I have found the align, bleach and bond approach provides the ability to reverse dental collapse and improve anterior guidance, which if left untreated can lead to future problems. Align, bleach and bond is much more than aesthetic treatment. It is also functional and preventive and can change the way we approach all patients, not only those requiring cosmetic treatment. Carrying out Dahl build-ups is also important. When the Dahl technique is properly applied, it can be one of the most powerful tools in dentistry.
Monitor, retain or treat?
I believe patients often agree to treatment even if they do not really understand the functional advantages. Would it be more helpful if patients who decided to have aesthetic and cosmetic dentistry really understood the functional and potential lifetime benefits of those treatments?
Developing a long-term relationship and communicating with patients keeps them informed about what could happen to their teeth over time. Understanding the occlusal and functional effects of continued tooth movement enables the patient to make an informed decision about intervention. I believe that it is crucial that we talk to patients, present the facts and avoid rushing into treatment with veneers and crowns.
It is important to explain the slow, minor positional and functional changes and educate the patient about what is happening in his or her mouth. I record the amount of dentine exposure and look very carefully at enamel chipping. I always explain that dentine is six to eight times softer than enamel and that it will stain more heavily.
Taking regular photographs of the patient is also important, even if no treatment is provided. Each time a patient presents, we can look at the images together to see the changes over time. I do not think dentists are taught or conditioned to take photographs often enough. I will also undertake a regular fremitus check, demonstrating the pressure of fremitus and helping the patient understand what it means to have a constricted envelope of function.
The key issue is that we explain that the change is gradual and progressive. We observe, we do not panic. We offer to monitor, retain or, of course, treat. Patients gain an appreciation that, over time, teeth keep moving, become more crowded, collide and discolour.
The following case highlights the treatment of a patient over 17 years. With simple orthodontics, direct edge bonding applied according to the Dahl principle and a little maintenance, the patient’s teeth were prevented from becoming worse at a relatively low cost.
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