Autumn Leaves me Smiling
Connie scans a young patient with a state-of-the art CT machine at Pfister Orthodontics.
What a difference two weeks make!
Thanks to La Niña and a low stalled over the Northern Pacific Ocean which has caused the jet stream to dip South into the Northern Hemisphere (according to Scott Sabol, meteorologist for Channel 8), we’ve had the coldest two weeks in Ohio (for this time of year) in the last eleven years.
But thank goodness the Cleveland Guardians and local high school football have warmed up our area.
Congratulations must go out to the Cleveland Guardians, the youngest team in the MLB, for clinching the American League Central division title. These men have really put “watching baseball” and “getting excited” in the same sentence… without any drama. Imagine that!
I must give a shout out of congratulations and good luck for the remainder of the season to my high school alma mater, Highland High School, whose varsity football team was 7-0 going into Friday’s action. Other Medina County teams are also having great seasons, with Medina at 6-1, Buckeye at 6-1, and Cloverleaf at 6-1.
Along with the change in weather and sports, October is also breast cancer awareness month.
It is very important that we all be aware and vigilant for ourselves and our loved ones to have proper yearly breast exams. It is also important to be reactive to any lumps or changes in tissue color, texture, or feelings in our breasts, in general, and specifically if there are any family traits. In the last 20 years, the gold standard has always been 2-D mammography. But I must throw in my two cents here and say, just like in Orthodontics, 2-D is entry-level diagnosis; and only through 3-D mammography can even the smallest lump be found.
My cousin had 2-D done for years because insurance would not pay for 3-D, so she just went along with it. Once cancer was suspected, it was found with 3-D, due to my cousin’s particular type of cancer. She had a non-lump forming, stratified, thin-spreading sheet… undetectable with 2-D mammography. Radiologists have told me 3-D works much better with women having dense breast tissue, rather than predominantly glandular.
The BRCA gene test is an informative blood test that can look at mutations in your DNA in the breast cancer gene, either BRCA1 or BRCA2, to see if you have a higher risk of breast cancer. And please, I do not profess to be an expert on breast cancer, but having gone through it with my cousin and two other family members, you know what I have always told my readers… it’s your life and your responsibility! Ignorance is not a good medicine for cancer prevention or an excuse for death!
The iTero scanner used at the office of Dr. Pfister is another amazing development in orthodontic technology.
October is also Orthodontic Awareness Month; and after 37 years in the orthodontic field, I feel comfortable going over some of the really neat changes in orthodontics that have occurred in just the last five years…
Last weekend was Homecoming in several of our local high schools. This is an especially busy time for the orthodontist. We took eight students out of braces and two out of Invisalign®… then comes contouring and shaping the edges of various anterior teeth. In essence, we were going through a smile make-over.
As an orthodontist, it is truly the most heartwarming part of my profession to be able to complement a patient’s facial aesthetics, eyes, hair, and skin with a pleasing smile. My staff and I were hugged by quite a few moms and patients last week, who were overjoyed and speechless at what a difference a confidence-building smile can do for a person! Yes, this may have been a reaction to the cosmetic side-of-things. But orthodontics today goes much deeper with life-long lasting benefits for the entire body. The smiles created last week were not done overnight, but rather with parental and patient cooperation. With cooperation and a proper early intervention treatment plan, an orthodontist can work and guide genetic and pubertal growth to achieve a properly functioning bite, along with a dynamite smile.
Cosmetics without function is a shallow goal…
Let’s take a closer look at the pathway last week’s patients took to get the smiles they wanted.
The orthodontics of 20 years ago was pretty much like this: go in as an eighth or ninth grader, have several teeth extracted, and go into hardware for the next two to three years. Little attention was paid to genetics, growth periods, or familial traits — just straighten the teeth, especially the upper front six, go to a retainer for two years, and see what the future brings!
Today, in a nut shell, we have Phase I and Phase II. Phase II is full braces or Invisalign. It is the orthodontics of our parents. Phase I is early intervention, before nine years of age in many cases. Its purpose is to make room for the permanent teeth to erupt and allow the skeletal portion of the jaws to reach their genetic potential.
Phase I orthodontics (early intervention) has really come into its own in the last ten years for several reasons…
As with cancer diagnosis, 3-D radiography has raised the bar on orthodontic diagnosis to levels unheard of just ten years ago. My newest 3-D machine was delivered just a month ago. Powered by Windows 10, the resolution and capabilities dwarf my last two machines. Phase I, years ago, primarily involved an expander and pulling a couple of baby teeth… these are still valuable components of today’s Phase I, but we can now go even further with more stable results. The 3-D image can show the actual suture that we are expanding and show any impacted or hidden teeth that would interfere with expansion. These interferences are not able to be seen in any other dental x-ray, due to 3-D’s unique multidirectional camera angles.
We can also predict puberty, within 70% accuracy. Additionally, we can measure the airway three-dimensionally and get a volume-to-lung value that aids in evaluating sleep apnea in both adolescents and adults. I will go into this in a later blog, but suffice it to say that adolescent sleep apnea, with its accompanying hyperactivity and contribution to possible ADD and ADH issues, has been a recent field of orthodontic study, with major long-term benefits for the adolescent beyond straight teeth!
