I have decided to invent a new form of treatment: 24 month braces revisited!
I have decided to invent a new form of treatment: 24 month braces revisited!
One of my most popular posts is called 24 month braces. I posted this several years ago and I have decided to update it to reflect the current state of orthodontics.
This is how I would promote 24 month braces…
A new paradigm in orthodontics
The 24 month brace orthodontic system/paradigm is a revolution for the treatment of malocclusion. The system is based around using stainless steel brackets and wires. You can fix the brackets to the teeth with glue. The wires fit into the specially made brackets. Magically designed polymeric “modules” hold the wires in the brackets. The first wires fit loosely into the brackets and straighten the teeth. You then fit thicker wires. We call these “rectangular” wires and you move the teeth along these wires using “space age” springs. You put the teeth in ideal positions using this technology.
You can use this appliance to correct overjets, overbites, crowding and buccal segment relationships. It can even be used as part of orthognathic orthodontics.
Who can you treat with twenty four months braces?
You can treat any malocclusion with 24 month braces. Occasionally, you need to make space by extracting teeth. However, research shows that this does not lead to harm to the patient.
Unfortunately, the appliance does have some side effects. For example, most patients have some minor loss of the length of the roots of their teeth but this is about 1.7mm. After you adjust the 24 month braces your patients may feel some pain and they need to be careful about what they eat.
When should I do this treatment?
Research shows that the best time to do this treatment is when a young person is about 12-13 years old. Nevertheless, some orthodontists routinely provide treatment when children are younger. Interestingly, this is more profitable expensive, not evidence based and makes the most of normal dental development.
Does it help with breathing problems?
There is no evidence that breathing problems can be corrected by 24 month braces, jaw developers or snake oil lubricated bits of plastic.
How long does the treatment take?
On average it takes about 24 months to treat a patient, sometimes slightly more and sometimes less.
Can the treatment be speeded up?
There are several new methods of trying to speed up tooth movement. These include making cuts in bones, shining laser lights on the gums and even vibrating teeth for 20 minutes a day with a special vibration device that your patients hold in their mouths. Orthodontists can use these with 24 month braces. However, if you are up to date with the literature, you will be telling your patients that these methods do not work.
Is there any research behind this treatment?
Yes, researchers have looked at the effects of these braces for many years. Unfortunately, scientific journals restrict the publication of this research behind paywalls, and not available to the general public. If you want to read this research you have to be a member of an orthodontic society.
Orthodontic societies organise conferences. At these conferences research on this appliance is often presented to empty rooms by academic orthodontists.
However, some orthodontists present to packed rooms and show their best treatments to expound their own treatment mechanics and marketing. Other orthodontists call them “the rockstars of orthodontics”. They often put posts on social media saying “watching Dr ?? rocking the AAO at San Diego”. Key Opinion Leaders, who are paid by the supply companies to promote their products are also called “rockstars”. They sometimes talk at special company events and other orthodontists worship at their feet and take selfies with them.
Training
This treatment cannot be taught by attending a day course based in an airport, helped out by business coaches, interested advocates, flash advertising and one man and a dog “schools of orthodontics”.
Unfortunately, there are no shortcuts. You can attend a three year specialty training course or gain considerable supervised experience as a general practitioner. This takes time, effort and hard work….
How do I sell the treatment?
You do not need to sell this type of treatment. It is the best way to comprehensively treat malocclusion. You should explain this to your patients to help them decide whether they want to have 24 month brace treatment. Alternatively, they can try another method that is a short-term compromise, not supported by scientific evidence, speeded up by myths or provided by people with minimal training………
Emeritus Professor of Orthodontics, University of Manchester, UK.
Sir gud one and nice thinking giving a paradigm shift in the orthodontic treatment and sir I want to add something if you permit can we put nano sensors in the bracket or the coil spring so that we can get the knowledge about the space closure progress and the casting with the software if possible than we can see the patient’s intra oral view at our own mobile
Bravo Kevin. This says it in a nutshell. I think it’s the most sensible thing I’ve read in many years regarding orthodontics!
Thanks also for the ongoing blog which is a must read for anyone associated with (evidence based) orthodontics.
Sounds like some form of archaic treatment from the 1900’s… frightening stuff!
I like your Humor…
I promote the Edgewise Zero slot bracket for 40 years now…I lecture on this subject since a long time….I ask you to lecture on Edgewise at London WFO meeting …Never response…I presented a lecture on Finishing at San Diego Meeting …never saw you! And now this is your “new Blog ” Let me surprised..
I have No sponsors because they make ni profits with the zero slot bracket, 0;30 its the bracket ..a little less that Damon or others snake oil traders!
I give courses at University for post graduate a Three day typodont course . I teach Non extraction treatment, and extraction treatment. 12 day course in Four session. That’s my way. You shows a lot of humour with your new paradigm. Let make everyone laugh.
