Last week, I had a mother bring her children into the practice for new patient exams. There was nothing too remarkable about the kids’ teeth and I’d like to believe that most orthodontic specialists could give the children beautiful smiles and a healthy bite without too much difficulty. Mom admitted that she was going to see another orthodontist “just to be sure” and that she’d contact me afterwards.
When she did call me back, she asked me:”Why don’t you use Damon brackets? The orthodontist told me that they are better than traditional braces because they can finish quicker than traditional braces.” This is a question I’ve gotten many, many times when patients have seen offices that use “The Damon System”.
I’m about to venture into very deep and tempestuous waters, and I’m sure to get a lot of backlash, but my interests in writing this blog are to give parents and patients the absolute truth about dentistry and orthodontics to help them make informed decisions. Why would I get backlash, you ask?
Damon brackets are produced by a company called Ormco and the brackets themselves (or the system, as Ormco calls them) are named after their inventor, Dr. Damon. The details aren’t as relevant as understanding that in order to properly use the system, one needs to use specific wires and brackets, all produced from Ormco to achieve what they believe are faster results with a reduced need to remove teeth. Again, to properly address all of the claims that Ormco makes about the Damon system would take more room than I have here, where I simply want you to understand a proper answer to the aforementioned mother’s question. Understand that the essential difference between Damon (and all other self ligating brackets) versus traditional brackets is that they use a door to hold the wire into the slot rather than little rubber “o-rings” which the manufacturer claims reduces friction (of metal wire to metal door versus metal wire to rubber o-ring, which they claim is higher) but numerous scientific studies would show no difference in treatment outcomes or times. Other claims are shorter appointment times and better cleanliness (because the rubber o-rings purportedly catch more plaque than the stainless steel doors) but I have seen the dreaded “white spots” from poor home care in both Damon and traditional cases.
I was thoroughly trained in the Damon system, have attended their annual user’s meeting and actually have nothing against the brackets themselves. In my hands (and substantiated by scientific literature listed below 1,2,3) they work no better or worse than any other brackets. No better and no worse. However, me and many of my colleagues would tell you that these particular brackets are slightly higher profile (stick out further on the teeth) and are far narrower, which makes the “finishing” stage of orthodontic treatment more difficult. Again, note my statement above: Having treated numerous Damon system cases, I believe that I have seen results no better and no worse than any other bracket, traditional or self ligating. I am making it clear that it’s the claims of superiority made by Damon users and NOT the bracket that I have a problem with.
That said, many of the Damon system practices I know have great doctors who do great dentistry and firmly believe that the Damon brackets are superior to others. They might genuinely believe that the system allows them to minimize the need for things like palatal expanders and extracting teeth in severely crowded cases. Again, full disclosure would require that I mention there are no studies to substantiate these claims, yet many practices that utilize the Damon system will still state the aforementioned claims as if they’ve been proven and explain that the traditional brackets that I use won’t allow the same result.
As I mentioned, I am well trained in the Damon system and when I went for my orthodontic board certification I had to “defend” cases to examiners who looked at every detail. Two of my 6 cases were Damon cases and ultimately, all 6 cases passed. This is important to note. There are objective criteria for scoring the cases and all 6 cases, Damon and traditional scored well enough to pass. So, why do many Damon practices continue to advertise that they use the Damon system as if it offers some huge advantage over traditional braces? Why do parents and patients come back to me asking why I don’t use the “superior” and “faster” Damon brackets? Well, let’s look at what Ormco says about the Damon system on their own website:
“From Ormco, the Damon System is a consumer branding approach to help you better connect with patients and capitalize on their growing demand for faster, aesthetically-pleasing orthodontic treatment that delivers remarkable results and a new, beautiful smile.”
From the Ormco website, http://ormco.com/products/damon-system/ (3/26/16)
Read that sentence again and see the words “consumer branding” and “capitalize“. I don’t think there are two better ways of categorizing how most Damon practices feel to those of us who don’t use that system.
Look at what Ormco says on their website about what the Damon system can do.
“Damon smiles are full, natural 10-tooth smiles achieved with light biologically-sensible forces, and are specifically designed to improve the overall facial result of each patient.”
From Ormco website,http://www.damonbraces.com/choose/,(3/26/16)
This is no different than any other bracket and wire “system” but I ask: “What makes their biologically-sensible force different from any other?”
A simple search for “Damon Braces” on the web shows up images like the following on Damon practice websites:
It’s easy to understand that if the Damon bracket can’t stand out as a better bracket with a better outcome, how can those practices “capitalize” or create “consumer branding”?
When I bought my practice, I had $47,000 in Damon bracket inventory yet I still chose to order that much 3M Clarity Advanced clear bracket product. Why? Because I’ve already told you that I believe that great results come from clinicians who can create those results with any bracket. I’ve treated cases with 8 different bracket systems and the end results all look the same and none finished faster than the others. So, if I know that I can get to where I want with any bracket, why not use one that is clear, lower profile, has rounded edges, is wide enough to allow me control of my finishing, comes with cement already applied (for faster bonding and less cleanup) and has a cleave line that allows the bracket to collapse onto itself for easier removal when the case is done? That’s what my 3M bracket allows me, and if someone else made one that I felt worked the same way, I’d switch if it made sense.
I chose to go with what I believe is the best bracket for my needs, but I would NEVER tell a patient that I can finish a case faster with it or that the tooth moves differently with it, or that the bracket was part of a “system” that allows me to change the way I can treat the case (like avoiding extractions).
I have many friends who are Damon users and they’re great clinicians who turn out amazing results. They’ve made a decision to use a bracket that works for them and that’s great. I’m just tired of patients returning to me with misinformation given to them from Damon practices, unsubstantiated by any scientific literature.
As always, I welcome your feedback and questions.
Here are screenshots of the three articles I cited above. Take a look at the sections listed as “Conclusions”.