Children with Braces
Realities of Aligners for Children: What every parent needs to know or may have heard
Although we can offer aligners for children (and certainly teens), since the majority of approximately 75% of patients in most specialty orthodontic practices in North American continue to be children many parents have been choosing mini braces as well. Our office is similar and again, we do recommend aligners for children if:
1) They do not have many dental impactions, delays in eruption, jaw growth issues such as asymmetries, or deciduous teeth being lost in the future, etc., in order to reduce repeated dental re-scanning of the newly erupting permanent teeth.
2) The parent, and child need to be prepared according to the literature (Shahabuddin AJO/DO, 2023) for up to 3 extra sets of refinements above and beyond the first large group of aligners, that is directly related to 1) above.
3) The parent can be aware that their child particularly if in the average age group of 12-14 years old or younger, may not have all their teeth fully erupted and consequently have short crowns that make the aligners loose, or have newly erupting permanent teeth that can also make the aligners loose.
4) The parents are absolutely confident their child can wear the aligners the required 23hrs/day (to allow brushing-flossing, eating and snacking) for approximately a year or more, meaning each child may need to remove the aligners at least approximately 4 times/day X 365 days/year =1,460 times/year or more.
5) The child can seat each set of aligners with the new rectangular chewable “Kubie” (see their individual use also under EDUCATION, Biliateral Molar Intruder) to “track” the aligner with Kubie pressure tightly against the teeth to prevent air bubbles and express all of the orthodontist’s programmed movements accurately.
6) The child can remember to immediately place the aligners back onto their teeth after eating without feeling it is “gross” as reported at school particularly when having lunch. We recommend rinsing the teeth and aligners in the bathroom and placing the aligners with greater privacy and personal comfort.
7) The child is responsible enough not to lose the aligners that would delay their aligner treatment since new aligners would need to be ordered.
8) The child is careful not to break or flatten the aligners by lifting them with their hands and tongue, and chewing on them as we have seen. This would also delay their treatment, along with other complications.
Aligners for Adults:
Since most orthodontic practices in North America treat from their total number of patients, approximately 25% adults, aligners are a good treatment choice that we recommend regularly.
Aligners have been found for adults to be comfortable, esthetic and have the option of being removed for oral hygiene, eating, snacking and drinking.
One-Third Effective Rule Improved in Our Office:
It is important to keep in mind that in complex orthodontic treatments the literature reports that thermoplastic aligner forces fatigue significantly within the first three days. This appears to lead to the first large group of aligners being approximately 1/3 effective for incisor extrusion, intrusion, or torque (Kravitz, Kusnoto et al AJO/DO 2009, Haouili, Kravitz et al AJO/DO 2022, Simon et al BMO 2014, respectively). These are complex orthodontic treatments that involve correction of the vertical dimension, or transverse width of the bite ideally by an orthodontic specialist since they often involve much more than just the simple forward or backward movement of teeth for minor corrections. The vertical and transverse dimension problems include Open bite, Deep bite, Class III (underbite), Asymmetries, Extraction treatment, Orthognathic-surgery treatment and others, that are often a major challenge to correct with aligners.
However, today the three levels of the Supercorrection Prescription of 110%, 150%, and 200% overcorrection as guides have been developed and employed successfully to improve the performance of thermoplastic aligners significantly and reduce the number of refinements for adult patients. The Supercorrectoin Prescription Level 2, published in 2022 as a guide with the Seminars in Orthodontics article published in Jan 2022 demonstrating nine complex aligner treatments are used today at the university level. The rationale is that they uniquely employ comprehensive, scientific evidence-based data to aligner therapy (please see under EDUCATION, ALIGNER PUBLICATIONS) .