Meadows Orthodontic Blog

Soon after I opened Meadows Orthodontics in Castle Rock, my wife, Julie, came up with fantastic idea. We had always stressed the artistic side of orthodontics, and its importance in creating the most  aesthetic results possible for our patients. We had decorated our office with my oil paintings to let patients know that art has always been a major part of my life, and that there isn’t a minute of my workday that I am not putting to use my training in the arts towards my work as an orthodontist. But there was something missing. I heard from so many of our young patients that they too had an interest in drawing and painting.

My wife suggested that we offer to supply a canvas, paints, and brushes to each patients that starts with us, and invite them to make a painting that we would hang on a wall in our practice to go along with my paintings. I was expecting to get 20 or 30 a year from our patients, but boy did I underestimate the response. The original wall we had set aside was soon full, so we opened the largest wall in our treatment area to display the all the amazing paintings that our patients were creating…and soon that wall filled up. So started to fill the walls of our game room!

Kids that had just started braces painted pictures of their favorite football teams, hockey teams, their pets, landscapes, Harry Potter characters, Dr, Who, Sponge Bob, Nemo, ballerinas, landscapes, dinosaurs, parents college mascots and logos, rainbows, unicorns, abstract art, family portraits, and much more! In addition to the acrylic paints that we supplied, they used oils, crayons, melted crayons, charcoal, sequins, feathers, glue, popsicle sticks, stones…

I certainly think my patients benefit greatly from the artistry that I introduce into their smiles, but it has been amazing how much they have given back to me and my staff. Many times every day, while I have time to look around for few moments, I see something new, inspiring, or just really cute in all the hundreds of paintings that are on the walls from our patients. It is also really nice to see parents that are sitting with their children checking out all the art work and smiling spontaneously when they see something that makes them happy.  Hundreds of children have also looked in pride at their artwork that is on display in a place where hundreds of other people get to view their work.  Many pieces have been given back to families as their children finish their time with us and leave with new smiles. Other paintings we just cant seem to part with, and have been on our walls since the first few months that we opened!

Early last year we opened our second office in Castle Rock near the Founders, and we have continued our tradition there also. The paintings are multiplying, walls are filling fast, and I am always amazed at our patients creativity and talent on a daily basis. Stop by anytime and take a look.

Dr. Dan Rejman is the owner of Meadows Orthodontics. Before his years of study in dental school and orthodontic specialty training, he studied studio arts in composition, color theory, drawing, painting and drafting.

A relatively common problem that I see as an orthodontist is a patient who never developed upper lateral incisors. Lateral incisors are the teeth immediately to the right and left of the two front teeth. The first thing that I explain to the patient and their parents is that this is not something that went wrong with the way the child was raised- this did not happen because they didn’t eat enough broccoli, or because there was an accident or lack of fluoride! Technically, the condition is called lateral incisor agenesis, and the failure of these teeth to form is thought to have a strong genetic component, arising from mutations in specific genes that impacts about 2% of the population.

The earlier missing lateral incisors are detected the better, as early detection often keeps more treatment options open. This is one of the reasons the American Association of Orthodontists (AAO) recommends an initial orthodontic examination around the age of 7. At this age, we can clearly detect that lateral incisors are not developing, and start to review options for the family involved. Lateral incisors usually erupt and replace the existing primary (baby) teeth at the age of 7-8 years old. If the laterals are missing, the baby teeth usually will remain and the missing laterals could go undetected by the family unless detected by the dentist or orthodontist. The upper canines, which are the third teeth from the center, will often erupt where the lateral incisors should be, and make the lateral baby teeth fall out. This is the age (usually 10-13 years old) where the problem will become visibly apparent.  Young teens have social and aesthetic concerns, as the pointy canines are in a place that they don’t belong, and are often accompanied by excess spacing.

When missing lateral incisors have been identified by your dentist or orthodontist, the decision of how to treat this issue can be quite complicated, and involves many factors including facial and skeletal structure, dental relationships, individual tooth morphology (shape and appearance), aesthetic preferences, the age of the patient and financial considerations. Because I see so many of these patients in my practice, the following is a basic guide to properly treat this condition.

