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by John Fish, DDS
I
used to think I would never introduce ortho into my
practice. The following case demonstrates both the scope
of treatment and the ease of use of the Six Month Smiles
short-term orthodontic system, a system I have found favorable in my practice.
Chris presented to my office after finding me listed as a
provider on the Six Month Smiles Web site. His chief cosmetic complaints centered on the general crowding and
asymmetry in his smile. According to Chris, his smile
“looked like a train wreck.” The appearance of his teeth had
always bothered him but aside from traditional orthodontics,
he wasn’t aware of another feasible option. Chris had thought
he was going to live the rest of his life with crooked teeth.
Fig. 1
Fig. 2
The first step in the process was to assess Chris’ dentition
and make an orthodontic diagnosis. This included a slight
Class II canine and molar relationship bilaterally, generalized
moderate crowding, narrow and flat archforms and multiple
anterior crossbites in the region of the lateral incisors. When
I was trained at the Six Month Smiles seminar, I learned how
to make an orthodontic diagnosis and determine which adult
cases can be treated with the Six Month Smiles system. The
entire case selection and treatment planning process primarily revolves around understanding and treating based upon
the patient’s chief cosmetic complaints. I have found that
most adults with crooked teeth are candidates and most cases
are completed in approximately four to nine months.
Fig. 3
Figs. 1, 2 & 3: Pre-operative photos demonstrate the severity of Chris’ tooth position discrepancies, including moderate crowding in both arches, anterior crossbites and
under-erupted canines which created extremely large incisal embrasures. Chris was embarrassed of his smile.
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feature orthodontics
I was a bit skeptical about performing ortho since I
wasn’t taught much about it in dental school. I was essentially taught how to pick up a referral pad and refer out
patients with malpositioned teeth. I was also taught that if
teeth are moved with too much force, it can result in root
resorption. The Six Month Smiles system involves use of
extremely light tooth-colored archwires and unique clear
cosmetic brackets. Additionally, the goals of treatment are
different than those typically associated with traditional
orthodontics. The short-term, ortho-specific materials and
simplified treatment goals are what allow Six Month Smiles
providers to treat cases like Chris’ in such a reasonable
amount of time and without any increased chance of root
resorption. Providers focus on giving patients like Chris a
highly aesthetic new smile while maintaining a practical
approach and focused treatment goals.
I started doing Six Month Smiles cases because I liked
that it doesn’t aim to make the most time consuming orthodontic alterations. The goals of treatment are very similar to
porcelain veneers and clear aligners in that the aim is to create a dramatic improvement to the appearance of the teeth
without making significant changes to the posterior occlusion. However, I’m able to address important aspects of the
occlusion such as deep bites, minor cross bites and constricted
envelopes of function.
When I saw Chris in the office, I discussed his options with
him. Traditional orthodontics is always my first recommendation for patients with malpositioned teeth. But many adults
aren’t interested in traditional ortho – whether for aesthetic reasons or concerns about the length of treatment. Before Six
Month Smiles, I would treat some of these patients with veneers
but had to tell most of them that I couldn’t help them. I also
discussed clear aligner treatment with Chris but explained to
him that extruding his upper and lower canines with clear
aligners would be incredibly difficult, if not impossible. Based
on our discussion about the options available to him, Chris
decided quickly that Six Month Smiles was the approach that
made the most sense for him. We took impressions that day.
Fig. 5
Fig. 6
Figs. 5 & 6: Post-treatment photos demonstrate Chris’ final result which was
accomplished in six months.
About two weeks after gathering our records and taking
impressions, we started the case. The bracket technicians at
Six Month Smiles determine the ideal positions for the
brackets and fabricate bonding trays. The system was definitely designed with GPs in mind.
We saw Chris every four weeks for his adjustment visits. At
these visits, we removed the wires, evaluated the teeth and provided some very conservative interproximal reduction where
appropriate. The system involved a sequence of three gradually
larger archwires and we changed the size of the wires in both
arches every other month. The tangible nature of this treatment
really makes it enjoyable for everyone involved in the process.
Chris’ case was completed in about six months, as expected.
When the desired results had been achieved, we removed the
brackets and made retainers for Chris. Retention for Six Month
Smiles is similar to any type of orthodontic treatment in that a
good retention protocol is critical for long-term success. There
are varieties of retention options, both fixed and removable,
and the decision of which option to choose depends on the specific case and the desires of the patient.
There are still a few more things we have planned for
Chris. We have discussed some aesthetic crown lengthening
procedures in the upper posterior quadrants. We also plan to
replace his missing lower molar with an implant-supported
crown when appropriate.
Chris was thrilled with the result. In fact, he told me that
it was “life changing.” It was a dramatic change in regard to
both aesthetics and occlusion.
I am pleased to have the ability to deal with tooth position discrepancies in a way that is both conservative and
attractive to patients. n
Author’s Bio
Fig. 4: Mid-treatment photo shows how much tooth movement has already been
accomplished within two months of treatment. The photo also shows the bracket design.
Dr. John Fish has been in practice in Western North Carolina since
1983. He is a fellow in the American Academy of Implant Dentistry, the
Misch International Implant Institute and the Academy of General
Dentistry. He is also a diplomate in the American Board of Oral
Implantology and a mentor at the Kois Center in Seattle. His practice has
a special focus on implants, cosmetics, sedation and Six Month Smiles.
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