Innovation is not easy, particularly medical innovation. Along with the genius of scientists and clinicians, we need humans who are willing to try new products.  

Annie Kurowski was one of the early adopters of a revolutionary innovation in orthodontia. Under the care of Dr. Negaar Sagafi, the orthodontist behind the PoshOrtho and the brand’s two locations, Spring Valley Orthodontics and Bethesda Orthodontics, Kurowski tried Brava, which could change the field of orthodontics forever. 

She said the choice was easy. “Brava is one of those innovations where there is very little risk with a lot of reward,” said Kurowski. “It’s a perfect solution for busy working professionals who want fast results and for children who already have too much to worry about without keeping track of an aligner.” 

So, what is this new innovation, and why are more and more Washington, D.C. residents being drawn to it?

The pandemic sent tens of millions of Americans home to work — and sat them down in dimly-lit, makeshift offices to look at themselves on web-based meeting platforms all day. While we were covering our smiles outside, inside we were obsessively examining our appearances, including our teeth.

According to Sagafi, these forces caused an explosion in adult requests for orthodontia, a treatment that used to be reserved mainly for teenagers. Even a generation ago it was rare to see an adult with braces. According to the American Association of Orthodontists, today one in four patients who come through an orthodontist’s office is over the age of 18.

“I’m getting a lot more parent-child duos now, or even entire families looking to straighten and freshen their smiles,” said Sagafi, who owns Spring Valley Orthodontics and Bethesda Orthodontics. 

The adults who come into Sagafi’s office seem to have two prevailing concerns, however: like anxious teenagers, they worry how braces will look and they worry about the length of time they will have to wear them.

Enter Brava.

 

Historically, there have been two options for straightening teeth: braces or aligners. Technology limitations meant patients either chose aesthetics (aligners) or efficiency (braces). They could have one benefit, but not both. 

That’s changing now. Sagafi said Brava by BRIUS is a “game changer.” She is the only licensed Brava provider in the Washington, D.C. area. 

Like traditional braces, Brava is a custom, super-light metal-alloy appliance that applies a pre-calculated force onto the tooth surface to gradually move the teeth. These forces, as well as the directions of movement applied, are all dictated by Sagafi’s treatment plan and monitored by her. Also like braces, Brava uses brackets, but, with Brava, the brackets are hidden behind the teeth. 

Unlike traditional braces, most of Sagafi’s Brava patients are out of their appliances in a year or so. (Treatment times do still vary.) If Brava is so similar to traditional braces, how does it work so much faster? Brava technology uses a new orthodontic technique that moves each tooth independently. 

Working with technologists at BRIUS and with digital workflows, Sagafi determines the best natural position for each tooth. Then, BRIUS manufactures a customized device for the patient that will move the tooth toward its predetermined position. The bespoke design allows for the optimal force needed to move each particular tooth independently, on its own, without being slowed down by the other teeth.

The Brava device has two main components: a stabilizing bar and several flexible, metal arms. Each arm is unique, like a snowflake. Together the arms move each tooth independently and efficiently into position, and because the arms work independently, one tooth’s movement does not impact another’s. Additionally, because Brava moves the teeth in all planes of space at the same time, it is correcting the tooth’s rotation, tip, and torque simultaneously, combining all stages of classic orthodontic tooth movement. In traditional orthodontics, clinicians have to stage movements separately because the technology is antiquated. The Brava technology is like multi-tasking multiple movements at once. 

Bethesda resident Kurowski said the shorter length of time for treatment is one of the reasons she chose to go with Brava and Sagafi. “Within three months my teeth were pretty much aligned,” said Kurowski. “After a year, it’s astonishing how straight they are. My teeth weren’t this straight with braces in high school.” Kurowski’s older son uses aligners and is on his third year of treatment, she said. 

Another benefit for Kurowski was the fact that Brava fits on the inside of a patient’s teeth. Sagafi told her it would be invisible on the many video calls that she has daily with clients. “I knew the Brava was there, but whether I was out to dinner or at work, no one else could tell,” Kurowski said. 

There also is less pain with Brava than there is with braces, since the technology uses a much lighter force to move the teeth. Kurowski said she had some pain from the brackets being on the inside of her teeth, but that Sagafi was able to mitigate that pain by putting wax over the metal on the inside of the teeth, which, soon after, she no longer needed. She also said the pain was much less severe than when she had braces as a teenager. “It was brilliant,” Kurowski said. “I wish I’d had this when I was younger. The Brava pain was just dull and went away with an aspirin.” 

Brava is slightly more expensive than traditional metal braces, but the cost is comparable to Invisalign. Unlike Invisalign, however, the patient doesn’t have to take out Brava to eat (and, therefore, does not have to remember to put it back in) and, unlike with wire braces, Brava users can floss normally. That means there is no danger of having those terrible (and permanent) white spots on teeth after treatment is over.

Because Brava faces inward, the tongue might feel strange right after it is affixed to the teeth. That awkwardness could cause a lisp in the patient’s speech, but Kurowski said that side effect quickly went away.

 

Brava also requires fewer visits to the orthodontist. Because there are no wires, there are no wires that need to be adjusted. The system is autonomous. Sagafi has patients flying from all over the East Coast and the West Coast for Brava treatments. 

Sagafi said this convenience factor is an especially big bonus for young adults in college. Current patients are going to school in San Francisco, Chicago, and Boston. Sagafi bonded Brava to the backs of their teeth before they left for the term and will not need to see them again in person until at least the semester break. But since Brava is a technology-based product, Sagafi can keep up with her patient’s progress on a weekly basis via a phone app called DentalMonitoring. It is easier to look for the provider who is right for you when you don’t have to make a lot of time to see them.

“It’s miraculous, actually,” Kurowski concluded. She wishes she had known about the innovation sooner so her son, now a college student, wouldn’t have to worry about his aligners at school.