Wednesday, August 31, 2016

1988 Article regarding root resorption

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.655.8358&rep=rep1&type=pdf

TAD - intrusion of the posterior maxillary molars - mild to moderate open bite cases

Recently, the minimally invasive placement of TADs (temporary anchorage devices) has allowed orthodontists to treat some of these patients without orthognathic surgery through intrusion of the posterior maxillary molars. While TADs are not a substitute for surgery in all cases, they do provide a treatment alternative for specific mild-to-moderate open bite cases without other skeletal malformations.

http://www.dentistryiq.com/articles/2015/07/temporary-anchorage-device-use-in-the-treatment-of-anterior-open-bite.html
In 1-2% of patients, however, obvious root shortening occurs during routine orthodontic treatment. These patients are just more genetically susceptible to root resorption. I have even noticed that root shortening runs in families (after noticing resorption in two children from the same family I looked at the mom’s records and found the same thing). This genetic predisposition is important and should be communicated to your orthodontist if you are aware that it has been noticed in your family.
Are there things an orthodontist can do to cause or prevent root resorption? Some have theorized that root resorption happens if the teeth are moved too quickly or too slowly. Teeth that are moved too quickly may be subject to too much force they say. However, in my cases where I’ve seen resorption I’ve used exactly the same amount of force for exactly the same amount of time as everyone else. Braces that are on longer logically have more time to cause a problem. Having said that, I’ve seen transfer cases that have had braces on for more than 5 years with no signs of root change. There really is neither documented cause of nor protocol to follow to prevent this shortening.

So what can be done about root shortening during treatment? About the only thing we can do as orthodontists is monitor our patients during treatment using routine x-rays. These should be taken at least annually as long as the braces are on. If root shortening is noticed, it should be pointed out and discussed with the patient and their family. Depending upon the amount of shortening, treatment may be continued as normal, the treatment time shortened (stopping after spaces close for example), or the braces immediately removed. It is generally believed however that a tooth can lose up to half of its root length and never have a problem. In my 21 years of private practice, not a single tooth has been lost to root resorption.

Unfortunately there is nothing you can do to “re-grow” the length of the roots. All we can do in cases like this is to educate the patients, stabilize the teeth (passive bonded lingual retainers), and encourage mouth guard wear for any activities that may threaten the teeth. As I’m sure you’ve read in my article, some patients are just predisposed to root shortening and some aren’t. The only thing the orthodontist could have done differently is recognize the shortening earlier (i.e. 6 to 12 months in) and change the treatment goals (like leaving some uncorrected overjet). Luckily the shortening usually stops once the orthodontic movement stops, so it shouldn’t get any worse.
http://www.gregjorgensen.com/blog/2013/03/do-braces-make-the-roots-of-your-teeth-shorter/

miniscrew - time needed longer, dispose to more root resorption.

But the time needed for the greater amount of maxillary en-masse anterior retraction with miniscrew anchorage is longer and might dispose the patient to more apical root resorption.

Sunday, August 21, 2016

self-treatment orthodontics

http://jawpain-tmjtreatment.com/

When a child is growing up, consuming foods like beef and lamb livers as often as possible, along with organic (grass fed) ghee and fermented cod liver oil on a daily basis will ensure prominent cheekbones, wide dental arches built upon long jaw-bones with enough room to accomodate wisdom teeth, and teeth that are impervious to cavities. If orthodontic work should be deemed necessary for some odd reason, one must choose an orthodontist who refuses extractions and seeks to widen the arches in order to deal with tooth crowding.
...
 So I searched high-and-low for an orthodontist who:
->Rejected the idea of extractions and embraced the idea of expanding the arches.
->Embraced the idea of biologically-compatible "lightwire" forces that are incorporated into self-ligating bracket systems.

WHAT NOT TO DO...

