Revolutionary Movement

April 1, 2008
If you're like most hygienists, your working knowledge of orthodontics is probably limited to your own experinces as a patient...

by Anne Nugent Guignon, RDH, MPH

If you're like most hygienists, your working knowledge of orthodontics is probably limited to your own experiences as a patient or a parent of a child undergoing orthodontic treatment. Most of us are familiar with the basic classifications of occlusion. We also recognize the increased risk for caries and periodontal disease if there are too many teeth for the arch.

Long gone are the days when every tooth, encircled by a wide metal band, was subjected to heavy forces after the routine extraction of four bicuspids. Teeth moved but the process was painful and many paid a high price with flat facial profiles, abnormally short roots, and teeth relapsing in the mid-adult years.

In today's world, patients of all ages want more attractive, functional smiles. There are more options today than ever before to achieve this goal. Like most revolutions, some people have met the changes in orthodontic treatment with skepticism, while others bravely seek new ways to provide less invasive, more comfortable treatment.

My experience with orthodontics centered around trying to perform complete biofilm and calculus debridement, getting patients excited and proficient enough to perform effective home care techniques, and the frustrating task of removing orthodontic residual cement or bonding materials.

Like many hygienists, I encouraged hundreds of patients to seek orthodontic care. Many took my recommendations. Some had rapid palatal expanders to widen the maxillary arch. Others had headgear, wore lip bumpers, fiddled with elastics, or had perfectly sound teeth removed. Some even underwent surgical procedures to reposition the mandible or maxilla.

A decade ago, a process of moving teeth using a series of clear rigid aligners was hailed as a new way to straighten teeth. A novel concept at first, treatment systems like Invisalign have provided many people with better occlusion. Patients appreciate that the removable aligners are nearly invisible. The easy-to-remove aligners make homecare, eating, and dental hygiene visits a snap and have become increasingly popular among adult orthodontic patients.

Not all types of malocclusions can be corrected with a removable aligner-type system, which move teeth through existing bone. In certain cases, teeth undergo a process called slenderizing, where small increments of enamel are removed from mesial or distal surfaces so teeth can fit into a prescribed space.

I was recently invited to attend a special orthodontic symposium that focused on a technique known as the Damon System, which was developed by a Spokane orthodontist named Dwight Damon. I had no idea what to expect, but what I learned challenged many of the sacred concepts ingrained in me through the decades. The information and science supporting this technique are based on concepts that fit well into the burgeoning science of minimally invasive dentistry/dental hygiene. The technique has many aspects that appeal to those of us who focus on incorporating ergonomics into our dental hygiene practices.

On the surface, the Damon technique looks like traditional orthodontics. Brackets are bonded to the facial of all teeth with a series of arch wires that pass through the bracket. The resemblance ends there. The goal of the Damon technique is to align teeth in the arch using light forces and slim, high tech arch wires. Most cases are completed without extractions, and the treatment time is typically less than traditional orthodontics.

In traditional orthodontics, arch wires are tightly bound to the bracket via wires or elastics, which create great pressure and discomfort as teeth are moved through the bone. Teeth move as the force crushes the existing periodontal ligament and cut off the blood flow to the bone, creating a necrotic, painful environment. It takes time for the body to recover from such an assault. Patients under traditional treatment undergo office visits every couple of weeks to change out arch wires and tighten the forces on the teeth.

Damon brackets are sleeker and smaller than traditional models. Arch wires, made with new high tech metal alloys, slide easily through a large lumen in the bracket. They are not tightly bound to the teeth. The Damon System subscribes to the concept of combining light forces and low friction with the natural movement of a patient's lips, tongue and cheeks. Patients undergoing this treatment typically have arch wires replaced every 10 to 12 weeks, with a total of 10 to 15 visits to treat a case to completion.

The new tech wires passing through the brackets create passive ligation and team up with Mother Nature to produce amazing results. Light forces and low friction do not cut off the blood flow to the alveolar bone, which allows the body's osteoblasts and osteoclasts to destroy and remodel bone as the teeth undergo their journey to improved occlusion. The results, verified by cross-sectional CAT scan technology and periodic panoramic radiographs, demonstrate significantly wider maxillary and mandibular arches which are able to accommodate dentition that was previously crowded.

This technique holds particular promise for patients at high risk for periodontal disease. The gentle movement that repositions the teeth in the arch minimizes inflammation and encourages the growth of new alveolar bone. In addition, patients previously treated by traditional methods report that the Damon System is a lot more comfortable. Other benefits include improved facial profiles, wider smile lines, reduction of deep facial folds, and improved lip contours. Some patients that gain a wider arch also experience a more open airway, reducing the risk for obstructive sleep apnea.

This technology has significant benefits to those of us in clinical practice. Damon brackets are designed so the front of the bracket opens easily with a special tool, making it easy to remove the arch wire. Debriding a tooth devoid of an arch wire is much simpler and more ergonomic than accommodating the limited access created by a tightly bound steel wire.

We all know how difficult it is to create an optimal oral hygiene outcome with a mouth full of orthodontic elastic ties. Those miniature rubber bands are biofilm magnets. The result is decalcification, caries, and gingival inflammation. Even more troublesome is the lack of consistent structural integrity of elastic. Over time, there is no way to create consistent movement forces with a material that loses tension in a matter of days.

Regarding home care, it is far easier to clean a small bracket with a slim arch wire that is devoid of elastic. Today's power brushes are designed to effectively debride today's orthodontic appliances. We also have many unique devices that supplement hand and power brushes. Patients will benefit from the wonderful assortment of remineralization therapies available today.

It is easier to stay in our comfort zone than it is to challenge the status quo and build a new place to house emerging thoughts. If the Damon System sounds exciting, check the Web site at for more information or to sign up for the workshop at RDH Under One Roof. It's exciting to see opportunities unfold when we keep our minds open to the possibilities of a revolutionary movement. Join me in exploring these new thoughts.

About the Author

Anne Nugent Guignon, RDH, MPH, is the senior consulting editor for RDH magazine. She is an international speaker who has published numerous articles and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member and has practiced clinical dental hygiene in Houston since 1971. You can reach her at [email protected] or (832) 971-4540, and her Web site is