About Steven Litwin DDS Expertise I can answer all questions pertaining to dental health for all ages. Topics can include but not be limited to: TMD/migraines; Orthodontics, Implants, cosmetic procedures, crowns, veneers, periodontics (gum treatment), oral surgery, and other areas of interest/concern in the dental field.
Experience I am a practicing dentist in the Baltimore area and have been for over twenty years. I have treated thousands of patients over the years and continue to provide dental health care for them in all aspects of dentistry. I also include non invasive treatment for patients having been diagnosed with TMD and/or chronic headaches/migraines and have had great success without the use of medications.
Organizations Member of The Greater Baltimore Implant Study Club
Education/Credentials I graduated from Georgetown University Dental School in 1987 with a D.D.S. degree. I have completed countless continuing education programs throughout the years in all areas of dentistry.
Past/Present Clients I have patients that travel from out of state to have me provide for their care. Patients come from Pennsylvania, Florida, Delaware, and other areas in addition to the state of Maryland.
Question My son had a Frankel appliance starting at 7 years old and my
wife and I were told this would guide the growth of his jaws
as he wouldn’t need anything else down the line. The
orthodontist tragically died a month ago. We have now
consulted 2 other orthodontist about completing the treatment.
One said to extract teeth and give him braces and the other
wants to give him some special retainers that he turns a key
in to give his teeth more room and then use braces after. I
thought the Frankel was supposed to prevent a need for braces.
Should I go with the extractions or the retainers or should I
just leave his teeth as they are (he has retainers glued
behind his lower and upper front teeth
Answer Hi Richard,
Thanks for the question. Richard, I am sorry to hear about the Orthodontist and the position you and your daughter are now in. Let me give you some basics and hopefully this will help you in your decision process. A Frankel appliance is one of those appliances that was designed to do several things at one time. Ideally, it would be used with the intention of minimizing the need for braces at a later date but unfortunately even though competent analysis are performed nature does not always like to cooperate. The other factors that need to be considered include the amount of crowding present. As a general rule of thumb if there is greater than 7mm of crowding then extraction(s) are usually indicated as no appliance will create sufficient space that will be stable after treatment. Now if there is crowding less than this amount then depending on the amount and location of crowding space can be created by wearing an expander type of appliance that widens the arch and creates some room for the teeth to be moved into place with braces. Other ways include slightly opening the contacts between the teeth through a process called stripping. I would only recommend this process if the the amount of space needed is small as you do not want to strip too much tooth structure. I would hope that the current orthodontists have evaluated the amount of crowding present and have made their suggestions based on what works best in their hands. Leaving the retainers in place and not doing anything may not be the way to go if in fact there is still crowding. If there is room for all of the teeth but they have not all come yet then it may be feasible to wait until all teeth have erupted and then evaluate if they need to be tweaked into position. The main thing is to make sure there is space for them to erupt and hopefully the Frankel appliance would have done that. Hope this helps and wish you the best of luck.