Most orthodontists these days are pretty awful. Many of them learned their craft from a paint-by-numbers course that was created by an idiot. Naturally said idiot who created it doesn't want to turn around to the orthodontic community after years of mutilating the population and admit he was wrong. So the evil perpetuates itself. Some examples of idiocy/evil include:
->A palate cannot be expanded without surgery once one is an adult (yes it can because bones remodel and furthermore sutures never fuse until advanced age due to over-calcification).
->Using elastics to tie the upper and lower teeth together will "level" a smile because they act on the sphenoid bone (scientifically impossible as the sphenoid bone can only be acted upon directly with endo-nasal balloon therapy or the modern-day equivalent known as NCR). Forcing the smile to level with rubber bands without addressing the sphenoid bone directly creates a smile like Drew Barrymore has - NOT the most downloaded woman on the internet. ;)
Most orthodontists are so out-of-touch with their own bodies, that even if they embrace an "out-of-the-box" technology like the A.L.F. device which uses biologically-compatible, lightwire forces they follow it up with old-school braces and then wonder why they produce unsatisfactory results. Seriously, I know several adults who wore braces for like 4 years and then one day their orthodontist just gave up and admitted defeat.
Then there are the oral surgeons who love to do palatal expansion surgeries for $20,000 a pop. They even want to do a surgery to bring the maxilla forward. It is all unnecessary. As I said earlier, the effects of palatal expansion can be accomplished in the majority of cases with self-ligating braces by an orthodontist who believes in expanding your dental arches. Palatal expansion in a child using a rapid palatal expander (RPE) is possible due to the suture still being very loose, but palatal expansion with an RPE or surgery at any age always produces a 2D smile that looks stupid UNLESS dental arch expansion is targeted with biologically-intelligent braces by an orthodontist who believes in expanding your dental arches.

MY JOURNEY IN THE VALLEY OF ORTHODONTICS

So I found two orthodontists in the tri-state area (California may be better for this sort of quest) who were open to what I wanted to accomplish and went to work with one of them. After about 1 year I was getting depressed as hell because my orthodontist was NOT working on expanding of my arches for that "10-tooth smile" and idiotically focusing on "leveling" my smile (a-la Drew Barrymore) by running elastics between my upper and lower teeth to "close my bite." After injuring the periodontal ligament on one of my teeth with this asshatery my gum receded and I have constant nerve pain due to its' exposure. Thank god I have a high pain tolerance and can live with it. Luckily at this point I stumbled upon this "face pulling" technique through aforementioned mutual friend and decided to give it a try. Not only does it "close the bite" naturally without any of that stupid elastics crap, but it gives you massive cheekbones without surgery, cures TMJ permanently, gives you a beautiful maxilla and jawline, and is the "3rd dimension in the NCR experience." Basically what it does is it clears the roadblock one can encounter after a few years of NCR and allow for the sphenoid bone to "swing freely" again. Oh yeah... and it opens up your pelvis! Meow!
I also changed my orthodontist. I am completing my treatment with the amazing David H. Seligman DMD 212.988.8235 who understands what I'm trying to do. He is all about bone remodelling, trained under the inventor of the Damon system, and has access to the latest custom brackets that are engineered for each individual tooth. He "gets it" and so he's awesome. :)
Here are two resources for removable orthodontics, both located in Germany and Germans (my ancestors) are the masters of engineering and craftsmanship:
Now before you say "But I don't live in Germany" I'll say "Contact them anyway." Trust me, contact them no matter what chatter is in your head. ;) We limit ourselves all the time with negative thoughts. You have nothing to lose by going forward despite the defeatist chatter. If I had to do it all again, I would go with removable plates instead braces. But I also had the thought "But I don't live in Germany." Where there's a will, there's a way!
BTW, if anyone needs a regular dentist in NYC who does the finest dental work, shoot me an email and I will tell you whom I go to. She'll always work to save the tooth and doesn't drill when not needed, doesn't kill the root to make money doing root canals, etc. Does the finest implant work as well.

MY RESULTS

Your maxilla will come forward without surgery. As it comes forward, the bones around your condiles will rotate and your jaw will become loose and drop forward. Therefore, you will not be pulling JUST the maxilla forwards and end up looking like an inbred retard. Not only your maxilla will come forward but YOUR ENTIRE FACE WILL! Especially your cheekbones, so if you don't have cheekbones, you will get them with this technique. Your whole face will come forward and your jaw will follow along getting rid of TMJ forever! Below are my results...

