It doesn’t happen every time and many patients adapt with no symptoms at all , but many do not, and suffer terrible symptoms . Dentistry really is far more important than any of us have been taught at dental school .
It needs more study . I have clinically witnessed many remarkable , things haooen in my own surgery, by freeing the mandible up , that I do NOT now think were psychosomatic . It needs more study . Hope this makes some sense ?
There is nothing new here unfortunately
Carefully worded advertising aimed at the general public , claimed unsupported by scientific evidence (either by lack of publication or evidence showing that the claim are false ). . The phenomenon is almost as old as orthodontics itself.
Almost started with Begg who claimed faster treatment time results (but did not do the agressive self delusioning advertising ) and never stop after that 🙂 .
This made me chuckle!
There are 2 issues here, the speed of tooth movement and who should do what?
The speed issue could easily be tested. I think it unlikely that there would be any effect on treatment time due to the fixed brace design although I’ll keep an open mind. There could be effects depending on other things such as time interval between adjustments, wires used, lack of extractions, etc. I think we should all aim to keep treatment time as short as possible and have thought that there should be a study of NHS cases (courtesy of the bsa) to see who the operators are who have the shortest treatment times and what their secrets are (if any). Over to you. I would say that as a specialist I would be wary of making unsubstantiated claims about myself and would be wary of others who do so.
Who does what is always a contentious issue without a good answer. I would want my surgeon/dentist/expert to have done a large number of cases (although we all have to start somewhere), to have learnt from treating those cases, to be up-to-date and to not see me as a walking cheque book. The argument here from fast braces seems to be that braces aren’t that difficult so you don’t need to do many cases to get competent and that there has been a specialist stranglehold over carrying braces out. How do you test this? Is this true?
Over to you again.
I suppose the market will determine ultimately what gets done and where and I can forsee ortho becoming more of an undergrad subject when/if caries rates drop, the undergrad course is long enough after all.
Great little article, Patient education is so important, keep up the good work!
Hey Kevin, just a brief note of thanks for the talk at the AAO. I thought it was splendid
and I particularly enjoyed the features you mentioned about ROs (real orthodontists)
being as guilty as GPs in fallacious claims. I thought you might enjoy a couple of things
I discovered recently. “Prophets of foolishness would be powerless were it not for a genetic
human flaw that keeps yearning for a balm against uncertainty. Science seems powerless
against such inherent fears.” And then from Saul Bellow, “A great deal of intelligence can be
invested in ignorance when the need of illusion is deep.” Again, congratulations on a
lecture well done.
Let me just say this. I started my fast braces journey in August 2016. They are coming off April 27th. My teeth are now straight. My gums are healthy.. Before the application of these braces i had to undergo a deep cleaning and have a recovery period of a few weeks. My gums were reading 4s and 5s. I had over130 bleed sites and 120 areas that pegged 4s in recession. After the cleaning and application of Braces my next cleaning revealed only 3 areas of 3s and the rest were 2s. And only 7 bleed sites. So as for speedy movement of the teeth, yes that is a definite result. Receding gums or other damage, no. My gums were able to heal properly even under the amount of pressure from the braces and 3 week adjustments. I had a crossbite on the top with the tooth beside the front one…. It Was tucked behind the bottom row and The gums had grown down over the majority of the tooth as it was tucked so far behind. The bottom row had slight over lapping in the middle. The front 5 brackets on top were applied for 3 weeks. In most cases they apply the front 6 but in my case the tucked tooth Was too crowded in by my canine and front tooth. Within 3 weeks they were able to get a bracket on it when they applied the rest on top and lower brackets. I was put in a bite block and within 6 weeks that tucked tooth Was completely out front. Bite blocks were removed. My gum tissue thinned out and raised properly to form a perfect shape on that problem tooth and my Bite is perfect! Yes I’m having to wear Elastics these last 3 weeks to drop my premolars a little more before the big removal!!! I will for ever recommend fast braces along with the amazing dental team that changed my life. I’ve got progress photos if anyone is interested. Fastbraces is something I won’t let my friends/ family mis out on! Half the price and half the time. P.s. one of my friends has traditional braces… She got them 8 months before i got my fast braces… Mine are coming off 2 weeks before hers and my teeth are more straight than her finished results. She’s highly upset with hers.
