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Early orthodontic treatment for children as young as six can reduce the need for braces, but compliance is a key area of concern. By Angela Tufvesson
At Art of Smiles in Alexandria in Sydney’s inner south, early orthodontic treatment is all about reducing the need for braces, explains dentist and practice owner Dr Artur Shirokov. “Our main goal is for the kids to have the possibility of avoiding braces in the future,” he says.
One of the practice’s most important tools in this endeavour is the LM-Activator, a prefabricated silicone appliance developed in Finland more than 20 years ago. It can be used in children as young as six years old—and the results are impressive, says Dr Shirokov.
“From what we see, I would say out of 50 kids who use it, maybe one is wearing braces in the future,” he says. “We do braces as well, but we hope to have our kids not wear braces.”
The LM-Activator corrects malocclusions and is suitable for the treatment of overjet, vertical overbite, deep bite, anterior open bite, crowding, distal bite and anterior crossbite.
It has been specifically developed for the needs of early orthodontic treatment. “When a child is about six years old, the lower front teeth are usually erupting, but not yet the upper front teeth. This is the ideal time to start early orthodontic treatment,” says orthodontics specialist Professor Emeritus Juha Varrela, a spokesperson for Finnish manufacturer LM-Dental.
One study published in the American Journal of Orthodontics & Dentofacial Orthopedics, co-authored by Prof Varrela, found using an eruption guidance appliance in early orthodontic treatment to be an effective method to restore normal occlusion and eliminate the need for further orthodontic treatment.
It depends on whether the child is compliant. We need to assess if they’re ready, emotionally and mentally. We can’t just force it and enforce it as they won’t see the result and the benefit from it. Often a nine-year-old is a little bit better in terms of understanding why we’re trying to help them early and prevent them from having braces.
Belinda Tuong, oral health therapist, Art of Smiles
Dr Shirokov first used the LM-Activator in 2008 when he was practising in Russia, but he was unable to find it when he migrated to Australia. He contacted LM-Dental to arrange a license, and his practice is now the only one in Australia providing the LM-Activator to young patients. “We’ve been doing it for the last four or five years,” Dr Shirokov says.
He likes that the LM-Activator is specifically for children, addresses a range of orthodontic problems, comes with free training webinars and is the “softest that you can find in Australia. It’s a bit easier than other devices to adapt to. Around nine out of 10 kids we see wear it no problem, compared to other trainers, where roughly 60-70 per cent of kids wear them.”
Starting orthodontic treatment early offers another important benefit for families: significantly reduced costs, explains Prof Varrela. “Fewer treatment visits are needed, and those visits are shorter in duration than the treatment visits of orthodontic treatment performed with fixed appliances. The biggest cost factor of orthodontic treatment is the treatment time spent at the clinic.”
Dr Shirokov estimates that treatment with the LM-Activator is about half the cost of braces, which makes it more accessible to families across broader socio-economic groups.
“If braces are a little bit out of reach for families, this is a middle ground where children can get improved alignment without going through with braces,” he says. “Sometimes families know that it’s not going to be perfect, but it’s still better than with no treatment.”
Children typically use the LM-Activator at night and remove it during the day. At Art of Smiles, treatment often begins when children are around nine years old, but in some cases it’s appropriate to begin as early as six years old, explains oral health therapist Belinda Tuong.
Fewer treatment visits are needed, and those visits are shorter in duration than the treatment visits of orthodontic treatment performed with fixed appliances. The biggest cost factor of orthodontic treatment is the treatment time spent at the clinic.
Professor Emeritus Juha Varrela, LM-Dental
“It depends on whether the child is compliant. We need to assess if they’re ready, emotionally and mentally. We can’t just force it and enforce it as they won’t see the result and the benefit from it. Often a nine-year-old is a little bit better in terms of understanding why we’re trying to help them early and prevent them from having braces.”
Prof Varrela says the first month is key for getting into the habit of wearing the device. “It’s important to make sure the patient and their family understands that irregular use may be equivalent to no treatment at all.”
Dr Vas Srinivasan, specialist orthodontist at Invisible Orthodontics, which has practices in Queensland’s Hervey Bay and the Sunshine Coast, agrees that compliance is a major consideration when recommending orthodontic devices like the LM-Activator to families.
“Children are not young adults or teenagers; they’re still children. The most important reason why many of these appliances fail is because this is a patient group whose attention span can be extremely limited. And even if the attention span is good, it’s the consistency of having to wear some of these appliances.”
He says dentists should be careful about recommending unfamiliar treatment approaches to families. “A paying patient should not be your trial person. Talk to your colleagues and understand if a product has been tested in your community before you embrace it.”
Dr Shirokov’s team is gathering data to compare results and see in which circumstances, and among which ages the LM-Activator is most effective. They may then introduce it to other practices as an alternative to braces, perhaps with a short course.
For practices keen to contact the manufacturer directly, Dr Shirokov recommends beginning treatment with older children.
“Start with nine- or 10-year-olds,” he says. “Once dentists feel confident that it works for them, they may move on to younger kids.”
