lithgow valley Smiles,
Mark Cordato,
Orthodontist

155 Main Street

Our message to you:

We aim to provide outstanding orthodontic treatment

We are determined to make your treatment as comfortable as possible using efficient evidence based methods.


We work hard to deliver the best treatments possible in Australia. 



My being a member of many  orthodontic and dental organisations helps me be up to date and well informed about all aspects of orthdontics and dentistry.



Some of my Fellowships and Mebershiips are shown.

We guard your personal information

Health professionals are entrusted with their patient's information. This includes what we are required to gather for diagnosis and records. 


We need to be trusted to keep your private records private. If they may prove a good example for teaching I will ask for permission for that circumstance alone. It will not go to a website.

Photos


We do not use any of my patient before and after images on a website because:

I regard it as a breach of patient privacy;
the Dental Board of Australia discourages use of patient images;

I need images for my work. Photos of you are not my property to advertise my business; and

once placed on the Internet, other people can copy the images and use them how they choose (for good or bad).

Photos of people on my website are either professionally taken and usually from overseas.

Straightening (Aligning) teeth

Metal braces in orthodontistcs

We use the smallest braces


Control of the teeth is just as good with small or large brackets (braces). We choose the smallest brackets because they look better. If you need larger brackets we can order them in for you. We know our brackets are the smallest used in the area.


For more information on my brackets see:


 https://www.dentaurum.de/eng/equilibrium-mini-12646.aspx


Tranparent braces in orthodontics

Clear brackets made of artificial sapphire are available for people who are gentle and a low risk of breaking the ceramic. They look less visible and some adults prefer this. 


Breakage can be a problem with ceramics as can staining from foods such as curries, tomato paste and red wine. Poor cleaning shows up even more on clear braces.


 We currently use the Ormco Inspire Ice brackets


Whatever you choose we can move the teeth

We are highly experienced in metal and clear braces. We also use Invisalign for those who want even less visibility.


The control and idividualisation braces allow is unmatched by any other orthodontic approach.

Braces that we use #2

 Braces at Lithgow valley smiles  

Improving your smile

We know braces are visible, often not attractive but only braces have the best control and flexibility to get the best smile we can. So we use the smallest metal braces and the clearest clear braces. You get control with less show of the braces. 

Types of braces

Metal braces

We use the smallest commercially available braces (Dentaurum equilibrium mini brackets). They give full control and because they are small, they are less noticeable and more comfortable. I have to use special dental magnifiers when I work with them but you have to wear them all the time and I am told by patients they notice that my brackets are smaller than any others.  lithgow valley Smiles - our Orthodontic braces Metal braces don’t shatter like clear braces can. They can take wear and tear. Metal braces are smaller and more comfortable. They are used on most young patients and older patients who do not need clear braces. If you are interested in a more thorough explanation of braces and their history I have written a small article. 

Clear braces

These are monocrystalline sapphire brackets. They are small and clear. We currently use the Ormco Inspire Ice brackets. The ties can pick up stains from highly coloured foods such as curry, tomato paste and even red wine. There are good reasons they should not be used in contact sports.  The clear braces are very clear and are a good choice when less visibility is required.      

These braces are also used at Mark's Bathurst office see creatinggreatsmiles.com.au

A short History of braces

  

Braces in Orthodontics


The braces we use and why

Dr Mark Cordato uses Dentaurum mini twin brackets for his treatments.  These are the smallest brackets in commercial production and as such they are less visible, yet still have the same control as other brackets. One of the few disadvantages of small brackets is that magnification is needed to both place and adjust the brackets. The magnification helps Mark to more accurately of place the brackets and all aspects of treatment. Nowadays many dentists use magnification as it helps in doing their work accurately and many would say better. The engineering tolerances of the system that Mark Cordato uses are the equal of any. He has studied and lectured on engineering tolerances and he knows the wire and bracket combinations and how that affects rotation of the teeth in each of the three axes of space.   
 

The history of Orthodontic Braces

First known braces

Orthodontic appliances have been found on corpses of young Etruscans 2000 years old. Obviously, they did not like their crooked teeth and wanted them fixed. 

