Cosmetically focused adult straight teeth for the General Practitioner

Part 2 - Case presentations

Instructors:

Dr. Michael Miyasaki, DDS

Dr. Michael Miyasaki, DDS

Dr. Michael A. Miyasaki is a 1987 graduate of the University of the Southern California School of Dentistry, and has been involved in dental education for over 21 years, 12 of which he was involved in live-patient treatment programs internationally giving him a unique perspective on the global challenges of the dental professional.

Dr. Miyasaki shares cases where CFast has enhanced the patient's smile.

So let's discuss some of the application of CFAST. We can often use CFAST very easily to round out arches, to level and align the front teeth. We can actually use it to correct simple and moderate crowding. So as we go through these sample cases, I want you to think about your patients. The patients you may have seen this last week and those that you’ll see in the coming days. So here is a case, again, where you have the crowding of the anterior teeth. We have some rotations of the upper centrals. Now when we straighten that case out, how much nicer that smile looks. So just the before and after. So how many of your patients did you see just last week that have the teeth that were crowded like that. And maybe you didn’t have anything better to offer to them beside a prepared veneer or a crown. So by aligning the natural tooth structure, we can be very conservative in giving them the straight smile that perhaps they want. We can use it to correct simple and moderate spacing issue. So here’s a patient between two centrals there’s a diastema. Again, we might look at this patient without having something like CFAST in our tool belt to offer them. We might think about things like veneers. We might think about direct bonding. Again, things that would not be very easy to accomplish and we’d be afraid with two centrals that are very wide. So why don’t we recommend CFAST, move the teeth together. Again, this is done in just a matter of a month or two. So again, these are the type of solutions we can offer our patients to give them that smile they’ve always wanted. Not only does it gives them the smile they’ve always wanted, but the perception of a patient perhaps with a large diastema is different than a patient when they have closed that up. So we look at this patient, I don’t know, she looks just happier, much more mature. Minor rotations. So on the lower arch; think about how many of your patients you’ve seen during your checks that have crowding of the lower anterior teeth. And again what options do you have to offer them. It may be prepare the teeth for veneers to make them appear to be straight. But again you’re doing something that’s very invasive. What I offer my patients is have you ever thought about straightening those teeth out. And often times the patient will say yes, but how long will that take and how much will that cost. And I say you know really we have another option. That option is CFAST. And with CFAST by the time you come back for your next cleaning, we could have straighten these teeth out. So here’s a case where that arch has been rounded out so it minimizes the need to do any kind of interproximal reduction or stripping. And there’s a lingual wire being placed, fixing wires so that we don’t get relapse, those lower anterior teeth crowding up again. We can use it to align gingival margins and improve the emergence profile. So in this case what we’re going to do is we’re going to look at a lower arch because many times we’re thinking about esthetic being on the upper arch. Here’s a lower arch case where we have again the two centrals that super erupted. And you look at the gingival positions and there’s a large difference between the centrals and the lateral positions. You look at that arch form; the arch is kind of crowded up. Those centrals are being lingualized every more. Which often times patients will complain about rubbing their tongue. So in this case what we’ve been able to do is round out that lower arch. You can see that in rounding out that lower arch, the centrals we’re going to treat a little bit so the soft tissue positions are much uniform, much more esthetic and just how that arch rounds out. And again with the retention, the fixed lingual arch wires. I, myself, had just finished CFAST about a month previous to this taping and I currently have fixed single arch wires on my upper arch and my lower arch. So just the before and after. And again how many of these patients have you seen and you just did not have another solution to offer your patients especially one that was conservative as you like it to be. CFAST is now that solution. We can straighten those teeth out. We can line up the soft tissue contours and we can round that arch out. Upper [anterior] teeth that are flared. So again we’re not talking about even doing an entire arch. But here’s a cuspid on the patient’s upper right hand side that’s flared out a little bit. So we asked the patient does that bother you. Often times especially with female patients they don’t like that cuspid sticking out. It’s kind of a masculine appearance. It’s kind of that vampire look. And again if we can offer them CFAST, let’s just straighten out that arch, just round it out and tuck that cuspid back in, it softens that smiles up. Here’s a lower cuspid on the right hand side that’s flared out. So again have you ever though about straightening