Posted on 10 October 2019

Looking back to when I cut my first class 1 restoration in dental school, to the way I approach my treatments roughly 12 years later, is a rather incredible evolution. From being focused on “the tooth” and making the “the tooth” my primary concern, to an almost complete reverse, where “the tooth” now becomes the last thing I treat. Clear aligner treatment has opened my eyes to the powerful, and undeniable, forces of teeth against each other.

When two objects act on each other with both equal and opposite forces, those objects remain stable. Change the direction of the force to no longer being equal or opposite and there is no longer stability. This is essentially Newton’s first law, and its application in Dentistry is profoundly obvious. When two teeth are aligned vertically from each other, and the force of biting is applied, those two teeth will remain in a stable, non-erosive state. As soon as the vertical angulation changes in one of the teeth – even by a few degrees – we see erosion and destruction over time. We see this in many forms, namely abfraction, clefting, recession, cuspal wear, fractures, erosion of enamel etc. What I am alluding to is the importance of having a correct occlusion, which we, as clinicians, may only be able to achieve with the introduction of orthodontics in our practices. We know and we see that malocclusions will destroy the teeth, the gums, the bone, the TMJ, the muscles and most importantly, the dentistry that we place every day.

Understanding that good arch width and arch form and balanced inter-cuspation and vertical alignment teeth will bring about long lasting stable dentistry, has transformed my treatment approach to every patient I see. While I used to believe that aligning teeth was all about aesthetics, I now realise it is part of a much bigger treatment approach.

It is understandable that clear aligner treatment is the fastest growing sector in the dental industry globally. More and more patients are demanding this treatment and with the advent and advancement of digital orthodontic software and hardware, this is now becoming accessible to the appropriately accredited general dentist. Over 5 years ago I began doing clear aligner treatments. Starting on cases that were simple and easy and slowly advancing to more complex cases. I now incorporate aligner therapy into all my treatment plans where possible. I have and always will refer complex orthodontic cases to my specialist colleagues and do not claim to be able to treat every malocclusion. However, the option to do aligner treatment before starting any aesthetic case – be it with composite or ceramics – is now available to me through clear aligners. I have experienced working with different aligner companies in South Africa and in 2019 was introduced to Active Aligners.

Active Aligners offer a complete package when it comes to entering the aligner workspace. They receive digital or analogue impressions, review and advise on each case, offer full treatment planning with all the movement protocols built-in, as well as deliver on quality materials and packaging that the patient receives, with detailed explanations and instructions on treatments. Working with them has boosted my overall aligner success and case load. Plus, there is the “wow” factor for the patients. Having a 3D intra-oral scanner and being able to show each patient their mouth in full colour and detail is a significant practice builder. Being able to show the patients a digital mock-up of the their treatment with before and after pictures is invaluable.

I have always been excited by new technology and try and embrace change as it arrives. I have also learnt that patients will thank you for it. They tell their friends and family and help you grow your practice.

We live in a rapidly changing and evolving world, and nowhere have I experienced this more than in the field of Dentistry. Gone are the days where we as dentists are simply drilling and filling teeth. We must evolve to treating the entire oro-facial region and we must now understand the mechanisms of this region in detail. Since my journey into aligner therapy I have begun to grasp these concepts. It has opened new avenues and I keep learning every day.

Dr Marc Sher

[jpshare]

Private Practice,
Cape Town,
South Africa

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