Figure 1a: The patient has a wide smile
Figure 1a: The patient has a wide smile

Thomas Sealey discusses building an ortho-dentist practice with complete and invisible tooth alignment solutions.

In recent years, there has definitely appeared to be a shift in the types of treatment patients are requesting, with more demanding the perfect smile but without the financial burden and invasive treatment procedures of ceramic smile makeovers.

The evolution of orthodontics has created solutions that can achieve these desired results – and meet the needs of our patients. The rapid rise in the available products from short-term orthodontic companies has somewhat created a monster – a new type of high-demanding patient with very high expectations. These patients are expecting veneer-perfect results in a timeframe of less than six months, at a competitive cost and with a totally invisible solution.

Figure 1b: Incisal symmetry is upset by the crowding of the anterior teeth
Figure 1b: Incisal symmetry is upset by the crowding of the anterior teeth

Patients are bombarded with social media messages extolling the virtues of ‘a perfect smile in only six months’ and are expecting exactly this. This is understandable though, as in today’s dental environment there is a seemingly never-ending plethora of invisible orthodontic system choices, with all competitors offering similar solutions with affordable price tags.

These patients arrive in surgery au fait with the abundance of worldwide companies that will offer these systems, usually having dedicated time to online research. This new generation of treatment-savvy patients are also more than happy to have multiple consultations before they commit to a particular dentist. This has created a whole new niche of patients for dentists to capitalise on, and can be a fantastic practice-building opportunity for those who embrace it.

The new GDP

Figure 1c: The anterior malocclusion of lower teeth are suitable for repositioning with cosmetically-focused adult orthodontics
Figure 1c: The anterior malocclusion of lower teeth are suitable for repositioning with cosmetically-focused adult orthodontics

Indeed, this new breed of patient has stimulated an evolution of the general dental practitioner. When once upon a time the realm of orthodontics was outside of the GDP’s daily practice – and confined to the mysteries of the local orthodontic clinic – we now find ourselves in a world of opportunity and progress. So, with this ever-growing important facet of practice life, it cannot be overstated that we must ensure we stand out to avoid missing an opportunity to possibly develop this very profitable aspect of a general dental business.

The evolution of invisible, short-term, cosmetically-focused orthodontic systems has created a new generation of dentist – the ‘ortho-dentist’. This growing culture of ortho-dentists can use an array of solutions to straighten teeth, but are limited by certain rules and conditions that cannot be over-stepped. These dentists are not orthodontists and should never claim to be so.

Figure 1d: The anterior malocclusion of upper teeth are suitable for repositioning with cosmetically-focused adult orthodontics
Figure 1d: The anterior malocclusion of upper teeth are suitable for repositioning with cosmetically-focused adult orthodontics

However, they are cosmetically-focused and able to provide patients with simple orthodontic correction of anterior teeth, and when combined with composite-bonding techniques, can produce a straight smile that meets the expectations of patients at a cost and within a timeframe that this new group has come to expect.

If you are just beginning to develop your ortho-dentist practices – or are already streamlining this exciting area of dentistry into your daily life – I hope this case study will give you tips and ideas on how to increase uptake and profits.

A 10-week case study

Figure 2: The teeth were correctly aligned in eight weeks
Figure 2: The teeth were correctly aligned in eight weeks

The following case was completed in only 10 weeks, with an invisible fixed bracket solution from Cfast. This demonstrates the speed at which cosmetic tooth alignment can work and the excellent results that may be achieved.

The journey begins with a simple case of anterior malocclusion. The smile is wide (Figure 1a) but the incisal symmetry is upset by the crowding of the anterior teeth (Figure 1b).

The anterior malocclusion of both upper and lower teeth (Figures 1c and 1d) are suitable for repositioning with cosmetically-focused adult orthodontics. In only eight weeks the teeth were correctly aligned (Figure 2) and the orthodontic brackets were removed from the molars and second premolars (Figure 3).

Figure 3: The orthodontic brackets were removed from the molars and second premolars
Figure 3: The orthodontic brackets were removed from the molars and second premolars

Poly-vinyl siloxane impressions were taken using red ribbon wax to block out the undercuts of the remaining brackets (Figure 4). Cfast is then able to fabricate an indirect, fibre-reinforced composite retainer that is placed on the teeth while the brackets are still in situ.

