Ortho Made Easy
By Tom Orent, DMD
About the author
Dr. Orent has lectured in five countries and 48 of the 50 United States with "1000 Gems Seminars TM." He created "1000 GemsTM" in 1988, and has authored four books and numerous articles ranging from Esthetic Dentistry and Practice Management to TMJ and Extreme Customer Service. His publications have been sold in 24 countries around the globe.Dr. Orent's personal coaching group member dentists, the "Gems Gold Dozen" have seen average annualized increases of $203,654.00 to as much as an astounding $420,000.00. To receive Dr. Orent's FREE "1000 Gems e-letter," biweekly clinical, practice management and marketing GEMS delivered by e-mail, sign up at www.1000gems.com,
or, e-mail firstname.lastname@example.org. Or, fax 508-872-0020 with your name and e-mail address, or mail requests to: Gems Publishing, USA, Inc., 12 Walnut St., Framingham, MA 01702. Just write, "Gems e-letter."
Would you like to significantly increase the number of terrific cosmetic cases you're currently performing? Become the local expert on "instant orthodontics." It is the hottest esthetic "quick fix" we offer today. A large number of new cosmetic patients to my practice, the Center for Esthetic Dentistry, are looking for that non-orthodontic quick fix. Done well, the results are spectacular. Patients, dental team members and doctor alike enjoy a highly rewarding sense of satisfaction from the "wow" factor from seeing these cases completed - often in just two visits.
Although there are many facets to consider in this technique, there are two that will significantly contribute to consistently successful dramatic results.
If there are enough crooked, overlapped, malaligned teeth that you are uncertain exactly where you're heading, invest the time and effort to complete a preoperative wax-up. If you have the skills, time and interest, doing it yourself will aid in your planning of the final preparations. In effect, you will have completed the case, once pre-op, as a "dry run." Otherwise, simply send study models to your lab, and request that they perform the wax-up for you. Advise them that you are attempting to achieve the most ideal arch form possible. The same goes for golden proportion ratios. One bit of information they will need from you (something they can't determine on the lab bench) is the desired incisal edge position and length. Since this requires the ability to compare the soft-tissue with the existing dentition, you will need to help them here.
If, for example, the teeth are crowded, which are more representative of the desired arch placement? Should they try to align with those that are currently more lingually placed, or with those slightly labial to the others? This is to be determined partially from the room afforded by the existing occlusion, and partially by the effect of the arch form on the patient's lips. Involve the patient, as well. Ask them how they feel about the way the lip rests on their teeth. If the lip appears to be stressed labially, attempting to align the new arch form with those teeth further lingually positioned may be helpful. Assuming of course that the occlusion allow for this correction.
The lab will also need to know where, in relation to the existing incisal edge line, you would like them to place the waxed version. This is determined by the relationship of the incisal edges with the resting upper lip line. Have the patient speak a few words, and then relax, with their lips slightly parted, in a comfortable resting position. Young adults should show a minimum of 2 to 2.5 millimeters of incisal edges past the resting upper lip. Older adults ideally reveal 1.5 to 2. Let your lab know where they are at now, and what changes in length (if any) you'd like to see. There is no way for your lab to anticipate where to place the incisal edges without your guidance. With this information plus a good set of study models and mounting, your lab should be able to render an excellent diagnostic waxup of the anticipated final result. Full-face photos would also be of great value to the lab at this point. A silicone putty registration (followed by a PVS wash reline) of the waxup works as an incredible form from which to make the final temporaries right in the mouth. A number of new materials are great for the task: Integrity, Luxatemp, and Turbotemp (Danville Materials).
The Pre-Operative (Irreversible) Mockup
This is not the mockup we use during case presentation. This is the "Real McCoy" and is irreversible. The reason this is so different is that you are not only adding composite, but you are removing tooth structure as well. So if this isn't done to help "sell" the case, what's the purpose?
There are three reasons I routinely perform a pre-operative mockup on difficult "instant ortho" cases.
Although these may seem like time-consuming, costly steps, they are really neither. Just the opposite. By performing the steps necessary to work out the intricacies of the case in advance, you will typically save time, as well as assure all parties a satisfying and dramatic esthetic result.
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