Time is flying by! Kids are back in school, days are getting shorter but at least the sun is still shining. We have been so busy, that we have not posted our case of the month for August. However, the wait has been well worth it with a superb smile transformation using Invisalign clear aligners, tooth whitening and composite bonding or teeth bonding. 

Initially, our patient came to us with quite short, yellow and crowded teeth. The brief was to be as minimal as possible and try to maintain the teeth as much as possible which was music to our ears. For those of you that know anything about us will know that we are minimally invasive at heart and hate to destroy natural tooth for cosmetic reasons. 

One of our favourite treatments is that of ABC:

A is for alignment or straightening teeth

B is for bleaching of tooth whitening

C is for cosmetic or tooth bonding 

Our case highlights this treatment philosophy beautifully. The before photo highlights the issues at hand:
 

Our case of the month for February 2020 involves using one of our favourite teeth straightening options- the Social 6 lingual brace and composite bonding to correct asymmetry. The treatment was completed by Dr Nissit Patel who comments: ' Over many years of being a dentist, I have realised how important it is to have teeth in the correct position before attempting any form of cosmetic dentistry. There are many benefits of this. Ultimately, if the front teeth are properly aligned then the following cosmetic dental treatments can be simple and have great results. For example, simple tooth whitening and composite bonding can have a profound effect without having to even touch the teeth in question. After all, enamel is precious and we should not be removing it for the sake for a quick fix. Modern day dentistry should not involve elective removal of tooth enamel - full stop. If teeth are crooked, without some form of orthodontic treatment, the only option is to drill the tooth down to create space for the restorative material to alter the appearance. This could be ceramic or composite resin. If any of you watched the series Extreme Makeover, you will recall how the patient was left with little stumps prior to the ceramic crowns and veneers. Yes, the transformation was profound but at what cost? Once the enamel is removed, which is the hardest tissue in the body, the protective layer has vanished leaving the tooth weak and prone to attack. We can be certain that a tooth that has been cut down will need additional treatment in the future whether this is replacement crowns, root canal treatment, post core crowns or even removal. Why take the risk? I advocate a minimal approach to cosmetic dentistry where the risks are extremely low. In our case below, the steps are simple:
 

1. Straighten using a Social 6 lingual brace
2. Tooth whitening with a take home kit
3. Teeth bonding with composite to enhance the symmetry
4. Retainers

In this case, there was absolutely no drilling of the enamel at all. Therefore the biology remains exactly the same and all that remains is a maintenance program to maintain the alignment using retainers and the polish of the composite. Yes, this is a commitment also but everything in life requires maintenance from cars, houses, fences (Storm Dennis recently took ours apart!) and teeth. Please take a look at the before and after photos. I was delighted and so was our patient.'
 

2020 is flying by and January has thankfully passed with slightly longer days ahead of us. Our case of the month for January involves a simple yet effective smile makeover using the Social 6 lingual brace to make one tooth more visible on smiling. Often we seen huge dental transformations where there is huge difference in the overall smile with multiple veneers, crowns and crazy white shades that resemble white goods rather than teeth! This is not our style. For those of you that read our blog, you will know that we strongly believe in minimally invasive dentistry that looks natural, highly aesthetic and lasts a long time. Our case involves one using the Social 6 lingual brace (one of our favourite treatments), to align one tooth and dramatically change the smile in just 3 months. Here are the before and after photos:
 

Time has certainly flown by and we are now in full swing into a new decade! We forgot to posy our case of the month for December but it is one worth waiting for. The case involves ICON treatment to treat very opaque white areas on the upper front central teeth. Now white areas on teeth are generally not a biological issue but they can be unsightly and have an affect on smiling with confidence. In the past, the treatment for such areas was to cut away the whiter area and then place a filling to mimic the adjacent tooth structure or place porcelain veneers. However, the major issue with this is that this involves drilling away sound tooth which can never be replaced. There will always be the issue of maintenance and replacement fillings or veneers over time. Drilling can be traumatic to the pulp (nerve and blood supply) and if this can be avoided, our advice is to be minimal and less destructive. ICON treatment involves a process called 'resin infiltration'. In simple terms, the areas are washed and dried in a specific manner to open the white areas to resin application to hide the lesions. Here are the before and after results:
 

