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Cosmetic Ortho – The New Frontier for General Dentists Ryan Swain, DMD

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by Ryan Swain, DMD

Consumer demand is the driving force behind changes in our great profession of dentistry. Most dentists who effectively gauge consumer demand and respond to it appropriately achieve the practice success they desire. Over the last five years, a strong trend has developed potentially affecting all general dentists. Adults with crooked teeth refuse to settle for "doing nothing" if they decide that traditional orthodontics is not for them. The pent-up demand for cosmetically focused orthodontic treatment is enormous. This field has become a strong area for general dentists who are looking to provide a great service for their patients and grow their practices at the same time. The use of various orthodontic systems such as Invisalign, Six Month Smiles, OrthoClear, ClearCorrect, Fast Braces and High Speed Braces allows general dentists to cater to these patients with systemized solutions that are effective, reasonable and attractive.

Traditionally, most general dentists have steered clear of orthodontics. Dental schools typically provide students with a limited understanding of ortho, and most dentists graduate with a fear of performing orthodontics. There are many orthodontists who treat adult patients, but oftentimes it is if the patient agrees to undergo treatment for as long as it takes to yield a comprehensive result (which might include braces and other traditional methods). In my experience, I've come across few adults who are willing to accept a comprehensive option because of the significant time that is involved and the appearance of metal braces. Adults with crooked teeth are seeking more reasonable alternatives to traditional orthodontic treatment and progressive general dentists are taking it upon themselves to learn and offer these alternatives.

During the last 15 to 20 years, many general dentists began to recognize the growing demand for straight teeth and they chose to cater to these patients with an approach that was comfortable for them – using a handpiece. Veneers became the general dentist's tool for treating patients with crooked teeth. Big veneer cases, oftentimes confusingly referred to as "instant orthodontics" became ubiquitous. Porcelain was being used to mask crooked teeth and both general dentists and dental labs were happy to help these patients. However, the aggressive nature of some veneer preparations, coupled with the possibility of future replacements and repairs, have lead many conservative dentists to wonder if this option is the most appropriate or even responsible.
Then, in the late 90s, clear aligner systems became available to general dentists and changed everything. Thousands of dentists incorporated clear aligner systems into their practices and were excited to offer their adult patients a relatively simple, aesthetically pleasing and cosmetically focused alternative to traditional braces. One advantage of clear aligners is that treatment times are generally shorter. This, along with the fact that the Invisalign system utilizes clear aligners rather than metal braces, was a very attractive feature for both general dentists and their adult patients.

Clear aligner systems have proven to be valuable for dentists and patients and have changed the face of dentistry forever, for the better. After the success seen with Invisalign, many other aligner systems began springing up as other dental companies and labs developed and began marketing their own systems. Aligners will continue to be a good option for many cases but many dentists are now using fixed orthodontic options in order to complement their repertoire and add to their service mix.

Dr. Clifton Georgaklis of Brookline, Massachusetts, pioneered a cosmetically focused fixed orthodontic approach in the early 90s. Since that time, short-term ortho systems have gained in popularity. I've pioneered the Six Month Smiles system to be a "general-dentist friendly" orthodontic system with some attractive features for patients. The system involves the use of short-term ortho specific brackets and wires, both of which are tooth-colored. Additionally, the average treatment time is six months. These features prove to be attractive for adult patients who aren't interested in traditional orthodontic treatment. Similar to aligners, short-term ortho systems are not a complete replacement for comprehensive ortho, but a more aesthetically oriented and time-sensitive alternative. Aligner treatment and short-term ortho treatment are both aimed at increasing symmetry, improving occlusion and addressing the patient's chief cosmetic complaints rather than providing a total occlusal overhaul.

The feedback I've received indicates that aligner users are pleased with the additional control and predictability that brackets and wires provide for them. Additionally, I've heard from dentists who are familiar with both agree that a fixed orthodontic approach offers a more efficient method for providing cosmetic tooth movement. Relatively low lab fees also allow Six Month Smiles providers to offer flexible payment options for their patients. Dentists who have both aligner treatment and short-term orthodontics in their arsenal are particularly successful because of the flexibility afforded to them and their patients.

When cosmetic orthodontics is discussed amongst dentists, the topic of occlusion is inevitably part of the conversation. Dentists who aren't familiar with cosmetic ortho are usually curious to learn about what the occlusal goals are when compared to the goals of traditional orthodontics. In dental school, we learned that the goals of traditional orthodontics are to establish: a Class 1 molar relationship, a Class 1 canine relationship, ideal overjet, ideal overbite and ideal crown/root positions. Generally, when these features are achieved orthodontically, the result is highly aesthetic and if adult patients are willing to undergo orthodontic treatment for years, then this type of result is achievable.

 Cosmetic orthodontic systems allow general dentists to provide significant improvements to dental symmetry. This case was treated in six months with the Six Month Smiles System.




Many dentists have become involved with clear aligner systems like Invisalign.




Cosmetically focused orthodontic alternatives that are time sensitive make treatment a possibility for adult patients who otherwise would choose to do nothing about their smiles. This short-term ortho case was treated in six months.



Brackets and wires that blend in with the surrounding tooth structure, are very attractive to adult patients.

Cosmetic orthodontics is primarily aimed at adults who simply aren't willing to undergo years of orthodontic treatment. Usually, the less comprehensive the treatment, the shorter the treatment time will be. For instance, most cosmetic ortho cases (fixed or removable) do not involve altering the existing angle relationship. The primary goal of aesthetically oriented orthodontic systems is to create a symmetrical and pleasing dental display while simultaneously improving certain aspects of the occlusion. This can include: improving deep bites, correcting minor crossbites and freeing-up constricted envelopes of mandibular function. So, although the focus of treatment is cosmetic, the occlusal scheme can be improved significantly as well. This is a major benefit of this orthodontic approach when compared to porcelain veneers, which provide limited ability to correct these particular occlusal issues. In many ways, cosmetic orthodontics is better compared to treatment with veneers because the goals and scope of treatment are more similar than those usually associated with traditional orthodontics. Similar to porcelain veneers, the main objective of cosmetic ortho is to give patients a smile that looks remarkably better than what they had previously, while improving the occlusion as much as possible. But, compared to veneers, an orthodontic approach allows the clinician to more pragmatically and conservatively solve the primary problem for adults with crooked teeth, which is non-harmonious tooth position.

Most general dentists have hundreds, if not thousands, of adult patients with crooked teeth in their practices. General dentists have long seen this issue, heard the patient-imposed restrictions and have mostly stopped asking questions about traditional braces. Now, dentists can suggest that patients can have straight teeth by their next prophy. Those who make a small investment in themselves and their practices can now help these patients after becoming involved with cosmetic orthodontic systems like Invisalign and Six Month Smiles. One very interesting phenomenon I've found is that these dentists actually end up referring more patients to the orthodontists in their community. Since these dentists are now talking to and marketing to many more patients about orthodontic options, they end up treating those who refuse comprehensive ortho and referring the rest to an orthodontic specialist. This new frontier is not about general dentists competing with orthodontists; it is about general dentists being able to help their patients who refuse traditional braces in a manner that is safe and easily implemented in a general practice. When done correctly, everyone can win.
Author’s Bio

Dr. Ryan Swain is a graduate of the University of Florida College of Dentistry. He practices in Rochester, New York, and focuses on short-term ortho and other conservative cosmetic dental procedures. He is CEO and clinical director for Month Smiles, Inc.
Dentaltown Magazine
September 2025
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