I was on a plane with one of the most respected orthodontists in Dallas when we started discussing the age he generally likes to start treatment on adolescents. We’re talking about typical, healthy adolescents with no secondary complicating factors such as impacted teeth, sleep-related issues or significant A-P issues.
“I love to start treatment when the lower E’s are getting pretty loose or when they are just lost” the patriarchal orthodontist told me. Why? because the E space allows him that extra 3-5mm in the lower arch to unravel anterior crowding by managing the space properly and if he waited, the 6’s would drift forward, stealing valuable space for correction.
A week later I was having dinner with another respected DFW orthodontist who told me that she always waits for the 7’s to begin erupting before starting treatment on any adolescent. “Nothing drives me crazy or is more unfair to a child than having to carry on treatment because you’re waiting on 7’s to erupt. So, I start treatment when the 7’s are coming in.”
In the years that have passed, the treatment timing question is one that I’ve asked a lot of friends and peers and it’s rare when I get the exact same answer. Yes, the decision is multifactorial, but it seems that from a rationale perspective, there’s no one set time that seems to be the consensus, though within practices, there does seem to be a set timing pattern.
Of course, one of the advantages of aligner therapy versus actual braces is that one can see crowding in the lower anterior with loose E’s and drop into less than 10 aligners to correct the crowding and take advantage of the spacing, then stop for a bit while waiting for teeth to erupt in a way that’s simply not possible with braces.
To be clear, I am NOT saying that we should be treating adolescents with aligners over braces. What I am saying is that it’s been great to be able to fabricate a series of aligners to be able to treat specific problems, then pause, then pick it back up whenever I want, without having to remove brackets and go through significant bonding. I don’t do this often, but it has certainly affected the way I treat a certain age group.
How about you? I’d love your thoughts.
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Wishing you all the best!!!
GLENN KRIEGER IS AN ORTHODONTIST WITH 20 YEARS OF RESTORATIVE AND COSMETIC DENTISTRY EXPERIENCE BEFORE HE RETURNED TO ORTHODONTIC RESIDENCY. DR. KRIEGER LEARNED ABOUT THE IMPORTANCE OF WELL-DESIGNED PRACTICE POLICIES AND SYSTEMS DURING A YEAR AT THE SCHUSTER CENTER FOR PROFESSIONAL DEVELOPMENT IN SCOTTSDALE ARIZONA, AND AN UNDERSTANDING OF GENERAL ACCOUNTING PRACTICES AND INDUSTRIAL PSYCHOLOGY AT THE UNIVERSITY OF WASHINGTON GRADUATE BUSINESS SCHOOL’S “DENTIST AS CEO” PROGRAM. HE IS THE HOST OF “THE ORTHOPRENEURS PODCAST”, MANAGES THE ORTHOPRENEURS FACEBOOK GROUP AND RUNS THE ANNUAL ORTHOPRENEURS SUMMIT.