Tif Qureshi speaks to Dentistry about starting out with clear aligners and why Suresmile is the most predictable system he’s ever used.
1. Always keep a record
As dentists we should be trained to use imagery as a tool for educating and informing our patients. As well as a permanent baseline record of a patient’s teeth. I always take an image, or now a scan, of the patient’s teeth. It allows me to document their dentition.
Having an image allows you to discuss the case with your patient and technology helps enormously with this. You can rotate and manipulate the image via the software and look at wear facets, dentine exposure and tooth position. This enables patients to see things for themselves, rather than you looking into their mouth and telling them what they need.
I realised the power of imagery some time ago just using basic photography. But now scanning has taken this to a whole new level.
The ability to superimpose an intraoral scan on top of a diagnostic scan lets me see movement changes, tooth surface loss, gum position. And this is a real game-changer.
If we also consider the current medicolegal environment, then images and scans are very important aspects of case documentation. It’s important for dentists to understand the benefits of using these tools.
2. Show the patient what’s happening
The most important thing is to show a patient what’s going on with their teeth. Yes, I want their teeth to look better and for them to have orthodontics and bonding if that will improve their function and aesthetics.
But the key thing is for them to understand that there have been changes in their dentition. So they can say: ‘Okay I can see this problem, what can you do?’
I can also show a patient a case from maybe five years ago of someone who didn’t have treatment. They can then appreciate what non-treatment might look like. This can literally be an eye-opening moment for the patient.
I use the before and after software and digital smile design. But I don’t use these tools to ‘sell’ treatment to patients.
I find it much better to explain to the patient what’s happening to their teeth and for the patient to take up the treatment when they’re ready, which they invariably do. Eighty per cent of my patients who are having orthodontics are existing patients who have been with me for many years.
When someone does come in and wants treatment straightaway, of course it’s great. I pick up my Primescan and show them a simulation of the finished result and bang – they’re sold. But that’s not the way it usually happens for me.
3. Use intraoral scanning
Suresmile is a scan-only system. I must admit, when I first heard this I thought it was a big mistake and that clinicians wouldn’t take up the system. However, the more I have learned about clear aligners in general and Suresmile specifically, the more I think what a great move this is.
Impression taking causes some of the biggest issues in clear aligner treatment. It makes them less predictable and the reality is, even if you get a really good impression, the likelihood is that you’ve caused a bit of muco-compression on the gum line. This then makes it more awkward to obtain a high finish line on the aligner.
There are a lot of systems that just use scalloped edges. But they are using this to get around poor impressions.
I think scan only is a genius move from Dentsply Sirona. Looking back at my cases, it’s absolutely clear that because it’s scan only, Suresmile has been the most predictable system I have ever used.
4. Get the set-up right
Firstly, I would recommend using landmark points. By this I mean there is usually a tooth or a point of a tooth that is in the correct plane, either anterior/posterior or vertically. You want to make sure this tooth remains in the same position. And I always indicate this on my prescription.
Knowing this enables you to always have a reference point and helps relate the patient’s teeth to their lips and face.
Another general tip, and one which I write on almost every prescription, is to avoid IPR on overlap contacts at the start of treatment. If you have a lot of crowding in the upper or lower anterior zone, the last thing you want is to carry out more than 0.1mm or 0.2mm of IPR.
In my opinion, anything more than this is clinically damaging to the teeth. So I ask them to defer IPR to a later stage of treatment.
5. My advice if you’re just starting out with aligners
Well, in my opinion a camera is vital for all dentists. But particularly when starting with aligners! Of course, a scanner would be great, but a camera is vital.
Imagery, via whatever method, is a truly immense tool in terms of patient experience and education. And of course, a Primescan would transform your ability to deliver both of these things.
It also helps in documenting cases, which can prove very useful if you are able to show another patient the results from a similar case, or the consequences of not having treatment. This can be equally, if not more powerful.
Also, take some education, like the programme we have put in place for Suresmile, one that is well structured and includes mentoring, that will help you filter your cases. I have been mentoring for many years and I’ve realised the most important thing is to help dentists recognise when to say ‘no’ and to guide them through and help them to treatment plan, starting with simple cases.
Listen to the full podcast with Tif Qureshi in which he discusses how clear aligners work in his practice.
Book a no-obligation one-to-one consultation with a Suresmile specialist at www.dentsplysirona.com/suresmile and see how quickly you can get started.