Posts tagged “smile makeovers”

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.


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:


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.


My first Invisalign consult………….who never came back!

I was so broke in 2004,spending money left right and centre ( or on upper left, lower right and central incisors ) that I had to find a way out of my predicament.
An orthodontist had introduced me to INviisalign by playing their corporate video.
I was so impressed that an general dentist could do ortho that I signed up.
I did the 2 day course, but being in an overdraft scenario I could not prepay the course, so Alison would not give me my certificate 🙁
Eventually my cheque went through and I was a certified Invisalign Monkey.
Anyway my first patient came in through the door and wanted a consultation on upper and lower veneers.
He had proclined teeth with multiple gaps and large fleshy lips. He was causasian.
I could have made £15-20,000 but I told him:
His teeth stick out
He has very large gaps
If I do veneers I cannot bring in the teeth much
and the veneers will be too big for his already wide mouth
In fact he would have looked like the Mask (Jim Carey)
So without hesitation I took his money and did 20 veneers ……
Just joking.
I told him with my hand on my heart that he needed braces. I told him that he would be my first case and that Invisalign would be perfect for him.
He handed over £4000 and I took impressions.
I fitted his aligners, but he never came in for reviews.
I was dying to see the progress but never got to see the results.
I rang him to enquire and he just said that all was progressing nicely and that he was happy.
So my first case, but no photos.
Gaps are so easy to close with Invisalign that I can close them with my eyes closed. |Next time I will show you a case that I did in 2 visits only.
Below is the initial scan of my first Invisalign patient and the hopefully finished case.

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.