There are two main treatment options for replacing these missing laterals:

1) Opening the space where the laterals should be (and moving the canines back to their proper location if they erupted too far forward) which will set things up for implants and crowns to be placed in the future.

• Advantages of this option are: 1) All the teeth are left in their natural, ideal position in the mouth, with all their individual shapes and contours looking like they “belong” in that position. 2) Once the implants are placed, they are extremely durable and should last a lifetime. 3) Placing an implant leaves the surrounding teeth in their natural healthy state, as opposed to bridges that require greatly reducing the tooth structure of the two usually entirely healthy adjacent teeth (this option has largely fallen out of favor for this reason).
• Relative disadvantages/considerations of the implant option: 1) After the braces are removed, the patient usually has several years of open spaces where the space was left for the future implant (I will explain the reason for this below). 2) Because there are spaces, a removable retainer or “flipper” with plastic teeth will be worn in public so it appears that there are teeth in these areas. Usually these need to be removed while eating. For some patients there are there are “fixed” options that are bonded in place to the adjacent teeth, but they are not as durable as the future permanent tooth replacements. 3) The longer there are missing teeth in an area, the more supporting bone (called the alveolar ridge) disappears. A bone graft is often needed in these areas to make sure that there is a sufficient thickness of bone under the gingiva (gums) to support and completely surround the implant. 4) This is usually a highly visible area, and it may be difficult to make the gingival area look really nice, especially if there has been a fair amount of bone loss in this area. It is truly an art form to get the gum contours to look natural around an implant site! 5) Of course, finances are a consideration, as having bone grafts, implants and crowns done properly will come with their respective fees.

2) The second option for missing lateral incisors in what is called canine substitution. This is where the orthodontist moves the canine into the missing laterals space.

•  Advantages of this option are: 1) All the teeth in the mouth are natural, 2) At the end of braces, all the spaces are closed, and there is no time period waiting with open spaces in the mouth, 3) there is no need for large procedures such as implant placement or bone grafts after the braces are removed, and therefore the associated costs are usually less. 4) The finish of the gingival (gum) structure is usually more predictable.
• Relative disadvantages of this option: 1) The upper canines are taller, wider, have a more convex surface, have a pointed tip, and are a darker shade than the lateral incisors. Therefore, these teeth need to be extensively reshaped in order to have the appearance of lateral incisors, and may need additional cosmetic procedures by your dentist to get the color and shape correct (bonding, veneers, or whitening). 2) Every upper tooth other than the two central incisors are technically not in the correct space, they are one full tooth forward of where they should be located. Often they will fit great in this position, sometimes they will not- your orthodontist will have a good idea if your teeth will fit together nicely with this option.

Having said the above, these factors are “all things being equal” comparisons. Facial structures, teeth, and the upper and lower jaws come in all variety of shapes, sizes and relative relationships to one another. These individual factors will also largely influence the decision as to which option to choose. For example:

• If your bite is fitting ideally with little crowding, you have a great profile and lip structure and you are just missing two lateral incisors, you will likely be a great candidate for two implants.
• If the shape of your canines would require too much tooth removal to have an acceptable appearance (or your first premolars are very short and will not look acceptable in the canine position), then you may lean towards the implant option.
• If you have upper teeth that protrude forward of the lowers, or have considerable crowding of your lower teeth, you may be a better candidate for canine substitution.
• If your upper and lower teeth are both tipped outwards too much (called biprotrusion), with or without lower crowding, you may be a candidate for canine substitution, along with extraction of two lower teeth.
• If the upper canines have erupted into the missing incisor spaces, and all the premolars and molars behind the canines have drifted forward a large distance, it may be extremely difficult to move them back to make space for implants, especially as a late teen or older.

