Q&A with Dr. Randy Kunik Feb. 14, 2010, 11:22 p.m.
Question and Answer with Dr. Randy Kunik
Dr. Kunik recently sat down with one of our UT Grad Students and answered a few questions regarding modern orthodontic technologies. Here are a few of the responses.
What do you think about 6-Month Smiles?
First of all, this is a concept of bracket positioning in a lab versus in the mouth which we have used in our office for 19 years called indirect bonding. It uses flexible nickel-titanium wires and accurate brace positions to move and straighten front teeth in sometimes as fast as 6 months. However, the goal of just straightening the upper-front “social” six teeth may lead to many complications such as gum problems, root problems from moving teeth too fast, and likely an unstable result. In my opinion, the subtle benefit of orthodontics done well is a broader smile. With 6-month smiles, they are not bracing the back teeth so you won’t get a broad smile. Additionally, this is a “weekend” training course for non-orthodontists. Dentists who do not do orthodontics routinely “don’t know what they don’t know.” I would for sure recommend anyone considering this option to get a second opinion from an orthodontist prior to starting.
What’s up with the concept of braces being fast?
Another marketed technique to get your teeth straight is through the one year “braces that are fast or easy.” Most people who offer these services are general dentists and are not orthodontists. Getting your teeth straight in 6-12 months is normal in my experience, however getting the bite to fit properly is generally what takes more than a year.
Do you use the Damon braces?
This is a family of self-ligating brackets and they are too big and metal-looking for my tastes. The advantages touted by the manufacturer are not at all proven by research. I’ve stuck with 3M Unitek, the absolute best product on the market.
Do you use the Herbst or Frankel appliances to correct bites in children?
No, I would not put products in my patient’s mouths that I would not put in my own mouth or my kids’ mouths. In my opinion, these products are too uncomfortable to use and there are other options that work just as well without the discomfort.
Is there a difference between a general dentist and an orthodontist doing Invisalign?
A non-orthodontist doing Invisalign may not have the experience or training to straighten teeth. A general dentist may not have the materials such as special braces to detail a case after Invisalign. Invisalign requires virtual movement of the teeth and this is in the operator’s hand. I feel that after 900 virtual setups my technique has evolved for a more predictable result whereas general dentists who do a few cases a year are relying on a technician in Costa Rica. If things don’t work out, they don’t have the experience to alter the case to get the results needed.
What do you prefer, Invisalign or Braces?
I don’t prefer one over the other; they are both tools that are used in orthodontics. In certain cases Invisalign works better than braces, and vice-versa. That’s why I offer complimentary exams at my office to decide which treatment works best for each patient.
Will you offer Invisalign to teenagers?
Invisalign is becoming a first choice for many middle school and high school kids in my office. Mostly because hygiene is not an issue with Invisalign and we don’t see white stains that we do with braces. My goal is to offer Invisalign to almost everyone by the end of my career including middle-schoolers and high-schoolers because of those reasons. In general, Invisalign is just a lab product, it is not a treatment. It is a series of retainers designed by me, the orthodontist, and fabricated by a state-of-the-art technique allowing for mass customization. With more than 10 years of using Invisalign it is a tool of choice for more and more of my practice. Never forget that it’s just a series of retainers.
What do you think about wisdom teeth? Do wisdom teeth affect orthodontics?
No, this has proven in research to be an old wives tale.
What causes relapse?
Settling of the teeth and recurrence of a deep bite causes narrowing of the cuspids and this causes the lower incisors to crowd again. Half of my practice are adults that were treated 10+ years ago who have narrowed in the back and crowded in the front, which is not related to the wisdom teeth
Is anyone too old for orthodontics?
I would say that as long as the treating dentist says your teeth, gums and bones are healthy you are never too old for orthodontics. I have treated many patients in their 60s and 70s.
What sets you apart from other orthodontic offices?
Though the technology we use for orthodontics changes frequently with Invisalign, temporary anchoring, and laser technology, the level of care we have for our patients stays as high as it could be. I’ve been in the same location for the past 19 years so my patients. I only practice out of this office and do not split my time between multiple locations. My patients look forward to seeing me and the same team members on all their visits. We have a no wait policy in our office which ensures you come in and get the care you need without wasting time.
What treatment do you recommend for young patients?
In general, I like to see patients in about the first or second grade for their first x-ray so I can establish some baselines for future changes. This is one of the reasons why I offer a complimentary first appointment at my office. It is very important to take an x-ray by age 7 to check for missing, extra or impacted teeth. It’s not unusual for me to recommend for some baby teeth to be removed to help out mother nature. Sometimes I suggest an upper expander is needed to help with crowding or crossbites. By and large, in more than 95% of cases I prefer to monitor and help out mother nature and then treat one time with orthodontics in middle school and then late middle school.
What are the benefits of in-office teeth bleaching over whitening strips from the drugstore?
I’d say that all these teeth whitening products seem to work. Trays with professional bleach seem to be the best option over other teeth whitening products. This is due to effectiveness and long-term maintenance of the shade correction. We provide all our patients bleach with their Invisalign trays. Whitening strips work well, but you should talk to your dentist to see what options work best for you as they may cause teeth sensitivity.