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Esthetic Orthodontics 104: Incognito

Esthetic Orthodontics 104: Incognito

We have come to what is largely considered the “State of the Art” when it comes to esthetic orthodontic treatment, Incognito™.  Incognito™ is a whole system that involves a patented technology to allow braces to be placed on the inside (tongue side) of the teeth so that the braces do not show.  This is generically called “lingual braces.”

At first, lingual braces appears fairly simple, but there is actually a lot more to it than just putting the brackets on the inside.  In the past, lingual braces were performed by orthodontists with mixed success.  The problems were that the brackets were much more bulky and uncomfortable and the mechanics were very difficult for the orthodontist to get just right.  3M makes the Incognito bracket system to overcome these shortcomings of the past.  Through a proprietary system of customized brackets, wires and tooth planning, they deliver on the possibility of achieving the results that we get with braces on the outside of the teeth.
The first innovation is that the brackets are custom made for each patient.  This allows the brackets to be made very thin and close to the tooth surface.  This increases comfort and helps the brackets stay on the teeth.  Next, the wires are also customized by having the whole set of wires bent by the lab.  This removes the challenge of bending the wires for the orthodontist and allows a very high level of precision to be obtained.  Finally, all of the tooth movements are pre-planned.
Pre-planned and customized tooth movements are quickly becoming the way that orthodontic treatment is planned.  We can set a goal on the computer and then have the brackets and wires manufactured to achieve that end result. 
Here isan example of what a “set-up” looks like for a patient.  The orthodontist role is to guide the lab and make sure that the tooth movement is correct and the end result achievable.

We can even superimpose the final ‘goal’ with the ‘initial’ position of the teeth to better plan the tooth movement.  Here the initial position is in purple and the final position is represented in white.

The most impressive aspect of the Incognito system is that fact that we can achieve with great precision the tooth movement that we set out to accomplish.  In other words, the final result will match the “set-up”.  Published in AJODO in 2011, “Accuracy in tooth positioning with a fully customized lingual orthodontic appliance” by Dan Grauer and William Proffit showed how the system can produce the set-up goal in actual clinical patients.

But of course, what patients care about is that the brackets do not show and yet we can accomplish all of the movement.   This patient has lingual braces on the upper and lower teeth and has even had a teeth extracted.

We also have lingual braces on just the upper teeth as shown here on a different patient.  This helps reduce the added cost of the customized braces but improves the esthetics of the smile during  treatment.

To see more videos of our patients with lingual braces and to hear how this might affect speech, visit our video library.
 

 

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Employee Spotlight: Fran

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Employee Spotlight: Fran

Employee Spotlight: Fran

One of the things that sets AOA apart from other orthodontic offices is our team. We're not just coworkers; we're family. And our family is dedicated to creating an inviting and warm environment for our patients. Every single team member is vital to our organization, and bring their unique talents and personalities to the office. So we want to turn the spotlight on them! Every month, we'll be highlighting one member of our team to help you get to know them a bit better, and to share what makes them special.

Name: Fran
Title: RDA (Registered Dental Assistant)

What is your favorite ice cream flavor?
Cookies 'n Cream

What do you do for fun?
I like to go see live bands play!

What is your favorite spot in Austin?
Barton Springs

What do you love most about AOA?
The people I work with, and the wonderful environment.

Why is having a beautiful smile important to you?
Having a great smile is so important! It makes people have more confidence.

Thank you, Fran - you are a joy to work with and a valuable asset to the AOA family!

 

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Esthetic Orthodontics 103: Invisalign

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Esthetic Orthodontics 103: Invisalign

Esthetic Orthodontics 103: Invisalign

“Invisalign” is a brand name of the biggest and best manufacture of clear “aligners” that can be used to move teeth.  The idea of moving teeth with clear trays is not a new one.  Orthodontists have moved teeth with clear trays for more than 50 years!  In the past, an orthodontist would make a physical model of a patient’s teeth and then move one or two teeth a small amount and make a clear tray to fit the teeth in the new position.  When worn by the patient, the tray would put pressure on the teeth that had been moved on the model and the patient’s teeth would adapt to the new position.  It worked great, but it was extremely limited because we could not move “all” the teeth and for every tray we made, it would require a new impression and new model.  So moving teeth very far was not really practical.

The genius of Invisalign is that they applied a computer design and manufacturing process to this idea of moving  teeth with clear trays.  This allows an orthodontist  to model “all” the teeth moving and also allows tray after tray to be made in a series without the need for multiple impressions!  Yeah!  In fact today, we can do the whole process without a single impression  by using a digital scan of the patient’s teeth (but the advantages of a digital scanner will have to be a blog for another day;  stay tuned).

