Before Treatment Begins
This is an information leaflet for patients who are considering a course of orthodontic treatment. It will give you an idea of what to expect during treatment, and what will be expected of you. It also points out some risks and problems that may occur before, during or after treatment. This surgery is not a Specialist Orthodontist practice and your dentist Dr Krina Patel is not a Specialist Orthodontist, but has been trained to provide clear aligners.
We will devise a treatment plan just for you, involving procedures appropriate for your individual situation and goals. If there are hazards or limitations specific to your treatment, we will explain them to you during your consultation appointment.
Orthodontic treatment is not an exact science. Like any treatment of the body, much of its success depends on the understanding and co-operation of patients. Please read this leaflet carefully, and ask your dentist to explain anything you do not understand. It will clarify what is expected of you as a patient to achieve the best results. Keep in mind that with orthodontic treatment, like other dental procedures may take longer than expected as it depends on the individual person.
When treatment begins, you will be asked to sign an informed consent form on your own behalf, verifying that you understand all issues associated with orthodontic treatment.
What are Nimrodental Clear Aligners?
The Nimrodental Clear Aligner system is a popular form of orthodontic treatment designed to straighten teeth relatively simply and in small increments. Usually, a number of aligners will be required to achieve your ideal smile. The number necessary is reliant upon the complexity of your case, straight forward cases can be completed with only two or three aligners but can range from 1 to 20 aligners.
What are the benefits of using Clear Aligners?
Clear Aligners are almost invisible, thin and very easy to wear, an attractive alternative to wired braces. Speech is not impeded during treatment and you will be able to brush and floss your teeth normally. They are ideal for adults who wish to solve simple relapses and those who do not wish to use veneers or crowns. Simply, Clear Aligners are for adults who covet an improved smile.
What is the process of using Clear Aligners?
Once you and your dentist have discussed treatment with Clear Aligners, impressions will be taken of your teeth and sent to the lab along with a lab sheet outlining the proposed treatment. Once received, the models are scanned and a sequence of plastic aligners are produced on printed models of the final alignment.
May I wear Clear Aligners straight away?
In certain cases, space needs to be created before treatment with clear aligners. This is accomplished by using separate arch expanders. Once the required space has been achieved, the aligners can then be manufactured and worn. During treatment, space may also need to be created between the teeth by carrying out Interproximal Reduction (IPR). This technique involves mechanically removing some of the outer tooth surface, called enamel. Your dentist should inform you before treatment if expansion or IPR are necessary.
How long do I wear each aligner for?
Each aligner should be worn for approximately two weeks, at the direction of your dentist. After this period the aligner should become loose, at which point it will be time for the next aligner. The Nimrodental Clear Aligners are sequentially numbered so you and your dentist will know which aligner in the package needs to be fitted next.
Steps in Formulating a Treatment Plan
Orthodontic Examination and Orthodontic Records: The first step in determining your treatment plan is learning as much about your orthodontic condition as possible during a consultation visit. This begins with an orthodontic examination, during which your teeth are inspected. Your dentist will then collect a complete set of orthodontic records, which may include impressions of your teeth, x-rays of your teeth and jaw joints, photographs, and your medical-dental history.
Planning and Consultation: After examining you and studying your orthodontic records, we will design a treatment plan for you. We will discuss with you any significant risks or limitations to your treatment and you will have an opportunity to discuss the points raised in this leaflet.
Dental Check-ups and Care: Before orthodontic treatment begins, it will be necessary to have a check-up and any necessary dental work. Once orthodontic therapy begins, you will be expected to continue to have regular 3 to 6 month check-ups and routine care. Routine dental care will help ensure the best possible results from your orthodontic therapy. This may include hygienist appointments prior, during and post treatment.
Your Co-operation is Essential: Generally speaking, excellent orthodontic treatment results can only be obtained with co-operative and informed patients and parents. Successful treatment is a team effort: patients, parents, staff and the dentist working together.
Initial Discomfort: When wearing clear aligners for the first time discomfort is likely to be experienced. This should pass after the first few days. Speech may also be affected for the first few days as well, which should pass with time as well as a feeling of excess saliva in the mouth.
Oral hygiene: Decalcification (permanent markings), decay, or gum disease can occur if patients do not brush their teeth properly and thoroughly during treatment period. Excellent oral hygiene and plaque removal is a must. It is recommended to see the hygienist every 3-4 months throughout treatment. The cost per appointment is usually £51 but if you need more or less treatment this will be advised. If this has been recommended by your dentist please arrange these appointments at the beginning of your treatment with reception.
Decay: Never wear the aligners whilst eating or drinking as tooth decay is possible if the patient is not careful in when and how they consume sugary food and drinks whilst wearing the aligners. It also predisposes them to breakage and fractures.
