SmileFast: The predictable short-term cosmetic orthodontic treatment

adult | ORTHO
PART FOUR
IN A SERIES
SmileFast: The predictable short-term
cosmetic orthodontic treatment
Elite training, elite technology, elite support!
By Geoffrey Hall, BDSc (Melb), Cert.Orth (Penn) and
Dr Derek Mahony, BDS (Syd), MDS (Lond)
S
mileFast is a short-term cosmetic
orthodontic solution suitable for
the majority of adult patients
who present with crowded or
spaced anterior teeth.
Traditionally, the majority of adult
patients have refused conventional longterm or ideal orthodontic therapy for
many reasons. The main barriers for adult
orthodontic treatment acceptance are
cost, appearance and time. In addition to
this, many adults are reluctant to undergo
dental extractions or orthognathic surgery.
Most of these adults are only concerned
about their anterior aesthetics.
SmileFast is a short-term cosmetic
orthodontic solution which involves the
use of clear braces and tooth-coloured
archwires to be able to transform aesthetic
smiles usually within six to nine months.
It is an innovative shift in orthodontic
treatment philosophy which can greatly
benefit dentists and their adult patients
as it offers enormous advantages over
other systems.
Figures 1 to 8 show examples of
patients and treatment times treated with
Smilefast technique.
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In a study performed in our practice over
a three-year period, we have been offering
every adult patient (if eligible) three different treatment options. Firstly, we always
offer the ideal treatment plan. This usually
involves upper and lower fixed braces for
24 months in conjunction with elastic wear
and if necessary, extractions and/or orthognathic surgery. If they are a candidate for
SmileFast cosmetic orthodontic alignment,
which 80% of our adult patients are, I offer
SmileFast as a second option and explain
to them I am purely aligning the teeth
to improve the cosmetic result and not
affecting the bite or occlusal relationship.
Patients are informed that this approach
will take approximately six to nine months
and usually involves a non-extraction
treatment plan or in the worst scenario,
a lower incisor extraction. Finally, I also
offer every adult patient - if they are an eligible candidate - aligner therapy. I explain
to them aligner therapy will require attachments, IPR (Interproximal Reduction) and
usually elastics, requiring 18 months to 2
and a half years of treatment.
The results of our survey have found
90% of our adult patients who undergo
any orthodontic therapy in our practice
will choose the SmileFast approach over
conventional/traditional comprehensive
orthodontic care or aligner therapy, proving
the main objection/barrier to orthodontic
treatment, apart from orthognathic surgery
or extractions, is the time in braces. We
believe there is a psychological barrier with
patients. If we can finish the orthodontic
treatment within 12 months, preferably six
to nine months, adults feel very comfortable
with proceeding with orthodontic alignment. Most of our SmileFast cases take
approximately six to nine months to obtain
an excellent cosmetic orthodontic outcome.
More patients are becoming frustrated with the outcomes with aligner
therapy as there are a variety of difficult
to achieve tooth movements so treatment
can be unpredictable, unless treated by
an experienced and knowledgeable clinicians. Patient cooperation is paramount
to achieve a satisfactory result with any
type of aligner therapy. SmileFast braces
allow dentists to take far better control of
these cases and ultimately provide a more
attractive and optimal aesthetic outcome
in a very short period of time.
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1a. Initial
1b. 9 Months
2a. Initial
2b. 8 Months
3a. Initial
3b. 9 Months
4a. Initial
4b. 7 Months
5a. Initial
5b. 10 Months
6a. Initial
6b. 6 Months
7a. Initial
7b. 7 Months
8a. Initial
8b. 8 Months
Figures 1-8. Examples of patients who have been treated with the SmileFast approach with shortened treatment times.
The treatment aim of SmileFast is to
dramatically improve the appearance of
their smile, without altering their occlusal
scheme. Usually the following items are
not addressed when treating patients with
any type of short-term orthodontics: Class
II or Class III malocclusions, severe openbites, mid-line discrepancies and bi-lateral
posterior cross-bites.
The concerns addressed by SmileFast
are levelling and alignment of the anterior teeth, correcting anterior cross-bites,
closing most spaces, rounding out the
upper and lower arches, treating minor
dental open-bites, improving deep dental
bites and levelling the gingival margins.
The overall goal of treatment is to transform a smile from being asymmetrical to
one which is balanced and harmonious.
Symmetry within the arch, gums and
incisal edges is paramount in creating an
attractive smile.
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What makes SmileFast unique?
I
n Part 1 of this series - Cosmetic
orthodontics: navigating the world of
superlative driven solutions (May/June
2014) - eight areas were identified as to how
to assess each of the short-term orthodontic
systems which are presently available. We
would like to utilise these areas to discuss
the unique quality of the SmileFast system.
1. Training
S
mileFast has been developed by a
Specialist Orthodontist who has been
involved in teaching general practitioners
for over 20 years, ensuring sound orthodontic principles, CORRECT simple
orthodontic diagnosis and the most efficient mechanics. It has been designed for
the doctor to treat ONLY those patients
of which he or she will achieve consistent
quality outcomes. The goal is minimal
treatment time, minimal doctor chairside
time, maximum profitability and most
importantly, happy patients.