 Dentists and orthodontists focus on teeth too much and ignore the skull which is the most important. Underbites come about because the skull doesn't develop properly. So the child has an underbite. Sometimes during delivery, the doctor applies forceps and deforms the child's head. Sometimes babies get dropped and nobody wants to admit this. The result is that the face gets squashed. So you have an underbite. The rest of the face needs to catch up. The solution is face-pulling! But of course all those idiot orthos try and jam the jaw back in. Stupid.

CONCLUSION

So that's about it. I've told you what you need to know to solve your trigeminal neuralgia, jaw pain, TMJ, cluster headaches, poor posture, jammed pelvis, etc., etc., etc... all in 30 minutes a day! You will notice results in 1 week. In 3 months you will be a different person. The ride will be rough because your entire psyche will be changing for the better. But it is only 30 minutes a day and the equipment costs less then $50! Assuming you have braces of course, otherwise you will need a custom retainer made and that will be the main cost and is dependent on who makes it for you. Print out those pictures of that custom retainer above and show it to a dental lab or an orthodontist - just don't show him this website or he will get pissed off because orthodontists have big egos and don't like their treatment paradigm threatened. Also, oral surgeons won't be too happy that such a cheap solution supplants a $20,000 surgery. How will they be able to afford that Mercedes SL63 AMG now?
If you are a parent with young children, please don't let an orthodontist destroy their future! I get emails all the time from adults whose lives were destroyed by childhood orthodontics. Lucky for them they find this site! If you remember anything, remember this and stick to it as if your child's future happiness depended on it:
UNDER NO CIRCUMSTANCES ALLOW TOOTH EXTRACTIONS IN A CHILD!!! GO FOR EXPANSION OF ARCHES AND LENGTHENING OF JAWBONES VIA PROPER NUTRITION AND GENTLE ORTHODONTICS IF NEEDED!!!
Here is an Australian "60 Minutes" interview on why extractions suck:http://sixtyminutes.ninemsn.com.au/article/259072/straight-talk
Basically, do not allow the usage of anything that resembles a torture device on your child. This includes braces, reverse headgear, etc. Your child is still growing, and you want the growth to be as natural as possible so if you want to do any "orthodontics" on your child to assist the natural process, then use only removable plates or myofacial trainers or such. If you are an adult, then go for Damon braces if needed. Adults are no longer growing, so more extreme measures are needed. But children should not be fucked with. Would you let a dental professional sexually molest your child? No? So then why would you let them abuse your child with painful, beauty-destroying orthodontics?
However, your main weapon is nutrition! Even if you are an adult! Follow in the footsteps of the great dentist, Weston A. Price by giving your child 1 tablespoon of each of these every day:
http://pureformulas.com/cod-liver-oil-q-liquid-8-fl-oz-96-svgsbottle-by-premier-research-labs.html?CAWELAID=532166621 (link disconnected because product has been discontinued)
In addition, eating 1 grass-fed beef or lamb liver 1x per week will give them nutrition through the roof.
If you have kids, put the above into them on a daily basis as soon as they can eat. They'll never get cavities again! You should be eating the same thing yourself!!! If you are planning to make a baby, both you and your wife should be eating this sort of diet starting 1 year before you make the baby. Make sure to load up on iodine before you get pregnant so your baby will be as smart as possible. If the baby is a boy, the mother should CONSIDER taking Indonesian Tongkat Ali in 50:1 extract or 100:1 extract while pregnant because the amount of testosterone the fetus is exposed to in the womb will determine his testosterone "set-points" as an adult. It will also make sure he comes out with a really large penis! Why wouldn't you want the most powerful child possible? Make sure he/she is tall, strong, beautiful, healthy... Nobody puts any thought into what they create anymore. They make children out of spite and just to have someone to boss around. If you give your child a shitty physical vehicle, what sort of suffering are you creating for it?
Here are some other useful links:

