What kind of problems does an orthodontist correct?
What are the benefits of orthodontic treatment?
Do braces hurt, and if so why? And how do teeth move?
How long will I have to wear braces?
When will I get my braces off?
I have been to more than one orthodontist and received different opinions. Why is that?
What is the difference between orthodontics and orthopedics?
Why do the patients seem to start at a younger age, and why do they get two sets of braces?
What is the next step to getting started with orthodontic treatment?
What is the general sequence of appointments?
If I need to have teeth removed to make room for aligning my teeth with braces, when do I get the teeth taken out? Will you take them out?
If I have dental fillings or cavities that need to be fixed, when should I get that done?
At what age should my child be seen by an orthodontist?
What are the ages of the youngest and oldest patients that you’ve treated?
How much is an initial exam?
Do you take my insurance?
How much do braces cost?
How often are appointments?
How do you handle emergencies?
What kind of paperwork will I need?
Will my wisdom teeth (third molars) cause more crowding?
I’ve heard that braces can damage teeth. Is that true?
Will you work with my dentist?
Do I have the choice between Invisalign and regular braces?
How long has Dr. Wirant been in practice?
Who made this website?
What is your treatment philosophy?
Do you take transfer cases if I’m already wearing braces?
Do you need to use needles or injections to put braces on?
Can I choose the color of my braces?
The orthodontist fixes many types of problems. Teeth and/or jaws can be misaligned, which may be due to a poor skeletal growth pattern. Also, crowding and spacing issues, due to jaw and tooth size discrepancies, are other common problems. The orthodontist can also address orthopedic (jawbone) problems when treatment is started at an early enough age. Some problems may require an interdisciplinary approach with other specialists in the dental and medical fields. (TOP)
Benefits from orthodontic treatment include improvements in the following:
- Self-esteem: how you perceive yourself
- Dental function: chewing, minimizing tooth wear (attrition)
- Aesthetics: a beautiful smile—how others perceive you
- Oral hygiene: the health of your teeth, gums, and mouth (TOP)
New technology in the past 20 years has improved the flexibility of the wires used in orthodontic treatment. This increased flexibility reduces discomfort, because the force applied to the teeth is reduced. By taking a non-aggressive approach, and gradually changing the wire material (metal type) and size, we find that many of our patients remain comfortable throughout treatment.
To move teeth, certain biological changes have to occur. Bone around the roots of the teeth has to remodel to allow for tooth movement. To make this remodeling occur, Dr. Wirant applies orthodontic pressure on a tooth crown, which is transmitted to the tooth root, usually through the use of wires. Pressure causes compression of the blood vessels around the root of the tooth, which, if applied long enough, leads to mild inflammation. (This inflammation is normal.) It is this inflammation that may cause some discomfort. When necessary, a medication, such as ibuprofen, that reduces swelling can help with relieving discomfort. (TOP)
Treatment time can vary greatly; however, for an adolescent, the average total treatment time is typically between one to two years. Many Invisalign cases last less than a year. The time is shorter because Invisalign cases are usually less involved, and all the permanent teeth have erupted. Some factors influencing the time involved include:
- The underlying nature of the problem(s) (skeletal vs. dental)
- The goals of treatment: limited (less than ideal results) or comprehensive (ideal results, addressing all problems)
- Patient compliance/cooperation (the most important factor): keeping appointments, following instructions, and minimizing breakage
- The patient’s second molars (12-year molars: when they erupt, and if they need to be leveled and aligned)
- The severity of the problem (TOP)
This varies for each individual and whether the patient starts at the best time. Many times it is better to start treatment in the mixed dentition (with baby teeth) at around 10 years of age, and the braces are removed around 12 years of age (when the 12-year molars erupt). When your braces are removed depends on several factors:
- Treatment start time
- Type of treatment: comprehensive, interceptive, or limited
- Patient compliance (again, the most important factor)
- See “How long will I have to wear braces?” (TOP)
Orthodontic treatment is, to a large degree, an art as much as it is a science. As in any of the healing sciences, there may be more than one treatment option.
