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Over the past couple of decades there has been a shift in orthodontics from extracting teeth to expanding the arches when there is crowding present. Expanders work great, but there are some side effects that catch parents by surprise. One of them is the appearance and disappearance of a gap between the front teeth.
The palate or roof of the mouth is made up of two bones joined together down the center by a junction called a suture. When a patient is young, this suture is made up of stretchable cartilage that is the area where growth takes place (a “growth plate”). After skeletal maturation somewhere between 14 and 17 years of age, this suture fuses and the palate becomes a single solid structure. Expanders take advantage of the presence of the growth plate if they are used before it is fused. One sign that the expander has actually moved the two halves of the palate apart is the appearance of a space between the front teeth. The central incisors are located on different sides of the growth plate and they spread apart as the palate is expanded. The result is a visible gap between the teeth. This gap is normal and desirable.
After the expander has provided the desired amount of expansion, the orthodontist will typically leave it in place for several months holding the two halves of the palate apart while new bone develops between them. Upon removal of the expander, there is always some relapse or loss of arch width. Most orthodontists over-correct by a few millimeters in anticipation of this change.
During this stabilization period, the gap created during expansion tends to close on its own. This happens slowly over time, but it shocks many parents the first time they notice it is smaller or gone altogether. Understandably, many parents call our office worried that the expander has slipped and that the benefits achieved during the activation phase have been lost.
During palatal expansion there are two forces on the teeth. The force created by the expander pushes the palate apart and a gap appears between the teeth. At the same time there is an opposite force acting on the teeth produced by the gum tissues. Just like other soft tissues in the body, the gums are elastic. As the expander pushes outward, the gum tissue starts pulling the teeth back together. You can tell this is happening by comparing the size of the gap between the teeth with the amount of expansion visible on the expander. Rarely will the size of the gap between the teeth ever get as large as the distance between the two sides of the expander because the teeth start moving back together even before expansion is complete. Another sign that the front teeth are being pulled back together is that they get sore and feel a little loose during expansion for no obvious reason (just like when braces are moving them). Now you know that they are being pulled back together by the elastic fibers in your gum tissue. In fact, it is not uncommon for the gap between the two front teeth to be completely closed by the time the expander is removed.
Knowing ahead of time that an expander will create a gap between the front teeth and that it will go away on its own is reassuring when it happens. Understanding what is normal will save you some worry and an unnecessary phone call to your orthodontist. If what you see in your mouth or in the mouth of your child does not seem to follow the pattern described however, give your orthodontic office a call and let them know. It is better to be safe than sorry!

Hannah was the winner of our Valentine's Candy Corn Counting Contest. She won a $25 itunes gift card! Congratulations Hannah and we will see you soon at your next appointment!

Many people who want straight teeth never go through with treatment because they just don’t like the way braces look. In 1998, Align Technology introduced Invisalign tooth positioning aligners. Up until that time, the only cosmetic alternatives to silver braces on the teeth were clear (ceramic) or lingual (inside) braces. Why do orthodontists still use clear braces when Invisalign seems so much better?

Align Technology’s introduction of Invisalign changed the field of orthodontics forever. For appropriate cases, Invisalign does provide the esthetic alternative to metal braces that many patients are seeking. When Align bypassed professional providers and marketed directly to the public, they created a demand for their product and an expectation that teeth can now be straightened without wires and brackets glued to the teeth. Because the Invisalign system seems so much easier to use than conventional braces, more than 300,000 non-specialist dentists are now also offering orthodontic services in their practices. Although these changes have encouraged more patients to seek treatment, Invisalign is not a replacement for braces in all cases.

Although clear aligners are appropriate for many orthodontic problems, they are still biomechanically inferior to conventional braces in many situations. Because it is more difficult for plastic shells to create some of the forces required for complex tooth movements like turning round teeth, making teeth longer, and paralleling roots in extraction cases, most orthodontists still prefer to use brackets and wires for moderate to severe cases.

By taking Invisalign directly to the public without explaining its limitations, Align forces orthodontists to be “the bad guys” who more often than not have to give disappointing news to overly optimistic prospective patients. Only one out of eight patients who come in hoping for Invisalign have problems that qualify for aligner therapy. The other seven would obtain better result with braces.

Because Invisalign appears easier to use than braces, dentists with little or no orthodontic training are now also offering orthodontic services to their patients. Since most of us trust the advice of our family dentist, rarely do we question when he recommends a new service. The results obtained by any doctor however are determined by his skills and experience. Eliminating brackets and wires does not eliminate the need for accurate diagnosis, treatment planning, and case management. Invisalign is simply a tool not a replacement for experience and skills.

Dr. Hughes uses Invisalign to treat mild to moderate crowding and alignment cases. It is especially good for patients who have had previous orthodontic treatment but did not wear their retainers and have experienced some relapse. The fact that patients can take out their aligners to eat and brush is very convenient. Patients like it because it looks so much better than braces. So in many cases, Invisalign is actually the treatment of choice.

However, if Invisalign is not appropriate for your particular problem, you do have other options. The most tried and true economical alternative is clear braces. They have been around a long time and are now better than ever! Modern manufacturing techniques have overcome practically all of the long-standing weaknesses that have plagued previous generations of clear brackets. Today’s appliances are stronger, smaller, and do not stain like previous models. They can be used for the exact same complex movements as metal brackets and move the teeth just as efficiently. The only two drawbacks that remain are that they are still more fragile than metal (for athletes in contact sports), and they still cost your orthodontist more to purchase (which she must pass on to you).

So if you are dead set against metal braces you have options. Invisalign might be perfect for you if your problems are only mild to moderate. If you want the most cost-effective esthetic alternative to “railroad tracks” that can actually move your teeth like metal, ask your orthodontist to show you today’s clear braces. I think you’ll be impressed.

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