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 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 that contribute to dental arch constriction and can contribute to poor orthodontic outcomes and stability. Our treatment coordinator, Julia, has also taken training with AOMT to be able to administer myofunctional therapy under Dr. Farrar's supervision. She is also trained to provide Buteyko breathing re-education.

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 practicing using straight-wire 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.)

Smile Studio offers clear aligner technologies beyond brackets and wires, such as Angel Aligners and 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, and 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 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 lingually tipped 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 for early underbite correction. But, thankfully, the old headgears like Darla’s in Finding Nemo are a thing of the past! Molar distalizers or the Carriere Motion appliance can be used to correct the molar fit either before all the permanent teeth erupt or right before braces or aligner treatment. 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 during accident-prone elementary school years, and minimizing the time needed for (and cost of) full braces treatment later on.

Dr. Farrar does not use cemented oral devices to block thumb-sucking or tongue-thrusting. Instead, she prefers to identify and treat the cause of the oral habit. Many oral habits, such as lip trapping and tongue thrusting, are compensations for muscular or structural deficits. These imbalances in tongue and lip function may be improved by orthodontically correcting tooth positions, but the orthodontic correction may not be stable without myofunctional therapy to retrain the muscular habit. Mouth breathing can become a habit that is perpetuated even after the cause is eliminated. Buteyko breathing re-education can help habituate nasal breathing, which is critical for optimal craniofacial growth and overall health.

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 association between bruxism and nighttime hypoxias due to airway restrictions, as well as the role of low tongue posture and inadequate lip seal in the development of daytime clenching or even just "teeth-together" posture. These parafunctional habits are at the root of many TM disorders. Appropriate TMD treatments can include limited myotherapy for jaw stabilization, bruxism guards, TMJ “Farrar” splints for symptom resolution, as well as 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 that 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 and glossopharyngeal muscles as well as the pharyngeal walls.

We use permanent and invisible retainers to make retention a breeze. All comprehensive treatments include one lower permanent (bonded) retainer, two sets of invisible retainers, and a full year of retention checks. We have partnered with Retainer Club to provide replacement retainers for our patients. This innovative service offers 24/7 online retainer ordering and FREE home delivery. Existing patients can register here. Once you are registered and have had your first set of retainers fitted, you can log in here to order replacement retainers.