Smilelign Essentials Everything You Need to Know

13/06/2019

Smilelign Essentials Everything you need to know

Presented by Dr Milad Shadrooh

Who are Smilelign?

• UK-made clear aligner system • Established in 2012 • Growing YOY • Wealth of ortho experience • Pre-aligners with each plan

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Our people

Matt Everatt Technical Director [email protected] Neil Bullement Commercial Director [email protected] Matt Norie Technical Manager [email protected] Ellis Bullement Smilelign Ops Manager [email protected] Maddie Udall Marketing & Comms [email protected]

Agenda

Morning • Dr Milad Shadrooh – Smilelign Essentials

Lunch • View samples of Smilelign clear aligners • Other S4S appliances, including the SCi and Sleepwell

Afternoon • Dr Milad Shadrooh – Smilelign Essentials • Smilelign: Marketing Hints & Tips

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Smilelign Essentials Everything you need to know

Presented by Dr Milad Shadrooh

Who am I?

• General Dental Practitioner • Qualified 2004 from Barts and The London • Own a mixed practice in Basingstoke, Hampshire • Used clear aligner systems for 12 years • Met S4S 9 years ago and started using Smilelign in early 2012

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My First Case

The Wife!

• She had relapsed ortho • Been assessed by other systems • Treatment options complicated and lengthy • We had a wedding deadline

Smilelign Treatment Plan 9 upper and 6 lower aligners The deadline was achievable

My First Case

Before treatment After treatment

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My First Case

Before treatment After treatment

My First Case

Before treatment After treatment

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What is Smilelign?

Pioneering 3D Orthodontic Planning and Clear Aligner System

• White light scanning technology • Powerful treatment planning software • FREE Version of the viewer for dentists

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What is Smilelign?

• Non-extraction • Fewer attachments • Quick and predictable results • No sectional fixed • Less surgery hassle • Less invasive IPR • Lower lab fees • No upfront lab fees • Happier patients • No additional training • Increased profits • No lengthy delays • No barriers to beginning

What makes Smilelign better?

The USPs!! • Free software - patients can see their case and the dentist has ownership of digital files • Simultaneous tooth movements – 0.3mm and more/less if required: • Less aligners • Quicker treatment

• UK lab with in-house printing - everything manufactured in Sheffield: • No delays in treatment – quick as 14 days • Always speak to someone straight away

• Pre-aligners – really valuable 1st stage

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What is a pre-aligner?

Passive fit appliance used to: • Check the accuracy of the impressions prior to fitting active stage aligners. • To maintain a stable position for a firm start point. • Can be used as a “test appliance” if a patient is unsure about clear aligner treatment. • Only give go-ahead once pre-aligners are fitted and treatment plan is acceptable.

What makes Smilelign better?

• Pre-assessment by experienced lab technicians before Scan + Plan. This allows an idea of case suitability before costs incurred. • Price - as little as £375 for up to 5 aligners, £900 maximum price for 12+ aligners. • Storage of digital models (indefinitely). • Treatment is adaptable.

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What makes Smilelign better?

• Catered for patient’s requirements: Perio patient = reduce movements per aligner. • Catered for dentist’s requirements: Do a lot or do a little based on experience. • Parafunction – pre, during and post treatment! Dealing with a company that specialises in this field.

Why STO? (Aesthetic Orthodontics)

• Patients want straight teeth. • Move away from veneers. • ABC – new protocol for Aesthetic Dentistry Align Bleach Contour • If you don’t do it…someone else will!

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GDP Ortho

• Easy to get into orthodontics now. • Easy to get into trouble…. • We should know what to treat and what to refer. • Make sure the support is there. • If we are doing orthodontics, we should have fundamental knowledge of orthodontics.

Orthodontics – the basics

• Definition: “Orthodontics is the movement of the teeth within the jaw bones to straighten them and help them to bite more evenly together; it’s about improving the harmony of your mouth and jaws.”

- British Orthodontic Society

• Definition of Aesthetic Orthodontics (STO):

“Orthodontic treatment that focuses on the alignment of the teeth in the aesthetic zone with little to no effect on the posterior occlusion; it should usually be completed in under a year.” - Milad Shadrooh

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How do we move teeth?

Tooth movement happens our entire life: • Eruption during dental development • Mastication • Trauma – accidents and iatrogenic • Tooth migration and drifting

How do we move teeth?