Some reasons for different opinions among doctors are:
- Differences in the prediction of how future growth will affect the patient’s orthodontic prognosis
- Differences in expertise with a particular appliance used in orthodontic/orthopedic treatment
- Differences in educational background (theory) (TOP)
Orthodontics pertains to the teeth, and orthopedics (in cases involving your bite and smile) pertains to the jawbones. At the right age, growth modification of the jaws can be implemented with functional appliances—orthopedics. After a patient reaches a certain age, orthopedics becomes more difficult or impossible, because jaw growth is complete and therefore less malleable. When this occurs, corrective jaw surgery (orthognathics) may be recommended. (TOP)
The American Association of Orthodontists recommends that a child be seen no later than age 7 for an initial orthodontic evaluation. Early treatment is usually interceptive in nature and may also be referred to as Phase One Treatment (P I). Goals of early treatment are usually limited, and the need for future treatment cannot be ruled out. If a problem is severe enough, probably orthopedic in nature, "orthodontic" treatment can start at a very early age, with an orthopedic component, such as palatal expansion (the most common). Sometimes early treatment will reduce future crowding, or aid in a non-extraction (of adult teeth) approach during comprehensive phase of treatment (during adolescence). Comprehensive orthodontic treatment would involve the complete dentition (excluding the wisdom teeth), and could be started as early as ten years of age. Everybody’s tooth and jaw development is a bit different, so treatment timing is very individualized. You can look at these examples of patients with early treatment needs. (TOP)
At Dr. Wirant’s office, every person is treated as an individual, and each treatment plan is based on that person’s individual needs. For instance, not everyone is going to need a palatal expander (a device that creates more space in the upper jaw). This appliance requires additional lab work, which pushes back the actual start date for braces, thereby increasing the initial number of appointments before commencement of treatment.
An initial exam, evaluation, or consultation appointment is when you will meet Dr. Wirant for the first time. This is when you will need medical and dental acquaintance form and insurance information. You can go to this page and download the forms in advance or submit them online (Medical and Dental History Forms) At this appointment, Dr. Wirant will give you a general idea of the orthodontic problem(s).If something seems amiss and there are still baby teeth remaining, the orthodontist may want to take an X-ray (CBCT in 3-D) to see where the other teeth are.There is no charge for this appointment.
If treatment is recommended, the next appointment is usually for records . It is at this appointment that X-rays and intra/extra oral photos are taken. We are no longer taking impressions for study models on a general basis since the CBCT captures an excellent 3-D view.
A final consultation appointment may be necessary if a particular case is complex, and Dr. Wirant will go over a finalized treatment plan based on the previously taken records.If you would like a more detailed review of the diagnosis and treatment plan prior to starting, let us know. At this appointment, you will be asked to sign the financials and informed consent.
Separators are placed if a fixed appliance such as braces (but not always) or another appliance (expander) is made that uses bands. This is because metal bands may require a slight amount of space between the teeth so that they will slide on more easily. If an appliance requires fabrication at a lab, then the bands will not be cemented, but will be removed so that an appliance can be made.
At the banding/bonding appointment, or an appliance insertion, you will actually start with your braces or another appliance.
Regular visits are your normal orthodontic adjustment appointments. (TOP)
As a general rule, the more severe the crowding, the more likely it is that extractions (pulling) will be required before placing the braces. In some situations, it may be possible to align the teeth with braces and then re-evaluate the need for extractions.In either case, we will require a consult, orthodontic records, and a signed informed consent, before an extraction letter/prescription will be sent to your dentist/oral surgeon.
