Dear Mack and Hansen Orthodontics Family,

We are beyond ready to get back to work and see everyone that we have missed so much! We hope this letter finds everyone healthy, happy and prepared to ease back into regular routines. Much has changed since we saw you last. We are all still coming to grips with the COVID-19 pandemic and events triggered by it. Everyone on the planet has been affected by COVID-19. We want to update you on our office, its measured re-opening, and the steps we are taking to ensure we do everything possible to keep our patients and our team healthy.

While our office has been closed, Dr. Mack, Dr. Hansen, and our team have been very busy working to ensure each of our patients are cared for! From conducting virtual visits, to setting up MHO Pop-Ups to pass out wax and rubber bands in cities outside of Longview, to preparing the office for a safe reopening, we’ve been hard at work and anxiously awaiting seeing your smiles in person! Thanks to our new Virtual Portal, which can be found on our website homepage, we’ve be able to see some patients virtually for regular appointments throughout this time. Moving forward, we plan to continue to use this technology to address issues on the fly, and we will plan your virtual and/or in-person appointments accordingly.

To that end, we will be reopening on Friday, May 1. We will be following rigorous scheduling protocols and office measures per the guidelines of the Texas State Dental Board to ensure the safety and well-being of you, our patients, and our team. We ask for your patience. We had to cancel over 1000 appointments, and we know that there is a strong desire to be seen as soon as possible. We will be adding additional clinical hours to ensure patients are seen in a timely manner. We have already begun rescheduling patients on a first-canceled-first-rescheduled basis, which is fair, efficient, and will serve everyone with getting back on track. The protocols below have been well-thought-out and reviewed countless times by Dr. Mack, Dr. Hansen and our entire team.

Our office procedures have temporarily changed and will include the following:

Appointments:

-Please wait for our office to call you to reschedule your appointments. We have a very accurate and comprehensive list of every appointment canceled, including the day and time. When we do speak with you to schedule your visit, we will conduct a pre-appointment questionnaire over the phone.

- This simple questionnaire will assess who you have been in contact with, your recent travel, if applicable, and the status of your current health. Any question indicating recent exposure to someone with COVID-19 or having signs and symptoms of the same will require us to delay your visit for 3 weeks.  Please note that it is absolutely essential these questions are answered honestly and truthfully for us to continue doing our part in flattening the curve & keeping all of our loved ones safe.

-You will also receive an additional screening form in your appointment reminder text that you receive 2 hours before your visit. You will need to complete this form- it should not take more than a minute and can be found HERE.

-Emergencies will continue to be defined only by trauma or bleeding. For now, broken brackets do not constitute an emergency.

Visits:

- Just as we were doing in early March, we will continue with our virtual waiting room. When you arrive for your appointment, please stay in your car. The front door will remain locked. Please call or text our office upon your arrival. One of our team members will text you to let you know when we are ready to start your visit, so please keep your phone handy after you check in. At that point, the team member will meet you at the front door. Don’t worry– it won’t be this way forever!

- Your temperature will be taken by an MHO Team member using a forehead thermometer. If your temp is over 100 degrees F, we will work to address any issues or concerns with a Virtual Checkup and reschedule your in-office appointment.

-Following Gov. Abbot’s mandate, only the patient that is being treated will be allowed to enter the office. The only exception for this will be for patients under the age of 18. In those situations, only one parent/caregiver may accompany the patient. Absolutely no other family members or friends will be allowed inside. We love to use FaceTime to communicate with any guardian waiting in their car while their child is being seen. Erika, CeCe, and Katelyn will also be able to text a summary of what took place at the visit.

-For any guardians entering the office, please consider bringing your own mask and wearing it inside. Federal guidelines for social distancing and wearing masks in businesses continue, so bring the mask you have been using.

- Maintain the 6-foot social distancing guidelines when in the office until seated in the treatment chair.

- Our brushing station will be temporarily closed during this time period. We ask that all patients brush at home and arrive clean and ready to be seen for their appointment.

-All patients will be provided with a hydrogen peroxide rinse to use once they are seated in their private treatment room.

- We will continue to utilize hospital-level sterilization techniques throughout our office for your safety and health. We will continue to be diligent in our efforts to keep our office safe for you and your family.

MHO Team:

- We will take the temperatures of every team member, including Dr. Mack and Dr. Hansen, immediately upon arrival at work and after lunch. Any team member at 100 F or above will go home.

- Every team member will answer the health questionnaire that our patients are required to answer and will do so every day. If any questions disqualify the team member, they will be sent home following the same procedures we are asking our patients to follow.

General:

- You will find upon arrival that our furniture has been rearranged. You'll also notice other changes made to ensure the health and well-being of our patients and our team including the addition of Medical Grade Air Filters throughout the office and hand sanitizer dispensers everywhere you look. We have also temporarily removed the coffee station and water fridge per instruction by the State Dental Board.  We are so grateful for every one of our patients, and this time away has only served to make us even more thankful for each of you. You are the life-force of our practice, and this is why we are taking your safety VERY seriously. Thank you for your patience and understanding during this crazy time. If you have any questions, please feel free to call our office or call/text, Dr. Mack or Dr. Hansen directly. We love all of you! Most importantly, please remember to be kind to one another- we need that in our world right now!

- Dr. Mack, Dr. Hansen, Brittany, Makenzi, Erika, CeCe, Katelyn, Haylee, Emily, Gabby, and Laikyn

Pre-Visit Wellness Survey Link

Dear Mack and Hansen Orthodontics Family,

Thanks to our new Virtual Portal, which can be found via the PINK button at the bottom our website homepage, we’ve be able to see some patients virtually for regular appointments throughout this time. Moving forward, we plan to continue to use this technology to see certain appointment types and address issues on the fly. Below you will see specific instructions for the select appointment types we can see virtually which include Retainer Checks, Quick Checks for an Expander/Palatal Expander, and Observation/Growth Checks.

For Retainer Checks:

You can complete this at any time during the day of your scheduled visit, it does not have to be exactly at your scheduled appointment time. Please complete the questions via the Virtual Portal by clicking the PINK button at the bottom of our homepage. When it comes time to take your series of selfies, please do so WITH YOUR RETAINERS IN. Turning your camera's flash on will also help provide a clear photo. After submitting all your photos, our team will evaluate how your retainers are fitting and provide further instruction via email or text within 24 hours. If your retainers are not fitting or you lost/broke them, please CALL or TEXT our office (903-212-7737) and let us know.

For Quick Checks for an Expander/Palatal Expander:

You can complete this at any time during the day of your scheduled visit, it does not have to be exactly at your scheduled appointment time. Please complete the questions via the Virtual Portal. When it comes time to take your series of selfies, please turn your camera's flash ON. The most important photos for this visit are the photo of the top set of teeth and the center photo with the patient biting down in their normal/usual bite. After we receive your photos through our portal we will evaluate them and provide further instruction via email or text within 24 hours.

For Observation/Growth Checks:

You can complete this at any time during the day of your scheduled visit, it does not have to be exactly at your scheduled appointment time. Please complete the questions via the Virtual Portal. When it comes time to take your series of selfies, please turn your camera's flash ON. When taking the photos, please try to capture as much of the teeth as possible. This may mean holding the lips or cheeks out of the way when taking the photos. After we receive your photos through our portal we will evaluate them and provide further instruction via email or text within 24 hours. If you have any questions, please don't hesitate to let us know (903-212-7737).

Dear Mack and Hansen Orthodontics Family,

We are beyond ready to get back to work and see everyone that we have missed so much! We hope this letter finds everyone healthy, happy and prepared to ease back into regular routines. Much has changed since we saw you last. We are all still coming to grips with the COVID-19 pandemic and events triggered by it. Everyone on the planet has been affected by COVID-19. We want to update you on our office, its measured re-opening, and the steps we are taking to ensure we do everything possible to keep our patients and our team healthy.

While our office has been closed, Dr. Mack, Dr. Hansen, and our team have been very busy working to ensure each of our patients are cared for! From conducting virtual visits, to setting up MHO Pop-Ups to pass out wax and rubber bands in cities outside of Longview, to preparing the office for a safe reopening, we’ve been hard at work and anxiously awaiting seeing your smiles in person! Thanks to our new Virtual Portal, which can be found on our website homepage, we’ve be able to see some patients virtually for regular appointments throughout this time. Moving forward, we plan to continue to use this technology to address issues on the fly, and we will plan your virtual and/or in-person appointments accordingly.

To that end, we will be reopening on Friday, May 1. We will be following rigorous scheduling protocols and office measures per the guidelines of the Texas State Dental Board to ensure the safety and well-being of you, our patients, and our team. We ask for your patience. We had to cancel over 1000 appointments, and we know that there is a strong desire to be seen as soon as possible. We will be adding additional clinical hours to ensure patients are seen in a timely manner. We have already begun rescheduling patients on a first-canceled-first-rescheduled basis, which is fair, efficient, and will serve everyone with getting back on track. The protocols below have been well-thought-out and reviewed countless times by Dr. Mack, Dr. Hansen and our entire team.

Our office procedures have temporarily changed and will include the following:

Appointments:

-Please wait for our office to call you to reschedule your appointments. We have a very accurate and comprehensive list of every appointment canceled, including the day and time. When we do speak with you to schedule your visit, we will conduct a pre-appointment questionnaire over the phone.

- This simple questionnaire will assess who you have been in contact with, your recent travel, if applicable, and the status of your current health. Any question indicating recent exposure to someone with COVID-19 or having signs and symptoms of the same will require us to delay your visit for 3 weeks.  Please note that it is absolutely essential these questions are answered honestly and truthfully for us to continue doing our part in flattening the curve & keeping all of our loved ones safe.

-You will also receive an additional screening form in your appointment reminder text that you receive 2 hours before your visit. You will need to complete this form- it should not take more than a minute and can be found HERE.

-Emergencies will continue to be defined only by trauma or bleeding. For now, broken brackets do not constitute an emergency.

Visits:

- Just as we were doing in early March, we will continue with our virtual waiting room. When you arrive for your appointment, please stay in your car. The front door will remain locked. Please call or text our office upon your arrival. One of our team members will text you to let you know when we are ready to start your visit, so please keep your phone handy after you check in. At that point, the team member will meet you at the front door. Don’t worry– it won’t be this way forever!

- Your temperature will be taken by an MHO Team member using a forehead thermometer. If your temp is over 100 degrees F, we will work to address any issues or concerns with a Virtual Checkup and reschedule your in-office appointment.

-Following Gov. Abbot’s mandate, only the patient that is being treated will be allowed to enter the office. The only exception for this will be for patients under the age of 18. In those situations, only one parent/caregiver may accompany the patient. Absolutely no other family members or friends will be allowed inside. We love to use FaceTime to communicate with any guardian waiting in their car while their child is being seen. Erika, CeCe, and Katelyn will also be able to text a summary of what took place at the visit.

-For any guardians entering the office, please consider bringing your own mask and wearing it inside. Federal guidelines for social distancing and wearing masks in businesses continue, so bring the mask you have been using.

- Maintain the 6-foot social distancing guidelines when in the office until seated in the treatment chair.

- Our brushing station will be temporarily closed during this time period. We ask that all patients brush at home and arrive clean and ready to be seen for their appointment.

-All patients will be provided with a hydrogen peroxide rinse to use once they are seated in their private treatment room.

- We will continue to utilize hospital-level sterilization techniques throughout our office for your safety and health. We will continue to be diligent in our efforts to keep our office safe for you and your family.

MHO Team:

- We will take the temperatures of every team member, including Dr. Mack and Dr. Hansen, immediately upon arrival at work and after lunch. Any team member at 100 F or above will go home.

- Every team member will answer the health questionnaire that our patients are required to answer and will do so every day. If any questions disqualify the team member, they will be sent home following the same procedures we are asking our patients to follow.

General:

- You will find upon arrival that our furniture has been rearranged. You'll also notice other changes made to ensure the health and well-being of our patients and our team including the addition of Medical Grade Air Filters throughout the office and hand sanitizer dispensers everywhere you look. We have also temporarily removed the coffee station and water fridge per instruction by the State Dental Board.  We are so grateful for every one of our patients, and this time away has only served to make us even more thankful for each of you. You are the life-force of our practice, and this is why we are taking your safety VERY seriously. Thank you for your patience and understanding during this crazy time. If you have any questions, please feel free to call our office or call/text, Dr. Mack or Dr. Hansen directly. We love all of you! Most importantly, please remember to be kind to one another- we need that in our world right now!

- Dr. Mack, Dr. Hansen, Brittany, Makenzi, Erika, CeCe, Katelyn, Haylee, Emily, Gabby, and Laikyn

Pre-Visit Wellness Survey Link

Affordable Orthodontist in Carthage TX

Have you been looking for an affordable orthodontist in Carthage TX or an orthodontist near Carthage Texas? Well look no further! Here at Mack and Hansen Orthodontics, we serve all of East Texas. We are your In-Network Orthodontic Provider for both braces and invisalign and we treat children, teenagers, and adults of all ages.

Don’t have insurance? No worries! We are committed to making the investment in orthodontic treatment an affordable one for you and your family. We offer low down payments and monthly payment plans with 0% financing.

Only interested in closing that gap or just fixing that “one” tooth? Be sure to ask about our NEW Limited treatment options for correcting those simple issues.

Don’t like impressions? Us either! We offer impression-less treatment using our digital intra-oral scanner.

We also understand your schedule is busy. That’s why we are open after school and until 6 PM on Tuesday’s and Thursday’s. We are also the only orthodontic office open on Friday’s.

We are committed to serving you. If you would like to reserve a FREE consultation, please submit a Free Consultation request HERE. You can also call or text us directly at 903-212-7737, and one of our wonderful scheduling concierges will reach out and get you all set up.

Directions from Carthage TX:

Coming to visit our orthodontic office from Carthage TX? Simply begin by heading north on TX-572 Spur W/Cottage Rd to TX-149 W and take TX-149 W to Longview for 36 miles. 

Turn onto Medical Circle and you will find us on the right at 801 Medical Circle.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Mount Pleasant, Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Affordable Orthodontist in Mount Pleasant TX

Have you been looking for an affordable orthodontist in Mount Pleasant TX or an orthodontist near Mount Pleasant Texas? Well look no further! Here at Mack and Hansen Orthodontics, we serve all of East Texas. We are your In-Network Orthodontic Provider for both braces and invisalign. We treat children, teenagers, and adults of all ages too.

Don’t have insurance? No worries! We are committed to making the investment in orthodontic treatment an affordable one for you and your family. We offer low down payments and monthly payment plans with 0% financing.

Only interested in fixing that “one” tooth or just closing that gap? Be sure to ask about our NEW Limited treatment options for correcting those simple issues.

Don’t like impressions? We offer impression-less treatment using our digital intra-oral scanner.

We also understand your schedule is busy. That’s why we are open after school and until 6 PM on Tuesday’s and Thursday’s. We are also the only orthodontic office open on Friday’s.

We are committed to serving you. If you would like to reserve a FREE consultation, please submit a Free Consultation request HERE. You can also call or text us directly at 903-212-7737, and one of our wonderful scheduling concierges will reach out and get you all set up.

Directions from Mount Pleasant TX:

Coming from Mount Pleasant? Simply begin by heading south on TX-49 E and US-259 S for 54 miles on to 4th Street in Longview. Then take a right onto Medical Circle and you will find us on the right at 801 Medical Circle.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Mount Pleasant, Marshall, Carthage, Henderson, Kilgore, and Gilmer.

If you have been thinking about starting orthodontic treatment with braces or invisalign, or are currently going through orthodontic treatment, you may be thinking about retainers…

Will you need to wear retainers once you finish treatment? The answer is yes, you will. Let us explain why. Once your teeth are straight, you need to keep them straight, and that is exactly what retainers will do. Changes in tooth position is a naturally occurring phenomenon that will occur throughout one’s lifetime. If you want to keep your teeth in the position they are after you finish your orthodontic treatment, regardless of it is with braces or invisalign, you must wear your retainers. While small changes after treatment finishes is normal, retainers prevent teeth from going back to their original positions.

Why do I need retainers?

Retainers are recommended for two main reasons. The first reason is to allow your bone to heal and rebuild after your teeth have been moved to their new position. The second reason is to maintain the new and healthy positions of your teeth themselves. Just as your body changes throughout your whole life, so do your teeth.

Are there different retainer options?

We have a few different retainer options here at Mack and Hansen Orthodontics. Each patient receives 1 set of retainers at the completion of their treatment. We also offer retainer upgrades, which you can learn about here.

How long do I have to wear my retainers?

You will need to wear your retainers for as long as you want to keep your teeth straight. Many patients wear retainers nightly for life.  Basically, it becomes part of your daily oral hygiene routine. You brush and floss your teeth before bed, and then place in your retainers to wear at night.

We offer several treatment options to take care of those front teeth that have rotated since you had treatment. Often, the cost of orthodontic treatment for an adult will be less than for a child if you've already had treatment when you were younger. To learn about your options you can request a complimentary consult here or you can give us a call or text us at 903-212-7737. We are located just a short drive from Gilmer, Marshall, Kilgore, Henderson, Carthage, and Mount Pleasant TX.

Packing a lunch for your children that is braces friendly can sometimes be a challenge. We put this list together to help you pack braces friendly foods for your child. We recommend putting in snacks that your children think are yummy, but at the same time healthy and braces friendly. Here are some of the best options to consider this school year in Longview that are Orthodontist Approved...

Yogurt or Pudding
Yogurt is usually a healthier option than pudding, but both are braces friendly. Yogurt is loaded with probiotics that can help keep gums, mouths, and stomachs healthy. Orthodontist's love this food for patient's!

Whole Grain Pita and Hummus
Instead of packing buttery popcorn, which is a big NO with braces, add whole grain pita or chopped up vegetables with hummus instead. Popcorn can damage your children’s teeth, with or without braces, and can even lead to tooth decay.

String Cheese
Cheese is great for your child’s teeth and definitely a braces friendly food. The calcium boosts their enamel, which makes their mouth stronger.

Fresh Fruit
Fruit cups and dried fruit snacks contain high amounts of sugar that if not brushed off of teeth will lead to decay and cavities. Fresh fruit like apples, pears, and watermelon have lots of water which helps wash away the sugar.

Flavored Water
Fruit Juice is something that you will want to try and avoid due to its high sugar content. Natural flavored, sugar-free water is a great alternative.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how our Orthodontists, Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. Our orthodontic office is conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Are you in the middle of your orthodontic treatment? Getting close to the end? Regardless of the stage of treatment you are in, we put this list of tips together to help you through your journey. Here’s are some of our best tips and tricks!

1. Water picks are GAME-CHANGERS. We recommend anyone who struggles with flossing to get one of these to help with maintaining their oral health during treatment.
2. Have a handy mirror or mirror app. Food can get stuck in your teeth regardless of if you have braces on or not. Having a handy mirror or an app on your phone can make it easy for you to check for anything that might have been left behind after a meal.
3. Using a tweezer can help fix wires. In the beginning of treatment when lighter wires are used sometimes they can slipi out of a back bracket. Using a tweezer to place the wire back into the orthodontic bracket can save you a trip to our Longivew orthodontic office. This can be especially convenient if you are traveling to us from Gilmer, Carthage, Marshall, or Kilgore.
4. Eat and drink things that won’t stain your teeth. Just because a food is healthy, like a strawberry or raspberry, doesn’t mean it can’t stain your teeth or get stuck in your braces. Avoid highly acidic drinks and sugary sodas as well.
5. Warm salt water rinses. If you experience soreness on any of your lips or cheeks after getting braces on, rinsing with warm salt water can help decrease and heal up any open sores in your mouth.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

It’s back to school time around Longview, Kilgore, Gilmer, and all of East Texas! Did one of your children go back to school with braces on? Congratulations! They’re on their way to a healthier smile. It is important for them to continue to take care of their braces even while they are at school…

Tips on Keeping Braces Clean At School:

1. Bring your MHO Brushing kit to school

Help them out by putting a brushing kit in their backpack! Here at Mack and Hansen Orthodontics we give each patient one of these the day they start their braces journey with us. These orthodontic care kits help children stay on track with their oral hygiene and keep all their braces care tools handy during the busy school year.

2. Brush Or Rinse After Every Meal

It is important to brush not only at night and in the morning, but at school as well! Remind your children to brush their teeth and around their braces at school too. If they are unable to use their toothbrush, rinsing with water after eating or drinking anything containing sugar can help minimize the chance of developing a cavity on their teeth.

3. Drink Plenty Of Water

We all know drinking water is important. Having a handy water bottle can help children not only keep their teeth clean but also stay optimally hydrated during the school day. Soda and other sugary drinks such as Gatorade can leave sugar behind and damage teeth so drinking water instead is the best way to go!

4. Protect Your Mouth During Sports

We recommend all children, regardless of if they have braces on their teeth or not, to wear something to protect their teeth while they are engaging in sports. Wearing a mouthguard can help prevent any damage to teeth or other serious injuries that can occur while playing sports.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

We cannot tell you enough how much we appreciate you being a part of the Mack and Hansen Orthodontic Family. If you have a moment, we would be forever grateful if you shared your experience on Google!

Please click HERE to leave us a review on Google!!

If you do not have a Gmail account, feel free to share your experience on Facebook!

Click HERE to Like our Facebook Page!!

Click HERE to Follow us on Instagram!!

Thank you again! We look forward to seeing you soon :)

Love,

The Mack and Hansen Orthodontics Team

When is the best time to start your orthodontic treatment?

If you asked a person that question, they may say something like Summer, Christmas, or Spring Break.  But the real answer to that question is ANY TIME!! Here at Mack and Hansen Orthodontics, we do our best to make any time a good time for getting your braces or Invisalign.  We do this by being available to you with early morning, late afternoon, and Friday appointments.  Our team is here to meet your needs however we are able to.  With that being said, school is almost out, summer is right around the corner, and it is a great time to schedule your complimentary consultation with us for your smile needs.   Whether you are interested in the Traditional Metal braces, the Forever Gold braces,  Clear braces or Invisalign, we are here to help guide you through the process.  If you aren’t sure what treatment you need, our doctors and staff will help explain how each appliance works and help you decipher through what best fits your lifestyle and needs.

Getting braces in the summer usually is a popular option, as kids are out of school.  With that in mind, summer is also a busy time here at Mack and Hansen Orthodontics, so it is always a good idea to schedule your appointments in advance.  Some people prefer to get their braces in the summer because they think they need downtime to “recover,” but this is not necessary.  Granted, braces and Invisalign can make your teeth a teeny bit sore right at the beginning, but this soreness is nothing that prevents you from being able to go back to school or work.  Taking something like Advil (ibuprofen), Tylenol (acetaminophen), or another type of anti-inflammatory medication can usually control much of the soreness people experience, allowing them to go about their day as usual.  Now there are some foods, as most people know, that you are unable to eat when you have braces because they will cause damage to the appliances.  But the beauty with Invisalign is that you are able to remove your trays when eating, so there are no food restrictions.  That is something a lot of young adults and adults like to consider when choosing the direction they wish to go on their journey to a better smile.

So in summary, you have many options when it comes to bettering your bite and your smile, and there is never a bad time to start!  With summer upon us and potentially more free time available, consider getting yourself or your loved one in for their complimentary consultation to see what treatment may be right for your smile!

If you are looking for a Longview orthodontist and would like to learn how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us. Our free consultation will allow you to discover what our orthodontists can do for you. We’re conveniently located in Longview, TX next to Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Gilmer, Henderson, Mount Pleasant and Carthage Texas.

