I am writing in response to an article posted in PPD magazine March 2013. Aimed at fellow dentists.
View from the practice
I disagree with Rahul Doshi who is the clinical director of PPD magazine in the way that orthodontics has been side lined as a minor form of cosmetic dentistry and where smile design is still king.
In the article he states that orthodontics can be used to pre align teeth before placing composite bondings or ultra thin veneers on them.
He states that this technique is less invasive, with which I agree, but bondings are not reversible.
Bondings are short term, discolour and can deteriorate. Veneers last longer however.
Everyone is jumping on the BBB bandwagon. Braces, bleaching and bonding.
Would you place 10 composite bondings on the already already straightened teeth of your spouse?
So instead of saying we are going to do 10 porcelain veneers, we will say “we will charge you the same as 10 veneers but we will use a removable brace and then some cheaper composite bondings”.
Whether they are ultra thin veneers or bondings you still have to remove enamel to accommodate the extra thickness. Unless you can retrocline all the front upper teeth without the lowers getting in the way and then just add some labial veneers?
What about maintenance? What if a veneer chips, decements or fractures in half because it is so thin?
How many people do we see that have discoloured and crooked teeth in the UK?
Most patients that I see do not want veneers of any sort, but want a whiter, straighter smile.
The ideal treatment is orthodontics to correctly align the teeth and then to bleach them as best as possible. There are deep bleach techniques that do not fall foul of new legislations.
I cannot think of a patient in 9 years of orthodontics that needed alignment and then 10 upper veneers!
In the article he also states that orthodontics in the cosmetic dentistry world incorporate fast, limited techniques. This is untrue as Invisalign is a slow full arch technique which will give maximum alignment in most cases. There is no point in thinking that ortho is of limited value.
I strongly disagree that idealistic ortho options are for children only. Teeth move at any age and with a complex and researched system like Invisalign, most patients would benefit from orthodontics and would not need veneers.
Veneers are a lifetime worry for the patient, whereas the teeth God gave you, if looked after will last you well into your 90s.
Dr Raj Kumar