May 12th, 2012

Getting straight teeth with Forma/Invisalign before my wedding

As a cosmetic dentist I always felt uncomfortable about filing down teeth for porcelain veneers, and more so with younger patients.

I treat a lot of brides getting married within the next 6-12 months. These ladies know that the wedding pictures, in this digital age are scrutinised even more now, and the brides want to look their best.

So for the last 8 years I have being using Invisalign to straighten teeth, close gaps and make people smile.

In fact 95% are female and hardly any grooms!

Here is an example of a lady late 20′s who was engaged for over 3 years, but never had the time to plan the wedding. She knew that her upper incisor was rotated and it bothered her. So she asked me if she could have  it straightened? I said yes with Invisalign and she agreed to have treatment.

Within 2 months she had decided to tie the knot (and not with floss) and then told me she had 8 months to improve her smile.

So we pressed on and over 10 months she got a smile that she could be proud of for her wedding. We removed some of the attachments and gave her tooth whitening gel so she could whiten her teeth before the wedding.

We took impressions for a minor refinement and the new aligners will be fitted after her honeymoon.

Invisalign is a non invasive, painless way to get the smile that you always wanted without damaging your teeth.

 

 

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May 6th, 2012

Invisalign success after near failure

This is a good case of when a failure turns into a success.
Mr W. attended in 2010 and had Invisalign impressions. After paying half the fee he decides not to continue because we did not return hos phone call once.
So I had half a bill to settle and a box of aligners to fit.
The box collected dust for about 1 year when Mr W. decides to start his treatment.
Magically the aligners fitted perfectly. We did about 10 months of treatment and the patient was delighted.
When we had removed the small buttons and polished his teeth, he held upp a mirror and said ” how do I smile? It’s just that I”ve always held up my hand when I smiled and I don’t know how to”
I was amazed at this great comment and I remarked for him to raise the corners of his mouth and to practice without using his forehead. Otherise he will get lines and need Botox.
Disaster turned into success.
He wrote a lovely testimonial and here are the pictures.
So Invisalign is accurate enough to work even 1 year past its fit by date.

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April 23rd, 2012

Panoral Xrays during an Invisalign initial assessment

I see a lot of new patients for initial consultations about Invisalign.
I assess the condition and see how crowded the teeth are. In my experience I can see if orthodontic movement is possible with Invisalign.
Most patients are going to more than 2 consultations and they are just gathering information.
So I do not see the need for an Xray until the pateint agrees to having treatment with us.
So why do some dentists take large panoral xrays which produce a lot of radiation on just an inital visit?
Well a patient came to see me with severe crowding and he had been to 2 other consultations. During one of the consults one of the dentists had taken a panoral xray.
The new patient decided to let me treat him.
I was not going to do another xray and the patient asked the dentist for a copy of the xray.
The dentist decided to charge the patient £50, even though the consult was free.
So why is this wrong?
1 The patient was irradiated despite not agreeing to treatment
2 The new dentist may have preferred his own xray machine
3 Was the initial panoral of good diagnostic quality?
4 Did the dentist report on any pathology?
So when you want to get an opinion about your smile then do ask if the xrays are necessary at such an early stage

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April 12th, 2012

What is a free Invisalign consultation?

What are free Invisalign consultations?
Many patients want to know more about how to straighten their teeth and whether they are suitable for Invisalign.
Usually 30-60 minutes are set aside at Forma for this.
Here are a few examples of what dentists are doing wrong with consultations:
1
Some dentists spend about 1 minute looking at the teeth but then spend 10-15 minutes talking about Invisalign
2
Some dentists have no cases to show, but do not tell the patient of their inexperience and yet show off cases from the Invisalign website.
3
Not listening to what the patient is concerned about
4
Trying to quicken the treatment by talking about aggressive enamel stripping and calling it mild spacing?
5
Sometimes telling a patient that they are not suitable for Invisalign, when in fact they are
6
Asking for an immediate decision then and there
7
5 minute free consultations
8
Bringing in a colleague as good cop bad cop and saying Invisalign is not suitable
9
Trying to sell simple systems like Inman, simply 5 etc. for complex cases etc.

At Forma we spend about 40 minutes on average. We carry out a full head and neck survey before even looking in the mouth.
Once we enter the mouth we look at the whole arch and not just the front teeth.
Most dental crowding is due to the back teeth and so they are included in the planning.

WE show Invisalign cases that we have completed and also before and after cases as well.

The patients images are then uploaded onto our website so that the patient can view them at home.

We do not ask for an immediate decision, but let the patient think about it.

We contact the patient a few days later for feedback.

This way we have few misunderstandings and even less unsatisfied patients.

Dr R Kumar BDSLDSRCS

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April 9th, 2012

Should patients have Invisalign offered on Groupon?

When I started carrying out Invisalign there was only 1 product, Invisalign full. This product allowed me to treat full arch cases from simple to complex malocclusions.
I started off in at the deep end and some of my earlier cases were very challenging with some up to 40 + aligners.
Invisalign full was like doing an apprenticeship for 2 years.
I was learning slowly and as cases progressed that Invisalign can treat most ortho cases but planning is the key.
Align Technology, the parent company of Invisalign, then brought out Invisalign anterior/express and even lite.
Some of these products only provided 14 aligners and with no refienements.
Now with these limited products, you can only treat limited cases.
If 1 tooth is out of line then there is usually crowding at the back of the arch and I prefer to create space at the back to get that 1 tooth in line.
But with the cheaper products Invisalign Lite etc. this was not possible.
So what did dentists do?
They would treat a moderately complex case, by ignoring or failing to treat the back of the arch and just strip the enamel between the front teeth.