These are just a few of the different factors that we consider when helping patients decide what is best for their situation. The take home message is that there are multiple factors that go into deciding the best course of action when dealing with the issue of missing lateral incisors. Your orthodontist and dentist should work together to determine the best plan for your individual teeth, facial structure, and esthetic preferences.

Dr. Dan Rejman is a board certified orthodontist in Castle Rock, Colorado. He maintains two busy practices exclusively in Castle Rock.

There is no easy answer to the question “How long will I be in braces or invisalign?” Every patient has a unique bite, jaw structure, occlusion (how teeth fit together), and personal goals on how they would like their smile finished. After treating thousands of patients, I can can give a relatively accurate estimate of how long treatment will take IF the patient is consistently excellent with compliance (how well they wear rubber bands, maintaining excellent oral hygiene, etc…). In the article below, I will discuss what influences how long orthodontic treatment will take.

1. Patients treated with braces and clear aligners in my practice have had treatment times ranging from one month to several years in length. IN GENERAL the most very minor cases take 6-12 months, “average” teen and adult cases are about 14-24 months, and more difficult cases involving severe malocclusions or a combination of orthodontics and orthognathic surgery can take over 24 months.

2. The above time frames are EXTREMELY influenced by the patient’s compliance with what the orthodontist asks them to do in addition to just being in braces or invisalign. One example is if the patient is asked to wear elastics (rubber bands). I usually instruct my patients to wear them 22-23 hours a day, which gives them time to brush their teeth, eat, or practice instruments or sports. If the patient wears the elastics 18 hours a day on average, this could delay treatment by 6, 9, or 12 months (or more), depending on individual biological variation. If they wear elastics only 12 hours a day, the delay will be even greater, to the point that no progress may be made after a certain point. We are in constant communication with our patients about this, and coaching and encouraging is a large part of our job.

3. If you have been given an estimate of 18-22 months for your orthodontic treatment, and if you are consistently compliant with elastics, the majority of patents will finish within this time frame… but some WILL NOT, even if they are doing the exact same treatment, with the exact same elastic compliance. Why? The human body is incredibly complex, and biologic variation with bone density, enzymes, genetic factors, etc… all vary from person to person. This may make treatment proceed faster, or it may make treatment take a bit longer!

4. A quality orthodontist will want to end treatment when your teeth are in their most ideal aesthetic, healthy, and stable position, not when a certain date is reached on a calendar. For me, many patients are thrilled that this occurs before the estimate, most are within the estimated range, while others are understandably disappointed that their treatment takes a bit longer than expected. This is part of being an individual human being! Orthodontic treatment is not like building something mechanical on an assembly line.

5. The take away message is, when your orthodontist gives an estimate of how long your treatment will take, it is an estimate and can vary significantly from patient to patient…some on the fast side, and some on the slower side. We are trying to be efficient and move things along as fast as possible! Do your part with wearing elastics 22-23 hours a day, and you are moving at your own personal maximum speed (which will vary from your friend’s and classmate’s maximum speed!).

Dr. Dan Rejman practices orthodontics exclusively in his two practices in Castle Rock, Colorado. He is a board certified specialist by the American Board of Orthodontics

We are lucky to live in a town with such great food choices. My staff and I put together a list of our favorite foods in Castle Rock. Some are fancy, some not so fancy, but they are all great! Support our local restaurants and try them out!

