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Broken Appliances/Emergencies

Broken appliances are the most common form of an orthodontic emergency. Most of the diverse problems are addressed on our web page. Usually wax or cutting the wire with wire cutters will address most common problems. But for most common problems look at our web page.

Daily use of fluoride rinse is a good protection from decay that might occur if the home care is not up to expectations. Brushing at least 2x-3x a day is ideal. In the early stage of treatment, a daily salt and water rinse (1tsp of salt per 1/2 glass of water) will help the soft tissue to toughen up. In those cases where an ulcer may occur near the braces use a mix of Benadryl and Malox in equal proportions hold in the mouth for 1 minuet and then spit it out. This will help reduce the inflammation do this at most 3x’s per day.

On those occasions where emergencies may occur contact the office as soon as possible to allow us to view the problem and make any additional intervention.


Dr. Roland Nentwich, D.D.S., M.S


Hygiene Tips for Braces

Most children do not produce calculus (tartar). Thus, the importance of good brushing habits would entail the patient brushing for more than two minuets daily, “I advise the use of an egg timer, or electric tooth brush with a timer”. Then following up with a fluoride rinse, this can be done 1x-2x per day as to the incidence of cavities. The use of floss or water picks although helpful in most cases, for kids is unnecessary. For adults on the other hand, the process is a little more arduous. Most calculus build up is located behind the lower front teeth or lateral to the six year molar. With that thought in mind, I feel it is advantageous to use an electric tooth brush and toothpaste. Toothpaste containing baking soda seems the most effective, but there are so many variants out there predicated upon the conditions of ones teeth, I would follow the recommendation of your dentist. Here as an adult I would use either a water pick or some of the various interproximal utensils available on the market.


Dr. Roland Nentwich D.D.S., M.S.

What is Dentofacial Orthopedics, and Why Do I Need It?

Dentofacial-orthopedics is an orthodontic concept my profession is desperately trying to embrace, with some limited success. In essence the term relates to creating an effective balance between the jaws, teeth, and the soft tissue drape. It is not just a matter of creating nice little models of the teeth that appear to interdigitate properly. The term requires that we establish the best possible relationship between the upper and lower jaw. We must determine if there is sufficient space available for the tongue. From here we evaluate how the jaw inter-relationship reflects upon the functioning airway. Once all of this has been established it is imperative we provide the best possible aesthetic relationship of the teeth to the soft tissue. What is the appearance of the smile, what is the lip support being provided, and how do the teeth function relative to one another for a comfortable/ functional bite.


Dr. Roland Nentwich D.D.S., M.S.

Invisalign: Dentist vs. Orthodontist

The advances made by Invisalign over the last five years have been nothing short of remarkable. When Invisalign first came on the scene in 2007 it was little more than a fascinating quaint idea on broadening the availability of orthodontics to a broader range of patients. The additional bonus of this type of care could be delivered by a general dentist. They have now elevated the capability of this product to almost mimic that achieved by traditional braces, and for certain procedures it is superior to the traditional treatments. Here in lies the present-day problem.

In order to appropriately treat even mildly complicated orthodontic cases, one requires a deeper understanding of orthodontic concepts then just straightened teeth. Invisalign case treatment is determined by the lab (who has no greater understanding of dental biology than the average consumer). The training of an orthodontist is presented with entails, mechanics and dynamics of tooth movement, bone biology, the physics of forces, force vectors, and the implications when acted upon in the oral environment. Much time and energy is spent understanding what is most effective in any given circumstance. One must also have a deep understanding of the anatomy associated with the bones, teeth, and underlying bone. Many orthodontic programs require 3 additional years of training after one has completed their requirements for dental school. This often entails anywhere from 7-10 additional years in training.