Enamel stripping can be done if the teeth are aligned in a straight line at the front ( then why would you need ortho? ) and usually to help reduce triangular spaces between teeth at the end.
But when teeth are crowded and or overlapped, then enamel stripping is difficult as there is no straight line to follow.

So some patients end up with sort of straight teeth, with enamel and tooth corners missing or misshapen teeth.

What has this got to do with Groupon?

Well Groupon allows dentists to advertise their Invisalign fees at firstly a reduced fee, and then Groupon take a 30-40% CUT.
We charge £3500 + but if a dentist charges £1900 on Groupon, then after Groupons cut the dentist is really charging £1200?
Now if Invisalign full costs more than this to the dentist then is the dentist working for nothing? NO. The dentist is probably using Invisalign Lite and is probably earning £500 per case.
Now would you want your teeth straightened by a dentist that earns just 25% of the normal fee?
Exactly how much service, planning and treatment do you get at 75% discount?
Well there have been a lot of patients signing up to Groupon.
With the special offer the prospective client/patient has to pay the whole fee upfront without even seeing the dentist.
The dentist then meets up with the patient on a specific day.
Now because the dentist is overwhelmed by bargain hunters, he/she does not have a lot of time to explain to each patient all about their teeth, options, fixed V Invisalign, will Invisalign be suitable etc.
What should take about 1 hour ends up as 15 minutes or less.
That surely is not in the best interests of the patient.
Groupon is ok for a night out or a massage but surely not for complex life changing treatment.
We see a lot of consultations and some of the patients have told us what they experienced with Groupon dentists:

1 5 minute consults
2 no examination of the crowding
3 money upfront without even seeing the dentist
4 limited appointments limited movement
5 no follow ups
6 incomplete treatment
7 damaged teeth
8 gaps left open as the back teeth were left untreated etc.

Now Align Technology has been forced to distance themselves from Groupon and is actively declining to provide product to these dentists.

Finally after many complaints from patients and dentists, Invisalign is again being provided by ethical and caring dentists.

Moral: never have body procedures at massive discounts on social coupon sites such as Groupon, Qype, Living Social etc.

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April 9th, 2012

Why I stopped doing cosmetic dentistry and started doing Invisalign

As a cosmetic dentist of 22 years experience I have a lot of different types of dental treatment under my belt, but cosmetic dentistry was the most fulfilling.
When I started in 1989 I was wet behind the ears but I had a fully loaded dental drill.
We were taught at Guys Hospital how to do crowns and veneers on patients and in fact in the early days as an associate I was termed the veneer king.
My principal was quite taken a back at my work load and profitability but asked me to slow down.
Now in those days and even on the NHS we were allowed to provide multiple crowns and veneers.
We were happily providing celebrity teeth/veneers on the NHS and for free!
I had even done cases with 16-20 full crowns on the NHS.

I then progressed to private practice in London and continued to do smile makeovers round about the time that “10 Years Younger ” was being televised.
I ran a cosmetic practice in Harley st and also rented out some sessions to another cosmetic dentist.
I remember one day passing by to see him but he was busy talking to a blonde “patient”.
Then one day my surgery was televised on the “10 years younger” programme, but I was not the dentist being featured. It was my cosmetic dentist tenant.
I was really jealous as I had missed a great marketing opportunity.
Some of the reasons that I had not been featured were:
a) he was more handsome?
b) did more schmoozing with the media?
c) I had by then stopped doing veneers and crowns

Now you may ask why would I stop doing something that was bringing me £20K every month in those days?
Well I had being doing smile makeovers for a very long time and the next step in my evolution was to get some US training under my belt.
So I looked up the dentist to the stars in New York. I googled him but what I got was baddentist.com.
I was appalled that a patient would be so aggrieved by a dentist that he/she would set up a website!
This NY dentist was doing what we were all doing….shaving off lots of enamel and dentine to provide the space for beautiful crowns/veneers.
He was however taking off much more than usual, but was promising veneers like baby’s finger nails. He was suggesting minimum preparations but was a bit too heavy handed.
I was shocked and then I thought about what I was doing.

Patients were coming from all over the country to see me and they wanted beautiful, white, straight teeth and all within 2 weeks.
I was providing veneers and crowns because patients did not want metal braces.
I was very successful but also stressed.
I had to correct dental crowding/ spacing with porcelain veneers.
I had to prepare the teeth in 2 hours and then take impressions and place temporaries.
Once that enamel was removed, it was not coming back.
Despite the success of my practice I was not happy with what I was doing.
Top prove a point, what did I have slightly goofy teeth and not had braces? Why was I not wearing porcelain veneers?
The reason was that I did not like the appearance of braces and I certainly was not going to damage my teeth.
After much soul searching I said adios to “10 years younger” and auf widersehen to Cosmetic Dentistry.

It was just by chance that an orthodontist had invited me to an open evening and was busy selling to me his wares when he mentioned Invisalign. A clear, nearly invisible system of aligners that straighten teeth.
I thought this would allow me to create beautiful smiles without damaging the teeth.
I enrolled on the course and started Invisalign procedures in 2004.
In the next blog I will tell you of my initial experiences with Invisalign.

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