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A Short-term Ortho Success Story John Fish, DDS

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by John Fish, DDS

I used to think I would never introduce ortho into my practice. The following case demonstrates both the scope of treatment and the ease of use of the Six Month Smiles short-term orthodontic system, a system I have found favorable in my practice.

Chris presented to my office after finding me listed as a provider on the Six Month Smiles Web site. His chief cosmetic complaints centered on the general crowding and asymmetry in his smile. According to Chris, his smile "looked like a train wreck." The appearance of his teeth had always bothered him but aside from traditional orthodontics, he wasn't aware of another feasible option. Chris had thought he was going to live the rest of his life with crooked teeth.

The first step in the process was to assess Chris' dentition and make an orthodontic diagnosis. This included a slight Class II canine and molar relationship bilaterally, generalized moderate crowding, narrow and flat archforms and multiple anterior crossbites in the region of the lateral incisors. When I was trained at the Six Month Smiles seminar, I learned how to make an orthodontic diagnosis and determine which adult cases can be treated with the Six Month Smiles system. The entire case selection and treatment planning process primarily revolves around understanding and treating based upon the patient's chief cosmetic complaints. I have found that most adults with crooked teeth are candidates and most cases are completed in approximately four to nine months.


Figs. 1, 2 & 3: Pre-operative photos demonstrate the severity of Chris' tooth position discrepancies, including moderate crowding in both arches, anterior crossbites and under-erupted canines which created extremely large incisal embrasures. Chris was embarrassed of his smile.

I was a bit skeptical about performing ortho since I wasn't taught much about it in dental school. I was essentially taught how to pick up a referral pad and refer out patients with malpositioned teeth. I was also taught that if teeth are moved with too much force, it can result in root resorption. The Six Month Smiles system involves use of extremely light tooth-colored archwires and unique clear cosmetic brackets. Additionally, the goals of treatment are different than those typically associated with traditional orthodontics. The short-term, ortho-specific materials and simplified treatment goals are what allow Six Month Smiles providers to treat cases like Chris' in such a reasonable amount of time and without any increased chance of root resorption. Providers focus on giving patients like Chris a highly aesthetic new smile while maintaining a practical approach and focused treatment goals.

I started doing Six Month Smiles cases because I liked that it doesn't aim to make the most time consuming orthodontic alterations. The goals of treatment are very similar to porcelain veneers and clear aligners in that the aim is to create a dramatic improvement to the appearance of the teeth without making significant changes to the posterior occlusion. However, I'm able to address important aspects of the occlusion such as deep bites, minor cross bites and constricted envelopes of function.

When I saw Chris in the office, I discussed his options with him. Traditional orthodontics is always my first recommendation for patients with malpositioned teeth. But many adults aren't interested in traditional ortho – whether for aesthetic reasons or concerns about the length of treatment. Before Six Month Smiles, I would treat some of these patients with veneers but had to tell most of them that I couldn't help them. I also discussed clear aligner treatment with Chris but explained to him that extruding his upper and lower canines with clear aligners would be incredibly difficult, if not impossible. Based on our discussion about the options available to him, Chris decided quickly that Six Month Smiles was the approach that made the most sense for him. We took impressions that day.


Fig. 4: Mid-treatment photo shows how much tooth movement has already been accomplished within two months of treatment. The photo also shows the bracket design.


About two weeks after gathering our records and taking impressions, we started the case. The bracket technicians at Six Month Smiles determine the ideal positions for the brackets and fabricate bonding trays. The system was definitely designed with GPs in mind.

We saw Chris every four weeks for his adjustment visits. At these visits, we removed the wires, evaluated the teeth and provided some very conservative interproximal reduction where appropriate. The system involved a sequence of three gradually larger archwires and we changed the size of the wires in both arches every other month. The tangible nature of this treatment really makes it enjoyable for everyone involved in the process.

Chris' case was completed in about six months, as expected. When the desired results had been achieved, we removed the brackets and made retainers for Chris. Retention for Six Month Smiles is similar to any type of orthodontic treatment in that a good retention protocol is critical for long-term success. There are varieties of retention options, both fixed and removable, and the decision of which option to choose depends on the specific case and the desires of the patient.

There are still a few more things we have planned for Chris. We have discussed some aesthetic crown lengthening procedures in the upper posterior quadrants. We also plan to replace his missing lower molar with an implant-supported crown when appropriate.


Figs. 5 & 6: Post-treatment photos demonstrate Chris' final result which was accomplished in six months.
Chris was thrilled with the result. In fact, he told me that it was "life changing." It was a dramatic change in regard to both aesthetics and occlusion.

I am pleased to have the ability to deal with tooth position discrepancies in a way that is both conservative and attractive to patients.
Author’s Bio
Dr. John Fish has been in practice in Western North Carolina since 1983. He is a fellow in the American Academy of Implant Dentistry, the Misch International Implant Institute and the Academy of General Dentistry. He is also a diplomate in the American Board of Oral Implantology and a mentor at the Kois Center in Seattle. His practice has a special focus on implants, cosmetics, sedation and Six Month Smiles.
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