Edgewise Braces

Edgewise braces have become the standard in the orthodontic world and they are used by virtually all orthodontists.

Virtually all braces on the market are variations on the standard Edgewise braces. There are well over 150 different models available, each claiming to be the best. The difference in orthodontic work is in the operator, not the type of bracket used. If any dentist or orthodontist claim their braces give them a superior edge, this claim should be questioned. If one model was superior, why would the rest of the profession ignore this fact, and why would the other brands remain on sale.

In particular I would caution patients about the claims made by some dentists using brackets capable of treating a patient in half the time. If this was true, wouldn't every orthodontist and dentist use these brackets and so double the number of patients we can treat?

Clear Braces

Dr Vaughan uses clear braces on all his patients, for no extra charge. Clear braces are made from ceramics and although more difficult to use, once mastered they produce a beautiful result and look fantastic. Some important points about clear braces are:

1. Patients respond better to clear braces. They are more likely to be proud of their braces and this results in better care of the teeth and braces, and happier patients.
2. Clear braces make it easier for the orthodontist to see the teeth. I have no doubt this produces a better result. Clear vision is everything.
3. Clear braces are not as strong as metal braces. If the orthodontist puts too much force on they break. This is good as it helps protect the patient from excessive forces. 

Invisalign

Dr Peter Vaughan is a registered Invisalign Orthodontist. Dr Vaughan did his Master of Dental Science thesis on a precurser of the Invisalign, called the Tooth Positioner. Although this study found many shortcomings in this appliance, the Invisalign has been improved very significantly and today is an appropriate appliance to treat many patients. If you wish for Invisalign treatment we will explain to you what can be achieved.

Surgery

Some patients have jaw size discrepancies that cannot be corrected with braces, and the patients are not suitable for, or do not wish to use, functional appliances. In these cases surgical lengthening or shortening of the jaw may be indicated. Dr Peter Vaughan works with maxillofacial surgeons in the treatment of these cases.

Surgery sounds a dramatic treatment, and many parents become very worried. All potential surgery patients are given non surgery options for treatment, and the advantages and disadvantages of surgery are explained. The main advantage with surgery is that it can shorten treatment time considerably, and produce a better result.

We encourage prospective surgical patients to talk to patients who have already undergone the surgical procedures.

Dr Peter Vaughan has worked at length with Dr Paul Coceancig, Maxillofacial Surgeon, to develop a new technique for surgical correction for shorter lower jaws. Previously this surgery could not be performed until patients had stopped growing. This new technique, Mandibular Intermolar Distraction Osteogenesis, can be undertaken at the ages of 13 to 15, a much better age to treat this problem. This technique has been presented at national and international conferences and has been published in the International Journal of Oral Surgery. Dr Peter Vaughan is the leading orthodontist in Australia on this form of Distraction Osteogenesis and the results are very pleasing for the patients. 

Functional Appliances

Functional appliances are a form of removable appliances or plates.  

The practice of Dr Peter Vaughan, Specialist Orthodontist, utilises functional appliances with some patients. However we always stress the following points prior to commencing:

1. Many patients want plates as they perceive plates to be easier than braces. This is often not the case. Functional appliances are usually more difficult for the patient than braces.
2. With functional appliances the control is often taken out of the hands of the operator, and put in the hands of the patient. This is successful if the patient cooperates well, but can also be the reason for failure. Unless the plates are worn virtually all of the time (to school, to bed, and around the house) the desired movements will not be achieved. Because of the level of cooperation required, older patients are more suited to functional appliances. The failure rate in patients under 12 years of age is unacceptably high.
3. Functional appliances are very good at correcting growth discrepancies, but are poor at aligning teeth. Consequently functional appliances usually do not remove the requirement for braces. However if braces are worn following functional appliances, keep in mind that much of the work has been achieved, and the braces should be on for a shorter time and significantly cheaper. Generally if both braces and Functional Appliances are required I prefer to use Functional Appliances following the braces as they are then worn for a much shorter period.
4. A small number of patients will not achieve the desired growth, even with good cooperation. 
5. Functional appliances require growth for their success. Consequently the more growth the patient experiences during treatment the greater the likelihood of success. The stage of greatest growth for most patients is after they enter high school. This also coincides with a period that most children are having orthodontic treatment, and so peer pressure is reduced. This is the best stage to use Functional Appliances

