Cosmetic Tribune UK No. 1, 2016
Annual conference in Edinburgh / Interview: “Make everything about tooth whitening predictable” / Conservative smile design for the general dentist
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[1] =>
COSMETIC TRIBUNE
The World’s Cosmetic Dentistry Newspaper · United Kingdom Edition
www.dental-tribune.co.uk
Published in London
Vol. 10, No. 10
Annual conference in Edinburgh
BACD calls for excellence in cosmetic, appoints Chandrapal as president
By DTI
EDINBURGH, UK: Once a derided
field, cosmetic dentistry has
changed so much that it has become the basis of almost everything that dental professionals are
doing in practice today. Despite
the revolution begun by the introduction of new digital technologies in recent years, dentists
should continue to better their
knowledge about materials and
technologies, as well as challenge
themselves constantly to become
better clinicians, President of the
British Academy of Cosmetic Dentistry (BACD) Dr Bertie Napier said
to attendees of this year’s annual
congress in Edinburgh.
“Dentists who were doing
cosmetic procedures used to be
looked down upon by the profession,” he stated. “Now the focus
has changed to aesthetics, so
much so that it is now an integral
part of what we do on a daily
basis.”
In addition to these issues, a
focus of this year’s BACD conference was digital dentistry. By looking at a wide range of new products and techniques in this regard,
delegates were given a thorough
introduction into this new and
growing field.
Over 300 members of the
BACD attended the three-day
event, which was held from 10 to
13 November at the Edinburgh
International Conference Centre.
In addition to a presentations by
1
2
Abb. 1: BACD exhibition.—Abb. 2: Dr Andrew Chandrapal (second from left) took over the BACD presidency from Dr Bertie Napier (right).
a number of internationally and
locally prominent experts, including Dr Florin Cofar from Romania,
Dr Jordi Manauta from Spain and
Gary Takacs from the US, the scientific programme was complemented by a hands-on session and
a trade exhibition, supported by
industry heavyweights, including
DMG, Enlighten, Ivoclar Vivadent
and Henry Schein. Business topics
were also covered and so too
where some pertinent issues for
dental technicians.
“Our education committee
has once again assembled top educators from around the world,
to present you with cutting-edge
education that will enable you to
continue to deliver quality, ethical
cosmetic dentistry in this digital
age, with a better understanding
of the technology, the materials,
the techniques and the possibilities they will bring,” Napier told
the delegates.
The BACD Annual Conference
was also a fantastic opportunity
for delegates to meet and network
with like-minded, talented professionals. Undoubtedly, one of the
event highlights was the gala dinner being held at the Balmoral, on
the Edinburgh’s landmark hotels,
on Friday.
“It was great to see so many
colleagues,” said Dr Donald Sloss,
Chair of the Academy’s Credentialing Committee. “The Annual
Conference gives us the chance
not only to learn together, but also
to play together in the true spirit
of the BACD. This interaction is at
the Academy’s core and it just gets
better year on year.”
“I want the BACD to become
one of the most dynamic, inviting
and open Academies in the UK,”
commented Dr Andrew Chandrapal, who was appointed as the
organisation’s new president in
Edinburgh. “Following the example of my predecessors, I will continue to reinforce the exceptional
quality the profession has come to
expect from the BACD.”
“More than that, I want the
BACD to become the champion
of cosmetic dentistry—a strong,
academic base for the profession
that is based upon high quality,
good education and inflexible
ethics.
“As President, I will welcome
input from our devoted members. Without their vital feedback,
the BACD would not be the ex-
ceptional institution it is today—
and nor would it be able to develop further. As such, I do not
want my year of leadership to be
one of dictation—I want this to
be a year of leadership through
teamwork.”
Chandrapel, who works as a
cosmetic prosthodontist in London, will serve as BACD president
for the next two years.
For dental professionals who
missed out on this year’s conference, will have another chance in
2017, when the next edition will
be held in the capital from 9 to
11 November. The topic of the
fourteenth annual conference of
the BACD will be “FAB: Function,
Aesthetics, Biology”. More information are available on the organisation’s website at www.bacd.com.