The Primary Advantage of Invisalign is Esthetics.

Of course, the reason that Invisalign has capture so much of the orthodontic market is because it allows patients to have the tooth movement that they need without the look of braces.  The trays are clear and are changed every two weeks so they stay very clear and unnoticeable in social situations.  Another huge factor in the “esthetics” arena is the fact that the aligners are removable.  So if you have a particularly important speaking engagement or photographs to take, you can remove them for the special occasion.

Here is one of our patients, wearing her aligners.  As you can see (or should I see can’t see), it is very unnoticeable.  

The Seconday Advantages are Numerous.

Patient’s understand the esthetic advantages of the aligner process, but often underappreciate the other advantages of moving  teeth in this way.   At the risk of being  too long-winded.  Here is the top 10 reasons that aligners are cool (beyond the estethics).

1. Brushing and flossing  are tons easier!  The fact that the trays are removable can be a great benefit to the ability of a patient to clean their teeth.  Instead of brushing and flossing ‘around’ the orthodontic appliances affixed to your teeth, you remove the trays and ‘have at it’.  

2. Aligners are much more comfortable than braces.  Braces take some getting used to in terms of the lips and cheeks or tongue adapting to the roughness of the braces.  Aligners are very smooth and being removable, can be easily modified if there is part of the tray that is rubbing. 

3. The forces are very controlled.  Because each step along the path is calibrated to very precise degree, the forces that patients’ have on their teeth is much more controlled and limited.  The ‘soreness’ that patients can have with braces is almost completely eliminated  with aligners. 

4. The tooth movement is pre-planned.  With aligners we pre-program the system to achieve a desired end-result.  This is very different than with traditional braces where our ‘target’ only exists in the mind of the orthodontist.  If the teeth are being moved to facilitate some other dental work, the final result can be visualized before the treatment begins.  This also allows us to be selective about which teeth to “NOT” move or stay in the pre-treatment position.  Maintaining an exact pre-treatment position is often difficult with braces, but is simple when the movement is pre-planned.

5. Emergencies are almost entirely eliminated.  With fixed braces, there can be discomfort associate when a wire or bracket becomes detached from the rest of the orthodontic appliances.  This can lead to pokey wires and undesired tooth movement if the patient is not seen fairly shortly after the bracket or wire breaks.  With aligners, there is almost nothing to ‘break’.  If a tray is lost, we have the patient go to the next tray and continue on the sequence.  This makes aligners particularly attractive to patients who come to see us from great distances.  If getting to our office involves a plane trip, we want to minimize the risk of extra ‘emergency’ appointments.

6. Speech is largely unaffected.  Most patients adapt to speaking with the aligners within a couple of days of wearing them.  With some other orthodontic appliances, speech affects can be much more. . .eh-em. . . . ‘pronounced’.

7. Tooth wear from grinding is prevented.  With the trays covering the teeth, if you grind your teeth, you simply wear the plastic.  So if you are prone to grinding this is a great way to protect the teeth during your orthodontic care.  With traditional braces, this is a challenge because a nightguard will stop fitting as the teeth are moved with braces.  These following photos are of a patient who was specifically concerned with tooth wear from grinding.  You can see the wear on the edges of the teeth in the first picture.  Then the second picture is with the aligners on the teeth.  Notice that there is plastic between the teeth protecting them as they move.

Without Invisalign

Without Invisalign

With Invisalign

With Invisalign

8. Tooth bleaching can be done with the aligners.  As patients’  teeth straighten, many also desire show off their pearly whites with ‘more white’.  The invisalign trays can actually be used as a bleaching tray to whiten the teeth as we go along.

9. Retainers are digitally stored and can be reordered.  With traditional braces, the retainer is made on a plaster model that is destroyed in making of the retainer.  If a patient loses or fails to wear the retainer and the teeth shift slightly, often the best option is just to make a new retainer in the shifted position to prevent further shifting.  When aligners are used, the patient’s final tooth position is saved and the retainer can be made to the ‘digital model’.  If a new retainer is needed, another can be ordered without the need to take another impression.  If the teeth have shifted (a very small amount) the new retainer can move the teeth back to their final position.  If the shifting is more pronounced, then the new retainer may not fit.

10. Patient’s love them.  For the most part, our aligner patients really appreciate how easy this process is for them.  Of course, there are some who struggle with remembering to wear the trays or find it inconvenient to take the trays out for meals, but for the most part, patients really like the Invisalign process.  This is especially true for patients who have worn braces in the past.