1. Cronuts (Croissant donuts), The Donut House, Wilcox St. By Orthodontic tech Amber. Be warned- highly addictive.
2. Pear and mascarpone pasta purses, Vista Vino, Wilcox St. By Dr. Dan Rejman (sounds different, but these things are amazing!).
3. Everything Pizza, 212 Pizza Co., N. Ridge Road, by orthodontic tech. Stephanie R. (and a second choice for their Presto Pizza by Dr. Dan!)
4. Wisconsin Cheese Curds and Tenderloin Filet, Uncle Tapas Food truck at 105 West Brewing, Park Street. By Orthodontic tech Jenna. Great food and beverages every night at locals favorite gathering area.
5. Cobb salad with grilled chicken, Crave, Limelight Ave. By Julie, office manager (yes, their salads are as great as their burgers!)
6. Tortellini Alfredo, Rose’s Bella Cucina, Limelight Ave. By Doc’s daughter Caroline. Impressive classic Italian family recipes.
7. Pan Fried Chicken, Castle Cafe, Wicox St. By financial coordinator Stephanie H. A Castle Rock classic. Doc adds, “Dont miss the banana chocolate cream pie- I get one instead of a birthday cake every year!”
8. Homemade Hummus, Damascus Grille (middle eastern food), Wilcox St. By Front Desk Admin. Marla. Another family owned Castle Rock gem with a simple atmosphere, but great food!
9. Steak Nachos, Yolandas, Wilcox St. By treatment coordinator Sam. Everything here tastes fresh.
10. Enchiladas, Guadalajara, Wolfensberger Rd., by front office admin. Whitney. This place is always busy for a good reason.

Dr. Dan Rejman and his staff are all locals who love our small town and our Castle Rock family of orthodontic patients. For questions about what braces or Invisalign can do for you or your family members, contact us at 303-660-0112.

One of the more involved things that I do as an orthodontist is to give parents guidance and advice if we have identified something in the cranial facial growth of their child that indicates that they may benefit from a surgical procedure in addition to traditional orthodontics. Some parents are familiar with these procedures if they (or a family member) has had surgery to help correct their own jaw relationships in the past, or can clearly visually recognize that there is a significant jaw imbalance. The purpose of this article is to act as a starting point to help parents and patients understand why they may be a candidate for jaw surgery, how it may benefit them, what the potential risks are.

Hearing that a child’s jaw growth has, or may progress to the point where surgery is needed to achieve an acceptable bite or facial aesthetics is usually a cause of great stress to the parents of the child. Having had this conversation with hundreds of families, and having a daughter of my own that is a possible candidate for a surgical jaw correction, I can empathize with the worry, uncertainty, and parental concern that naturally accompanies such a decision. Here are some of the most common questions about orthognathic (jaw) surgery that I commonly address.

” Why might my child need jaw surgery?”  Jaw surgery (orthognathic surgery) is most often an option when the upper jaw (maxilla) or lower jaw (mandible) has grown disproportionately in size to the other. Other indications for surgery may stem from issues due to jaw asymmetry, congenital defects or syndromes. Most commonly though, I guide people through making decisions about surgery due to a lower jaw that is growing too much, a lower jaw that has not grown enough, or an upper jaw or midface that is not growing enough.

“What are signs that my child’s jaws are not growing in proportion?”  If the lower jaw is not growing enough, there is often the appearance of a “weak chin” that is set far back, or upper teeth that appear excessively forward of the lower teeth. If the lower jaw is growing too much, or the upper jaw not enough, the chin often appears to protrude too far or to be too large. The front teeth will also often be in a crossbite (lower teeth ahead of the upper teeth), even at an early age. An upper jaw that is too narrow will often cause a posterior crossbite (back teeth that are on the wrong side off one another).

“Cant crossbites, overbites, underbites, and jaw issues be corrected by orthodontics?”  Most often these issues can be corrected with orthodontics, but there are two main factors that must be considered. The first is the magnitude of these conditions. If the jaw imbalances are severe enough, no amount of orthodontic treatment will obtain a result that is within normal limits. The second factor is the age that these issues are treated. Certain relatively severe issues, such as crossbites and some underbites can be corrected or greatly improved if treated early enough. It is important for an orthodontist to identify these imbalances early, as there are age appropriate times for these conditions to be treated most effectively (for example, many crossbites cannot be fixed after the maxillary suture fuses during the mid-teen years). However, it is just as important for an orthodontist to have discussions with the family if it appears that orthodontics and braces alone cannot result in a satisfactory outcome. This is when the option of a surgical correction comes into the equation, and the sooner it is discussed, the better prepared the family will be.

In several weeks, I will continue this article with more information regarding surgical orthodontics in the second half of this blog.

