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An interview with Dr. Ryan Swain,
founder of Six Month Smiles

In the last decade, the principal options for moving teeth have been braces or clear aligners. The final goal for all orthodontic patients is an aesthetically pleasing smile, and for many, the quicker it can be achieved the better. Short term ortho isn’t really a new concept, but Dr. Ryan Swain and Six Month Smiles reintroduces this third orthodontic option in a big way – and largely to the general dentist population. Dentaltown Magazine had a chance to catch up with Dr. Swain to find out more about short term ortho and Six Month Smiles.

Dr. Swain, first of all, what is Six Month Smiles?
Swain: Six Month Smiles is a company dedicated to partnering with general dentists so that they can make short term ortho a successful and streamlined part of their practices. From initial clinical training to case setup and marketing support, Six Month Smiles provides a solution for general dentists who want to add orthodontics to their practices. Six Month Smiles demystifies ortho and systemizes the process.

Can you please explain what you mean by short term ortho?
Swain: Short term ortho (STO) is cosmetic ortho that is primarily focused on adults. The goal of STO is to provide patients with a pleasing and symmetrical smile in an average of six months. Most adults with crooked teeth believe that they are stuck with no attractive options. STO involves a focus on correcting the patients’ chief cosmetic complaints while using tooth colored brackets and wires. This allows us to overcome the two biggest obstacles for adult patients with malpositioned teeth: long treatment times and metal braces.

Is this technique for adults only? What’s the youngest patient you’ve placed on this system?
Swain: Dr. Vince Kokich, a well-respected orthodontist, has said in his seminars that kids should be treated idealistically and adults should be treated realistically. I share this treatment philosophy. STO is not for patients under the age of 15 and the average STO patients are in their early 30s. This can be a great treatment option for some older teenagers but the consultation process should be exceptionally thorough with these patients. STO allows dentists to help adults and teens who are ashamed of their smiles and who feel that they are stuck. STO is not a replacement for traditional orthodontics but it is a viable alternative for patients who are unwilling to proceed with traditional treatment.

How long has STO been around?
Swain: Strictly speaking, STO has been around since braces were first invented. The first practitioners who placed brackets on teeth were aiming to improve the symmetry of smiles and were not focused on a rigid finishing protocol. However, the first dentist that I’m aware of who created a niche out of marketing straight teeth in six months to his patients was Dr. Clifton Georgaklis of Brookline, Massachusetts. He has been providing STO successfully to multitudes of patients in and around Boston for more than 20 years. Dr. Jack Sheridan, an orthodontist on the faculty of Jacksonville University, has also been a pioneer in the field of shortened and cosmetically focused orthodontic treatment.

How does STO compare to orthodontic treatment with clear aligners?
Swain: There are some patients who will not wear braces no matter how clear the braces are or how short the treatment time. I think clear aligner therapy is a good arrow for every dentist to have in his or her quiver. However, STO has many advantages. Tooth movement with brackets and wires is simply more efficient than movement performed with aligners. Because more tooth movement can be done in shorter amounts of time with brackets, more patients are potential candidates for STO treatment. Clear aligner treatment and STO share aesthetically oriented goals but movements like rotations and extrusions are much more predictable with brackets. This provides the dentist more control over the cases.

Another advantage is that the costs for the dentist are much lower than are typically associated with clear aligner treatment.

Is root resorption a problem with STO?
Swain: Root resorption, when it exists, is typically associated with high orthodontic forces being applied over long periods of time. STO involves light forces being applied over short periods of time. STO does not involve the use of heavy forces. Very light nickel titanium wires are used. The short treatment times are due to the fact that we, as clinicians, aren’t attempting to correct some of the most time consuming changes typically associated with traditional orthodontics.

What about occlusion?
Swain: The goal of STO is not to completely revamp the occlusion. The goal is to provide a significant cosmetic improvement in an average of six months and improve the occlusion as much as possible during that time. In this shorter time period, we can do much of the tooth movement that is associated with traditional orthodontics but we are usually not altering the existing Angle class, significantly moving the roots of teeth buccolingually or making significant alterations to dental midlines. Altering these items is usually quite time consuming and can involve years of treatment.

As dentists, we are all taught in dental school that the goal of orthodontic treatment is a Class I occlusion with ideal overbite and ideal overjet. This “ideal finish” usually provides a very pleasing cosmetic result. I think that one of the questions that everyone should consider is, “What tangible functional benefits does an ‘ideal orthodontic finish’ provide for patients?” As dentists, we all know that the large majority of our patients do not have perfect bites yet they are able to function well.

Many dentists tend to think that an “ideal orthodontic finish” might help lower the risks associated with temperomandibular disorders (TMD). However, the literature shows clearly that there are few, if any associations between malocclusion and signs/symptoms of TMD. There was an interesting study by Gesch, Bernhardt, and Kirbschus published in March 2004 in Quintessence Int. They analyzed existing studies on the topic and determined that there was no correlation between malocclusion/functional occlusion and signs or symptoms of TMJ disorders. In other words, the particular fit of a patient’s teeth does not have an effect on their probability for developing TMJ problems. Similar studies published in The Angle Orthodontist in August 2004 (pp. 512-520) and March 2005 (pp. 183-190) showed comparable findings.

