By Daniel S. German, DDS This article delves into the critical considerations for selecting braces, aligners, and orthopedic jaw-growing appliances in orthodontic treatment. It draws on evidence-based research to elucidate the factors influencing these choices and examines scenarios where a combination of these modalities offers the optimal outcome for patients. he history of orthodontic tooth movement goes back many centuries, perhaps even millennia. Many agree that a quantum leap occurred about 120 years ago when Edward Angle developed fixed orthodontic appliances, the predecessor of modern braces. The creation of fixed orthodontic braces greatly enhanced the predictability and effectiveness of teeth straightening. In parallel, many practitioners enjoyed the benefits of working with removable appliances to improve tooth and jaw alignment. Both systems have evolved dramatically over the years. The most notable advancement since T the creation of bonded brackets was the introduction of plastic teeth aligners about 25 years ago. This article will outline some founda-tional considerations when choos-ing whether to apply braces, align-ers, or orthopedic appliances. Some practitioners advocate using braces or aligners exclusively, justifying their choice by stating that one works better. Adhering to one appliance or the other remains reasonable for the dentist, based on practice management strategies or knowledge base. There are indica-tions for referring patients to other practitioners with the appetite and skills to provide better care. We are emphatic that there is evidence that each option may be an effec-tive choice depending on the patient’s needs. By analogy, there are multiple ways to travel; we often have to decide whether to use a car, an airplane or a boat. Although there are many instances when either of the three would work, frequently, there is a preferred path for effec-tiveness and efficiency. (Figs. 1-3) A second analogy is which screw-driver is most effective. Of the options shown, many of us are guilty of using a flathead screw-driver for a Phillips screw. I know firsthand that some have even used a butter knife to turn a Phillips screw with success. It is undoubt-Fig.1: The car is a preferred method of travel for certain distances on a paved road. Fig.2: The airplane is more effective at traveling longer distances even when paved roads are available, and especially when they are not. Fig.3: A boat may offer the most advantages in navigating to specific locations over water, particularly when an airport is unavailable. 14 Spring 2024 JAOS
Journal of the American Orthodontic Society Spring 2024: Page 14