Our case of the month for November involves a re-construction of the bite over a number of years. The main reason for treatment was due to severe tooth wear due to bruxism. Bruxism is essentially grinding at night to such an extent that the enamel is worn over a number of years. This can cause a number of problems such as:
 

• Tooth sensitivity
• Difficulty in eating
• Lack of a coherent bite
• Aesthetic issues
• Pain leading to root canal treatment in severe cases

Tooth wear, on the whole, can be prevented or at least treated with relative ease in the early stages. However, severe tooth wear is a complex subject and requires a dedicated and staged treatment process. Here is a smiling view of our patient before any treatment:
 

Our case of the month is a simply stunning one involving cosmetic bonding. We have posted many cases of bonding before but for those of you who are unaware of the procedure, here are 7 factors about cosmetic bonding:
 

1. It is a great technique for creating symmetry, enhancing aesthetics, closing spaces and repairing chips
2. The tooth enamel is not drilled away like for veneers
3. The process is reversible
4. Highly aesthetic composite (white filling ) materials are used which look natural
5. Maintenance is required over the years but this is simple and stress free
6. Bonding to enamel is extremely reliable. A volume of 1cm3 can elicit a weight of approximately 90kg
7. The process is cost effective and requires NO needles

Our case involves enhancing the symmetry of the lateral incisor teeth.
 

Our case of the month for September 2019 is one featuring a lingual brace. For those of you that follow our blog and case of the month series, we love lingual braces. They are hidden braces placed behind the teeth and hence the ONLY invisible brace despite what others may have you believe. Before we show you the case, we will discuss the advantages and disadvantages of lingual braces. The technique is not for everyone and hence this is really useful information.

Advantages of Lingual Braces 
 

1. Cannot be seen; hidden from view
2. Excellent at alignment, leveling, rotation correction when space is present
3. Excellent at space closure when the bite allows
4. No lip irritation
5. No damage to the outer surfaces of the teeth whilst placing and removing

Disadvantages of Lingual Braces
 

1. Contact on the brackets whilst biting, eating, chewing which is hard to get used to
2. Harder to clean
3. Tongue soreness
4. Greater likelihood of knocking the brackets off inadvertently
5. Use of lower night guard essential if only upper teeth are being treated
6. Cannot be used if teeth are very crowded as there will not be enough space for the brackets to be placed
7. Extremely fiddly for the treating dentist to place and adjust!
8. More expensive than conventional braces- for good reason!

Here is our case, a great end result:
 

Our case of the month for August is a beautiful one involving a very natural smile transformation using minimally invasive dentistry. For those of you who have not read any of our case of the month articles, we believe in the least invasive techniques to produce stunning smiles. After all, we are all born with teeth that should last a life time. If the healthy tooth enamel is drilled away for cosmetic reasons, the tooth may not last a life time which would be a travesty. Our client was told to have a set of 6 veneers to produce the 'perfect smile'. Understandably, she was not happy with this solution which would mean cutting all of the enamel off the front teeth. Her aims were that of a natural smile rather than perfection and a treatment that involved keeping her teeth intact. The presenting situation showed uneven, crowded front teeth with some spacing present:
 

Our case of the month for July is an unusual one in the sense that we are not highlighting a wonderful new smile , straighter teeth, whiter teeth or a fantastic new technology. This month, our focus is on peri-implantitis. Now you may wonder what on earth is peri-implantitis. Well, we can report that peri-implantitis is becoming a major issue in relation to dental implants and the prevalence will only increase as more and more dental implants are placed.