Please activate JavaScript!
Please install Adobe Flash Player, click here for download

Dental Tribune Indian Edition

14 Dental Tribune Indian Edition - April 2013 Un-cosmetic dentistry Are you ready to reduce your dependence on porcelain restorations? Dr Michael Zuk Canada While there are some occasional re­ ferences to concern about the overuse of porcelain, many articles in dental trade publications show off before and after dental makeovers that from my perspective were quite satisfac­ tory prior to expensive intervention. I will not argue that there are people who truly have displeasing smiles and they can benefit greatly from cosmetic dentistry, but all too often people with body­image issues related to a distor­ ted perception of their teeth seem to be easy victims. “Smilorexia” is the fanciful term I coined for this disorder, which ap­ pears to affect attractive young wo­ men more than others. If you open the pages of any journal published by the American Association of Cosme­ tic Dentistry, you will no doubt find at least one or two of these patients having extensive veneer treatment that could easily have been avoided with unbiased professional advice. The problem is that too many den­ tists have dedicated their lives to pure cosmetic dentistry, which is often based on using porcelain as a cure­all. Sadly, many of the cosmetic den­ tists recognised as the top tier appe­ ar to use their standing as a licence to drill. It is time to adopt a signifi­ cant change in philosophy if the den­ tal profession wishes to maintain any level of integrity. Lip service to conservative cosmetic dentistry me­ ans nothing. To truly practise “un­ cosmetic dentistry”, a dentist must back away from ceramics and make use of composite to restore worn ed­ ges in combination with orthodontics to correct alignment. This style of treatment does not have to be unprofitable. It does not have to be only for the simplest of cases either; actually, very complex cases can be treated to a high stan­ dard when multiple disciplines are employed together. The collaboration of specialists can be one alternative, but for patients on a budget or in areas with lower access, a general dentist trained in advanced therapies can of­ fer comparable results for a fraction of the fee. Biggest bang for the buck—The STO combo Let’s cut to the chase: if you are a general dentist and want to knock your practice out of the park with new opportunities, look at venturing into the realm of advanced shorter­ term braces. I specifically say “shor­ ter” because your goal needs to be always trying to be faster because people hate being in braces, and ali­ gners are often too slow or they do not give the dentist enough control of tooth movement. There are a number of dentists who promote STO, but I developed my own system before I had heard of any others so I have some different ideas. Frankly, levelling and aligning simple orthodontic cases is easy and can be learned through just a short course, which these dentists (Drs Swain, Barr or De Paul) appear to teach very well. I would rather remain on the fringe of even these trend­setters, and offer my twisted perspective with less corpora­ te influence. As hugely popular as these STO courses are, there is however some potential for abuse by dentists who simply have a weekend course and no other training in orthodontics. While I would rather see a dentist do more orthodontics than veneering, ortho­ dontists are partially justified for their concerns about GP orthodontics. Taking courses alongside ortho­ dontists and reading their journals, it is apparent that there is negative sentiment directed towards general practitioners who dare to bracket te­ eth. I do feel that a united profession is a favourable concept but, having experienced extreme levels of sabota­ ge in my local area, I now refer less than in the past. Some other general dentists have mentioned similar pro­ blems (on online forums) with turf protection that appears oddly focused on orthodontics. An article recently used the term “soft science” to describe orthodon­ tics, and I would certainly agree that it is difficult to claim that orthodon­ tists know the “right way to straighten teeth”, since few of them agree on anything. The reality is that the scho­ ols of thought in orthodontics are as polarised as the holy war between the myo­centric doctors and the centric relation believers. As an example, the use of the Herb­ st appliance forces the TMJ forward, in an attempt to correct a deficient mandible. This is like someone stan­ ding on the balls of her feet to be tal­ ler. While the practice appears to be commonplace, there are orthodontists who would never use this technique on their own children or grandchildren. The studies always seem to conclude with a recommendation for long­term data, but the device has been used for 100 years already. Mandibles are not stimulated to grow after all, and patients may be holding their jaw forward in a Sunday bite simply to get their uncomfortable braces off. Orthognathic surgery may be va­ stly underutilised in some cases and overused in others. The use of TADs Trends & Applications “It is time to adopt a significant change in philosophy...” Anterior alignment is completed in extremely short periods of time, as in this example the lateral incisor was proclined in only 3 1/2 months. (DTI/Photos M. Zuk, Canada) Dr Zuk is also known as the crazy dentist who bought a tooth from John Lennon. (DTI/Photo courtesy of Sandra Olson, Canada) → DT page 15