 

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Employee Spotlight: Venita

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Employee Spotlight: Venita

Employee Spotlight: Venita

One of the things that sets AOA apart from other orthontic offices is our team. We're not just coworkers; we're family. And our family is dedicated to creating an inviting and warm environment for our patients. Every single team member is vital to our organization, and bring their unique talents and personalities to the office. So we want to turn the spotlight on them! Every month, we'll be highlighting one member of our team to help you get to know them a bit better, and to share what makes them special.

Name: Venita
Title: Dental Assistant/Lab Tech

What do you do for fun?
Have cook outs, and go fishing or camping.

What is your favorite ice cream flavor?
Vanilla

What is your favorite spot in Austin?
The lakes - I love the outdoors.

What makes you smile?
The smile on a baby's face.

What's the funniest moment from the time you've been at AOA?
When Dr. Hime and Dr. Salome first became partners,  they commemorated it by putting on one giant pair of tighty whiteys!
(Ed. note: We'd love to see the picture of that!)

What do you love most about AOA?
The closeness of the staff, and how well we work together.

Why is having a beautiful smile important to you?
It makes you feel better about yourself!

Thank you Venita, for all of your hard work, and for being such a vital member of the team! 

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Esthetic Orthodontics 102 - Ceramic

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Esthetic Orthodontics 102 - Ceramic

Esthetic Orthodontics 102 - Ceramic

The next step up on the “esthetics” ladder for orthodontic options is to consider ‘clear’ or ceramic brackets.  These have traditionally been made out of a variety of tooth colored materials, but the state of the art today is to make these esthetic brackets out of porcelain.  Being made out of porcelain means the brackets are strong enough to withstand the rigors of being in a patient’s mouth, and still hold up and deliver the correct forces to the teeth to create the desired change.  Porcelain is also very resistant to picking up stains, which of course is important to the esthetically minded patient.

The ceramic brackets that we recommend incorporate a gate to hold the bracket to the wire similar in design to the Speed brackets that we use.   This again eliminates the need for using ties which helps with a number of mechanical properties, but also eliminates the staining of the ties.  Clear brackets that require ties can be prone to looking bad due to the rubber tie itself staining.  Our brackets eliminate this problem by eliminating the rubber tie.

Finally, this photograph shows how we recommend to avoid using ceramic braces on the lower teeth for most patients.   First off, the lower teeth just do not show as much; and second, it avoids the risk of chipping the upper front teeth.   Although there are some exceptions, usually the upper front teeth have some risk of contacting the lower braces because of the overlap of the upper and lower front teeth.  Since ceramic is a much harder material than tooth enamel, there is a risk of chipping the upper front teeth if the ceramic brackets on the lower teeth come into contact with the edges of the upper teeth.  Metal brackets do not have this risk as the metal is softer than tooth enamel.  This is main reason we almost always recommend metal brackets on the lower teeth.
While improving the esthetics of the orthodontic treatment, ceramic brackets allow us to retain all the functionality and flexibility of orthodontic treatment with braces.   We can easily make adjustments along the way and change the treatment as needed.  If you are looking for ideal control of the teeth with some improved esthetics over metal braces, then ceramic braces might be the perfect choice for you.

 

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Esthetic Orthodontics 101

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Esthetic Orthodontics 101

Esthetic Orthodontics 101

It may be surprising to some of you, but I am going to begin our discussion of esthetic choices for orthodontic treatment with metal brackets.  I know, you are thinking “what an orthodontist!”  However, by the end of this blog, I hope that you will see that there is really no better place to begin!   You see, NOT all orthodontic brackets are created equally, and I could spend the next several blogs talking about the wonders of this little masterpiece of engineering wonder.  At the risk of not boring those of you who are not in the dental field, I will limit my discussion of the advantages of this bracket solely in regards to ESTHETICS.  

speed bracket small.png

This is a Speed bracket and it is THE MOST esthetic metal orthodontic bracket on the market today.   Now before you say, “A metal orthodontic bracket cannot be esthetic.”  Let me show you some brackets from the past and present.   30 years ago, each tooth had a band that went all the way around the tooth which obviously was not very esthetic.  When bonding brackets directly to the teeth became possible, the esthetics improved, but orthodontists needed to use little rubber rings to connect the brackets to the wire.  These brackets were better than bands in regards to esthetics, but still nowhere near where we are today.  

Not so good old days of Full bands.  No orthodontist uses these anymore.

