- The Washington Times - Thursday, May 15, 2003

Dentistry is a peculiarly suicidal profession: First it came up with fluoridation, putting dentists out of work. Then there were sealants, again reducing the number of cavities to fill. Now orthodontists are self-destructing. A company called Invisalign is the culprit.

We’re all familiar with ordinary braces, usually applied to teenagers, with brackets and wires.

There is another way. Invisalign makes clear plastic shells — called “aligners” — that fit over the patient’s teeth to push, pull and generally wrestle teeth into the desired position. Conventional braces do the same thing, but more unpleasantly.

The aligners are made in a series: When the patient’s teeth have been moved a tiny bit by one aligner, the next aligner goes in and moves them a bit further. Each one is used for about two weeks. They aren’t irritating. No wires.

I don’t own stock in Invisalign. It’s just that anyone who has had conventional braces thinks almost any other approach is a splendid idea. However, the treatment is generally more expensive than braces, the company says.

The idea of using aligners isn’t new. What is slick about it is that a computer, working from molds of the teeth, generates the aligners in proper sequence using 3-D imaging. The patient just has to remember to wear them.

Why is this a good idea? For one thing, the aligners are made from transparent plastic and are nearly invisible. Nobody wants to go to a prom looking like industrial scrap with legs.

For another, patients are not restricted in what they can eat. You take the aligner out, eat steak or saltwater taffy and put it back in.

Also, you take it out to brush and floss, so there’s no problem with food getting trapped under wires, and consequently no worry about decay.

I talked to Dr. Ralph Gitomer, a dentist licensed in Maryland, about the technology.

“It [the idea of aligners] has been used for many years for minor orthodontic movement. Now it’s being used for more complex problems. The technique is easy, since the dentist just makes molds of the teeth and the computer at Invisalign does most of the rest. So general dentists can do what once required an orthodontist.”

Conventional braces have other drawbacks, Dr. Gitomer points out. They can stain teeth. Wires break. Removing them can damage teeth since they are glued on. They are hard to keep clean.

Straightening teeth sounds like a simple idea until you talk to a dentist. For example, to move teeth into a different position, you have to push or pull them with considerable force. The molars serve as anchors and other teeth are moved with respect to them.

Further, they get mispositioned in various ways.

Dr. Gitomer says, “The rule is ‘Level, align, rotate,’ in that order. Rotation is the hardest part.”

Not everybody needs all of this. For example, gaps between teeth, if not complicated by other problems, are particularly easy to close, according to the company.

Invisalign says 40,000 patients are now being treated, adding: “Doctors can use Invisalign to treat a vast majority of patients with fully erupted molars.”

The company says treatment usually takes from nine to 15 months and requires 18 to 30 aligners. The technology isn’t the perfect answer for all patients: Sometimes conventional braces are essential.

According to Invisalign, 70 percent of orthodontists in the United States are certified to use the technique.

The interesting thing is that computers have the expertise needed for this technology.

Figuring out how to make 30 aligners by hand would be time-consuming and require real skill. Computers do this quickly, and one computer presumably can do it for a large number of orthodontists.

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