Techniques and Treatments

Emphasis on Airway and Tongue Function

Our 3-D X-ray (CBCT = cone beam computed tomography) makes it crystal clear to Dr. Farrar just how critical nasal breathing and proper tongue posture and function are in order to achieve ideal outcomes and retain them for life. Our 3-D views let her evaluate the nasal and oropharyngeal airways for potential blockages that can be contributing to mouthbreathing and snoring. Dr. Farrar took extensive training from IAOM and AOMT to become highly educated on proper tongue posture and function and how to correct imbalances in the orofacial musculature. Our treatment coordinator, Julia, has also taken training with AOMT and Buteyko to be able to administer myofunctional therapy and breathing re-education under Dr. Farrar's supervision. There is a growing body of evidence pointing to the role of the tongue in not only the development of the dental arches but also in maintaining the oropharyngeal airway. Our patients are experiencing improved outcomes (better bites, greater facial balance, less snoring, more restful sleep, and less TMD) since we implemented our myofunctional protocols.

High-Tech Braces

Dr. Marie Farrar has long awaited the time of fully customized brackets, and is thrilled to offer LightForce to her patients. She trained on traditional "Tweed" brackets which required lots of heavy forces and time-consuming wire bending. She started practice using straightwire brackets and bands, which had standardized tooth positions built into the brackets but still required wire bending to finalize the tooth positions (because not all teeth are standard). She spent about two decades using self-ligating brackets which add the ability to use low forces early in treatment, making teeth move faster and better with less discomfort. At one point, she tested a process of customized wires but abandoned it because it proved unnecessary for her to achieve great results quickly. But now, technology has progressed to the point of scanning the teeth and planning the final result digitally, then milling brackets specifically for each patient that are fully customized to their teeth! We still start with low forces but can finish with little to no wire-bending stages required, meaning better outcomes with fewer appointments and faster treatment times.

Emphasis on Esthetics

Today's ceramic brackets make a significant esthetic improvement over traditional metal braces with little to no compromise in treatment efficiency or outcome. Dr. Farrar uses high-tech metal archwires that are non-reflective and far less noticeable with clear braces—again with little to no effect on treatment efficiency. And best of all, this is standard fare with no extra charge; they are automatically included in every patient's treatment fee! (Yes, metal is still an option for those who prefer it, but they don't have the benefits of fully customized brackets.)

In a hurry for your best smile but unwilling to compromise on a limited result? There is no need to sacrifice quality for speed.  Dr. Farrar offers V-Pro treatment acceleration, which has been demonstrated to reduce treatment time by a third.

Beyond brackets and wires, Smile Studio also offers clear aligner technologies such as SureSmile.  There are many options now for clear aligners.  Just as Kleenex used to be the only brand of facial tissues, Puffs are just as good.  Since Invisalign no longer corners the market, prices for aligners have dropped at Smile Studio such that they no longer cost more than traditional brackets and wires! Plus, they come with the V-Pro acceleration device included.

Early extraction of deciduous (baby) teeth can alleviate crowding during the transition from baby incisors to their much larger permanent tooth replacements. Midline issues can be headed off by early diagnosis and intervention when four permanent incisors take up the space of five baby ones, and impacted upper cuspids can often be prevented by early baby tooth extractions. Even with crowded incisors, we can often avoid permanent tooth extractions by using a space maintainer to preserve the "leeway" space (the extra space that is gained when the baby molars are replaced by the much smaller permanent premolars).

Several problems that show up during the mixed dentition (the stage when kids are losing their baby teeth and growing in their permanent ones) are best handled before all of the permanent teeth have erupted to avoid asymmetric or unbalanced jaw growth caused by the poor fit of the teeth. It's an exciting time in orthodontics, as a variety of appliances can now be fabricated digitally with no separators or goopy impressions. We use rapid palatal expanders for cross bites of the back teeth as well as to widen constricted palates. We use spring expanders to upright lower teeth. Because of the risk to developing permanent teeth, Dr. Farrar rarely advises brackets and wires for this age unless there is a significant concern such as an anterior crossbite. Nobody wants braces twice! Protraction "facemasks" can often be useful in intercepting underbites, but, thankfully, the old headgears like Darla’s in Finding Nemo are a thing of the past! We use molar distalizers or other Class II correctors to guide the 6-year molars into the proper bite relationship before the 12-year molars erupt. After the eruption of 12-year molars, we can correct the molars using the Carriere Motion appliance. All early treatments share the goals of preventing bigger problems: expanding crowded arches, correcting the fit of the molars, balancing jaw growth, minimizing the possibility of damage to permanent teeth from damage during accident-prone elementary school years, and minimizing the time needed for (and cost of) full braces treatment later on.

There are several oral and functional habits that orthodontists are uniquely qualified to treat. Dr. Marie loves to help young thumb-suckers realize they no longer need the comfort their thumbs used to give them when they were younger! Lip-trapping and tongue thrusting are often related to abnormal tongue posture and function, which we treat with myofunctional therapy. Chronic mouth-breathers should consider allergy treatments and/or airway evaluations by an ENT to ensure the ability to breathe nasally in order to improve facial balance and optimize jaw growth. Once the airway is clear, we often have to re-train the habit of nasal breathing with Buteyko breathing re-education.

The daughter of renowned temporomandibular joint dysfunction lecturer and clinician Dr. Bill Farrar, Dr. Marie has a deep appreciation for and profound understanding of occlusion. Dr. Farrar got her start in dentistry by assisting him both in his practice and in the preparation of his lectures and publications. She now recognizes the role airway obstruction, sleep-disordered breathing, and low tongue posture play in the development of nighttime bruxism and daytime clenching or even just "teeth-together" posture, which both, in turn, affect the TMJs. She is adept at treating patients with TM dysfunction both with bruxism guards and TMJ “Farrar” splints for symptom resolution, as well as with full orthodontic treatment to stabilize the occlusion following splint therapy. 

The wife of a respected prosthodontist, Dr. Marie has seen firsthand many long-term effects of untreated malocclusions, and has much clinical experience with complex occlusal cases. She is comfortable working with general dentists and other specialists such as oral surgeons and periodontists in the management of pre-prosthetic cases. Such cases may involve improving the underlying bite or spacing teeth properly for ideal implant or crown & bridge work. They may also involve molar uprighting and orthodontic crown lengthening.

Dr. Farrar has significant experience using traditional retainers to align teeth and close gaps. Sometimes minimal aligner treatments can be used as well. Many patients appreciate the significant cost savings which can be achieved with this approach to minor tooth position problems.

For patients with a clinical diagnosis of mild to moderate sleep apnea, a dental snoring appliance can often be effective in reducing snoring and improving the quality of sleep. These are typically much better tolerated than CPAP machines, though they must be properly fitted and overseen by a clinician who understands the occlusion and dynamics of jaw function. We can also prescribe myofunctional exercises designed to strengthen the palatoglossal muscle as well as the pharyngeal walls.

We use permanent and invisible retainers to make retention a breeze. All comprehensive treatments include one lower permanent retainer, up to two sets of invisible retainers, one thicker upper night guard, as well as one year of retention checks. You can save time and money on replacement retainers if you keep your post-treatment models on hand, but if you lose them we can order new models off of your latest scans.