Start to finish
Everyone look, no braces. This was the big day for this 13 year old. No braces! We just took her orthodontic brackets off her teeth. We were able to help her have a great smile with timely intervention. We started her treatment when she was 11 years old. Her teeth were crowded without enough room for her maxillary, or upper canines, canines to erupt. After careful analysis including model analysis and cephalometric analysis (that is an x-ray taken of the side of the patient’s head, a decision was made to do non extraction orthodontic therapy.
Our first goal of treatment was to save the e-spaces. The e-spaces is our term for the space generate by the loss of the primary second molar, called in our nomenclature the e-tooth. Saving the e-space can generate approximately 5 mm per arch. Even with saving the e-space we were short space in her upper arch. We generated space with appliance therapy, called the Greenfield Molar Distalizer, creating enough room for all her upper teeth. If there was crowding on the lower arch space can be generated by using a lip bumper. We used bonded retainers on the inside of her upper teeth to help them stay straight after appliance therapy. You can check out non-extraction orthodontics at https://nextortho.com/
Here is her picture the day the braces came off.
The alternative treatment often used for crowding is to extract all the first premolars and then close the spaces. This often has the added benefit of ideal placement of the front teeth. Once the front teeth are positioned the back or posterior teeth are brought forward to close the remaining spaces. Dentistry has gone back and forth between non extraction and extraction treatment. When well done there is little difference in the final smile. Often which treatment is chosen is a preference the dentist or orthodontist and their training and may have little to do with the patient. Some orthodontist choose no braces and rely on removable appliances. It is a little different than most techniques but I saw an orthodontist lecture from Long Island and his no braces technique was working very well creating beautiful smiles. In Europe appliance therapy without braces is more commom.