Standard brackets with bands on the molars.  Most orthodontist still use these style of brackets.

Our brackets (made by Speed Systems) are much smaller than traditional brackets!

Here is side-by-side comparison between speed braces and some of the other brackets (both metal and ceramic).  You can easily see how much smaller the speed brackets are which (of course) means BETTER ESTHETICS!

Ok, let’s take another look, because there is another feature that will greatly enhance our esthetics of these brackets.  Speed brackets have a gate that holds the wire and therefore do not require the rubber rings of traditional brackets.

A patented gate holds the wire to the bracket thus foregoing the need for ligature ties.  By using a gate instead of the rubber ligature rings, it not only improves the reliability of the bracket-to-wire connection, but it GREATLY improve oral hygiene!  This was actually proven in a study from the University of Texas Health Science Center in San Antonio, but here is a patient that shows how much this can make a difference.

Here is a patient that came to our practice with traditional braces and very poor hygiene!  We informed him that to finish his treatment we would have to change his brackets to Speed braces that would be easier for him to keep clean!

This is the SAME patient one month after we changed out the brackets to Speed braces!  WOW!  Hard to believe that this is the same patient, but this is how his teeth looked walking in to our office for his first adjustment with his Speed braces.  Much of this improvement can be attributed to better brushing, but I think having the smaller Speed braces without the rubber rings really enhanced his ability to keep his teeth clean!   They were this clean at every remaining appointment that this patient had.

“What about colors?” you might ask.  We have many patients that really want to decorate their braces with the colors.  Of course, we allow them to do so, but only if they are keeping up their part with good brushing!

Image from Speed website

Image from Speed website

So there it is, all the reasons that I thought the discussion of “ESTHETIC ORTHODONTICS” should begin with our little metal braces.  Tune in next time for the next step toward better esthetics by looking at clear (ceramic) braces.

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MossFest Fundraiser

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MossFest Fundraiser

Family means everything to us here at AOA. Our children, or spouses, and even our work family holds a very special place in our hearts. The idea of anything happening to our loved ones in a scary thought, though sadly it is a reality for some families.

When Jessica and J Pieratt lost their 14-month old son Moss to SUDC (Sudden Unexplained Death in Childhood) they were heartbroken and searching for answers and comfort. Moss was a joyful spirit, singing songs and bringing a smile to the face of everyone he knew.

In honor of his short but smiled-filled life, his parents created the Moss Pieratt Foundation. The foundation serves as a honor to Moss' memory, an outlet for raising funds and awareness for SUDC, and a place to help those also going through the loss of child. 

In an ultimate celebration of Moss's life and love of music, the Moss Pieratt Foundation is proud to announce the first annual MossFest! Held during the Kite Festival on March 6, 2016, this festival will be the first family-friendly celebration of music in Austin. You can learn more about the event in the video below.

Austin Orthodontic Arts is proud to help sponsor this event. We are accepting donations at our office, and will match them up to $5,000. If you would like to donate, please stop by our office during business hours or call us at (512) 458-4103. Help us bring MossFest to Austin, and honor the memory of Moss Pieratt.

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Loss Aversion and Esthetic Orthodontic Treatment

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Loss Aversion and Esthetic Orthodontic Treatment

The last few blogs have addressed some of the esthetic benefits that we can achieve with orthodontic treatment.  So now I would like to turn our attention to the possibilities of achieving the outcome in an esthetic way.   But of course, we need to back-up and elucidate the psychology behind the importance of keeping orthodontic treatment esthetic. 

There are lots of great examples of how despite our belief that we are making strictly rational choices, we are in fact subtly guided by tendencies of which we have no conscious awareness.   One of the best examples of this irrational behavior is called “loss aversion”.  Loss aversion, simply put, is the almost universal tendency to avoid losses over pursuing similarly sized gains.  We avoid pain more than pursue pleasure.  Think of a five dollar gamble on a coin flip.  For most of us, losing the flip and the five bucks is FEELS much worse than the winning FEELS good.  Psychologist have actually quantified this tendency and have found that it is nearly 2:1 depending on the study.

One of my favorite examples of Loss Aversion in a study comes from Dan Ariely (Predictably Irrational, 2009).  I like this example because it shows how even kids are guided by Loss Aversion.  In the study, he offers kids a choice:

Two Hershey's Kisses
OR
A Snickers bar

Now (of course) the overwhelming majority of kids want the Snickers because it is just MORE chocolate.  But Dr. Ariely then gives a different group of kids the same choice but offers it a bit differently, and here is where it gets interesting.  

