Our commitment is to provide quality orthodontic care to the best standards possible. At Dentics we provide the widest range of treatment options available, give you impartial advice to help you in your choice of treatment and during treatment you are given Dr Mew’s personal mobile and you are encouraged to contact him personally if ever you have problems with treatment.

To ensure the quality of your care copies of all your records are provided to you, including photos, Clincheck and x-rays. At any point you will be able to verify if the treatment was necessary and appropriate. You will be encouraged to seek a second or even third opinion on all work proposed and we always ask potential clients to go away and think about whether this is something that they really want to go through with.

We hope that this page with help you find a quality orthodontist. Dr Mew is always happy to give a 2nd opinion

Finding a Quality Orthodontist Reading this website you are quite possibly considering embarking on orthodontic treatment. There are many dentists and orthodontist providing orthodontic treatment, although orthodontist’s have undergone a specialist orthodontic training program research suggests that the quality of care provided by dentists compared to orthodontists does not vary. The reasons behind this may be that Dentists are often providing treatment for their own patients who they will know for many years so have an interest to provide quality work. This is obviously not true of orthodontists, or for that matter general dentists providing your orthodontic treatment only.

The introduction of a simple, aesthetic and potentially effective treatment such as Invisalign has encouraged many general dentists and some orthodontists, without sufficient (or any) experience to provide Invisalign. Where a three year, full time, specialisation course is required to specialise as an orthodontist (which does not cover Invisalign treatments), Invisalign allows dentists to provide treatments with only a one day programme largely spent explaining technical aspects such as the software and required impression techniques. Also most specialist orthodontist spend a considerable period of their working lives in “factory” NHS orthodontic clinics where the emphasis is too often on quantity and not quality. These reasons go some way to explaining the international reputation of British orthodontics. Quality once lost is hard to regain.

The best advice is to choose someone that you feel cares about the result that they will achieve and whose company you like, as this says a great deal about someone, and you will have to spend some time together. Avoid anyone that seems more interested in the money, does not seem to enjoy their job and is pushing you to start treatment such as booking an appointment or paying a deposit immediately. One good sign is someone who can take good photographs, someone that is good at taking clinical photographs is more likely to be a good clinician than someone who cannot. This site has many examples of a good standard of photographs.

Invisalign There are many Invisalign providers and it is only when problems arise or you finish with an unsatisfactory result that you realise that in the real world things do not always go to plan. It is the ability to plan well and cope with problems that separate providers of Invisalign, and for that matter all forms of dental and medical care. Done well this is a simple and easy treatment, done badly it is a waste of time and money, and can even be damaging.

The consistent problem would appear to be that many practitioners are not proficient or are too busy to fully analyse the Clincheck. This is the virtualisation programme that predicts the tooth movements, starting from the pre-treatment position and finishing with the desired result. The Clincheck is set up by technicians, who are not dentists, who have never met you and frequently write down impossible treatment plans. The clinician is supposed to give comments back for modifications and changes, this does not often happen.

Common problems with Invisalign

• Impossible treatments. However treatment is done, the aligners cannot by themselves move the whole dental arch in any direction. This is against the basic principles of physics and orthodontic treatment. If one tooth is pushed forward the others are pushed backwards, you cannot move all the teeth forwards or backwards, except in a computer.
• Inappropriate treatments. Invisalign cannot achieve some difficult tooth movements such as correction of deep bites, open bites, widening of either arch by more than 2-3mm, rotation of canines or excessive crowding especially of the lower front teeth. This can usually be overcome with some pre-treatment (see sectional systems) and effective Myotherapy.
• Upper front teeth are not well supported by the lower front teeth at the end of treatment. This is not easily noticed at the Clincheck stage, the result is that additional upper arch retention will be needed for ever.
• Teeth not following with the aligner, leading to gaps appearing between the aligner and the tooth (shadowing). Can be due to poor wear, in appropriate tooth movements in Clincheck or insufficient grip of the aligner around the tooth. Often affects lower front teeth or upper teeth number 2. Rescue mechanics can be used to recover the fit of the aligners

Aligners not fitting due to poor wear, showing ‘shadowing’

Using buttons and elastics as rescue mechanics the problem is corrected before continuing with Invisalign

• Myotherapy. It is well known that the resting or postural position of the tongue and lips is a major cause of crooked teeth. Since the teeth sit in a balanced position between the lips- cheeks and tongue. Giving exercises and advice termed Myotherapy can assist in correcting these problems. This is not often mentioned, and it is difficult to correct a problem without correcting one of the major causes.
• Not taking additional impressions for a refinement cycle. Unless teeth fit perfectly into the aligners, the image in the Invisalign computer will not be the same as the reality. If every tooth does fit perfectly into the aligners and the attachments into their homes then a new impression should be taken. To gain precise result the next set of aligners must fit precisely.
• Lack of alignment phases. At Dentics three separate alignment phases are provided to ensure that the result is perfect. The only condition is that there is not a 120 day break at any point in the treatment. If you are not happy with the initial result a second, third and forth series of aligners will be made until you are happy with a silicon impression taken for each stage.
• Dark triangles, teeth that are crossed over are moved apart to gain alignment and this can lead to a lower gum level and so called “Dark Triangles” between the teeth. These can be reduced by moving the teeth together, this often has to happen in a second phase of treatment.

Dark triangle after phase 1 of Invisalign

Tips of teeth trimmed and space closed raising gum level after phase 2

• Retention management. Being such a distant thought when checking the Clincheck this is often over looked. Few people if anyone will wear a retainer for the rest of their lives and it is important to look ahead to minimise retention wear at the end of treatment. If the upper teeth rest neatly onto the lowers when the teeth are together a simple wire fixed unobtrusively behind the lower front teeth can maintain the alignment in most cases. An initial period of upper alignment is usually required, mostly at night. Over the long term the resting tissue balance will try to return the teeth into their former position. Myotherapy training is the only way to overcome this. At Dentics we continue Myotherapy training and maintenance of the retainers for 3 years offer treatment.

Other forms of Orthodontics
Obviously there can be problems with all forms of orthodontic treatment, since these treatments are not new and the problems too innumerable we do not cover them here. Good planning and good responses to problems are essential.

Orthodontics can only really be assessed several years after treatment has finished.
Our commitment to quality and long term follow up care is unusual within the community and increases the time and expense of our treatment in comparison to some less concerned general dentists providing Invisalign without specialist orthodontic or Invisalign training. Nearly all adult orthodontic treatment requires an element of permanent retention (unless myotherapy is successful), it needs to be well planned from the start.

Always visit several orthodontists before choosing what form of treatment to have and who to go with. Think twice (or more) and act once (as you don’t want treatment twice).