Why do I have to avoid eating chips with braces?

When you get your braces on, it is important to keep in mind not only how to take care of your braces, but also what foods are okay to eat with your braces, and what foods you should avoid. One of the most popular types of foods that needs to be avoided while in orthodontic treatment with braces is chips. Any type of hard and crunchy food is something you will want to avoid while wearing your braces. Chips like Fritos, Doritos, Tostitos, Cheetos, Takis, as well as pretzels and other hard breads are foods that can not only damage your wire, but also cause your brackets to break.

How can chips and hard breads (such as pizza crust) mess up my wire?

Well, we are glad you asked! Especially in the early stages of your braces treatment, the wires in your mouth are really flexible. As such, if you were to be eating chips and salsa from your favorite restaurant, when you bite down, the chips can cause these light and flexible wires to bend, and put permanent deformations in your wire, or even break the wire entirely!

What are some other types of foods to avoid while in orthodontic treatment with braces?

Chips and hard breads are not the only foods that should be avoided while in treatment. Peanuts should also be avoided during treatment. Sticky foods like taffy can get stuck around the brackets on the teeth and you may be unable to clean the taffy off.

What are some foods that I am able to eat?

As a general rule, softer foods will be better while in orthodontic treatment with both braces and invisalign. Foods like mashed potatoes, macaroni and cheese, and pasta are going to be both more comfortable to eat while in treatment and also not cause any broken brackets, invisalign attachments, or orthodontic wires.

One of our goals in taking care of our wonderful patients here at Mack and Hansen Orthodontics is to always provide exceptional experiences and customer service in a professional, caring, organized and respectful manner.
We are a highly skilled, energetic team, with a common vision of always striving to do our best. Compassion, kindness, respect and trust are some of our main core values with our patients and team members alike.

Do you have a goal of being part of a professional orthodontic team? Do you enjoy interacting with children and adults? Do busy phones and a fast-paced work environment filled with multi-tasking fit with your personality?

Katelyn visited our office a few times over the past couple weeks to learn more about dentistry and orthodontics in particular. Here is what she wrote about her time with us:

"I learned so much from watching the girls and how they work. Lindsey was so patient with me and let me ask any question. She taught me how to remember what color goes with what quadrant. The lower right is red and it is fire, the upper right is black that is because smoke comes after fire. Then you go to the lower left and that is white because after smoke comes ashes. Last but not least you have the upper left and that is green because after ashes comes new growth. She helped me remember how the reverse curve wire goes and how it works, frown down smile up.

I also learn how to properly clean a room after each patient, and how to clean the instruments. The instrument name took me a little longer to remember but after seeing what each instrument was used for it helped me to remember then. I loved getting to watch Lindsey take the pictures for the Invisalign. Out of all getting to watch the process of putting on the brackets for the first time was the best. Y'all walked everyone through the process and made sure they where comfortable through the whole thing that’s what I liked best. I didn’t get to see anyone finish their time in braces but I can only image how it must feel to help a child or an adult feel better about their smile.

Thank you so much for having me and teaching me all that y'all did. I couldn’t have asked for a better place to do my externship."

If you are looking for a Longview orthodontist and would like to learn how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us. Our free consultation will allow you to discover what our orthodontists can do for you. We’re conveniently located in Longview, TX next to Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Gilmer, Henderson, Mount Pleasant and Carthage Texas.

How does invisalign work?

Today’s post is on one of the more esthetic options in orthodontic treatment, invisalign. If you have been wondering how invisalign works we are here to help clear some things up. As orthodontists, Dr. Mack and Dr. Hansen make teeth move using different tools. One of the most commonly used tools is braces (brackets and wires). Invisalign is also one of those tools they use to move teeth. How the process works here at Mack and Hansen Orthodontics is pretty simple. It starts with a FREE consultation where we get some diagnostic x-rays and photos, and then Dr. Mack or Dr. Hansen take a look at your teeth and bite and visit with you about what your concerns are.

Since Dr. Mack and Dr. Hansen are comfortable treating even the most complex cases with invisalign, if you feel invisalign is a good fit for you and fits your lifestyle then we can get you started that same day. To start, we simply scan your teeth with our intraoral digital scanner. We use the digital scanner instead of taking gooey impressions to not only make your experience better, but it also allows us to have a more accurate record of your teeth and therefore better fitting trays.

After your scan, Dr. Mack and Dr. Hansen plan each and every tooth movement from the start of your treatment to the end to give you the most effective, efficient, and beautiful result. When you return to our office after your scan we provide you with trays and place any attachments on your teeth. Attachments are little tooth-colored bumps of glue that help the invisalign trays transmit the appropriate force to your teeth so they can move how they are supposed to.

We also include a bleaching kit with each invisalign treatment, so you and whiten your smile while we are straightening your teeth and aligning your bite. And to answer the Trivia Tuesday question: Yes – we can correct overbite and underbite with invisalign using rubber bands.

You typically wear your invisalign trays for 7 to 10 days at a time, and we see you for visits every 8-12 weeks.  Once we finish going through your first set of trays, we evaluate where your smile and bite are at, and if we need any more trays to get things just the way want, then scan to get you some extra trays.

After you finish your treatment, you still need to wear retainers just like after any other form of orthodontic treatment.

Please let us know if you have any questions about Vivera retainers. If you are looking for a Longview orthodontist and would like to learn how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us. Our free consultation will allow you to discover what our orthodontists can do for you. We’re conveniently located in Longview, TX next to Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Gilmer, Henderson, Mount Pleasant and Carthage Texas.

As some of you may already know, October is National Orthodontic Health Month. Some may ask why October, of all months, is Orthodontic Health Month. Many will consider that since Halloween is in October, it is a great month to bring awareness to the proper way to take care of your teeth while undergoing orthodontic treatment.

Now we all know that with Halloween comes Trick-or-Treating which means lots and lots of candy and sweets. While some of you may not have gone Trick-or-Treating this year due to the rain and storms here in Longview, Kilgore, Marshall, and Gilmer. There are obviously a number of reasons why it is important to minimize sweets and candy intake, especially during orthodontic treatment.

Candy and other sweets obviously have lots of sugar in them. Sugar, of course, leads to cavities for whoever is eating them, even adults, if proper oral hygiene is not up to par. During orthodontic treatment with braces or invisalign it takes more effort to properly take care of your teeth and gums. Having excessive amounts of candy during this time of year means it is of upmost importance to brush and floss your teeth.

Another important thing to remember while going through all of that trick-or-treating candy is that the hard candies are typically the ones that will cause brackets to come off and orthodontic wires to bend, which can cause delays in orthodontic treatment and hinder your orthodontic treatment progress. Furthermore, sticky candies can get stuck between the brackets and wires as well.

As an alternative to eating all that candy this year, bring it out to our Candy Give-Back Drive taking place Saturday November 3rd here in Longview at Menchie's on Hawkins Parkway. In exchange for trading in your candy (which we will donate to Operation Gratitude), you will get a Mack and Hansen Orthodontics Toothbrush kit with a travel toothbrush and gift cards to local Longview restaurants including Menchie's, Bubba's 33 on Loop 259, and other restaurants.

Please let us know if you have any questions about invisalign clear aligners. Our free consultation will allow you to discover what our orthodontists can do for you. We’re conveniently located in Longview, TX next to Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, and Carthage Texas

Invisalign in Longview TX

Are you interested in orthodontic treatment but don’t want to go with traditional braces? Here at Mack and Hansen Orthodontics we love when our patients opt for Invisalign clear aligners as their treatment option. Invisalign offers a number of benefits to patients, most notably the convenience of being able to take their trays in and out when they choose, such as for social gatherings, parties, and of course to brush and floss their teeth.

For our patients we actually do not take molds/impressions of your teeth. Instead, we use our digital scanner to scan your teeth and bite. This gives us trays that fit more comfortably and accurately than when you have molds taken.

Dr. Mack and Dr. Hansen were trained in residencies placing a strong emphasis on this new and improved orthodontic treatment. Having recieved training from orthodontists in the top 1% of Invisalign providers worldwide, Dr. Mack and Dr. Hansen are comfortable treating even the most complex and difficult cases effectively and efficiently using Invisalign clear aligners.

Typically, orthodontic treatment with invisalign lasts between 9 and 15 months, depending on the complexity of the case. However, there are cases that take longer and some that are shorter, again it all just depends on what needs to be done to your teeth. Our orthodontic consultations are free of charge and we use those to determine what your specific treatment needs are.

Another nice thing about invisalign is that you can bleach your teeth with the trays in your mouth, giving you the opportunity to whiten your smile at the same time you are straightening your teeth. We now include a bleaching kit with all of our invisalign treatment options!

Please let us know if you have any questions about invisalign clear aligners. Our free consultation will allow you to discover what our orthodontists can do for you. We’re conveniently located in Longview, TX next to Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, and Gilmer Texas

Each year, Operation Gratitude sends hundreds of thousands of care packages to those who serve our country. Since 2003, Operation Gratitude has sent over 2,000,000 care packages to Troops, First Responders, Veterans, and their families.  Each of those care packages include a handful of candy, the majority of which comes from donations made by groups and drives such as this held in October and November where children donate their Halloween candy as a way of showing gratitude to those who serve.

This year, we are offering an extra incentive to children to give back their candy. The first 500 children who bring in and donate over a pound of Halloween candy to our Give-Back Drive will receive a Mack and Hansen Orthodontics toothbrush kit filled with gift cards and coupons to local restaurants including Menchie’s, Bubba’s 33, Raising Cane’s, Buffalo Wild Wings, Slim Chickens and more!

All of the candy collected will then be sent off to Operation Gratitude’s packaging center where the care packages are put together and shipped all over the world.

This year’s event will take place on Saturday, November 3^rd from 11 am to 2 pm in the parking lot at Menchie’s at Hawkins Pkwy Center. There will be fun and games for the whole family so be sure to come out, bring your candy, and have some fun while giving back to those who serve our country!

If you are interested in scheduling a FREE Consultation for braces or invisalign with Dr. Spencer Mack or Dr. Andrew Hansen you can do so here. We are your in-network orthodontic provider and treat children, teenagers, and adults of all ages, offer low down payments and affordable payment plans. Come see why we give East Texas a reason to smile!

Investing in your smile is a decision you’ll never regret. Orthodontic treatment at Mack and Hansen Orthodontics located in Longview and just a quick drive from Marshall, Mount Pleasant, and Carthage Texas, will allow you to have the healthy, beautiful smile you’ve always wanted.

Throughout your smile journey you will be required to attend visits at our Longview office where your orthodontist, either Dr. Mack or Dr. Hansen, will make sure your braces are continually moving your teeth into the optimal position. Depending on your stage of orthodontic treatment, your wires may be replaced or adjusted to ensure proper alignment. These adjustments may cause you some temporary discomfort as your teeth move and your bite changed. Be sure to consult with your orthodontist, Dr. Mack or Dr. Hansen in Longview about the different ways to manage the soreness and irritation that can arise from orthodontic treatment.   But start with these easy, at-home tips to get comfortable right away.

Ice Water or Soft Cold Treats

Just as ice or cold packs can be used to help soothe sore muscles or joints on your body, drinking ice water or snacking on cold treats can help reduce the soreness that may occur with orthodontic treatment. Initially after a wire adjustment or other orthodontic procedure is when soreness can be experienced.   Ice cream, milkshakes, and smoothies are great examples of braces friendly cold treats that you can indulge in to help alleviate the discomfort!

Swish warm salt water

Your cheeks, lips, tongue, or gums may become irritated. Things that can cause this are new brackets, wires, attachments, aligners, or other orthodontic appliances placed at your appointment.  Rinsing with warm salt water for 60 seconds can help provide relief.

Use your orthodontic wax

In addition to the warm salt water rinse, use the orthodontic wax that we give you to smooth any part that is bothersome. Orthodontic wax is easy to apply and will act as a physical barrier between your cheek and your braces allowing the sore to heal.

Eat softer foods

If you are experiencing any discomfort after your orthodontic appointment, avoid foods that require a lot of chewing.  Instead, search for a softer food option, such as yogurt, soup, pasta, mashed potatoes, smoothies, or even ice cream.

Take over-the-counter pain reliever

If orthodontic discomfort persists, over—the—counter pain relievers can be used to alleviate soreness. These include Advil and Tylenol. Be sure to consult with your orthodontist, Dr. Mack or Dr. Hansen, about their recommendations of pain relievers for you or your child.

Be patient

The discomfort that arises from braces eventually will resolve as your teeth adapt to each adjustment. Your orthodontic journey might not always be pain free, but it will all be worth it when you achieve your healthy, beautifully aligned smile in the end.

For additional tips on how to relieve braces pain, consult Dr. Mack and Dr. Hansen.

Fun Times at the Orthodontist in Longview Texas

It’s only been a few months since Laney started her braces smile transformation and she already wants to be an orthodontist ?. We are here to support you in any way we can Laney!! ??? Thanks for being so awesome ?

You have to look ?? really close to see Jaydin’s Clear Braces she got yesterday ?. Congratulations Jaydin and welcome to the MH Ortho Family!! ???

We just wanted to give a big shout out and congratulations to one of our awesome patients and Kiki dancers, Bryce, for being recognized as Panther of the Month by Spring Hill ISD!! We are so proud of you and are grateful to have you as part of not only our MH Ortho family but also our community ?#heevenwearshisrubberbandstoo

More Trivia Tuesday Questions from your neighborhood Orthodontist

Happy Trivia Tuesday ??? !! Here are this week’s questions?. Let us know your thoughts!!
1️⃣ Does a palatal expander have the potential to help a child with breathing or snoring issues? Yes or No
2️⃣ What should you do if you get a tooth knocked out of the mouth? Put in a glass of water? Put it in a glass of milk?
3️⃣ Do braces attract lighting? ⚡️⚡️

It’s that time of the week again ???? #triviatuesday
1️⃣ Is it ok to bleach your teeth while you have #braces, or should you wait until you get them off?
2️⃣ True or False: Braces will set off a metal detector
3️⃣ What are the shapes of the wires orthodontists use with braces?
Round, square, and rectangular?
Round, square, and triangular?

And a Trivia Tuesday Answer Explained:

One of our #triviatuesday questions from last week came to us because a patient of ours had an adult tooth knocked out while riding bikes. Fortunately their parents did the right thing and placed the tooth back in the mouth within 30 minutes ??. Doing this significantly improves the chances of saving the tooth.

If this ever happens to you, pick the adult tooth up by the crown ? (not the root) and wash it briefly under cold water (do not wipe it off), and place it back in its socket in the mouth. Bite on a cloth or napkin to help keep it in place, and see your dentist as soon as possible.

If you are unable to put the tooth back in the mouth right away, place the tooth in a glass of #milk and head to an emergency clinic or dental office so a dentist can place it back in the mouth. They may also place a splint or wire to help hold the tooth in a passive position. The prognosis is always guarded with a tooth that is knocked out, but the sooner you can get it back in the mouth, the better ??#spreadtheword #saveatooth #nowyouknow #dentaltrauma

Please let us know if you have any questions about orthodontic treatment. If you are looking for a Longview orthodontist and would like to learn how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us. Our free consultation will allow you to discover what our orthodontists can do for you. We’re conveniently located in Longview, TX next to Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Gilmer, Henderson, Mount Pleasant and Carthage Texas.

Orthodontist Open After School

As you would expect, one of the most popular and sought-after appointment times at the orthodontist is after school. Here at Mack and Hansen Orthodontics we understand this and that is why we offer more after school appointments with our extend evening hours. On Tuesday and Thursdays we are open until 6 pm and as such offer many after school appointment options. We offer new patient consultations after school as well as regular orthodontic adjustment visits and appointments to get braces on after school as well!

If you would like an after-school appointment for your braces or invisalign adjustment/visit, please mention that to our scheduling coordinator when you call in for an appointment, or when you are scheduling your next visit with one of our clinical assistants.

Trivia Tuesday:

It’s Trivia Tuesday ??? Headgear Edition

1️⃣ If your 7 or 8 year old has an underbite, what type of headgear could help correct their bite? (Yes, there are different types of headgear): Cervical Pull Headgear or a Reverse-Pull Headgear (Facemask)?
2️⃣How many hours a day should a child wear their Headgear? 6-8 or 12-14?
3️⃣How long would early treatment with a “headgear”typically be for a child? 6-8 months? 12-14 months?

Let us know your answers!! ?

Trivia Tuesday: Primary (Baby) Teeth and Dental Development Edition.

We have some tough questions this week so let us know your answers and any questions you may have!!?
1️⃣If your child’s primary teeth don’t have spaces between them, does that mean they will have enough room for their adult teeth or that they will likely have crowding when they get their adult teeth??
2️⃣At the age of 9, how many adult teeth (on average) will a child have? 8 or 12 ?
3️⃣ Your child has an adult tooth right next to a baby tooth. Which one is typically going to be whiter? Adult tooth or primary tooth??

Trivia Tuesday: Rubber Bands Edition

1️⃣Can you wear rubber bands with Invisalign?? Yes or No?
2️⃣Can wearing my rubber bands as instructed by my orthodontist help me finish treatment on time⏰and even early? ?? Yes or No?
3️⃣ What is a typical force? amount of the rubber bands we give you to wear during treatment? 4-8 oz. or 12-16 oz.?

Adults Braces Cost, Braces Cost, and Invisalign Cost

Some of the most common questions we get asked by members of our community in Longview, Marshall, Gilmer, Kilgore and more is:

How much do braces cost?

How much do braces cost for adults?

How much does invisalign cost?

The short answer to these questions is: it depends on the complexity and duration of treatment needed.

Treatment complexity is the biggest factor that determines how much braces cost or how much adult braces cost. The same is true for invisalign. With any orthodontic case, it is difficult to fully asses the type and complexity of treatment that will be needed in order to transform a bite or smile.

Because of this, we are glad to be able to offer FREE orthodontic consultations for both braces and invisalign to all patients. Regardless of if you are coming in for one of our popular evening or after school orthodontic consultations, or one in the middle of the day, they are always FREE of charge.

At your orthodontic consultation we will take some diagnostic x-rays that help us see what exactly is going on with your bite and smile, as well as photographs. Our orthodontists, Dr. Mack and Dr. Hansen will also perform an exam to diagnose what all is going on in you or your child’s mouth.

After your free consultation our orthodontic treatment coordinator will go over with you what your options are and the different options we have for payment. We always offer low down payments, affordable monthly payment plans, and 0% interest on all of our already affordable orthodontic treatment options.

On top of that, since we are an in-netowrk orthodontist office, if you have orthodontic insurance you can expect to have an additional discount on top of our usual orthodontic treatment fees.

We would be happy to help answer any questions you may have about orthodontic treatment. If you would like to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us and request a free consultation to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

We absolutely LOVE our patients here at Mack and Hansen Orthodontics. We appreciate each and every one of them and are so grateful for the reviews they leave us. Here are some of our recent reviews from Facebook and Google:

“I can not think of one negative thing to say about Mack and Hansen Orthodontics. From the minute I called them I knew this was the right choice to get my daughter’s braces done. They were quick and professional at all times. Kind and caring when it was needed and always polite. My daughter even got a welcome bag and a pop socket! We are so glad we chose Mack and Hansen!” – Julia G.

“So friendly, warm and welcoming. They had my very nervous daughter laughing and relaxed as soon as she walked through the door. As a parent they had everything broke down and easy for me to understand. The staff is very knowledgeable and kept me informed every step of the way from consultation to completion. Highly recommend!” – Carrie D.

“When your 15 year old son walks out of every single appointment smiling and laughing because his smile is improving but he’s also having fun with the Mack and Hansen crew, I’d say that’s a huge WIN! Thanks for loving what y’all do , and providing exceptional care !” – Meredith S.

“I was referred by my dentist to see an orthodontist about some minor corrections. I found Mack and Hansen on FB and loved that they offered later appointments which made it easy to schedule a day and time to come in for my free consultation. Went in for the consultation and everyone was so welcoming and warm! It did not feel like we conducted business at all, it was easy to talk to them and they made sure I understood what I wanted. I was scheduled to get my braces on two days later and it went fast and easy and we had fun in the process! I will ALWAYS recommend Mack and Hansen in the Future to anyone I talk with wanting to know more about an orthodontist. This team is absolutely fabulous!” – Andrea R.

“Dr . Mack and Dr. Hansen, and staff are they most kind office we have been to. We have been pt’s for over 6 months, and every visit we are all welcomed with open arms. They know all my kids by name, they let the kids know how interested they are in them. Can not say enough good this about this amazing office!” – Leslie N.

“This is the nicest dental office that I have been to. Very professional and they made my daughter feel so comfortable. I really appreciate the experience.” – Yolanda M.

“I’m a patient at Mack & Hansen Orthodontics and in my opinion they are the best in East Texas. Friendly staff and excellent care! If you are in need of orthodontic care, this is the place to go. I highly recommend Mack & Hansen Orthodontics to anyone needing orthodontic care!” Zeek V.

“So excited to start my invisalign journey!! the staff and doctors are so kind, welcoming, and make you feel so comfortable in their office. thank you, Mack & Hansen Orthodontics!!!” – Kaitlyn H.

“The doctors and staff were so friendly and caring. They made my daughter's experience getting braces so fun and relaxing. The office is so relaxing, comfortable, just great. Thanks so much!” – Yuvonda B.

“I’m still pretty new into my Invisalign journey but I can not say enough good things about this office and these people!” – Erica A.

“I am so glad I went with my gut to give y'all a try! Abel and me loved y'all! Super amazing and very informative with everything that was happening. Thanks for taking care of my baby boy!” – Krystal A.

“I LOVE being apart of the Mack & Hansen Orthodontics Family! They provide complimentary consultations & have the best team around. I met with Dr. Spencer during my consultation, she answered all of my questions in depth & she made me feel so comfortable about the process of getting braces. She wasn’t pushy about starting the treatment either, she let me explore all of my options before hand. Given that I’m a college student and work part time. I saw Dr. Andrew for the procedure which took about 25 minutes total, with NO needles (I’m scared of needles ha). He made sure I was doing okay during the process and kept me very involved in what he was doing! I most definitely recommend Mack & Hansen Orthodontics, they treat you like family! “ – Madi G.

“Made my daughter feel very comfortable throughout the whole process.” – Kelly M.

We would be happy to help answer any questions you may have about orthodontic treatment. If you are looking for a longview orthodontist and would like to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us and request a free consultation to learn more. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

Every year the Longview News Journal runs their Best of East Texas Reader’s Choice Award Program. Readers from not just Longview but all over East Texas including Marshall, Kilgore, Gilmer, Carthage, and Henderson are able to vote through their online voting!

We are honored to have been voted by readers as the Best Orthodontist in East Texas! We can’t say thank you enough and from the bottom of our hearts, we are truly appreciative and grateful for all of your love and support! We promise to continue doing our absolute very best to serve our patients and our community.

If know of any events or fundraisers taking place in our community that help raise awareness or resources for local organizations that are having a positive impact in our Longview and East Texas communities, we would love to participate. Please let us know of any way we can serve. Thank you so much again for all of your support!!

We would be happy to help answer any questions you may have about orthodontic treatment. If you would like to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us and request a free consultation to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

Let us be the first to say Congratulations on your new braces and welcome to the MHO Family! You’ve just begun a process that will change your smile forever!

Since you were probably a little preoccupied when you left our office and may not have remembered everything we said, here are a few things you should know about what to expect, what foods to avoid, and how to take care of your braces.