Appearance survey shows UK men
concerned about their teeth
By DTI
LONDON, UK: The look of their
teeth is of great importance to British men. More than a quarter would
choose to have their teeth straightened if they could, according to a
new survey that asked men about
the one thing they would like to
change about their appearance.
A significant 63 per cent of
men would investigate means of
treatment to have their teeth
aligned if they had concerns in
this regard, it also found.
The results are from a survey
conducted by media intelligence
Although men between the
ages of 18 and 24 felt it was wrong
for men to take steps to change
their appearance, they were also
the age group most likely to have
looked into treatments to alter
their appearance.
provider Gorkana on behalf of
clear aligner manufacturer Align
Technology on men’s confidence
in their appearance and the likelihood of them seeking treatments
to address physical imperfections.
According to the survey, almost one in two men have had
great concerns about their appearance in the past and these occasionally prevented them from
dating.
While men from Scotland, the
North East and London were
found to be the most content with
their appearance and teeth, men
surveyed in the South West and
Londoners were most likely to
look for ways to change how they
look. One in three admitted that
they were considering treatment
for their imperfections, such as
straightening their teeth.
West Midlands were less likely to
consider themselves happy with
how they looked.
Those least satisfied with their
appearance were from Yorkshire
and the Humber.
The survey was conducted
among all age and socio-economic
groups, as well as geographical
regions, in the UK.
[2] =>
COSMETIC NEWS
16
Cosmetic Tribune United Kingdom Edition | 10/2016
“Make everything about tooth
whitening predictable”
An interview with Dr Payman Langroudi, head of Enlighten Smiles
Enlighten Smiles is one of the
UK’s most trusted tooth whitening
brands. With guaranteed results and
a strong marketing system, as well
as its own laboratory that helps
develop consistent products and
its exclusive Centres of Excellence
programme, the company aims to
be the ideal partner for every dental
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business wishing to expand its portfolio. Dental Tribune spoke Enlighten
Smiles head Dr Payman Langroudi
him briefly about changing perceptions with regard to tooth whitening
and where his concept fits in.
Dental Tribune: Dr Payman, how
would you describe the philosophy
behind the Enlighten system?
Dr Payman Langroudi: It is not
only the product we are presenting,
but also the marketing service that
we are offering to increase performance of every individual practice.
Consider that, in the Western world,
80 per cent of people desire a
whiter smile, but the average dentist only performs one whitening
per month. There is a complete disconnect. Dentists do not want to
be seen as chasing sales or being
pushy and therefore it is necessary
to change the mindset completely.
If one goes to McDonald’s, for example, the staff ask whether one
wants fries with one’s order and it
is considered a normal thing. So,
what we would like to see is it becoming usual to ask every patient
about the colour of his or her teeth.
Changing the mindset of both the
public and dental professionals is
what we are working on with this
system.
Does this philosophy apply to education too?
Tooth whitening is still not
taught in any of the universities in
the UK and often what students
learn in dental schools is out of date
anyway. In a way, this is a problem,
but also offers opportunities for
us to educate dental professionals.
By ensuring that the entire dental
team knows how the product works
and the side-effects that patients
might experience, one can provide
a well-rounded service to patients
when they come into the practice
with questions, for example.
Cosmetic dentistry now seems—
and the President of the British
Academy of Cosmetic Dentistry
spoke about this development this
morning—to be an integral part of
general dentistry. Where does tooth
whitening fit into this picture, in
your opinion?
Tooth whitening is the foundation and the first thing patients do
before they do anything else. These
dentists here want to make a difference for their patients and this can
be in terms of either pain or beauty.
While beauty sounds very superficial—and in many ways it is—
they can make a difference to patients in a very predictable manner.
What we are trying to do is to make
everything about tooth whitening
predictable.
Thank you very much for the interview.
SUBSCRIBE NOW!
