Dental Economics: Thank you Dr. Swain for taking the time to answer some questions about the Six Month Smiles Short-Term Orthodontic System. There is a tremendous amount of buzz around Six Month Smiles and general dentists doing cosmetic orthodontics. Since most GPs typically don’t do fixed orthodontics and the idea of “straight teeth in six months” seems counterintuitive, I’m excited to give you an opportunity to answer some questions. I believe that adult orthodontics is an important topic that has not been sufficiently focused on by our profession. I’d like to learn more about the Six Month Smiles and ask some questions that I’m sure many of our colleagues have about the system.
Dr. Swain: I agree with you that the area of adult orthodontics has been one that our profession has not adequately focused on. Back in 2003, I was working as an associate dentist and was amazed by how many adult patients with crooked teeth were asking me if there had been recent advancements in orthodontics. These patients were very unhappy with the appearance of their teeth and were stuck with no options that were acceptable to them. Hardly any of these patients would accept a referral for conventional orthodontic treatment because of the years involved and the appearance of metal braces. I took proven orthodontic methods, tweaked them slightly, and started developing a more time- and lifestyle-sensitive approach to providing a solution for these adult patients and to grow our practice at the same time. This became the Six Month Smiles Short-Term Orthodontic System. I wasn’t the first dentist to offer a more rapid orthodontic option to patients. What I did was to develop a training protocol and unique materials that made the process easy and accessible for GPs.
DE: Can you describe the system and how it is possible to accomplish orthodontic treatment in six months?
Dr. Ryan Swain: The best way for me to explain the system and how it works is to say that it is like clear aligner systems, but with some significant benefits. The system involves the use of specific clear braces and tooth-colored wires to provide adults with straight teeth in an average of just six months. The scope of treatment and the patient population is very similar to that associated with aligner systems like Invisalign®. And like aligners, Six Month Smiles is not an exact replacement for comprehensive orthodontics. The treatment goals are more cosmetically focused. For most cases, we’re not changing angle class or moving the roots of the teeth substantially. This shift in treatment goals, along with the unique brackets and wires, are what make the short treatment times possible. The prescription built into the Six Month Smiles brackets is specific for achieving short-term orthodontic treatment goals.
DE: When I first heard about Six Month Smiles, the first question that came to mind was “What about root resorption?” I’m sure you’ve heard this question before from other dentists.
Dr. Swain: Yes. Most of us learn very little practical orthodontic information in dental school. We are essentially taught how to diagnose a malocclusion and then refer the patient to a specialist for comprehensive treatment. One other thing that we are told is that if teeth are moved too fast, the roots of the teeth can shrink. Root resorption is a real phenomenon that we have all seen on X-rays. However, there is no increased risk of root resorption with Six Month Smiles. In fact, there is less opportunity for root resorption because the forces placed on the teeth are extremely light and there is simply less treatment time for resorption to occur. The short treatment times are possible because of the cosmetically focused treatment goals and the unique brackets and wires.
DE: You mentioned that Six Month Smiles is similar to aligners in some ways. Can you compare and contrast them?
Dr. Swain: Aligners have provided an easy way for general dentists to start offering orthodontics in their practices and the idea of achieving straight teeth without metal braces is an attractive proposition for patients. Unfortunately, aligners are not the panacea that we all hoped they would be. It is incredibly hard to control tooth movement with aligners. Certain movements like rotations and extrusions can be very unpredictable, if not impossible. This is frustrating for dentists and patients because cases tend to drag on and it is very difficult to predict treatment times. Aligner costs are high too. Rather than aligners, the Six Month Smiles System involves clear brackets and wires that allow for reliable and efficient tooth movement. The cases are set up in the Six Month Smiles case processing facility by highly experienced bracket specialists. Based on the desired outcome, the brackets are pre-positioned in custom bonding trays. A general dentist with no ortho experience can learn how to use the system and easily bond brackets. The wires have shape memory and work in conjunction with the brackets to gently move the teeth into their final position. The clinician sees the patient every four weeks and guides the process along, working through a three-wire sequence and making any adjustments as needed. Additionally, the costs associated with Six Month Smiles is about one third that of aligners.
Before (left) This case was treated in just six months with the Six Month Smiles Short-Term Orthodontic System. The system involves unique clear braces and is specifically for general dentists. Treatment times generally range from four to nine months.
DE: How can a dentist with no orthodontic experience begin selecting the appropriate cases and using the system to treat adult patients?
Dr. Swain: The Short-Term Orthodontic training process happens at the two-day hands-on seminars that are offered all over the USA and in Europe and China. This involves a very principled approach that is focused and systemized. It is very important that dentists learn the principles and mechanics of the system. Proper case selection is crucial and this centers on identifying the patient’s chief cosmetic concerns. With good awareness of what is possible with the system and a keen understanding of what the patient’s desires are, case selection becomes relatively easy after proper training. Most adults with crooked teeth are candidates for short-term orthodontic treatment.
DE: What about occlusion? If the goal is not always to provide a Class 1 occlusion, what are the occlusal and functional goals?
Dr. Swain: That’s an important question. The goal of short-term orthodontics, similar to most aligner cases, is to improve aspects of the occlusion and to provide an occlusal scheme that is more favorable. Unlike cosmetic treatment that is done with veneers, with Six Month Smiles we can easily improve deep bites, correct minor crossbites and relieve envelopes of mandibular function that are constricted. We can also very easily move the positions of the gingival margins and create much needed symmetry and balance within the smile. So, unlike comprehensive orthodontics that is aiming for a text-book Class 1 finish, we’re aiming to provide a great cosmetic change while improving aspects of the occlusion. If a patient is willing to undergo comprehensive treatment, I steer them in that direction because with years of treatment, we can provide the optimum esthetic result. But, since the vast majority of adults will not accept conventional treatment, Six Month Smiles provides for a much needed and conservative alternative.
DE: Is orthodontic retention any different with the Six Month Smiles protocol?
Dr. Swain: No. Regardless of how teeth are moved, retention is no different. Whether the teeth are moved with aligners, braces, or a Hawley appliance, retention should be taken very seriously. It’s one thing to move the teeth to a new position; it’s another thing to keep them there. I don’t think a case can be considered a success if the teeth are not kept straight. And regardless of how long the active phase of orthodontic treatment is, retention is the same. Particularly for adults who are done with growth and development, lifetime retention is the best way to ensure that the new smile is preserved. This can be accomplished via fixed or removable retainers (or a combination of both) but in my experience, the patient needs to be educated effectively so they are motivated to follow the protocol.
DE: Can you tell me more about Six Month Smiles? How many Six Month Smiles Providers are there and what have their experiences been? Also, how long has the system been around?
Dr. Swain: Six Month Smiles has been around since 2007 and there are almost 3,000 providers in about 25 countries. There have been about 20,000 patients treated with Six Month Smiles. The average dentist that gets involved with Six Month Smiles has little or no ortho experience, although many are frustrated aligner users. We regularly hear all kinds of great stories from our providers. Most of the stories revolve around particular cases in which the patient’s life was affected significantly and how rewarding that was for them. They are continually amazed by how easy the system is to learn and use. Most of these dentists never thought they would get into orthodontics but Six Month Smiles gave them a practical tool that they are using to help patients who otherwise would have been stuck. It’s a true win-win for the dentist and the patient. That is what I set out to do in 2003 – to create a commonsense and pragmatic orthodontic approach that allowed GPs to help adult patients. The way that it has caught on has been truly amazing, and the results speak for themselves.
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