Periodontal Ligament • 0.5mm wide. • Contains nerve fibres that allow proprioception. • Not highly vascular. • Contains many cells: • Osteoblasts • Osteoclasts • Fibroblasts • Cementoblasts • Cementoclasts

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Biomechanics and forces

• Applying a sustained and continuous force on a tooth results in movement as the collagen fibres in the PDL detach, then reattach.

• It requires a minimum amount of force, otherwise the forces are dissipated and no movement takes place.

• Different teeth need different forces, due to their root surface area (incisors need less than canines).

• Movement occurs due to bone resorption and bone deposition.

• Lighter forces cause frontal bone resorption, which is favourable. Heavy forces can cause necrosis in the PDL and undermining bone resorption.

Forces on teeth a) Pressure: • periodontal ligament is compressed. • osteoclasts resorb bone. b) Tension: • Periodontal ligament is stretched. • osteoblasts lay down bone.

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Types of movement

Tipping - Crown moves more than the root in any given direction.

The crown and root move in opposite directions (30-75g).

Types of movement

Bodily movement - Crown and root move the same amount of distance in the same direction (60-150g).

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Types of movement

Intrusion - Axial movement of the tooth along the long axis towards the apex of the root (10-25g).

Extrusion - Axial movement of the tooth along the long axis towards the coronal part of the tooth (30-75g).

Types of movement

Torque – movement of the root in a bucco-lingual direction (sometimes mesio-distal).

The root moves more than the crown (50-125g).

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Types of movement

Rotation – spinning of the tooth along its own axis.

True rotation requires coupling of forces otherwise the tooth will tip, not rotate (50-100g).

Orthodontic terminology

Class 1, Class 2, Class 3, Overbite, Overjet, Crossbites, Malocclusion…lets start talking like Orthodontists!

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Terminology

Overbite – amount that the upper anterior teeth overlap the lower anterior teeth in a vertical plane.

Terminology

Overjet – amount by which the upper anterior teeth protrude from the lower anterior teeth in a horizontal plane.

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Terminology

Anterior Open Bite – no contact between the upper and lower teeth when the posterior teeth are in contact.

Terminology

Anterior Cross-Bite – upper anterior tooth occludes lingually to the lower anterior tooth.

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Terminology

Posterior Cross-Bite – buccal cusp of the upper posterior tooth occludes in the central fissure of the lower posterior teeth.

Terminology

Classification – Class 1, Class 2, Class 3

This is used to describe: • Skeletal pattern • Incisor relationship • Molar relationship • Canine relationship

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Terminology

Angle’s Classification – Edward Angle, 1850

The classification is based on the relationship between the mesiobuccal cusp of the maxillary first permanent molar and the buccal groove of the mandibular first permanent molar.

• Class 1 • Class 2 division I • Class 2 division II • Class 3

Terminology

Class 1 – Mesiobuccal cusp of upper 6 occludes in line with buccal groove of lower 6:

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Terminology

Class 2 – Mesiobuccal cusp of upper 6 occludes anterior to the buccal groove of lower 6:

Terminology

Class 2 div I – Class 2 molars with proclined upper centrals (can also be normally inclined):

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Terminology

Class 2 div II – Class 2 molars with retroclined upper centrals:

Terminology

Class 3 – Mesiobuccal cusp of upper 6 occludes posterior to the buccal groove of lower 6:

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Terminology

Incisor relationship – position of the lower incisal edge and the upper incisors cingulum in occlusion.

• Class 1 – Lower edge occludes ON or immediately below cingulum.

• Class 2 – Lower edge occludes BEHIND cingulum: • Div I – upper incisors are proclined • Div II – upper incisors are retroclined

• Class 3 – lower edge occludes IN FRONT of cingulum.

Terminology

Incisor relationship

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Canine Relationship

Class 1 Upper canine occludes with distal half of the lower canine and the mesial half of the lower first

Class 2 premolar. Distal surface of the lower canine is distal to the midpoint of the upper canine. Class 3 Distal surface of the lower canine is mesial to the midpoint of the upper canine.

Terminology

Skeletal Pattern – the relationship of the maxilla to the mandible in a horizontal plane.

Class 1 Class 2 Class 3

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Terminology

Vertical Dimension – the vertical distance between two selected anatomical marks.

Terminology

Ideal occlusion – Hypothetical position where the maxilla and mandible are correct size in relation to each other and the teeth show all the ideal characteristics:

• Coincident mid-line. • No crowding. • No overlapping. • No rotations or spacing. • Correct crown angulation and inclination. • Molar relationship is class 1. • Incisor relationship is class 1 with over-jet of about 2-4mm. • Canine relationship is class 1. • Flat or slightly upwards curve of spee.