F +49 341 48474 173
subscriptions@dental-tribune.com
[3] =>
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Tribune Group GmbH is an ADA CERP provider. ADA CERP is a service of
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[4] =>
COSMETIC TRENDS
18
Cosmetic Tribune United Kingdom Edition | 10/2016
and should look for any skeletal discrepancies. Compromises
must be signed off.
Conservative smile design
for the general dentist
1
By Dr Rami Chayah, Lebanon
Abstract
This article discusses the advantages of short-term anterior tooth
alignment using the Inman Aligner
system, particularly for general dentists. The article will give a brief description of the Inman Aligner appliance and its use in short-term orthodontics, and it will answer three major
questions the general dentist should
ask himself or herself during the treatment planning process. In support of
this treatment modality, three case
scenarios general dentists see daily
will be given as examples.
Treatment
concept
and case
presentation
treatment or Class II or III treatment.
Only certain types of movements are
possible and some patients will still
need conventional orthodontic treatment or indirect restorations. Certain
criteria should be met before treat-
ment proceeds. At consultation, other
orthodontic alternatives should be offered. The dentist must quote for the
long-term retention maintenance
2
3
4
5
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Dentists need to consider three
questions about treatment during the
treatment planning process. The first
question: can the patient’s teeth be
Introduction
General dentists face the daily challenge of performing instant veneers
for patients with misaligned anterior
teeth who refuse orthodontic treatment, many of whom regard fixed
orthodontic treatment as too long
a commitment for achieving their
desired aesthetic results. In today’s
fast-paced life, some patients are not
prepared to wait or to go through
long treatments.1, 2 One of the greatest
benefits of short-term anterior alignment is that many people who would
refuse comprehensive orthodontic
treatment may accept short-term removable alignment techniques such
as the Inman Aligner system.
The Inman Aligner is a simple removable appliance, a modification
of the removable spring retainer. It
uses super-elastic coil springs to apply
highly efficient light and consistent
forces on both the labial and lingual
surfaces of the anterior teeth (Figs. 1 & 2).
The appliance is fabricated on a cast
on which, based on a surgical model,
the anterior teeth needing correction
have been removed and reset in the
ideal position in wax on the working
cast.3 When the patient wears the appliance, the built-in forces generated
by the spring coils will correct the
misaligned anterior teeth (Fig. 3).
What distinguishes the Inman
Aligner appliance from other shortterm orthodontic systems such as
Invisalign (Align Technology) and
Six Month Smiles is its low cost, low
risk and short learning curve for general practitioners. Only one appliance
is used from the start to the end of
the treatment. Sometimes, several
clear aligners may be used to de-rotate
resistant canines. The system is well
received by patients because it is fast
and relatively cheap. It also accommodates today’s active lifestyle. Usually,
most cases take from six to 16 weeks.
Patients can take the appliance out
during meals or work meetings.
As with any other treatment techniques, the Inman Aligner has its
limitations. Hence, case selection is
imperative, as the Inman Aligner is
not suitable for posterior orthodontic
Fig. 1: Inman Aligner appliance.—Fig. 2: Illustration of the Inman Aligner showing the appliance components.—Fig. 3: Inman Aligner appliance in the mouth. Case 1—Fig. 4:
Frontal view with the teeth in occlusion before treatment.—Fig. 5: Frontal view with slightly open bite showing the status of the teeth before treatment.—Fig. 6: Frontal view
with the teeth in occlusion after alignment and bleaching.—Fig. 7: Close up frontal view of the maxillary teeth after ABB.—Fig. 8: Right side view of the maxillary teeth before ABB.
—Fig. 9: Right side view of the maxillary teeth after ABB.—Fig. 10: Left side view of the maxillary teeth before ABB.—Fig. 11: Left side view of the maxillary teeth after alignment
and bleaching.—Fig. 12: Full face before treatment.—Fig. 13: Full face after treatment.—Fig. 14: Frontal view showing the patient’s natural smile before treatment.—Fig. 15:
Frontal view showing the patient’s natural smile after treatment.—Fig. 16:Full face showing the patient’s natural smile before treatment.—Fig. 17:Full face showing the patient’s
natural smile after treatment.—Fig. 18: Occlusal view showing the maxillary arch before treatment.—Fig. 19: Occlusal view showing the maxillary arch after treatment.
