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Dentistry Specialists talk about Traditional Orthodontics and Short-Term Orthodontics for Adults


The 21st century client requires evidence based treatment.

Nowadays orthodontics is different from the orthodontic treatment of the last century in three fundamental aspects:

Ingrida Ivance, DDS
Margarita Musteikyte, orthodontist

1. Teeth and facial appearance is emphasized more than ever before. Psycho-social problems concerning the appearance have considerable influence over the quality of life of an individual, which is reflected by parents and adults interest in orthodontics regarding the appearance.  Recently, the orthodontic research has revealed that 80 percent of patients visit the orthodontist not because of a perfect bite, health and good teeth contacts, but to improve smile esthetics (Albino et al., 1981).

2. Patients are taking an active role in treatment planning. Currently, a client is not satisfied with a ‘paternalistic’ doctor who just specifies what treatment the patient needs. Informed 21st century patient chooses himself/herself the clinic in which he/she can participate in selecting treatment possibilities and alternatives.

3. Orthodontics for adults – a stage of interdisciplinary treatment. Together with other dental and medical fields, orthodontics is applied much more often to adult patients. The aim of the orthodontic treatment is not necessarily the best possible occlusion (teeth bite) or facial esthetics, but also teeth preservation, their long-term retention and treatment duration. Thus, the orthodontic treatment is being integrated into restorative dentistry that E.H. Angle (a father of modern orthodontics, the USA) was tended to separate in his teaching.  .



V.G.Kokich (The USA, 1944-2013), one of the most renowned specialists of the modern orthodontics, in the Article ‘Who determines when orthodontic treatment is complete?’ [1] that was published in the leading orthodontic magazine AJO-DO, comes to the conclusion: ‘The lesson to be learned is that the restorative dentist should help to determine when orthodontic treatment is complete’


Until 1970 the orthodontic community of dentists had lacked a conception on specific aims and standards of the orthodontic treatment. The situation changed when in 1972 Dr. Lawrence Andrews published ‘Six Keys to Normal Occlusion’ that later was renamed to ‘Six Keys to Optimal Occlusion’. At the same time the ‘straight wire’ technique based orthodontic treatment with braces was developing [2]. Andrews examined 120 dental casts of patients who had never had the orthodontic therapy, a smile of whose was esthetic, the teeth looked adjusted to biting, and patients would not benefit much from orthodontic treatment. The main ‘six keys to optimal occlusion’ used in the traditional orthodontics are presented below:

  • Proper molar inter-arch relationship (Angle I class relationship of molars and canines with a proper cusp position);
  • Proper mesio-distal crown angulation;
  • Proper labio-lingual crown inclination;
  • Absence of teeth rotation;
  • Tight contacts with neighboring teeth;
  • Flat curve of Spee (currently, a bit more expressed curve of Spee is recommended).

As can be seen, these are only anatomical criteria and none of them relates to function. Andrew did not examine on his patients how they bite, chew, how their temporomandibular joint functions, and whether these patients experience pain. Andrew’s research was based on a static view as well as on how teeth fit when models are fitted together. Therefore, the term ‘occlusion’ is used here only when discussing the static view of jaws. Andrews acknowledged that even ‘the most ideal’ bite usually has compromises. That was confirmed by the research [3] in which six keys to optimal occlusion in bites of natural human teeth were assessed. It was established that a normal bite of patients meets only one to three occlusion keys and none of them matches all the six.

Dental system ‘Criteria for optimal functional occlusion’ describes movements of jaw, teeth contacts during these movements, direction and volume of forces affecting teeth – all of this determines good functioning of bite [5].


Seeking to achieve ideal occlusion in cases of teeth crowding, the majority of older generation traditional orthodontists still recommend the extraction of 2-4 premolars in order to make space for other teeth. Recently, in the West European countries the teeth extraction has been rejected by the modern orthodontists since:

1. Usually completely healthy teeth are extracted;
2. Teeth arches become narrower;
3. Oral cavity becomes smaller;
4. The amount of air and simultaneously oxygen accessing blood decreases, which provokes the occurrence of arterial hypertension, cardiovascular diseases and worsens cognitive functions;
5. Molars in the back do not have proper contacts and that may cause a temporomandibular joint dysfunction, especially for women;
6.  Facial profile changes, face acquires ageing characteristics, etc.
The courses for orthodontists in the USA and the UK have already taken place on how to expand such narrowed jaws again, place implants into the site of extracted teeth and make prosthetic crowns.

In the short-term orthodontic therapy Six Month Smiles (STO), in clinical cases of extreme teeth crowding, one of the lower front teeth is extracted instead of premolars.

Even though STO is limited by its short treatment time, this limited orthodontic treatment also has its advantages, which are not only esthetic ones. Applying the principle ‘Function  follows form’, teeth positioned harmoniously in teeth arches also improve the function. The curve of Spee improves; teeth rotations are reduced, contacts between the teeth and crown inclination improve.