You’re probably going to be a little sore for the first few days while your teeth, gums, cheeks, and lips get used to the braces. Don’t worry though, this is completely normal. Taking Advil or Tylenol as directed will help with any soreness. If you do have any questions about this, please don’t hesitate to call us!

Warm salt water rinses a few times a day will help with any cheek biting sores or general irritation. You can also take a pinch of the wax we gave you and place it directly on any part of the bracket that feels rough or sharp.

While you are wearing your braces, you should use a fork and knife and cut up everything. Foods like ribs, corn on the cob, and apples are okay, but please be sure to cut them up first. Stay away from any sticky, gooey foods and hard breads too. And be sure to avoid what Dr. Hansen likes to call the -itos family. This means no Cheetos, Doritos, Fritos, and Tostitos (Nachos). For more information please read the take home packet we gave you in your MHO Folder.

There are 1440 minutes in every day, and we need you to spend just 6 of them brushing: 2 after breakfast, 2 after lunch, and 2 before bed. We recommend using an electric toothbrush over a manual one when you can. When brushing, please look in the mirror and make sure you’re focusing not just on the teeth, but the gums too. Your gums will get swollen and puffy if you are not paying close enough attention to that area.  Rinsing with Listerine after you brush will help kill the bacteria that cause the gum disease, gingivitis, and using a fluoride rinse at night before bed is a great way to help prevent cavities. And don’t forget to see your dentist regularly for your scheduled checkups and cleanings while you are in braces. You can also visit the Brushing and Flossing page on our website at www.etxortho.com/brushing-and-flossing for more info.

You have made a wonderful decision to undergo orthodontic treatment and we are so grateful you’ve chosen us to transform your smile. If you need anything at all between now and your next visit, please don’t hesitate to reach out to us! 903-212-7737 or email info@etxortho.com

Thank you again and we will see you soon!

We would be happy to help answer any questions you may have about orthodontic treatment. If you would like to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us and request a free consultation to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

Longview Orthodontist

If you are looking for an orthodontist in Longview, then we have some great news!! Mack and Hansen Orthodontics is now open Monday though Friday here in Longview Texas!!

We know that despite school being out of session, summer can still be a busy time for families here across East Texas (Longview, Gilmer, Marshall, Kilgore, Carthage, Henderson, and Mount Pleasant).

Being that we are open Monday through Friday, summer is always a great time to get in for one of our free orthodontic consultations!! Even though school is out, we still offer late “after school” and “after work” appointments for those of you who have a hard time getting in to see us.

IF you would like to set up a complimentary orthodontic consultation for you or your child, please do not hesitate to give us a call at 903-212-7737. You can also request a visit online at https://www.etxortho.com/request-a-complimentary-consult

We treat children, teens, and adults of all ages and start seeing children as early as age 7 for orthodontic evaluations. At those evaluations we will look at more than just the teeth, but the jaws as well. We check to see if your child has any crossbite, or underbites that may need to be corrected while the jaws are still growing.

Summer is also a great time for cook outs and barbeques. If you are already in braces or invisalign and are cooking out with family and friends, remember to use some caution when eating corn on the cob! And remember to not place your invisalign trays or retainers in a napkin because they will end up being thrown out and forgotten about!

These are just some friendly tips from your East Texas neighborhood orthodontist!!

We would be happy to help answer any questions you may have about orthodontic treatment. If you would like to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us and request a free consultation to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

Kilgore Texas is just down the road from us here in Longview. If you live in Kilgore or nearby in Liberty City or Overton, and are trying to find an affordable orthodontist nearby, then you have come to the right place. Here at Mack and Hansen Orthodontics we are committed to making orthodontic treatment affordable for everyone. We are your local orthodontist who is in-network with almost all insurance companies, including Delta Dental, Cigna, Blue Cross Blue Shield, United Healthcare, and many more!

We are open Monday through Fridays in Longview, which is just a short drive away. We also offer before school and after work appointment times so that even the busiest of schedules are able to come in for an orthodontic consultation (which are free of charge here at Mack and Hansen Orthodontics).

For directions to our orthodontic office, we will have you start near Kilgore Middle School, and Turn right onto US-259 BUS N/S Henderson Blvd. After about 5 miles you will turn slightly right onto TX-31 E/US-259 N. You will stay on this road for about 7 miles or so and turn right onto W Marshall Ave. After 1.2 miles you will take a left onto Fourth Street and follow that for 2.3 miles. Take a left at the light on Medical Circle and you will arrive at our orthodontic office.

If you are interested in coming in for a free orthodontic evaluation/consultation, we would love to see you. At your first visit, we will take a series of dental photographs and diagnostic x-rays. Then Dr. Mack or Dr. Hansen will do an exam to see what exactly is going on with your teeth, jaws, and your bite. After the oral/dental exam, Dr. Mack or Dr. Hansen will sit down with you and go over what exactly your orthodontic treatment needs are and how we can go about taking care of you and your concerns.

We would be happy to help answer any questions you may have about orthodontic treatment. If you would like to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you get the smile you have always wanted with metal braces, clear braces, or invisalign please contact us and request a free consultation to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Kilgore, Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

If you are in search of an affordable orthodontist in Gilmer Tx, then look no further! Mack and Hansen Orthodontics serves patients from all over East Texas. In fact, we have many orthodontic patients in both braces and invisalign who come to us from Gilmer or even Pittsburgh, Winnsboro, and Mount Pleasant Texas. We are open Monday through Friday in Longview which is just a short drive away.

If you are needing directions to get to Mack and Hansen Orthodotics from Gilmer TX, Pittsburg TX, or even Mount Pleasant Texas, begin by heading south on by taking US-271 S and TX-300 down to Longview.

If you are coming to the orthodontist from Gilmer TX then head east on TX-154 E/E Marshall St toward S Roberts St. Then turn right on to FM 1650, which you will be on for about 9 miles. After this you will turn right onto US-259 South which you will take for 7 miles. You will next turn right onto Fourth St, then right on Medical Circle.

If you are coming to to us from Pittsburg TX, you will also take US-271 S and TX-300 down to Longview and follow similar directions as if you were coming from Gilmer TX.

If you are interested in coming in for a free orthodontic evaluation and consultation, we would love to see you. At your first visit, we will take a series of dental photographs and diagnostic x-rays. Then our orthodontists, Dr. Mack or Dr. Hansen, will do an oral exam to see what exactly is going on with your teeth, jaws, and your bite. After the oral/dental exam, Dr. Mack or Dr. Hansen will sit down with you and go over what exactly your orthodontic treatment needs are, discuss the difference in options between metal braces, clear braces, gold braces, and invisalign, and how we can go about taking care of you and your concerns.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

Mack and Hansen Orthodontics is in network with most dental insurances

If you are looking for an orthodontist that is in network with your dental or orthodontic insurance, then look no further! Here at Mack and Hansen Orthodontics we are your in network orthodontic provider for braces and invisalign. We treat children, teens and adults of all ages too. If you have questions about your orthodontic coverage or insurance, we would be happy to help you understand your insurance coverage.

What does it mean that we are an in-network orthodontist? How much do braces cost?

Well, what that means to you is that you will receive an even greater discount on your orthodontic treatment, whether that is with braces or invisalign. If you have an orthodontic benefit as part of your dental insurance, then that benefit amount will go directly towards treatment. It is what your insurance will pay towards braces or invisalign, which means it is that much less that is out of pocket for orthodontic treatment. Because we are an in-network orthodontic provider you get that additional discount on your orthodontic treatment, meaning there is even less that comes out of pocket for treatment, and that is great news for you!! There is a wide range of orthodontic insurances and depending on the type of insurance you have your orthodontic benefit may be greater than other insurances.

How do I know if I have orthodontic insurance?

When you give us a call for your complimentary consultation and give us your insurance information we reach out to your insurance company and get all the details regarding your orthodontic benefit. We will go over these details with you at your visit, so you know exactly what the out of pocket portion will be for orthodontic treatment.

If you are looking for an in-network orthodontist or orthodontic provider in your area, be sure to reach out to your insurance company.

What if I do not live in Longview, but you are in network with my insurance company?

Whether you are here in Longview, or you are coming to us from Marshall, Kilgore, Gilmer or even Henderson or Mount Pleasant TX, we are going to be in network with your insurance company (Delta Dental, Cigna, Blue Cross Blue Shield, Humana, and many more) and you can come to us for orthodontic treatment, so you receive those in network benefits.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

If you are looking for an affordable orthodontist in Marshall, Texas or close to Marshall, TX we are here for you. We are open 5 days a week from Monday through Friday here in Longview Texas and have a number of patients who come to us for orthodontic treatment (both braces and invisalign) from Marshall, Elysian Fields, and even Waskom and Shreveport/Bossier City.

If you are interested in coming in for a free orthodontic evaluation/consultation, we would love to see you. At your first visit, we will take a series of dental photographs and diagnostic x-rays. Then Dr. Mack or Dr. Hansen will do an exam to see what exactly is going on with your teeth, jaws, and your bite. After the oral/dental exam, Dr. Mack or Dr. Hansen will sit down with you and go over what exactly your orthodontic treatment needs are and how we can go about taking care of you and your concerns.

If you are coming to us for an orthodontic visit from the Marshall, TX area, you can get to us here in Longview by either taking US-80 or I-20. Once you are in Longview, merge onto TX-281 N/E Loop 281 and then turn left onto Hollybrook Dr, followed by a right onto N Fourth St. After turning onto N Fourth St take a left onto Medical Cir and we will be on your right. If you are having trouble finding out office, you can enter our name (Mack and Hansen Orthodontics) into your phone’s Apple Maps or Google Maps App and it should take you right to our front door here in Longview.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

Have you ever wondered what the difference is between braces and invisalign? Can adults wear braces? Can children or teenagers be treated with invisalign? These are some of the common questions that people have about orthodontics (braces and invisalign) so we are going to help clear up some of that here today for all of our readers in Longview, Gilmer, Kilgore, Marshall, and as far away as Carthage, Henderson, and Mount Pleasant TX.

One of the main differences between braces and invisalign is that braces are actually glued to your teeth whereas invisalign is like a removeable retainer that can be taken in and out in certain social situations and when you eat. Now there is somewhat of an exception to this because with invisalign, sometimes you will have what we call “attachments” glued to your teeth. These attachments are specifically designed and shaped for the type of orthodontic movement that needs to take place with your teeth and as such they are not all the same. Sometimes you may not have one on some teeth whereas you may have some of these invisalign attachments on other teeth.

When undergoing orthodontic treatment with braces, we engage a wire into the bracket that is glued to your teeth. This wire then moves the tooth in a certain direction, depending on where the bracket is placed. When you are receiving orthodontic treatment with invisalign or invisalign teen, the plastic material itself is responsible for moving your teeth. With braces the force of the wire is being applied 24 hours a day, 7 days a week. With invisalign or invisalign teen, the force is only being applied to the teeth when the trays are being worn. This is why it is important for the invisalign trays to be worn at least 20 hours a day, but preferably 22 hours a day.

When it comes to teenagers and orthodontic treatment, this need to actually wear your invisalign or invisalign teen clear aligners sometimes makes braces a better option for the patient. If a teenager is deemed responsible enough by their parent to wear the aligners, then by all means teenagers can be treated with invisalign clear aligners or invisalign teen clear aligners. If Mom or Dad do not think they will be responsible enough to wear their invisalign aligners, then usually braces or even clear braces are the better option for that teen. If the teenager is looking for a more esthetic option then clear braces are a great option and our patients love the clear braces we have here at Mack and Hansen Orthodontics.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

A lot of people wonder when is the best time to visit the orthodontist here in Longview, Texas. Well, the answer to that question will depend on a number of things, so let us break it down a little bit for you...

The beginning of the year is a great time to come in if you have received new orthodontic insurance or new orthodontic insurance benefits. Because we are an in network orthodontic provider here in East Texas, having new insurance or getting an orthodontic benefit on your insurance plan can mean a big difference in terms of the cost of treatment. Our patients love that we are in network with their insurance plan so if you have Delta Dental or Blue Cross Blue Shield, Cigna or MetLife, or another dental or orthodontic insurance, rest assured we are your in-network orthodontic provider.

Spring is also a great time to come in for braces for your child, especially because there are some times when school is closed in the spring, such as during spring break, which make it easy to get in for your orthodontic appointment without having to take your child out of school.

For this reason the summer is obviously a popular time to come in for an orthodontic evaluation or consultation. Despite school being out for summer across East Texas we are still open 5 days a week and offer later orthodontic appointments on Monday and Wednesdays. This means there is plenty of openings for you or our children to come in for their orthodontic visits and the best part is there is no school they will have to miss.

There are also some pros to coming to the orthodontist office or starting orthodontic treatment, whether that is with braces or invisalign, during the end of the year. If you have a flexible spending account through your employer or a health savings account where your benefits expire at the end of the year, those benefits or funds can be used for orthodontic treatment!! This is great news and if you have questions using your FSA or HSA funds, just ask one of our team members next time you are in our office.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today!

Orthodontist in Longview Tx that accept Medicaid

A lot of people have questions about Medicaid and whether or not it covers orthodontic treatment. Well, we are here to help clear that up and answer your questions and the most common question: Does Medicaid cover braces?

While Medicaid does cover most dental treatment for children, it does not cover all treatment. Orthodontic treatment is considered to be different than dental treatment in regard to coverage by both Medicaid and by private insurance companies. In years past, here in the state of Texas, Medicaid was much more accepting of orthodontic cases. Unfortunately, some of the larger dental chains and orthodontic chains were taking unethical advantage of this and since then, Medicaid in the state of Texas has, for the most part, not covered orthodontic treatment. Even in the most severe malocclusions where patients are missing a number of teeth or have a cleft lip and/or cleft palate, treatment is still not being approved.

Here at Mack and Hansen Orthodontics we take this all in to consideration and as such do our absolute best to ensure everyone, regardless of if you have insurance, Medicaid, or neither, are able to afford braces with us. We are committed to offering affordable orthodontic treatment, low down payments for braces and invisalign, low monthly payment plans for braces and invisalign, and offer zero interest financing. Should you have orthodontic coverage with an insurance company, we are also in-network providers with the major insurance plans in town. What this means for you is that you get an even greater discount on braces and invisalign with us making orthodontic treatment even more affordable

In summary, while you may be searching for a Medicaid orthodontist in here Longview, Marshall, Tyler, or elsewhere in East Texas, there is no orthodontist who is able to “take Medicaid” since Medicaid, for the most part, does not cover orthodontic treatment anymore in the state of Texas. Again, that is why we are committed to making treatment affordable for everyone and offer payment plans for braces that do not put a strain on your family’s wallet. If you have any questions or would like to schedule a free consultation for braces or invisalign, please reach out to our office and one of our fantastic orthodontic team members will be able to get you scheduled.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

Dr. Mack and Dr. Hansen spent this past weekend at the American Association of Orthodontists Annual Session in Washington D.C. This is a meeting and continuing education conference that is held in a different location across the United States every year. Over 20,000 orthodontists and orthodontic team members from all over the world travel to this meeting, which is the largest orthodontic meeting in the world.

At this meeting Dr. Mack and Dr. Hansen attended lectures on a number of different orthodontic topics including breathing and sleep disordered breathing in adults and children, palatal expansion, ways to accelerate orthodontic treatment, improved retainers, and new types of braces and clear aligners.

With all the different orthodontic companies present at this meeting as well, Dr. Mack and Dr. Hansen were able to learn more about all of the new clear aligners that companies are now offering as well as learn about the newest changes to invisalign clear aligners.

With so many orthodontists attending the meeting, Dr. Mack and Dr. Hansen were also able to visit with many of their colleagues from different parts of the country and discuss these new orthodontic trends and which ones are the best for patient care.

To see more photos and videos from the conference, be sure to visit our Facebook and Instagram page. Should you have any questions about the meeting itself, please let us know at your next visit. We hope you have a wonderful week!!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our affordable braces and invisalign clear aligners. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Mount Pleasant, and Gilmer.

Today was a great day for the entire team at Mack and Hansen Orthodontics. We just finished up with the Move for a Cause 5K hosted by the Julie Woods & Associates Real Estate Firm. The event raised funds and awareness for the East Texas Angel Network. 

If you don't know about the East Texas Angel Network it is a wonderful organization that was established in 1995 by Neal McCoy and his wife, Melinda, who both wanted to support the families of children with severe medical needs.

For over two decades, the organization has been cutting red tape and making funds available for hundreds of local families to pay off their secondary expenses.

Eighty-five cents of every dollar received by the organization goes directly to the families assisted by the East Texas Angel Network.

Being able to sponsor and be a part of an event such as this is something that we are very grateful for here at Mack and Hansen Orthodontics. Our whole team came out in support of this event and some of our patients even came out as well and yes, they were wearing their invisalign trays.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Have you ever wondered about the orthodontic research that Dr. Mack and Dr. Hansen conducted in their residency programs for their Master's Thesis?

A few weeks back we posted Dr. Hansen's thesis regarding the differences in lip position as part of braces and a specific type of orthodontic treatment in adults! Today we are posting Dr. Mack's thesis which is based on the digital intra-oral scanner that we use for our invisalign patients! Her research was actually published in the American Journal of Orthodontics and Dentofacial Orthopedics which is sent to orthodontists all over the world! Check it out and let us know what you think!

ACCURACY OF CHAIR SIDE SCANNERS FOR SURFACE MEASUREMENTS ALONG A CURVED LINE

By Spencer M. Mack, DDS

INTRODUCTION:

Outstanding orthodontic care is based upon the correct diagnosis and creation of a proper treatment plan.  Correct diagnosis rests heavily on the use of photographs, radiographs, study models, and a clinical exam.  The proper diagnosis can easily be missed if any of these components are missing or inaccurate.  Therefore, it is crucial that all of these components be as descriptive and precise as possible in order to aid the clinician during this important phase of treatment.

Over the past few centuries, may advances have been made concerning the process of acquiring orthodontic records.  With the arrival of the computer age, the ability to move beyond plaster models became an actual reality.  Plaster models are a key component of orthodontic records, and any replacement method must be accurate.  Advancements in technology have allowed for digital photography to replace film, new sensors allowing for digital radiography, and maintenance of health records digitally.  An alternative to plaster models has been the last form of dental records to make the move to the digital world, but with advances in intraoral scanners, this technology has become more available to clinicians.  Digital models have many advantages, including elimination of storage space for plaster models, elimination of the need to search and retrieve these models, and durability.

There are currently many ways to acquire digital models, with many intraoral scanners to choose from.  Plaster models and impressions can be scanned to obtain digital models.  It is also possible to extrapolate models from cone beam computed tomography (CBCT) images.  There have been limited studies performed comparing the accuracies of these scanners to plaster models, but there is still limited information.  The purpose of this study is to evaluate and compare the digital dental models acquired from two commercial intraoral scanners with manual measurements when performing curvilinear measurements.

REVIEW OF LITERATURE

In order to diagnose a malocclusion and develop an appropriate treatment plan in orthodontics, a number of diagnostic aids are needed: study models, photographs, radiographs, and a clinical examination. ¹ In fact, the American Association of Orthodontists (AAO) updated their Clinical Practice Guidelines in 2003 to reflect that pre-treatment and post-treatment records should include both extraoral and intraoral photographs, dental models, intraoral and/or panoramic radiographs, and cephalometric radiographs. ²

Each of the elements of orthodontic records gives the provider a different insight into each case. However, it has been argued that study models hold the most value. In fact, a group published an article in 2004 reporting that in the majority of cases, adequate information for making treatment decisions can come from study models alone. ³ Han et al. looked at the consistency of orthodontic treatment decisions in relation to diagnostic records. In this study, it was shown that 55% of treatment plans formulated from study models alone did not change when information from photographs and radiographs became available. ⁴ Traditional radiographs and photographs provide only two-dimensional (2D) images, while study models are able to provide a three-dimensional (3D) view of the dentition. Study models also allow for more extensive measurements that may not be possible in a clinical examination where other factors (e.g., soft tissues) can get in the way.

Throughout the years, orthodontists have used a variety of methods to measure plaster casts: from methods as simple as overlaying the teeth with brass wire to measure arch perimeter to sectioning out the teeth for the creation of a diagnostic wax up. Today, the standard measuring techniques that new methods are evaluated against include dividers, calipers, and Boley gauges. ⁵

Plaster study models have many benefits and are crucial to a proper diagnosis; however, there are drawbacks and limitations to these models. While they are very accurate if done properly, this accuracy can be quickly jeopardized. The first step to a good model is a good impression. Without a properly made impression, the model holds no chance of being accurate. The first dental impression was made in 1684, and the process of impression making has since made drastic improvements. The most commonly used impression material in orthodontics today is the irreversible hydrocolloid alginate material, which first became available in the early 1900’s, along with reversible hydrocolloid materials. Alginate was the first material to allow details such as undercuts to be accurately captured in a single impression. Materials such as polyvinylsiloxanes (PVS) have since been introduced to the market and further improve impression accuracy while minimizing distortion – a problem that alginate can have if not used properly.  Despite polyvinylsiloxane’s advantages, alginate continues to be the predominate material used due to its ease of use and cost effectiveness. ²

In addition to the potential for inaccuracy, another downfall of plaster models is that they are subject to wear and breakage. Measuring devices can be the cause of this wear, which in turn decreases accuracy and may lead to increased chance of fracture. Careful handling of the casts is also vital, as one drop of the casts can lead to chipping or complete fracture. Another problem or nuisance of dental casts is storage space and convenience of retrieval. Dental casts are typically stored in special boxes and in a designated room. For liability purposes, these casts must be kept for a number of years, and for practices starting several hundred cases per year, space limitations may prevent keeping initial, progress, and final casts on all patients. Many offices do not have this type of space available for models, particularly in large cities. Additionally, many orthodontists work out of multiple locations, which further complicates finding appropriate storage.

As mentioned above, liability purposes add another element. For fear of being sued, many orthodontists keep models for a length of time determined by their state’s statute of limitations. This range is from 5-15 years for most states and may not begin until after the patient has turned 18. This means that although a Phase I treatment may have been completed when the patient was ten years old, the orthodontist may still need to keep modes on hand for an additional 23 years after their work has been completed. Therefore, time is a factor that must not be ignored.  In addition to keeping models for legal reasons, many clinicians chose to keep models for academic purposes as well. Taking serial sets of models or retaining casts for growth and retention studies demands even more space.