those teeth out Mrs. Jones. We have a solution, CFAST. Within a matter of months, we can straighten out your lower teeth. We can actually tuck that tooth back towards the tongue side so it’s not longer sticking out. Cause many times that tooth is sticking out is an irritant to the upper tongue. Pre-cosmetic treatment alignment. So we have a patient that requires a lot of work. In this case, we’ve got a lateral that’s flared out. What you can actually do is to use CFAST to kind of align the teeth in the upper arch before having the restorative work. Often times, there’s a small edentulous area. We might actually use CFAST to open that space up so we can put the implant or maybe a bridge pontic in there that would be much more esthetic. So again we can use CFAST and the CFAST technique to better align the teeth, to help us do better restorative esthetic work. Avoid elective endodontics. So here’s a case where you might consider veneers, maybe a prepared type veneer because the patients left central in this case is way out of the ideal arch form position. So you might be thinking about doing a lot of tooth preparation on the facial or another option we can offer to our patients today is CFAST. So why don’t we go and use tooth colored brackets, white wires, and within a matter of weeks we can actually align that tooth and pull it back into the arch. So in six weeks’ time you can see that upper left central has been tucked back. We have more of an idealized arch form and we may or may not be able or need to or have to do veneers. If we have anterior crossbite like the laterals in this case, what we can now offer our patients, in the past maybe it was again veneers. We might do veneers. We might just build up the patients of the laterals to make them appear as if the fall into the proper form of the arch. But what we can do is we can offer CFAST to that patient. We’re going to put brackets and wires on the teeth and in a matter of months what we’re going to be able to do is we’re going to be able to pull those laterals out facially towards the lip and the cheek side of your mouth, put them in the proper position and correct that crossbite. These are the dramatic changes we can accomplish with CFAST in a very short amount of time. So, when I’m looking at a patient what I need to figure out is do they have crooked teeth. If they don’t have crooked teeth, they’re not a CFAST candidate. Then as we work our way down the chart, do they have good periodontal and joint health. If they are stable periodontally and their bite and their joints are healthy then they’re still a candidate for CFAST. But if they have crooked teeth and periodontally they have active disease, I’m going to treat that active periodontal disease before you put them to the CFAST procedure. Then I need to figure out if they’ve got crooked teeth and they’re stable periodontally joint use and bite wise, can I accomplish that case within the timeframe that I set in my mind. You know typically that’s 5 to 7 months. If I think I can accomplish the CFAST treatment within that timeframe then again they are CFAST candidate. If it looks like it’s going to take much more time or maybe they need comprehensive orthodontics and again they are not a CFAST candidate but they’re a candidate that I would then refer out to my orthodontist colleagues for comprehensive orthodontics. One of the things that I try to get the CFAST practitioners to understand is we want to take the easy fast cases. If those cases are going to take more time, I want to refer out. Again if they’re easy and quick both fun wise for me, I love to see the before and after results. I’m going to accomplish that and I’m going to be able to see that within a few months time. Profitability wise. I can keep my cost down to my patients and we can both create a win-win situation. If I have to accomplish an orthodontic treatment plan that’s going to take much longer than six months, to be longer than that, it’s not going to be much fun for me. It’s not going to be fun I don’t think for the patient. We’re going to have more visits. And I have to charge my patients more. So in those cases, what I do is just refer the patient out. And remember it’s more than just CFAST. What we’re going to do is we’re going to take the patient with often crooked teeth. We’re going to align them with our CFAST treatment. But now often times they’re going to require other treatment such as whitening or some restorative maybe in veneers. So CFAST often times is just the first step in kind of a longer treatment plan. But it’s one that our patients appreciate because at this point we’ve taken their crooked teeth. We straightened them out so now they can enjoy a smile with straight teeth. As far as color and contour, those are things that we’ll get to in our treatment plan a little bit later on. So what I’d like you to think about as far as practicing and your practice growth is how can you generate more revenue providing this CFAST type of cases. If you do one CFAST cases a week or maybe two CFAST cases a week, again you can add hundred of thousands of dollars to your practice, bottom-line by providing I think a treatment that’s beneficial to your patient because it’s very conservative. It’s a treatment that many of your patients actually want and they’re seeking. They just don’t know that CFAST or a treatment like CFAST is available. And it’s very conservative so it’s a win-win situation.