FINAL WORDS

Don't get me in any trouble, because I just want to help all those people who are suffering in this world. In China they say that "your face is your fortune" and everybody deserves the good fortune to be beautiful. =^_^= To reiterate, I don't want to vex the dental community who won't take kindly to my challenging their paradigms. Sadly, many tenets of their paradigms are flat out wrong: sutures are NOT fused past a certain age. The spehenoid bone CANNOT be acted upon via elastics strapped between the upper and lower brackets. Pulling the face forward as explained on this website will NOT give you an overbite.
Do you want to chat with me?  email me!
Also, I did a radio interview on Rumor Mill News: http://jawpain-tmjtreatment.com/rumormillnewsfacialremodelling.mp3
BTW, check out my website on NeuroCranial Restructuring!

TMJ The Great Controversy

TMJ The Great Controversy (starts at page 27 of the PDF file which is page 519)

http://www.cda.org/portals/0/journal/journal_082014.pdf

(Description of the Airway Centric philosophy starts at page 59 of the PDF file (p. 551))

t. Focusing on the relative position of the condylar head in the fossa to an idealized position within the fossa misses on two counts:
■ Morphological changes of the condyles — bending, breaking, flattening and other compensatory changes make the position of such a condyle different from an undamaged condyle within the same fossa.1
■ Anatomical appearance shows the current condition of the structures that have resulted in response to the forces over time. It is akin to looking at the rearview mirror. Physiologic parameters — such as electrocardiogram (EKG), apnea–hypopnea index (AHI) and EMG give current data on the function of the organism. Function changes the form just as oral breathing changes maxillary shape.

manipulating patients into centric relation, making splints in that position

The early dentists who attempted to help TMD patients through occlusal therapy include the following:
Nathan A. Shore (1914-1984)  Spent 40 years focusing on “TMJ Syndrome”, NYC
Harold Gelb, NYC, did much to popularize “TMJ” from the 60’s thru the 80’s.  He had several controversial methods, including putting condyles in what he called the “4/7 position” and building a “Gelb splint” which did not follow the principles of occlusion.
In the early 70’s several dentists who had been trained in gnathology began eliminating the more esoteric methods (i.e., tripodized occlusion) and making it more user-friendly for clinicians.  I call it gnathology-lite.  They include:  Peter Dawson, Henry Tanner, Niles Guichet, Peter Neff, Bob Lee, and Terry Tanaka.  They perpetuated the concept of treating TMD through focusing on the occlusion, although Dr. Tanaka has done much to advance our understanding of the TMJ with excellent anatomical research via cadaver studies.
Barney Jankelson, a Seattle dentist, invented a jaw tracking device in the early 70’s.  He incorporated the use of TENS on the jaw muscles, and claimed that this method proved where the jaw “belongs.”  He then advocated rebuilding the occlusion to this “scientific” position, which almost always resulted in opening the bite.  His mantra was “If you can measure it, it’s a fact; if you can’t, it’s an opinion.”  He is considered the father of electrodiagnostics and neuromuscular dentistry.
Dr. George Goodheart, D.C., 1918-2008, Detroit, Michigan.  In 1964 Goodheart developed applied kinesiology—a method of “testing” the body in ways that “diagnosed” any physiologic or medical condition the patient may have.  For dentists, this technique was popularized by George Eversole, who had studied with Goodheart.  Many dentists interested in TMD took weekend courses from Eversole in the 1980’s.  Applied Kinesiology is widely used by chiropractors today.
Bill Farrar (pronounced “fair-ah”), Montgomery, AL, 1924-1985.  Bill Farrar, along with an oral surgeon, Bill McCarty, “discovered” the internal derangement of the jaw joint.  Prior to Farrar, the biomechanical function of the joint was poorly understood.  In 1979, Farrar began lecturing on his discoveries, which transformed our understanding of this condition.  He introduced (along with others) transcranial x-rays to study condylar position.  He introduced disc re-capturing and jaw unlocking techniques.  He used a pull-forward appliance on many of his patients to prevent their jaws from locking again.