“What does puberty have to do with my teeth?” you might ask. Human upper jaws grow from nine to eleven or twelve years of age, but the lower jaw doesn’t start until the onset of puberty. That is the time to initiate bone growing procedures or moving upper front teeth more forward, to allow the lower jaw to grow. Many young people’s lower jaw never gets to reach its genetic potential, due to suppression by backward inclined upper anterior teeth, narrow upper jaws, or deep bites.
If these lower jaws are freed up and allowed to grow by early expansion and rounding out of the upper jaw through early intervention in Phase I, the child may not need Phase II (or not need teeth extracted). In the most extreme cases, a child that would normally have needed jaw surgery to advance the bone forward may not need jaw surgery at all!
One of the best summary statements I can give for Phase I is that the upper jaw is like a shoe and the lower like a foot — it’s easier to fit into a Double E than a Double A. But Ben Franklin may have said it best, “An ounce of prevention is worth a pound of cure.”
Yes, there have been a lot of recent orthodontic advances for adolescents, but it doesn’t stop there. The use of 3-D radiography and Invisalign has made tremendous advancements in adult orthodontic treatment.
There has always, as long as I have been in business, been a certain stigma about metal wires and brackets of conventional braces when adults considered getting a better bite and smile. The majority of the resistance to orthodontics by adults, especially males, has been removed with Invisalign.
I first tried implementing Invisalign in 2008 and, by 2011, I finished the last case and vowed I was done with clear tray therapy. Enter 3-D printing and polymer research to rival any dental product to date (except maybe the toothbrush) and I was back on board! Being in the Invisalign Fellowship (Invisalign’s ongoing educational institute) over the last two years has allowed me to be able to follow the current aligner research and has shown many groundbreaking advancements in adult treatment.
The current aligners/trays are made out of a special G8 proprietary polymer. I left Invisalign in 2011 at G3. This new G8 polymer is so predictable and has significantly less discomfort for the patient. It has made treating adults very enjoyable on both sides of the chair. We actually had a female patient go to the altar, yes, and say “I do” (and she did so with her Invisalign trays in place)!
Many people actually feel their teeth look better and feel better with the trays in, rather than out. This was never the case with conventional braces. Ever!
The fact that Invisalign can complete treatment in half the time of braces has also been a big plus for adults wanting a bite and smile enhancement.
But before you dial up your local orthodontist, you must first look in the mirror and ask yourself if you can be disciplined enough to follow a routine for 12-14 months! Yes, it is a great, no super, treatment modality, but I have been criticized for making it sound too easy! It is far easier than braces. But it takes determination, like starting an exercise program, to complete; and you must have clear goals about your bite and smile before you start.
Let me close with one of the coolest diagnostic instruments to come down the pike in the last several years…
Many of my readers will attest that the impressions, goopy material placed in trays and then into your mouth, were a remnant left over from the Spanish Inquisition. The impressions were required to produce plaster study models to diagnose a patient’s malocclusion, bad bite, and only the bite could be viewed with these skeleton-like teeth reproductions.
Enter the age of the digital wand scanner.
With the iTero scanner, data is shown in real time during a scan of the patient.
The size of a matchbox, a digital wand is waved slowly and methodically over all surfaces of your teeth. The data being captured is shown in real time on the scanner’s screen next to the patient. This data can now be used to show actual biting problems in the dark corners of the patient’s jaw, as well as demonstrate the outcome of several treatment options, including removal of teeth and space production for implants. It is truly amazing!
I take the data and create Invisalign treatment plans. Then, sent to a cloud, the plans are captured by Invisalign in Costa Rica and converted into clear polymer trays, numbered and sequenced for that particular patient’s treatment.
I’ve been invited to the Invisalign Summit meeting in Las Vegas in November (the first summit in two years), where the newest and greatest innovations will be unveiled for 2023. My regional manager let a little of the cat out of the bag… he said be ready to trade in your four-year-old scanner for the new 5G version. It is designed to integrate with our new Windows 11 3-D radiography. It will produce treatment plans using actual patient faces and design the trays to maximize the polymer’s effectiveness on actual root movements. We will also be able to integrate the software from both machines for prediction and treatment plans for our conventional brace cases!
It is truly hard to convey my awe and respect for the changes that have occurred in orthodontic treatment over the last five years…
It does have a little Star Wars flavor to it! But better diagnosis and better instrumentation means better and more predictable outcomes for the patient… truly a win-win scenario.
Just as the leaves are changing this Autumn, you can change your bite and smile and be seeing significant changes by the onset of Spring.
I would be remiss if I didn’t tell all my readers to get outside this weekend and stoke up the fires with your loved ones. Rekindle old flames. Roast an apple or marshmallow on a stick, cover it with chocolate, a few graham crackers, and you are in Fall Heaven!
Here’s to hoping Autumn “leaves” you smiling,
Dr. Pfister