What about retention?
Swain: Retention with any type of orthodontic treatment is extremely important and must be taken seriously. Regardless of how long an adult patient has been in treatment, lifetime retention with fixed or removable retainers should be provided to ensure longevity of the result. Whether teeth are moved with brackets, clear aligners or spring retainers, adequate retention should be provided and the patient should be educated effectively. Six Month Smiles can provide lingual retainers that are pre-fabricated and bonded to the teeth indirectly with custom bonding trays. I’m a proponent of fixed retention because it essentially removes the issue of patient compliance.

Can a general dentist with little or no orthodontic experience learn STO in two days?
Swain: Yes. In our two-day seminars, we ensure that dentists leave with the knowledge they need to start cases the following week. This knowledge includes good case selection, focused treatment planning, mechanics of tooth movement, excellent patient communication and technical skill via hands-on training. Six Month Smiles provides a focused approach that involves selecting the right patients and referring the patients who are not good candidates for STO. Most dentists who offer STO actually refer more patients to their local orthodontists because they are talking to many more patients about orthodontics in their practices.

In regard to the initial question, our track record shows that dentists who have attended our seminars are able to apply the knowledge they learn and make Six Month Smiles a substantial part of their practices.

What type of feedback do you get from your Six Month Smiles providers?
Swain: We’re very proud of our courses. The knowledge and excitement that dentists demonstrate afterward undergoing the training is phenomenal. We routinely hear from our dentists that they are more excited than ever before to go back to their practices and immediately implement what they have learned. Amazingly, our surveys show that 98 percent of seminar attendees rank our seminar in the top five percent of CE courses that they have taken.

Six Month Smiles does not just provide clinical training. We provide support with case selection, treatment planning, marketing and staff training. One of the keys to the success of the partnership is the ease provided by the Six Month Smiles Patient Tray Kits. When a dentist submits a case to Six Month Smiles, a custom Patient Tray Kit is returned. The kit includes all of the items that are needed to treat that particular patient, including custom bonding trays. Our bracket specialists set up the case by placing the orthodontic brackets in precise locations and fabricating the custom trays. The bonding trays make delivery of the brackets incredibly easy and efficient.

Dr. Swain, do you do comprehensive ortho cases in your practice as well? If so, which cases get this treatment?
Swain: I do treat cases comprehensively in my office. However, I’ve become so busy with STO that I typically refer most patients who aren’t good STO candidates to orthodontists in my area for comprehensive treatment. My goal is to discuss all of the options with my patients and ensure that they get the treatment that is appropriate for their situation.

When you apply braces for six months, the crowns will move but the roots don’t have time to catch up – so retention of these cases is critical. How do you address this with patients? Is there a greater risk for relapse?
Swain: Crown movement by itself does not always happen first. For example, many patients have upper central incisors with poor crown angulation. This oftentimes creates a canted maxillary arch, which can be a severe detriment to the patient’s smile. For a patient like this, one of the first things that happens when the archwire is engaged is mesio-distal root movement as the entire tooth uprights. This is a very efficient movement and usually happens very quickly. Patients are elated when they see these changes happening early in treatment.

Regardless of how long a patient has been in treatment or what appliance was used to move the teeth, relapse can happen. Many of the patients that are treated with STO or clear aligners are patients who underwent orthodontic treatment in the past and have experienced relapse. These patients, in particular, understand the importance of retention.

What does the future look like for Six Month Smiles?
Swain: The demand for reasonable and focused orthodontic treatment is enormous. Adults who are uninterested in traditional braces have not typically been catered to in the past. This population is extremely large and looking for a reasonable solution to their problem. Offering them a conservative, fast and effective way to improve their lives is just good old-fashioned commonsense. That’s the beauty of the procedure and the treatment protocol. It is a down to earth way to provide our patients with a great service and grow our practices at the same time. The magic combination of short treatment times and clear braces is powerful and attractive for people who thought they were stuck with crooked teeth.

Six Month Smiles works hard to ensure that our providers are successful. We launched a new Web site in October 2009 that drives patients into their practices (www.6monthsmiles.com). We provide staff training for our providers since success with STO is most easily achieved when the whole team is trained. Furthermore, we’ve doubled our number of courses for 2010 to match the demand we have for doctor training. We also have a dynamic lineup of certified Six Month Smiles instructors. These are all general dentists who have made STO an important part of their practices.

We feel blessed to have positively affected patients and dentists all over the world. Orthodontics is an area of dentistry that has traditionally been untapped by general dentists. With STO, Six Month Smiles has changed all of that and there are thousands of patients around the world who are smiling with pride and living happier lives because of it.
Dentaltown Magazine
September 2025
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