Posts tagged “forma”

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 to widen the arch and instil confidence

How to widen the arch and instil confidence without metal braces


Miss SM was a very shy person and could not really afford Invisalign. But she hated her smile and had absolutely no confidence.  She hated that her front tooth was sticking out so much.

She had moderate crowding with a narrow high upper arch, which compressed her dental arch leading to overcrowding.

She wanted to know if I could treat her with Invisalign, and I said yes.

My aim was to use the Invisalign aligners in a sequence to gently push out the dental arch and create spaces for her front teeth.

We took did not take any upper teeth out and we started Invisalign.

Even though she did not come as regular as I had hoped, I could start to see a change in her confidence. She was more talkative and open.

We are at the end of the initial set of Invisalign aligners and she is getting married soon. We will continue with refinements afterwards.

You can see a nearly perfect rounded arch form that needs some slight refinement.


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.


Do you treat yourself to a television or a better smile?

Dental crowding is a major factor in low self esteem, low confidence, bullying, hiding behind your peers, lack of social contacts and even a better spouse!
So if teeth are such trouble then why don’t we do something about it?
Let’s imagine the 46″ Sony Plasma is looking a little jaded and the picture looks so fuzzy that you thought that England had just scored 5 goals?
Well you thought wrong, that was Germany.
So now it’s time for High Definition TV.
So you drag your wife ( as it’s usually men who buy big TVs ) to the local Comet and convince her that you need a HD LED 50″ Sony.
So that evening the TV is placed on a wall bracket and they both watch Top Gun in HD.
As a thank you he has an early night and they have some fun.
Problem was that he has bad breath and his teeth are very crowded, she can taste his meal on his teeth.
So the moral of this little story is you cant take your high tech HD TV with you to bed.
If you have a dental problem and your spouse is kind enough to point it out, then at least look into sorting it out before your adorn your house with the latest gadgets.
Here is an example of how Forma Dental can make a difference.

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:


When is a consultation a waste of time?

As a teenager or an adult you have usually had all your permanent teeth come through and in most cases they are misaligned or sometimes spaced.
As we are not related to sharks that have numerous sets of teeth, then we must look after our 1 set.
Be it by watching our sugar intake or brushing the teeth regularly we can make an attempt at looking after our teeth.
But when something goes wrong then we have to employ the services of a dentist.
We are at the mercy of the dentist, his skills at examination, assessment, explanation and execution.
So when a patient enquires at what can be done with their crooked teeth, then there are 3 types of patient consult:

1 The patient has no idea of what options there are and wants the advice of the dentist
2 The patient has some idea of the options from having visited other dentists and wants a 3rd or 4th opinion
3 The patient knows exactly what they want from meticulous research/consultation and tells the dentist what they want

Now as a seasoned dentist with 22 years of experience I am rarely told what to do. I have a wealth of experience, opinion, tried and tested methods etc.
So the patient would benefit from my consult.
The problem is the last patient consult type. They know what they want but they want to mine information from me and then find the cheapest dentist around.
Cheaper does not mean better. The product may be the same, but it is how the product is used that make the difference.
So back to my no obligation consult. Having assessed the patient, taken photos, shown said photos, shown similar finished cases, I have proved that I can do the job.
The patient is enlightened, in fact in awe of my skills.
I do not ask for a decision there and then as the patient needs to reflect on their decision ( it’s not like you are buying a TV! ).
Now when I do Invisalign I do the whole mouth treatment and not just the front 6 teeth.
My philosophy is that the anterior crowding has happened because of back of the mouth crowding/collapse. So to ignore it is very short sighted.
My fees reflect the long term, no quibble commitment.
But there are many dentists offering Invisalign but only the anterior version.
So how do they make space?
By filing inbetween the front teeth. The front teeth, especially the lowers are
narrow and overlapped. To file between crooked teeth means losing lots of enamel.
SO I create space at the back to alleviate anterior crowding.
This is FULL INVISALIGN which is longer in terms of treatment and number of aligners.
So I am bemused when patients think they are getting the same treatment as mine for a 50% reduction.
Invisalign like many dental treatments is a complex, fully committed method of straightening teeth, so why belittle it?
It is not like you are buying a sofa set or a 3D television that has a short life expectancy.
Your teeth are for life, so treat them with respect.
Private orthodontics involves
full planning
about 12months of treatment
no quibble guarantee treatment
refinement at the end
full set of retainers
and costs about £3-4000
When patients run off to a Groupon campaign they really are letting themselves down.
Do the research, read the reviews and expect to pay above £3000.
Below is an example of a case finished within 6 months leaving the teeth with uneven stripped edges.

Invisalign for international patients

Invisalign is not available in many countries and yet patients want it.
Recently I treated a patient who was in fact English, but worked in Hong Kong.
His dilemma was that he did not like his teeth/smile and yet could not walk around mid 40s wearing metal braces. He wanted an aesthetic/removable solution.
I assessed him to severely crowded with an underbite ( which is technically an overjet where the lower jaw was set back ).
We spent an hour assessing his occlusion and I advised him that to reduce the underbite and correct the severe crowding I would need to remove 2 upper premolar teeth.
As he could not attend every 4-6 weeks, I placed him on a 2 month review programme with a leniency of 2 more weeks.
I was able to do that because of 3 things:
1 Because I am great at what I do lol
2 Extractions creates space that can be accurately measured by Align Tech. and the planning is more predictable
3 I would not need to do any interproximal stripping on a regular basis
So we agreed to start.
I noticed some cavities around the premolars and advised him to have them treated in Hong Kong.
Whilst the clinchecks were being programmed from the impressions I removed the 2 lower teeth under local anaesthetic.
Aligners were fitted initially with no attachments for 8 weeks, as his crowding was so severe and he was going to be away.
During the year treatment the patientt switched from HK to Africa and Libya but this presented no problems to his treatment.
As his extraction spaces closed, his anterior crowding began to correct itself.
I reviewed him every 8 weeks and he had no problems in scheduling his appointments in advance.
A year has passed and he is at the refinement stage. New impressions were taken for minor anterior correction.
See what you think.


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

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:
Some dentists spend about 1 minute looking at the teeth but then spend 10-15 minutes talking about Invisalign
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.
Not listening to what the patient is concerned about
Trying to quicken the treatment by talking about aggressive enamel stripping and calling it mild spacing?
Sometimes telling a patient that they are not suitable for Invisalign, when in fact they are
Asking for an immediate decision then and there
5 minute free consultations
Bringing in a colleague as good cop bad cop and saying Invisalign is not suitable
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.


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.