o Review:  The underlying philosophy regarding appropriate condylar/mandibular position for TMD patients divides these experts into two basic camps:
Centric Relation/ Ideal occlusion
                      Gnathology,
Restorative occlusionists
Anterior Condylar Repositioning
                        Kinesiologists
                        Gelb
                        Jankelson
                        Farrar
We will revisit when and where to employ condylar repositioning later on.  Farrar was erroneously interpreted as saying that you had to hold the condyle forward forever.  He never said that.  However, he is the one most responsible for “phase II” dentistry on TMD patients.  More accurately, Farrar (along with Gelb, Jankelson, kinesiology) is used as an excuse by too many dentists to perform phase II dentistry  (orthodontics and/or extensive crownwork) on TMD patients.
The lite gnathologists, who I will now call the occlusionists, especially Dawson and Guichet, were adamant that Farrar was wrong about what caused jaw clicking and the need for provisional condylar repositioning.  They dismissed kinesiology, Gelb, and Jankelson out-of-hand as little more than quacks. 

#6  The claims of so-called experts in the field

By the early 1980’s, it became the battle of the gurus with egos, primarily between the occlusionists and Bill Farrar.  The occlusionists ganged up on Bill Farrar.  He was telling us that attempting to put TMD patients in centric relation was iatrogenic.  He was bringing their jaw forward to recapture their disc, or at least reduce joint capsulitis. The occlusionists regarded this as heresy.  However, Farrar was unflappable at conferences in which he was attacked.  I was privileged to be with him every year until he died in 1985 of emphysema.  He was only on the TMD national stage for 6 years, but he made a huge impact on TMD treatment throughout the world. 
Over 900 dentists traveled to Farrar’s small Montgomery AL office from 16 foreign countries and 46 states.  He taught 79 courses in Montgomery between 1980 and 1985.  He published numerous articles in American and European dental journals over a 25 year period.  He worked in his office until he died.
“My time is short, I will fight and I am not bitter. I have accomplished much of what I wanted to do. It has been exciting…Criticism on a professional level is actually beneficial, because it stimulates us to re-think and re-test our viewpoints and concepts.  We must not accept old ideas not based on scientific fact.”
--Bill Farrar
“Dr. Farrar considered his patients his primary teachers. His clinical findings encouraged him, even drove him, to scientific contributions. He possessed a mind that did not allow intermissions and a heart that reached out to his patients.”  
--Dr. Jack Haden
In his final days, Farrar was heard to say, “Medical science has not yet been able to attach a prognosis of doom on man’s spirit nor to predict the physical strength it can harness. I ask only to contribute to life as long as I live it.”
Bottom Line:  Bill Farrar caused a huge paradigm shift in the world of TMD.  More than any other before or since.  Those who profess expertise in this field are standing on the shoulders of Bill Farrar, whether they know it or not.  For more on Dr. Farrar, see Jack Haden’s guest editorial in the Journal of Craniomandibular Practice, Oct, 2008, found here:  FarrarHadenCranioArticle.pdf
For those of us who grew up in the world of gnathological occlusion, we could see the writing on the wall.  We realized within a year of Farrar’s 1979 revelations that the days of manipulating patients into centric relation, making splints in that position and subsequently equilibrating them into this position was not the answer for TMD patients.  If the disc is dislocated, as it is in the majority of TMD patients, there is no such thing as “centric relation.”  The most you can hope to accomplish is identify an “adapted centric position” (Dawson’s term).
Also, by the late 1970’s we had some excellent clinicians who were leading the way in looking at more than just occlusion in evaluating and treating these patients.  They include:



All three organizations support the use of splints, although they use them for different purposes and have different beliefs about the mechanism of how a splint works.

create a false dental open bite thereby creating the need for unnecessary dental treatment.