Dr. Dan Rejman has two orthodontic specialty offices located in Castle Rock, CO. He is happy to have complementary consultations with families or patients that are looking for advice regarding dental or oral-facial developmental concerns. 

There is so much new and exciting technology available in the field of orthodontics, and I like to share with our patients and the community when we invest in something that makes their treatment more comfortable, more efficient, safer, or increases the quality of their experience or their end result. Below are two pieces of technology that we recently added two our two locations in Castle Rock.

One of our employees is a full time laboratory technician who makes our retainers in house, which means that we rarely have to order appliances (such as expanders, retainers, space maintainers, etc…) from outside sources. This is a great advantage to our patients, as we can turn around and fabricate retainers within a day, where it often takes up to two weeks when using an outside laboratory. We recently added a Drufomat Scan Pressure Machine to our laboratory. This machine is the same unit that large, professional laboratories use to make custom retainers, and it will largely replace the machines that made our vacuum formed retainers. The Drufomat machine uses very strong positive pressure to evenly and more accurately form plastic retainers to fit your teeth more precisely. Well molded retainers are more comfortable, fit more snugly, and reduce the need to re-make retainers that don’t quite fit perfectly. This technology also uses bar code scanning for the specific type of plastic that is used, and automatically sets the proper heat, time, and pressure to largely eliminate human error and variation that was unavoidable with the traditional machines. Geeky stuff, but our patients are really going to like the new retainers that they receive.

We have been using optical-digital scanning to largely replace the amount of traditional, goopy impressions that are needed in our office. It has been almost one year since we first upgraded our first scanner to the new iTero Element. This scanner uses a hand-held wand with advanced optics to scan our patients teeth, which replaces the goopy impressions that are taken before and after treatment. It is also used as the only record needed to treat our patients with invisalign. We simply scan our patient’s teeth (our technicians can do an entire scan in under 2 minutes!), send the information to invisalign, and the process is immediately started for me to set up the patient’s case for orthodontic correction. No time is lost in the mail, and when touch-ups are needed, it immediately gets the needed information to invisalign for any detailing that I need accomplished for my patient’s teeth. This technology has been a huge time- saver, has greatly increased patient comfort by elimination impressions, and is completely safe (this is optical technology- there is no radiation!).

If you are interested in further details on how the latest technology we utilize can improve your experience with orthodontics, please give us a call at Meadows Orthodontics. I will be glad to give you a tour and explain what is the best option to get a new, amazing smile!

Dr. Dan Rejman is the owner of Meadows Orthodontics in his hometown of Castle Rock, Colorado. Dr. Dan travels extensively for continuing education and seminars throughout the year, and places a priority in keeping his two Castle Rock practices state-of the-art for patient comfort and safety, and to increase treatment quality and efficiency.

As most of our patients and their families are aware, our family has been preparing for the addition of our fourth child this spring. I would like to thank all of you for being flexible the past several weeks as Julie and I have flown to China to meet her and finalize the adoption process!  We like sharing important events with our family of patients and friends in Castle Rock, so as I travel back to the States (I am currently somewhere over the Pacific in the midst of a very long flight!), I will write a bit about our new family member and our adventures this past week.

