Metal Mouth Message Board

A recent study using Cone Beam CT technology shows that claims made by Damon System proponents are unsubstantiated. Read more:

http://markhamortho.blogspot.com/2009/0 ... rkham.html

Hi Dr. Tam,

Interesting article, thanks for posting it. I was wondering if the same holds true for all types of self-ligating braces or if this is specific to DBS?

We're neighboors btw, I'm in the west end of Toronto!

thunderkat wrote:Hi Dr. Tam,

Interesting article, thanks for posting it. I was wondering if the same holds true for all types of self-ligating braces or if this is specific to DBS?

We're neighboors btw, I'm in the west end of Toronto! :)

Hi Thunderkat. I hope your treatment is going well out west :).

The Damon System has been adamant that their forces are so light that teeth move much faster and that bone can be generated beyond the previously accepted standards. It will be interesting to see how Ormco, the parent company of Damon, responds to this new study.

I'll post an article about self-ligating brackets shortly. To answer your question, with all patients, expansion beyond the limits of biology can cause these sorts of issues, whether traditional or SL brackets are used.

What's the actual bad news for the layperson?

That it's not as fast as advertised or that it can damage one's teeth?

If it's not as fast as advertised, that's okay and not really bad news, but if it does damage then it is.

Can you please clarify. Thanks.

Ormco has been telling people for years that if you need extractions, they can be avoided in many cases by using Damon brackets. It will be interesting indeed to see how they respond to the new study.

Thanks for the information, DrJasonKTam. Like bbsadmin said, it'll be interesting to see how these studies play out.

But can I still hold onto my FAVORITE thing about self-ligating brackets? No ligatures! Not having ligatures was always the biggest draw for me. It'll be funny if that gets refuted in the next week or so.

Was this a published journal article? Please provide the complete citation.

Am I correct in thinking the reference was in response to damage caused / lack of stability in treating moderate to severe crowding without extractions, which is surely bad news.

The other issue mentioned here was increased speed of treatment with self ligating brackets, albeit a marginal reduction in treatment, due to reduced friction, is this also in question?

Thanks for this interesting post

There are a number of things wrong with the study, not the least of which is the extremely small number of subjects (19).

I also think it is inaccurate to attribute to Ormco the claim that Damon brackets eliminate the need for extractions when in fact they make no such claim. Ormco has successfully demonstrated - with as much or more evidence as provided by the study mentioned in this thread - that Damon brackets can function as an alternative to extractions when there is a "borderline" need for extractions, or to help reduce the number of extractions required for successful orthodontic treatment.

The whole thing is suspect to me. And I don't even have Damon braces.

If I understand it correctly, this is a dentist who only graduated last year as an Orthodontist:

http://dentistry.ouhsc.edu/gradortho/Residents.htm

So long as there's no damage in using these braces, there's really nothing to worry about. I can't see there being any claims to that in all these years that they have been used. The marketing aspect of the "brand" is just that.

If they do the job as intended, fine and good, if not, then we would have heard about that long ago.

I don't hang out much on this board, as I'm usually on the orthognathic surgery forum. However, I popped over and this post caught my eye.

I have Damon braces, and I have to admit that I have always been skeptical about their marketing. I have them because it is what my orthodontist is comfortable with.

I personally don't believe that severe crowding or severe occlusial issues can be corrected in a long term and healthy manner with braces alone. I had a consultation from an orthodontist who swore Damon braces alone could fix me up. After doing some simple research (and finding a GOOD orthodontist) I found out such treatment in my case could have serious consequences down the line. Those consequences are similar to what this article suggests. I opted for an expansion surgery that I had in February, braces, and then another round of jaw surgery sometime in 2010. I felt that was the best route to go for long term stability and health of my teeth and gums. Trust me, this was not an easy decision.

I wanted to respond here because I am taken aback by title of your post, especially since it is made by a practicing orthodontist.

Doctor, how are YOU any better than the Damon practitioners that put Damons on patients that should seriously be looking at extractions and/or surgery to PROPERLY correct their occlusions?

Your post is clearly meant to scare Damon wearers into thinking that the use of these braces is somehow a bad decision with future consequences. Clearly, over 10 years of practical use and multiple studies have demonstrated that self-ligating brackets are a safe, stable, and proven way to accomplish a class I occlusion. That science cannot be debated.

As a practicing orthodontist, I would expect you to present facts to this board, and not interject what is clearly some sort of personal opinion that is supported by what appears to be a somewhat unscientific study with a patient pool of 19!

Yes, the article you post may have some truth to it and it will be interesting to see how it plays out. But to suggest that this is "bad news" to everybody that wears Damons is terrible. And, what is a "fan" of Damon braces? Do you think there is one person on this board that is a "fan" of any specific type of braces? Nobody wants to have to deal with these things, and I'm pretty sure most people on here would live with barbed wire braces if they resulted in a stable and healthy occlusion.

The bottom line is this...Any type of braces that are used incorrectly, or on patients that have underlying skeletal deficiencies that are not treated, is a recipe for disaster. To suggest this problem is unique to Damon is flat out ridiculous.

Respectfully,
Chicago29

I appreciate the discussion generated by this post. Please understand that it is not meant to scare anyone, or suggest superiority of one provider over another. Take the information for what it is. I have addressed some of the concerns of the board below:

Ormco has successfully demonstrated - with as much or more evidence as provided by the study mentioned in this thread - that Damon brackets can function as an alternative to extractions when there is a "borderline" need for extractions, or to help reduce the number of extractions required for successful orthodontic treatment.

The bottom line is this...Any type of braces that are used incorrectly, or on patients that have underlying skeletal deficiencies that are not treated, is a recipe for disaster. To suggest this problem is unique to Damon is flat out ridiculous.