1. Isn't this just anterior repositioning of the Mandible?
It is very important to distinguish between the position of the condyle in the healthy patient and unhealthy patient. In a healthy joint complex with asymptomatic patient we usually find the condyle to be sitting the ideal centered position in the glenoid fossa. There is usually 3mm of space behind and above the head of the condyle. This allows the retrodiscal tissue to nourish the joint complex and room for the articular disc to sit on the head of the condyle and provide the important function of guiding the condyle through its movements. This position is commonly referred to as the "Gelb 4/7" position as described by Dr. Harold Gelb, New York, widely acclaimed leading authority on TMD. The common finding in symptomatic patients is that the condyle is superiorly and distally retruded, sometimes resting against the back wall of the glenoid fossa. In these situations, the retrodiscal tissues are crushed and the articular disc is pushed forward off the head, which accounts for the clicking and popping during opening. So, treatment for retruded condyles does reposition the mandible in a three dimensional direction towards its normal position of health that must have existed before the patient became symptomatic. The mandible is brought down, forward and laterally as required to position it where Mother Nature can heal the injured tissues. 

2. Does TMD Treatment pull the jaw out of its socket?
IT IS IMPORTANT TO UNDERSTAND THAT TMD ORTHOTICS ARE MOVING MANDIBLES TO A POSITION OF HEALTH .... NOT AWAY FROM A HEALTHY POSITION TO A MORE ADVANCED POSITION. There is great confusion about this repositioning concept. Some TMD detractors will try to convince you that the jaw is being pulled out of its socket to create a false dental open bite thereby creating the need for unnecessary dental treatment. Nothing could be further from the truth. 


Saturday, August 20, 2016

Gelb 4/7 position in non-extraction expansive orthodontics

A little history – the Fathers of Gnathology, Drs. Stallard, Stuart and McCollum followed Bonwill’s mechanical occlusion theory and translated the movement of the jaw to an articulator in 1930. They developed a jaw position called Centric Relation, which was the most retruded superior postion of the jaw joint.

These men were revered at the time and are still in the USC Dental Hall of Fame. Around the same time, Tweed had just graduated from Angie’s School of Orthodontics and rejected non-extraction theory as producing faces that were too protrusive. He began extracting permanent bicuspids to “flatten” profiles and supposedly give more stable results (Figure 3). Ron Roth and Robert Williams took the CR concept to orthodontics in ensuing years. Over the next 25 years, the Gnathologists and Tweed orthodontists each contributed to a more retruded jaw position with fewer teeth (Figure 3). This jaw position was taught and utilized in American dentistry from 1930-1995.

To dentists like Bill Farrar, Barney Jankelson, and Harold Gelb, this made no sense. The condyle wars in the 1970s pitted gnathologists from Pankey, Dawson, and SOS against Gelb, Farrar, Jankelson, and Witzig. Witzig taught the European school of functional orthodontics popularized by Schwartz and Frankel which used the Gelb 4/7 position in non-extraction expansive orthodontics. There was a landmark legal case involving a 4 bicuspid extraction patient who ended up requiring TMJ surgery following extraction orthodontics. Witzig was the expert witness and the patient ended up receiving over a million dollars, which was a huge settlement at the time. Dawson realized in the 1980s along with the glossary of prosthodontic terms that the gnathologists had no biologic or physiologic evidence for a retruded centric position. They followed Gelb, but in more conservative anterior superior position (Figure 4).

 ...

Dentistry will now start to understand that jaw position is dependent on the development of the maxilla and mandible. Most maxillas (82% ) are underdeveloped and iatrogenically retruded by dentists and orthodontists as taught by major dental schools and orthodontic programs in the country. We can now understand the folly of Stuart, Stallard, and McCollum, perpetuated by Peter K. Thomas, Pankey, and Dawson in restoring a jaw in the most reproducible retruded nonphysiologic iatrogenic position. Even more harmful was the extraction of permanent teeth during orthodontics, which closed airways and retruded jaws. It is now time for the professionals to become aware of the benefits of the Gel-B Bite Balance Breathing System and AIRWAY CENTRIC ™ appliances.
http://ww1.prweb.com/prfiles/2012/12/03/10199255/Gelb_ebook_AirwayCentricDentistry_FINAL-11-12-12.pdf

loss of cortical plate or flattening of the superior surface of the condyle

even with a modern panoramic, the relative position of the condyle in the glenoid fossa cannot be determined. You cannot see boney changes such as loss of cortical plate or flattening of the superior surface of the condyle on a panoramic x-ray. The reason for this stems from the angulation of the x-ray beam through the condyle itself. Because the x-ray beam is directed from a position under the joint, the lateral pole of the condyle is projected upward and therefore details are lost because the image is superimposed over other boney structures. A panoramic may provide lots of information about other things, but don’t depend on a panoramic to tell you much of anything about the joint.

