SmileFast: The predictable short-term cosmetic orthodontic treatment

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1 PART FOUR IN A SERIES SmileFast: The predictable short-term cosmetic orthodontic treatment Elite training, elite technology, elite support! By Geoffrey Hall, BDSc (Melb), Cert.Orth (Penn) and Dr Derek Mahony, BDS (Syd), MDS (Lond) S milefast is a short-term cosmetic orthodontic solution suitable for the majority of adult patients who present with crowded or spaced anterior teeth. Traditionally, the majority of adult patients have refused conventional longterm or ideal orthodontic therapy for many reasons. The main barriers for adult orthodontic treatment acceptance are cost, appearance and time. In addition to this, many adults are reluctant to undergo dental extractions or orthognathic surgery. Most of these adults are only concerned about their anterior aesthetics. SmileFast is a short-term cosmetic orthodontic solution which involves the use of clear braces and tooth-coloured archwires to be able to transform aesthetic smiles usually within six to nine months. It is an innovative shift in orthodontic treatment philosophy which can greatly benefit dentists and their adult patients as it offers enormous advantages over other systems. Figures 1 to 8 show examples of patients and treatment times treated with Smilefast technique. In a study performed in our practice over a three-year period, we have been offering every adult patient (if eligible) three different treatment options. Firstly, we always offer the ideal treatment plan. This usually involves upper and lower fixed braces for 24 months in conjunction with elastic wear and if necessary, extractions and/or orthognathic surgery. If they are a candidate for SmileFast cosmetic orthodontic alignment, which 80% of our adult patients are, I offer SmileFast as a second option and explain to them I am purely aligning the teeth to improve the cosmetic result and not affecting the bite or occlusal relationship. Patients are informed that this approach will take approximately six to nine months and usually involves a non-extraction treatment plan or in the worst scenario, a lower incisor extraction. Finally, I also offer every adult patient - if they are an eligible candidate - aligner therapy. I explain to them aligner therapy will require attachments, IPR (Interproximal Reduction) and usually elastics, requiring 18 months to 2 and a half years of treatment. The results of our survey have found 90% of our adult patients who undergo any orthodontic therapy in our practice will choose the SmileFast approach over conventional/traditional comprehensive orthodontic care or aligner therapy, proving the main objection/barrier to orthodontic treatment, apart from orthognathic surgery or extractions, is the time in braces. We believe there is a psychological barrier with patients. If we can finish the orthodontic treatment within 12 months, preferably six to nine months, adults feel very comfortable with proceeding with orthodontic alignment. Most of our SmileFast cases take approximately six to nine months to obtain an excellent cosmetic orthodontic outcome. More patients are becoming frustrated with the outcomes with aligner therapy as there are a variety of difficult to achieve tooth movements so treatment can be unpredictable, unless treated by an experienced and knowledgeable clinicians. Patient cooperation is paramount to achieve a satisfactory result with any type of aligner therapy. SmileFast braces allow dentists to take far better control of these cases and ultimately provide a more attractive and optimal aesthetic outcome in a very short period of time. 76 Australasian Dental Practice January/February 2015

2 1a. Initial 1b. 9 Months 2a. Initial 2b. 8 Months 3a. Initial 3b. 9 Months 4a. Initial 4b. 7 Months 5a. Initial 5b. 10 Months 6a. Initial 6b. 6 Months 7a. Initial 7b. 7 Months 8a. Initial 8b. 8 Months Figures 1-8. Examples of patients who have been treated with the SmileFast approach with shortened treatment times. The treatment aim of SmileFast is to dramatically improve the appearance of their smile, without altering their occlusal scheme. Usually the following items are not addressed when treating patients with any type of short-term orthodontics: Class II or Class III malocclusions, severe openbites, mid-line discrepancies and bi-lateral posterior cross-bites. The concerns addressed by SmileFast are levelling and alignment of the anterior teeth, correcting anterior cross-bites, closing most spaces, rounding out the upper and lower arches, treating minor dental open-bites, improving deep dental bites and levelling the gingival margins. The overall goal of treatment is to transform a smile from being asymmetrical to one which is balanced and harmonious. Symmetry within the arch, gums and incisal edges is paramount in creating an attractive smile. What makes SmileFast unique? In Part 1 of this series - Cosmetic orthodontics: navigating the world of superlative driven solutions (May/June 2014) - eight areas were identified as to how to assess each of the short-term orthodontic systems which are presently available. We would like to utilise these areas to discuss the unique quality of the SmileFast system. 1. Training SmileFast has been developed by a Specialist Orthodontist who has been involved in teaching general practitioners for over 20 years, ensuring sound orthodontic principles, CORRECT simple orthodontic diagnosis and the most efficient mechanics. It has been designed for the doctor to treat ONLY those patients of which he or she will achieve consistent quality outcomes. The goal is minimal treatment time, minimal doctor chairside time, maximum profitability and most importantly, happy patients. SmileFast has now trained over 400 dentists and auxiliaries with the Smile- Fast Pro course and SmileFast Advanced course having received rave reviews. Over 95% have rated the course 9 out of 10 or higher for quality and learning content. i.e., all lecture slides, USB stick (which contains PowerPoint presentations, marketing information, clinical videos, modifiable forms/documents etc), a folder with hard copies of patient forms, brochures and other useful material. Also, the help desk on the unique portal has enormous amounts of clinical and practice material which is updated regularly. Doctors comment the knowledge they obtain from the SmileFast course gives them the confidence to treat their own patients. January/February 2015 Australasian Dental Practice 77