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Terminology

Normal occlusion – a normal occlusion is one which shows some deviation from that of the ideal but is aesthetically acceptable and functionally stable for the individual.

Malocclusion – misalignment or incorrect relation between the teeth of the upper and lower arch as they bite together. Defined using the molar relationship.

Terminology

Malocclusion

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Stages of treatment

1. Assess the patient and see if Smilelign is possible. 2. Obtain consent. 3. Take records – ortho assessment, imps, photos, X-rays. 4. Lab pre-assessment and then Scan+Plan. 5. Pre-aligners fitted and Plan agreed. 6. Treatment aligners arrive with Instructions. 7. Review of treatment. 8. Bleaching and Contouring – if needed. 9. Retention.

Stages of treatment

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What cases can Smilelign treat?

• Clear aligners are a very effective orthodontic treatment for many cases – not all! • Smilelign keeps movements within workable limits. • More complex cases undertaken with experienced clinicians • Access to Consultant Orthodontist for difficult case planning

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Space analysis

• Accurate space analysis done digitally by software.

• “Eye-ball” estimate using periodontal probe to measure the contact point displacements.

• Quick chairside estimate using micro calipers and copper wire.

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Can we treat difficult cases?

• Smilelign has the ability to treat more difficult cases. • Experienced clinicians can work with Smilelign Scan and Plan to incorporate: • More extensive IPR • Pre-aligner expansion with URA • Design attachments specific to case or desired movements

Can we treat difficult cases? Special Extrusion technique

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Can we treat difficult cases?

Special Extrusion technique

Stages of treatment

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Consent Things to include apart from the usual:

• Oral hygiene must be maintained at high level. • Need to wear aligners full-time, except when eating or brushing teeth. • Must stick to protocol (2 weeks per aligner, move on when passive). • Costs may be charged for lost/broken aligners. • Total treatment duration may increase, due to unforeseen circumstances.

The 4 Rs • “Refinement” - may be needed at end of initial treatment. • “Recontouring” - bonding/mild cosmetic contouring may be needed to correct discrepancies. • “Retention” - lifetime retention will be necessary. • “Relapse” – may occur and retention protocol is key.

Stages of treatment

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Clinical assessment

• Routine Examination (dental charting, BPE, soft tissues, extra-oral, etc) • Ortho Examination.

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Clinical assessment

• Routine Examination – Dental Charting, BPE, Soft tissues, Extra-oral etc…

• Ortho Examination.

• Radiographic Assessment: • Intra-orals • OPG • Ceph

• Patient summary.

Patient summary

A 34 year old female presenting with a class 2 div 1 incisor relationship on a class 2 skeletal base with increased vertical dimension. Overjet is 5mm and the upper left 5 is in crossbite. There is mild crowding in the lower anterior segment.

Patient’s main complaint was the proclination of the upper incisors and the mild crowding of the lower anterior teeth.

Patient is not concerned by upper left crossbite and slight midline shift.

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Clinical assessment

• Routine Examination (dental charting, BPE, soft tissues, extra-oral, etc)

• Ortho Examination.

• Radiographic Assessment: • Intra-orals • OPG • Ceph

• Patient summary

• Photos

Photos

Extra-oral • Front Face rest • Front Face Smile • Profile Face • ¾ Profile

Intra-oral • Front view of teeth in occlusion • Front view of teeth slightly opened • Right side showing molars in occlusion • Left side showing molars in occlusion • Upper Occlusal • Lower Occlusal

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Photos

Extra-oral

Photos

Intra-oral

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Records for lab

• Upper and lower silicone (putty & wash) good quality impressions. • Bite registration. • Clinical photos – can help with more complex cases. • Brief outline of patient's main complaint and treatment objectives. • OPG – especially if perio concerns or worried about root alignments or previous orthodontics.

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Stages of treatment

Emails – case received

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Scan + Plan

SCAN

• Models cast in normal way in stone.

• All cases pre-assessed with treatment objectives in mind - if deemed appropriate, move on to scanning.

• Scan with white-light scanner to create virtual models.

• Email sent by admin with shipping details.

Smilelign - Scan

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Smilelign - Plan

PLAN

• Keep movements within sensible range. • Expansion/Derotating/Tipping/IPR. • Full Occlusal Analysis – Simulate Articulators.

Smilelign - Plan

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Email – treatment plan

Treatment plan – ortho studio files

Each case treatment plan will include:

• Ortho Studio Treatment Plan.

• PDF showing the before and after models, movement of each tooth and the IPR required.