Julie, my eight year old daughter, Nina, and I arrived in China last Friday, and we were taken to our hotel near downtown Beijing. We had Saturday and Sunday free to explore before we were to meet our new daughter on Monday, and we were excited to see the sights of Beijing. Unlike the glittering cities of Shanghai and Hong Kong, Beijing has a more historic feel to it, with a relatively sprawling, less vertical architecture than these other large cities that have skyscrapers dominating their downtown areas. We were excited for Nina, who we adopted from China as an infant 8 years ago, to see this country for the first time. On the first day we explored the Forbidden City, where dynasties of Chinese Emperors used to reside. We learned an early lesson on how tourists that stick out like a sore thumb can be taken advantage off – we took an unknowingly VERY costly ride on a motorized “rickshaw”. At least Julie was told she was “very, very beautiful” before and after we learned our lesson! The breakfast buffet at our hotel was wonderful, and served a variety of food that was very non-traditional for Western breakfasts. Nina and I loved the station where we filled a metal bowl with noodles, greens and mushrooms, then handed it to a cook who submerged them in boiling water, placed it in a bowl with broth, and we then topped it with red chili, cilantro, tiny salty dehydrated shrimp, and soy sauce! We spent Sunday afternoon wandering an enormous outdoor and tented market, weaving among the 3000 vendors that were selling small sculptures, teapots, beads, jewelry, art work, clothing, books, and hundreds of other items. Those of you who know how social Julie is may find this amusing: At the very FIRST vendor we approached after entering the market, she started talking about where we were from to the vendor who knew little English. As we tried to move on the woman followed Julie with a calculator for 30 minutes trying to get her to buy items. The woman loudly fended of other vendors as they crowded around Julie, as surely this nice lady who had proudly described Colorado and Castle Rock (to someone who didn’t understand her) within seconds upon entering the market must want to buy some goods. Alas, Julie finally succumbed and bought a bracelet that was too large for Nina, and learned not to make eye contact or make small talk unless she wanted to attract a crowd of “friends” listing prices on calculators!

We woke early Monday morning and met our adoption coordinator, April, and a very nice family from Hawaii that was adopting a son from the same orphanage.  We drove together to the outer suburbs of Beijing where the orphanage was located, and we were unsure exactly how we were going to meet our new daughter for the first time. It had been seven months since we had made the decision to welcome a new family member. Her name is Dang Li, and she is a thirteen year old girl with spina bifida that had been abandoned soon after she was born. We had seen photos and videos of her, and could see that despite her diagnosis, she was full of energy and life. For a time period in China, the name Dang was given to orphans, and through letters she wished to change her name Vivian Li before moving to the States. We had also “met” one another (including Stanley and Mabel- she had never seen dogs before!) using FaceTime and an interpreter several weeks ago.

When our van pulled up to the orphanage grounds and we started to unload, there was no time to wonder as we were met outdoors by the two children and their caregivers in a sea of welcoming greetings, Julie and I received hugs, but Vivian and Nina immediately held hands and headed down the sidewalk towards our meeting area, where we signed documents, gathered Vivian’s belongings (so little), and headed back to central Beijing for more official documentation stops, bonding over McDonalds (Nina was thrilled with Mc Macaroons) and then back to our room.

What a brave little girl. Can you imagine at the age of 13 leaving the home you have known for your entire life, with very foreign looking people that do not speak your language (and are very tall and dress funny)? Then she has to immediately stay with us in a hotel room (her first night ever out of her room she shared with five girls) in close quarters. Julie and I were afraid that if we snored she would be terrified! Luckily the other couple that traveled with us to adopt their son were both language teachers, and the husband, Thomas, is currently an English as a second language teacher at BYU Hawaii. They were so helpful and filled with knowledge about the process of integrating an older child into a family with a new language. They had adopted a 12 year old son from China the year before, and they helped us download an amazing translating program to our iPad that we used to communicate with. She knows so little English! And we know so little Chinese! We jumped right in and we will patiently learn a bit more every day.

We hear all the time, “She is going to be so happy to leave with you and move to Colorado”, and there is a part of that that can be true. But people who are familiar with adoption, especially with older children, know that we hope to see that she is sad as much as she is happy. This means that she has formed bonds with the people in her life and a healthy connection to where she is from, which are just as important as physical well-being. The better she was taken care of, the harder it is for her to leave, but the easier it is to adjust well in her new life ahead of her. We returned to Vivian’s orphanage on Thursday, as her caregivers wanted to have us all for a farewell lunch, and we learned what a best case scenario this orphanage has been for her. Given the hardships that that all the children there have endured, they were nothing but smiles and energy, and the caregivers were laughing with them and treating them as family members. Goodbyes were difficult, but this was encouraging.