Recommendation of the traditional comprehensive orthodontic treatment to an adult patient with crooked teeth should be compared with currently existing alternatives. A large number of patients contact dentists because of esthetics, asking to drill thecrooked corners and perform direct or indirect esthetic restorations or remove misaligned teeth and make prosthetic bridges (see photos below).

V.G.Kokich (The USA, 1944-2013) one of the most renown specialists of the modern orthodontics, in the Article ‘Who determines when orthodontic treatment is complete?’ [1] that was published in the leading orthodontic magazine AJO-DO, comes to the conclusion: ‘The lesson to be learned is that the restorative dentist should help to determine when orthodontic treatment is complete’.

Before and immediately after esthetic restorations/reconstructions:
direct and indirect esthetic restorations

1. BEFORE and AFTER direct restorations

1a. Smile before
1b. Smile after
1c. Teeth before
1d. Teeth after
The client has refused the orthodontic treatment and her front teeth were ‘aligned’ with direct esthetic restorations in one visit. In the case of teeth alignment by such method, it is necessary to cut off a part of the healthy teeth which is misaligned.

2. BEFORE and AFTER indirect restorations with ceramic veneers

2a. Smile before
2b. Smile after
2c. Teeth before
2d. Teeth after
The client has refused the orthodontic treatment, thus her front teeth were ‘aligned’ with indirect esthetic restorations using CEREC technology in one visit. In the case of teeth alignment by such method, it is necessary to cut off a part of the healthy teeth which is misaligned.

If a dentist refuses to ‘cut off, extract or devitalize the teeth’, due to different reasons patients often decide to ‘better do nothing than wear braces’ and because of poorer appearance they live with psycho-social  problems which have influence over their self-feeling and social behavior.

Currently, there is an additional dental service in the World, a Short-Term Orthodontic treatment Six Month Smiles (STO) which an adult client may or may not choose. Here is an example.


3. After the extraction of teeth and direct esthetic restorations

In 2009 a patient NB from Lithuania who resides abroad came to VivaDens complaining about
a palatal position of #12 and #22 teeth. Having categorically refused the traditional comprehensive orthodontic treatment
and due to the absence of STO at that time by the patient's request two lateral incisors were extracted and
applying direct restorations, the teeth were fixed to neighboring teeth.
The patient was informed about possible the short-term treatment result.

3a. Teeth before
3b. Teeth after extraction of teeth #12, #22
3c. Teeth after direct esthetic restoration
3d. Upper teeth arch before
3e. Upper teeth arch after extraction of teeth #12, #22
3f. Upper teeth arch after direct esthetic restoration


In 2012, the patient's AB brother NB, who resides in Norway, came to VivaDens with request to align his teeth using the same method as for his sister. Similarly, he categorically refused the traditional comprehensive orthodontic treatment and asked to extract palatally positioned #12 and #22 teeth and make the bridge prosthesis for his #13-11 and #21-23 or likewise. After reasoned argumentation the man agreed to undergo STO treatment and was very satisfied with anticipated and received result.

4. Client's AB smile BEFORE and AFTER 7-month STO, restoration of incisal edges of 11-21 teeth and teeth whitening procedure

4a. Smile before
4b. Smile after
4c. Teeth before
4d. Teeth after
4e. Teeth - side view before
4f. Teeth - side view after
4g. Upper teeth arch before
4h. Upper teeth arch after

Given the real situation and acknowledging the right of choice of the informed client, STO with improvement of occlusion and further restorative procedures is a non-rejectable alternative and nearly always better than teeth drilling, extraction or absence of any treatment.
Of course, the traditional comprehensive orthodontics has its positive sides which explicitly need to be presented to a client, its novelties should be compared with results of other types of orthodontics, however, the informed client of the 21st century, who travels freely throughout the World, has his/her final right to choose.


Short-Term Orthodontics is applied as the first stage of the complex interdisciplinary treatment, taking into consideration the functional requirements of stomatognathic system, teeth position is improved, incisors are de-rotated, and space for implantation is prepared. All of this decreases aggressive preparation for direct restorations (fillings) and indirect restorations (prosthesis).

5. STO – the first stage of complex interdisciplinary treatment – teeth position is improved

5a. Teeth before
5b. Teeth after
5c. Upper teeth arch before
5d. Upper teeth arch after

Short-term orthodontic treatment has its criteria according to which patients are selected whether they are suitable candidates for STO treatment [2]. The clients, especially while they are less aware of STO results, are provided with detailed information about the treatment possibilities, alternatives, risks and complexity.

STO is simpler and shorter orthodontic treatment compared with the traditional comprehensive orthodontics. It is applied for reduction of crowded teeth, corrections of gaps and teeth position in dental arch as well as for space preparation for implantation. During STO the deep bite might be corrected (possibilities for prosthesis are introduced without lengthening dental crowns periodontologically and periodontal structures are preserved), gingival contour is improved according to the principles of esthetics. After STO there is no need to drill dental enamel and worn biting edges are restored by direct composites, this way creating more perfect esthetics. Such method with similar quality of result is cost-effective and helps to preserve hard teeth tissues and periodontal tissues. The clients are pleased with minimally invasive treatment protocol.


