Are Braces Needed after Vivos Appliances?
In most cases braces will not be necessary after DNA and Homeoblock devices. There are many things to consider before getting braces or Invisalign after adult expanders. It is best to wait 6 to 12 months and not jump into another appliance for cosmetic reasons about spaces in between teeth. This time allows the jaws, facial bones and the bite to settle into a final stable and comfortable position. During appliance therapy the jaws grow wider, more forward and achieve better facial balance. At the end of treatment there can be small spaces between the teeth (mostly in the back). Once time is allowed for everything to settle, the spaces normally close and there will no longer be a need for orthodontics. The exception is when there are rotated teeth prior to treatment. The DNA and Homeoblock will create enough space for all the teeth to fit, but orthodontics will be needed after treatment if there are teeth rotated more than 15-20 degrees. Or if there is a high cosmetic expectation, orthodontics should be assumed.
Teeth Spaces will normally close 6 months after DNA Appliances
When the jaws get bigger during expansion, it only makes sense that there is more space between the teeth. Space is a good thing. Most people with small mouths and airways have crowded and crooked teeth. More room can be used for the teeth to fit better and be straighter. But are the spaces going to get large and unsightly? Usually, the spaces are very small and focused between the back teeth as the palate expands. The additional space will make it easier to floss, but the spaces will rarely get large enough to create a cosmetic problem. The round retainer-like wire in the front of most adult appliances (called a labial bow) does a nice job keeping the front teeth aligned and prevents spaces from developing between the front teeth. The Homeoblock and Vivos appliances are tailor-made for adults who have already had braces.
The Bite Needs to Settle and Stabilize after DNA Treatment
Vivos and Homeoblock appliances grow bone in three dimensions. During the appliance phase of treatment (when the appliances are worn daily) bone growth is directed wider and forward. Then the appliances are worn for 30 days as a retainer and usually removed forever. But the treatment is not finished. The vertical growth phase of the treatment needs to complete. And the overall fit of the teeth top to bottom needs to settle to a point of stability. This phase of treatment can last 3 months to 1 year depending on the case.
Teeth Spaces Close 3-6 Months After Adult Expanders
Teeth have a self-leveling and closing biomechanism. What keeps a tooth in a stable position is the tooth above due to biting pressure. If the biting pressure is not present, the tooth will move till it makes contact with another tooth. Or till it finds a position of stability. If there are spaces in between teeth, they will shift towards the front of the mouth (medially) until they are up against other teeth. It is very important not to initiate orthodontics immediately after using a Homeoblock or Vivos device. In fact, after any expansion device, it is better to wait 3-12 months after the expanders have been removed. Most of the time orthodontics is not necessary after adult expanders because the small horizontal and vertical spaces will close on their own without the need for braces. Closing these spaces prematurely with braces and Invisalign can be detrimental. The small spaces generated during treatment need to close naturally. Allowing spaces to close naturally completes the final phase of vertical bony jaw growth. If the spaces are closed too early with orthodontics, much needed vertical growth will be compromised.
Braces or Invisalign after Adult Palatal Expansion Treatment
There is nothing wrong with having orthodontic treatment 6-12 months after expanders and forward growth appliances. Cranial and jaw bone will not un grow. Teeth positions after expansion can still be adjusted with clear aligners or braces. And if teeth are not in a stable position, they can shift. Most of the time teeth will shift and naturally settle into a stable position 6-12 months after adult expansion. We prefer clear aligners such as Invisalign because they are more gentle on the jaw and cranial bones. Sometimes teeth that are severely crooked will require conventional braces. The most important thing is to allow time for vertical and horizontal growth and settling after Vivos DNA appliances. Dr. Adams is usually good at projecting what cases will need orthodontics after adult expansion appliances.