Yet another issue that arises with plaster models is the lack of ease of transferring or portability. Situations often occur when the practitioner would like to share or send plaster models. Whether it is to another provider due to the patient transferring or a learning situation where the provider wants to share the case with his or her local study club, there are times when models need to be transported.  A major problem with this is the potential for fracture or breakage. Even with proper packaging, there is no way to insure that the casts will not be damaged throughout the mailing process. Additionally, the costs of sending plaster models can be a factor as the weight of plaster increases baggage fees and shipping costs. In an effort to have a back-up cast in the case that something goes wrong along the way, models can be duplicated before shipment. This, however, requires both time and money and may not be feasible in a busy practice. ²

Many advances have been made in technology in the dawn of the new millennium. Digital radiography, digital photography, and digital records are quickly becoming the norm in orthodontic practices and institutions of higher education. ^1,4 Digital photography and radiography have proven to be more accurate and even more financially beneficial than traditional film. Additionally, new legislative policies seek to make paper charts obsolete.  For these reasons, it seems only fitting that now is the time to put away the dated plaster models and replace them with up-to-date digital models. However, before replacing the trusty stone models, the accuracy, reliability, practicality, and usefulness of these models must first be systematically evaluated. ⁵

Since digital scanners were first introduced to the dental field, they have been adapted to be used for a variety of in-office purposes. Initially, they were used solely as an outsourced technology for storage of 3D models. As intra-oral scanners were developed, they began being used to fabricate clear aligners, custom braces, indirect-bonding trays, and laboratory appliances efficiently and accurately. ⁶ A paradigm shift in orthodontics is represented by the replacement of alginate and PVS impressions with intraoral digital scanners. ⁷

Seeing the need for traditional models to enter the digital world, companies such as OrthoCAD, eModels, and OrthoSelect are providing the new standard. Such companies now offer services that allow a doctor to receive three-dimensional models of a patient’s dentition without purchasing any additional equipment or subjecting their patient to radiation. To do so, a doctor takes an alginate impression and mails either the impression or a plaster model to the company. After receiving the cast or impression, most companies use a proprietary laser scanner to generate the file. The scanned file is then digitally cleaned up by a technician and emailed back to the submitting dentist, with the entire process taking approximately one week. After the file is made available, the doctor can download and view it in the provided software where many desired measurements can be made. ⁸ The typical file size is less than one megabyte – so small that a single hard drive can easily store over two million sets of models.²

While there are benefits to using these digitizing services, there are a number of factors that orthodontists must consider before going forward and losing the plaster models. First of all, there is a fee that is assessed with each model sent in for digitization; this is in addition to the expense of obtaining the required impressions and bite registrations (and plaster models if the doctor chooses to take that route). Another factor is that orthodontists must wait a minimum of a week before their casts are available, assuming that the staff, shipping company, and digitation service all operate at maximum efficiency. If a doctor is interested in digital models, using a service like this is often the path of least resistance. As a result, large amounts of literature have been published on these techniques.

Variable conclusions have been shown in the literature when evaluating the accuracy of digitized models compared to their plaster counterparts, and little is known regarding the minimum degree of accuracy of intraoral scanners required for orthodontic treatment planning and patient consent.⁹  In a study performed by Zilberman et al., measurements made on OrthoCAD models were compared to caliper measurements on the original plaster casts.  Twenty sets of models were used, and measurements included tooth sizes and inter-tooth distances. Digital calipers on the physical models proved to have the highest level of accuracy and reproducibility, followed closely by OrthoCAD models. The author concluded that the digital models were clinically acceptable.¹⁰

Tomassetti et al. performed a study that found a much larger variance. For this study, Bolton analysis was performed physically using Vernier calipers as well as digitally in QuickCeph, the Hamilton Arch Tooth System, and OrthoCAD software. Researchers found no statistically significant error for any of the methods (with a confidence interval of p<.05), but they did note a significant difference of >1.5 mm for each method. ¹¹ This difference, however, could be attributed to their use of additive measurements that could compound any existing errors in measurements.
Stevens et al. performed Bolton analysis on plaster casts and eModels. Dental casts from 24 patients were included in the study, which used measurements to the nearest 0.01 mm. Paired t-tests revealed no significant difference between the digital and analog method, and even showed the reproducibility to be slightly higher in the digital models. The authors concluded that digital models are not a compromised choice for treatment planning or diagnosis.¹²

Costalos et al. used an entirely different technique for evaluating the reliability and accuracy of digital versus plaster models. Plaster and OrthoCAD models were taken on 24 patients and scored using an American Board of Orthodontics (ABO) measuring gauge and the seven criteria of the ABO Cast Radiograph Evaluation previously known as the Objective Grading System (OGS). The results of this study showed interproximal contacts were not significantly different between the two versions of the models. However, the means for alignment and buccolingual inclination were significantly different. The author did note that a study such as theirs is subject to examiner calibration, and that this could account for the significant difference they found.¹³

Like Costalos, Okunami et al. also looked at the ABO OGS. In this study, 30 sets of casts were evaluated in plaster and in the OrthoCAD software. Of the seven aspects included in the OGS, the buccolingual inclination could not be calculated due to software limitations (using version 2.2). The remaining six areas of scoring showed no significant differences between digital and plaster components, further supporting that the digital casts were sufficient.¹⁴

Santoro et al. used two examiners and 76 pretreatment patients to assess the accuracy of OrthoCAD in comparison to plaster models. The results showed a statistically significant difference between the two groups for tooth size and overbite, with no significant difference in overjet. While corresponding measurements were significantly different between casts, the differences were all less than 0.49 mm, which the author concluded would not make a clinical difference.¹⁵ The study could have been improved if measurements had been made after the crowding was resolved, allowing for easier and more repeatable measurements to be made.

A study from Whetten et al. evaluated Class II malocclusion patients and their corresponding treatment plans based on the method of acquiring models. Class II malocclusion cases are widely called the most difficult to treat and treatment plan. This study used 20 orthodontists and 10 Class II malocclusion subjects to determine if there is a difference in the resulting treatment plan if a doctor uses plaster or digital models (eModels). On two separate occasions each orthodontist treatment planned all ten cases with either the plaster or digital models. The researchers found no statistical difference in their treatment plans and concluded that digital orthodontic study models were a valid alternative to traditional plaster models for the treatment planning in Class II malocclusion patients.¹⁶

For just over two decades, Cone Beam Computed Tomography (CBCT) has been commercially available. Cone beam scanners involve a cone shaped beam of x-rays rotating around an object to produce a volume of data. Internal area of the object can then be detected by overlaying the series of 2D images.¹⁷ Many orthodontic practioners have begun incorporating CBCTs into their practices, especially as machine prices drop and availability increases. Numerous companies and machines are on the market today, with each machine differing slightly in their field of views (display volumes), voxel sizes, image detectors, and special resolution.¹⁸ The radiation emitted during a CBCT is equivalent to or only slightly greater than the radiation a patient receives from a traditional panoramic and cephalometric film. A great benefit of using a CBCT machine is that the acquired image not only allows for the generation of 3D study models, but also for the creation of a reconstructed cephalogram, which bears no significant difference to traditional cephalograms.¹⁹ However, while these CBCT machines produce significantly less radiation when compared to a traditional spiral CT, they do so at the expense of the image resolution.

CBCT derived images virtually eliminate certain issues with traditional radiography, including problems with magnification, distortion, and superimposition. A study done by Benington et al. claims that 3D images reconstructed from a CBCT are relatively free of these problems. ²⁰ As a result, many clinicians favor using this method. Additionally, Scarfe et al. state that CBCT imaging of the head and neck brings a true paradigm shift from 2D to 3D approach in imaging and that an appropriate diagnostic approach must soon follow. ¹⁷

The virtual study models generated from CBCTs allow for advantages previously unavailable with plaster models, such as the ability to see root and crown morphology in a single model, something Kapila et al. call “the anatomical truth.”¹⁹ Kau et al. found that these generated models were as accurate for measuring crowding, overjet, overbite, and making linear measurements as were OrthoCAD models.²¹ Creed also showed linear CBCT measurements to be more than adequate for diagnosis and treatment planning when compared to OrthoCAD measurements.²² Lightheart used surface analysis to show that models generated from CBCTs were “adequate” for initial diagnosis and treatment planning.²³ While Damastra claimed that CBCT scans acquired with 0.25 to 0.4 voxels of resolution show no difference in linear measurements, it must be noted that the amount of discernible tooth anatomy is greatly influenced by the voxel size.²⁴ Thus, not all CBCT scanners will be appropriate for generating study models.

Although a decrease in price has allowed for greater access to CBCT technology, issues like radiation exposure and the quality of the resulting image must still be considered before subjecting a patient to a scan, especially if it is done solely to produce a study model. Furthermore, doctors must be trained in interpreting any image they capture and must also make the financial commitment of purchasing the required CBCT machine. The practicality advances in CBCT technology allow for cheaper machines, variable fields of view, higher resolution scans, less radiation to the patient, and less doctor liability.

In a study from Akyalcin et al., values comparing virtual dental models were obtained from the Ortho Insight 3D laser scanner, the eModel system, and CBCT scans. The study showed that arch length discrepancy measurements made on digital model files made from these sources had similar patterns of random error when compared with direct caliper measurements. The best surface overlap correlation was observed between the virtual scanned models and the eModels. ²⁵

One alternative to the headaches imposed by model services or CBCT imaging is the use of intraoral scanners. Over the past ten years, numerous intraoral scanners have emerged onto the orthodontic scene, some from startup companies, and others from well-known dental supply companies. In their earliest stages, these scanners cost well over $100,000 and were highly technique sensitive. The field to be scanned had to be completely dry, and some companies even required you to lightly dust the surface with a fine powder in order for the enamel to properly register with the scanner. Too much powder would result in lack of detail, while not enough powder would result in the scanner being unable to generate an image. Each company would generate the scans in their own proprietary software format that could only be viewed or manipulated in their software. Furthermore, if a physical copy was desired, it had to be ordered directly from the scanner company.

Today, much has changed. Scanners cost significantly less than a new car, thrive in moist environments, and produce files that can be saved in a variety of formats or printed in office with equipment costing less that $1000.

The most widely available intraoral scanners are the iTero™ and the OrthoCAD iOC. Both are manufactured by Cadent and use the same laser and CMOS sensors. Since their debut in 2007, general dentists have used the iTero™ scanner to fabricate over 250,0000 restorations.^26,27  Orthodontists have taken notice, and in the summer of 2011, Align Technology, parent company to Invisalign, purchased Cadent to help make the iTero™ technology more readily available to orthodontists and streamline its integration into Invisalign case submission.

Unfortunately, despite the advances in scanning technology and all the time and money being invested by dental companies in research and development, few scientific papers have been published to verify scanner accuracy. In fact, more information is available about the financial status of the scanner manufacturers than on the scientific accuracy of the product they produce.   A systematic review by Goracci et al. investigated accuracy, reliability, and efficiency of intraoral scanners for full-arch impressions.   It was considered a remarkable observation that very few studies have evaluated complete-arch scans acquired directly in the patient’s mouth, and of all intraoral scanners available for use in orthodontics, only two (Lava COS and iTero™) have been tested in clinical settings.  Of the sixteen articles deemed relevant to this study, only eight published studies with complete-arch scans and only four studies reported data on validity, repeatability, and reproducibility of digital measurements.²⁸

A recent study from Akyalcin et al. showed that measurements taken by the iTero™ were acceptably interchangeable when compared to manual measurements, as well as interchangeable with measurements from a CBCT scan. This tells us that both the iTero™ and CBCT are sufficient to use in the diagnosis and treatment planning of orthodontic cases.²⁹

Ender and Mehl have published one of the most scientific articles to date on the accuracy of intraoral scanners. Their results show that after taking into account distortion from the impression material and stone, the digital models acquired using an intraoral scanner are just as accurate as traditional models.³⁰ However, the limitation to their study is that only five scans were performed on a single cobalt-chromium dentiform and not natural dentition. Accurately detecting enamel despite its translucency was a major obstacle that had to be overcome in the scanner development and must not be ignored when evaluating its accuracy.

A 2013 study from Flügge compared the precision of digital impressions taken intraorally by the iTero™ vs. the extraoral digitization with the iTero™ and a model scanner. It was shown that the precision of the intraoral iTero™ scan is similar to the values documented in the literature with the conventional polyether impressions for reproduction of the intraoral situation. However, scanning with the iTero™ intraorally is less precise than model scanning with it, which demonstrated that patient-related factors can influence the scanning process. ³¹

Grünheid et al. conducted a study in 2014 assessing the accuracy, reproducibility, and time efficiency of dental measurements using different technologies, including eModels, SureSmile, and AnatoModels.  Mesiodistal tooth-width measurements were made on models while being timed.  These measurements were compared with the plaster models, and differences in time efficiency were tested for statistical significance.  The data reported that SureSmile models were the most accurate and reproducible.  SureSmile models and eModels were also significantly faster than those taken on AnatoModels and plaster models.  It was concluded that linear measurements on digital models can be as accurate and possibly more reproducible and significantly faster than those measurements obtained from plaster models.  Another important take-away from this study comes from the conclusion that although plaster models are currently considered the gold standard, this should not suggest that they are measured without errors.  Digital models could result in more valid measurements than plaster models because of the lack of physical barrier dictating point placement for measuring.  Calipers are unlikely to reach the exact interproximal contact point of a tooth in contact with other teeth.  Therefore, neither method can be considered as providing unequivocally correct measurements.⁷

Another study by Grünheid et al. evaluated the clinical use of a direct chair side oral scanner with regard to accuracy, time and patient acceptance.  The accuracy of the digital models was compared with the existing standard, alginate impressions. Through the use of mathematical superimposition of the digital models, it was found that there was high relative accuracy of digital models made from intraoral scans, and these models can be as accurate as those from alginate impressions.  However, impressions required less chair side time and were favored over intraoral scans by most patients.  This study concluded that as scanning technologies become faster and more efficient, direct scanning will become more readily accepted in the orthodontic setting.³²

Another study by Patzelt et al. evaluated the time efficiency of intraoral scanners.  Three intraoral scanners were investigated: Cerac AC, Lava COS, and iTero™.  In contrast to the Grünheid study, the implementation of computer aided impression making with intraoral scanners improved work flow and lead to higher patient satisfaction.  Scanning for impression making was up to 23 minutes faster when considering all steps involved with traditional alginate impression material.  However, it was noticed that there are opportunities to reduce the actual chair time for both approaches by sharing several steps among the dental team members.³³

The Lythos scanner from Ormco was designed specifically for orthodontic use. As a newer product on the market, there is not a significant amount of research available about its accuracy. Advantages of the Lythos scanner include its compact size and its powder-free use during scanning. Images are captured by video in continuous motion and images are then stitched together. The software first captures a “backbone” from which future scans stem, which allows the program to have memory so that the scanner knows where to stitch the scans together. ⁶

Despite these products entering the market and proving to be acceptable for use in diagnosis and treatment planning, a number of factors contribute to the slow entrance into offices across the country. As mentioned earlier, cost is a factor. Over the past decade, however, cost of the scanner continues to decline and is within the manageable range for many practioners to purchase. For digital scans such as eModels, however, there remains the extra cost of storing the models in a database. Another factor is that taking intraoral scans requires more chair side time, particularly before adequate training, than alginate impressions. Older practitioners in particular may not see the benefit of purchasing a scanner at that stage in their career due to comfort in using traditional models and the cost and training that goes into transitioning to using digital scanners.

As technology improves and availability increases, orthodontists will frequently have new tools to assist in diagnosis and treatment planning.  It is the duty of the orthodontic community to consider the advantages and disadvantages of these new technologies to determine their clinical usefulness.  Like most new products, it will take time for scanners to be fully integrated into practices. It is evident that scanners, like other digital technology, are on the horizon of becoming the new gold standard in orthodontics.

REFERENCES:

1. Rhende et al. An Evaluation of the Use of Digital Study Models in Orthodontic Diagnosis and Treatment Planning. Angle Orthod. 2005;75:300-304.
2. J. Peluso et al. Digital Models: An Introduction. Semin in Orthod. 2004;10:226-238.
3. Joffe. Current Products and Practices OrthoCADTM: digital models for a digital era. J Orthod. 2004;Dec:31(4):344-347.
4. K. Han, K.W. Vig, J.A. Weintraub, P.S. Vig, C.J. Kowalski. Consistency of orthodontic treatment decisions relative to diagnostic records. Am J Orthod Dentofac Orthop. 1991;100:212-219.
5. L. Quimby, K.W. Vig, R.G. Rashid, A.R. Firestone. The Accuracy and Reliability of Measurements Made on Computer-Based Digital Models. Angle Orthod. 2004;74:298-303.
6. D. Kravitz et al. Intraoral Digital Scanners. J of Clin Ortho. 2014;Jun: 48(6):337-347.
7. Grünheid, N. Patel, N.L. De Felippe, A. Wey, P.R. Gaillard, B.E. Larson. Accuracy, reproducibility, and time efficiency of dental measurements using different technologies.  Am J Orthod Dentofac Orthop. 2014; Feb: 145:157-164.
8. Bell et al. Assessment of the accuracy of a three-dimensional imaging system for archiving dental study models. J. Orthod. 2003;Sept:30(3):219-223.
9. B. Martin, E.V. Chalmers, G.T. McIntyre, H. Cochrane, P.A. Mossey. Orthodontic scanners: what’s available? J Orthod. 2015; Jan 42:136-143.
10. Zilberman. Evaluation of the Validity of Tooth Size and Arch Width Measurements Using Conventional and Three-dimensional Virtual Orthodontic Models. Angle Orthod. 2003;73:301-306.
11. Tomassetti, L. Taloumis, J. Denny, J. Fischer. A comparison of 3 computerized Bolton tooth-size analyses with a commonly used method. Angle Orthod. 2001;71:351-357.
12. Stevens et al. Validity, reliability, and reproducibility of plaster vs digital study models: comparison of peer assessment rating and Bolton analysis and their constituent measurements. Am J Orthod Dentofac Orthop. 2006;Jun:129(6):794-803.
13. A. Costalos et al. Evaluation of the accuracy of digital models analysis for the American Board of Orthodontics objective grading system for dental casts. Am J Orthod Dentofac Orthop. 2005;128:624-629.
14. Okunami et al. Assessing the American Board of Orthodontics objective grading system: digital vs plaster dental casts. Am J Orthod Dentofac Orthop. 2007;Jan;131(1):51-56.
15. Santoro et al. Comparison of measurements made on digital and plaster models. Am J Orthod Dentofac Orthop. 2003;124:101-105.
16. Whetten et al. Variations in orthodontic treatment planning decisions of Class II patients between virtual 3-dimensional models and traditional plaster study models. Am J Orthod Dentofac Orthop. 2006;Oct:130(4):485-91.
17. C. Scarfe et al. What is Cone-Beam CT and How Does it Work? Dent Clin North Am. 2008;Oct:52(4):707-30.
18. Kaeppler. Applications of Cone Beam Computed Tomography in Dental and Oral Medicine. Int J Comput Dent. 2010;13(3):203-19. English, German.
19. Kapila et al. The Current Status of Cone Beam Computed Tomography Imaging in Orthodontics. Dentomaxillofac Radiol. 2011;Jan:40(1):24-34. Review.
20. C. Benington et al. An Overview of Three-Dimensional Imaging in Dentistry. Dent Update. 2010;Oct:36(8):494-6, 499-500, 503-4.
21. H. Kau et al. Evaluation of CBCT Digital Models and Traditional Models Using the Little’s Index. Angle Orthod. 2010;May:80(3):435-9.
22. Creed et al. A Comparison of the Accuracy of Linear Measurements Obtained from Cone Beam Computerized Tomography Images and Digital Models. Semin Orthod. 2011;Mar:17(1):49-56.
23. Lightheart et al. Surface analysis of study models generated from OrthoCAD and cone-beam computed tomography imaging. Am J Orthod Dentofac Orthop. 2012;141(6):686-93.
24. Damstra et al. Accuracy of linear measurements from cone-beam computed tomography-derived surface models of different voxel size. Am J Orthod Dentofac Orthop. 2010;Jan:137(1):16.e1-16.e6.
25. Akyalcin, D.J. Dyer, J.D. English, and C. Sar. Comparison of 3-dimensional dental models from different sources: Diagnostic accuracy and surface registration analysis. Am J Orthod Dentofac Orthop. 2013;Dec:144(6):831-837.
26. Garino, B. Garino. The iOC Intraoral Scanner and Invisalign: A New Paradigm. J of Clin Orthod. 2012;Feb:46(2): 115-121.
27. Redmond, et al. The OrthoCAD iOC Intraoral Scanner. A Six Month User Report. J of Clin Orthod. 2011;March:45(3): 161-164.
28. Goracci, L. Franchi, A. Vichi, M. Ferrari. Accuracy, reliability, and efficiency of intraoral scanners for full-arch impressions: a systematic review of clinical evidence. Eur J Orthod.  2015; Oct: 1-7.
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ABSTRACT

AIM:

Chair side scanners offer the advantage of obtaining digital dental models directly from the patient without the need for dental impressions. To date, no study evaluated their accuracy in obtaining surface measurements along a curved line (curvilinear). The aim of this study was to evaluate and compare the digital dental models generated from two commercial intraoral scanners with manual measurements when performing curvilinear measurements.

MATERIALS AND METHODS:

The study sample was comprised of 61 dry mandibles with intact dentition chosen from a unique collection. Each skull had the mandibular arch scanned with Cadent iTero™ scanner (Align Technology, San Jose, CA) and Lythos™ Digital Impression system scanner (Ormco Corporations, Anaheim, CA). Surface measurements along a curved line were performed digitally in three different directions (anteroposterior, mesiodistal, and buccolingual) on the digital models and manually on the dry skulls. One-sample t test and linear regression analyses were performed. To further graphically examine the accuracy between the different methods, Bland-Altman plots were computed. Level of significance was set at p<0.05.

RESULTS:

There were no significant differences between any of the paired methods, which indicated a certain level of agreement between the methods tested (p>0.05). Bland-Altman analysis showed no fixed bias of one approach vs. the other, and random errors were detected in all comparisons. Although mean bias of iTero™ and Lythos™ scanner measurements when compared to direct measurements were very low, minimum mean bias occurred for the comparison of two intra-oral scanners. However, Lythos™ scanner and direct measurement comparison had the largest confidence interval (agreement level, 0.85 to -1.11) range.  None of the comparisons displayed statistical significance for the t scores, which indicated the absence of proportional bias in these comparisons.

CONCLUSIONS:

Intraoral scanners tested in this study produced digital dental models that were highly accurate when performing direct surface measurements along a curved line in three dimensions of the space.

INTRODUCTION

The last few decades have shown significant advancement in the orthodontic field, especially with regards to technology.  Much of the dental field, including orthodontics, has been steadily transitioning to the digital world.  The digital world provides a means for more efficient and sophisticated systems, and more and more clinicians are pursuing these kinds of digital-based practice models.  Many practitioners have embraced digital photographs, digital records, and digital radiographs. Diagnostic models have been a little slower to make the digital transition; however, over the last decade, more and more orthodontists are now moving in the direction of digital models as well.¹

Intraoral scanners were initially used for fabricating restorations in general dentistry.  Their increased use in the dental field led to orthodontists’ utilization of these scanners.^2,3  A number of appliances such as retainers, expanders, etc., as well as clear retainers and indirect bracket set-ups can all be produced directly from an accurate digital model.⁴ Because of the ease and efficiency of these scanners, orthodontists are now using these services daily with the expectation of speeding up treatment time and/or reducing costs.   With a digital model, the time and cost of taking impressions and sending them to the laboratories can be minimized, if not completely eliminated.  Indirect bracket set-ups performed correctly can be extremely accurate, helping to decrease the need for bracket repositioning later in treatment, thus reducing overall treatment time. ⁵

A number of recent studies have assessed the accuracy of several different digital model platforms. These studies evaluated digital models produced by intraoral scanners used both extraorally on plaster models and intraorally, from extraoral scanners, and from 3-dimensional (3D) radiographs. Overall, the findings show that digital models are just as accurate as traditional models and are appropriate to use in the diagnosis and treatment planning of orthodontic cases.^6,7,8

To date, there have been no studies evaluating the accuracy and validity of the different intraoral scanners along a curved line. The aim of this study was to investigate the curvilinear accuracy of two commercial intra-oral scanners, the Lythos™ scanner and the iTero™ scanner, in comparison to indirect digital caliper measurements when using a nylon monofilament to measure directly on the same dentition.