6. STO is a link of complex inter-disciplinary treatment which helps to preserve hard teeth and periodontal tissue. Minimally invasive treatment protocol is greatly appreciated by clients.

6a. Smile - side view before
6b. Smile - side view after
6c. Teeth before
6d. Teeth after
6e. Upper teeth arch before
6f. Upper teeth arch after
6g. Lower teeth arch before
6h. Lower teeth arch after

All STO clinical cases of Angle I class are fully treated by articulating the occlusion in this manner: the posterior teeth hold the Shimshtok’s articulating paper in the habitual intercuspidation, canine- guided bite is created, and central line is corrected.

During the majority of Angle II class cases the occlusion is opened, inclined upper incisors are repositioned, space for mandible protrusion is created and orthodontic elastics are prescribed for occlusion correction. STO patients are strongly motivated, thus, particularly good treatment results are achieved with orthodontic elastics.

7. BEFORE and AFTER 5-month STO

7a. Smile before
7b. Smile after
7c. Smile - side view before
7c. Smile - side view before
7e. Teeth before
7f. Teeth after
7g. Upper teeth arch before
7h. Upper teeth arch after


STO corrects completely the marginal Angle III class occlusion with a frontal cross-bite. Also posterior teeth are positioned into the correct occlusion.

8. BEFORE and AFTER 8-month STO

8a. Smile before
8b. Smile after
8c. Smile - side view before
8d. Smile - side view after
8e. Teeth before
8f. Teeth after

All the other children and teenagers under 16 years of age, who have complex occlusion problems, and also orthognathic patients are referred to the traditional orthodontists for more complex orthodontic treatment.


Teeth with braces

Sequence of arch wires. The protocol of changing STO arch wires is the same as in the traditional comprehensive orthodontics. The arch wires are changed every month in turn: 012NiTi, 014NiTi, 016NiTi018NiTi, and 016x022NiTi. Treatment control is carried out according to the protocols recommended by the traditional orthodontics, periodontal pockets are examined before the treatment, orthopanthomogrammes  are made before and after the orthodontic treatment, also, the condition of dental hygiene and carious lesions are monitored. Professional dental hygiene is performed before STO, 3 months after STO starts and after the removal of braces.

Laser biostimulation

Biostimulation - is the increase of tissue blood supply, that is stimulated by soft laser  waves radiation. During the first STO appointment after placing the braces, laser therapy is applied, which improves capillary blood circulation of periodontal ligament and gingivae, stimulates regenerative processes, decreases unpleasant sensations and increases comfort [4].

Using biostimulation, more cells required for osteosynthesis accumulate from a blood flow, teeth movement is accelerated, thus, the possibilities of straightening extremely misaligned teeth are extended. Therefore, STO treatment allows success in completely correcting lateral and frontal cross-bites.

9. Frontal cross-bite that has been completely corrected after 6-months STO treatment

9a. Teeth before
9b. Teeth after


Enamel reduction. The IPR (interproximal enamel reduction) applied during STO treatment, is based on interproximal reduction protocols and recommendations of the traditional orthodontics and thereinafter fluoride therapy is applied.

Root resorptions. At universities many dentists were instructed that ‘if you move the teeth too fast, the root resorption commences’. Root resorption is a real phenomenon which many of us have seen in radiograms.  However, root resorption is caused not because of fast teeth movement, but because of strong long-term orthodontic forces [5]. During the traditional comprehensive orthodontic treatment the physiological root resorption also naturally occurs. That might be a teeth response occurring within the limits of 0,5-1 mm [6] [Proffit].

Stability. Orthodontic forces are active in mouth all lifetime; teeth supporting apparatus, bone density, periodontal ligament width change and thus teeth migrate. These are natural physiological processes. Because of that neither orthodontic treatment is stable, and after STO as after any term orthodontic treatment the same retention protocol is applied.

VivaDens info, 22-07-2013


  1. Kokich VG. Who determines when orthodontic treatment is complete? Am J Orthod Dentofacial Orthop 2011;140:451).
  2. Ryan B. Swain, DMD. The Six Month Smiles System. Complete training manual for general dentists. Revised 3rd edition. 2011
  3. Maltagliati L, et al, Avaliacao da prevalencia das seis chaves de oclusao de Andrews, em jovens brasileiros com oclusao normal natural. Revista Dental Press de Ortodontia e Ortopedia Facial, 2006. 11(1)
  4. Doshi-Mehta G, Bhad-Patil WA. Efficacy of low-intensity laser therapy in reducing treatment time and orthodontic pain: a clinical investigation.Am J Orthod Dentofacial Orthop. 2012 Mar;141(3):289-97
  5. J.P. Okeson. Management of Temporomandibular disorders and Occlusion, 3rd edition: 109-125, 1992, Mosby.
  6. Becks H, Cowden R. Root resorption and their relation to pathologic one formation. Am J Orthod oral Sur 1942:28:513-26.