A reason to smile at new technology

Clear plastic molds can replace braces for some people

Health & Fitness

October 10, 2004|By Donna Gehrke-White | Donna Gehrke-White,KNIGHT RIDDER / TRIBUNE

Carolyn Bodzin, a business owner and mother of three in Golden Beach, Fla., felt she had to do something about her crowded teeth.

But she didn't want a mouthful of metal.

So she turned to plastic - thin, clear molds that cover all of her teeth but can be taken out for eating and drinking. The molds are realigning her teeth without the discomfort and embarrassment of braces.

"It seemed so easy and painless, I decided to do it," Bodzin says.

From teens to sixtysomethings, people are trying the new, nearly invisible, technology that is attracting an increasing number of once reluctant folks into dental chairs.

A University of Florida researcher has found in preliminary studies that the molds do straighten teeth and may actually be less of a threat to healthy gums than braces.

"It has re-energized me," says Dr. Stephen Grussmark, a former University of Florida orthodontics associate professor who says he uses the molds at his practice to correct even serious under- or overbites as well as to straighten teeth.

"I feel like I am a pioneer," he adds. "I know I can do something for people."

But the molds are more expensive than traditional orthodontic wear and they are not for everyone. Dentists steer away adults with more serious problems, as well as children who don't have their 12-year molars. Indeed, many dentists don't recommend the plastic wear except for minor cosmetic work.

Bodzin's orthodontist, Dr. Margo K. Brilliant, says she has to tell some patients that braces may do a better job. She reassures them that today's braces offer far less discomfort than in the past. Porcelain braces, for instance, are almost as hard to see as the plastic molds.

Still, Brilliant has become such an advocate of the new technology, which has been available for about seven years, that she put a computer at each patient's chair at her new dental office in Aventura, Fla.

That way, she said, they can look at how teeth would be gradually moved with the plastic molds.

The St. Louis-based American Association of Orthodontists does not comment on dental products, says spokeswoman Pam Paladin.

At least two companies now make the plastic molds.

Align Technology of California uses a process called Invisalign, in which 3-D computer technology translates a treatment plan into a series of plastic molds. A one-year treatment plan, for example, will have about 26 molds. Each would be worn about two weeks and then discarded for the next one to nudge the teeth still farther.

The molds "tend to be a lighter force" than braces, says David Thrower, Align Technology's vice president of global marketing. As a result, he says, many patients feel little or no discomfort.

Another California company, Ormco, offers a plastic mold technology called the Red, White and Blue no-braces system. It requires fewer molds and hence is cheaper, says Dr. Larry Elliott, a Fort Lauderdale, Fla., orthodontist and former president of the Florida Association of Orthodontists. He said he has used it on one patient for minor work and found it effective. He prefers Invisalign for more complicated cases.

Elliott says he has had to disappoint about half the folks asking for plastic molds to correct their overbites, underbites or crooked teeth. It turns out that they have more serious problems that braces and even jaw surgery can better solve.

Many, though, who want the plastic molds are professionals who want to avoid the embarrassment of braces, orthodontist Grussmark says.

Many men especially have shied away from braces because they felt they would hurt their careers, he says. (One of the founders of Align Technology, in fact, was an investment banker who was ribbed for wearing braces as an adult.)

But now several doctors and the head of a major corporation are trying out the nearly invisible plastic molds, Grussmark says. He has had some patients fly in from as far away as Europe and Latin America, he adds.

In a preliminary study of 60 patients - half with the molds, half with braces - Dr. Timothy Wheeler, chairman of the Department of Orthodontics at the University of Florida College of Dentistry, found that those with the molds didn't complain as much about discomfort.

The molds were also found to move teeth where orthodontists wanted. "It's just another force on the tooth," Wheeler says.

And another study of 100 patients wearing the Invisalign molds found they actually may be healthier for gums. Many of those wearing braces develop some gum problems because they can't floss or brush as well with the hardware on, Wheeler says. But since patients can remove the plastic molds to eat, drink, brush and floss, "only one or two" patients in the study developed gum problems, he adds.

"At first I was skeptical," says Dr. Daniel S. Meister, a former president of the Florida Association of Orthodontists who is in practice with Brilliant. "Then I saw the results. ... It does amazing work."

Pros and Cons

Orthodontists see advantages and disadvantages in using plastic molds instead of the more traditional braces.

Pros:

The clear molds are almost invisible.

Patients are not limited to certain foods because they can take out their molds at mealtime.

Gums can be kept healthier because the plastic aligners are removed for brushing and flossing.

There is little or no discomfort. There may be some discomfort when new molds are inserted. Doctors say the discomfort lasts a few hours at most. There are no metal wires to irritate a patient's cheeks and tongue.

Cons

Clear molds are more expensive, perhaps costing a third more than braces.

They aren't for children. Patients must have their 12-year molars.

Some doctors feel uncomfortable with the new technology or aren't convinced it works for difficult cases.

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