http://halligantmj.com/quick-and-easy-tmj-xray-basics/

various, often contradictory, occlusal philosophies practiced by these well-meaning dentists

I believe that all dentists want to do their best for their patients. We chose dentistry as our profession to be helpers and healers. Yet, there are various, often contradictory, occlusal philosophies practiced by these well-meaning dentists. Why is that the case? Dental training and education should equip us to come to our own conclusions on the validity of these occlusal philosophies, which are reviewed here. In my opinion, choosing an occlusal methodology should be entirely based on what we would use for our own families when financial considerations are not a factor. This is our profound obligation to our patients. Therefore, it matters not who and with what credentials or titles makes pronouncements about occlusion.

http://www.dentaltown.com/dentaltown/article.aspx?aid=2498

Tuesday, August 2, 2016

Things to Consider when Choosing an Orthodontist

Consider education and experience.

Once you have a list of a few orthodontists, do a little research. Find out about their educational background, where they went to school, and what kinds of continuing education or specialty training they’ve had. Before you set up a consultation with an orthodontist, make sure he or she is a licensed member of the American Association of Orthodontists. This ensures that they remain up-to-date on the newest and most effective clinical procedures.
Dr. Markham is a Diplomate of the American Board of Orthodontics and an Affiliate Member of the Edward H. Angle Society of Orthodontists. He has years of experience using the finest orthodontic treatments and techniques to ensure you achieve a life-transforming smile.

Get a consultation from more than one office.

Orthodontists have different treatment styles, so getting a consultation from more than one office is a great idea. Some may offer specific orthodontic treatment options or products that others may not. Compare the length of recommended treatment time with the cost of that treatment. It’s also important to feel comfortable with your orthodontist. Do they have a pleasant chairside manner? Do you feel like they’re really paying attention to your concerns? Is the staff friendly and helpful? By visiting more than one office, you’re more likely to find an orthodontist who can meet your individual needs while staying within your budget.
Here at Markham Orthodontics, the answer to all those questions is a resounding “Yes!” We believe that we offer the finest orthodontic experience in our neighborhood! And we know that perfection is never achieved, it is only pursued; we pursue that perfection with a passion!

Ask questions.

During your complimentary consultation at our Sacramento or Auburn offices, don’t be afraid to ask questions. After all, that’s why you’re here! It’s important for you to understand what type of orthodontic issues you have and the most effective ways to treat them. The more informed you are about your own dental health, the better decisions you will be able to make.
During your complimentary initial consultation, Dr. Markham will evaluate your jaw joints, jaw bone alignment, tooth alignment, and gum tissue health. He will put together a treatment proposal, and your treatment coordinator will present a financial plan with affordable payment options.

A few things to consider:


  • Who will be overseeing your treatment: the orthodontist or assistants? At Markham Orthodontics, Dr. Markham and Dr. Chiang oversee all aspects of their patients’ treatment and ensure that treatment is progressing appropriately at every visit.
  • Is the office located near your home or work to make appointments as convenient as possible? With two locations in Sacramento and Auburn, Markham Orthodontics is nearby wherever you are!
  • Do they offer extended office hours before or after work and school? We work hard to make scheduling appointments at our Sacramento and Auburn orthodontic offices as convenient as possible.
  • What types of insurance does the office work with and what kind of financing do they offer? We work with many insurance plans that cover orthodontic treatment. In addition, Markham Orthodontics offers affordable, no-interest payment plans.
  • Do the orthodontist and staff seem interested in making your experience personalized or do you feel like “just a number?” As our patient, you are the most important person in our office. We want you to enjoy your visits, so we strive to maintain a happy, fun environment, where you’re comfortable and feel at home.