3 Figure 9. Malocclusion in a digital world. Figure 10. Ideal alignment with ideal bracket placement in virtual/digital world. Figure 11. Brackets transferred to maloccluded position showing position of brackets that will ultimately produce ideal alignment. 2. Treatment support SmileFast has a unique online webbased portal which allows easy case submission by the doctor and total control of production. The portal also provides a total support system for the doctor case by case, with the ability to download progress photographs at each visit and ask questions about the case. Practitioner questions are answered by fully trained practitioners and confirmed by a group of Specialist Orthodontists, ensuring that doctors will learn very quickly as their skill level accelerates. In addition, the portal allows the doctor to load cases purely for treatment assessment and identify whether that patient is suitable for SmileFast treatment. There is no software to be purchased as the on-line portal is assessable on any Windows-based computer or a Mac running in a windows environment. 3. Lab/Doctor/Patient communication SmileFast utilises a 3D, web-based Case Viewer to show the dentist and patient the anticipated orthodontic outcome and how this outcome can be technically achieved. Showing a before and after view - before you commence treatment - creates clear, unequivocal and informed patient consent. This web-based viewer is also an excellent tool to communicate with patients and ensure they know the anticipated orthodontic result. Being online, the Doctor has instant access to the Case Viewer. Seeing the technical setup in 3D and understanding how the change will occur and to what extent it will occur, is an incredibly powerful tool, as seeing how each new case will evolve builds and extends a Doctor s knowledge base. For example, patients can see if there will be an overjet left in their particular case, as you may not be correcting a Class II Buccal relationship as one would do in a traditional comprehensive orthodontic treatment plan. 4. Ease of submitting cases The SmileFast unique online webbased portal allows easy case submission. The doctor initially loads all the patient details - including photographs and x-rays thereby enabling the doctor to access interactive treatment plan comments and communicate quickly with the laboratory and the orthodontic mentor. The portal is so easy to use, staff can be trained to upload all the necessary photographs and x-rays to save the doctor time in their busy practice. 78 Australasian Dental Practice January/February 2015

4 Figure 12. Indirect bonding trays with brackets using a digital computerised system which is a key to dentists easily mastering the orthodontic bracket placement approach. 5. The learning experience Uploading progressive photos during treatment doubles as a learning and communication exercise with the Smile- Fast teacher/mentor. This allows the mentor to discuss with the doctor where and how the case could be improved, using sound orthodontic principles that underpin SmileFast s treatment mechanics. The unique portal creates a comprehensive online record for you to refer to at any time, including billing and every comment or question/answer from the orthodontic mentor. In addition, the portal has a help desk with numerous videos and information to extend the doctor s knowledge of orthodontic treatment. 6. Indirect bonding The key to well-aligned orthodontic cases is the position of orthodontic brackets. A good training program will teach doctors the correct way to place orthodontic brackets, but even after 20 years of hands on experience, this is the most difficult aspect of orthodontics. Incorrect bracket placement creates multiple problems. If left in the wrong place, treatment will not proceed to plan unless the bracket is removed and correctly placed. Accordingly the patient will need to spend more time in the chair and longer time in braces to achieve the desired result. The Doctor s profitably on that case drops accordingly. A digital indirect bonding solution is, without doubt, the most efficient and accurate way to place orthodontic brackets in the correct position. SmileFast utilises a unique digital indirect bonding system where the digital setup is performed via the computer. This digital setup and bracket positioning in the virtual world is then sent to the doctor for approval or revision. Once the doctor approves the anticipated alignment of the teeth, the case is submitted and the indirect bonding trays, with brackets, are custom fabricated for each case, guaranteeing ideal bracket placement. As I mentioned in the initial article, the big question is who places the orthodontic brackets. Most systems utilise dental technicians to manually place orthodontic brackets. Doctors can choose to place them manually themselves, but I cannot emphasise enough, even experienced clinicians cannot place orthodontic brackets perfectly each and every time. It is impossible to train anyone to deliver perfection using manual bracket placement techniques. This digital setup is a wonderful communication and marketing tool for patients. They can see the anticipated result of the treatment, similar to a Clincheck from Invisalign. This increases patient conversion rates and one of the reasons more and more patients are choosing SmileFast, over alternative cosmetic orthodontic treatments. Now if we suggested you could purchase a new aligner system for $500, but you have no access to see the visual final outcome or make any changes to the system, would you consider purchasing? The answer would almost certainly be NO. And if we suggested you buy a new crown for $50, one that was not fabricated on any model, nor could you see it in the virtual world, but that it would just arrive for you to fit, would you be willing to use this? The answer I believe is still NO. The point we make with the example of a cheap aligner system and a cheap crown is that a manual indirect bonding system has the same principles. You receive brackets in a tray without any idea of the final result and you have minimal control of the final outcome. Any short-term cosmetic orthodontic system utilising braces that relies on a dental technician or the Doctor placing the brackets, is asking for trouble. It is the short cut to inaccurate bracket placement and significant inconsistencies in treatment. Failure to precisely locate brackets requires the dentist to undertake revisions to correct the earlier mistakes and this in turn means more chairside doctor time, longer treatment time for the patient and more often than not, patient outcomes that are a less than ideal. 7. Cost We are all aware one of the barriers to conventional orthodontic treatment for our patients is cost. SmileFast s aim is to keep the cost to an affordable amount but still maintain the highest quality. Many competing systems use cheap, poor quality composite/plastic brackets which discolour, break and are very ineffective in orthodontic movement. SmileFast uses high quality, clear porcelain brackets and aesthetic tooth coloured orthodontic archwires to provide a discreet aesthetic appearance. With the digital technology of indirect bonding and the systems which are taught in the SmileFast approach, total doctor chairside time for a case is approximately five to six hours, with most of this able to be delegated to dental hygienists/therapists. As such, many dentists are charging patients approximately $5,000 for SmileFast treatment and still maintaining an excellent rate of close to $1,000 per hour. January/February 2015 Australasian Dental Practice 79