SmileFast has now trained over 400
dentists and auxiliaries with the SmileFast Pro course and SmileFast Advanced
course having received rave reviews.
Over 95% have rated the course 9 out
of 10 or higher for quality and learning
content. i.e., all lecture slides, USB stick
(which contains PowerPoint presentations, marketing information, clinical
videos, modifiable forms/documents etc),
a folder with hard copies of patient forms,
brochures and other useful material. Also,
the help desk on the unique portal has
enormous amounts of clinical and practice
material which is updated regularly. Doctors comment “the knowledge they obtain
from the SmileFast course gives them the
confidence to treat their own patients”.
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Figure 9. Malocclusion in a digital world.
Figure 10. Ideal alignment with ideal bracket placement
in virtual/digital world.
3. Lab/Doctor/Patient
communication
2. Treatment support
S
mileFast has a unique online webbased portal which allows easy case
submission by the doctor and total control
of production. The portal also provides a
total support system for the doctor case by
case, with the ability to download progress
photographs at each visit and ask questions about the case. Practitioner questions
are answered by fully trained practitioners
and confirmed by a group of Specialist
Orthodontists, ensuring that doctors will
learn very quickly as their skill level
accelerates. In addition, the portal allows
the doctor to load cases purely for treatment assessment and identify whether that
patient is suitable for SmileFast treatment.
There is no software to be purchased
as the on-line portal is assessable on any
Windows-based computer or a Mac running in a windows environment.
78 Australasian Dental Practice
Figure 11. Brackets transferred to maloccluded position
showing position of brackets that will ultimately
produce ideal alignment.
S
mileFast utilises a 3D, web-based
Case Viewer to show the dentist
and patient the anticipated orthodontic
outcome and how this outcome can be
technically achieved. Showing a before
and after view - before you commence
treatment - creates clear, unequivocal and
informed patient consent. This web-based
viewer is also an excellent tool to communicate with patients and ensure they know
the anticipated orthodontic result. Being
online, the Doctor has instant access to the
Case Viewer.
Seeing the technical setup in 3D and
understanding how the change will occur
and to what extent it will occur, is an
incredibly powerful tool, as seeing how
each new case will evolve builds and
extends a Doctor’s knowledge base.
For example, patients can see if there
will be an overjet left in their particular
case, as you may not be correcting a Class
II Buccal relationship as one would do in
a traditional comprehensive orthodontic
treatment plan.
4. Ease of submitting cases
T
he SmileFast unique online webbased portal allows easy case
submission. The doctor initially loads
all the patient details - including photographs and x-rays – thereby enabling
the doctor to access interactive treatment plan comments and communicate
quickly with the laboratory and the
orthodontic mentor.
The portal is so easy to use, staff can be
trained to upload all the necessary photographs and x-rays to save the doctor time
in their busy practice.
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Figure 12. Indirect bonding trays with brackets using a digital computerised system
which is a key to dentists easily mastering the orthodontic bracket placement approach.
5. The learning experience
U
ploading progressive photos during
treatment doubles as a learning and
communication exercise with the SmileFast teacher/mentor. This allows the
mentor to discuss with the doctor where
and how the case could be improved, using
sound orthodontic principles that underpin
SmileFast’s treatment mechanics.
The unique portal creates a comprehensive online record for you to refer to
at any time, including billing and every
comment or question/answer from the
orthodontic mentor.
In addition, the portal has a help desk
with numerous videos and information to
extend the doctor’s knowledge of orthodontic treatment.
6. Indirect bonding
T
he key to well-aligned orthodontic
cases is the position of orthodontic
brackets. A good training program will
teach doctors the correct way to place
orthodontic brackets, but even after 20
years of hands on experience, this is
the most difficult aspect of orthodontics. Incorrect bracket placement creates
multiple problems. If left in the wrong
place, treatment will not proceed to plan
unless the bracket is removed and correctly placed. Accordingly the patient
will need to spend more time in the chair
and longer time in braces to achieve the
desired result. The Doctor’s profitably
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on that case drops accordingly. A digital
indirect bonding solution is, without
doubt, the most efficient and accurate
way to place orthodontic brackets in the
correct position.
SmileFast utilises a unique digital indirect bonding system where the digital
setup is performed via the computer. This
digital setup and bracket positioning in
the virtual world is then sent to the doctor
for approval or revision. Once the doctor
approves the anticipated alignment of
the teeth, the case is submitted and the
indirect bonding trays, with brackets, are
custom fabricated for each case, guaranteeing ideal bracket placement.
As I mentioned in the initial article, the
big question is who places the orthodontic
brackets. Most systems utilise dental technicians to manually place orthodontic
brackets. Doctors can choose to place
them manually themselves, but I cannot
emphasise enough, even experienced clinicians cannot place orthodontic brackets
perfectly each and every time. It is impossible to train anyone to deliver perfection
using manual bracket placement techniques.
This digital setup is a wonderful communication and marketing tool for
patients. They can see the anticipated
result of the treatment, similar to a Clincheck from Invisalign. This increases
patient conversion rates and one of the
reasons more and more patients are
choosing SmileFast, over alternative cosmetic orthodontic treatments.
