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Over the years, Invisalign has transformed drastically to embrace digital technology and improve their product which is by far and away the best on the market (our opinion having used all of the copycats!). There are now several Invisalign products available to dentists which brings us to Invisalign Lite. The Lite version is specifically for mild to moderate crowding with treatment time frames of around 6-8 months. Within the package, there are 14 initial aligners to correct the main crowding issues. After this first set, we have the opportunity to fine tune any crowding using refinement aligners. As of October 2021, Invisalign Lite allows 2 sets of refinements of 14 aligners within each package. This provides us with ample scope for adjustments and minor corrections.
 

Our case of the month for July 2021 is quite a complex one involving multiple ceramic crowns after an accident during the first lockdown. Our patient, Xavier, had a cycling accident where he cracked 3 of his front teeth. Now with any trauma case, there is a certain way to handle the situation and it is important not to rush into a specific treatment. The reason being is that once the teeth and gums have been damaged, the consequences may not be apparent for several weeks or months. Hence the use of provisional materials such as composite and temporary crowns are vital during this healing phase.

Periodontal or gum health is paramount also and we needed to spend some time stabilising the gum health with conventional and laser treatments. Beata Kynsak did a wonderful job using Waterlase i Plus and the Epic 10 diode laser with a complete transformation from inflamed , swollen gums to a pink, firm attached gum line. Laser dentistry, although not new, is still a rarity across our profession but we are firm believers in the technology and have many years of experience highlighting great results. 

Once the gums were stable, provisional crowns were made using a diagnostic wax up. This is where our laboratory, Ceramic Studios, re create the teeth using digital means to provide us with a prototype of the final teeth. We can use this guide to define our preparations of the teeth, make the temporary teeth and allow our patients to see what the final crowns can look like. Our temporary crown material of choice is Luxatemp; the gold standard. 

After some time in the temporary crowns, we were ready to proceed with the final crowns which were E Max all ceramic crowns, again the gold standard when it comes to aesthetics. There is no better. Ceramic Studios did a great job and just take a look at the before and after results:
 

Our case of the month for May 2021 was a simple one involving ICON to treat a white spot and then cosmetic bonding to repair a small chip. Initially. we used Invisalign Express to treat some mild mis alignment. Putting teeth in the correct position will mean that that any future treatment will always look better especially bonding. 

The treatment in our case is completely non invasive. There is no need for any drilling, no needles of any sort and no pain! Furthermore, the cost is affordable compared to traditional veneers or crowns. A no brainer! 

ICON white spot treatment works by changing the light refractions of the white spot using resin infiltration. This way the white spot is camouflaged and blends in the surrounding tooth. The process is super simple and takes only a few minutes. 

Cosmetic bonding can further enhance the appearance of the tooth by using highly aesthetic composite resin to layer over an defects such as chips, uneven edges, gaps, sharp edges and even discolouration. 

Here are the before and after photographs:
 

Our case of the month for June 2021 was one where spaces were closed using composite bonding or teeth bonding. Often there are spaces between teeth which are either natural, developmental, after orthodontic treatment or following a trauma. One of the simplest ways to close the spaces is via bonding.
 

Our case of the month for April was one involving E Max crowns by Ivoclar, which is our opinion, give the best aesthetic results. In the past, tooth coloured dental crowns had a layer of metal underneath for strength with the ceramic bonded on the outside. Now these could look perfectly acceptable but there were issues. Having two layers means that more of the underlying tooth has to be cut down to accommodate the material. For any of you that has read any of our posts knows that we believe in minimally invasive dentistry, cutting away more tooth than necessary just does not sit right with us. Another issue with metal ceramic crowns is that the metal layer may become visible over time as the gums recede which gives that classic grey line around the tooth. Not very desirable. One of the main advantages of ceramic crowns is that there is no metal underneath and this grey line will never be an issue. 

The aesthetic qualities of E max crowns are second to none. Our case shows that the crowns can be fully customised with translucency at the edges, varying shades, light reflection and opaque areas to name a few. The skill of the dental technician plays a huge role here and we work with some excellent laboratories know for excellence. 

For our case, Ceramic Studios in Kensington made the wonderful E max crowns fully which were fully customised.
 

Our case of the month for March is a simple but great one- we love it so much! It features composite bonding which is a favourite treatment of ours. People often ask what is cosmetic or composite bonding. Well the answer is simple. For many years, dentists have been using adhesive technology to bond fillings inside of teeth. The same technology can be applied to the outside of teeth to make them look pretty! In essence, if a tooth is worn down, fractured, uneven or discoloured then composite bonding can be used to enhance the tooth without having to cut the tooth down or destroy healthy tooth enamel. After all, dental enamel is the hardest tissue in the body for a good reason. It is there to protect teeth- why on earth would we cut it all away? The old days of Extreme Makeover (remember that show) are over. 

Often cosmetic bonding can be used for very subtle treatments such as our case. In this example, we treated the front teeth using Social 6 lingual braces to straighten the teeth first and then use composite bonding to enhance the smile line to even the edges, make pointed teeth look natural and camouflage the canine teeth which were quite pointed. There was absolutely no drilling of the underlying teeth, no needles were required, an entirely pain free process. Take a look at the difference:
 

At the end of orthodontic treatment, retainers must be worn otherwise you run the risk of undoing all of the hard work straightening your teeth. This is called relapse. We advise a combination approach of a fixed wire retainer placed behind the front teeth as well using a removable retainer at night.
 

Our case of the month for last month February 2021 is a stunning case which involves a smile transformation using three techniques:

1. Lingual Braces

2. Tooth whitening using a take home whitening kit

3. Cosmetic bonding 

We like to call this a Progressive Smile transformation as there is no drilling, no injections, no pain and the process is affordable and easy to maintain. In contrast to porcelain veneers or crowns which require drilling away of healthy tooth enamel to cover the teeth with the ceramic. Granted, this may look good to begin with but what about in 10 years? Biologically, removing the enamel means that the hardest tissue in the body can no longer protect the underlying tooth which could lead to bacterial leakage and infection. Why risk this? 

Time has flown by and we forgot to post our case of the month for December so we have decided to combine them with a tremendous case study involving a complete smile makeover. 

Our client really hated her smile. The main issues were that the smile was not wide enough, the back teeth caved in so that they were not visible on photos and the bite was all over the place. As well as teeth crowding and an overall yellow shade, so a number of aesthetic problems. 

After careful planning, which is always the key to success, Dr Nissit Patel formulated a treatment plan which involved full upper and lower invisible braces which would develop the arches and improve the smile width. The bite, or we call it occlusion, was improved and treatment was completed with tooth whitening. 

Overall, the treatment time frame was 12 months and we needed adjustment visits every 6 weeks in general. One of the key aspects in a comprehensive case like this, is the use of elastics. These are worn from the upper teeth to the lower teeth , ideally 20 hours of the day. The reason for this is to improve the way the teeth sit together. If you are not committed, the end results will not be as good! 

Here is a before and after photograph. Truly stunning!