MATERIALS AND METHODS

The study sample was comprised of 61 dry skulls with intact dentition selected from a unique collection at the University of Texas Health Science Center at Houston School of Dentistry. The mandibles from each skull were used for this study. No IRB approval was needed for this study, as cadavers are no longer considered human subjects.

Lythos™ Digital Impression system (Ormco Corporations, Anaheim, CA) was used to scan each mandible running software version 1.9.10398. Once the scans were completed, the raw images were available for chair side viewing.  Images were then sent via the Internet to Ormco Corporation where they were immediately made available via a secure webpage for download as stereolithography (STL) files.  STL files are the industry standard for computer-aided design (CAD) and allow the viewer to be able to view and manipulate the object in a number of different applications while preserving the quality of the image.  Next, a Cadent iTero™ scanner (Align Technology, San Jose, CA) was used to scan the 61 dry skull mandibles running software version 5.2.1.290.  These scans were also available for chair side viewing within minutes and were then sent via the internet to Align Technology where they were stored as STL files and made available for viewing. See Figure 1 for a photograph and STL files from both the Lythos™ and iTero™ scans of a mandible used in the study.

Digital calipers (Carrera Precision CP5906 0-6-Inch Electronic Digital Caliper, Carrera Precision) were used to indirectly carry out initial measurements on the dry skulls after using nylon monofilament to directly obtain the curvilinear measurements on the skulls.  Vertical curvilinear measurements were obtained by measuring from the tip of the lower right canine tip directly down to the crestal bone.  In cases where permanent canines were not yet erupted, the primary canines were measured.  Sagittal curvilinear measurements were obtained by measuring the crestal bone along the lingual of the lower right first molar.  Transverse curvilinear measurements were acquired by measuring the lingual cusp tip of the lower left second premolar, starting from the center of the mesial marginal ridge and ending on the center of the distal marginal ridge (See Figure 2 for illustrations). In instances where the second premolars had not yet erupted, the primary 2^nd molars were measured.  All measurements were carried out by the same operator to the nearest 0.01 mm, and the digital caliper was zeroed out prior to every measurement to assure increased accuracy.

The files from both the Lythos™ and iTero™ scans were opened as STL files and measured electronically using 3-matic Research 9.0 (x64) by Materialise (Materialise, Belgium).  The same operator carried out all of these measurements, and the same three dimensions that were measured directly on the mandibles were measured electronically on these STL files.  Measurements were carried out on unsectioned, shaded models of the mandibles to the nearest 0.01 mm with the software’s built in ruler tool.  The ruler tool was set to measure the distance over a surface with a curve creation method set on the true shortest path of a curve using the World Coordinate System.

Measurements for each tooth were paired in twos for the methods tested. A one-sample t test was used to test the hypothesis that there would be no difference between the two measurements. The test value was set at 0. No significant differences were found for any of the paired measurements. Therefore, measurements from the same model were averaged for the iTero™, Lythos™ and direct measurements. Bland-Altman analysis was performed using XLSTAT Mac (version 2012; Addinsoft, New York, NY) and Bland-Altman plots were computed for the paired comparisons of the three methods. The analysis was used to visually demonstrate the agreement for measurement values between the manual caliper measurements, the Lythos™ scan measurements, and the iTero™ scan measurements.  The within-observer repeatability was evaluated using intraclass correlation analysis (ICC) by repeating all of the measurements from ten randomly selected skulls at a one-month interval.  Furthermore, linear regression analyses were used to investigate whether there was a proportional bias in the data. The level of significance was set at p<0.05 for all tests.

RESULTS

The intra-observer repeatability for each paired measurement set was excellent with the ICCs ranging between 0.96 and 0.98. Mean bias, SD, confidence interval, and p values for the paired method comparisons are demonstrated in Table I. According to the one-sample t test, there were no significant differences between any of the paired methods, which indicated a certain level of agreement between the methods tested. Bland-Altman plots of the method comparisons are shown in Figures 1-3. Bland-Altman analysis showed no fixed bias of one approach vs. the other, and random errors were detected in all comparisons. Although mean bias of iTero™ and Lythos™ scanner measurements when compared to direct measurements were very low, minimum mean bias occurred for the comparison of two intra-oral scanners.  However, the Lythos™ scanner and direct measurement comparison had the largest confidence interval (agreement level, 0.85 to -1.11) range.

Linear regression analyses were summarized in Table II. None of the comparisons displayed statistical significance for the t scores. This indicated that there was no proportional bias in any of these comparisons. Therefore, the null hypothesis was accepted. In other words, no trend was shown for any of the mean differences being above or below the mean bias level shown in Bland-Altman scattergram plots.

DISCUSSION

The precision and validity of the Lythos™ intraoral scanner and the Cadent iTero™ scanner along a curved line were evaluated in this study.  Results were based on comparison to indirect caliper measurements along a curved line when using a nylon monofilament fiber to directly measure from the mandibular dentition. Based on our findings, it is evident that intraoral scanners, the Lythos™ and iTero™, can be used interchangeably with caliper measurements for diagnosis and treatment planning.

Dry skull caliper measurements served as the gold standard reference.  Based on our findings, the confidence intervals for the Lythos™ scanner and direct measurements had the largest confidence interval (agreement level, 0.85 to -1.11) when compared to the intervals for the iTero™ scanner and direct measurements.  This was likely due to the difficulty in repeating the landmark locations, particularly along the crestal bone of the molars and the lingual cusp tip landmarks of the premolars, as it can be somewhat ambiguous.

One of the main problems with the direct measurements on the skulls, as well as the digital dental models is the consistent identification of landmarks.  It was also difficult measuring curved lines on the actual mandibular dentition with the nylon monofilament.  The filament was marked from the beginning of a landmark and wrapped carefully along the curvature being measure.  Once the second landmark had been reached, another mark was placed on the monofilament and the calipers were used to obtain the final measurement.  These marks were placed with a 0.2 mm extra precise, ultra fine point black Sharpie pen.  The narrowed tip allowed for improved control during measurements, and the fast drying, smear proof, fade- and water-resistant ink contributed to the consistency of the measurements.  It was much easier using the digital scanners to measure these curved lines since multiple points could be marked along the curved line and measured section by section; there was also increased ability to place points directly in smaller spaces that were difficult to reach when directly measuring the skulls.  The operator tried to minimize human error when directly measuring the skulls as well as digitally attempting to duplicate the same landmarks as much as possible, but inevitably, there will be differences.  As mentioned above, reaching the interproximal edges along the crestal bone was often difficult with the direct measurements on the dry skulls, as the contacts with other teeth precluded it. The calipers were likely mildly inconsistent for these values as well, again, due to the neighboring teeth blocking the points of measurement.  The results reflected that the digital scanners matched almost perfectly in their agreement, which confirms their ease of use when measuring curved lines digitally.  These scanners’ results were closer in agreement than either scanner to the direct measurements, though the Lythos and direct measurement comparison has a larger confidence interval.  Though there is a possibility for deformation of a STL file, or losing information on a millimetric level, it is an insignificant occurrence as this loss is so minimal.

One of the goals in evaluating the accuracy of these scanners along a curved line was for future use of digital fabrication of lower fixed canine-to-canine (3-3) retainers.  Lower fixed 3-3 retainers could be fabricated from final digital models with a high level of accuracy and delivered to the patient at the debond appointment, increasing time efficiency and reducing chair time.  Another curvature that could be measured with these scanners is the curve of Spee. The curve of Spee refers to the anterior-posterior curvature of the occlusal surfaces, beginning with the cusp tip of the lower cuspid and following along the buccal cusp tips of the premolars and molars.  This is a very significant and often overlooked curvature of the dentition that is important when leveling and aligning in orthodontic treatment.⁹  Accurately measuring this curve on digital models can aid in treatment planning, progress and final evaluations.

Intraoral scanners were first used by restorative dentists for the production of fixed prosthodontic restorations.  These intraoral scanners hold promise since they only emit optical radiation.   A 2013 study¹⁰ proved that three of the leading intraoral scanners (Lava C.O.S. [3M Espe], CEREC [Sirconia], and iTero™ [Strauman]) were able to create highly accurate restorations with as much accuracy as a 2-step putty-and-wash technique.  Many previous studies were performed on plastic or chromium cobalt dentoforms, which have different refractive indexes than tooth structure.  This led researchers to perform a study later in the year testing the accuracy of the iTero™ on natural dentition to ensure that the prismatic properties of enamel and its effect on the accuracy of the scanner would not be overlooked.  Aforementioned study confirmed that measurements acquired from iTero™ scans are clinically acceptable for orthodontic diagnosis and treatment planning. ⁶

Another study by Nedelcu and Persson evaluated the accuracy and precision of four intraoral scanners (3M Lava COS, Cerec AC/Bluecam, E4D, and iTero™) to assess the influence of different test materials and coating thicknesses.  Models were fabricated with three materials (polymethyl methacrylate [Telio CAD], titanium and zirconia) and were scanned with an industrial optical scanner.  Telio CAD was used to simulate tooth substance because of the similarities of its refractive index to enamel and dentin.  These models were then scanned with the intraoral scanners; a thick layer of coating was applied when scanning with the 3M Lava COS.  These scanners displayed similar results when comparing deviations, while maximum deviations were noted in the noncoating scanners.  The iTero™ scanner displayed consistent material-specific, localized errors on the Telio CAD translucent material, while the E4D displayed the largest deviations.  Excessive coating showed no negative affect.   The use of 3D analysis software has become a norm within reverse engineering and has been adopted into the field of dentistry.¹¹  Reverse engineering is the process of determining the technological principles of an object or component through analysis of its structure and function.  This analysis can then be used to redesign the object rapidly using computer-aided design (CAD) in concert with rapid-manufacturing processes to produce small numbers of components adapted to the needs of the customer.  This has huge benefits of speed and flexibility over traditional mass-production-based design and manufacturing processes.¹² In this study, scanners using still-image acquisition indicated errors due to pattern recognition, where stitching of overlapping images could not be combined into larger segments.  It was also noted that the visual evaluation of high-resolution images found that triangle density and mesh topology varied greatly among the scanners, contradicting previous thoughts that scanners with higher-definition sensors would produce higher accuracy.¹¹

The use of natural dentition is considered as one of the strengths of this current study.  Evidence shows that both reflection and refraction occur when light moves between materials.¹³   As mentioned above, a scanner’s diagnostic accuracy can present differences when used on plastic and chromium-cobalt dentoforms versus natural dentition.  Plastics exhibit a variety of different refractive indexes, all of which are different from the refractive index of tooth structure. Differences in light reflected back to the scanner can affect the scanner’s ability to determine the actual depth of an object accurately.⁶   Because of these differences,  natural dentitions from the 61 dry skulls were used in this study in order to eliminate the chance for refractive indices to influence the results.  Our current study was not done in vivo because of the difficulty involved when obtaining direct caliper measurements from a patient’s mouth.  Impression materials would be necessary to obtain plaster model replications of the patient’s dentition, and as reported in previous studies, impression materials and stone are prone to deformation.¹⁴  It was important when designing our study to be able to compare digital measurements directly to the main object to eliminate the above mentioned inconsistencies with materials. Results may also differ in an in vivo setting due to the presence of blood, saliva and patient movements,¹⁵ and because we were testing the accuracy of these scanners along a curved line, we wanted to eliminate these unpredictable variables.

Flügge et al. compared virtual models produced from stone models scanned by an extraoral scanner (D250, 3Shape, Copenhagen, Denmark) versus those same models scanned by the iTero™, versus intraoral scans taken by the iTero™.  The lowest precision was demonstrated with the intraoral scans; this was likely due to the condition of a wet and unpredictable intraoral environment versus a dry extraoral environment.  The extraoral scanner used on plaster models showed the greatest precision of the group. The mean difference between the two groups was 27 micrometers, a very small difference. ⁸ This study also helped support an in vitro study design by demonstrating the lower precision of the intraoral scans when subjected to the wet intraoral environment.

A study by Cuperus in 2012 evaluated the validity and reproducibility of measurements using the Lava scanner from 3M ESPE versus caliper measurements taken on skulls. However, they used only ten dry human skulls in their study, and they printed their STL files into 3D models. Statistically significant differences were noted between the measurements of the STL and digital models, but these differences were considered to be clinically insignificant.  It was concluded that the measurements made with the Lava scanner were valid and reproducible for measuring distances in dentition.¹⁶ Because this study investigated the accuracy between digital files and 3D printed models and concluded the differences to be clinically insignificant, it was decided to proceed with our current study without printing models and without making impressions of the dry skull mandibular dentition.

A study by Campanelli et al. implied that the accuracy of laser scanners depends on the shape, texture, and material reflectivity of the object being scanned.  A complex object, the distal femur, and a simple object, a gage block, were scanned by five laser scanners (Nikon, Laser Design Inc., Creaform, Northern Digital, and NextEngine).  The repeatability in the 3D models generated by the laser scanner was less repeatable when scanning the more complex distal femur than when scanning the gage block.  In other words, the repeatability of the 3D models generated by the laser scanners tested was worse on average when scanning a complex freeform surface.  Little difference between the scanners, aside from bias, was also noted.¹⁷

A study published in January of 2016 compared digitally fabricated custom edentulous mandibular trays with handmade trays.  The scanned data was imported into a reverse engineering software, and after statistical analysis, it was discovered that the digitally made custom trays achieved good matching with the mandibular model and also showed higher accuracy than the handmade trays.  An efficient method for custom tray fabrication was accomplished using 3D scanning, computer-aided design and fused deposition modeling, and this method resulted in high reproducibility and accuracy.¹⁸

The importance of measuring lines along the curve and the accuracy of these measurements lie within the ability of these scanners to properly stitch together these images and transform the geometric information into 3D models.  In our current study, we attempted to evaluate whether digital models are prone to geometric distortion during this transformation, and if so, how much distortion existed.  In a 2012 study by Van der Meer et al., the accuracy of three intraoral scanners was compared.  A master model was scanned by the CEREC (Sirona), iTero™ (Cadent) and Lava COS (3M) scanners, and the distance between the centers of the cylinders and the angulation between the cylinders were measured and evaluated against a high accuracy 3D scan of the master model.  Small differences were noted between these scanners with none being statistically significant.  It was noted that differences in the results may be attributed to the registration of the 3D images and post-processing procedures.  How the registration takes place and what algorithms were used in the different scanners was not shared knowledge, but algorithms involving registration based on surface overlap was most likely.  Registration errors will always occur in the registration procedures, however minute, but one would expect this to have an additive effect over the length of an arch.  This explained how there might be an accumulation of registration errors of the patched 3D surfaces with increased length in the distance and angular measurements, but the effects of the accumulation were deemed statistically insignificant. ¹⁹

The ease of measuring along a curve on the digital models is an important point to note in this current study.  Digital models can be manipulated easily on the computer screen to reach many different angles.  Placing points on the digital skulls with the computer mouse was much easier than manually trying to use nylon monofilament to reach the difficult and small interproximal areas on the mandibular dentition.  The mean bias between the iTero™ and direct measurements (-0.17) was slightly more than between the Lythos™ and direct measurements (-0.13); however, the smallest mean bias, noted at -0.03, existed between the two intraoral scanners.  This would confirm the consistency and ease of use when measuring these scanned models digitally rather than manually.  As noted in the above results, the Lythos™ and direct measurement comparison did have the largest confidence interval (agreement level, 0.85 to -1.11) range.   None of the comparisons exhibited statistically significant p values, indicating everything was homogenous and no proportional bias existed between the clusters of points in one area on all three Bland-Altman plots.

There is no current literature evaluating intraoral scanners’ accuracy in measuring along a curved line.  Future projects could use intraoral scanners on actual patients rather than skulls to give more realistic results as patient factors such as saliva and soft tissue may play a role in affecting the scanning process and accuracy.  Data may also be more consistent if one mandible was measured with all methods in the same sitting to insure more consistency with landmark identification of points.  It would also be beneficial to mark points on the skulls prior to scanning them so that landmark identification would be more precise throughout all measuring procedures.

CONCLUSIONS

Our study shows that the intraoral scanners tested in this study, the Lythos™ and iTero™, produced digital dental models that were highly accurate when comparing to direct surface measurements along a curved line in three dimensions of the space.  Both scanners are interchangeable with direct caliper measurements, if not more accurate and require a more effortless measuring approach.

REFERENCES

1. J. Peluso et al. Digital models: An introduction. Semin in Orthod. 2004;10:226-238.
2. Garino, B. Garino. The iOC intraoral scanner and invisalign: a new paradigm. J of Clin Orthod. 2012;Feb:46(2): 115-121.
3. Redmond, et al. The orthoCAD iOC intraoral scanner. A six month user report. J of Clin Orthod. 2011;March:45(3): 161-164.
4. D. Kravitz et al. Intraoral digital scanners. J of Clin Orthod. 2014;Jun: 48(6):337-347.
5. J. Redmond, M.J. Redmond, W.R. Redmond. The OrthoCAD bracket placement solution. Am J Orthod Dentofac Orthop. 2004;May:125(5):645-646.
6. Akyalcin , B.E. Cozad, J.D. English, C.D. Colville, S. Laman. Diagnostic accuracy of impression-free digital models. Am J Orthod Dentofac Orthop. 2013;Dec:144:6, p916-922.
7. Ender, A. Mehl. Full arch scans: Conventional versus digital impressions – an in-vitro study. Int J Comput Dent. 2011;14(1): 11-21.
8. V. Flügge, S. Schlager, K. Nelson, S. Nahles, M.C. Metzger. Precision of intraoral digital dental impressions with iTero and extraoral digitization with the iTero and a model scanner. Am J Orthod Dentofac Orthop. 2013;Sept: 133(3):471-478.
9. G. Spee. Prosthetic dentistry.  Medico-Dent Pub Co. 1928.
10. Seelbach, C. Brueckel, B. Wostmann. Accuracy of digital and conventional impression techniques and workflow. Clin Oral Investig. 2013; 17:1759-1764.
11. G. Nedelcu, A.S.K. Persson. Scanning accuracy and precision in 4 intraoral scanners: an in vitro comparison based on 3-dimensional analysis. J of Pros Dent. 2014; Dec:112(6): 1461-1471.
12. Raja, K. J. Fernandes. Reverse engineering: an industrial perspective. London: Springer; 2008: 1-69.
13. Crew. The wave theory of light – Memoirs by Huygens, Young, and Fresnel. American Book Company, New York (1900).
14. Torassian, C.H. Kau, J.D. English, J. Powers, H.I. Bussa, M.A. Salas-Lopez, J.A. Corbett. Digital models vs plaster models using alginate and alginate substitute materials. Ang Orthod. 2010;Jul;80(4): 474-481.
15. D. Hack, S.B.M. Patzelt. Evaluation of the accuracy of six intraoral scanning devices: an in-vitro investigation. The ADA Prof Prod Rev. 2015; Sept:10(4).
16. M.R. Cuperus, M.C. Harms, F.A. Rangel, E.M. Bronkhorst, J.G.J.H. Schols, K.H. Breuning. Dental models made with an intraoral scanner: A validation study. Am J Orthod Dentofac Orthop. 2012;Sept:142(3):308-313.
17. Campanelli, S.M. Howell, M.L. Hull. Accuracy evaluation of a lower-cost and four higher-cost laser scanners. J of Biomech. 2015; Nov: http://dx.doi.org/10.1016/j.jbiomech.2015.11.015.
18. Chen, X. Yang, L. Chen, Y. Wang, Y. Sun. Application of FDM three-dimensional printing technology in the digital manufacture of custom edentulous mandible trays. Sci Rep. 2016; Jan:6 (19207).
19. J. Van der Meer, F.S. Andriessen, D. Wismeijer, Y. Ren. Application of intra-oral dental scanners in the digital workflow of implantology. PLoS One. 2012; 7:e43312.

Figure 1. Example case as seen in photos, Lythos™ scan, and iTero™ scan.

Figure 2. Diagrams of measurements taken, demonstrated on iTero™ digital models. (From left to right: An overall view of measurements, the facial curve of the canine, the lingual cusp tip of the premolar, and the crestal bone along the molar).

Table I. Mean bias, SD, confidence interval, and p values for the paired method comparisons.

Table II. Summary of the linear regression analysis.

Figure 3. Bland-Altman plot for iTero™ and direct measurements

Figure 4. Bland-Altman plot for Lythos™ and direct measurements

Figure 5. Bland-Altman plot for iTero™ and Lythos™ measurements

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

If you have had braces before, chances are you've been told by your orthodontist to wear rubber bands. A lot of times patients are unaware of the reasons why it is important to wear rubber bands during their orthodontic treatment, so we are going to help break it down for you.

There are a number of different reasons why your orthodontist will tell you to wear rubber bands, but almost always it is because the rubber bands will help coordinate your bite while you are undergoing orthodontic treatment.

Whenever an orthodontist (Dr. Mack and Dr. Hansen) make space for a blocked out tooth, the teeth on the arch where that tooth is blocked out have to be moved. During the process of sifting those teeth around and making space, the bite changes, and not always for the better. As a result of opening space for a tooth, such as a blocked out canine or lateral incisor, the front teeth will have a tendency to stick out more. As such, ones overjet (or what some people call an overbite) gets bigger. Rubber bands in this situation help decrease that overjet and coordinate the bite after space is made.

Another time your orthodontist will tell you to wear rubber bands is if you have what is called an open bite. An open bite is when your front teeth do not overlap when you are biting down all the way. This type of bite makes it rather challenging to rip into foods such as biting into a sandwich, or an apple, or a piece of pizza for that matter. When the front teeth do not overlap, the orthodontist will work on correcting the position and relationship of those teeth so they do overlap.

As the orthodontist, Dr. Mack and Dr. Hansen are able to put bends in the orthodontic wires to help move the top and bottom front teeth closer together. However, placing these bends in the wires only works so well. In order to help move the teeth in the intended direction, rubber bands can be worn from the front top teeth to the front bottom teeth to help close that "open bite". When Dr. Mack and Dr. Hansen ask you to wear these types of rubber bands, chances are they will tell you to wear them at home and at night time only. The reasoning for this is because wearing rubber bands in the front of your mouth makes it rather difficult to talk during the day while at school or work.

Even if your teeth are all straight but you have an overjet/overbite or an underbite, your orthodontist will have you wear rubber bands to help address those malocclusions as well. The idea behind the rubber bands here is to move the entire set of teeth in each jaw to a better position to correct your bite.

While these are just a few of the reasons Dr. Mack and Dr. Hansen will have yo wear rubber bands while in braces, there are many other ones as well. If you are unsure how to wear your rubber bands on your braces or how often to wear them, please do not hesitate to ask Dr. Mack or Dr. Hansen at your next visit in our Longview office. Have a wonderful week!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, Gilmer, and Mount Pleasant.

Have you ever wanted to try food from a whole bunch of different restaurants in Longview all at the same time? That would take a long time to visit all those different restaurants right? Wrong!

The 36th Annual Taste of Longview is coming up this Tuesday at Maude Cobb Convention Center.  The event will feature a bunch of different restaurants from Longview and around East Texas. Each one will be offering selections from the menus to the public.

The event itself, which brought in almost 2,000 East Texans last year, serves as a fundraiser for the Pilot Club of Longview as well as the East Texas Restaurant Association.