[5] =>
COSMETIC TRENDS
19
Cosmetic Tribune United Kingdom Edition | 10/2016
fixed without orthodontic treatment
in a very short period? In order for the
general dentist to answer this question, he or she should first establish
whether the patient does not wish
to pursue orthodontic treatment because of the time commitment and
cost. Would he or she also refuse
short-term anterior tooth alignment?
Would the occlusion be improved
even though a Class I molar or Class I
canine relationship may not be
achieved? Patients may prefer shortterm alignment techniques because
of the shorter treatment time and
the lower cost.
Case 1
The first case presented is a good
example of a scenario relevant to
the question above. The patient was
a young woman at college who presented at my office requesting a full
smile makeover of 20 veneers; she
desired a “Hollywood smile” as expressed in her own words. Her complaint was the retracted maxillary
right and left central incisors, the incisal edge wear on the maxillary central incisors and mandibular anterior
teeth, the pointy shape of the maxillary and mandibular canines, and
the yellow colour of her teeth overall
(Figs. 4 & 5). It could be argued that it
would be highly unethical to prepare
the sound enamel, transforming her
ten maxillary teeth into stumps, for
the rest of her life, especially at this
young age. After long discussion and
explanation of the disadvantages of
the shortcut route of preparing her
teeth for ceramic veneers, this option
was excluded. Several other options
were available and discussed with her,
but because she wanted a smile enhancement in a short period of time,
conventional fixed orthodontic treatment was also excluded. After checking her bite, it was observed that there
was insufficient interocclusal space
to shift the maxillary central incisors
forwards without opening the bite.
However, the patient accepted use of
the Inman Aligner system owing to its
short treatment time and flexibility
regarding being able to take the appliance off during the day while eating.
The treatment plan was to follow
the ABB protocol (alignment, bleaching and bonding). This concept still
constitutes a smile makeover but in
a very conservative manner. Taking
into consideration her age and her
sound enamel tissue, this was agreed
to be the most progressive means of
carrying out her smile enhancement.
First, her maxillary teeth were aligned
using the Inman Aligner with an
expander for nine weeks. Two extraclear aligners were used in the last
two weeks of treatment to de-rotate
the maxillary left lateral. Once the
maxillary teeth had been aligned
and in the last two weeks of treatment,
the teeth were bleached with customfitted super-sealed trays (Fig. 6). Now
that the teeth had been straightened
and whitened, the patient became
more aware of the differential wear
on the incisal edges of her anterior
maxillary and mandibular teeth.
Incisal edge bonding using composite was completed using a simple
direct technique. The patient was
very happy with the final result
(Figs. 7–19).
Case 2
The second question to be considered regarding treatment: would
some of the teeth be aggressively
prepared or end up with root canal
treatment if treated with restorative
dentistry without alignment and
would the overall outcome be better
with alignment rather than without?
This question addresses the ethical
dilemma general dentists face every
day. We often have cases with overlapping anterior central incisors in
our office.
The patient presented in this case
was bothered by the look of his overlapping maxillary central incisors
(Figs. 20 & 21). His mandibular teeth
were also crowded, but for some reason, his concern was only with his
maxillary teeth. He had started to
hide his smile in front of his friends,
feeling embarrassed to show his
maxillary teeth. After the full orthodontic examination and discussion
about all of the treatment options,
including comprehensive orthodontic treatment, the patient chose the
removable Inman Aligner system
owing to its flexibility in that the
wearer is able to remove the appliance for several hours a day and
because of its short treatment time.