As a GP who has taken assorted comprehensive courses, full mouth recon, and many STO programs I would suggest a GP should only provide orthodontics after taking at least a comprehensive program designed for gp’s limitations. At least this rage of STO has been a substitute for the over-treatment experienced during the ‘instant orthodontics’ of the cosmetic dentistry revolution. The importance of keeping treatment time to the absolute minimum while achieving an acceptable result is reasonable. Dentistry is more complicated than most realise and even the specialty is still sorting out what works and what doesn’t. Stay critical my friend…we all need to be on guard to help offer patients a choice between the alternatives that are acceptable or less desirable.
Yes, appears to be the “American Way” unfortunately. In the 19th and early 20th centuries Dentistry in this country was hucksters, snake oil salesmen and “Barber Dentists”. By mid century, the ADA and regulatory boards had made it into a trusted profession through strict control and harsh penalties. However, they became extremely restrictive and sometimes arbitrary and even abusive, The pendulum swung back. Now, as a result of restraint of trade lawsuits and legislative reforms, the boards are relatively powerless, Our professional associations literally cower in fear of litigation to the extent that they will not take a stand on anything and we are back in the days of Painless Parker.
Love these blogs and try to follow the excellent study analyses by KEVIN ,BUT have we not seen all the above comments,or similar ,at least 3 times before ??
I am getting dizzy going round the carousel !
Kevin, I don’t know if you knew that the late Tom Creekmore with the help of Unitek Corporation developed and patented the triangular bracket, but he gave it up quickly because he could not control rotated teeth efficiently. This led him to develop the Unitwin bracket, which did give him the advantages of both single and twin brackets.
I was delighted when I attended two one day courses of Dr Viazi’s fast braces one in Sweden in 1995 (during my orthodontic postgraduate training) and another one in Athens before 95.
At that time it was heard by someone that a bit root resorption happened in some of the cases presented. I used the brace in my private practice in Greece and it could really speed up the treatment nicely. It promises a lot. Nevertheless, in my opinion and taking into account my own clinical experience, I feel that the bracket slot looks to be a combination of a Tip Edge and a Twin bracket which finally reflects a bit the outcome on the upper six anterior teeth arch curvature.
I have not yet used it in the UK, because of possible limited access to patients interested by today and also because Dr Viazis operated specific surgery in the UK since 2014.
As far as I remember Dr Viazis has a great straightforward teaching style and his textbooks are very helpful in terms of additional knowledge.
Mr Ioannis Koutsamanis, DipDS
Associate DwSI – Practice limited to Orthodontics
Not what I like to wake to on a footy public holiday!
Initial thoughts – “How embarrassing?/ You only know what you choose to know / Last I heard cellular metabolism dictated rate of tooth movement / Haven’t we already visited pros and cons of initial alignment with “square” wires? / Not 1 word about OCCLUSION – alignment is the “easy/ swifter” part / We have brought this upon ourselves.”
I do agree that by shutting GP’s out of specialty conferences, ignorance lives on. As an undergrad, could not understand why orthodontics was the only conference I was unable to attend, as Director of Predoc Ortho for many years, I did my best to teach as much as I could with hands on components (competency with fixed appliance mechanics could never be reached within teaching hours available (university accreditation committee) due to the time taken to start and complete sufficient number of spectrum of patients, even using an accelerated version of mechanics- diagnosis, treatment planning was large focus but we did include mechanics) , and as a specialist ortho and member of conference organizing committees, I still do not understand why we do not invite our colleagues to educational forums, side by side? We want their referrals, but we don’t want to sit next to them….??
I find this attitude abhorrent, Draconian, counterintuitive, against the Modern Hippocratic Oath (Lasagna 1964) and at least partially responsible for what we read above.
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
What are we waiting for? Take the blindfolds off – please!
Thank you for publishing this- I totally agree with your position. I have seen hundreds of FB cases (not mine!) and I have yet to see a result that I consider “standard of care”- they all look “untorqued” or “blown out”.