Conservative, cosmetic orthodontics

Dr Andy Denny BDS MFGDP(UK) MGDS RCS(Eng) describes how to take the complexity out of simple fixed orthodontic treatment

Within the dental community and among orthodontists, fixed braces are widely recognised as the most effective and efficient method of straightening teeth, giving the most predictable result. The Six Month Smiles Short-Term Orthodontic System is a system designed specifically for GDPs to meet the needs of patients who have crooked or spaced teeth. Most cases can be completed in an average of just six months, using unique clear braces and tooth coloured wires.

The system, like aligners, is cosmetically focused – it is not a replacement for conventional orthodontics. The goals of treatment are not as comprehensive but it provides an alternative for adults who have declined conventional orthodontic treatment.

The short treatment times with the Six Month Smiles System are possible for two primary reasons:

Cosmetically focused treatment goals Unique and specific brackets and wires

Thanks to the latest advances in short-term orthodontic technology, we are now able to provide simple, straigh tforward orthodontic treatment for patients over a relatively short space of time. Treatments such as Six Month Smiles give the general practitioner a powerful new tool with which to straighten anterior teeth, and provides a real, practical alternative to invasive treatment options such as crowns and veneers.

Case presentation

Kelly is a 29-year-old woman who came to our practice. She had always been concerned about the appearance of her teeth, particularly her crossed-over front teeth and the lateral teeth that she used to call “fangs’ (Fig 1-2). She was also aware that her front teeth at the bottom were fairly crowded as well. This meant she was seriously lacking in confidence and really didn’t like the way things looked.

Before she came to our practice, Kelly had been for a number of consultations with specialist orthodontists, and was keen to research all of her options. Though she had previously seen a specialist, she declined the long-term treatment option as she wasn’t prepared to undergo a course of treatment that would last in excess of a year and would also involve extractions.

When she came to see us, we discussed her previous consultations, as well as her treatment expectations. We discussed how the ideal situation would be for her to have comprehensive orthodontic treatment, but if she still wasn’t interested in the long-term option, there may be an alternative solution in the form of Six Month Smiles. This option was extremely appealing to Kelly who was keen to have a faster solution to her crooked teeth so we then proceeded to carry out a full assessment of her teeth to check her suitability for the treatment and plan her course of treatment.

It soon became clear that, before we commenced orthodontic treatment, we would need to carry out some routine stabilisation dental care first. This involved hygiene care to improve the health of her gums, and root canal treatment in her upper left central incisor due to a carious cavity caused by her crossed over incisors. We were then able to carry out a full orthodontic assessment to assess her cosmetic needs and the issues relating to the malocclusion. We also assessed the amount of crowding in her mouth so as to confirm this was a case we could treat with the Six Month Smiles system.

Once this was complete we then carried out the normal consent process, reiterating with the patient that Six Month Smiles is not comprehensive – it’s short-term orthodontics, which means we’re not trying to correct everything about her teeth. We reminded her that this treatment option is mainly concerned with correcting the position of the front teeth, so we wouldn’t be correcting her bite at the back. Kelly was happy with this, so we then moved on to the impressions stage of. Following standard Six Month Smiles protocol, we took records including upper and lower PVS impressions as well as bite registration. We then prepared directions for the technical setup, all of which was sent off to the Six Month Smiles lab for preparation.

A few days later, we received her individualised Patient Tray Kit (PTK) from Six Month Smiles that included her custom indirect bonding trays, which make accurate placement of the brackets a simple and straightforward process. The normal Six Month Smiles protocol for placing the brackets using the trays and tying the wires in was followed (Fig 3).

After just over six months, the orthodontic element of the treatment was complete (Fig 4-5). At the debond appointment, her brackets were removed, her teeth were polished, and she had palatal fixed bonded retainers fitted, which again were provided by Six Month Smiles in sectional indirect bonding trays, for ease of placement (Fig 6-7). Kelly was also provided with removable Vacuum Formed Retainers, which doubled as bleaching trays, allowing her to perform home tooth whitening. To complete the treatment, we carried out some edge bonding and shaping of the tips of the upper incisors, to enhance the final aesthetic result.

Following conclusion of the treatment, Kelly was absolutely delighted with the result (Fig 8). There was a noticeable improvement in her smile and, from a hygiene point of view, her teeth are now easier to maintain. Another pleasing aspect of the result is the regeneration of her papilla between the upper central incisors. This is a particular aesthetic benefit of orthodontic treatment over a pure restorative solution in a case like this, as it’s not just about the shape of the teeth but having them in the right position that gives a pleasing cosmetic result – enhancing the pink aesthetic frame for the teeth.

Conclusion

One of the great things about the Six Month Smiles system is that it takes a lot of the complexity out of providing simple fixed orthodontic treatment for patients whose chief complaint is cosmetically focused, and who have already turned down comprehensive orthodontics. It allows us to achieve a fantastic cosmetic result without having to resort to aggressive veneer preps or other restorative procedures.

The system is simple and with the patient tray kits you are provided with everything you need for an individual case in a single box. This includes the wires, the ligatures, the bonding agents and the indirect trays. With treatments such as Six Month Smiles there is now a powerful option for patients who have in the past either had to opt for comprehensive treatment, or have instead just done nothing at all. For general practitioners, it also gives us an appropriate middle ground treatment option that is extremely popular with patients and is very satisfying to carry out. The results, I think, speak for themselves.


About the author

Dr Andy Denny is joint principal of Twenty 2 Dental, a private cosmetic and implant practice in Weston-super-Mare, UK, where he receives referrals for aesthetic and implant dentistry. He is particularly interested in cosmetic dentistry and multi-disciplinary care, often combining short-term orthodontics and cosmetic treatments having studied extensively in the USA, Europe and the UK.

He is a full member of the BACD, the BPS, the ITI, the ADI and the AACD.