Now if we suggested you could purchase a new aligner system for $500,
but you have no access to see the visual
final outcome or make any changes to the
system, would you consider purchasing?
The answer would almost certainly be
NO. And if we suggested you buy a new
crown for $50, one that was not fabricated
on any model, nor could you see it in the
virtual world, but that it would just arrive
for you to fit, would you be willing to use
this? The answer I believe is still NO.
The point we make with the example of a
cheap aligner system and a cheap crown is
that a manual indirect bonding system has
the same principles. You receive brackets
in a tray without any idea of the final
result and you have minimal control of
the final outcome.
Any short-term cosmetic orthodontic
system utilising braces that relies on a
dental technician or the Doctor placing
the brackets, is asking for trouble. It is the
short cut to inaccurate bracket placement
and significant inconsistencies in treatment. Failure to precisely locate brackets
requires the dentist to undertake revisions
to correct the earlier mistakes and this in
turn means more chairside doctor time,
longer treatment time for the patient and
more often than not, patient outcomes that
are a less than ideal.
7. Cost
W
e are all aware one of the barriers
to conventional orthodontic treatment for our patients is cost. SmileFast’s
aim is to keep the cost to an affordable
amount but still maintain the highest
quality. Many competing systems use
cheap, poor quality composite/plastic
brackets which discolour, break and are
very ineffective in orthodontic movement. SmileFast uses high quality, clear
porcelain brackets and aesthetic tooth
coloured orthodontic archwires to provide
a discreet aesthetic appearance. With the
digital technology of indirect bonding
and the systems which are taught in the
SmileFast approach, total doctor chairside
time for a case is approximately five to
six hours, with most of this able to be delegated to dental hygienists/therapists. As
such, many dentists are charging patients
approximately $5,000 for SmileFast treatment and still maintaining an excellent
rate of close to $1,000 per hour.
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The SmileFast future
S
mileFast is in the process of developing
a program for lingual orthodontics
and will be releasing several different
aligner options in 2015 including the
Magic Aligner (which combines aligners
with brackets) and also a unique aligner
finishing system which is incorporated
with the initial digital setup. It is believed
that the aligner finishing system will
reduce treatment time in fixed braces significantly and this will be an even more
powerful tool for adults to undergo shortterm cosmetic alignment.
In addition, 2015 will also see the beginning of one-on-one, orthodontist-supervised
patient treatments. Doctors will bring their
SmileFast patients to a venue and have their
treatment supervised by a Specialist Orthodontist to help develop their technique
and clinical procedures. Doctors can learn
the correct and most efficient way to treat
their patients to achieve the highest quality
results in the shortest period of time.
Figure 13. Indirect bonding trays inserted.
Acknowledgement
In Part 2 of this series on the Inman
aligner, Dr Mahony would like to thank
Dr Tif Qureshi for his contribution and
case presentation within this article.
About the authors
Figure 14. Braces and wires placed in a total chairside time of 45 minutes.
With regards to the overall cost, once
you compare this to normal high-end
dentistry, i.e. crown and bridge work,
most dentists would be charging approximately $1,500 to $2,000 for a crown.
Usually 25% of the total fee charged
to the patient is the laboratory fee (somewhere between $400 and $500). This
provides a reasonable guideline for shortterm orthodontics. So assuming you will
be charging a patient approximately
$6,000 for a case, then a $1,500 lab fee
(which would include the digital setup,
the indirect bonding trays with brackets,
a selection of archwires, elastics, ligatures
and other miscellaneous products required
for that particular case and retainers)
would be appropriate for the return
that you would expect for this type of
high-end treatment.
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8. Scope and indications
M
any short-term orthodontic treatment
systems only correct the alignment
of anterior teeth, excluding rotation of
premolars. With the SmileFast technique,
the aim is to correct posterior rotations,
because this can create significant space to
accommodate crowded anterior teeth. The
SmileFast approach is proven to be very
efficient and effective in extrusion of teeth,
intrusion of teeth, tipping of teeth and some
minor translatory movement. The key to the
efficient tooth movement is the use of light
orthodontic forces, in conjunction with
excellent bracket placement, to achieve the
desired tooth movement. SmileFast utilises
light forces with exceptionally accurate
bracket placement through the digital indirect bonding approach.
Dr Geoffrey Hall is a specialist orthodontist based in Melbourne, Victoria and
inventor of the SmileFast cosmetic orthodontic system. He graduated from the
University of Melbourne’s in 1983 and
subsequently completed post-graduate
studies in Orthodontics at the University of Pennsylvania. Dr Hall has been
on the teaching staff at both the University of Melbourne and the University of
Pennsylvania. He has an extreme passion for orthodontics and specialises in
early treatment, braces, lingual braces
and interdisciplinary treatment, including
orthognathic surgical cases. Dr Hall
lectures to dental professionals nationally and internationally and has written
many articles and more recently was a
co-author in a lingual orthodontics book.
Dr Derek Mahony is a Diplomate of the
International Board of Orthodontics and
Visiting Faculty at the City of London
Dental School.
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