Posts tagged “veneers”

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.
NOT DONE BY FORMA!

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.

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:
1
Some dentists spend about 1 minute looking at the teeth but then spend 10-15 minutes talking about Invisalign
2
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.
3
Not listening to what the patient is concerned about
4
Trying to quicken the treatment by talking about aggressive enamel stripping and calling it mild spacing?
5
Sometimes telling a patient that they are not suitable for Invisalign, when in fact they are
6
Asking for an immediate decision then and there
7
5 minute free consultations
8
Bringing in a colleague as good cop bad cop and saying Invisalign is not suitable
9
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.

Dr R Kumar BDSLDSRCS