Let’s talk 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 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 sometime looking at Fastbraces and I thought that I should give my academic opinion based upon the advertising and any clinical trials that I could find.
Fastbraces is an orthodontic system that has been actively promoted on websites and discussion boards throughout the World. The advertising is directed at practitioners and the general public and is carefully worded. For example, if you have a look at this link, you will see that they state that “authorized Fastbrace providers typically describe the following differences between old technology and the wonderful Fastbraces”. I have taken this table directly from the website.
|Randomised clinical trial||31 (25%)|
|Prospective controlled trial||40 (33%)|
|Retrospective controlled trial||48 (39%)|
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 from day 1. So the treatment is really fast. 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 he lists a large number of publications on the website. Most of his early work was bonding studies and he then expanded into studies of bracket design in 1991. He published the first papers on the Viazis bracket in 1995. Shortly after this he left academia to concentrate on his new brace system. The company has expanded and currently Fastbraces are available in all continents.
The Viazis system is now heavily marketed as an orthodontic appliance, and philosophy, that provides treatment faster than traditional orthodontics.
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 which 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 are 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 dental journals. I have blogged about this before. Interestingly, orthodontitis appears to be cured by Fastbraces.
What do I think about all this?
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, but some are not well documented and it is not clear what has been achieved. 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 for the treatment of teenagers. This concerns me because the practitioners may be inexperienced. If there are problems, I am not sure what safeguards are built into the system.
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 and whenever I have tried to find out more about the system I have been told to attend one of the courses. I even asked to buy some Fastbraces brackets so that I could 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.
I have also asked to see clinical cases reports and these are not forthcoming. I wonder if the dentists in my favourite Fastbraces video are willing to publish their treated cases, along with treatment times, on this blog? If you are, just get in touch with me.
In summary, I have three main concerns.
My first is with the competence of practitioners. I am not 100% 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, who 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 not clear 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 supports the claims, but I may have missed them. So, if any Fastbraces advocate would like to point out these to me, I will happily discuss them on this blog. However, 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.
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 in order to start a discussion. Let the comments begin!