ARE WE THERE YET?

orthodontic treatment duration are we there yet sign
Are we there yet? Are we there yet? How much longer? Are we there yet? Anyone who’s taken road trips with kids knows that ritual pretty well. Kids are impatient. They don’t have a well-developed sense of time. Telling a child that a drive will take X hours is like writing it in water with a spoon. It just doesn’t take.  Much like trying to explain to a child how long his or her orthodontic treatment’s going to last.  To a child,  “four years” is as useful a forecast as “four centuries” or “four months”.  Kids know about right now. Sometimes, they can get their heads around “tomorrow”. Parents, though, have a valid need for a timeline.  In this post, we’ll discuss some of the factors known to affect orthodontic treatment duration. Factors that act to make it longer or shorter than the average.

It’s very important to orthodontists to provide accurate, reliable forecasts of how long a patient’s treatment will last. There are elements of professional pride behind this, to be sure. Additionally, accurate treatment duration forecasting has very concrete value to orthodontists. Studies have shown a connection between this and the success of orthodontics practices. Orthodontists who provide accurate estimates of how long treatments will last tend to be successful practitioners.

Accurate forecasting, though, is not the ultimate goal. The priority, of course, is shorter rather than longer treatment durations.

STARTING LINE

One obvious key factor is the patient’s initial condition. Initial severity of the condition has a huge influence on treatment duration. Treatments requiring tooth extraction, for example, tend to last longer than those that don’t.  Some, orthodontics treatments have to shape and guide the growth of jaw bones, top and bottom.  This takes longer.

In short, and in general, simpler and milder conditions favor shorter overall treatment durations.  Other things being equal, of course. Which they almost never are!

HOW OLD ARE YOU NOW?

First, there’s a big difference between juvenile patients and those with all of their permanent teeth.  Among adults, there seems to be little or no connection between age and orthodontics treatment duration. This makes sense. The layout of an adult’s teeth and jaws is fairly stable over several decades. So, too, are the several bodily systems involved in the movement of teeth.

The picture is a bit less clear with kids. On the one hand, the process of bone remodeling is faster in kids. It’s inversely related to age. The younger the child, the faster his or her bone remodeling.  Bone remodeling is fundamental to orthodontic treatment. The general public seems to think that orthodontists gently move teeth through the gums, to new positions. A more accurate version is that the critical movement is through bone. The jaw bone. Bones are hard, and the movement is slow. The pressures which braces, aligner trays, and other hardware apply to teeth cause the jawbone to break down and rebuild itself to adapt. This is what allows teeth to move to new positions, and to stay in them.

IS EARLIER BETTER?

On the other hand, some research studies find that the younger a kid is when orthodontic treatment starts, the longer the treatment lasts. These findings need a lot of untangling. On the face of it, it’s almost a “self-fulfilling prophecy”.  As long as a child or adolescent is growing and developing, the size and shape of his or her jaws are changing.  These changes affect tooth alignment. As long as such changes are in progress, can orthodontic treatment end? The treatment duration in such cases is, plainly, tied to the patient’s growing up. Growing up can’t be speeded up.

If we can’t declare victory until late adolescence or early adulthood, then of course treatment begun at an earlier age must last longer. Research shows the connection between age and treatment duration is stronger too, for certain conditions. Class II, Division I malocclusions are the most common alignment condition orthodontists treat. Buck teeth, with related skeletal issues. For this class of patient, starting treatment at younger ages clearly leads to a longer duration.

Our research into the connection between age and treatment duration is further clouded by the matter of outcomes. Mainly because the research has not taken outcomes into account. It may well be, for example, that starting treatment at younger ages leads to longer treatments. But do these longer treatments produce better results than short treatments started later?  The conviction that this is true underlies the so-called “two-phase” treatment approach. 

TREATMENT MODE

This brings us to the matter of how the orthodontist treats a specific patient’s condition.  Other things being equal, there’s a lot of value in choosing the fastest possible treatment mode.  Expense, inconvenience, and risk of complications are reduced by shorter durations. Where personal appearance is concerned, people want cosmetic improvement sooner, not later.  But, as usual,  other things are not equal.

Take the case of a patient who’s a candidate for Invisalign. This offers the potential for a significantly shorter treatment than with traditional metal braces. Invisalign trays also eliminate the “metal mouth” look many patients want to avoid. What’s not to like, right? A no-brainer. Except it isn’t, because of the cost factor. Treatment with metal braces is less costly. For some patients, that difference decides the day.

The jury’s still out on the “accelerated orthodontics” devices promoted by companies like Acceledent and Propel. These try to speed up bone remodeling with physical stimulation through the gums. The science makes sense. As we gain experience with such devices, and with more research, outcomes are likely to improve. It’s probably a matter of learning to better identify the patients for whom accelerated orthodontics methods are most likely to work.

COMPLIANCE AND ORTHODONTIC TREATMENT DURATION

This is, by most accounts, the biggie. The 800lb gorilla in the room. The single most powerful factor affecting orthodontic treatment duration.

Patients, after all, are not passive objects. On the contrary, orthodontic treatment calls for patients to actively take part in it.  Patient compliance means keeping appointments and following orthodontists’ instructions to the letter. Whether it’s about emplacing rubber bands and aligner trays, avoiding certain types of foods, or wearing mouthguards. Better compliance means shorter treatments. An orthodontist’s best efforts can either be supported or defeated by a patient’s cooperation or lack of it.

ORAL HYGIENE

A related factor is oral hygiene. It’s largely under the patient’s control.  A healthy mouth is the best support for moving teeth. Problems like tooth decay and gum disease can throw a monkey wrench into orthodontic treatment. Keeping teeth clean and gums healthy is more difficult with braces or even aligner trays, yes. It’s critical, though, to keeping treatment as short as it can be.  Orthodontists provide guidance in adapting self-care during treatment. Patients should make the extra effort to follow it.

THE PRACTITIONER

Finally, the skill, experience, and diligence of the orthodontist are factors in treatment duration. Fortunately, the orthodontists we produce in America are very good. It’s impossible to make it through that training without being very good. That said, an experienced, devoted orthodontist is better able to make the many treatment decisions that keep durations shorter. Your Lake Worth Orthodontics practitioners fit that bill.  We keep each patient’s orthodontic treatment duration to the minimum possible given their ages, conditions, preferences, and budgets.