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.