Ed Gracza, DDS on Orthodontics
Here are a few words about my experience, treatment philosophy and treatment methods.
I’m a general dentist and have practiced orthodontics for about 27 years. At any given time during that period, except for one year, I have carried an average caseload of about 40 people. I am not a specialist in orthodontics, who is called an orthodontist and completes 2 or 3 years of additional training beyond dental school. Orthodontists practice only orthodontics and not any other discipline of dentistry.
Providing orthodontic care is very rewarding because we are helping our client obtain something they truly desire. This is in contrast to having a tooth filled or extracted, which people do because they have to. We see the young person every month for about 2 years and get to watch them grow and change. We often see an increase in self confidence. When planning cases I’m reminded that everyone is unique. Although every client finishes with straight teeth they don’t lose their uniqueness. There are endless varieties of “straight”. The position of the teeth relative to the face and how it blends with their facial form and personality “unfolds” as their treatment progresses. It’s an amazing process. I’m sure glad God decided to make our teeth movable. What a great idea!
Today a good treatment philosophy will have respect for methods that involve the extraction of teeth and arch expansion methods (non extraction technique) . I think there is still a school of thought among certain practitioners today which prevailed in the 1970s and 1980s; that extracting teeth is always bad, that it always creates a “dished in” face. It’s just not that simple. There are many cases where extracting teeth is the best plan. Expanding jaws to make room can work well in younger patients. But expanding too far in adults can be unstable and compromise the health of the supporting bone and gums. Practitioners vary greatly in their approach to expansion vs extraction.
About 20% of our cases involve the extraction of teeth. I’m a firm believer in not trying to push the supporting bone to its physiological limits and being realistic about how far we can redirect growth. The face is the starting point and foundation of treatment planning: where do the teeth need to be to support the lips and cheeks and look great in relation to the form of their face? We decide with the client what that position is, then realize it as well as possible while respecting the physiological limits. We rarely can achieve ideal results; the goal is for maximum improvement. For every person it’s a compromise, trying to balance the desired treatment effects and the limitations.
Treatment is accomplished with orthopedic appliances, brackets and archwires. Redirecting bone growth is done with orthopedic appliances and there are many such appliances. I’ve used many kinds over the years and have learned that by far the most effective are the fixed appliances (as opposed to removable appliances ) such as the Rapid Palatal Expander and MARA (Mandibular Anterior Repositioning Appliance). Regarding bracket systems we use elastic-ligated and self-ligated, and regarding archwire mechanics we use a combination of sliding mechanics and custom looped archwires. So most of our treatment employs combining 2 or 3 of the above. Cases vary from simple to complex and last from 1 to 3 years. Most cases last about 2 years.