Six Month Smiles Case

orthodontics Six Month Smiles Case Short term orthodontic treatment can provide nice cosmetic results without the removal of tooth structure for veneers. This is a sample case. Posted: 1/19/2010 Post: 1 of 53 I haven t posted a case in a while and I feel like I ve been delinquent. I d like to share this case. This case is a great example of what Six Month Smiles cases are all about... the scope of treatment, types of changes that can be made, and type of patients who are great candidates for the treatment. This 25-year-old female presented with chief complaint: I have always wanted straight teeth and I m interested in hearing about the options. A thorough exam was done that revealed healthy teeth and periodontal structures. Upon further discussion, the patient was most concerned about the symmetry of her smile and the alignment of her anterior teeth. Four options were discussed: Comprehensive Orthodontic Treatment, Six Month Smiles, Invisalign and Porcelain Veneers. The patient selected Six Month Smiles. For those of you who know about my practice, you probably aren t surprised; 95 percent of what I do is Six Month Smiles (Short Term Ortho) and a big reason for this is because it is the only thing I market. So when patients come in to see me, I present all the options but most of these patients are in my chair because they are interested in Six Month Smiles. For those of you who aren t familiar with the scope of treatment, here is a short synopsis. Six Month Smiles is cosmetic orthodontic treatment that is an alternative for adults who are not interested in traditional comprehensive orthodontics and who aren t good candidates for veneers. The goal of treatment is to greatly improve the smile by increasing symmetry, alignment and the overall position of the teeth. Treatment times usually fall within four to nine months with the average treatment time being six months. The posterior occlusion is tweaked for most cases but most cases do not involve changes to angle Class or significant bucco-lingual root movement. This is a streamlined and systemized way for general dentists to be able to provide an effective and conservative option to patients with crooked teeth. The brackets are set up by Six Month Smiles and the case is seated using bonding trays. This makes bracket placement extremely efficient and stress-free. Six Month Smiles also provides support with case selection, treatment planning and mid-treatment suggestions. Fig. 1 Fig. 2 Fig. 3 Fig. 4 Figure 1: Pre-op smile. Notice extreme rotation of #7. Figure 2: Pre-op right lateral view. Figure 3: Pre-op left lateral view. Notice Class 3 tendency. Figure 4: Pre-op retracted biting. 46

orthodontics Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Figure 5: Pre-op retracted right side biting. Figure 6: Pre-op retracted left side biting. Figure 7: Pre-op upper occlusal view. Figure 8: Pre-op lower occlusal view. Figure 9: Pre-op facial photo. Figure 10: Post-op facial photo (seven and a half months treatment). Want to read more about what Townies are doing to incorporate ortho in their practices? Check out these boards... Why I Love Doing Six Month Smiles! Search: Love Six Month Smiles Fig. 11 Fig. 12 Ortho Course for General Dentists Search: Ortho Course Unwanted Tooth Movement Search: Unwanted Tooth Movement Fig. 13 Fig. 14 Figure 11: Post-op smile. Notice dramatic improvement to gingival symmetry and overall symmetry of the teeth, lips, gums. Figure 12: Post-op right lateral view. Notice correction of severely rotated #7 (a very difficult movement if attempted with aligners). Figure 13: Post-op left lateral view. The treatment process involves a three wire sequence. Conservative interproximal reduction is provided when crowding exists. The goal is to maintain favorable shapes of teeth and minimally reduce. When done properly, this is an easy and safe way to provide some control over the fit of the teeth within the arch. Figure 14: Post-op retracted biting. continued on page 48 dentaltown.com «May 2010 47