In the second group he gives the kids one Hershey’s Kiss to hold in their hand.  This first Kiss becomes “theirs” and its value is greatly elevated.  Dr. Ariely then tells the kids that they can have one of two choices again. 

He offers one more Hershey's Kiss "for free
OR
He offers them the option to trade in the one Hershey's Kiss for a Snickers bar

Notice that the end points of the choices are the same as the first scenario; either the kid will end up with two Hershey’s Kisses, or the kid will end up with one Snickers bar.  So the choice seems exactly the same as the first scenario, only now the outcome is just the opposite. The overwhelming majority of the kids will keep their Hershey’s Kiss and take another “for free” rather than give up the one that they have for the Snickers.

What does this have to do with orthodontics?  Well, it turns out to have very much to do with “esthetic orthodontic treatment”.  One of the main reasons that patients seek orthodontic care is to help them (and their smile) look better.  So when they come to the orthodontist, they are seeking some improvement in smile esthetics, but are faced with the potential loss of smile esthetics associated with the application of braces on the outside of their teeth.  Because these patients are ‘loss averse’ they cannot get over the psychological hurdle of ‘the look of braces’.  This ‘aversion’ is particularly poignant because it is a loss of the same quality for which the patient is seeking care for in the first place.  That short-term loss of dental esthetics looms much larger (in their minds) than the long-term gain after treatment is complete. 

All of orthodontics is a short-term liability for a long-term gain in better dental esthetics.  Just imagine if I could tell you that if you exercised for 18 months that you could have the body of your dreams for the rest of your life.  Who wouldn’t do that?  I have to say that one or even two years of braces does not seem like a big deal to me when the reward is a lifetime of a beautiful smile and proper bite, but that may just be the orthodontist in me talking.  I have come to appreciate that for many patients, an esthetic means of treatment is the only way that they will consider care. 

For these esthetically minded (and loss-averse) patients, we have a whole myriad of choices that we offer.  We offer clear (ceramic) brackets, Invisalign and lingual braces (that are placed on the backs of the teeth).  Each has some definite advantages and disadvantages, and I will spend the next few blog posts high-lighting each in turn.  So if you have thought about improving your smile but have thought that the process would be too much to consider, stay tuned. . . .

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Orthodontics and Facial Beauty, Part IV: Mid-line Discrepancy

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Orthodontics and Facial Beauty, Part IV: Mid-line Discrepancy

In the past few posts, I’ve shown examples where our patients started out with pretty straight teeth, but because the manner in which the teeth were positioned within the lips led to imbalances in the profile, lips, and smile.  This post will address another such example that we deal with routinely in our practice.  When the teeth are not centered in the smile, we call this a mid-line discrepancy.  

Mid-line discrepancies are very common in our patient population (people who have come to us because of crooked teeth or a bite related problem).  Most pre-orthodontic patients have some degree of mid-line discrepancy in either the upper or lower teeth, and sometimes in both.  Mid-line discrepancies are often an indication of a more significant functional problem with the manner in which the back teeth bite together.  Upper mid-line discrepancies can detract from the beauty of the smile, and today I’d like to show you the treatment of an adult patient who had an upper mid-line discrepancy.

Here is an initial photograph of a patient who had pretty straight teeth, but the upper mid-line is not aligned with her nose or the center of her upper lip.  The little dip at the top edge of our upper lip is called the cupid’s bow, and the upper teeth should be centered with the cupids bow.

A closeup picture of her teeth shows that the upper mid-line does not line up with her lower mid-line either.  This was an indication to us that there was a bite problem with the way in which the back teeth were biting together. Correction of her bite problem would correct the problem with her upper mid-line as well.

Facial Beauty Part 4 Pic 3.png

A progress photo taken part of the way through treatment shows that the mid-lines have been aligned with each other as the bite problem is being corrected.  This patient wore Speed braces, and had her upper left second premolar tooth removed to provide the necessary space to correct her upper mid-line discrepancy, and to correct the bite problem that was primarily on the left side of her mouth.

Here is a picture of her final result.  You can see that her upper mid-line now is in perfect alignment with her nose and her cupids bow.

If we look at a closeup photo of her teeth after treatment, you can see that her upper mid-line is now almost perfectly in line with her lower mid-line.  Her bite problem was corrected, and her dentist remade the porcelain crown on her upper left front tooth that had begun to deteriorate.  The patient’s concerns about her upper mid-line deviation, and her dentist’s concerns about her bite being off were both addressed with her orthodontic treatment.

