Monthly Archives

April 2021

Straightening with clear aligners

By | Cosmetic | No Comments

Clear aligners versus bonded braces

Both clear aligners and bonded braces have their pros and cons and what suits you best will need to be assessed by an oral health professional. With clear aligners the major advantage is that they are nearly invisible, cleaning is far easier, movements are usually more gradual and may be less painful, you get to view your digital setup before and during treatment, and your records are saved digitally and can be accessed many years after you complete your treatment, even by other oral health professionals. Bonded braces, on the other hand, are usually cheaper, require less compliance (cannot be removed), and can achieve more difficult movements and correct larger bite discrepancies. Both should be able to achieve similar outcomes depending on the original orthodontic challenges.

Am I a good candidate for clear aligners?

To be suitable for orthodontic treatment patients need to have a well managed dental health, with any decay, faulty restorations, or gum disease addressed prior to starting treatment as these can be exacerbated if not corrected beforehand. Clear aligners are taken in and out of the mouth but need to be worn for a minimum of 22 hours a day – this means compliance is essential. If a patient does not follow this then they will not likely achieve the projected movements.

Mild to moderate crowding and bite problems can usually achieve good results. More complicated cases can be addressed with clear aligners though they may pose more challenges – teeth may lag and other gum problems could arise. Better quality aligner providers are still able to correct moderate to complicated cases, though not all, so your case will need to be closely assessed. Clear aligners are generally very good at straightening the front but not as successful when attempting large movements with back teeth, so your goals here will help determine whether to go ahead.

What’s the difference with aligner brands?

Lately, a lot.

There is a big range of what you can pay for clear aligners and this is a circumstance where you really get what you pay for. Leading aligner partners, like SmileStyler involve many more sets of eyes reviewing these cases that are dentally trained. Going through a dentist or orthodontist means you’ll be able to discuss your concerns, your oral health professional will scrutinise your smile closely and likely identify many issues you weren’t even aware of. They’ll also be watching for signs where straightening is causing unintended changes. Better providers will allow more revisions during treatment and enable your health professional more control in the setups. The more oral health professional involvement, the better your outcome will be.

More recently there are systems where you take impressions at home or in a studio that gets sent to a lab. You’ll view the simulation and will be told that a oral health professional signs off on it, but you’ll never meet them or be able to talk with them. These providers are not regulated by AHPRA (Australian Health Practitioner Regulation Agency) and therefore are exempt from a lot of health protection laws. This means if there are adverse outcomes as a result of your treatment they are not usually held accountable. In addition, the orthodontist or dentist they employ to sign off on these treatments are often not Australian or not trained to our standards, and usually only look at these plans very briefly, without any further monitoring. This essentially leaves your treatment in untrained hands. The treatment delivered is limited in what can be achieved as they are not able to employ techniques dentists and orthodontics do to allow additional spacing and predictability, and gum disease and recession is much more likely to occur here. Some of these changes may be irreversible.

How do I get started at Smile Design Dental?

To start your aligner journey with us we require a comprehensive examination and x-rays, which we recommend to have with your clean. Once your are deemed dentally fit and appear to be a good candidate for aligners, we will start with a new case setup. Photos and impressions will be taken and we will discuss what your treatment goals are. One to two weeks later you will receive a digital simulation of how your teeth will look at each aligner stage right until the end. You’ll be able to view different perspectives and compare to your original starting point. If you have any concerns we can alter the setup as you wish.

Our preferred aligner partner is SmileStyler, an all Australian aligner provider that gives us the advantage of talking with your simulation technicians directly. The waiting time is far reduced to some overseas providers and you have the confidence everything is managed to Australian standards. SmileStyler are different in that scans are made at each 6 aligner interval to check how closely your teeth are tracking. If things are a bit off we simply adjust for it in the next set of 6 aligners to keep you as on track as possible. This gives us a lot more room to alter things as needed and a much higher quality result. At the end if you’re not 100% satisfied, we simply take more impressions and issue a few more aligners to make sure we get you teeth to where you want them to be. With SmileStyler, you can expect a much better result than with other aligner providers.

Our preferred partner, SmileStyler, is an all Australian aligner provider, that works with our dentists in close conference to achieve desired treatment results. With regular scans every 6 aligners together we ensure we are achieving not just a better result, but your ideal result.
Clear aligners almost invisible to the untrained eye.
V5-Pro is an additional device that can be utilised to halve treatment time. This is bitten down on gently for 5 minutes daily, stimulating bone turnover allowing the movements to be taken up sooner. 2 weekly wear gets halved to just 1 week.
Hook and chewies are provided to allow easier removal and full seating of aligners when fitted.

These aligners are normally worn for 2 weeks at a time, 22 hours of the day, however using the V5Pro this can be sped up to 1 week for each aligner. The V5Pro is a device that you bite down on gently for five minutes a day that vibrates and stimulates the supporting bone. This allows the movements to be taken up faster. The number of aligners you wear will be determined by how much movement is required, so this will vary from person to person and you will have a better understanding after your initial digital setup. Mild cases are generally around 12 aligners, moderate to advanced cases will be closer to 30+.