These were mainly the use of wire to move teeth. Pierre Fauchard[1] described moving teeth in the 1800s and Surgeon John Hunter also described ways of moving teeth soon after that. 

Early orthodontic braces (20th century)

Braces became the quality treatment choice over 100 years ago. EH Angle was the founder of two great dental specialities, orthodontics and occlusion (the study of the way upper and lower teeth meet). Orthodontics became Dentistry’s first specialty. It has developed in this specialty environment for the last 120 years with a huge knowledge and skill base just in this area.  The bands were made from 18carat gold strips of thin metal, they were stretched around the tooth the folded and soldered and welded . Brackets were needed to hold the wire to the band. These brackets were hand made as wax molds and then cast in 18carat gold and welded to the metal strip that would eventually form the band.  Some of the earliest brackets and bands were developed by Angle and made the pin and tube appliance. The wires had other wires soldered to them to allow control of the teeth and to move the teeth.  In 1928 Angle patented another appliance which has become the basis for the dominant braces technique around the world. It was the edgewise bracket. It still needed bands and brackets welded to them. The wires were also made of gold and were made up to sizes of 0.022 * 0.025 inches (0.55*0.625mm). These were wrought wire for better strength and resilience. The bands were individually formed from metal strip, initially 18carat gold strip, tightly pulled around a tooth and then folded and welded (the orthodontists at the time use the term soldered) with gold solder. Later, stainless steel strip was used and electric welding was used to close the strip. This was a very long process and it became much faster when the Rocky Mountain Orthodontic company introduced seamless bands. Brackets were welded to the bands and more recently they have been laser welded. 

More modern braces

There were some problems in the use of braces over the years. Obviously, the cost of gold was exorbitant and the labour in drawing up bands and custom making brackets, soldering parts together made the expense of braces at a level where so few could afford it. During the second world war gold was being used as a currency and was being stolen or hoarded. Use of gold in the mouth in the years after the second world war in Europe was not allowed.  Stainless steel was patented early in the 1900s. The early stainless steels were marketed as stainless but they did experience pitting and corrosion. They were not the stainless steels we know today. The alloys had far less nickel and chromium than modern alloys. Stainless steel would eventually take over from gold as the main material for braces, stainless steel is harder, corrosion resistant , and formable. Steels such as the 304 series can be work hardened to improve strength and other physical properties. Such standard steels are used in cooking ware. This is not marine grade stainless as these steels cannot be work hardened and all dimensions would need to be larger, thicker and bulkier. Some of the consequences of stainless steel use became apparent during the Korean war in the 1950s. Nickel became very difficult to source and some orthodontists had to use piano wire but unfortunately, they corroded and rusted. Other sources of nickel were discovered and soon after an Australian metallurgist, Arthur Wilcock began drawing orthodontic wires in Melbourne. Even today, the Wilcock wires are probably the finest in the world with the greatest strength and resilience. 

The Begg technique

An Australian orthodontist, P R Begg, studied under Angle and after using edgewise brackets he then developed a radically different technique and in collaboration with Wilcock they developed the Begg technique. It used a tipping technique which moved the crowns and then the roots were moved.  In skilled hands it is a powerful technique that can produce quality results but Barry Mollenhauer showed ways of controlling molars and anterior rotations to a consistently high level. There were philosophical problems including change to the technique was actively discouraged and eventually it has almost faded into history.  A version derived from Begg still exists. Tip Edge technique tries to combine the advantages of Begg and edgewise techniques and it has to some extent but it is only used by a few orthodontists. 

Straightwire

In 1972 Laurence (Larry) Andrews published a study on ideal orthodontic cases. He then reverse engineered a straight wire and brackets that could be move the teeth to positions with minimal bending of the wires.  This idea has been adapted by many companies and brackets embodying so many differing ideas on how to produce a system which can produce good orthodontic results with no wire bending. It is an interesting theory but engineering tolerences, bracket shapes and variations in tooth shape conspire to make this a rarely achieved dream.  Variants such as the Roth system have become the most widely used of all brackets. This takes the assumption of a slightly undersized wire in a rectangular slot and there are angles built in to compensate for the ‘slop’. This slop was taken further by Robert M Ricketts who used even smaller wires in a smaller slot, this dramatically decreased forces which then allowed for intrusion of incisors and he managed to treat with fewer extractions. Even at this stage, bands were still being used around the teeth. 

