Posts tagged “dr Kumar”

My teeth are so good that I forgot how bad they were

My teeth are so good that I forgot how bad they were

This lady had complained of anterior crowding and had already had orthodontic treatment. Her main complaint were the 2 severely overlapped upper incisors.

We assessed her scans and decided against extractions. The arches were expanded, the lower teeth pushed down and out into a wider arc.

The biggest problem we had was the overlap of her central and lateral incisor. Due to this overcrowding, the gum tissue had never developed or was deficient. So when we straightened the teeth, we had a soft tissue triangular space.

We had to reshape the sides of the 2 teeth to be less triangular and to allow Invisalign to bring the teeth together.

It took over 2 years to finish, because the patient became obsessed with these 2 teeth and had actually forgotten how crowded she was initially.

We spent about 9 months just refining the 2 upper incisors.

I was happy with the result but the patient had forgotten the beginning until I showed her the original photos. She then agreed with me, but she never wrote a testimonial.

See for your self.


Invisalign; when to take a tooth out

Dental crowding is an issue of too many teeth and not enough space.

Why is that?

Are we normally born with too many teeth? The answer is No! What has happened is that the size of our dental arch is either developing into a smaller arc, or our dental arch is being constricted.

The latter is usually the case. As we stress over our studies, partners, work and health, we tend to clench and grind our teeth.

The action of our chewing muscles on the teeth causes movement inwards and constriction, leading to dental crowding.

So with Invisalign I usually expand the dental arch to create space, but not always.

Sometimes it is easier to take out the offending tooth and then straighten the teeth

See below, a severely crowded lower arch, corrected by Forma with Invisalign in just over 10 months. The outer tooth was removed first and Invisalign worn night and day.


Good reason when veneers supersede orthodontics

Teeth if they are perfectly healthy, intact and of good appearance, BUT are in the wrong place, should be moved orthodontically.

But what about teeth that are just too broken down/heavily filled to be ignored?

As one gets older and especially patients born pre 1980s there are lots of anterior composite fillings present from all those fizzy drinks we used to have.

Post 1950 there was a big sugar rush; sugar was in everything including healthy fruit juices, baby bottle drinks and even hidden in processed foods.

So as a sugar consumer, you have to be great at brushing and flossing away food particles and germs.

Germs digest sugars and produce acids as by products, which causes tooth enamel erosion and cavities.

The teeth get filled but the patient continues the abuse and thus the enamel edges around the fillings begin to rot as well. Thus fillings get bigger and the teeth get weaker.

White composite fillings when first done blend very nicely with the surrounding teeth, but over time they do absorb stains etc.

There comes a time when the fillings are too big to be replaced and it is then that we should think about more permament solutions.

Porcelain veneers replace the front and sides of the tooth by 1-1.5mm. Porcelain crowns replace the back as well.

I only advocate porcelain veneers/crowns if the teeth are relatively straight; some minor crowding imperfections can be corrected during the veneer preparations.

Now remember, once your teeth are filed, you cannot put the enamel back. So make sure the dentist is confident that the teeth need veneering.

Most teeth will need preparation of 0.5mm or more in order to create space for veneers that are within  the natural contours of the teeth.

Sometimes you can have veneers that are too thick and the patient can look slightly horsey.

Here is a case of mine where it is evident that the teeth are heavily filled, patient is mid 30s and she would like a nicer smile.

The teeth were prepared and temporaries were placed. Chameleon Fortress porcelain veneers were then placed.

Red lipstick always enhances my work. Hope you like the transformation.

For example:


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.