The mission of the Pilot Club of Longview is to improve the quality of life of the Longview Community, with a specific focus on brain health. The Club uses funds raised to support the Alzheimer's Association as well as Unforgettable Tuesdays Day Club, which is a care program for persons with dementia, and Project Lifesaver which is a program in Gregg County to help citizens with "wandering" diseases like Alzheimer's and autism, among other organizations.

The East Texas Restaurant Association uses funds to provide scholarships to culinary arts students from area high schools.

This is a unique opportunity to support local businesses, eat some great food, and help raise money for two great organizations so we hope to see you there!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Have you ever wondered about the orthodontic research that Dr. Mack and Dr. Hansen conducted in their residency programs for their Master's Thesis?

Yesterday we had a patient ask about this very thing so we today we wanted to give you the opportunity to read Dr. Hansen's thesis regarding differences in lip position as part of braces and a specific type of orthodontic treatment in adults. We hope you enjoy!

Perception of Differences in Lip Profile between 2-D and 3-D

Introduction

An individual’s face plays an important role in determining overall attractiveness, aids in interpersonal communications, and has been shown to have a profound influence on judgements by peers.¹  Additionally, there is a symbiotic relationship that exists between the dentition and the face. This dental-facial relationship, specifically the role the dentition plays in the esthetics of the face, is of particular interest to dentists and orthodontists.²  What is currently defined as attractive becomes even more important to contemporary orthodontists when taking into consideration that patients seeking orthodontic treatment are frequently motivated more by esthetics than an improvement in masticatory function.³

In 1968, Ricketts defined the “esthetic plane” (E-plane) as a line extending from the tip of the nose to the tip of the chin when a subject is seen in a two dimensional (2-D) profile view. He found the lower lip in mature Caucasians to be positioned at a mean distance of 4mm + 3mm posterior to the E-plane.⁴ Since then, the E-plane has become a common reference in analysis of lip position in orthodontic evaluation.  Coleman et al,⁵ using 2-D soft-tissue profiles, found that patients, parents and orthodontists preferred the lower and upper lip to be on average about 5 mm and 7 mm posterior to the E-plane, respectively, for Class I subjects.

The use of three-dimensional (3-D) surface imaging has gained clinical acceptance and popularity among oral and maxillofacial surgeons, plastic surgeons and, more recently, orthodontists as a useful adjunct in the treatment planning process.^6-10 This technology provides clinicians with an anthropometric representation with greater precision and accuracy than other commonly used images, such as 2-D photographs. The 3dMD imaging system (3dMD, Atlanta, GA) in particular is one of the fastest 3-D surface-imaging systems. It captures images within 1.5 ms, creating very reliable 3-D computer-generated replicas of patients’ facial soft tissues with a mean global error of 0.2 mm.⁸ The system also has the ability to fuse computed tomography (CT)/cone-beam computed tomography (CBCT) images with 3-D surface-imaging data, further enhancing the treatment planning process by allowing clinicians to better understand, compare and predict various orthodontic or surgical treatment outcomes.^6,9

Some orthodontic treatment options such as premolar extraction, have been shown to produce changes in a patient’s facial soft-tissue.^11-16 The decision to extract teeth in orthodontics involves many factors including the amount of tooth size-arch length discrepancy, incisor and lip protrusion, severity of skeletal discrepancies, curve of Spee present, growth potential, and esthetics. The use of premolar extraction in orthodontics was initially shunned in the early 20^th century but gained popularity later on as a method for achieving greater long-term stability.¹⁷ Toward the end of the 20^th century, however, controversy developed regarding the possible negative side effects of this treatment. Claims that premolar extraction resulted in “dished-in” or flat faces, making patients look less youthful or less esthetic, were made based on the assumption that soft-tissue changed in a particular manner in response to the hard-tissue changes associated with orthodontic treatment.^18,19

Numerous researchers have attempted to settle this debate through extensive profile studies using pre- and post-treatment cephalometric measurements^11,12,14-16 as well as through esthetic evaluation by panels of laypeople and dental professionals of 2-D photographs,^20,21 silhouettes,²² and profile tracings.¹⁵ However, in 2008, Shafiee et al²⁰ attempted to identify the relative strengths of the full-face, smiling, and profile photographs individually in predicting facial attractiveness and found that the profile view is not the optimum perspective from which to evaluate facial attractiveness. Most studies analyzing incisor and lip retraction in response to premolar extraction have shown relationships of varying strength, but it is generally agreed that the correlation between soft tissue and hard tissue change is subject to large variation in such cases.²³ Relative to Ricketts E-plane, some of the greatest average retractions reported following four premolar extraction were 3.4 mm for the upper lip and 3.8 mm for the lower lip.^12,14 At times, extraction of four premolars resulted in the perception of substantial improvements in profile while other times they were considered to induce a flatter, less esthetic profile, and this was dependent on the initial protrusion.^15,16

In the past, studies evaluating esthetic preferences were done using 2-D photographs because that was all that was available. Given the superiority of 3-D imaging, this technology should be investigated for its use in analyzing the impact of orthodontic treatment on facial soft tissues and esthetics. In 2005, Todd et al²⁴ attempted to compare the perceptions of facial esthetics between 2-D and 3-D images, but found inconclusive evidence that there was a difference between them. More recently, Stebel et al²⁵ compared the 2-D and 3-D evaluations of nasolabial esthetics, and found greater reproducibility of ratings when evaluated in 3-D, and that 3-D images were regarded by layperson evaluators as more informative than 2-D images. Analyzing treatments in 3-D might be more appropriate than 2-D because real-life social interactions and interpersonal communications occur in 3-D. Moreover, a treatment result deemed as unesthetic in 2-D might be perceived differently in 3-D.

Therefore, the purpose of this study was to determine how laypeople perceived esthetic differences in lip position (flat versus ideal lip fullness) in 2-D versus 3-D. This was accomplished specifically by evaluating whether laypeople identified ideal lip fullness as being superior as often and as decisively in 3-D than in 2-D. If a difference were detected, it would provide a rationale for using 3-D technology to evaluate treatment results.

Materials & Methods

Before beginning the study, approval was obtained from the Institutional Review Board of Virginia Commonwealth University. After obtaining consent, 3dMD (3dMD, Atlanta, GA) images were taken of 8 adult Caucasian volunteers (4 male, 4 female) at Virginia Commonwealth University in Richmond, Virginia. The mean ages of the volunteers were 26.8 + 1.4 years for the males and 27.3 + 2.8 years for the females. Inclusion criteria were: Caucasian adults between the ages of 24 and 34, who had no history of orthognathic surgery or extractions other than third molars and had no facial hair or distracting markings.

Using the 3dMD Vultus 2.2.025 imaging software, the 8 subjects had the positon of their lips digitally altered to an “ideal” (ideal) position, based on the results of a previous study.⁵ Each subject’s upper and lower lips were placed 7 mm and 5 mm posterior to Ricketts E-plane, respectively. Following this alteration, each subject’s lips were retracted an additional 3.5 mm to a “flat” (flat) position, based on the results of previous studies.^12,14 The resulting flat group had their upper and lower lips placed 10.5 and 8.5 mm posterior to Ricketts E-plane. This created an ideal and flat version of all 8 subjects in 3-D.

20 second animation videos were created of each subject’s ideal and flat 3dMD images. The videos began with the 3dMD image at the facial front view. As the video progressed, the image slowly rotated on a fixed vertical axis until it reached the right-facing profile view, at which point the rotating image paused for 2-3 seconds. This allowed a brief static view of the subject’s profile, and then the image began rotating again, back to the facial front view, and then all the way to the left-facing profile view where the 3-D video ended.

In order to obtain the 2-D images for the study comparison, each subject’s altered 3dMD images (ideal and flat) were positioned in right-facing profile view within the Vultus software. Screenshots were then taken of this profile view, and the resulting images were cropped to include only the subject’s profile with a black background.

Two parallel surveys were created using Microsoft Access 2013 (version 15.0.4797.1003, Microsoft, Redmond, WA). Each survey contained an ideal vs. flat comparison for each of the 8 subjects, either using 3-D videos or 2-D static images. If a subject’s 2-D comparison appeared in survey 1, then their 3-D comparison was used in survey 2. It was randomized as to which image (ideal or flat) appeared on the left and right of the screen. The characteristics and order of the images used in the 2 surveys are shown in Table 1.

Table 1. Survey Order and Image Characteristics

A total of 209 evaluators completed the surveys by indicating the 3-D video or 2-D image from each pair that he or she preferred and signifying how much they preferred their selection.  The evaluators were asked to participate if they were between the ages of 18 and 30. No other inclusion or exclusion criteria were applied. Evaluators were recruited on the undergraduate campus of Virginia Commonwealth University in Richmond, VA. In exchange for their participation, evaluators were given a bottle of water. They were not told the purpose of the study or that it was related to the position of the lips. Each evaluator randomly received either survey 1 or survey 2.

Evaluators received directions on how to compete the survey, which was administered on a laptop computer. They were asked to fill out basic demographic information including age, sex, and race. The remainder of the survey featured the subjects’ comparisons. Under each pair of images or videos was the statement: “Please select the image you prefer from the above pair by sliding the bar below toward your preference. The extent to which you slide the bar signifies how much you prefer your selection over the other image.” This statement was accompanied by a visual analog scale (VAS), scaled from -100 to +100, and labeled “Much Better” at each end. A sliding bar was initially placed in the middle at 0 (neutral). The corresponding numeric value of each evaluator’s selection was recorded in an Excel 2013 (version 15.0.4797.1003, Microsoft) file. In testing for the differences between the 2-D and 3-D comparisons, the absolute value of these numbers was used. The relative magnitude of the response was used to assess “decisiveness”. There were 8 comparisons in each survey, for a total of 8 ratings by each evaluator. No evaluator viewed both the 2-D image and 3-D video of the same subject, since those appeared in different surveys. An example of the survey showing an ideal and flat 2-D image comparison is given in Figure 1.

Basic demographic data were summarized and compared between the two survey versions to ensure there was no evidence of bias as a result of the randomization. Categorical variables were compared using chi-square tests and continuous variables were assessed using t-tests. The primary focus of this research was to determine if laypeople were less critical of a flat profile in 3-D versus 2-D. A repeated-measures analysis of variance (ANOVA) was fit which accounted for the inherent correlation between responses from the same reviewer. Pairwise comparisons were performed to determine specific differences in levels of categorical variables and were adjusted for multiple comparisons where appropriate. When all pairwise comparisons were of interest, Tukey’s HSD adjustment was used and where only a specific number of pairwise comparisons were of interest, Bonferoni’s adjustment was used. Additionally, a chi-square test was used to evaluate differences in the preference (ideal, flat, neutral) for the two dimensions. Neutral was defined as being in the middle, or 0, on the VAS. SAS EG version 6.1; SAS Institute, Cary, NC) was used for all analyses with a significance level of 0.05.

Results

A total of 209 responses were collected. Of those, 196 were included for analysis after removing subjects outside of the targeted age range (18-30) along with those who did not answer the questions appropriately (invalid responses for sex, race, etc.). Demographics (age, sex, and race) were compared across respondents of the two surveys to determine if subjects were randomly distributed between the two surveys. There were no differences in the demographics between the evaluators completing the surveys (Table 2).

Table 2. Demographic Summary Statistics, Evaluators

Table 3 presents the breakdown of the evaluators’ preference for both the 2-D images and the 3dMD videos. The results showed the majority preferred the ideal profile:  62% when viewing 2-D images and 50% with 3-D images. The differences in distribution for 2-D and 3-D preferences were statistically significant (P <0.0001).

Table 3. Evaluators Profile Preference in 2-D and 3-D

Since the primary research question included how decisive evaluators were, an absolute value of the VAS rating preference value was used for analyses of 2-D vs. 3-D rather than the original signed measurement. The results of the repeated-measures analysis of variance (ANOVA) indicated a significant interaction between the image and the dimension in which it was presented (P = 0.0005). Table 4 presents the estimated difference in VAS preference score for each subject. There were three cases for which there was a significant difference between the dimensions, all of which had a significantly higher score, meaning a stronger preference indicated, for the 2-D comparison than for the 3-D comparison. The results of these significant pairwise comparisons are presented in Figure 2. In these cases, respondents were on average over 10 units more decisive with 2-D images than they were for 3-D images.

Table 4. Estimated Difference in 2-D and 3-D VAS Rating Preferences for Each Subject (|2-D| - |3-D|)

Figure 2. Cases with Significant Differences in 2-D and 3-D Ratings

*Indicates significant at 0.00625 level (Bonferoni adjusted p-value for multiple comparisons)

Additionally, sex and race of the evaluator were also associated with differences in the absolute value of the VAS scores (P = 0.0361; <0.0001, respectively). Female respondents’ scores were on average 3 points more decisive than males.  Hispanic respondents gave significantly higher scores to rate differences than Asian, Black, White, and Other races; and Asian respondents gave significantly higher scores than White and Other respondents, but were not significantly different from Black respondents after adjusting for multiple comparisons. Table 5 includes the statistically significant pairwise comparison results for both sex and race.

Table 5. Pairwise Comparison of Ratings for Significant Evaluator Race and Sex Differences

Discussion

The results of the current study provide new insight in an area of research where little previous work has been done.  Some aspects of this study, such as the findings on preferred lip position, are supported by previous research.^15,26 Other findings, such as how preferences differ depending on which dimension they are evaluated in, are new and unique.

In the current study, the 2-D evaluation showed a significantly greater preference for the ideal profile (62%) rather than the flat profile (22%) (Table 3).  Foster²⁶ found that laypeople considered the most pleasing profile for an adult female to be one with the lower lip about 5 mm posterior to the E-plane, with males being slightly flatter.  This supports the findings of the current study in which laypeople evaluators preferred the profiles with the lower lip placed 5 mm posterior to E-plane. Bowman et al¹⁵ found that extraction treatment and the associated lip retraction hurt profiles where the lower lip was greater than 3.5 mm behind the E-plane.  This also supports the findings of the current study in which lip retraction beyond the lower lip position of 5 mm posterior to E-plane negatively affected the profile.  The ideal lip positions used in the current study were chosen based on what Coleman et al⁵ found as being the most preferred lip position by patients, parents, and orthodontists. The current study’s findings support those findings.

Similar to previous studies using 2-D profile images, the 3-D evaluation in this study also showed that evaluators more often preferred the ideal profile (50%) compared to the flat one (27%) (Table 3). The 3dMD imaging system used in this study has been shown to be more precise and accurate than 2-D photography for making measurements.⁸ The superiority of 3-D imaging has also been demonstrated in studies comparing cone-beam computed tomography (CBCT) and conventional lateral cephalograms. CBCT facilitates more precise identification of cephalometric landmarks, particularly bilateral landmarks such as orbitale, condylion, and gonion.²⁷ It also gives more accurate data regarding the specific location of impacted teeth, pathologic lesions, and identifying possible root resorption. Compared to 2-D lateral cephalograms, 3-D imaging with CBCT allows orthodontists to more accurately analyze airway volume changes resulting from treatments such as maxillary expansion.²⁸ The results of the 3-D evaluation in the current study show that 3-D imaging can be successfully used to evaluate lip position preferences, a new finding in this area of research.

The results of the current study demonstrated that the overall impact of lip position on esthetics is viewed differently in 3-D than in 2-D. The 3-D evaluation showed a significantly more frequent preference for the ideal profile rather than the flat profile, but less often than in 2-D (Table 3).  Additionally, evaluators tended to prefer the flat profile in 3-D (27%) more often than in 2-D (22%). Furthermore, a greater percentage of evaluators tended to responded neutrally when viewing 3-D videos (22%) than 2-D images (16%). Using a logistic regression model, the odds ratios for selecting various profiles were calculated. The odds that a viewer was rating a 2-D picture was 1.77 (95% CI: 1.36-2.29) times higher if they selected the ideal image rather than neither (neutral), indicating a significantly greater incidence of neutrality in 3-D (P < 0.0001). Similarly, evaluators were 0.66 (95% CI: 0.52-0.83) times as likely to be viewing a 2-D image if they selected the flat compared to ideal profile, demonstrating a significant increase in preference frequency for the flat profile in 3-D (P = 0.0004).  This showed that not only were evaluators less likely to be critical of a flat profile, they also tended to be less decisive as a whole when evaluating esthetics in 3-D vs. 2-D.

The results in Table 4 indicate that the ability for laypeople to discern differences between the two images was different depending on the subject and the dimension in which the images were presented. In each of the three cases where there was a significant difference between the dimensions, the 2-D VAS value was greater and thereby evaluated more decisively than the 3-D images (Figure 2). The clear pattern found between the 2-D and 3-D images contrasted the findings of some previous studies comparing esthetic evaluation between 2-D and 3-D images.^24,25

Todd et al²⁴ took facial scans of two Caucasian adult males and females using a 3-D photogrammetric face scanner (3dMD LLC, Harefield, Middlesex, UK) and created 5 different profiles using computer software. Evaluators were asked to rank the images in order of preference from most favorable to least favorable in 2-D and 3-D. When comparing the results for the 2-D and 3-D images, no clear pattern was found. Evaluators preferred one profile significantly more frequently than the rest in 2-D, but not in 3-D, for one of the subjects. For another subject, evaluators preferred a profile significantly more frequently over the others in 3-D, but not in 2-D.  In the current study, evaluators showed a significantly more frequent preference for the ideal profile rather than the flat profile in both 2-D and 3-D formats (Table 3). Stebel et al²⁵ compared the reliability of rating nasolabial appearance on cropped 2-D and 3-D images (3dMD, Atlanta, GA) in prepubertal children. The mean rater scores showed no difference between 2-D and 3-D formats. This is different than what was found in the current study where raters were less decisive in 3-D than in 2-D (Table 3). The study also asked evaluators two questions regarding which image format (2-D or 3-D) provided more information and was easier to evaluate. The raters of the study chose 3-D images as providing significantly more information than 2-D images, and there was a non-significant tendency to consider 2-D images as being easier to use in evaluating esthetics.

The evaluation of facial soft-tissue esthetics in 2-D compared to 3-D is a relatively new area of research and additional investigation is needed to confirm the findings of the current study. This study was able to provide preliminary evidence that there is in fact a difference in how esthetic appearance is perceived by laypeople, depending on whether it is evaluated in 2-D or in 3-D. More importantly, there is evidence to suggest that laypeople judging a flat profile are less likely to be critical of that profile in 3-D. Shafiee et al²⁰ suggested that the 2-D profile view is not the optimal method for evaluating facial attractiveness. While it might be most accurate to evaluate facial attractiveness on a live person, this is usually not possible or practical for research purposes. Nevertheless, the use of a 3-D image incorporating the profile, full-face, and every angle in between is probably closer to reality than the 2-D alternative.

One limitation to the current study design that should be acknowledged is that the 3-D videos used were 20 seconds long and repeated themselves up to 3 times until a decision was made by an evaluator. When taking the survey, however, the evaluators were able to make their selection before the 20 second video completed. In future studies using this design and 3-D videos, it might be better to have the video complete at least once before evaluators are able to make their selection on the VAS or simply have the 3-D images available and allow the evaluators to rotate them at their own pace.

The results of this study demonstrated an increase in neutrality and a decrease in decisiveness of esthetic evaluation in 3-D compared to 2-D. 3-D images are likely to facilitate a more accurate representation of the real-life perception of lip position changes that can occur as a result of orthodontic treatment. Previous studies in 2-D have demonstrated that evaluators are sensitive to small differences in facial soft tissue and esthetics.^5,11-16,26  However, based on the findings of the current study, evaluators might be less sensitive to small differences in facial soft tissue and esthetics than previous research in 2-D has led orthodontists to believe.

Conclusions

• Lip positions (lip fullness) identified in previous studies as being ideal were more frequently preferred by evaluators than flatter lips in both 2-D and 3-D images.
• Ideal lip fullness was less often identified as superior to flat lips when viewed in 3-D images than in 2-D profile images.
• Ideal lip fullness was less decisively considered as superior to flat lips when viewed in 3-D images than in 2-D profile images.
• Evaluators were more likely to have no preference (neutral) of lip position in 3-D images than in 2-D profile images.

References

1. Shaw WC. The influence of children's dentofacial appearance on their social attractiveness as judged by peers and lay adults. Am J Orthod. 1981;79(4):399-415.
2. Davis LG, Ashworth PD, Spriggs LS. Psychological effects of aesthetic dental treatment. J Dent. 1998;26(7):547-554. doi: S0300-5712(97)00031-6 [pii].
3. Shaw WC, Gbe MJ, Jones BM. The expectations of orthodontic patients in South Wales and St Louis, Missouri. Br J Orthod. 1979;6(4):203-205.
4. Ricketts RM. Esthetics, environment, and the law of lip relation. Am J Orthod. 1968;54(4):272-289.
5. Coleman GG, Lindauer SJ, Tufekci E, Shroff B, Best AM. Influence of chin prominence on esthetic lip profile preferences. Am J Orthod Dentofacial Orthop. 2007;132(1):36-42. doi: S0889-5406(07)00327-7 [pii].
6. Karatas OH, Toy E. Three-dimensional imaging techniques: A literature review. Eur J Dent. 2014;8(1):132-140. doi: 10.4103/1305-7456.126269 [doi].
7. Kau CH, Richmond S, Zhurov A, et al. Use of 3-dimensional surface acquisition to study facial morphology in 5 populations. Am J Orthod Dentofacial Orthop. 2010;137(4 Suppl):S56.e1-9; discussion S56-7. doi: 10.1016/j.ajodo.2009.04.022 [doi].
8. Lubbers HT, Medinger L, Kruse A, Gratz KW, Matthews F. Precision and accuracy of the 3dMD photogrammetric system in craniomaxillofacial application. J Craniofac Surg. 2010;21(3):763-767. doi: 10.1097/SCS.0b013e3181d841f7 [doi].
9. Metzger TE, Kula KS, Eckert GJ, Ghoneima AA. Orthodontic soft-tissue parameters: A comparison of cone-beam computed tomography and the 3dMD imaging system. Am J Orthod Dentofacial Orthop. 2013;144(5):672-681. doi: 10.1016/j.ajodo.2013.07.007 [doi].
10. Tzou CH, Artner NM, Pona I, et al. Comparison of three-dimensional surface-imaging systems. J Plast Reconstr Aesthet Surg. 2014;67(4):489-497. doi: 10.1016/j.bjps.2014.01.003 [doi].
11. Erdinc AE, Nanda RS, Dandajena TC. Profile changes of patients treated with and without premolar extractions. Am J Orthod Dentofacial Orthop. 2007;132(3):324-331. doi: S0889-5406(07)00497-0 [pii].
12. Drobocky OB, Smith RJ. Changes in facial profile during orthodontic treatment with extraction of four first premolars. Am J Orthod Dentofacial Orthop. 1989;95(3):220-230. doi: 0889-5406(89)90052-8 [pii].
13. Bishara SE, Cummins DM, Jakobsen JR, Zaher AR. Dentofacial and soft tissue changes in class II, division 1 cases treated with and without extractions. Am J Orthod Dentofacial Orthop. 1995;107(1):28-37. doi: S0889-5406(95)70154-0 [pii].
14. Bravo LA. Soft tissue facial profile changes after orthodontic treatment with four premolars extracted. Angle Orthod. 1994;64(1):31-42. doi: 10.1043/0003-3219(1994)0642.0.CO;2 [doi].
15. Bowman SJ, Johnston LE,Jr. The esthetic impact of extraction and nonextraction treatments on caucasian patients. Angle Orthod. 2000;70(1):3-10. doi: 10.1043/0003-3219(2000)0702.0.CO;2 [doi].
16. Kocadereli I. Changes in soft tissue profile after orthodontic treatment with and without extractions. Am J Orthod Dentofacial Orthop. 2002;122(1):67-72. doi: S0889540602000367 [pii].
17. Tweed CH. A philosophy of orthodontic treatment. Am J Orthod. 1945;31(2):74-103.
18. Proffit WR. Forty-year review of extraction frequencies at a university orthodontic clinic. Angle Orthod. 1994;64(6):407-414. doi: 10.1043/0003-3219(1994)0642.0.CO;2 [doi].
19. Case CS. The question of extraction in orthodontia. Am J Orthod. 1964;50(9):660-691.
20. Shafiee R, Korn EL, Pearson H, Boyd RL, Baumrind S. Evaluation of facial attractiveness from end-of-treatment facial photographs. Am J Orthod Dentofacial Orthop. 2008;133(4):500-508. doi: 10.1016/j.ajodo.2006.04.048 [doi].
21. Spyropoulos MN, Halazonetis DJ. Significance of the soft tissue profile on facial esthetics. Am J Orthod Dentofacial Orthop. 2001;119(5):464-471. doi: S0889-5406(01)74498-8 [pii].
22. Bishara SE, Jakobsen JR. Profile changes in patients treated with and without extractions: Assessments by lay people. Am J Orthod Dentofacial Orthop. 1997;112(6):639-644. doi: S0889-5406(97)70229-4 [pii].
23. Zierhut EC, Joondeph DR, Artun J, Little RM. Long-term profile changes associated with successfully treated extraction and nonextraction class II division 1 malocclusions. Angle Orthod. 2000;70(3):208-219. doi: 10.1043/0003-3219(2000)0702.0.CO;2 [doi].
24. Todd SA, Hammond P, Hutton T, Cochrane S, Cunningham S. Perceptions of facial aesthetics in two and three dimensions. Eur J Orthod. 2005;27(4):363-369. doi: cji024 [pii].
25. Stebel A, Desmedt D, Bronkhorst E, Kuijpers MA, Fudalej PS. Rating nasolabial appearance on three-dimensional images in cleft lip and palate: A comparison with standard photographs. Eur J Orthod. 2015. doi: cjv024 [pii].
26. Foster EJ. Profile preferences among diversified groups. Angle Orthod. 1973;43(1):34-40. doi: 10.1043/0003-3219(1973)0432.0.CO;2 [doi].
27. Ludlow JB, Gubler M, Cevidanes L, Mol A. Precision of cephalometric landmark identification: Cone-beam computed tomography vs conventional cephalometric views. Am J Orthod Dentofacial Orthop. 2009;136(3):312.e1-10; discussion 312-3. doi: 10.1016/j.ajodo.2008.12.018 [doi].
28. Zhao Y, Nguyen M, Gohl E, Mah JK, Sameshima G, Enciso R. Oropharyngeal airway changes after rapid palatal expansion evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2010;137(4 Suppl):S71-8. doi: 10.1016/j.ajodo.2008.08.026 [doi].