Smiling is an expression that conveys pleasure, happiness, friendliness, and amusement.  Therefore, it is one of the most important features associated with facial beauty.  In our last few posts, we have written about how subtle things (like how much gum tissue shows when we smile broadly, if our teeth are not level with our eyes and other facial features, or if our teeth are not well centered in our face) can detract from the appearance of our smiles.  More importantly, it can create a self-conscious smile in which we seek to hide our true smile.  Our happiest of smiles (one that involves our mouth AND our eyes) is called a Duchenne smile, named after the 19th century neurologist Guillaume Duchenne who discovered that we have two kinds of smiles-a “fake” smile that involves our mouth only, and a “true” smile that involves our mouth and our eyes.  Recent research shows that it is only our “true” smile that is associated with positive emotions.  For these reasons, it is important that we not be self-conscious about our smiles.  When we are happy, we need to show that we are happy-without reservation.  In this way, we are able to convey to the world that we are friendly, happy, and approachable.  Anything less, and we might send the wrong message to those around us.

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Orthodontics and Facial Beauty, Part III: Tilted Teeth

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Orthodontics and Facial Beauty, Part III: Tilted Teeth

In my last post, I showed that straight teeth don’t necessarily make for an attractive smile.  If the smile is too “gummy”, the smile is not as attractive as if the teeth are positioned properly between the lips.  If the smile is not attractive, it is natural for a person to “hide” their smile.  “Hiding” the smile can be done quite literally by hiding the smile with the hands, or can be done in subtle ways like turning the head or avoiding a broad smile altogether.  I think that sometimes, a cynical personality can develop from a lifetime of hiding a happy smile.

So have you ever considered what it would look like if the right side of the smile was not level with the left side of the smile?  We encounter the situation of a “tilted smile” every so often, and correction of this problem has a dramatic effect on the beauty of the smile.  This particular problem is technically called a “canted occlusal plane”, and oftentimes, the problems roots like with the manner in which a person’s jaws have grown.  Uneven growth of the lower jaw changes in the way that the upper jaw grows, leading to a tilted smile.

Here is a patient who exhibited a tilted smile.  You can see that although her front teeth are pretty straight, the edges of the front teeth are not level.  They tilt down on her left side.  The photo is cropped with her eyes and her ears level, and her head is held straight, so the problem is clearly with her teeth.

When we asked her to hold a stick between her teeth, the problem is readily apparent. 

Here you can see progress being made part of the way through her treatment.  We used Speed braces, and we used something called a temporary anchorage device (TAD) to help move the teeth on her left side upwards.  We will write more about the relatively new technology involved with TADs in a future post.  Combining this with the use of rubber bands on her right side to move those teeth downwards a bit is creating a level appearance to her teeth.

After the completion of her orthodontic treatment, you can see that we’ve completely corrected her tilted smile.

Just as verification, we had her hold the stick between her teeth again, and you can see that indeed her smile is no longer tilted down on the left.

Comparing her beginning smile to her ending smile shows the dramatic effect that having a level smile line can have on the beauty of the smile.

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Orthodontics and Facial Beauty, Part II: Gummy Smiles

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Orthodontics and Facial Beauty, Part II: Gummy Smiles

In my last blog post, I wrote about how well planned orthodontic treatment can positively affect facial appearance by improving the profile.  Consideration of the profile is critical in orthodontic treatment planning.  A well balanced profile is our goal on each and every patient we treat.  Another aspect of orthodontic planning that few people know much about is how orthodontic treatment can affect a “gummy smile”.

A gummy smile is one in which there is an excessive amount of gum tissue that shows over the front teeth when a person smiles.  It is normal for a teenager to show a small amount of the gums, but when there is too much gum tissue that shows, it is not attractive by most people’s standards.  As a result, a person with a gummy smile will “hide” their gummy smile by not smiling as big.  Imagine not being able to fully smile when you are happy!  People with gummy smiles get so good at hiding their gummy smile that they actually forget how to smile naturally!

Here is a smiling picture of a patient who shows about 4-5mm of gum tissue above his front teeth when he smiles.  This is not a big, natural smile either.  When he actually smiled fully, he showed even more of his gums.  Orthodontic treatment can be designed to move the upper front teeth in an upward direction.  This is not intuitive to most people, as it seems like the teeth would get shorter as they are moved upwards “into” the gums.  Actually what happens is that the gum tissue will move upwards with the teeth, and the gummy smile will be eliminated or reduced.

Here is a picture of him while he was still wearing braces, after his upper front teeth had been moved upward to reduce the gummy smile. You can see that his gums are now hidden behind his upper lip when he smiles.