All my best.
Sorry for my poor english..I’am French !
Thank you i have been practicing orthodontic for 25 years and have come to the same conclusion
Deaf ears out there dude
feisty!
Having attended the AAO in San Diego I can see your point about key opinion leaders.
However, there was plenty of ‘independent’ clinicians and researchers presenting with good quality evidence, sadly they were often tucked away in the smaller lecture theatres at 8am!
Without being too biased, Simon littlewood did rock the AAO in San Diego with his talk on retention. (No pun intended !)
This made me laugh out loud ……. sat alone at my desk after hours in an nhs hospital dreaming of being a rockstar!
I always enjoy your articles – I look forward to them, and keep copies to show people that what I am doing is the real thing!
Thank you Kevin for what you do. For various reasons, many specialist orthodontists who are all hospital trained, leave the nest to find work in practice.
Your blog is the link that connects us to the mother ship.
Your best blog to date! Love it!
Thank you for repeating this. Fixed appliance therapy is still the gold standard. Orthodontic Care provided by an Orthodontic Specialist is still the gold standard.
I suggest an additional system – “24 month no braces” a.k.a. Invisalign. I recognize that there are issues with Align Technologies and certainly agree that the company has done things at times that were troubling and perplexing. However, if you look at their 2016 published financial data, they had a BILLION dollars in worldwide sales last year. It is obvious that there is overwhelming patient/consumer acceptance for their appliance system. In fact, I have not seen an adult with fixed appliances in a few months and I live in a major American metropolitan area.
I think that this consumer preference has been going on since the inception of the system 16 or 17 years ago but many of us have been blind or non-accepting of this development. At the European Aligner Society (EAS) meeting that was held in Vienna, February 2016, Dr. Timothy Wheeler from University of Florida was reviewing the development and the tremendous progress of the Invisalign system that has been made the past 15 or 16 years. He first discussed a case report paper on a mildly crowded malocclusion (easily treated today) that was written by Doctors Vlaskalic and Boyd for the Australian Orthodontic Journal in March 2001. They reported that the system worked but was very limited: “when evaluating the occlusal outcome of this case, it is evident that conventional fixed or removable appliances could have achieved the same or a better occlusal result in arguably less time.” Incidentally I found it refreshing that these two academic investigators had high integrity with this honest evaluation since they were paid by Align Technologies. Somehow I think that the marketing and sales department would have preferred a more “gentle” evaluation.
The fact that fixed appliances may have given a better result in this particular case was really a moot point since the patient only agreed to treatment because there was an alternative to braces. In a way, I can understand that because 31 years ago when I was 35 years old, I had fixed appliances and found them to be difficult at times and certainly would have opted for an aligner system if it was available at the time. I wonder how many readers of this blog have ever undergone orthodontic treatment with fixed appliances as an adult?
Finally, I am not suggesting that fixed appliance therapy will disappear but only that we need to recognize that aligner therapy needs to be considered a legitimate alternative in many cases.
congratulations!
Professional must understand that the 24 months treatment i s all about the biology and not the metal or plastic we use. Orthodontists, along their life, fall in many traps. They place a lot of attention to those that promise faster, shorter, and more prifitable treatments systems, knowibg that they are being fulled. The problem is that once you falled you are ashamed to admit it and you pull your freind with you. Every body has to listen to Kevin and use hiz 24 months treatment idea.!
Please come to Washington DC in 2018 to talk to a packed room full of orthodontists! Everyone needs to hear this and reflect on what is going on currently in our profession!
And the good doctor hits another one out of the park! Thanks for your relentless pursuit of evidence and by extension excellence in orthodontics. Sadly this is in short supply in our present times.
In the age of airway focused treatment I think straight teeth is a very low bar to set for orthodontics.
Dear Kevin,
Here you go again – I have no problem acknowledging the additional training and expertise that Specialist Training brings – however there are alternatives out there that patients want and yes the published RCT evidence is generally poor for much in dentistry, as it is for Orthodontics generally!
Thus EBM/EBD includes multiple criteria NOT just RCTs, otherwise we’d have to down tools for 90% of dentistry if it was limited to RCTs being very clear, or nothing!!!
There is NO reason why GDPs shouldn’t do most of the ‘routine’ Ortho cases in Dentistry, with Specialists doing the more complex planning or cases or multi-disciplinary aspects etc, as happens in other Dentistry domains like Restorative and Oral Surgery, for example.
Orthodontics is still Dentistry, surely?
Yours proportionately,
Tony.
ps – you might want to change this blog’s picture OR suggest correcting the UR1 bracket position pronto 😉
Hi Tony, yes general dental practitioners should provide orthodontic treatment providing it is with in their competence. Can they gain their competence from a 2 day course. I do not think so…