So long as there's no damage in using these braces, there's really nothing to worry about. I can't see there being any claims to that in all these years that they have been used. The marketing aspect of the "brand" is just that.

If they do the job as intended, fine and good, if not, then we would have heard about that long ago.

Proper diagnosis and treatment planning can never be replaced by any bracket system, whether it is Damon or not. The Damon System makes claims that extractions are not required even in severely crowded situations, since their extremely light forces allow bone to regenerate around the tooth, no matter how much expansion is required. Yes, this system has shown to align teeth and expand arches. It has not demonstrated that there is still good bony support around the roots as they claim. Many of the Damon "fans" are actually orthodontists, who tell patients, such as some of those here, about their benefits without merit. CBCT technology is still relatively new in orthodontics. Should any of you have a CBCT study to support Damon's claims, I would enjoy seeing it.

To say that Ormco's marketing is "just that" is like saying it is OK for McDonalds to market their hamburger as 100% Pure Beef, with the name of their brand being 100% Pure Beef instead of actually being all-beef. Companies should market their product in a manner responsible to the public. As for not hearing about this for "all these years", periodontal problems do not happen overnight. They can take years and years to develop, and there still is no evidence to show that they will not occur.

If I understand it correctly, this is a dentist who only graduated last year as an Orthodontist.

The intention was to let this forum know about a piece of evidence refuting these claims. Orthodontic graduate students, under supervision of someone in the department produce an extremely large proportion of the studies and literature out there. It has been this way for many years. N=19 is not an unusually low number of subjects if you frequent the orthodontic literature.

If you do not trust a recent graduate, Brite Melsen, one of the most respected orthodontists and educators in the world, has also just shown a similar result in her study of SL brackets.

Transversal Expansion and Self-Ligating Brackets: A CBCT Study

Paolo Cattaneo, L. Cevidanes, M. Treccani, A. Myrda, B. Melsen

Aarhus, Denmark

Aim: To perform 3D assessment of the transverse changes of the maxillary alveolar bone on patients treated with active and passive self-ligating brackets. Material and Methods: Pre- and post-treatment CBCT-scans of 50 patients were taken. 3D models were generated from the scans, were registered using the cranial base stable structures, and superimposed. Changes in basal alveolar bone and dental arches were evaluated using a 3D colored mapping. Results: Expansion happened mostly in the canine and more in the premolar region, and was achieved by buccal tipping. No transverse augmentation of basal bone could be detected. High variation and strong patient-related patterns of transversal expansion were observed.

I state my personal preference not to use these brackets or to make claims that have not been substantiated. There is not enough evidence to support their claims. Now, we are actually seeing evidence to refute these claims. In health care, there are adverse consequences to real, live people. By using techniques that are evidence-based, we try to provide our patients with the best treatment for their individual situation.

Certainly, there is no problem in using SL brackets when severe expansion is not required and traditional treatment planning is employed. However, at that point, there is no advantage to their use, since SL literature has shown unequivocally that there is no difference in treatment time, and in fact, that certain brands are actually more uncomfortable. Detailing and finishing is also more difficult.

These studies are, in fact, "bad news" for those who have "bought" into the erroneous concepts presented by these orthodontic companies and the orthodontists that use them.

I appreciate your taking the time to better explain your stance. I think that much of what you stated in your recent post is fair and objective.

I share your concern that there are many orthodontists out there that believe Damon brackets (or some other self-ligating system) are some sort of cure-all for cases that typically need extractions and/or surgery.

Thankfully, I did a lot of research and realized these claims are likely just marketing. I say "likely" because of course I am not an orthodontist and I don't really know with any level of certainty.

My advice is that anybody with severe crowding or underlying skeletal deficiencies look at extractions and/or surgery to fix the underlying problem. Trust me...I know surgery is not something to take lightly. It is Hell...and if you don't believe me spend some time in the Orthognathic Surgery forum and read people's stories.

No brackets can fix these severe problems, and it is irresponsible for any orthodontist to suggest any specific system can do this. However, the Damon system clearly has its merits, and when used correctly and in the hands of a conservative orthodontist, I believe it is a very good system.

That being said, any patient's primary objective should be to find an orthodontist they trust. If you trust them, the type of brackets used is completely irrelevant. A great orthodontist could align your teeth using barbed wire if they had to

To say that Ormco's marketing is "just that" is like saying it is OK for McDonalds to market their hamburger as 100% Pure Beef, with the name of their brand being 100% Pure Beef instead of actually being all-beef. Companies should market their product in a manner responsible to the public

Call it 90% as they do

http://www.damonbraces.com/q05.php

Will I need teeth pulled?

With conventional braces, orthodontists are often forced to pull teeth in order to create space for crowded teeth. No one likes to have teeth removed, and a smile with a full display of teeth often produces a broader, natural smile and a nicer profile. The Damon System uses biologically sensible forces which work with the body's natural adaptive processes to create space naturally, so doctors using the Damon System can now treat most cases without extraction.

In the few cases which still require extraction, space is made to improve facial balance and symmetry to provide a natural smile and profile that will last as you age.

Re small number in study. I work with medicines not dentistry, however, in my field, in studies where there is clear evidence that a certain course of treatment is having a negative effect, it is not ethical to go on an continue with larger numbers of subjects. Therefore if the author, as was clearly the case here, found that this approach was worse for patients that going down the extraction route, it would not be ethical to continue. This may explain the small number of patients.

Thank you Dr Tam for this information, extractions certainly seem to have been a contentious issue on the board, as someone who went with them, it's encouraging to hear that they can sometimes produce the best results as extractions certainly seem to have their fair share of negative press.