After orthodontic treatment, you can see that even with a big, happy smile, he doesn’t show too much gum tissue when he smiles.  This is a more attractive smile, and he is no longer self-conscious about his smile so he fully smiles when he is happy.  The change in his smile did not happen by chance, but by a well thought out orthodontic treatment plan that included moving the upper front teeth in an upward direction as part of his overall bite correction.  This process (orthodontists call it intrusion) can be added to most orthodontic treatment plans in order to help correct a gummy smile.  The key is that the problem must be identified, and the orthodontic plan designed to correct this problem.  Straight teeth are not all that is necessary to have an attractive smile! 

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Orthodontics and Facial Beauty, Part I

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Orthodontics and Facial Beauty, Part I

We’ve established in our last several blog posts that the face and the smile are REALLY IMPORTANT!  We are hard wired in our brains to notice faces, and react to them emotionally on a very deep level.  In this blog post, we’d like to discuss the impact orthodontic treatment can have on faces, and how the decisions that are made can affect the appearance of our patients’ faces for the rest of their lives.

The profile is the view of the face or head when viewed from the side.  Although orthodontic treatment does not alter the shape of the forehead or the nose, we should consider the shape of these structures when evaluating our patient’s profiles.  Orthodontic treatment can have a dramatic effect on the shape of the lips and the chin, and we want to make sure that all the elements of the profile are well balanced, and in harmony.  There is actually a lot of science about how to measure a “balanced profile”, and we are taught in our orthodontic residencies how to “measure” a profile to see if the nose, lips, and chin are balanced.  We also know from research that the profile changes over time, with the nose and chin becoming more prominent as we age.  We also learn how important it is that our patients be able to easily keep their lips closed when breathing, chewing food, or simply resting.  If the mouth is held apart (because it is too difficult to close the lips, or because it is difficult to breathe through the nose), then the tongue is lowered inside of the mouth, and the muscle balance between the tongue and the lips/cheeks is disrupted.  This can cause the teeth to shift over time and contribute to the long-term failure of orthodontic treatment.

So how can good orthodontic treatment affect the balance of the profile?  Primarily by decisions that we make in regards to how we fix bite problem.

Facial Beauty P1 - Patient 1.jpg

This patient’s profile is affected by the position of his upper and lower front teeth.  Because the teeth are positioned too far forward, his lips cannot close easily.  When he forces the lips together, the chin muscle contracts, thus flattening out the chin.  This is not a balanced profile.  When they are closed together, the lips push out in front of the chin, and are strained.  Our goal is to help this patient to be able to easily and naturally keep his lips closed, without strain.  This will allow the chin muscle to relax, thus helping establish a more normal chin contour.

So the goal of this patient’s treatment was to bring the upper and lower front teeth inwards, to allow the lips to close more easily, and allow the chin muscle to relax.  How can the orthodontic treatment do this?  We did this by having the patient have 4 premolar teeth removed before the placement of his braces (these are the teeth halfway back on the sides).  The removal of these teeth created gaps that were closed with braces.  When the gaps were closed, the front teeth were brought back (which was the original goal of treatment).

If you look closely at these pictures, you’ll notice that the front teeth are not angled outward as much, and that there are fewer teeth in the right hand photo.  Orthodontic treatment was done in order to reduce the forward protrusion of the front teeth, and to bring the teeth further back so that the lips and profile could be affected in a positive manner.  The patient wore braces for 20 months and currently wears his retainers at night only.

After orthodontic treatment, this patient was able to easily and naturally keep his lips together, without straining his chin muscle.  This is the direct result of consciously directing his orthodontic treatment to resolve the specific problem of his front teeth being too far forward in his mouth.  As a result, it almost appears as if his chin grew, but in fact, the chin was unchanged.   The chin looks different because the muscles are no longer strained.  

Naturally, nobody desires to have teeth removed as part of orthodontic treatment, but sometimes, it is the best thing to help the profile.  The key here is that we keep the goals of treatment in mind when making up a treatment plan for each individual patient.  Sometimes, patients have wonderfully balanced profiles with very crowded teeth.  In these situations, we might recommend the removal of teeth like was recommended for this patient just to preserve the beautiful balance that is already present, while at the same time, straightening the crooked, crowded teeth.

The flip side of this story, of course, is that if the lips are flat and lacking support, good orthodontic treatment can help move the front teeth forward, thus giving the lips better support.  

