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Pragmatic restorations – Mark Allen General Manager at COLTENE

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  Posted by: The Probe      19th September 2019

Restorative and orthodontic dentistry have advanced considerably in recent years, with each offering patients impressive aesthetic outcomes. Depending on the patient and their needs, restorative treatment can be the more pragmatic choice.

Time and money

Time is arguably the most precious resource any of us have. The old saying goes that ‘time is money’, but time is also opportunity. Orthodontic treatment can take multiple years depending on the case, followed by ongoing usage of a retainer. Repeated appointments are required to ensure things are progressing as they should be, taking up valuable time that both practitioner and patient likely can little afford.

Life does not stop while receiving treatment and orthodontics can be aesthetically and psychologically intrusive. Wearing an orthodontic appliance can influence how others see and treat a patient, as well as their own self-confidence. Wearing braces can draw unwanted attention, they can make the wearer appear younger (even with the rise in adults receiving treatment they are still frequently associated with adolescence) and men may feel uncomfortable being seen to be receiving treatment for cosmetic reasons due to social conditioning. While many can use comparatively discrete options, this is not always possible and sometimes speech can be affected. This can potentially affect a patient’s social, romantic and professional life – effects that are incalculable but for some represent missed opportunities, real or imagined.

In some instances, patients seeking orthodontics for aesthetic reasons may be better served going straight to a restoration. This is particularly the case when it can be anticipated that the patient will ultimately require restorative treatment regardless. In such instances, it can save the patient time and money to not go through, what is in effect, unnecessary orthodontic treatment. An example of this could be a patient who requires a very substantial level of space closure, beyond what orthodontic treatment alone can achieve. In other instances, such as subtle straightening and correction of minor overlaps, a restorative procedure like dental contouring (often in concert with bonding) can quickly and inexpensively achieve the result the patient wants with a minimum of hassle and commitment on their part.

 

Compliance and risks

We must also acknowledge human nature – compliance is a significant issue among patients during and after orthodontic treatment. During treatment, many orthodontic patients struggle with their oral hygiene, as braces can make it difficult to thoroughly brush and make it easier for food and bacteria to become trapped. This can make patients more vulnerable to decalcification and caries – even five years after completing treatment patients who have undergone orthodontic treatment have a significantly higher incidence of enamel opacities than those who have not.[1]

Troublingly, a great many patients fail to wear their retainers, risking all the hard-won progress made. A study found that within the first year, more than a quarter of patients failed to wear their retainers for the required amount of time. After a year this drops even further, with less than half of patients wearing their retainer to an adequate degree.[2]Other patients frequently damage their appliances, whether by accident or carelessness, extending treatment time and necessitating additional appointments.[3]

Use of an orthodontic appliance can also damage the enamel. Where a fixed device is affixed to a tooth, the traditional method involves acid etching the enamel surface. While self-etching systems general result in substantially less enamel changes, there is still the potential for adhesion errors, which can increase the risk of cracks developing.[4]

 

Aesthetics

Orthodontic treatment can achieve excellent aesthetic outcomes for many patients, and a great many people seek treatment for precisely that reason. However, there are practical limits to what can be achieved orthodontically. Veneers can address aesthetic short-comings that orthodontic appliances cannot, primarily tooth shape and colour.

A great restoration can have a transformative effect on patients, not just restoring their smile, but potentially improving it. BRILLIANT COMPONEER™is a new composite enamel shell from COLTENE that enables you to perform outstanding restorations chair-side.

Some members of the public may be concerned about restorative treatments like veneers, having seen or read horror stories in the media and being unaware that minimally invasive treatment options exist. BRILLIANT COMPONEER™is a minimally invasive, cost effective solution that can be completed in just one session – with no laboratory support required whatsoever. No impressions need to be taken to offer highly customised, beautiful teeth. Offering great aesthetics with its high gloss retention and polishability, curtesy of proven submicron filler technology, this is a high-quality solution that gives excellent results.

When it comes to choosing between treatment options, particularly when the primary motive is aesthetics, the specifics of the case and the nature of the patient are crucial to achieving an optimal result. Non-compliant patients can end up sabotaging the success of their treatment, especially during treatment that requires long-term commitment. Others have considerably more time,  patience and diligence. Better understanding what the patient wants, and establishing realistic expectations rather than an idealised view of patient and treatment, will help see more patients receive treatment that is truly suited to their needs.

 

To find out more visitwww.coltene.com, email info.uk@coltene.comor call  01444 235486

 

Refernces

[1]Meeran N. Iatrogenic possibilities of orthodontic treatment and modalities of prevention. Journal of Orthodontic Science. 2013; 2(3): 73-86.

[2]Abeskharon A., Fischer M., Burnheimer J. Compliance with retainer wear in the first year: an analysis of 320 cases. Journal of the World Federation of Orthodontics. 2018; 7(1): 13-16. https://doi.org/10.1016/j.ejwf.2018.01.005 May 20, 2019.

[3]Seeliger J., Machoy M., Koprowski R., Safranow K., Gedrange T., Woźniak K. Enamel thickness before and after orthodontic treatment analysed in optical coherence tomography. BioMed Research International. 2017; 2017: 8390575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294353/May 20, 2019.

[4]Seeliger J., Machoy M., Koprowski R., Safranow K., Gedrange T., Woźniak K. Enamel thickness before and after orthodontic treatment analysed in optical coherence tomography. BioMed Research International. 2017; 2017: 8390575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5294353/May 20, 2019.


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