Sugars, fizzy drinks and between meal snacks should be reduced as much as possible. Aligners do not cause cavities, but they do trap food particles and increase the likelihood of you developing cavities or decalcification (white) marks. Most patients are able to prevent these problems with a combination of a good healthy balanced diet, good tooth brushing habits and regular check ups with the dentist. You should brush your teeth immediately after eating, using the proper techniques for brushing with braces. If brushing right away is not possible, vigorously rinsing with several mouthfuls of water is helpful. Excellent oral hygiene and plaque removal are must.
Swollen Gums and Periodontal Problems: Your braces may touch or press on your gums in some areas of your mouth. This gum tissue may get sore and swollen if you do not brush well. Your gums and braces need to be brushed and cleaned thoroughly after eating to keep them healthy. Let your dentist know right away if you suspect you have sore gums. Periodontal disease may lead to receding gums and gradual loss of supporting bone for your teeth. Some people are more susceptible to the disease than others. The exact causes are unknown, but there are some well-established contributing factors, including unsatisfactory oral hygiene, accumulation of plaque and debris around teeth and gums, incorrect brushing and general health problems.
A non-vital or dead tooth is a possibility: A tooth that has been traumatized from a deep filling or even a minor blow can die over a long period of time with or without orthodontic treatment. An undetected non-vital tooth may flare up during orthodontic movement, requiring endodontic (root canal) treatment to maintain it. On rare occasions, teeth that have been previously traumatised have large fillings, or periodontal problems, may experience tooth discolouration and/or nerve degeneration during orthodontic treatment. In such cases, root canal treatment might be necessary to maintain the health of a tooth. Bleaching may also be recommended to restore a more natural tooth colour. The cost of this treatment will be discussed with your dentist and is NOT part of the fees quoted for your Teeth straightening procedure.
Root resorption: In some cases, the root ends of the teeth are shortened during treatment. This is called root resorption. Under healthy circumstances the shortened roots are no disadvantage. However, in the event of gum disease in later life the root resorption may reduce the longevity of the affected teeth. It should be noted that not all root resorption arises from orthodontic treatment; it can also be caused by trauma, cuts, impaction, endocrine disorders and idiopathic reasons. Some patients are predisposed to this occurring, while most are not. Slight changes in root length are usually insignificant, but occasionally with severe changes, the longevity of the teeth involved may be jeopardised. The incident may increase with extended orthodontic treatment. Your co-operation during treatment is very important in the prevention of root resorption.
Ankylosed Teeth: In some instances, teeth will not move because they are attached to the jaw-bone (ankylosed). When a tooth is ankylosed, adjacent teeth may be forced to move, which may affect your bite. An ankylosed tooth may require surgery for movement into place or removal. It is not always apparent until after you have attempted treatment.
Gum tissues: The bone-gum relationship around teeth is always dependent upon whether there is enough bone to support the gum tissue properly. Many times when very crowded teeth are straightened there is a lack of bone and supporting gum tissues surrounding the teeth. Therefore, the gum tissue contour and support may not be adequate and require periodontal intervention. This is not a common issue, but must be mentioned for completeness.
Treatment time: The total time for treatment can be delayed beyond our estimate. Lack of co-operation, broken appliances and missed appointments are all important factors that could lengthen treatment time and affect the quality of the result. We will plan to have braces on and off as quickly as possible. Most cases will be completed between 3-12 months. In difficult or stubborn teeth movements, finishing may take longer. When you miss appointments and are not seen regularly by us, treatment times will increase.
X-rays/CBCT and Photographs: X-rays or CBCT scans are taken at the beginning and end of treatments as required. X-rays/CBCT assess bone morphology and levels and also root parallelism. Photographs will be taken at all stages of the treatment. This is very important in the progression of your case. Photos will be the property of the dentist.
Bone level: If your bone level is under 20%-25% loss (discussed with your dentist) long-term stability will be much more likely. If your bone had been lost prior to the starting the treatment, aligners may still be used, however long term stability cannot be guaranteed. You will therefore not be applicable for the lifetime satisfaction guarantee. This will be discussed if it applies to you.
TMJ: There is a risk that problems may occur in the temporomandibular joints (TMJ). Although this is rare, it is a possibility. Tooth alignment or bite correction sometimes can improve tooth related causes of TMJ pain, but not in all cases. Tension appears to play a role in the frequency and severity of joint pains, and there are many other causes of TMJ dysfunction. During the orthodontic process (teeth straightening) you may experience some discomfort, tenderness, crepitus (noise) popping clicking, headaches, earaches and pain from your jaw joint. These symptoms are usually temporary and will improve with time. You MUST inform you dentist of such symptoms. There is always the risk when moving teeth that conditions may develop and this needs to be consented for.