The SOLID (Single-visit Orthodontic Lingual and Invisible Dual Retainer System) retainer comes in a sealed pouch within a metal retainer tin. Once opened, it is activated using the enclosed flowable composite (Figure 5). It is then placed directly onto the patient’s teeth after etch and bond of the lingual surface of the anterior teeth. This is cured into position. No extra materials or expensive ceramic cements are necessary, and it only takes 30 seconds to cure the fibre retainer into place. The stent, which carries the fibre retainer, then doubles as the full Essix removable retainer and is removed after placement so the fibre retainer can be polished. The orthodontic brackets can then be removed.

Figure 4: Impressions were taken using red ribbon wax to block out the undercuts
Figure 4: Impressions were taken using red ribbon wax to block out the undercuts

Traditional orthodontic de-bond techniques require the orthodontic brackets to be removed from the teeth before an impression is taken for a retainer. However, as soon as the teeth are released from the orthodontic wire that is keeping them perfectly aligned, there is immediate tooth movement. I developed the SOLID retainer to be placed before brackets are removed to ensure absolutely no tooth movement can occur from your final and perfect end-positioning.

The SOLID retainer can also be used after clear positioner orthodontics. In this scenario, once you have achieved the correct alignment of your final positioner, you can simply send the last 3D-printed model to Cfast and they will make you the SOLID retainer – you don’t even need to see the patient for an impression. Without having to remove orthodontic brackets, you can place and polish a SOLID retainer in less than 10 minutes.

Figure 5: The Solid retainer comes in a sealed pouch within a metal retainer tin
Figure 5: The SOLID retainer comes in a sealed pouch within a metal retainer tin

The patient is encouraged to wear the Essix retainer every night as per recommendations from both the British Orthodontic Society and the American Association of Orthodontics. Cfast SOLID is not only the fastest placed invisible dual-retainer system in the world, it also provides a second removable Essix retainer – this spare retainer is also a great sales point for the patient as new retainers can usually cost them around £100.

I finished the case with two-week teeth whitening and this is always given to the patient as a free gift to celebrate their commitment to their ortho and enhance the desired smile. The final smile is natural and stable (Figure 6). The SOLID invisible retainers are kept at least 1.5mm from the incisal edge and from the gum level to ensure ease
of cleaning.

Figure 6: The final smile is natural and stable
Figure 6: The final smile is natural and stable

In the past, the final cosmetic result was often spoiled with visible wire retainers or ceramic retainers that made the lower teeth look twice as thick as they should. Another concern regarding ceramic retainers is the potential for de-bond and recurrent caries, much like you may see on failed double-winged adhesive bridges. SOLID is discreet, easy to clean, totally smooth and requires no additional cost to the dentist or patient.

As the ortho-dentist has evolved to provide cosmetic tooth alignment for the aesthetically focused patient, so orthodontic retention has evolved to meet the needs of the modern patient in the form of SOLID.

Figure 7: I finished the case with two-week teeth whitening
Figure 7: I finished the case with two-week teeth whitening

Cfast provides a complete invisible orthodontic solution – from initial consultation to final retention. Everything is stent-guided, thereby eliminating placement complications. There is also a fantastic UK-based support network to assist GDPs during patient treatments. Since providing Cfast orthodontic solutions – and fully engaging this progressive movement toward minimally invasive adult smile makeovers – I have seen my private practice profits double and patient numbers increase exponentially through word of mouth.

Good results are consistently achievable and this encourages both patient uptake and motivates the GDP to commit to an exciting and fulfilling aspect of dental treatment as part of a growing ortho-dentist practice.

Figure 8: It only takes 30 seconds to cure the fibre retainer into place
Figure 8: It only takes 30 seconds to cure the fibre retainer into place
Figure 9: The Solid invisible retainers are kept at least 1.5mm from the incisal edge and from the gum level
Figure 9: The SOLID invisible retainers are kept at least 1.5mm from the incisal edge and from the gum level