DENTISTS should print this off (Note it is in technical jargon and is written specifically for dental professionals)
Special Report: 20 Commonly Overlooked facts every Cosmetic dentist should review prior to recommending an EXTREME SMILE MAKEOVER
While it doesn’t make for great television, orthodontics is an exciting field of dentistry and is being advanced faster than most people even know. Gone are the days where a dentist can simply breeze over the option of using braces and simply employ porcelain facings. Now there are many different options including rapid orthodontics which make the option of wearing braces much easier to accept. While some of the following reasons to use orthodontics to compliment or as a substitute for other procedures may be obvious, some may surprise you and be the reason you may struggle with little nuances that didn’t quite work out.
1. Will the teeth involved in the makeover need to be restored, even if orthodontics is not done? When the teeth are heavily restored with composite/amalgam you may feel it is not worth bothering with orthodontics. Before you make that decision, read on.
2. Can you avoid doing a porcelain makeover if you simply use orthodontics? When a makeover can be performed with only braces and bleaching you can be a hero by being more conservative.
3. Are there any occlusion issues that are easily corrected with orthodontics? Many times cross bites and interferences are “jumped” by opening the bite with layers of porcelain when a little orthodontic work would easily correct the problem. Ask yourself, are you going to have to stretch the tooth beyond its normal contour above the root? Think braces.
4. Is there a cant that will be difficult to correct without aggressive crown lengthening or thick porcelain? By using some very new techniques, some corrections that used to be done surgically can now be done much easier using orthodontics and mini-anchors for intrusion.
5. Are the gingival levels where you want them? A laser does not solve every gum contour problem...you sometimes need to use orthodontics to get the CEJ’s into the correct position for an ideal result.
6. Do you find yourself having to cut away an excessive amount of tooth structure to get the tooth setup or “Golden Proportion” that you want in a makeover? It is often very easy to move a tooth a few millimetres and avoid having to “fudge” it with porcelain.
7. Do you consider how the papilla is affected by your decision about orthodontics? When the papilla doesn’t come half way up between the teeth it may be a sign that you took a shortcut which can make the makeover less attractive. Roots can be brought closer together to get a better papilla, while other methods of trying to grow them are pretty ineffective.
8. The facial gingival margins are greatly affected by the alignment of the teeth...are you considering osseous surgery when orthodontics should really be done first? A tooth that has a poor root angulation as in a lateral incisor in a class 2 div II case, will often be a challenge. If you think osseous surgery alone will give it the proper look (getting the gingival heights to be harmonious), you may find the correction is not permanent. Unless the root is moved the tissue often re-grows over the area.
9. Do you need to move the gingival margin more coronally and only think about grafting? Sometimes a graft will not work (it rarely holds onto enamel or restorative materials)and orthodontics should be used instead...do you know when to choose the best option and what compromises will need to be accepted?
10. Are you forced to prepare your porcelain margins down onto the root? Keep your mind open to the idea of intruding a tooth with orthodontics. If you can't do it yourself an orthodontist can help.
11. Do you have concerns about having sufficient room to achieve the color that you desire in your restorations? Is it just me, or are veneers starting to look more and more unnatural? If you need to use too much opaque porcelain, ask yourself if moving the tooth a little would help your patient’s situation.
12. Are you having to settle for “Big Horse Teeth” when you are closing diastemas with porcelain? A common shortcut to just fill gaps with bonding or porcelain sometimes makes the teeth look too wide, and while the patient may initially be pleased they may come back later wondering if... you could have done a better job if you had moved the teeth first. In fact, when the teeth already have ideal proportions they can simply be shifted to the correct position, sometimes in only months.
13. Are you cutting down healthy canines so you can widen a peg lateral? Using orthodontics to nudge a tooth over a little can make a big difference and help treat the patient conservatively.
14. Are you are going to have to prepare the tooth all the way to the pulp to make it straight with veneers? Maybe all it takes is a little tooth movement to be able to keep the nerve alive.
15. Will there be any tooth left when you are done drilling? It’s actually pretty scary for non-dentists to see what prepared teeth look like...is that a clue that maybe there is a better way? The more tooth structure you take away the less the next dentist will have to work with when the makeover needs to be redone!
16. The liability you may experience by excluding the huge benefits of doing orthodontics in makeover dentistry may be significant. If you do not have properly worded consent forms that clearly state the patient is choosing a compromise with higher risks of complications and long term costs you may have problems in the future...especially in the USA.
17. If you do not consider all kinds of orthodontics in your treatment plan you may be in trouble. If you are unaware of all the amazing new advances like accelerated orthodontics, transplantation, intrusion & extrusion and the use of mini-orthodontic anchors it may be time to get to some courses that teach something other than porcelain veneers. Challenging cases can sometimes employ a combination of skills to achieve a conservative and esthetic result.
18. Are you aware of the advantages of moving teeth to create bone rather than grafting? Congenitally missing teeth can give you a number of challenges that can be treated easier if you use a little orthodontic treatment.
19. If your patient’s situation would be improved by having a strategic tooth moved into a new location do you pause and consider orthodontics? As an example, rather than reshaping a canine into a lateral would it make sense to move it back into place and have it where is should be?
20. In a trauma case are you prepared to use orthodontics to simplify the smile makeover? When a tooth gets knocked out of position, you may not be able to re-position it exactly where it came from. If you have the orthodontic training you will be able to provide an added service to your patient and get them one step closer to a perfect smile.
NEWS UPDATE: A recent article written by Dr. Kockich from the University of Washington explained a few facts that are sometimes not fully understood by members of the dental profession: a) Root damage is not related to pressure or speed...it’s related to genetics and longer times in braces. b) There are ways to reduce orthodontic treatment times.
WAIVER: The author's opinion is that dentists and specialists are sometimes recommending treatment that may be more aggressive than it needs to be to provide satisfactory results. Patients are encouraged to seek the advice of competent dental professionals and if in doubt seek a second opinion. No liability is assumed by the author, the website or the publisher for use or misuse of the information provided. Consider using or not using the information provided at your own risk.