Julie will finish with legal work in China this coming week, and will return with Vivian and Nina this Saturday. We cannot wait to share our experiences with you all, and I’m sure Vivian will often be present around our office to say hi!

We are so lucky at Meadows orthodontics to have such great technicians, which are also called orthodontic assistants. The vast majority of orthodontic offices employ these professionals, who perform a large variety of tasks every day. They wear so many hats in our office, and our patients often become very close and form great relationships with our technicians! Because they are so important to me, and work by my side every day, I thought I would share a bit of what they do during a typical day, and describe what skills are required for their profession.

Before patients arrive in the morning, technicians arrive and open the office, turn on the computers, make sure their stations are fully stocked with all the items that we use during the day (there are hundreds!), sterilize the instruments that we use daily, and check that sterilization is working properly.

At our daily meeting, each tech has differing responsibilities to report on:

• One tech reports on the list of patients that we will be seeing that day. She checks that we are all prepared for any special procedures that we may be performing during the day, new patients that are visiting, patients that we are placing braces on for the first time, and patients that we will be removing braces for that day.
• One tech is in charge of keeping track of invisalign cases, and submitting them to the invisalign site after we have taken digital impressions of patients teeth from our iTero scanner. She informs me when the cases are ready for me to work up and “design”, and if there are any complications with delivery dates, etc.
• One tech is also a laboratory technician, and she makes most of the retainers, expanders, space maintainers and thumb habit guards that we use. She creates these appliances, solders and welds them, and has me check them before we deliver them to our patients.

Once we start seeing patients, their duties include:

• Greeting the patients, asking them about their day and lives, seating them in the treatment chairs, inquiring if they have any concerns with wearing rubber bands, if there are any loose braces, and making sure that all is comfortable.
• They untie and remove the wires from the braces, check oral hygiene is acceptable (and give coaching if it is not!), then inform me that the patient is ready.
• When I arrive to great the patient, they give me a summary of the patient’s progress, then record on the computer all the changes and adjustments that I perform, along with any conversations that I have with the patient or their parents regarding their dental development.
• They them retie in the wire to the braces, and show the patient how to wear elastics as I have requested, and help them set up their next appointment with us.
• When braces are first being placed, they clean and prepare the tooth surfaces, and help me place the braces on the teeth. I then place the braces in their final position and light cure (bond) them to the teeth.
• When the braces are removed, they usually remove the majority of the braces, and remove the cement from the teeth. I then do the final polishing and finishing of the enamel surfaces.
• They take radiographic images (they are all certified with radiography), take a series of photographs of teeth both before and after treatment.
• They take impressions of patient’s teeth, using both traditional impression trays, and digital iTero scanning. These impressions are used for diagnosis and creating retainers and expanders.
• They clean, disinfect, and sterilize the office, including our instruments, chairs, and treatment cabinets/surfaces.
• Just as importantly, they comfort our patients if they are nervous, and create a caring, fun atmosphere that makes visiting our office a special and positive experience.

As you can see, this is a very hands-on, technical, and very social job. I hope you appreciate all that they do- I sure do!

Dr. Dan Rejman

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. He currently has five orthodontic technicians on his team, who are all wonderful, dedicated professionals!

Youth sports are so popular here in Castle Rock (and around the country), and all of us at Meadows Orthodontics think it is important for kids and their families to be aware of the benefits of wearing a sports mouth guard if they play a contact sport. If your child wishes to have a custom fit, professional quality sports guard, please contact our office – we will happily make one for them! Here are some items of interest and statistics regarding sports injuries.

• More than 5 million teeth are injured or knocked out every year, resulting in nearly 500 million dollars spent on replacing teeth.
• Up to 39% of all dental injuries are related to sports
• Sporting activities account for the greatest percentage of traumatic dental injuries in teens
• 50% of all children and teens will suffer at least one traumatic injury to a tooth by the time they graduate from high school
• Broken teeth and other oral related injuries account for more than 600,000 emergency room visits a year
• Sports related injuries account for 3 times more facial and dental injuries than violence or traffic accident

Now the good news!

