CREATING BEAUTIFUL SMILES

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Posted by: Dental Design 19th October 2020

Dr Gurmukh S Raja is a cosmetic dentist providing aesthetic orthodontic solutions in Natural Smiles Leicester, Carillon Dental Care and Yorkshire Dental Suite. He is also a clinical tutor lecturing with Quick Straight Teeth and mentor.

A 32-year-old female presented with concerns about her upper and lower front teeth overlapping. She was looking for a straighter smile to aid her modelling career, as well as some teeth whitening.

Synopsis of treatment provided

3M Gemini clear bracket system on the upper and lower arches, with metal tubes on all first molars
Aesthetic coated NiTi wires ranging from 0.014 to 0.018
Used a variety of different methods to align the teeth including coiled springs, long/short chain elastics, metal tie ligatures and IPR (interproximal reduction) using metal strips
Teeth whitening using whitening trays and 16% carbamide peroxide for night time wear
Fixed lingual and palatal wires with removable Essix retainers

Consultation and clinical presentation

My standard consultations are made up of the following components:

Discussion regarding previous dental care, smile and what the patient wants to achieve
Full medical history
A digital OPG x-ray
Examination and assessment of extra-oral and intra-oral tissues, including the whole mouth, jaws, gums, teeth, existing restoration and prostheses
Small intra-oral photographs showing all existing restorations and other discussion points
Full set of oral digital images, including open and centric, 45 degrees, occlusal, and extra-oral views with including full face
Away from the clinical area, we discuss all treatment options in detail, time frames, potential treatment outcome, lifestyle and goals

After assessing this patient, I identified good oral hygiene, no bleeding on probing and no signs of decay.

We had Class I molar occlusion, collapsed, narrow upper arch with inclined pre-molar regions. The upper central incisors were overlapping and crossed over. The lower incisors presented with mild crowding and a slightly wider arch. The patient had competent lips and showed a slight gingival margin when smiling. The initial tooth shade was A3.

Treatment planning

The treatment options we discussed included:

No treatment
Crowns/veneers to correct the shape, shade and alignment of the teeth. This would offer only limited improvement due to the narrow upper arch, heavy preparations and risk of pulpal pathology. It would also require a long-term financial and health commitment
Orthodontic treatment to align the teeth:
- Fixed metal brackets which can be placed on the inner or outer surfaces of the teeth
- Clear 3M brackets placed on the labial surfaces
- Removable appliance
- Clear aligner system

After discussing all the treatment options, we decided to use 3M Gemini clear brackets as these would give me more control and we could assess the patients’ smile as the treatment progressed. The patient was also still modelling and preferred a treatment that wouldn’t hinder her career.

Treatment progression

Pre-treatment models were taken and brackets were placed on the upper and lower 5-5 using a selective etch, bond and cement. Metal tubes were placed on all the 6s and bite guards were provided. Treatment commenced with 0.014 NiTi aesthetic wires.

Regular monthly reviews proceeded to assess tooth movements. Treatment progressed using various auxiliaries, including coiled springs, chain elastics, metal ties, ligatures and IPR to gain the desired tooth alignment. The patient commented on how much more comfortable the brackets felt than she had expected.

Within the first two months, we had some arch expansion, the pre-molars were up-righting and the upper centrals had separated enough to help re-connect the mesial contacts. Crowding had also been reduced in the lower arch with the teeth up-righting and aligning well. No issues were reported with any of the brackets. We used a 0.014 wire for the first two months and then a 0.016 wire for the next two.

By month five, we switched to 0.018 wire to complete alignment and create perfect arch shape and form.

At this stage, fixed wire retainers were bonded to the lower 3-3 lingually and the upper 3-3 palatally. Impressions were taken for tooth whitening trays, which improved the tooth colour from an A3 to an A1 shade over a period of two weeks.

To complete treatment, I supplied and fitted Essix retainers for both the upper and lower arches. The patient was advised to wear these at night time for the first six months and thereafter every other day for the rest of her life to maintain her new smile.

Final thoughts

The driving force for any treatment is the end goal and complete patient satisfaction throughout their journey. I firmly believe that my patients are my adverts and if they are satisfied with the care and results, without asking, they’ll recommend me to others.

This case wasn’t overly complex, but as the patient was still working as a model, I needed to provide her with a solution that would not only achieve her dream smile, but also do so as discreetly as possible without any disruption to her career.

I’ve used the 3M Gemini brackets for over five years and have created 100s of smiles. Even with more complex and longer treatment plans, the brackets are un-phased and continue to work as required.

The 3M Gemini brackets are a gold standard of brackets as they are so discreet, comfortable and extremely effective. The ultimate reward is when you exceed your patient’s expectations and see the delight as you reveal their new smile. I strive for the best smiles, and will only use the best for my patients.

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