Dental Tribune UK Edition, September 13-19, 2010, Vol. 4 No. 21

September 13-19, 201024 United Kingdom EditionEducation D entistry in the UK has seen an exponential growth in orthodontic treatment over the past decade. The reasons for this are varied and include the developments in techniques and materials relating to orthodontic work, as well as increased patient aware- ness about the options available to them. New technology has allowed a progression towards pre- ventative dentistry that doesn’t require invasive treatment, ex- tractions or intensive interproxi- mal reduction. There has also been a shift in the cost to the patient for treat- ment. Whereas veneers were often quickly dismissed as an option due to the costly, invasive and time-consuming nature of the treatment, alternatives can now offer solutions to a range of malocclusions that are afford- able and quicker. Better smiles The private dental market has seen an increased number of adult patients seeking elective treatments to improve their smile aesthetic. The motivation for this could be attributed to media por- trayals through ‘makeover’ pro- grammes, which promise radical changes in appearance, thanks to whitening and porcelain laminate technology. It could be a greater sense of awareness about appearance that prompts people to take ac- tion over a smile they may deem ‘unattractive’: whatever the mo- tivation, it has been noticed that patients from higher socio-eco- nomic families/groups, and pre- dominately females, are more willing to undergo orthodontic treatment for tooth alignment and malocclusion. (1) In an ever-increasingly competitive market, and with a greater need to retain patients in the practice, being able to of- fer an attractive package of treat- ments is now easier to achieve, thanks to the development of new techniques and materials. One area that traditionally re- quired clinicians to refer their patients away from the practice was orthodontic treatment. Nat- urally, the knowledge and skills gained from the years of post- graduate study are invaluable, but GDPs are now able to offer patients with a wide range of malocclusions a treatment plan that, whilst designed by a trained orthodontist, is delivered by the general practitioner. Three types of treatment Traditionally, there are three categories of orthodontic ap- pliances: removable, fixed and myofunctional. Each has their share of advantages in terms of patient compliance, speed and cost, as well as their detractors, in terms of aesthetic, impact on health and longevity. For in- stance, there is evidence that small cracks in the enamel sur- face are seen following removal of orthodontic brackets. Such cracks provide the potential for caries to develop, discolouration and possible partial tooth frac- ture (2) and that there were more cracks with chemically bonded ceramic brackets. (3) For most adults, fixed brac- es would not be a treatment option because of their lack of aesthetic appeal. From a clini- cian’s point of view, fixed brac- es also mean referring the pa- tient away from their practice. The technology behind re- movable positioners has de- veloped remarkably over the past five years. Most clinicians would be amazed at the range of malocclusions they can treat, in child patients as well as adults, including functional jaw correc- tion and extrusion. Aesthetically pleasing Clear positioners have been available to clinicians for several years now and the capabilities of systems like Clearstep have improved immeasurably since their inception. Two advances of note have been the integra- tion of clear positioners with traditional mechanics to create ‘hybrid’ devices that remain es- sentially undetectable to anyone except the wearer and clinician. In fact, the range of potential treatments is much greater than when clear positioners were first introduced; general practitioners might benefit from a reappraisal of the systems available. The other development has been in the way the clinician can communicate the treatment outcomes with the patient. Often, relying on description alone isn’t enough to convince a patient how successful the treatment will be. Now clinicians can use a computer generated visuali- sation that gives a clear view of how the alignment will occur over the course of the treatment plan. It’s a simple yet effective way to gain patient acceptance of the proposed treatment plan, especially when the graphics are based on the patients actual teeth, and not a generic model: the reaction to seeing the align- ment being achieved is consist- ently positive. Growing treatment ranges As a general practitioner, being able to address a wide range of malocclusions in patients visit- ing the practice is a simple way to broaden the range of treat- ments being offered, made more attractive when the system also offers finishing such as home whitening. The system that utilises clear positioners as well as innovative appliances meets the patients’ requirement for a form of treatment that is non- invasive, avoids damaging the dentine and is almost invisible when being worn. Clinicians can tackle ortho- dontic treatment of a wide range of malocclusions confidently when they have received suit- able training and can rely on the support of expert diagnostic and laboratory support. DT A growing market Andrew McCance looks at how general dental practitioners can benefit from the increasing interest in orthodontics About the author Since quali- fying in dentist- ry from Glas- gow University, Dr Andrew McCance has gained a wealth of experience in multi-disciplinary practices. He has held several distin- guished positions including senior house dental surgeon at St George’s Hospital, Toot- ing and senior lecturer at Great Ormond Street, developing his expertise through a PhD at Uni- versity College London. In the mid 1990s, Dr McCance began to develop the Clearstep brace, based on the demands of the 4,000 patients treated annually in his specialist practices. He is currently taking his Clearstep vision to a worldwide audience. For more information, call the OPT Laboratory & Diagnostic Facility on 01342 337910, email info@clearstep.co.uk or visit www.clearstep.co.uk. ‘Most clinicians would be amazed at the range of malocclusions they can treat, in child patients as well as adults, including functional jaw correction and extrusion.’ For most adults, fixed braces would not be a treatment option because of their lack of aesthetic appeal. Refernces 1. Mitchell: An Introduction to Orthodontics, chapter 1. Oxford University Press, May 2007. 2.Zachrisson BU, Skogan O, Hoymyhr S. Enamel cracks in debonded, debanded, andorthodontically untreated teeth. Am J Orthod 1980; 77: 307–319. 3. Artun J. A post- treatment evaluation of multibonded ceramic brackets in orthodontics . Eur J Orthod 1997; 19: 219–228