• Athletes are 60 (!!!) times more likely to suffer harm to their teeth when not wearing a mouth guard. Mouth guards work amazingly well when worn!
• 80% of traumatic dental injuries occur to the top front teeth, which are usually covered by a mouth guard.
• An estimated 200,000 oral injuries are estimated to be prevented annually in the U.S. by wearing mouth guards
• Mouth guards help to prevent injuries to the teeth, lips, tongue and cheeks.

Can wearing a custom mouth guard help reduce the risk of sports related concussions? More peer- reviewed research is needed regarding this question, as some research has shown evidence that it does help, while other research is inconclusive. They certainly do not increase the risk, and if one is being worn to protect teeth, a side benefit may be reduced concussion risk. I will be watching for new, more conclusive research!

Dan Rejman D.D.S, M.S. is a board certified orthodontist in Castle Rock, Colorado. His children play sports in the area, and he has been instrumental with fitting their teams with custom mouth guards for years!

I have previous blog entries about the difficulty of treating underbites, which can be the result of the upper jaw (maxilla) not growing enough, the lower jaw growing too much, or a combination of both. It is vital that underbites be identified as early as possible, as successful  treatment of this type of bite is often largely dependent on a patients age. We are often trying to eliminate the need for a surgical correction later in life by identifying the problem and treating it appropriately at the correct age. For decades, the standard of care for treating underbites was the use of a facemask, or reverse pull headgear. Most studies have shown that the most successful results occur when treatment is started before the ages of 8 or nine (with the exception of severe cases, which should be identified early as needing surgical intervention at a later age). Some  problems with this treatment option are: 1) If the child is brought in for an exam at a later age, say 12-14 years old, often a window for successful treatment may have been missed. 2) There are issues with children being compliant with wearing the facemask appliance (even if only at night), as there are obvious social concerns, and comfort issues. 3) Due to these social concerns, the realistic hours of using this appliance outside of school hours is inherently limited. 4) The appliance is removable, and can be removed easily even if parents check that it is being worn when they take a look at bedtime.

Recently, devices called miniplates have started to be used as an alternative to facemask therapy. Miniplates are biocompatable, titanium attachments that can be fixed to the upper or lower jaws. An oral surgeon uses very small screws to attach the miniplates to the upper and back areas of the upper jaw (usually at the zygomatic butress), and also to the more forward area of the lower jaw. Of course, this occurs under anesthesia, and this is a relatively non-invasive out patient visit. The orthodontist can then attach elastic rubber bands from the upper miniplate to the lower miniplate. Advantages of this treatment option, as contrasted to facemask treatment, include:  1) Research is supporting the idea that miniplate treatment is ideally started at a later age (around the age of 11-14) than facemask therapy, when the density of the maxillary bone has increased. 2) The social stigma is reduced, as the mini plates are located intraorally, and are quite small as they emerge from the gum tissue. 3) Due to the applaince being located entirely in the mouth, elastics can be worn 24 hours without concern about them being noticeable or looking “out of place”. 4) The miniplates are semi-permanantly fixed until they are removed by the oral surgeon. Largely due to these reasons, recently published research is showing impressive results using this method vs. traditional facemask treatment. In summary, orthodontists have another great option to help achieve more successful cases, and to reduce the number of surgeries needed to treat these cases.

There are some obvious downsides to using this technology that must be considered. Miniplates require two visits to the oral surgeon; one for having them placed, then another for removal after orthodontic treatment is complete. There is also the additional asscoiated cost of having an oral surgeon perform these procedures. As with any treatment, dental or medical, the advantages must be weighed against disadvantages, and risk vs. reward. I have been having these conversations with families of children with underbites, and each conversation is as unique as the child’s unique facial structure. Please g ive me a call if you have any questions regarding underbites, and we will determine if miniplates are an appropriate option for your family member.

Dr. Dan Rejman is the owner of Meadows Orthodontics in castle Rock, Colorado. He is Board Certified by the Amerivcan Board of Orthodontics.