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Free Consultation for Braces and Invisalign

Here at Mack and Hansen Orthodontics, we want you to be able to learn about your orthodontic needs risk free!

Many times, you may hear something about a particular type of treatment or style of braces and not know what is fact or fiction. If you see a commercial or if one of your friends posted something on Facebook, you might have questions about it that you would like answered. Heard about our Clear Braces for Adults or our Gold Braces and unsure about which one would be better for you? If you do a search on the internet for that type of orthodontic treatment you may not find the answer to your question. This is why we always offer complimentary consultations for everyone.

It doesn't matter if you are coming to see us all the way from Dallas or Shreveport or  Mount Pleasant or Henderson. Whether you are an adult who is considering some of our adult braces options or you are a parent interested in learning about clear aligners (invisalign) for yourself or your teen, you can have all your orthodontic questions answered by Dr. Mack and Dr. Hansen at your complimentary orthodontic consult.

We get many questions about when our orthodontic office is open and when can someone be seen for a orthodontic consult. Our Longview office is located right by Longview Regional Medical Center and we see patients for consultations Monday through Friday. Our hours vary depending on the exact day of the week but we do have plenty of after school appointments available as well as appointments before school.

To schedule a free consultation you can do so online here, or you can call us and Audrey will be able to get you taken care of!

Have a wonderful week!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Directions from Kilgore, TX (75662):  Head North on US-259 to TX-31 E on into Longview.
Directions from Marshall, TX (75670):  Head West from Marshall on US-80 and continue through Hallsville to TX-281 into Longview.
Directions from Gilmer, TX (75644):  Head South on TX-300 for 21 miles.

Can you believe that March has already arrived? Neither can we! With April just around the corner that also means Spring Break season is upon us. Most of the local schools have their spring break during the month of March, including Longview, Marshall, Spring Hill, Pine Tree, Hallsville, Gilmer, Kilgore, Carthage and more! If you happen to be one of the families traveling during Spring Break we wanted to help you remember some important tips to take care of anything that may come up with your orthodontic appliances while you are away from East Texas.

Should you have any orthodontic braces that come loose while you are away rest assured that it is not something where you need to visit an orthodontist in whichever city you are in (Dallas, Tyler, Shreveport, etc…) to try and have them repair that bracket. If the bracket is bothering you, placing some wax around the bracket can help alleviate any discomfort you may be having from the loose bracket. Alternatively, if the bracket is one in the way back, you might be able to just slide the bracket off the wire, in which case you can save the bracket in a little bag and bring it home with you from vacation. We can then put the bracket back on once you return to Longview. If you do end up sliding the back bracket off your orthodontic wire, then you will end up with a long wire that is likely poking you.

There are also a couple different things you can do when you have an orthodontic wire poking you. You might be able to simply cut the wire with a cuticle cutter if you have a flexible wire in. If not, using some of the orthodontic wax we give you at your initial visit will again help temporarily alleviate any discomfort you may be having.

If you happen to misplace, lose, or break one of your Invisalign clear aligners, you can jump ahead and wear the next Invisalign aligner in your sequence. If you do not have your next Invisalign tray with you, then you can wear your previous Invisalign or Invisalign Teen tray. As you can probably tell, if you are going on vacation, please bring your next Invisalign or Invisalign Teen aligner with you, or your previous tray if you do not have your next tray with you. This way, in the unfortunate event that something should happen, you are not without a tray for your entire Spring Break.

In any of these cases though, please do not hesitate to contact our Longview orthodontic office and ask what you should do. We are more than happy to help walk you through any of these situations should something happen while you are away from East Texas.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

When undergoing orthodontic treatment with braces, true emergencies are a rare occurrence. When one does come up though, we are here for you!

Depending on what type of "orthodontic emergency" you are experiencing, you can reference your take home packet that we give you the day you get your braces on. In that packet you will find all sorts of tips and tricks to help take care of anything that may be going on. As a general rule though, you should always call our office if you are having any severe pain or an orthodontic appliance is bothersome and you are unable to take care of it yourself. Our fantastic Front Office Team will be able to get you an appointment scheduled so we can take care of whatever may be going on.

If you do reference your orthodontic take home packet though, you will be surprised to see how many things you can take care of yourself or at least temporarily until we see you in our Longview office. If something is loose and you can remove it from the wire, or it is already off the wire, you can simply put it in a plastic bag and bring it in with you to your next visit. If something is poking you, please do not hesitate to use the wax we give you to cover anything that is poking or sticking out, such as a bracket or a wire. If you wire has shifted to one side, which can happen, you can pull it back to the other side with a narrow tweezers or pliers.

If you are experiencing any general soreness from your braces or your new orthodontic wire, a soft diet will surely help. If you have any irritated or sore spots in your mouth, whether from your braces or your clear aligners (invisalign trays), you can rinse with a warm salt-water mouthwash. Taking Tylenol will help, as well as ibproufen (Advil or Motrin).

Please do not hesitate to reach out to us if you have any questions or are experiencing anything that you feel is out of the ordinary or not mentioned here or on our Braces First Aid page. Have a wonderful day!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Sometimes patients present to our orthodontic office with severe jaw discrepancies that include bad bites, jaw bone abnormalities, and malocclusion. Oral and maxillofacial surgery is a specialty in the field of dentistry that focuses on treating complex cases involving the face, mouth, jaw and skull. If you need surgical orthodontics, Dr. Mack and Dr. Hansen work with an oral and maxillofacial surgeon to give you the best result and experience possible.

WHEN MIGHT ORTHODONTICS AND SURGERY BE NEEDED?

Typically, jaw growth stops around age 15 in females and 18 or 19 in males. Surgical orthodontics may be used to treat patients whose jaw growth has completed and resulted in an improper bites or other aesthetic concern. When orthodontics alone is not able to address the bite issues resulting from abnormal jaw growth then surgical orthodontics may be needed. Orthognathic surgery can help properly align the jaw, and our doctors, Dr. Mack and Dr. Hansen will use orthodontic braces to move the teeth into the proper position.

HOW DO I KNOW IF I WILL NEED ORTHOGNATHIC SURGERY?

Your orthodontist, Dr. Mack or Dr. Hansen, can tell you if orthognathic surgery is needed as part of your treatment. Depending on the severity of your case and the alignment of your jaw, you may or may not need surgery.

HOW DOES IT WORK?

An oral and maxillofacial surgeon will perform your orthognathic surgery, and the surgery will take place in a hospital such as Longview Regional or Christus Good Shepherd. Orthognathic surgery can take several hours depending on each individual case. Once the surgery is complete, you will have about a two-week rest period. Since orthognathic surgery is a major treatment, we recommend that you schedule some time away from work and school during the healing process. After your jaw has healed, Dr. Mack and Dr. Hansen will once again “fine-tune” your bite using braces. After surgery, you will have to wear braces, and most braces are removed within six to 12 months following surgery. After your braces are removed, it will be important to wear your retainer to help maintain your new smile.

WHAT ARE THE RISKS ASSOCIATED WITH ORTHOGNATHIC SURGERY?

As with any major surgery, there may be certain risks of having orthognathic surgery. However, the process of orthognathic surgery is not new, and it has been performed for many years in practices and hospitals. If you're concerned about an upcoming treatment with orthognathic surgery, please contact our office, located in Longview right next to the Longview Regional Medical Center and let us know. We are happy to answer any questions that you may have, and provide you with any additional information.

WHAT ARE THE REWARDS OF HAVING ORTHOGNATHIC SURGERY?

For many patients, the most important reward of having orthognathic surgery is achieving a beautiful, healthy smile that lasts a lifetime. Whether you need orthodontic treatment to correct a bad bite, malocclusion, or jaw abnormality, orthognathic surgery can help restore your confidence and leave you smiling with confidence for many years to come.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

In 2002, the first Give Kids A Smile (GKAS) event was held in St. Louis where free dental care was delivered to nearly 400 children.

The American Dental Association recognized these efforts for their ability to raise awareness for oral health across the country. In 2003, with help from sponsors and of course the American Dental Association, Give Kids A Smile became a nationwide program.

Since it's inception in 2003, nearly 6 million children have received dental care from more than half a million dentists and dental volunteers. The program is now designed to address the dental health crisis in three main areas: 1. Provide immediate dental care to people suffering from active, untreated dental disease; 2. Grow the public/private safety net; and lastly, increase dental education and dental disease prevention in communities.

Here in Longview as well as in Kilgore, Marshall, Henderson, and across all of East Texas you will find a number of community programs taking place during the month of February. These will either be in association with Give Kids A Smile or National Children's Dental Health Month. Some of these events may be taking place at local schools while others will be at local dentist offices so be sure to keep an eye out for any events around your city!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists or dental braces,. We’re conveniently located in Longview, TX right by Longview Regional Hospital and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

We have been getting a lot of questions lately about invisalign, the process, and how it works. For a little background information, invisalign is a brand name of a type of clear aligner. Another type of clear aligner brand is Clear Correct. There are also some new brands of clear aligners coming out soon which will be similar to invisalign.

In our office, the invisalign process starts with your complimentary consultation. After your consultation, if you and Dr. Mack or Dr. Hansen decide that invisalign is the best option for your case and your lifestyle, then the next step is a scan of your teeth.

With our iTero intraoral digital scanner we are able to take an "impression" of your teeth without any of that gooey material used in the past. Additionally, the scan of your mouth, teeth, and bite are far more accurate than any of those gooey impressions of years past.

With this scan of your teeth we are able to start planning your orthodontic tooth movements, bite correction, and smile improvements almost immediately. Using our computer software Dr. Mack and Dr. Hansen are able to digitally plan your entire treatment from start to finish. After they are finished your aligners are then fabricated on 3-D printed models of your teeth and then shipped to us.

Once your invisalign aligners are delivered to our office, we give you a call to come in for your delivery. At that delivery we place any attachments that are needed on your teeth to help in tooth movement and give you your first set of orthodontic clear aligners.

After that your smile transformations are underway! We will see you back for visits to monitor your progress and determine if we need to incorporate any changes into your aligners! And now you know!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

That's right! Winter has arrived in East Texas. Last night we had our first snow of the year and with that came icy roads, closed schools in Kilgore, Marshall, Gilmer, etc... and a closed Mack and Hansen Orthodontics office. Our orthodontic office will be closed today, Tuesday January 16th, to allow for the weather conditions to improve.

There are even some schools, such as Longview ISD, already announcing they are closing tomorrow as well. If you've seen any videos on the news or Facebook, you can see that the roads are by no means safe to drive on. We will be keeping a close eye on the weather to determine if we will be closing the office tomorrow as well.

During this time we want to do our part to remind everyone to bundle up and stay indoors (and off the roads) as much as possible.

Now despite what you may think, braces do feel any different and do not cause any more discomfort when it gets below freezing temperatures. However, always remember that if you are having any discomfort from your braces to reference the your home care instructions given to you at your first visit.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

A lot of times people are surprised to see how many different options there are for straightening their teeth and correcting their bite.

While there is always the option of traditional metal braces, there are also more aesthetic options that patients absolutely love. These include clear braces and clear aligners such as Invisalign and Clear Correct. We offer all of these options for both adults seeking orthodontic treatment as well as teens.

We often get questions about the difference between these options such as which one is quicker and which one "works better". Since all of these orthodontic options have some unique qualities, it all depends on the patient and the case. For certain situations braces are a better option than clear aligners like Invisalign and Clear Correct. However in other cases, the clear aligners are a better option.

When we look at each patients individual lifestyle, that also helps in deciding which treatment option would be better. For those who prefer to snack throughout the day, sometimes aligners are not the best bet because they need to be removed each time you eat and clear braces may be a better option. For those who have specific aesthetic demands, using a clear aligner might be a better option because of the ability to remove them for socially sensitive situations.

Understanding the differences between the types of orthodontic appliances and options can be confusing, which is why we offer risk-free, complimentary consultations for orthodontic treatment. With a free consultation you are able to hear directly from Dr. Mack or Dr. Hansen about what your options are and ask any and all questions you may have about orthodontic treatment, clear braces, metal braces, or clear aligners like invisalign.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

With a new year comes those new year resolutions that everyone talks about. Whether or not you are making a new years resolution this year, consider what our orthodontic team can do for you and your smile here at Mack and Hansen Orthodontics.

Now we know that this recent string of cold weather has kept all of Longview, Marshall, Kilgore, GIlmer and even down by Henderson and Carthage all bundled up and staying inside but we want to make it known that our braces, regardless of if they are clear braces or metal braces, do not get extra tight or uncomfortable when the temperature drops below freezing. They feel just the same as when it is 80 degrees out as when it is 8.

Now if you are thinking about giving yourself a new smile this year, just know we have you covered. If you are looking at getting those bottom teeth straightened out since you haven't worn your retainer since 2006, we have you covered. If you are looking at having your front 6 teeth straightened, we have you covered. In fact, you will likely be surprised at how easy and affordable it is to have those pesky crooked teeth corrected.

Not only do we accept all insurance plans, we are also in network with many plans as well, making orthodontic treatment even more affordable. Even if you don't have insurance, or you have medicaid (which unfortunately does not cover orthodontic treatment anymore unless it is deemed medically necessary), we are committed to making braces affordable, as well as invisalign affordable.

There are a number of options to choose from when starting orthodontic treatment, and you shouldn't have to pay a fee to be told that you need braces. If you can look in the mirror, chances are you know if you need braces or not. That is why our consultations for braces and invisalign are complimentary, meaning NO CHARGE to you.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

We have been getting a lot of questions lately as to what types of insurance plans cover braces, which ones do not, and what the difference is between the different types of insurances so we decided to make this blog post about INSURANCE FAQs.

If we both have dental insurance through the same company, do we have the coverage?

There are many different types of insurance plans, and just because you have dental insurance through one company does not mean that you have the same coverage as another person who has their dental insurance through the same company. Furthermore, just because you are employed by the same company and have the same dental insurance, that still does not mean you have the same coverage.

Dental insurance can be a confusing thing and we are here to help you navigate the complex world of insurance!

What is the difference between dental insurance and orthodontic insurance?

There is actually quite a big difference between these types of insurances. You cannot have orthodontic insurance without having some sort of dental insurance, but you certainly can have dental insurance without having orthodontic insurance. A lot of times you can choose to have orthodontic coverage when purchasing your dental insurance for the upcoming year. In terms of the orthodontic insurance, sometimes this will only cover children up to a certain age, like 19 or 26 for example. Other times there will be no age limit and there will be adult coverage for treatment, which is great news if you do have that type of coverage since we are seeing more and more adults who are interested in orthodontic treatment. If you do have dental insurance and would like us to check on it to see if there is any orthodontic benefit we would be happy to do so!

Does Medicaid cover orthodontic treatment in the state of Texas?

In years past medicaid did cover a fair amount of orthodontic treatment, based on complexity/severity of the case. However, this is not the case anymore. It is rather difficult now to get approved for medicaid coverage of orthodontic treatment, even in the most complex and severe cases of orthodontic need.

We understand this though and are committed to making treatment affordable for everyone and are proud to offer consultations at no charge for anyone who is interested in orthodontic treatment or wants to learn about what their orthodontic needs are and what type of affordable payment plan they can be on when it comes to orthodontic treatment.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

There are a number of different appointment types when you visit us and so depending on the days’ schedule there may be more of some appointment types than others and therefore every day is different. Since we offer appointment times as early as 7am and as late as 5:30 pm in order to accommodate those patients who need after school or after work visits, some days at our office are longer than others. It just depends on how full the schedule is.

When patients come in for their first visit, which is always complimentary at our office, we take some x-rays and pictures, preform a quick but thorough exam, and then we sit down and have a conversation about what the patient is concerned about or what bothers them about their teeth or bite. We let them know what we see and what our diagnosis is, and then discuss with them about what their options are for addressing everything.

If a patient decides they would like to start treatment, then we get them scheduled to either get their braces on or to scan their teeth if they are wanting treatment with clear aligners, such as Invisalign. The appointment to get braces on takes about an hour while a scan of the teeth takes around 5-10 minutes. Both are always an exciting visit because they mark the start of each patient’s smile transformation.

Throughout the course of treatment we usually see our patients every six to eight weeks, sometimes intervals are longer though, it just depends. Each visit we look at a number of different things to see how treatment is progressing. Sometimes patients will get new wires (or trays if they are wearing clear aligners a.k.a. Invisalign) or we may instruct them to wear some rubber bands. They may be due for a progress x-ray or get some braces placed on teeth that have erupted since last visit, such as a second molar.  The neat thing about orthodontics, and braces in particular, is how fast the teeth start moving once treatment is started. It’s always an awesome feeling when a patient comes in for their first visit after getting their braces put on and hearing them say how happy they are with the progress that has already been made.

The appointment when the braces come off is just as exciting, if not more exciting, than when they are put on. That is when the patient gets to see the finished product for the first time and is such a special visit, one that makes being an orthodontist so awesome.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

While the practice of orthodontics has become more and more popular over the years, there are still many misconceptions about treatment. At Mack and Hansen Orthodontics, we want to help clear some things up for you:

Misconception #1: My orthodontist does the same thing as my dentist

The Truth: While it is true that the goal of both orthodontists and dentists is to help patients achieve lifelong oral health, we do so in completely different ways.

As an orthodontist, Dr. Spencer Mack and Dr. Andrew Hansen help patients achieve oral health by addressing the alignment of your teeth and jaws. By correcting these issues, they are able to help patients with a variety of oral health issues including; crowded teeth, bite problems and even speech impediments.

A dentist works with patients to prevent and treat a variety of oral hygiene and health issues including; teeth cleaning, gum disease, tooth decay and other common oral health problems.

Misconception #2: Orthodontists only treat children.

The Truth: Most of the time the people you will see at an orthodontist office are children and teenagers. However, there has been an increase in adults visiting the orthodontist. Treatment for crooked teeth and a bad bite can occur at any age.

Misconception #3: My child needs to have all their adult teeth before visiting an orthodontist for braces.

The Truth: The American Association of Orthodontists recommends that children see an orthodontist for their first evaluation at the age of 7. This gives the orthodontist an opportunity to treat any problems early on while the jaw is still growing.

Misconception #4: It takes too long!

The Truth: While the duration depends on the severity of your issues and the speed in which your teeth move, the majority of patients have braces for about two years, but sometimes it is a lot less. While two years may seem like a lot, it is a miniscule amount in time for a smile that lasts a lifetime.

A smile is a powerful asset. Do not let these common misconceptions prevent you from pursuing orthodontic treatment.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Over one-third of all orthodontics patients are adults who sought out adult braces and aligners to straighten their teeth. With smaller brackets, less obtrusive metal bands, and alternative straightening options at affordable prices, the reasons for not getting adult braces or aligners pale in comparison to the benefits. Straighten your teeth now to enjoy beautiful and healthy teeth for years to come.

ADULT BRACES AND ALIGNERS ARE EASILY ATTAINABLE

With time, braces and aligners have become more affordable, and you now have an income of your own to use as you please. As an adult, it is a great time to get braces because you can now afford it. Even if you are worried about finances, we can work with you to create a payment plan that works for you, and insurance may even help pay to have your teeth straightened, especially if your teeth are making dentist visits for repairs more prevalent.

ADULT BRACES AND ALIGNERS ARE MORE ATTRACTIVE

As mentioned in the introduction, braces are now being made with small components. The smaller the components, the less noticeable the braces. The braces we use for adults are hassle-free and comfortable to wear. If you don’t like the idea of traditional metal adult braces, you can choose ceramic (clear) braces that are tooth-colored for less visibility, or clear aligners that are transparent. No matter which option you decide on, the adult braces and straightening treatments we offer are as disguised as possible, so they do not distract others from your beautiful smile. With our adult braces and aligners, you can go about your business life and social life as you would have without braces while never feeling self-conscious or less attractive.

ADULT BRACES AND ALIGNERS ARE ADVANTAGEOUS

As you have most likely heard, adult braces provide you with more than just a more attractive smile. Straightening that occurs with adult braces or aligners results in fewer cavities, less cleaning hassle, a shorter flossing period, and a more comfortable bite. With crowding and crooked teeth, it is hard to reach every crevice and provide your teeth with the brushing and flossing they need to effectively remineralize, preventing cavities. Once you receive straightening treatment, you will experience a noticeable difference in your oral cleaning routine that frees up your time in more ways than one. You may even get to visit the dentist less for restorations and teeth whitening treatments.

These are merely a few of the reasons adults pursue adult braces and straightening treatments regardless of their age. If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign clear aligners please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Do you know what the best age is to bring your child to their first orthodontic evaluation?