Here is a young patient who’s lips were lacking support because her front teeth were “pushed back”.  Her mouth was very crowded, so the removal of premolar teeth as described above could have been considered.  However, because her front teeth and her lips would benefit from moving forward, we chose NOT to have any premolar teeth removed so that we could use braces to move her front teeth forward as they were uncrowded.

After orthodontic treatment, her front teeth are no longer “pushed back”, and they give her lips better support.   This is especially important as she ages, as her chin and nose will become more prominent with age.  Helping our patients have a well balanced profile throughout life is our goal, and the decisions we make when they’re teenagers can have important effects long into the future.

Hopefully, you now have some understanding of how orthodontic treatment can be planned to improve the profile, and create beautiful, balanced faces in addition to beautifully straight teeth.  We’ll talk more in future blog posts about other ways in which orthodontic treatment can affect facial attractiveness, and why it’s important to consider the WHOLE patient when planning orthodontic treatment.

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Psychology of Smiles, p. 4

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Psychology of Smiles, p. 4

Part 4 - Eye tracking and the Thatcher Illusion

So our brains are hardwired to see faces, but what does that have to do with smiles?  Well it turns out that the smile is one of the most important features of the face and this can be confirmed with eye tracking studies.  In these studies, a computer can register what parts of image the subject is focusing on.  These studies confirm that when we look at the human face we spend most of the time looking between the eyes and the mouth.  Most of our social cues come from these two areas, and our ability to read social cues may rely on this natural fixation.  Studies on patients with Autism seem to indicate that they have an an altered gaze pattern when looking at faces.  There are even studies that show that we when look at a smiling face, our eyes are drawn first to the smile itself first even before we look to the eyes!

Here is an example of how our gaze naturally focuses on the eyes and the mouth:

The Thatcher Illusion

Arising from our natural tendency  to focus on the eyes and the mouth, comes a fun visual illusion called the “Thatcher illusion”.  Look at the next two faces and you should find the one on the right far more disturbing than the one on the left:

The interesting fact is that these two images are exactly the same, only rotated 180 degrees.   (You can turn your computer screen upside-down to verify that last statement).   When the head is upside-down but we see the eyes and mouth are oriented correctly, it looks ‘ok’.  Our brains don’t mind that too much.  However when we see the eyes and mouth upside-down on an upright face, it really looks bad!  This illusion illustrates that when we look at a face, we really focus on the individual parts, the eyes and the mouth.  This is why it is so important that these parts of our face represent us well!

Let me "Thatcher-ize" you!

So for this week’s fun, if you will post a close-up selfie of just your face on our Facebook page, I will “Thatcher you”.  It is a little disturbing so be prepared.  Here is a picture of me “Thatchered”.   The left should look a little less weird, but if you ask me, they both look scary!

Here's my face "Thatcher-ized!"

And here is Rebekah's!

Read Part 1, Part 2, and Part 3 of our Psychology of Smiles series.

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Psychology of Smiles, p. 3

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Psychology of Smiles, p. 3

Part 3 - Pareidolia

Over the last couple of posts, I have introduced how much our brains are hard-wired to see and recognize human faces.  Now it is time to have some fun with our cognitive quirks.  Pareidolia is the phenomenon to perceive complex images in everyday objects, and the most common form is seeing human faces in all kinds of things. We see faces EVERYWHERE!  Here are some of my favorites from the internet:

Everyone remember the man on Mars?

Or what about this bashful face in the mountain?

Notice how when we look at these next ones that we not only see faces, but we naturally ascribe emotions.  This again points out how intimately our emotional centers are connected to facial recognition.

How can you NOT see this happy car face?

Or this over-worked and angry mop?

Click here to see 45 more found faces!

What are some of your found faces? Share your pictures with us on our Facebook page, and we'll pick the best picture to win a $50 Visa gift card. It has to be one you've taken; no internet searches allowed! 

Read Part 1, and Part 2 of our Psychology of Smiles series. 

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The Psychology of Smile, p.2

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The Psychology of Smile, p.2

In the last post, I introduced the special area of the brain called the fusiform gyrus and its role in human face recognition.  Today I would like to talk about how much this area is hardwired into the emotional centers of the brain, the limbic system.  There are two fascinating conditions that illustrate  the intimate connection between recognizing faces and our feelings of emotion...

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The Psychology of Smiles, p.1

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The Psychology of Smiles, p.1

Let’s start at the beginning with the importance of the human face.  It is remarkable fact of human cognition that there is a localized structure in our brains dedicated to the recognition of the human face.  We don’t have local structures for recognizing our houses, our cars, our pets, etc.; but faces in this regard are completely unique...

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