Ortho v. Non-Ortho

Orthodontic Tooth Movement

Orthodontics physically moves teeth with braces into their proper position by pushing them through bone.  When the proper amount of pressure is exerted on teeth (with the use of springs) bone will disappear (resorption) in the area where the tooth is being pushed and will reappear (deposition) in the area where the tooth was originally.  It is usually healthier to treat malpositioned or crooked teeth orthodontically rather than non-orthodontically because orthodontics actually corrects the problem while non-orthodontic methods cosmetically hides the problem.  The drawback to orthodontics is that treatment can involve six months to two years of annoying braces while non-orthodontic treatment can usually be completed in one to two weeks.  Since the fees involved for either approach is usually comparable the decision for the patient should probably focus on the issues of health, duration of treatment and convenience.

1.  Traditional fixed (non-removable) braces - brackets can be clear (white) or metal.

     Traditional fixed (non-removable) braces are typically used to treat more complex orthodontic problems.  They can be used to correct rotations and can cause bodily movement of teeth through bone.

2.  Removable active appliance - looks much like a retainer or bite plate but it isn' t the same since it is used to actually move teeth.

      Removable active appliances are typically used to treat less severe orthodontic problems where teeth may be crowded out of the dental arch, in either direction to the tongue or lip, but where the teeth are not rotated.  Though these appliances are removable the patient must have the dedication to wear them close to 23 hours a day during active treatment to physically move the teeth.  This is in contrast to wearing a retainer (a removable passive appliance) only at night following active treatment.

Non-Orthodontic Tooth Movement

 Malpositioned teeth can be made to appear in proper position with non-orthodontic methods of sculpting, bonding,  porcelain laminates (veneers) and/or porcelain crowns.  It is possible to use one, two, three or all four of these techniques in the same smile.

1.  Sculpting - gently reshaping the teeth with the drill.

       This technique can simply and dramatically reshape crooked teeth without the need for novocaine.  The benefits of this technique are its simplicity and cost-effectiveness.  However, it cannot be used to treat more severe cosmetic problems.

2.  Bonding - acrylic sculpted within the mouth and glued to teeth.

        Teeth that are rotated or displaced towards the lip can usually be made to look straight by sculpting the tooth and adding tooth-colored bonding material to the inner (tongue) side of the tooth.  The results can be dramatic and usually take only one office visit.  Other benefits:  relatively reversible procedure that requires minimal to no drilling of the teeth, one third the cost of porcelain laminates and crowns.  Drawbacks:  not as strong as porcelain laminates and crowns and the cosmetic result is not as good as porcelain.

3.  Porcelain laminates - ultrathin veneers about the size of a fingernail which are sculpted in a dental lab and then glued to only the front side of the teeth.

         Laminates offer patients an ideal cosmetic result with a minimum of drilling.  This procedure, which usually takes two visits spaced over three days, is ideal for cosmetically treating teeth which are rotated or displaced towards the tongue or for teeth which are badly broken and/or discolored.

4.  Porcelain crowns - caps that are sculpted in a dental lab to cover all four sides and then glued to the teeth.

Porcelain crowns offer patients the same cosmetic benefits as laminates.  They are typically preferred over laminates when decay (a cavity) or old fillings are present in the teeth to be treated.  They are also used when maximum strength is needed, for example, if a patient has a deep bite.

Root canal therapy is sometimes performed, at the patient's option, to properly position teeth in a non-orthodontic manner.  It can be accomplished quickly and with little discomfort.  Root canal therapy is typically followed by the placement of porcelain crowns.  Imagine the cross-section of a tooth having a circle within a circle.  The outer circle is the tooth enamel and the inner circle is a hollow canal or opening within which the nerve and blood vessel of the tooth travels.  It is possible to sculpt away tooth enamel to reshape how it looks up to a point beyond which the root canal would be encroached.