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Posted by: The Probe 18th January 2022
Dental professionals must continue to meet the demand for cosmetic dentistry, whose popularity has produced many new systems and modalities to satisfy patient needs and goals. Due to new materials and techniques, as well as a growing patient awareness, deciding the appropriate course of action for patients is as crucial as ever. Orthodontics is one branch of cosmetic dentistry that requires a focus on both function and aesthetics, and these outcomes are only as successful as the planning stages of treatment.
Dentists have a duty to their patients to devise and execute a detailed and tailored assessment, diagnosis and treatment plan, as well as communicate clearly the potential risks that could accompany their treatment. The planning stages will determine, alongside other things, the patient’s goals, the severity of their case and the orthodontic system that will best suit their requirements. The dentist must always work within their competency and refer to a more experienced clinician wherever necessary. If there are areas they wish to develop in, dentists should prioritise advancing their skills in order to deliver a more comprehensive range of treatment options to future patients.
Choose what is best
Those who seek orthodontic treatment will do so for many different reasons. Some patients may suffer from malocclusion and an increased overjet or dental spacing have been shown to have a negative impact on quality of life.[i] However, many will be aesthetically-driven, motivated by confidence issues, and the belief that straighter teeth will help boast self-esteem. Thus, striking a balance between the patient’s ambitions and their clinical needs is vital.
The range of orthodontic appliances on the market means dental professionals have a choice of solutions available to determine appropriate treatment for each patient. Those with more severe cases of malocclusion may require comprehensive treatment, such as fixed or lingual fixed appliances. Patients with mild to moderate cases may be treated with clear aligners.
All systems have their advantages and disadvantages – the positioning of the lingual fixed appliances render them near-invisible, though conventional fixed appliances are generally accepted to be the more popular choice for complex orthodontics. However, patients may be put off by potential discomfort whilst wearing fixed systems, as well as prolonged treatment times.
Clear aligners have become an increasingly popular choice for patients – they are discreet, and may cause less discomfort than treatment with fixed appliances. [ii]
However, research[iii] indicated that clear aligners were not effective in controlling certain orthodontic cases, such as anterior extrusion movement and upper molar bodily movement, highlighting that they cannot be used in every situation to full effect.
Always have a plan
Case assessment, diagnostics and treatment planning are pivotal stages within any dental treatment, and orthodontics is no exception. For example, studies[iv] have shown that issues encountered during dental treatment can be directly traced to factors overlooked during the planning stage, which further highlights the importance of these steps prior to treatment delivery. Effective planning will aid in identifying any potential compromises, providing an opportunity to minimise these issues and also manage patient expectations. The importance of communicating the chance of compromised results to patients cannot be understated – for example, if you are providing clear aligners, there is a possibility of black triangles (diastema) occurring, which can cause aesthetic concerns. Black triangles can be dealt with after tooth alignment; nonetheless, patients must be aware if their preferred treatment option might not yield perfect results.
Dentists should start with the ideal treatment plan, and compare this with one that accommodates the patient’s objectives, requirements and expectations. For example, a practitioner may recommend fixed orthodontics as the ideal treatment for crowding, but a patient may not wish to undergo a lengthy treatment, or have the financial means to proceed. Therefore, the dentist may draw up a compromised treatment plan, and suggest clear aligners instead – patients may not receive the same results as they would with fixed appliances, but the clear aligners would be more suitable to their needs and still provide an acceptable outcome to the patient.
Build confidence and skills in all cosmetic areas
If there are areas within orthodontics that you lack experience in, seeking out additional training will help you to build skills and confidence – as well as provide more choice for your patients. As with many other aspects of dentistry, the more you know, the better!
The BACD offers a learning pathway to members who wish to further their development through its BACD Accreditation Scheme. Members can demonstrate their ability to diagnose, plan and execute high-quality cosmetic treatment, covering a wide range of modalities from orthodontics to composite edge bonding, whitening and so much more. By encouraging members to self-scrutinise and push themselves to the limit, the BACD ensures that its ethos – providing exceptional, ethical cosmetic dentistry – is upheld.
The beauty of cosmetic dentistry is seeing your patients overjoyed by their final results – being able to offer aesthetic solutions that are functional and long-lasting makes all the scrupulous planning worthwhile. So, if you think you are ready to push yourself, your practice and your career further, why not consider becoming an accredited member today?
Dr Chris McConnell lives in Cornwall, and being an avid water sports addict spends his time off with his family sailing around the Southwest, surfing or windsurfing. He is also a private dentist with a special interest in advanced dental treatments including implants, sedation, cosmetic and digital dentistry. He has two practices, a General Practice, and a bespoke designed clinic that focuses on the digital workflow in cosmetic and implant dentistry. Chris is President of the British Academy of Cosmetic Dentistry and a Key Opinion Leader with a number of International companies, as well as founder of the REAL Dentist course which teaches Dentists how to maximise efficiencies in practice. He has undertaken the Royal College FGDP Implant Diploma and lectures on dental efficiencies, and advanced implant and cosmetic solutions using digital dentistry to improve your results.
For further enquiries about the British Academy of Cosmetic Dentistry visit www.bacd.com
[ii] US National Library of Medicine. Pain level between clear aligners with fixed appliances: a systematic review. Available online. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970090/. Accessed 6 Oct. 21.
[iii] The Angle Orthodontist. Efficacy of clear aligners in controlling orthodontic tooth movement. Available online. https://meridian.allenpress.com/angle-orthodontist/article/85/5/881/59502/Efficacy-of-clear-aligners-in-controlling. Accessed 6 Oct. 21.
[iv] US National Library of Medicine. Treatment planning in conservative dentistry. Available online. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467905/. Accessed 7 Oct. 21.