Fall Newsletter - October 2008

We posted the last newsletter on the www.inner-smiles.com website but we realized that after you download the initial forms that our website may not make it to your Favorites list. We’re hoping that you are enjoying the cool fall weather and are able to enjoy the Colorado outdoors. Dr. Bentele took the picture above while camping with his 8 year old son Timothy at Skaguay Lake in Teller County. Caught a few rainbow trout, too.

We really believe that successful and enjoyable orthodontic treatment is a collaborative effort involving the patient, family, general dentist and the whole orthodontic office staff. Each newsletter we’ll pass on items of orthodontic interest such as healthy snack ideas, tips from Angela on insurance issues and a review of an issue of controversy in orthodontics. In the last newsletter available on the website, Dr. Bentele reviewed what clinical research is telling the profession about the effectiveness of the popular Invisalign method.

Want a healthy snack during orthodontic treatment?
Jamba Juice Smoothie Recipe

• 1/2 cup apple juice
• 3/4 cup strawberry nectar
• 1 cup frozen blueberries
• 1 banana
• 1 scoop of sugar free raspberry sherbet
• 1 scoop fat-free vanilla yogurt
• 1 cup of ice
• Blend and enjoy
  

ANGELA’S INSURANCE CORNER

How does my insurance cover the cost of orthodontics? Insurance usually only covers a portion of the treatment cost. The amount applied towards orthodontics is dependent upon the policy and that amount is disbursed over the course of treatment and not all upfront. We strive to obtain the best estimate of benefits when calling the insurance companies on your behalf to include history of orthodontic services used, actual billing codes, and associated charges to inform patients of their financial obligation towards treatment. We also sit down with patients to discuss the various options of payment prior to the start of treatment.

Typically insurance will pay 50% up to a set amount.  That does not mean they will pay 50% of the total treatment amount.  We strive to maximize the insurance benefits available to you.

It is important to keep us informed when insurance changes occur to prevent delays. If we are unable to provide an answer we may refer you to the human resources department that negotiated your benefits for your employer or the insurance company.

What’s the latest story about extractions for orthodontics?

Orthodontics has gone through several cycles with respect to extractions.  Extractions were common early
 on in the profession then fell out of favor only to resurface as a common treatment mode when I was
treated by Dr. Jaynes.  (Things have come full circle – Dr. Jaynes was an early mentor of Dr. Shaner in a St. Louis study club).  Then in the 1980’s extraction of permanent teeth once again came under scrutiny mainly by general dentists and some orthodontists. 

Here are the opinions against extractions followed by a sample of what the scientific evidence actually says:

So the opinions against orthodontic extractions do not stand up to scientific scrutiny.  Avoiding premolar extractions is desirable but not at all costs such as risking losing other teeth.  So here’s my take on extractions:  Avoid extractions as much as possible by managing the excess space available in the baby molar area.  Assess the ability of the patient’s soft tissues to withstand squeezing the crowded teeth into the limits of the anatomy.  The presence of thin, recession prone gum tissue; protruding lips; lips apart at rest and incisor teeth already angled outwards all lean me towards extraction. If the top teeth stick out too far, can the patient tolerate treatment to push all the top molars back or would it be more effective to remove two premolars for “camouflage” treatment?

So here’s my promise to you.  Treat every patient with a blend of art, science and experience to come up with the best individualized answer that meets our treatment goals.  That is why objectives are such an important discussion for us.  When do I extract teeth?  -- Only when I need to in order to meet your goals for a great outcome

To download this newsletter go to the bottonm of the page.

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Spring Newsletter - March 2008

This month’s topic: Invisalign versus traditional braces

Welcome to our discussion about topics of interest to today’s informed orthodontic patient or parent. 

Most orthodontic patients are interested in a beautiful, well functioning smile that lasts a lifetime.  Modern materials and methods make this goal achievable more comfortably, esthetically and sometimes quicker than ever.  There is a greater emphasis today on the effects of proper tooth placement on facial beauty but there has been very little change over the decades in what orthodontists consider a good finish or occlusion of the teeth.

There is great interest generated by marketing and the media on achieving a great smile without traditional braces. (Invisalign and others) I firmly believe that the most important item to agree upon between doctor and patient is the objective. Where do we want to go?  If we jump to the path (traditional braces, Invisalign, removable appliances) before we agree on the objective then we may not end up in the desired place.

Whenever possible I like to use evidence based care to evaluate new treatment modalities. So let’s see what the scientific literature in two of our most respected orthodontic journals has to say about Invisalign:

In study 1, I found that “Invisalign did not treat malocclusions as well as braces in this sample. Invisalign was especially deficient in its ability to correct large anteroposterior discrepancies and occlusal contacts. The strengths of Invisalign were its ability to close spaces and correct anterior rotations and marginal ridge heights.”  In study 2, I read that, “Invisalign aligners had adverse effects on posterior occlusal contacts and positive effects on tooth alignment, buccolingual inclination, and interproximal spaces.” And in the 3rd study I reviewed, the authors studied the potential for relapse with Invisalign and found that “In this sample for this period of observation, patients treated with Invisalign relapsed more than those treated with conventional fixed appliances.”

These were the best scientific studies I could find that looked at outcomes and were not just based on opinion.  Although Invisalign does some things well, overall in these studies it is inferior to traditional braces and in some measures resulted in a worse outcome than the initial malocclusion.  Which brings us back to objective; if your objective is the best outcome, then clearly, traditionally braces excel.  If you have minor problems and do not mind a less than perfect outcome in many areas then Invisalign has its place. So what is the alternative for someone who desires a great smile but doesn’t want to experience the “tin grin” look?  Even traditional metal braces are now much less noticeable than in the past.  The truly esthetic alternative is the Clarity Self Ligating bracket offered in this office.

The Clarity SL bonds directly to the tooth yielding maximum control but it is tooth colored porcelain for maximum esthetics and there are no “O” rings to hold the wire in place which may become stained.  So now you can have the best of both worlds: the great outcome you desire while preserving a great look while you’re undergoing treatment.

www.3mbraces.com

1. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system; Garret Djeu, Clarence Shelton, Anthony Maganzini; American Journal of Orthodontics & Dentofacial Orthopedics; September 2005 (Vol. 128, Issue 3, Pages 292-298)
2. Evaluation of Invisalign treatment utilizing the American Board of Orthodontics Objective Grading System for dental casts; Scott Vincent; American Journal of Orthodontics & Dentofacial Orthopedics; February 2005 (Vol. 127, Issue 2, Pages 268-269)
3. Invisalign and traditional orthodontic treatment postretention outcomes compared using the American Board of Orthodontics objective grading system;  Kuncio D, Maganzini A, Shelton C, Freeman K.; Angle Orthod. 2007 Sep;77(5):864-9.
   

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1) March 2008
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2) October 2008
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