If you need extractions, we will refer you back to your dentist or to an oral surgeon. We do not extract teeth. (TOP)
This depends on the orthodontic treatment plan. The teeth that require dental work may be the same teeth that may need to be extracted (if extractions are necessary) for orthodontic treatment.If you are having a severe dental problem, it should be addressed immediately. Let your dentist know that you are considering orthodontic treatment so that he or she can address your specific needs. (TOP)
Dr. Wirant has treated a child as young as age three and a half, whose particular situation was very unusual. On the opposite end ofthe spectrum, Dr. Wirant has treated patients who were in their 60s and 70s. The bottom line is, any concerns or problems should be addressed when they are discovered so that the appropriate treatment (even if it is no treatment) can be rendered. (TOP)
The initial exam is complimentary. (TOP)
We accept most insurance plans. If your insurance carrier provides some benefit, we probably accept it. There are many, many dental/orthodontic insurances that change frequently, and we will need to know which insurance you have. Here is some helpful insurance information. (TOP)
OOrthodontic treatment can vary and so can the cost. We will be happy to try and give you a better idea about the cost involved at your initial exam or final consultation—to be fair, we have posted our fees for services on this page. (TOP)
With traditional braces, most appointment intervals were every 4 to 5 weeks. Today with some of the new technology and appliances, these intervals are longer, from 6 to even 12 weeks. The appointment interval also depends on the treatment, and patient cooperation, along with the doctor’s approach at each visit. Treatment of impacted teeth, which require “forced eruption,” can involve 3-week visit intervals so that traction can be applied to the affected tooth at each visit. Invisalign visits are usually at 12-week intervals. (TOP)
If you call after hours, our phone message provides a beeper number so that the doctor on call can get back to you. Currently, five orthodontists share coverage between their offices. Many “emergencies” can be taken care of by the patient or parent. (TOP)
The forms that we need at your first visit are on this website (if you would like to fill them out before your initial visit). You don’t have to worry about the other forms and paperwork until you are ready to begin treatment. The forms include the following:
- Medical and dental histories (on our website)
- Insurance information (on our website)
- Informed consent
- Truth in lending (actual contract with us)
- Office treatment fee policy
- Automatic withdrawal agreement (for your convenience) (TOP)
It is the opinion of many in the dental profession that third molars can cause crowding of the other teeth (especially the lower incisors). While there may be some truth to this widely held opinion, this opinion hasn’t been “proven” scientifically through research, and therefore is not an absolute reason to have wisdom teeth extracted. Because there are several other reasons to have wisdom teeth removed, we recommend a consultation with an oral surgeon. (TOP)
Most often when this question is asked, someone is referring to the braces used 20-plus years ago. Back then, braces were fastened to the teeth by using thin metal bands (rings) that went around every tooth and a bracket that was welded to the metal band. The adhesives used today in bonding brackets directly to the tooth without the aid of the band were not clinically available.Back then, the bands were cemented with zinc phosphate cement. Zinc phosphate cement could wash out or leach from under the metal band and allow food to reach this area underneath. If this was not discovered soon enough—the beginnings of tooth decay could take hold, underneath the band.
Today we no longer use zinc phosphate. Instead, a glassionomer cement is used, which contains fluoride and doesn’t wash out very easily if metal bands are necessary. Where brackets are bonded directly to the teeth (no metal bands), the bonding adhesives also contain fluoride.
Visible damage such as enamel scarring (white spots) is caused by poor dental hygiene. Braces allow many places for food to collect. Proper brushing technique is imperative to a great orthodontic result.
Another area of concern is external root resorption (ERR). ERR is a shortening of the tooth’s root. ERR can be caused by habits (thumb sucking), orthodontic treatment, and idiopathic [place link to case] (unknown) reasons. In most cases, ERR is not a problem and has become more rare with better orthodontic techniques. (TOP)
Yes, we work in conjunction with your dentist to ensure that the most appropriate treatment is delivered for each patient.Letters regarding your orthodontic treatment plan are sent to your dentist when you begin treatment. If your dentist needs to be involved before the orthodontic treatment begins, we will notify them. (TOP)
Whenever Invisalign is a valid option, it will be presented as such. To be successfully treated with Invisalign, you must first meet certain criteria for consideration as a candidate. Treatment with Invisalign is usually more limited in the scope of what can be accomplished, but this is changing with “advanced” techniques that require an excellent understanding of traditional orthodontic techniques and principles. In many cases, the Invisalign results are nothing short of spectacular. (TOP)
The Royersford office opened in September 2000. Dr. Wirant has been practicing orthodontics since the completion of his training in 1998. He is board certified. (TOP)
Dr. Wirant created this website, and took each picture contained herein. All content is original. (TOP)
Yes, we do! (TOP)
Absolutely not! (TOP)
Yes. The colored parts of braces are actually the ligatures (elastics) that hold the wire into the bracket. These are usually changed at each appointment and allow the patient to choose a different color. Many children find this appealing, and it makes it easier for some parents to get children to go through orthodontic treatment. Fun and functional!
Before colored plastic ligatures were introduced, steel ligatures were used. Steel ligatures were fastened by twisting the ends together, which could sometimes bend and poke the mouth—and cause ulcers. Steel ligatures still have their place today in orthodontics but are rarely used to tie-in/ligate every tooth individually. Clearly, the elastic plastic ligatures were an advance over the traditional method of ligation, and colors were just a clever way of making things more interesting.
Currently, there is a thrust in the orthodontic profession to use “self-ligating” brackets. These brackets do not need ligatures because they incorporate miniature sliding, swinging doors into the brackets themselves which engage and hold the wire. (TOP)