Dr. Allen Garai, Specialist In Orthodontics

Temporary Anchorage Devices (TADS)

2010-04-29T06:38:00.000-07:00

The development of temporary anchorage devices ( TADS) for use in orthodontics has increased the range of tooth movement possible without surgical intervention. TADS are a form of skeletal anchorage which, similar to headgear, can produce tooth movement and/or skeletal change without undesirable reaction forces on other teeth.
TADS are small screws, also called miniscrews or microanchorage, which can be inserted and are very well tolerated by most patients. Complications are rare. They are easily and atraumatically removed when no longer needed. Small bone plates, which are surgically placed beneath the alveolar mucosa with an orthodontic attachment extending into the oral cavity, are also temporary anchorage devices which have particular indications.

TADS have particular usefulness in adult treatment. Because adult patients are no longer actively growing, some orthodontic movements that can be accomplished in children are not possible in adults.

TADS provide the skeletal anchorage that makes these movements feasible.
Four major applications have been identified for skeletal anchorage in treatment of adults (ref: Proffit, Contemporary Orthodontics):
1. Intrusion of posterior teeth to close an anterior openbite; anterior open bite is frequently caused by excessive eruption of maxillary posterior teeth ( not infra-eruption of anterior teeth) and can sometimes be treated by posterior intrusion using TADS rather than surgery
2. Distal movement of maxillary molars (and the entire maxillary arch if needed)
3. Retraction and intrusion of protruding upper incisors
4. Positioning individual teeth when no other satisfactory anchorage is available

Recent research indicates a high success rate with TADS, as well as minimal discomfort for patients.

Orthodontic and Surgical Management of Obstructive Sleep Apnea

2010-04-29T06:37:00.000-07:00

Obstructive Sleep Apnea Syndrome (OSAS) is associated with increased morbidity and mortality; although the etiologic factor responsible for OSAS has not been clearly elicited, it is well recognized that disproportionate anatomy of the upper airway exists in OSAS, leading to obstruction during sleep. Although continuous positive airway pressure therapy is one of the most common forms of treatment for OSAS, surgery has always played an integral part in its treatment.

Diagnosis:

A lateral cephalometric x-ray is one of the most commonly used diagnostic tools in measuring posterior airway space. A fiberoptic nasopharyngeal laryngoscopy is highly recommended. This exam enables the clinician to directly visualize the entire upper airway from the nose to the larynx. A three dimensional CAT scan has also recently been used.

Treatment:

One of the most recent treatments of OSAS has been pre-operative orthodontic treatment followed by a maxillomandibular and genioglossous advancement procedure. Recently I have been recommending that our patients have four bicuspid extractions in order to retract the upper and lower anterior teeth to decompensate before the bi-maxillary advancement. This pre-operative orthodontic treatment can maximize the advancement and minimize the soft tissue lip protrusion which is usually observed after surgery. Our patients who have had the pre-operative orthodontic treatment followed by maxillomandibular and genioglossous advancement have shown 95-100% positive results with their sleep test.

New “Self Ligating” Lingual Braces– In-Ovation L

2010-04-29T06:33:00.000-07:00

A smaller self ligating bracket recently developed for lingual orthodontics that offers several advantages. The smaller profile means less interference with the tongue resulting in fewer speech difficulties and more rapid adaptations of the tongue with less discomfort. The smaller size also helps improve hygiene in the gingival area. The Brackets are self ligating which means less treatment time. Using this new technology in our practice has made lingual braces even more attractive to patients seeking truly “invisible braces.”

PALATAL EXPANDER

2010-04-29T06:27:00.000-07:00

Orthodontic expansion of the palate has several possible indications. The most frequent use is to correct a skeletal crossbite, making a narrow maxilla normal in width, allowing ideal occlusion and proper inclination of the posterior teeth. In some circumstances, palatal expansion may be used to increase the arch perimeter and gain space to align a crowded dentition. Palatal expansion can correct the axial inclinations of the roots of the posterior teeth. There may also be an indication for palatal expansion to improve a patient’s arch form and eliminate excessive buccal corridors that make the smile unattractive.
Posterior crossbite may be due to several causes:

1) Maxillary width too narrow for mandibular width;

2) Interference (often due to primary canines) that causes a functional shift and a “pseudo-crossbite;”

3) Mandibular asymmetry;

4) Palatal tipping of posterior teeth. Skeletal crossbites can be differentiated from dental crossbites and treated appropriately.

Proper timing is critical. Increasing age brings increasing interdigitation of bony spicules within the midpalatal suture. In the preadolescent, the suture opens easily using a variety of orthodontic appliances. By early adolesence, considerable force is required to open the suture. With some patients, as early as age 14, it may not be possible to open the suture without surgical assistance. Girls tend to have earlier fusion of the midpalatal suture than boys. By the late teenage years, virtually all patients require surgical intervention in order to have skeletal, rather than dental, expansion with an expander. Early evaluation of patients when a posterior crossbite is detected can allow simple, predictable and stable expansion and save the patient from later surgical intervention to expand the palate.

Orthodontic Check-ups By age 7

The American Association of Orthodontists (AAO) recommends that all children have a check-up with an orthodontic specialist no later than age 7.
AAO does not advocate comprehensive orthodontic treatment by age 7. However, interceptive treatment may be appropriate.

With the parent, dentist and orthodontist working together, early intervention can lead to significant benefits in both growth and development as well as:
· Guide facial growth to a more attractive profile.
· Reduce self-consciousness of appearance during critical years.
· Guide permanent teeth into a more favorable position.
· Reduce the need to extract teeth.
· Possibly reduce treatment time required for comprehensive braces.
· Overall improvement in the long-term health of the teeth and gums.