What kind of marketing are you doing? I start about four cases per month and would love to do more. But when a GP advertises ortho in my area they get cruciorthodontics continued from page 47 Figure 15: Post-op upper occlusal. Notice how the buccal cusp tips of the posterior teeth are now in alignment with the canine cusp tips and incisal edges of the incisors. Figure 16: Post-op lower occlusal. Arch is rounded out and symmetry now exists. Figure 17: Three-year follow-up photo. Six Month Smiles is an alternative for adults who are not interested in comprehensive orthodontics. It is a great arrow for every general dentist to have in their quiver because it gives us the ability to provide a conservative and effective cosmetic option for adults who otherwise might not have any good options. The streamlined nature of the system and the support that is provided makes this a predictable and profitable procedure for GPs regardless of their current level of orthodontic experience. This type of treatment is not a replacement for traditional orthodontics and is geared for adults. Operator knowledge must be sound and patient communication must be clear in order to achieve success with this treatment modality. Fig. 15 Fig. 16 Fig. 17 DrJLo Posted: 1/19/2010 Post: 2 of 53 Amazing! Isn t there an increased chance for external root resorption due to the high forces on the roots? I assume that the forces are bigger? Eric Krause, DMD Eric Krause Posted: 1/19/2010 Post: 3 of 53 Forces are not bigger. Lower chance of resorption due to the short length of time of treatment. Scott Leune, DDS Scott Leune, DDS Posted: 1/19/2010 Post: 5 of 53 These cases are sitting in my recall chair all day long... because they assume ortho will be two to three years, patients have accepted the fact their teeth are crooked. However, the minute they see that it takes six months without looking like the metal-mouth band-nerd image they have in their heads, a lot of my patients jump right in. We have had months where we started more than 40 new cases at $3,500 a pop. It s amazing. This is one of the most satisfying and predictable things I ve done in my practice. Day in day out, patients just say yes and are excited throughout treatment. I remember the first month after I learned the technique... I believe I had 12 cases or so. We just exploded. Great case, Ryan. This is so much more conservative than cutting those teeth down for veneers. Great job! scott Wade is Skiing Posted: 1/19/2010 Post: 15 of 53 48

orthodontics fied. Complaints to the board and badmouthing to everyone they know. I d like to advertise more but wonder how you keep it tasteful to the orthos or do you just say to hell with it. Contact the orthos and tell them what you are going to do. Tell them the criteria that you will be using to select patients and the cases you will be treating. Tell them that with the advertising you are likely to get cases more advanced than you can handle and in all likelihood will need a good referral option. Ask them if they can give you some advice now and then. I have a good relationship with my ortho and he knows exactly what I do and the number of referrals to him have actually increased. richard Richard Hayden, DDS rhayden Posted: 1/19/2010 Post: 16 of 53 It s interesting. I haven t had a single ortho (to my knowledge) disparage me or attempt to crucify me at all. And, the orthos I refer to have all been supportive. Very supportive. I d also like to simply agree with what s been said about how Six Month Smiles will benefit your practice. First it gives you and your patients cosmetic options that didn t exist before. That alone is very liberating. No more cosmetic limbo when the patient refuses either veneers or comprehensive ortho and ends up doing nothing. Many have posted impressive ROIs and certainly that is a key benefit, but I think adding SMS to your repertoire is a no-brainer whether it increases your Michael I. Barr, DDS mikebarrdds Posted: 1/20/2010 Post: 17 of 53 continued on page 50 FREE FACTS, circle 34 on card dentaltown.com «May 2010 49

orthodontics continued from page 49 annual production $300,000 or $100,000 or even $50,000. Everyone s practice is different. Not everyone has a $2 million practice. So my point is not to necessarily measure yourself against anyone s figures in particular. Here s the bottom line: You will pay your course expenses after doing one or two cases! After that, it s all gravy! And, any amount of gravy is good gravy! I don t know of any other course in dentistry that offers such an immediate positive ROI. The investment is small compared to most others. And it s a service that is desired. Finally, besides the liberating feeling of having a fantastic new cosmetic option for your patients... doing SMS is simply fun! It really is fun and relaxing. Of all the procedures I do (some of which are quite stressful); doing SMS is by far the most fun and satisfying. Patients love it. They can t believe how easy (and quick) it was to achieve the smile of what they thought were only their dreams. Making those dreams an easy reality is very rewarding in many ways. Mike Posted: 1/20/2010 Post: 19 of 53 I think the key is to make it very clear that Six Month Smiles is for adult patients who aren t interested in traditional orthodontics. It is also important to make it clear that you are a general dentist. If you do those things... people can gripe all day but they have no real claim against you. I have not had any problems marketing this treatment over the last five years in my area. I ve been doing strong radio and TV campaigns with very good effect. All the best. Ryan 50

