Hopefully the days of making teenagers wear fixed braces for a couple of years, often with extractions and headgear are nearly over. Most hate it and it’s now unnecessary.

My experience for every patient, at every visit, is that they ask ”when can the braces they come off”. The FREE price tag of the NHS may be hard to resist, but Private Orthodontics should be all about invisalign. Last year I placed about 100 teenagers in fixed braces, all done Privately. This year I will be treating all teenagers with invisalign. I may need to use a sectional fixed brace for a week or two to perform the odd movement that invisalign won’t work for in addition to the invisalign treatment. But that sure beats the confidence sapping treatment that teenagers hate. Why should they have to put up with yesterday’s technology?

The great thing with treating teenagers with invisalign is that the teeth move really well, better even than with adults who the system was conceived for. And because of the very real threat that they have of fixed braces if they don’t wear the braces, they comply brilliantly. Again, usually better than the adults.

So if you hear that your child “isn’t suitable for invisalign”, they probably are. Or that “they need extractions”, think again. They probably can be treated without. And they’ll thank you for it.

And if children aren’t ready for braces at all my advice is to relax. There is no ‘missed the boat’ feeling about invisalign as they can have the treatment at any age.

An overjet is the amount that the upper teeth protrude in front of the lower teeth. If teeth stick forward at an angle then they can be retracted with invisalign. Simple. Some tooth volume can also be removed by interdental reduction between the teeth. Then the teeth are retracted back to reduce the overjet. Again, simple.

However the biggest changes come when the upper arch, which is narrower than the lower is widened.  This allows the lower jaw to be freed to come forwards, which it does naturally or with the aid of twin blocks bonded to the invisalign appliance. Orthodontists experienced in orthopeadic orthodontics will rountinely build this into their treatment plans. An advantage of this, apart from the better aesthetic result is that the temporomandibular joint is aligned properly with the lower jaw.

This is advanced treatment that I routinely carry out for my patients, being particularly effective for teenagers who might have been told they need extractions or fixed braces with headgear. I have the cases to prove it works so I wonder why other orthodontists still use old fashioned methods. Still if the patients really want teeth out and braces and headgear for two years that’s fine. All referals welcome.

Experienced orthodontists will know all about using elastics and buttons to erupt the back teeth. Too compilcated for the Blog to be detailed here but advanced training Invisalign courses will train non orthodontists. Again it behoves the patient to choose a dentist with orthodontic training to get the best possible outcome when doing invisalign.

More usual though is the desire to produce level front teeth (the lateral incisors are often shorter than the central incisors).  Three choices exist to get level front teeth. Firstly porcelain veneers can be added to the shorter teeth to make them look longer. Secondly buttons and elastics can be used to erupt the smaller teeth with unpredictable results. And thirdly a partial fixed brace can be placed for a week at most to erupt the teeth as desired. Most patients will be fine with the idea with a brace for what is often just from Friday afternoon – Monday morning.

Attachments are shapes that are temporarily added to teeth to help with movements such as rotations. They are fine when on the back teeth, but do patients really want or need them on the front teeth? Attachments on incisors ruin the ‘invisible’ braces tag. So the trick is to see if they can be placed on the inside where they don’t show. Obvious really but no one else seems to do it. Also the need of attachments is age realted. Large rotations can be achieved without attachments as long as the patient is young enough, use aligner chewies and good about wearing the aligners. And for our older patients, even attachment won’t always untwist a twisted canine. Applying them in these situations prevents the seating of the aligners progressively throughout the treatment. Better to leave them off and concentrate on those movements that do work.