The maxillary left central incisor
would have been aggressively prepared had it been treated restoratively.7–9 By using a simple anterior
alignment technique, the treatment
took only eight weeks to straighten
the teeth and a great deal of sound
enamel tissue was preserved by conservatively resolving the unattractive appearance of the maxillary
teeth (Figs. 22 & 23).
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24b
Case 2—Fig. 20: Frontal view showing the overlapping central incisors before treatment.—Fig. 21: Side view showing the overlapping
central incisors before alignment.—Fig. 22:Frontal view showing the teeth after alignment.—Fig. 23:Side view showing the teeth after
alignment.—Figs. 24a & b: Side views showing the moderately crowded and worn teeth before treatment.
dentine of the incisal edges (Fig. 25).
The patient initially requested instant
veneers to resolve his smile problem,
but after mocking up the design directly in his mouth, he was discouraged from pursuing this option owing
the amount of tissue that would be
lost. The aggressive preparation of
The treatment plan was to align
the teeth first and then to reassess the
restorative work needed (Fig. 26). The
appliance was used for 12 weeks and
only worn for 16 to 18 hours a day. During the last three weeks of alignment,
the patient began to bleach his teeth.
By week 12, the teeth were straight and
loss. This clinical approach guarantees that the strength of bonding to
the enamel is much greater.
Conclusion
The goal of this article is to encourage general dentists to reflect
on the importance of considering
short-term tooth alignment alone
or in conjunction with restorative
dentistry when treating patients.
Hopefully, these three questions and
cases will prompt readers in thinking
through the process of this treatment modality.
Disclosure: Dr Chayah is the trainer for
Inman Aligner Training in the Middle East.
He provides hands-on full-day certificate
courses to general practitioners.
26
Acknowledgement: I wish to thank Dr Tif
Qureshi, the founder and Director of Inman
Aligner Training in London, for his mentoring and sharing the last case in this article.
Editorial note: A complete list of references
is available from the publisher.
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Case 3—Fig. 25: Occlusal view showing the tooth misalignment.—Fig. 26: Occlusal view showing the result of treatment.—Fig. 27: Maxillary
teeth after alignment to reassess the restorative work needed.—Fig.28:Natural-looking thin maxillary veneers owing to aligning the teeth first.
Case 3
The third question to be considered: will the teeth require restorative
work anyway, even after alignment?
The case presented serves to
demonstrate the necessity of aligning
the teeth even before placing ceramic
veneers.10–13 The patient in this case
exhibited moderate misalignment
with major anterior edge wear due to
occlusal trauma. In addition, the teeth
were darkened through years of stains
being absorbed through the worn
the tissue was explained to him using
the occlusal image of his maxillary
teeth. After an extensive orthodontic
examination and discussion of the
options, the patient refused fixed orthodontic treatment, as well as clear
aligners. He refused the first option
because he did not want anything
fixed in his mouth, and he refused
the second option because of the
proposed time involved. The Inman
Aligner system was introduced to the
patient, and he quickly accepted this
option owing to the short treatment
time and removability.
white (Fig. 27). At this point, a direct
mock-up was done to show the
patient the smile design that could be
achieved with composite. He felt that
the teeth were still flat and wanted a
fuller smile. Because we had aligned
the teeth, only minimal preparation
was needed as evident from the waxup and the decision was made to fabricate ceramic veneers instead (Fig. 28).
This case shows that for complex situations and considering patients’ high
aesthetic demands, pre-alignment is
essential to produce minimally invasive veneers with minimal enamel
Dr Rami Chayah
runs a cosmetic
dental practice
in Lebanon with
an emphasis on
minimally in vasive dentistry.
He seeks to share
his passion for
photographic and
video production and believes that
through his personalised dental approach, he can demonstrate a more
positive way of practising dentistry,
helping other dentists to view the
dental domain in a different way.
You can reach Dr Chayah through his
social media: facebook.com/ramichayah
and http://instagram.com/ramichayah
www.inmanalignertraining.com
[6] =>
Dental Tribune International
ESSENTIAL
DENTAL MEDIA
www.dental-tribune.com
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