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Stages of treatment

Pre-aligner set

What you receive:

1. Pre-aligners 2. Smilelign aligner case 2. Instructions for patient 3. Retainer Retriever 4. PuraDent disinfectant tablets

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Pre-aligner

• Fit pre-aligner and check the fit for discrepancies:

• If not right, will need another impression. • If fits well, let the patient take it away and use it for a couple of days. • Once they are happy, give the go ahead for aligners to be made.

Approval of treatment plan

• Ensure treatment plan is suitable for you & patient. • Send email to [email protected] confirming approval. • Return date will be sent. • On approval, active aligners will be printed.

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Email – case approval acknowledgement

Stages of treatment

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Aligners

IPR

IPR – interproximal reduction (stripping): • Abrasive strips and discs. • Oscillating discs. • Diamond burs. • Soflex discs – polish surface of really crowded teeth.

• I prefer to carry out progressive IPR, following the instructions provided. • Do it gently and respecting the natural anatomy of the tooth. • Apply fluoride varnish to IPR areas.

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IPR

The Smilelign IPR kit has everything you need:

0.08mm 0.1mm 0.13mm

Attachments

1. Ensuring the template is clean, check the fit on the patient’s teeth. 2. Following composite bonding techniques, prepare the teeth that will have attachments placed. 3. Making sure the template is completely dry, place a small amount of composite in the void where the attachment will be. 4. Seat the template firmly onto the teeth, applying firm pressure around the area of the attachment. 5. Cure the composite according to the manufacturer’s instructions. 6. Remove the template and test that the attachment is firmly bonded. Remove and excess or flash with usual composite polishing burs, ensuring you do not alter the shape of the attachment.

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Treatment aligners

• Each aligner should be used for 2 weeks.

• Only move onto next stage when: • Aligner becomes easy to fit and remove. • There is no pressure felt on any individual tooth. • No space between aligner and teeth.

• Moving on too quickly may increase treatment length.

• Each aligner must be worn full-time, only removing for eating food and brushing teeth.

Treatment aligners

• Keep aligner in hard case when not worn • Treatment log must be filled out accurately • Each aligner must be in its bag when moving on to next aligner • Check each aligner for cracks before putting back in

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Stages of treatment

Review

• Review every aligner initially, then 2 aligners if patient shows competence. • Patient must have current in mouth when attends. • Check the log to see how the teeth are progressing. • Check for signs of bruxism on old aligners. • Check for spacing between teeth and aligner. • Carry out further IPR if necessary.

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Possible problems

• Losing aligners – get the patient to wear the previous aligner whilst the lab re-print the lost one…you may need to charge.

• Broken aligners – try to find cause. If accidental, treat like lost aligner… if due to bruxism, should see signs at review, may affect your retention protocol… can incorporate SCi technology.

• Next aligner not fitting after 2 weeks – this may mean current aligner has not finished working. Advise patient to wear for another week and try again. If still not able to advance, check for reasons why teeth are not moving, e.g. not enough IPR or teeth locked in contact.

Possible problems

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Possible problems

• Patients moving on too quickly. This is not favourable as forcing the teeth to move too quickly does not allow adequate time for the bone and periodontal ligament to remodel. It will also distort the aligner without moving the teeth. Make sure patients do not “bite” the aligner in, instead, apply gentle pressure with fingers on either side.

• Getting to the end, but teeth still not quite right – “refinement”. Multiple reasons as to why this may happen; explain to patient that a few more aligners will be needed, re-imp and discuss options with lab.

Possible problems

Relapse – if teeth begin to relapse months after the treatment has finished, this is usually a problem with retention.

1. Ensure patient is following the retention protocol properly. 2. Consider fixed retention if removable is not sufficient… 3. Consider double wire fixed retention if more severe movements have occurred. 4. Using previous aligners to re-align?

Not sure this works well as the aligners lose their rigidity after being worn, so best to re-imp and send to lab for assessment and slight tweak if spotted early.

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Stages of treatment

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End of treatment retention

• Removable Retention: • Essix Retainer • Essix retainer with SCi • Hawley • Begg

• Fixed Retention • Direct placement • Indirect placement with jig

• Keep your options open and consent the patient for both at the start of treatment.

End of treatment retention - removable

• Essix retainer • Essix retainer with SCi • Hawley retainer • Begg retainer • DURATAIN

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End of treatment retention - fixed

• Direct placement • Indirect placement with jig

End of treatment retention

• With aesthetic orthodontics, retention is for life - not just for Christmas!