Early Orthodontic Treatment

2010-04-29T06:25:00.000-07:00

Prior to the development of interceptive orthodontics, it was common to wait for eruption of permanent teeth before initiation of any orthodontic treatment. Today, however, much more is known about the developmental patterns of jaws and face, therefore orthodontic abnormalities are often diagnosed and corrected at a much earlier age. There are several distinct advantages in early treatment:

· Extractions of the permanent teeth may be avoided.
· Early detection can lead to prevention of more severe problems.
· Possible growth modification that can be advantageous to the treatment.
· Younger patients, before reaching their latter teenage years, may be more amenable to treatment.

One of the pioneers of early orthodontic treatment, Dr. J Daniel Subtelny, Chairman of the Orthodontic Department of Eastman Dental Center in Rochester New York, is widely respected for his work in this field. Dr. Garai was trained by Dr. Subtelny and has done extensive research on growth and development of the face, while attending his post-doctoral residency at Eastman Dental Center . At our practice we employ special treatment procedures to facilitate our treatment goals. In conjunction with proper hygiene and good patient /parent cooperation, treatment can return big dividends in lasting oral health.

Chronic Mouth Breathing

2010-04-29T06:24:00.000-07:00

All humans are primarily nasal breathers, except in the case when there is a need for increased oxygen intake. Chronic mouth breathing may be the result of a deviated nasal septum, inflammation of nasal tissue, enlarged adenoidal tissue or a combination of the above.

Chronic mouth breathing may cause adverse changes in facial growth and development. Typically the skeletal changes include: a deficient upper jaw in width due to the contraction of masticatory muscles and a more downward growth of the lower jaw causing a skeletal openbite as a result of the contractions of the suprahyoid muscle.

Dental changes include excessive eruption of the molars, which in turn cause a counter clockwise rotation in the lower jaw, causing an increased overjet and more of a downward and backward change of the lower jaw.All of the above changes contribute to adverse facial esthetics. Frontally, the mid-face appears narrow and deficient and the lower facial height increases. Thus, the face becomes doliocephalic (or oval) and in profile, the face is extremely convex and the lower jaw is recessive. An orthodontic and a pediatric E.N.T. consultation at an early age may prevent the above changes.

Cleft Lip and Cleft Palate

2010-04-29T06:06:00.000-07:00

Cleft lip/cleft palate occurs in approximately 1 in 700 births in the U.S. Although treatment varies regionally, typically the cleft patient will have lip closure surgery at 3-6 months of age and palatal repair between 12-24 months. Although many cleft patients will be followed by cleft palate teams throughout their development, some will also be treated by the wider dental community. A cleft that involves the maxillary alveolar bone will frequently have missing teeth (often the lateral incisor), supernumerary teeth and rotated, malformed or hypoplastic incisors adjacent to the cleft site.

For most cleft patients, it is very important to have orthodontic maxillary expansion and a secondary bone graft in the cleft site before the eruption of the permanent canine into the cleft. Ideally, the permanent canine root should be half to two-thirds formed at the time of the graft. This allows the canine to erupt through bone which will ultimately give good periodontal support to the canine and adjacent teeth. If teeth have already erupted into the cleft site, a later bone graft will not be successful so timely referral and treatment is imperative. The ideal time is based on dental age determined by radiographs, but is typically between 8-11 years.

Just like any other patient, a cleft patient will exhibit his or her own skeletal developmental pattern (which may be Class I, II or III), but due to the unavoidable growth restriction caused by the early repair procedures as well as the tissue defects of the cleft itself, most cleft patients will exhibit maxillary sagittal deficiency resulting in anterior and/or posterior crossbites. The typical cleft patient will appear more maxillary deficient and mandibular prognathic with growth. Typically, in late adolescence the cleft patient will have orthodontic treatment in preparation for orthognathic surgery. Sometimes surgery is done before growth is completed in order to provide the patient with a balanced facial profile during psychologically formative years, even though it is realized that late growth may require an additional surgical correction.

Dr. Garai had extensive experience in treating cleft patients during his orthodontic residency at Eastman Dental Center in Rochester, NY and for over 10 years has been on the faculty of Children’s Hospital/Washington Hospital Orthodontic Residency program, which is a regional referral center for cleft treatment.

Invisalign Teen

2009-09-25T05:49:00.000-07:00

The new Invisalign Teen™ system straightens your teeth with custom-made clear aligners that are comfortable and practically invisible. It was developed with leading orthodontists. And it works – one million patients worldwide have made Invisalign their clear choice. See, lots of good reasons to smile.

You no longer have to straighten your teeth the old-fashioned way, with metal braces. The Invisalign Teen™ system lets you do it the modern, hygienic way. Your new smile is created with the most innovative technology – a series of clear aligners that are custom-fit to your teeth. The first thing you should know is that an average treatment takes about a year. Plus your treatment can begin even if you don't have all of your permanent teeth. Invisalign Teen was designed to meet your needs.

Lingual Braces

2009-09-18T18:17:00.000-07:00

Do you want straighter teeth, but don't want to sacrifice your smile to braces?

Dr. Allen Garai specializes in lingual "hidden" braces and other "invisible" orthodontic solutions for patients in Vienna, Virginia, and the surrounding Washington metropolitan area. With this specialized treatment, no one but you will know you have braces. Dr. Garai has been recognized as " One of the leaders in Lingual Orthodontics in the Washington area" by the Washingtonian magazine.
Concealed braces, also known as Lingual "hidden" or Invisible Braces, are the best and only non-visible form of fixed orthodontic therapy. Invented by the late Dr. Craven Kurz in Beverly Hills, Lingual Braces are truly a reliable form of orthodontic therapy by utilizing principles similar to those of traditional braces.