Bonding

Bonding was introduced into dentistry by Dr. Michael Buonocore after his 1955 paper[2], however, many processes needed to be introduced before orthodontic brackets could be attached to teeth with a bonding method. Initially the bracket was attached to a metal base with many perforations. Later, brackets were attached to stainless steel mesh and this was introduced in the 1980s and became the predominant method of attaching brackets to teeth from the 1990s onwards. The brackets were welded to woven stainless steel mesh often ranging from 60 to 100 per inch with 80 being the most common.  The bonding revolution was in full swing but there were issues with the orthodontic brackets and the mesh coming apart. Bond strengths were always an issue.  Methods of manufacturing have changed and brackets are no longer stamped and milled. Modern methods use computer aided design (CAD), metal injection moulding (MIM) and computer aided manufacture (CAM). The mouth is a harsh environment for metals and for having different metals close to each other the modern method of only one type of metal for brackets has advantages. 

Braces today

Recent changes

In recent years there has been much discussion regarding self-ligating brackets where metal gates are built into the bracket with the aim of reducing friction. The brackets can cost up to 10 times more. The idea was that it would lower friction and reduce aligning times, the first part of treatment. When tested it made no difference, it simply cost more. There are many articles and even a Cochrane study which plainly notes that self-ligating brackets have no time advantage and it can be easily deduced there is a monetary disadvantage to the patient, it costs more for no benefit. Self-ligating brackets have been a costly dead end. I do not use these expensive brackets as they have no treatment advantage.

Newer orthodontic bracket manufacturing techniques and materials

Braces are now most commonly manufactured with metal injection molding in one piece. There is often a bonding base in the manufacture that is used for bonding. Metal is still the most versatile material but it has changed to corrosion resistant powder metallurgy  such as 17-4PH (precipitation hardened) which has similar properties to the chromium nickel 300 series stainless steels[3].  I expect that in the future the use of duplex and triplex two or three differing metal alloy powders) powders will produce further property advances which will allow further size reductions. 

Other metals

Titanium is used by a few manufacturers to remove nickel from the orthodontic system. Titanium has a lower strength than steel and the titanium braces must be formed to work harden them. Titanium tends to be a very ‘sticky’ material, similar to a soft aluminium. Ask any engineer who has to tool aluminium or titanium and they will tell you how difficult this is. I have seen this first hand at the Wilcock factory and even when I obtained a new material, titanium-niobium for him to draw into wire. The stronger alloys of titanium and aluminium tend to machine and draw easier. The difficulty of using titanium in braces is demonstrated by only one company having a product on the market. 

Other materials

· Ceramic brackets 

· are very hard and can wear the opposing teeth. I do not use ceramic brackets on the lower teeth as these can cause rapid wear of the upper teeth.  · Ceramic brackets, like any ceramic, are brittle and do not show on X-rays, another reason to use them sparingly on younger patients. · The ceramics are most commonly mono- or poly-crystalline sapphire. · Ceramics need some bulk for strength so they are a little larger than metal brackets.  · They have a tendency to fracture tie wings when twisting forces are applied. 

· Plastic brackets

· Such as cross linked polycarbonate and acrylic brackets. These brackets had frequent bonding failures. The plastic is softer than metal or ceramic materials and when full bracket engagement is required later in treatment the dimensions of the bracket slot substantially reduce the accuracy of the appliances. · My experience many years ago was that these brackets did not bond well (fell off). Also, their wear resistance is low so that by the time you need great accuracy, the bracket slot is worn so control is much poorer. · I no longer use plastic brackets 

Conclusion

Orthodontic braces have developed over a long time. There has been a lot of progress in the last 100 years and many important changes in the last 40 years. Manufacturing techniques have gone from custom made casting and soldering to accurate manufacturing with metal injection moulding (MIM) and even some computer manufacturing techniques (CNC). I have had an interest in researching the materials, their properties and manufacturing techniques as this gives orthodontists a better understanding of how to best use these complex systems.
   [1] Dr Mark Cordato was invited to be a member of the Pierre Fauchard Academy in recognition of his philanthropic activities.   [2] Buonocore MG: A simple method of increasing the adhesionof acrylic filling materials to enamel surfaces. J Dent Res 34:849-53, 1955.   [3] 304 Stainless Steel and 17-4 PH (Precipitation Hardened) steel both have corrosion resistance, high strength and the capacity to be formed into complex, small shapes with reasonably fine manufacturing tolerances.    