Some of the most common causes of TM disorders (TMD) are chronic muscle tension associated with clenching or gnashing of the teeth, or habits such as gum chewing or stressed jaw posture at work or during sleep. The symptoms may originate with a joint disease, such as arthritis or result after a previous trauma, such as a blow to the face or sometimes from a whiplash type injury. The severity of the symptoms may be affected by tension, mood, and emotional distress. Neck and shoulder muscle tension may be a major contributor by referring pain and tightness to the jaws and face. Severity of symptoms may be exaggerated by faulty function of the pain suppression system at various levels of the nervous system.
In the past, it was believed that an imperfect bite (dental malocclusion) or a mal-positioned lower jaw was the cause of TMD problems. However, occlusion as a case of TMD has not been well demonstrated, despite many investigations seeking to test this relationship. ‘Bite problems’ that occur with TMD are most often the result of the problem rather than the cause of the problems. TMD are musculoskeletal problems similar to aches and pains on other joints of the body. A TMD is most often treated as a medical problem and not necessarily a dental problem. Treatment may require specialised care from other health professionals such as a TMD specialist, physical therapist, and stress control specialist. These procedures are beyond the scope of the usual orthodontic treatment, and if they are indicated, additional costs may be incurred. Any TMD signs or symptoms should be reported promptly to your dentist.
Very unusual occurrences: Breakage of the aligners
Tooth Attrition and Enamel Loss: The biting surfaces of adult teeth are frequently worn down by tooth grinding or jaw clenching behaviour. Tooth interferences during jaw movements can also contribute to tooth wear. As your teeth move during orthodontic treatment, your bite will steadily change and new interferences may arise. Halting enamel loss is not easy. It is difficult for orthodontics alone to establish a bite completely free from interference during jaw movement. Psychological stress or conditioned habits may be the cause of grinding or clenching. The biting surface of the teeth may need reshaping by special dental procedures. In some cases, an appliance to control the rate of enamel wear may be considered. Such procedures are beyond the scope of usual orthodontic therapy.
Termination of treatment: It is understood that treatment can be terminated for failure to cooperate, missing appointments, not wearing appliances, excessive breakage, failure to keep financial commitments, relocation, personal conflicts or for any other reason the doctor feels necessary. If termination is necessary, the patient will be given ample time to locate another dentist to continue treatment or the braces will be removed.
Expectations: The aim of treatment is to straighten your teeth in the least possible time frame in harmony with your dental health. Most cases take 3-12 months. It is very important YOU discuss your desires and wishes about treatment outcomes with your smile and teeth. Even though every effort is made to meet your expectations certain biological and anatomical variations may hinder the outcome with respect to time or final results. It is YOUR responsibility to discuss if your goals or desires change through treatment. We will endeavour to meet your goals and level of expectations, within realistic levels.
All orthodontic patients can expect improvement with their particular problem, but, in many cases, absolute perfection is impossible due to lack of muscle balance, tooth shapes and sizes and varying degrees of co-operation during treatment, along with heredity aspects that affects everyone’s specific treatment results. All symptoms experienced whilst wearing braces are individual.
Taking off braces and Retainers: Teeth have a tendency to return to their original position after orthodontic treatment. This is called relapse. Very severe problems have a higher tendency to relapse and the most common area for relapse is the lower front teeth. Braces will only be taken off when discussed with you and both parties are happy with the final results.
Once braces are removed two sets of retainers are made for the patient. A fixed retainer is offered to ALL patients. A fixed retainer will be strongly recommended to keep your teeth in an ideal position. We also recommend a plastic retainer to be made over these teeth to be worn as directed. The initial Fixed and clear aligner have been quoted for in you initial treatment plan. These have a 3 MONTH guarantee against breakage (not against accidental damage/loss). After this period if the fixed retainer requires replacement there will be a fee associated. The plastic retainers will wear and break over time and it is recommended to replace these over time which will again incur further costs.
Relapse Tendencies: ‘Relapse’ refers to the movement of the teeth back toward their original positions after your braces have been removed. Ideally, your teeth should remain stable after retention. However, teeth can move at any time, whether or not they have had orthodontic treatment. The most vulnerable teeth are those in the lower front. Periodontal disease, mouth breathing, and harmful tongue or oral habits can cause teeth to move.
For these reasons, and many others beyond the control of your dentist, it cannot be guaranteed that your teeth will remain in a perfect position for the rest of your life. Your teeth are unlikely to ‘relapse’ to their original position if you use your retainer properly; but if you do not, you may undo much or all of the progress you have made. Some patients must wear a retainer indefinitely to keep their teeth aligned.