Dental Products Report | September 2008
MID Report
A minimally invasive smile makeoverInvisalign and Lumineers can help you achieve the esthetic smiles your patients want with a minimally invasive approach.
By Dr. Joseph Whitehouse, Past President of the World Congress of Minimally Invasive Dentistry
Has this ever seemed absurd to you? Moreover, have your patients ever been asked if they would be willing to entertain the idea of using orthodontics to get the correct alignment before the enamel comes off? Finally, just how much enamel would patients be willing to give up if they knew there were techniques available to save tooth structure? Where does the philosophy of Minimally Invasive Dentistry (MID) enter into the equation?
There are a number of dentists who still believe that removing tooth structure is the only way to provide an esthetic smile. An interesting thing has happened, though, as more laboratories are replicating Dr. Robert Ibsen’s revolutionary idea of no- or limited-prep veneers. Lumineers from Den-Mat (denmat.com) have been around for quite some time, and now many labs have realized that a MID approach does work.
It would seem that for the sake of the patient, every dentist would learn about and offer, when appropriate, a minimally prepped solution for providing a nice smile. This includes moving the teeth that need to be aligned before the drill hits them. Enter Align Technology’s Invisalign (invisalign.com), a product that makes it possible for every dentist to treat the most basic alignment cases.
The following case incorporates both of these products; click here for details on a second case that illustrates the benefits of Lumineers alone. Both cases can be performed by any competent dentist who cares enough to take the time to explain how a MID approach would benefit the patient and to get certified by Invisalign to treat cases similar to the one shown.
Alignment and minimal preparation
This patient had been coming to my practice for years, and she always noticed the many “before-and-after” photos in the reception area. Many years ago she had bonding on the facial of No. 10 to bring it into the arch. She gradually became more interested in having a better smile. We discussed the process over several recare visits before getting started.
When she was finally ready to proceed, I offered to align the teeth first or provide veneers with a great deal of tooth preparation. We discussed the advantages of using Invisalign (or regular braces) to first get the teeth in an alignment, which would alleviate major re-contouring of several teeth. I also educated her about the benefits of the Lumineers material. I used an intraoral camera to show the issue to her, and she immediately saw the benefit of using the alignment concept.
The alignment
Figs. 1-5 show the patient before treatment. Notice the lingo-version of tooth No. 10, the overlapping of No. 7 by No. 6 and poor alignment of the lower incisors. If you look at Fig. 4, you can see the difficulty of placing veneers on teeth Nos. 6, 7, 9 and 10 without tooth reduction.
Tooth reduction might have been acceptable in the past, but why would one want to squeeze restorations on these teeth when an orthodontic movement would solve the problems? The reasons why may include:
• Fear of asking patients to have orthodontics
• Fear the patient might not accept a higher fee involving more treatment
• Lack of knowledge
• A desire to get the case done quickly
• No concept of what would look best
With the advent of Invisalign offering a straightforward approach to aligning teeth, as in this case, doesn’t it make sense that the standard of care should be at least to offer the patient this option, even if it is not a course of treatment in that office? I would suggest it be considered. Fig. 6-10 illustrate the results of using Invisalign to align the teeth, which are now ready for Lumineers.
The new smile
Once the alignment was complete, impressions were made and models sent to the Lumineers lab, where the minor reduction needed was done on the models and outlined in red (Figs. 11, 12 and 13). From this lab support, it was easy to provide the minimal reduction needed.
Three years after placement, the outcome has sustained the effort of meeting the patient’s cosmetic needs using the MID approach with Invisalign and Lumineers (Figs. 14, 15 and 16). The tissue is in healthy condition, and the patient is pleased with how the smile turned out.
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