• Patients must be prepared for life-time retention at the outset of treatment.

• If having fixed retention, I would still recommend removable retainer over the top for minimum of 6 months every night, and few times a week thereafter.

• If removable retainer from the start, I recommend every night forever! But minimum 6 months and then can try every other night.

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End of treatment retention

• In some cases, especially if the movements have been more severe, full time retention is needed straight away. If this is a problem, consider fixed retention.

• If the removable retainer ever feels tight, my advice is to wear it daily until it feels passive again.

• Retention disclaimer form – contains all the retainer advice. Patient will sign it and you also keep a copy.

How long does the production process take?

• 10-day turnaround between sending the impressions to the lab and receiving the treatment plan and pre-aligners.

• 10-day turnaround to receive the complete set of aligners after approval given to the lab.

• 10-day turnaround to receive the retainers, but can be 48 hours if express service used.

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How much does Smilelign cost?

Pay As You Go

Fee setting

• Consultation and diagnostics - initial consultation, ortho assessment, imps, X-rays, photos, pre-aligners.

• Bands of treatment: • Cosmetic = up to 3 aligners. • Mild = 4-6 aligners. • Moderate = 7-9 aligners. • Severe = 10+ aligners.

• Offer incentives and gifts – free whitening, free cleaning aids, referral gift.

• Include retention in the initial price: • 2 sets of removable • Fixed + removable

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Smilelign – case study

Before Treatment After Treatment

Smilelign – case study

Before Treatment After Treatment

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9 uppers, 6 refinement – mid treatment

Before Treatment After Treatment

9 uppers, 6 refinement – mid treatment

Before Treatment After Treatment

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8 uppers, 13 lowers

Before Treatment After Treatment

Bleaching & contouring

After Smilelign After flipper After bonding

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Happy patient!

Before Smilelign Final result

6 uppers, 6 lowers and contouring

Before Treatment After Treatment

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6 uppers, 6 lowers and contouring

Before Treatment After Treatment

5 uppers, 7 lowers & refinement

Before Treatment After Treatment

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5 uppers, 7 lowers & refinement

Before Treatment After Treatment

6 uppers

Before Treatment After Treatment

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6 uppers, 5 lowers & 4 refinement

Before Treatment After Treatment

6 uppers, 5 lowers & 4 refinement

Before Treatment After Treatment

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6 uppers, 5 lowers & 4 refinement

Before Treatment After Treatment

9 uppers

Before Treatment After Treatment

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11 uppers, 4 mid-treatment refinement

Before Treatment After Treatment

At aligner 8

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6 lowers

Before Treatment After Treatment

8 uppers, 3 refinement – mid treatment

Before Treatment After Treatment

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4 uppers, 9 lowers & 6 refinement

Before Treatment After Treatment

4 uppers, 9 lowers & 6 refinement

Before Treatment After Treatment

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Why get involved?

• Patients want straight teeth. • No additional ‘specialist’ training required. • Support from an experienced lab with no upfront fees. • Additional revenue: • Increase turnover • Attract new patients from word of mouth • Focus for PR. • Additional services for your practice. • Job satisfaction.

The future…

• Smilelign website – testimonial offer. • Integration with other companies – pretty much all IO scanners • Stability of S4S and Smilelign.

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Questions?

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Smilelign: marketing

• Do a case – build confidence

• Communicate to staff

• Communicate to your current patient base • New offering • Part of regular communications

• Online presence • Consumers are online – 65% online research • 46% research health & beauty online

Need Research Buy Confidence? Security. Privacy. Trust. From YOU

To get you started

• Marketing packs: • Patient leaflets • Posters • Data stick • Digital assets (on email) • Free Smilelign treatment plan

• Feedback forms • E-Newsletter – receive the latest news & offers from Smilelign • Find a Provider – opt in to be listed as a Smilelign provider.

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Support

• Skilled technicians on the end of the phone

• Marketing team available to assist: • Practice visits • Personalised materials

• Social media activity • Shareable content • Before & after pics • Testimonials • Blogs – lifestyle and product related

• Smilelign Reward Scheme – Progress through the levels to earn discounts and exclusive benefits.

NEW! Smilelign Patient App

• Free to download on Apple or Android

• Allows patients to track their progress

• Prompts patients when they are due to change their aligners

• Encourages them to share their Smilelign journey on social media

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NEW! Smilelign Reward Scheme

Already achieved

Questions? Please remember to complete your feedback forms, and collect your ECPD certificate.

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Thank you.

Please remember to complete our feedback form – we really do value your feedback.