We can guess that most people would think it is in their early teens. One of the things we hear all the time in our office is: “I can’t schedule my child yet because they haven’t lost all their baby teeth.” However, the recommended age for a child’s first orthodontic checkup is seven years old. Even if your child’s teeth seem straight, there may be an underlying issue that only the orthodontist can detect.

This is why Mack and Hansen Orthodontics in Longview, TX and the American Association of Orthodontists recommend every child to see an orthodontist by the age of seven years old. We want to make sure everyone from the dentist to the parents understands the importance of these early evaluations.

According to the American Association of Orthodontists, there are many reasons why your child should be seen by age seven. First of all, Dr. Spencer Mack or Dr. Andrew Hansen can spot subtle problems with jaw growth and emerging teeth while some baby teeth are still present. Your child’s check-up may reveal that your child’s bite is fine. On the other hand, our orthodontists may identify a developing problem that can be monitored with your child’s growth and development and then, if indicated, begin treatment at the appropriate time for your child. In certain situations, Dr. Mack or Dr. Hansen might find a problem that can benefit from early treatment and be able to achieve results that may not be possible once the face and jaws have finished growing.

Early treatment may prevent more serious problems from developing and may make treatment at a later age shorter and less complicated. It also allows our orthodontists to

– guide jaw growth
– lower the risk of trauma to protruded front teeth
– correct harmful oral habits
– improve appearance
– guide permanent teeth into a more favorable position
– improve the way lips meet

Our orthodontic consultations are ALWAYS complimentary, so you don’t have to worry about any cost or insurance claims taking anything away from your benefits. We just want to make sure we are doing what is best for your child. Have no fear, if your child doesn’t need braces we will simply follow up with them monitor their growth through set appointments ranging from 6-month to 12-month intervals. When they are ready for braces, we give you and your child all the information needed about their treatment.

Please feel free to call our orthodontic office here in Longview, TX at 903-212-7737 with any questions you may have. We will be happy to answer those questions and look forward to giving you and your family “Something to Smile About.”

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

What does an orthodontist do?

When it comes time to decide who you should see about orthodontic treatment (braces or clear aligners) there is some information you should be aware of.  While you might think of an orthodontist as someone who just straightens teeth, there is much more that orthodontists do. Not only do they straighten teeth and align bites, they also help correct irregular jaw growth. This is one of the main differences between a dentist and an orthodontist. While dentists do receive some training on orthodontics, an orthodontist attends a residency program after dental school. During this 2-3 year residency program they do nothing but learn and practice orthodontics.

Since most people focus on their front teeth and not their bite or how their jaws line up, it is understandable that many people do not think orthodontists correct these things. However, every orthodontist is trained in diagnosing and correcting malocclusions and aligning teeth and bites. Of course, there is a significant benefit to having straight teeth including increased confidence and self-esteem.

What types of braces are there?

There are a number of different types of braces used by orthodontists and they are not like the braces used in generations past. The types of braces we use today are much less noticeable, much smaller, and are less prone to breaking off the teeth due to advances in the orthodontic materials used. We provide numerous types of braces at affordable prices. For more information on the types of braces including metal braces, clear braces, and Invisalign clear aligners, visit our types of braces page.

What do I have to do differently if I am wearing braces?

It is important that you are brushing your teeth at least twice a day for two minutes each time while you are wearing braces. Even better, you should be brushing after every meal. Additionally, you want to do your best to avoid sugary drinks and acidic foods and drinks while undergoing orthodontics treatment. The reason for this is over time, areas of decalcification can start to appear on your teeth. These areas are commonly known as white spots. It is also important to avoid crunchy hard foods like chips and crackers, pretzels and peanuts. These types of foods are more likely to cause brackets to break.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Did your child go back to school with braces on? The good news: they’re on track to a straighter, healthier smile. The not so great news: they have to deal with cleaning their brackets and wires 24/7 — even during school hours.

Here’s How To Keep Braces Clean At School:

1. Carry A Care Kit

Help them out by putting together a small, private dental to-go kit. Here at Mack and Hansen Orthodontics we provide every patient with one of these at the time they get their braces on. This helps them stay organized and on track with their oral hygiene at school, practice, and even during a sleepover with friends.

2. Brush Or Rinse After Every Meal

Brushing is important in the morning, at night, and also after every meal. Remind them to brush or rinse after lunch and every snack.

3. Drink Plenty Of Water

Having a water bottle handy throughout the day will help clean their braces while keeping them hydrated at the same time. They should drink water instead of sodas or other sugary drinks since sugar can stain teeth and leave behind residue that can cause cavities.

4. Protect Your Mouth During Sports

Physical activity can be dangerous for anyone. But, it’s especially true for someone with braces. They should wear a mouthguard to protect their teeth and their braces from any impact or injury they may sustain out on the field or court.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

.For this reason it's critical to have your periodontal health evaluated prior to getting braces. This applies particularly to adults, since a 2013 study by the Center for Disease Control estimated that over 40% of adults 30 years of age and older had periodontitis (gum disease). If you do have periodontitis, moving your teeth with braces will only make things worse.

Conversely, there is also risk for periodontal disease if you don't get orthodontic treatment. Malocclusion, as well as crooked and spaced teeth, can all contribute to periodontal disease. In these situations your teeth and gums are more difficult to clean and become breeding grounds for disease causing bacteria. Bad oral hygiene combined with these traits can greatly contribute to the development of periodontitis.

So, periodontics and braces have a tricky relationship. On one hand, you shouldn't get braces if you show signs of developing or have periodontitis, while on the other hand, braces can help prevent the possibility of developing periodontitis by correcting the bite and straightening the teeth.

If you are 30 years of age or older and are considering getting braces, it would be wise to first:

• Let Dr. Spencer Mack and Dr. Andrew Hansen know about your desire to get braces
• Get an exam to make sure you're in good periodontal health and a good candidate for braces
• If you are a good candidate, keep an eye on your teeth and gums and get regular dental checkups throughout your course of treatment.

If you are in any doubt about the status of your teeth and gums, it's always best to get them checked before embarking with braces treatment. For more information or to have your periodontal health assessed for braces treatment, please contact us at our Longview office.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer

Have you ever thought about how you're cleaning and storing your toothbrush when you're not using it? Did you know that the way you store your toothbrush could have an affect on your oral health? In this post, we'll look at some steps you can take to maximize toothbrush cleanliness and minimize bacteria.

Below are some tips from Dr. Spencer Mack and Dr. Andrew Hansen for toothbrush use and storage:

• Don't share your toothbrush– This may seem obvious, but sharing a toothbrush exposes both users to bacteria and microorganisms from the other user, which can increase chances of infection. You will also want to avoid storing your toothbrush in the same container as other people’s toothbrushes.
• Thoroughly rinse your toothbrush after each use– Rinsing your toothbrush well under running water will help remove food particles, toothpaste, and other debris from the bristles of your brush that you definitely do not want on your braces.
• Store your toothbrush in an open-air container not a sealed one– Putting a wet toothbrush in a sealed container creates a favorable environment for microorganisms and bacteria.
• Soak your toothbrush in an antibacterial mouthwash after use– There is some evidence to suggest that soaking your toothbrush in an antibacterial solution may reduce the amount of bacteria present on the toothbrush.
• Change your toothbrush every three months– The bristles of your toothbrush become less effective and frayed after repeated use so it's a good idea to replace it on a regular basis. It's also wise to replace it after you've been sick.

There are many simple things you can do to make your oral-care regimen as clean as possible. Use common sense when storing your toothbrush—don't put it in a dirty place like the edge of your sink or in the shower (please, not by the toilet!), and keep it upright in a cool dry place—and you're usually good to go. If your toothbrush is looking a little worse for wear, drop by our Longview office and we'll be glad to provide you with a new one, or you can learn about the electric toothbrushes we have too.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

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If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

The alarm sounds in the morning, you hit snooze, then you finally wake up and realize you forgot to wear your retainer

If this only happened once, don't panic. Missing one night with a retainer is unlikely to cause significant teeth movement. However, if it has happened often, give our team a call to make sure your teeth haven’t shifted position.

Here are some tips from Dr. Spencer Mack and Dr. Andrew Hansen to help you remember your retainer:

1. Write down the instructions we give you for wearing the retainer, whether you should wear it all day or at night, or just a few times a week. Writing things out like this helps set the schedule in your memory.
2. Clean the retainer when you take it out each time. If you don’t you may not have time when you’re rushing to get to work or school to clean it properly and may be tempted not to wear it.
3. Put a note on your mirror or in your purse or wallet reminding you to wear your retainer.
4. Set an alarm on your phone to remind you when it’s time to put the retainer in. If you have email with a calendar you can set up daily reminders, too.
5. Always put your retainer in its case when you take it out to eat or sleep. This will reduce the risk of losing it or accidentally throwing it away.
6. If you don’t have to wear the retainer every day, you can use some recurring events to help you remember. With this system for example, watching your favorite weekly TV show, laundry day, or family pizza night can all serve as reminders that you should put in your retainer.
7. Don’t be shy about asking for help if you’re forgetful. Assure everyone around you that you won’t consider it nagging if they remind you to wear your retainer.
8. Ask your friends if they have had any teeth shift when retainers were not properly worn. Those stories can serve as a timely warning not to let the same thing happen to you!

Remember, you can always call our team in Longview if you feel your retainer is uncomfortable or painful. We'll work with you to protect your smile!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Of course you are aware that Halloween is just around the corner. For children, this means trick-or-treating is just around the corner as well. If you're a follower of our blog, you also know October is Orthodontic Health Month.

In terms of braces, this photo should help serve as a reminder of the types of foods that are OK to eat when you have braces on, as well as those we should probably avoid.

Regardless of if you or your child are undergoing orthodontic treatment with braces or invisalign, it is important to take care of your teeth and be healthy and safe this Halloween season. The American Dental Association recently published a great article on ways to keep your teeth, mouth, and body healthy this time of year.

The ADA recommends brushing your teeth at least twice a day for two minutes each time you brush. When you are undergoing orthodontic treatment, brushing more frequently is a great way to help combat any sugar bugs from sticking to your orthodontic appliances (braces or invisalign).

Many of our patients ask what is the best type of toothbrush to use. We will have a post coming soon about the different types of toothbrushes, but as a general rule, an electric toothbrush is going to be more effective than a manual toothbrush. Additionally, most electric toothbrushes have a 2 minute timer that makes it easy to know how long you have brushed for and if you have brushed long enough.

Be sure to check back for our post on toothbrushes, and have a safe and happy Halloween!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Good oral hygiene consists of a daily regimen of brushing, flossing, and rinsing to prevent tooth decay and other bacterial infections. We often get asked what the best type of toothbrush to use is, but we also get asked about mouthwash as well.

There are many different types of mouthwashes to choose form, and each will have varying effects on your oral health. So which type is best for you?

Gum Health

Antiseptic mouthwashes are made to reduce the majority of bacteria on and near the gum line. Using this type of mouthwash can help decrease your chances of getting gingivitis. If possible, look for a mouthwash with antibacterial or antimicrobial ingredients.

Fluoride

Fluoride is beneficial for not only oral health but it can help prevent tooth decay as well. If you drink a lot of bottled water without fluoride, we may recommend that you consider a rinse with fluoride in it.

Bad Breath

Although mouthwash is mainly designed to prevent bacterial build-up within the mouth, many people use it to fight bad breath. Most mouthwashes will help eliminate the bacteria causing bad breath, and some are specifically designed to do so.

However, if bad breath is a chronic problem for you, that requires daily treatment with a mouth rinse, let us know if this is that case and we can discuss your symptoms.

American Dental Association Approval

The ADA reviews mouthwashes and rinses for safety and effectiveness. If an item has the ADA Seal of Approval, that means it meets strict criteria, and will have scientific evidence or clinical studies that support the claims of the manufacturer. If possible, select a mouthwash that has the ADA Seal of Approval to ensure you are using a high-quality rinse.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Not sure what to put in those lunch boxes! You will want to add some snacks that your kids will think are yummy, but are also healthy, and tooth-friendly. From salty and sweet to crunchy and chewy, here are some fresh solutions for this school year:

Yogurt
Yogurt is a great substitution for pudding. This yummy snack is loaded with probiotics that can help heal mouth sores and promote healthy gums.

Pita Chips and Hummus
Consider adding whole grain pita or even vegetables with hummus instead of packing buttery popcorn. Popcorn can damage your children’s teeth, with or without braces, and can lead to tooth decay.

Fresh Fruit
Put the dried fruit snacks down! They contain high amounts of sugar which we all know does damage to your child’s teeth. Sugar bugs live on your children’s teeth and erode away their tooth enamel. Fresh fruits that have high water content, like apples and pears, counteracts the sugar in the fruit.

String Cheese
Cheese is great for your child’s teeth. It helps reduce plaque growth, boosts their enamel (making their teeth stronger) and tastes great!

Flavored Water
We know not everyone likes the taste of water, but keep the fruit juice and Gatorade out of their lunch box! It may be their favorite, but it has more sugar than eating fresh fruit. Add a naturally-flavored, sugar-free water alternative — or a packet for them to create their own at the lunch table.

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

If you’re an adult who is not happy with your smile, there is good news: Braces are just as effective for older people as they are for the young.

Years ago, adults were discouraged from having their teeth straightened. Back then, it was assumed braces worked best for children whose mouths were still growing.

Today, we know otherwise. Braces can create beautiful, lasting smiles for adults, too – even into their 80s. Delta Dental and the American Association of Orthodontists report more than 1 million Americans over the age of 18 are wearing braces.

It’s not too late to get that beautiful smile you’ve always wanted!

On the other hand, you may wonder if correcting your smile now is worth the time, energy, and investment. After all, you’ve lived with your crooked teeth this long. The answer is, resoundingly, yes. Bad alignment and related orthodontic issues can lead to health problems as you age. Correcting your smile is about much more than simply enhancing your appearance.

Here are some of the reasons to consider braces despite your age:

You will have healthier teeth and gums. Straight teeth are certainly easier to clean. Plaque contributes to tooth decay and gum disease and it is much more difficult for your toothbrush to reach when your teeth are crowded. Gum disease, or periodontitis, can cause tooth and bone loss and a host of broader health issues. Many adults are surprised in their later years to lose sound teeth because of unhealthy gums and bones.

Your jaw will be healthier, too. An uneven bite can lead to bone loss in your jaw and may be the cause of jaw joint issues, such as temporomandibular joint disease, or TMJ. A bad bite also can contribute to headaches. Orthodontics usually can improve these conditions.

Snoring or sleep apnea may be reduced. Excessive overjet, where your top teeth protrude – the traditional “buck teeth” – can be associated with your airway being blocked while you sleep. A partially blocked airway can lead to snoring. If it’s totally blocked, you could experience sleep apnea, which continually disrupts your rest. Sleep apnea is associated with several health issues, including heart problems.

Your self-esteem and confidence will get a boost. You may think you’re okay with crooked teeth, but if you purse your lips in photographs or cover your mouth when you laugh, you are more self-conscious than you realize. A confident smile has been shown to increase self-esteem, which in turn can open up career and social opportunities. In a recent Invisalign study, job applicants with straight teeth were 45% more likely to be hired over people with similar qualifications, but unattractive teeth. In the same study, 38% said they would not accept a second date with someone who has misaligned teeth.

Your happiness level may increase. Simply smiling makes you happier. When you know your teeth are beautiful, you’ll smile more often and more radiantly.

Just remember, when it comes to adult orthodontics, you have options – and none of them are the clunky metal ones you knew as a child.

Here are the primary choices:

Clear or ceramic braces. These braces function much like traditional metal braces except the brackets are clear ceramic rather than metal. Adults LOVE these types of braces because you can barely tell they are there. Plus, you can still choose to wear colors on them if you so desire.

Invisalign. These are clear plastic trays, called aligners, that can barely be seen when you wear them. These aligners are computer-generated at the start of your treatment, and you wear each one in progression for about one-two weeks. Besides their clear appearance, they are welcomed by many adults because they can be removed for up to two hours each day for cleaning and eating. You won’t need to buy special brushes or eliminate foods from your diet.

Modern metal braces. These aren’t the metal braces of your childhood. They are lighter and thinner – and just like the clear braces, you can choose colors that allow you to express your personality or mood. They still straighten your teeth with wires, metal brackets and rubber bands

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Here at Mack and Hansen Orthodontics we are committed to making orthodontic treatment affordable for everyone.

We get a number of questions during a typical week about how we make treatment affordable including our payment plans, which we do offer with 0% interest, insurance, and medicaid.

When it comes to braces, there is a difference between orthodontic insurance and dental insurance. Orthodontic insurance does cover braces, but just because you have dental insurance does not mean you have orthodontic insurance. It is important to understand this because if you have the option of adding orthodontic insurance, you may want to consider doing so.

We also often get asked if medicaid covers orthodontic treatment and braces, or if there is an orthodontist who accepts medicaid here in Longview, TX. Here in the state of Texas, it is rather difficult for an orthodontic case to be approved by Medicaid. In fact, very very few orthodontic (braces) cases are approved each year. So while there may not be a medicaid orthodontist in Longview, we do not want this to be a barrier for those who want and need braces and that is why we make every effort to ensure treatment is affordable for you and your family with our low down payments and payment plans

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

October brings lots of changes and new experiences…cooler weather, crackling leaves, cozy fires, and Halloween! For orthodontists across the country, October also brings National Orthodontic Health Month. This is a great opportunity for us here at Mack and Hansen Orthodontics to remind patients of some care and safety basics for their braces.

We have provided these 4 ways to protect your braces, aligners (Invisalign), and other orthodontic appliances for our patients to keep in mind all year round.

Avoid Sticky Snacks
This includes hard candy, sticky foods, crunchy or chewy snacks, and candy.  Bubblegum, taffy, caramel, gummies, and jelly beans can all become stuck in appliances and cause damage to your braces.  Instead, opt for a healthier alternative, such as fruit cut into bite- size pieces.

Hard Treats are a No No
Crunchy treats, such as the -itos family (Doritos, Fritos, Cheetos, and Tostitos), nuts, popcorn, and even ice are all foods that can cause braces, even adult braces, to break. Breaking the brackets or wires on braces causes damage to the appliances and requires a visit to us to fix them.

Make Sure to Brush
All the extra sweet stuff can cause cavities, so make sure to brush and floss regularly. When wearing braces, be especially careful about brushing and flossing after every meal and after having a sweet treat.  You can ask us about the right tools for caring for and cleaning your braces.

Find an Alternative to the Sticky Stuff
Not all treats are off limits to orthodontic patients.  Soft chocolates, peanut butter cups, and candies that don’t contain nuts are a good alternative for a sweet treat. Just make sure to follow the guidelines we give you when you get your braces on!

Mack and Hansen Orthodontics wants our patients to have a fun and healthy Halloween!  If you forget any of these tips and tricks and need to see us for any reason, contact us at 903-212-7737 for an appointment. See you soon!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Are you on the path to a straighter, healthier smile? Every patient has a different timeline, but typically it takes up to a little over a year to refine. That’s 12+ months of perfecting tricks, hacks, and all the tips in between. Here’s a list of our best hacks from Dr. Spencer Mack and Dr. Andrew Hansen:

1. Waterpiks are lifesavers. We recommend them over dental floss for everyone, especially when you have braces.
2. Download a mirror app. Food can get stuck in both your teeth and braces. But having a mirror always on hand — or on your phone — makes it easy for you to check for left-behind crumbs.
3. Fix wires with a tweezer. Wires can slip out of place very easily. Instead of swinging by to visit us, you can just slide the wire back into place with a tweezer.
4. Consume non-staining foods and drinks. Even healthy foods like berries can stain your teeth, and the seeds can get stuck in your brackets. Steer clear of stain-causing, acidic foods for more confidence while you’re at work or out with friends.
5. Have warm water and salt ready. If your mouth is every sore, rinse with 2 tablespoons of warm, salt water.

12+ months with braces can seem like a lifetime for both teens and adults. However, keep in mind that orthodontic treatment is often the best way to fine-tune your smile!

If you have any additional questions about Mack and Hansen Orthodontics or want to discover how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain straighter teeth and a healthier smile with braces or Invisalign please contact us today! You can also visit www.etxortho.com to learn more about our orthodontists and request a complimentary consult, or you can call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Dirt Pudding Pumpkin Patch

Ingredients:

• 2 (14 ounce) packages chocolate sandwich cookies (such as Oreo®)

• 1 (8 ounce) package of softened cream cheese

• 1/2 cup softened butter

• 1/2 cup confectioners' sugar (YUM)

• 3 1/2 cups milk (choose your type)

• 2 (3.5 ounce) packages instant chocolate pudding mix

• 1 (12 ounce) container thawed frozen whipped topping

• 1 (5 ounce) bag gummy worm candies (just for fun)

• 40 candy (mellocreme) pumpkins

• 1/2 cup vanilla frosting (optional)

• 1 drop green food coloring

1. Crush cookies in 2 or 3 batches in a food processor. Pulse until you get fine crumbs, about 30 seconds per batch. Transfer to a bowl.

2. Place cream cheese, butter, and confectioner's sugar in food processor; mix until smooth, about 30 seconds.

3. Whisk milk and pudding mixes together in a bowl until pudding is thickened; fold in whipped topping. Stir in cream cheese-butter mixture.

4. Press 1/3 of the cookie crumbs onto the bottom of a 9x13-inch pan. Sprinkle half of the gummy worms on the crumb layer. Spread half of the pudding mixture over the crumbs and candy. Carefully layer another 1/3 of the crumbs over the pudding mixture and sprinkle on more gummy worms. Add the last layer of cookie crumbs and smooth them out for your "pumpkin patch."

5. Place pumpkin candy in rows with enough room to for frosting "vines" and "leaves."

6. Tint frosting with green food coloring and transfer to piping bag. Connect pumpkins with "vines" and add swirling tendrils. Switch to a leaf tip and create some leaves.

   That's it! Check back regularly for our Recipe of the Month. Happy October!

   If you have any additional questions about Mack and Hansen Orthodontics or how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain a straighter, healthier smile, please contact us today! Visit www.etxortho.com to learn more, or call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

We had the best time this past weekend at the Buddy Walk with family & friends! Thank you to everyone who came out to support such a wonderful cause.

For those of you who don't know, the Buddy Walk is an event held every October to promote awareness and inclusion of individuals with Down syndrome and is put on locally by the East Texas Down Syndrome Group.

The Buddy Walk is especially close to our hearts because of our cousin, Alex, who was born with Down syndrome. She is the light of our family, and we love her dearly.

For more information about the East Texas Down Syndrome Group, please visit http://www.etdsg.org/

If you have any additional questions about Mack and Hansen Orthodontics or how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain a straighter, healthier smile, please contact us today! Visit www.etxortho.com to learn more, or call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.

Thank you for taking the time to visit our blog. Please check back often for weekly updates on fun and exciting events happening at our office, important and interesting information about orthodontics and the dental industry, and the latest news about our practice.

Feel free to leave a comment or question for our doctors and staff - we hope this will be a valuable resource for our patients, their families, and friends!

If you have any additional questions about Mack and Hansen Orthodontics or how Dr. Spencer Mack and Dr. Andrew Hansen can help you gain a straighter, healthier smile, please contact us today! Visit www.etxortho.com to learn more, or call us at 903-212-7737. We’re conveniently located in Longview, TX and are just a quick drive from Marshall, Carthage, Henderson, Kilgore, and Gilmer.