Many parents want early correction so their children do not have problems at high school. I caution against early treatment for the following reasons:

• Functional appliance treatment is required where the lower jaw does not grow as fast as the upper jaw. This growth pattern will continue. If treatment is too early then growth will undo the benefit of treatment and further treatment will be required.
• Functional appliances require a high level of cooperation. Younger patients have difficulty achieving this high standard. Consequently many treatments fail at a younger age due to lack of cooperation. If these treatments had been instigated later, the likelihood of success is much greater.

Expansion Plates

Expansion or growth appliances are used by virtually all orthodontists and dentists. 

Expansion is a valuable treatment form, and is often a better alternative to extracting teeth. As the maxillary canines are erupting is usually the ideal time for expansion. If expansion is performed too early it will need to be repeated later when these teeth erupt.

Remember, the last teeth to come into the mouth are often the canines in the upper jaw, also known as the eye teeth. These teeth are, on average, each 3 mm wider than the baby tooth they replace. Because of this many early treatments fail at this stage. I know of situations where the dentist or orthodontist treat patients early, then they have then acted surprised and informed the patient that the treatment "almost worked, if it wasn't for those last two teeth". Any alignment of the teeth by expansion must allow for 6 mm of space needed for the canine teeth.

Plates

Plates are removable appliances made of acrylic. Plates are useful if there are only a few teeth to be moved, or where patients do not want braces. Unfortunately plates are very limited in their actions and this must be explained to patients before treatment commences.

Beware of the offer of plates that can correct the teeth when being worn to bed. These plates rarely do anything. They are relying on natural growth to correct the dental problems. It appears that at least 25% of patients grow out of their crowding problems, whether or not a plate is worn.

Extractions

Extractions are one of the most controversial areas of orthodontics and dentistry. Dr Peter Vaughan previously worked in a practice where nearly all patients had extractions and he was not happy with the results he saw. For this reason Dr Peter Vaughan tries to avoid extractions as much as possible. Extractions are necessary for a very small group of patients, however these need to be chosen carefully and the extractions performed at the correct age

Habit Correction

Many alignment problems are caused by incorrect habits. Thumb sucking, incorrect swallowing action, mouth breathing and other problems can move the teeth into unfavorable positions.

Correction of these problems with simple exercises will allow growth to naturally correct the tooth positions in many cases. These exercises should be attempted before expensive options such as braces and plates are considered. It is preferable that these exercises are taught at a young age.

One of Dr Vaughan's most appreciated appliances is the paddle pop stick. Used at the correct age it can save a lot of children from the need for later orthodontic treatment.

Our practice philosophy is not to get people into treatment, but to try to get them out of treatment. There are plenty of patients still left to treat to make an honest living, and those that we get out of treatment refer us a surplus of patients to replace the work we lose.

Monitoring Growth for natural correction

Why is it that so many people require orthodontic treatment today? In the previous generation orthodontic treatment was uncommon, yet most adults have teeth that are very well aligned and look beautiful, although they are not perfect. Overtreatment is definitely a problem today. People who do not require treatment are being told they must have treatment.

Once a tooth comes through it cannot get any bigger, so all teeth come through adult size. Common sense tells us that adult teeth will not fit into a 10 year old child's mouth. Why do people act so surprised when there is so much crowding at this age? Nature will correct some of these problems.

Dr Peter Vaughan measures the growth of the mouth and does not instigate treatment while natural improvements are occurring.