Orthodontic Wires

  

Wires

I (Mark Cordato) spent several years doing post-graduate research with the University of Sydney Biomaterials Unit. My particular interests were orthodontic wires, metallurgy and biomaterials. During that time I learnt more about wires and I made opportunities to visit wire production facilities. I went to M M Cables to see the manufacture of various copper wires and also to Arthur Wilcock at Whittlesea in Victoria and developed a strong relationship with Arthur Wilcock Jnr and his manufacturing of specialist orthodontic wires. Wires are critical to orthodontic appliances. They store energy which can be used in moving teeth. 

Stainless steel wires 

are still the most common orthodontic wire. The stainless steel can be one strand, monofilament, and of many differing dimensions. It can also be braided (anywhere between 3 and 9 strands of wire) or woven wire. It can have varying levels of work hardening which was taken to whole new levels by AJ Wilcock at his factories in Victoria. I have spent many hours discussing wires and their properties and how to maximise these with the manufacturer Arthur Wilcock Jnr.  The time I spent on the factory floor have been important for understanding the variation in accuracy of the manufacturing which is critical in knowing how the teeth move with wires and brackets.

Titanium alloy wires

These consist of alpha titanium such as the popular Ti-6Al-4V. More recent wires have superceeded alpha titanium with beta titanium and a common one is the Beta III titanium. These can be used with non stainless steel brackets in rare circumstances. 

Nickel titanium wires

The early versions of nickel titanium wires were simply those close to 55:45 by weight which is close to 50:50 by atoms. These wires are highly flexible and were developed by NASA for aerials in space. The aerial was packed into a small compartment and it straightened out when the cover was opened in space.  These wire were further researched and it was found when the proportions of atoms were more tightly controlled it exhibited some differing and very interesting properties emerged. These properties could have a wider range when other elements such as copper are added in small proportions. The wires became heat and/or stress transformable. One of the formal names for this change is ‘martensitic-austenitic diffusionless phase transformation’ and the wires are often described as shape memory. These wires can be deflected and apply gentle forces over a long period. These wires also exhibit a distinctive hysteresis loop with differing loading and unloading slopes (the elastic or Young’s modulus changes when the wire is in its different state) and energy is stored within the area when the slopes diverge. These unusual memory properties are mainly associated with this shape-memory nickel titanium and is extremely rare in other materials and alloys. 

Expertise with various research tools

Electron microscopes Transmission and Scanning electron microscopes at the University of Sydney’s Electron Microscopy Unit EDAX – a tool for analysing the chemical composition of materials with electron microscopes UMIS-2000 Developed by CSIRO. Microscopic Brunel hardness tester. Tests for eleastic modulus, yield stress and ultimate tensile strength. Metallurgy microscopes (such as) Olympus    

Invisalign

Invisalign at lithgow valley Smiles

Improving your smile

Invisalign has been developed to move teeth with a series of clear aligners.   

Invisalign

Invisalign looks better than braces during treatment. For some people that’s all that matters. I have been an accredited Invisalign provider for over 10 years. Invisalign has developed and now has greater control than it used to. It is great for aligning teeth with a little spacing, minor crowding and small upper to lower tooth and jaw movements. 

 The more difficult the case the more challenging it is for this technique to get perfect results. Those that know this from the outset, know that if they lose an aligner treatment is slowed a lot and that not wear aligners will also slow treatment are usually very happy with the changes we get with this new approach. 

Because Invisalign aligners can be lost and not worn they can be an extra problem for teenagers. There are issues that there is less tooth visible for the aligners to ‘hang on to’ or engage so control is further limited.  

Our links to other practices

Dr Mark Cordato works in Lithgow and Bathurst patients can be treated or have problems fixed in Bathurst at times he is not inLithgow. 

Web www.creatinggreatsmiles.com.au 

Phone 6331 2788