orthodontics No bonded retainer? Change in protocol for SMS people versus the Powerprox? like2drill Posted: 1/23/2010 Post: 25 of 53 So both systems are about the same? Powerprox has no tray to place the brackets at the same time, am I correct? DrJLo Posted: 1/25/2010 Post: 26 of 53 You can get indirect bracket bonding trays if you like. I recommend Space Maintainers Lab for these as they have something like 50 years of experience in fabricating orthodontic appliances and their high volume buying ability gives you great prices. I teach both direct and indirect bracket bonding and we actually do direct bracketing hands-on at the live course. You need to know how to do both. Fixed retainers are not a given with Powerprox but you can use them if you like. For years I used primarily Hawleys but patients don t care for the aesthetics so I do more splints, Essix and Powerprox splints now. Still use Hawleys from time to time if the case warrants it. Rick DePaul, Jr., DDS drrick Posted: 1/25/2010 Post: 27 of 53 With the Six Month Smiles system, we encourage docs to select the method of retention that is best suited for the patient and for the doctor. There are pros and cons of both types of retainers (fixed vs. removable). Depending on the patient s bite, hygiene, etc. the best option can vary. I like bonded retainers because they remove the patient compliance part of the equation but bonded retainers have some cons too... including possible need for repair and collection of tartar. The goal of the Six Month Smles system to is to make appropriate and sensible decisions every step of the way, from case selection/treatment planning to final retention. This particular patient did have bonded retainers placed after the initial braces off photos were taken (Bonded retainers are usually placed about four weeks later in my office). All the best. Ryan Posted: 1/25/2010 Post: 28 of 53 Why do you choose to bond the fixed retainers later? Rick DePaul, Jr., DDS drrick Posted: 1/25/2010 Post: 29 of 53 What are the clinical indications for a Hawley retainer over a splint retainer? Why in the case posted did you wait four weeks before bonding a fixed retainer, isn t there a possibility that the teeth will move before then? dreamsmile Posted: 1/25/2010 Post: 36 of 53 In regards to the questions about bonded retainers and when to place them, etc. I have two protocols that I follow depending on the particular patients. I follow protocol number one 90 percent of the time because it expedites the process and allows them to start whitening right away (we include whitening with the case fee). Posted: 1/26/2010 Post: 44 of 53 continued on page 52 dentaltown.com «May 2010 51

orthodontics continued from page 51 Here are the protocols. 1. Normal Retention Protocol - If the patient comes in for their last adjustment and the teeth are almost where I want them but we d like to see some very minor changes, I follow this protocol: The necessary adjustments are made to the braces to ensure the final tweaks we are looking to see (usually slight rotations, etc.). The patient is then dismissed and set up for their braces off appointment in about four weeks. This gives enough time for the desired tweaks to take place. When the patient comes in to have their braces taken off, the braces are taken off and any places where there are pieces of a bracket or ortho cement jutting off the teeth are quickly smoothed. The majority of the cement is left on the teeth. This allows for a custom bleaching reservoir when the models are poured (the cement acts like a reservoir). Then impressions are taken with inexpensive PVS material (Silgimix, etc.), poured with Stat Stone (sets in five minutes) and the removable retainers/bleaching trays are made while the patient is in the office. While the retainers are being made, the rest of the cement is polished off of the teeth. The patient leaves the office with their removable retainers/whitening trays and the whitening material. They are scheduled to come back in two to four weeks to have their bonded retainers placed. The PVS impressions are then sent for fabrication of the bonded retainers (in bonding trays). The patient returns in three to four weeks (gives time for bonded retainers to be fabricated and for the patient to whiten their teeth) and the bonded retainers are placed. Finally, the removable retainers can now be trimmed on the lingual from canine to canine to fit over the bonded retainers. If you do not want to trim the retainer, new impressions can be taken to facilitate the fabrication of new removable retainers/bleaching trays. 2. Bonded retainers placed the same day as when braces are removed. If the patient comes in for an adjustment and their teeth are exactly where we want them to be (and the patient agrees), we will take the wires out, take alginate impressions of both arches and then tie the wires back in. The impressions are poured and sent for bonded retainers (in bonding trays). The patient is scheduled for braces off in about three weeks. On the day that the braces are taken off, the bonded retainers are placed. Then impressions (we use a PVS alginate replacement material for this; Silgimix, Alginot, Status Blue, etc.) are taken of both arches and the patient is dismissed. The patient returns in one to two weeks to pick up their bleaching trays/back up removable retainers that are made from the models that were created via the PVS impressions. The removable retainers/bleaching trays are made from.040 ortho splint material and are trimmed 2mm from the gingival margins. They work well as back-up retainers and whitening trays. We give the patient take-home whitening material and instructions so they can whiten their teeth at home over approximately two weeks. Find it online at www.dentaltown.com Six Month Smiles Case FREE FACTS, circle 32 on card 52