The reason for this required knowledge is to address any of the problems that may be encountered in a given case. My reasons for not embracing Invisalign before was due to the material not achieving the results I had come to expect in my cases. But as stated before, the new attachment designs have enhanced the product enough where it can handle a much broader range of dental malocclusions. This is where the additional training provided within an orthodontic residency becomes valuable. Once a case is set up by a technician it is my responsibility to make the necessary changes so the desired movements can be achieved. This will often require between 2-5 modifications. This is done with the realization that there may be additional appliances required at the end of treatment to achieve and maintain the desired results. This is not to diminish the skills of my colleagues but merely to point out that what one does not know, one does not know. This makes it advisable if you wish to move teeth, you are still best served by an expert.


Dr. Roland Nentwich D.D.S., M.S.

Advantages of Lingual Braces

Today there is an increasing demand for pleasing aesthetics. This is not only in regard to the finished product from an aesthetic procedure (plastic surgery, orthodontics, aesthetic dentistry), but is often preferred while the procedure itself is being performed. Thus in the field of orthodontics aesthetic appliances have become in demand. The forms of those aesthetic appliances are as followed; Invisalign, porcelain or clear brackets, veneers or crowns, and lingual braces.

As with all things there are pros and cons to each one of these procedures.  I will attempt to provide a clear view of what they might be:


Pros: Very well marketed, simple, less visible than traditional braces

Cons: Must be worn 24 hours a day with attachments necessary to move teeth, can hardly be considered invisible, has been proven to achieve the predicted result 41% of the time, requires a high degree of patient cooperation

Veneers and Crowns

Pros:  Allows for aesthetic correction in a relatively short period of time (3 to 5 weeks)

Cons: Invasive, requiring some requiring some reduction of the natural tooth in order to correct tooth position, encroachment on periodontium often occurs leading to potential problems down the road

Porcelain or clear brackets

Pros: Not as visible as metal brackets, provides greater control for tooth movement for the orthodontist

Cons: Visible

Lingual Braces

Pros: Invisible appliance, as brackets are located behind the teeth, eliminates the possibility of white marks on the facial surface of the teeth, provides complete control for the orthodontist in treating the malocclusion

Cons: Some irritation to the tongue, accommodated with two to three weeks, requires slightly more meticulous care and cleaning

Its been my experience, that in the right circumstances, lingual braces provides the best treatment appliance available in orthodontics today. This is in terms of both the ending aesthetics, tooth position, appearance, as well as treatment mechanics superior to the traditional braces used today. It was with this thought in mind that I felt it incumbent upon me to introduce the use of lingual braces to the Tufts orthodontic residency. The use of that appliance in this program has been ongoing now for a three-year period.

Cuspid Substitution

When missing upper lateral incisors, there are two options for their replacement.  The first is referred to as cuspid substitution; this is done when the eye tooth or cuspid is placed in the position of the lateral incisor. The cuspid is then modified in size and shape to mimic the lateral incisor. The other option is to replace the lateral incisor with some form of prosthesis. This form can either be a bridge or a single tooth implant.  There are advantages and disadvantages to both of these options.

When providing the cuspid substitution, there can be problems in both shade and tooth shape.  Often a veneer (or porcelain covering), is used to mask the discrepancies. There is also the problem of the root configuration for a cuspid. The root is often more prominent. The advantages of cuspid substitution, is a natural tooth is replacing the lateral incisor. This eliminates the problem of gingival architecture, bone heights changing during later growth periods and development, and possible implant show through in the bone and gums.

When providing prosthetic replacement, either with an implant or a bridge, one needs to look at a different set of problems. The first is the necessity to place an implant with a crown, at a cost of approximately $5000 to $6000. An additional problem is implant show through at the gum level.  A third problem is an alteration in gingival  and bone height later in the person’s development. This has created an interesting problem reading timing for implant placement. It was once believed the best placement time was ages 17 or 18. This has been altered to later in the early 20s. It has always been my advice that once the space is created and the root positions are appropriate.  The patient should place a semi-permanent replacement. This in the form of a Maryland bridge, a false tooth bonded in place with  metal tie wings to the proximal teeth. This should provide a reasonable aesthetic result that will address the patients need until thet decide to proceed with an implant.