5 Figure 13. Indirect bonding trays inserted. The SmileFast future SmileFast is in the process of developing a program for lingual orthodontics and will be releasing several different aligner options in 2015 including the Magic Aligner (which combines aligners with brackets) and also a unique aligner finishing system which is incorporated with the initial digital setup. It is believed that the aligner finishing system will reduce treatment time in fixed braces significantly and this will be an even more powerful tool for adults to undergo shortterm cosmetic alignment. In addition, 2015 will also see the beginning of one-on-one, orthodontist-supervised patient treatments. Doctors will bring their SmileFast patients to a venue and have their treatment supervised by a Specialist Orthodontist to help develop their technique and clinical procedures. Doctors can learn the correct and most efficient way to treat their patients to achieve the highest quality results in the shortest period of time. Acknowledgement In Part 2 of this series on the Inman aligner, Dr Mahony would like to thank Dr Tif Qureshi for his contribution and case presentation within this article. About the authors Figure 14. Braces and wires placed in a total chairside time of 45 minutes. With regards to the overall cost, once you compare this to normal high-end dentistry, i.e. crown and bridge work, most dentists would be charging approximately $1,500 to $2,000 for a crown. Usually 25% of the total fee charged to the patient is the laboratory fee (somewhere between $400 and $500). This provides a reasonable guideline for shortterm orthodontics. So assuming you will be charging a patient approximately $6,000 for a case, then a $1,500 lab fee (which would include the digital setup, the indirect bonding trays with brackets, a selection of archwires, elastics, ligatures and other miscellaneous products required for that particular case and retainers) would be appropriate for the return that you would expect for this type of high-end treatment. 8. Scope and indications Many short-term orthodontic treatment systems only correct the alignment of anterior teeth, excluding rotation of premolars. With the SmileFast technique, the aim is to correct posterior rotations, because this can create significant space to accommodate crowded anterior teeth. The SmileFast approach is proven to be very efficient and effective in extrusion of teeth, intrusion of teeth, tipping of teeth and some minor translatory movement. The key to the efficient tooth movement is the use of light orthodontic forces, in conjunction with excellent bracket placement, to achieve the desired tooth movement. SmileFast utilises light forces with exceptionally accurate bracket placement through the digital indirect bonding approach. Dr Geoffrey Hall is a specialist orthodontist based in Melbourne, Victoria and inventor of the SmileFast cosmetic orthodontic system. He graduated from the University of Melbourne s in 1983 and subsequently completed post-graduate studies in Orthodontics at the University of Pennsylvania. Dr Hall has been on the teaching staff at both the University of Melbourne and the University of Pennsylvania. He has an extreme passion for orthodontics and specialises in early treatment, braces, lingual braces and interdisciplinary treatment, including orthognathic surgical cases. Dr Hall lectures to dental professionals nationally and internationally and has written many articles and more recently was a co-author in a lingual orthodontics book. Dr Derek Mahony is a Diplomate of the International Board of Orthodontics and Visiting Faculty at the City of London Dental School. 80 Australasian Dental Practice January/February 2015