Posts tagged “smile makeover”

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.


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.

How to close a gap and build up a broken tooth with Invisalign

Over time teeth can move and the bite can become uncomfortable or traumatic. Sometimes the bite can cause teeth to wear down or chip resulting in uneven sizes teeth.
The following case presented with a young male aged 30 who had a traumatic bite that was slowly wearing away his front tooth. On top of which he had a moderate sized front gap.
The arch was narrow so we had to expand the arch, which naturally opens up the space at the front as well as close this space.
With Invisalign we decided to bring the front upper teeth together and upwards so as reducing the overbite and trauma to the teeth.
The treatment took 1 year as we had to treat the whole upper and lower arches.
The edges of the teeth are now level but the gum line of the lhs tooth is higher as this tooth was longer. He had a low smile line so this was not a problem.
We opted to have level incisal edges instead of trying to build up the broken edge, which would have meant constant repair/surveiilance/care of the tooth edge.
Patient was very happy to have not had the front tooth repaired and was very happy with the outcome.
Conclusion: Invisalign can help restore tooth length by moving the teeth.


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.


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.


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
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.