Once completed you will need to wear retainers at night time to prevent relapse. These are very similar to the clear aligners, just a little sturdier. All the forces that made your teeth crooked in the first place are all still there, that means that without support those teeth will want to return to their original positions. That’s why a retainer is required to be worn, just at night, to fight those forces and keep those teeth in their beautiful straight position.

Then you can enjoy your smile like never before.

What is TMD (Temporomandibular Joint Disorder)?

By | Dental Pathology | One Comment

Temporomandibular disorder, or TMD, describes a range of issues arising from in and around the temporomandibular joint (TMJ). These involve: night-time grinding or clenching; tooth wear and cracks in teeth; clicking or pain when opening and closing the lower jaw; pain resulting from long periods of mouth opening; or limited capacity for mouth opening. The causes of these symptoms usually have many factors involved.

So where do we start? Firstly, your general dentist will assess your symptoms and possible causes of TMD, then will tailor your treatment accordingly.

The temporomandibular joints (TMJ) provide the pivot points for the lower jaw’s range of movement. This joint can suffer damage over time from disc displacement (clicking or locking), arthritic wear, or other pathological issues.
The masseters are the main muscles of mastication involved in chewing. If these become overworked they can become hypertrophic (enlarged), may become tender, and lead to further grinding and clenching.
Wear tends to occur on the chewing surfaces of teeth over time due to excessive grinding. The small lower incisors shows the most wear but wear will also be occurring on all the teeth. In severe cases, the wear can be quite significant and lead to shorter teeth and reducing the vertical dimension of your bite.
The necks of teeth can also suffer abfraction, which is wear that leads to concavities here and exposes dentine. The exposed dentine can be quite sensitive and since this part of the tooth is less dense, further wear or decay is likely to develop here.
A major muscle of mastication that stretches out laterally here is called the temporalis. If increased tension is experienced here, headaches are commonly experienced.
Those who suffer TMD may find that their jaws fatigue quickly after holding there mouths open for a short period of time. This is generally because of the overworked muscles of mastication that work in the opposite direction to close the jaw.
Congestion in the nasal sinuses may lead to increased mouth breathing and this can increase the likelihood of congestive sleep apnoea. It is important to search for any issues that be contributing to TMD when selecting a treatment protocol.

Causes of TMD

Congestive sleep apnoea: occurs as a result of your tongue rolling back in your mouth at night, blocking your airways. Grinding and clenching may occur as an attempt to wake yourself up at night. Specialised splints or C-PAP machines can be useful in treating this condition.

Crooked teeth have been occasionally associated with TMD, though usually when there are more significant bite problems. Teeth straightening, at times with jaw repositioning surgery, may help to reset your bite into a more harmonious position.

Anxiety, stress, and personality quirks may just lead some people to grind without any other clearly defined cause.

What are the treatment options?


If sleep apnoea and bite discrepancies don’t seem to play a large role we usually start with a splint. This is a clear plastic mouthguard you wear on your top teeth at night. These are specially fitted for your teeth so they don’t fall out easily and provide an even bite with a free range of movement. These will not stop your grinding or clenching, but it will help to reduce it and ease forces. The plastic material acts as a buffer between your teeth and protects them from wear and cracks. The splint can look bulky at first, but after a couple of weeks most people adapt fairly well. For our splints, we use a hard firm material on the outside and a gel layer on the inside fitting surface. These are generally reported as far more comfortable than the standard plain hard splint design.

See General and Cosmetic Dentistry - Splints
Splints are specially moulded to your teeth to ensure they will stay on all night snugly.
At Smile Design Dental we use a gel internal layer to ensure comfort.
Hard plastic outer layer will keep the splint’s stability and absorb the wear from nocturnal grinding. The bite will be fairly even to ensure forces are well distributed and avoiding any locking from the joints.

Muscle Relaxant Injectables

Muscle relaxant injectables provide an alternative to those who find a splint still too bulky. These can be injected into the overworked, enlarged chewing muscles. The masseters, bands of thick muscle at the back of your jaws, are usually injected first and reviewed 4-6 weeks later. The muscles will lose some strength so that they will naturally release when clenched, easing tightness. The temporalis, a band over the temple and stretching laterally across the skull, may also require injecting. The injectables typically last 4-6 months and can be seen to slim the jawline giving a nice aesthetic side effect.

Injectables into the masseter muscles will reduce strength and bulk. Allowing the jaw to open with less resistance and will reduce capacity to clench tightly for long periods. Reducing the bulk can help to slim the jawline.
A thin wide band of muscle over the temples is the temporalis. When these muscles are overworked there is an increased tendency for headaches. Muscle relaxant injectables may be added here along with the masseters.

Other treatments

Physiotherapy can also be used as an adjunct to the prior treatment methods. This will focus on improving range of motion and decreasing tension. If your TMD is a little more complicated you may require a more specialised splint, anti-inflammatory or anti-anxiety medications. If there are physiological changes to the joints then surgery may be required. Arthritis or other changes can occur when TMD has been present for a long time without adequate intervention. These can be difficult to treat and may only provide a small improvement, therefore early management of TMD is critical.

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