Orthodontics is an ever popular and in demand field of dentistry. Traditionally seen as a specialist only practice, it is becoming ever more popular amongst general practitioners, seeking to both facilitate minimally invasive treatment and ultimately deliver the highest standard of care for their patients. 

In this article, Dr Tif Qureshi discusses his career pathway, followed by the developing trend of orthodontics in general practice and how it can be incorporated into the armamentarium of the GDP.

 

Dr Tif Qureshi | BDS

GDP & Clinical Director IAS Academy

Editorial Board Dental Update
Past President BACD
e: tif@iasortho.com
 

 BIOGRAPHY

Tif Qureshi qualified from Kings College London in 1992. He is the Past President of the British Academy of Cosmetic Dentistry, Tif has a special interest in simple orthodontics using removable appliances. Tif also pioneered the concept of Progressive Smile Design through Alignment Bleaching, Bonding and is also an experienced teacher in the Dahl concept to assist in minimally invasive dentistry. Tif now lectures nationally and internationally and has had many articles published on all these subjects. Tif sits on the Editorial board of Dental Update. He is a Clinical Director of IAS Academy.

ORTHODONTICS IN GENERAL PRACTICE

Orthodontics in General practice can be a very wide spanning range of treatments but it is critical dentists carry out treatments appropriate to their skill set. There are some GDPs with extensive training who have for years, provided a very high standard of orthodontics, working alongside orthodontists treating complex cased in children and some adults.  Also In the last 20 years, many adult patients started looking for aesthetic improvements so cosmetic dentistry exploded from the late 90s and thousands of people started having veneers placed. Many of these patients would not accept comprehensive orthodontics and accepted aggressive tooth preparation instead.  And for a time many patients were not given many other options other than comprehensive orthodontics. Anterior focused tooth alignment widely appeared around 2004 with a range of options to just treat the social six. Much of this has been carried out by GDPs and as a result some issues arose- but were often due to some inexperienced GDPs attempting to treat cases that were well beyond their scope and that perhaps were not properly diagnosed or consented correctly. With the right teaching and mentoring it should be perfectly possible for any dentist to do some simple anterior orthodontics, and then through time and continued education, start to explore a wider range of appliances. However unless a general dentist has undertaken a long, mentored comprehensive course of orthodontics, complex cases should always be referred to a specialist.

Why do it?

  • One of the most fundamental reasons for doing orthodontics is that teeth that are currently crowded, often continue to move and get worse through life. This does not just have an orthodontic significance, it has a potential affect on function/ guidance/ wear/ overlap/ ease of cleaning/ and aesthetics. Many dentists simply do not realize this but there is strong evidence * that all teeth that are now crowded are likely to get worse. The restorative, occlusal and functional implications for this are immense, but have not been widely acknowledged in dentistry. *Br J Orthod. 1990 Aug;17(3):235-41. Stability and relapse of dental arch alignment.
  • Of course this means that you can start to intercept simple crowding cases with early wear, rather than allowing cases to continually crowd and worsen
  • You can carry out cosmetic/ aesthetic dentistry without having to prepare teeth and take less risk. Because teeth can be moved into a far more ideal position simply and cost effectively rather than taking a drill to them.
  • One becomes far more aware of what is actually dynamically occurring in a patients mouth rather than just concentrating on ortho, or occlusion or perio… these things are  actually connected extremely intricately.
  • This will enable you to expand your skill in dealing with complex cases and help you also move into further education based on good  real experience VS just doing a course for the letters after your name.

Disadvantages

Dentists who start with inappropriate treatments for their skills will eventually get into trouble. I would strongly advise against any course that can profess to teach you “80 percent of comprehensive orthodontics in a weekend.” As orthodontics is not just about a clever bracket, it is about understanding assessment, diagnosis, treatment planning, development, and learning from experience.  Start very simple, pick your course based on its mentoring, and do things correctly. There are no shortcuts.

Overview of the Various Systems

You have two basic modalities; Removable or Fixed.

Removable braces like Inman Aligners, Clear Aligners, Invisalign, are made using a  “closed system”- that means they are build on models (normally 3D printing). This means the teeth move within a range of controlled position, and as long as you have assessed and planned correctly, the most common complication is that nothing happens (usually due to lack of compliance or enough space creation).

With Fixed Braces, you can incur more movement, however in inexperienced hands, this can result in a lot of unwanted movement and loss of anterior occlusal control unless dentists are able to protect functional points and understand fully the space needed. This can easily result in flaring.  I would recommend people start removable and understand how simple movements occur and how to control them before jumping into fixed orthodontics straight away.

I won’t comment about any individual systems other to say that many of the current systems out there are run by people who came on an IAS Academy course, and some of their lead trainers are still taking our courses or trying to!!

CASE EXAMPLES

Case 1- Align, bleach and bond (ABB)

  • Preop

  • Alignment and whitening

  • Direct composite

  • Postop

Case 2- Align, bleach and bond (ABB)

This case shows how orthodontics, with correct OB/OJ and retention, allows for the placement of edge bonding without the worry of later failure.

  • Preop

  • Post-op
    – Upper and lower treatment duration ~3-4 months

  • 5yr Recall

Case 3- Ortho-Restorative: Instead of 10 veneers

The patient was initially requesting 10 veneers. However, she eventually decided to have ortho (16 weeks), bleaching, four composite ‘edge bonds’ and one crown. Also, she was ‘dahled’ on the wire/composite to open the bite.

Case 4- Align, bleach and bond (ABB)

A case highlighting the control of tooth position for anterior guidance.

Case 5- Ortho-Restorative

GETTING STARTED

Wherever you go and look at what is being taught…is it appropriate for your understanding. Are you being fully mentored? Do you know where your work is being made? Are you able to speak to a mentor to feed back on your case setups? Is your mentor actually a dentist or orthodontist or perhaps not?!  Free courses are free for a reason, quality costs and doing things properly takes time and ethics.

CONCLUSION

I was lucky to enter dentistry at a time where being a little different, maverick, taking risks was perhaps a bit easier than it is now. But despite the changing times, legal climate, rules, regulations, it is still potentially a fantastic career, but it won’t happen automatically. You have to make that happen and chose the right pathway. One final piece of advice, that has got me this far (25 years) with no issues. Just be a good person, be kind to your patients, and if you do something wrong, admit it and put it right.  Don’t dig your heels in and don’t be bloody minded – Be open minded and you will flourish.

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