Using ABB to link orthodontics and restorative dentistry
Tif Qureshi explains how the ABB process links orthodontics and restorative dentistry and why this is so important.
Would you explain what the ABB process is for dentists wishing to go on your course?
Some dentists may not all know what ABB is because it has not been a long-term, conventional type of treatment. It basically means aligning, bleaching and bonding teeth. A concept that uses anterior alignment orthodontics to reposition the teeth for functional goals, then tooth whitening followed by composite edge bonding.
The important thing is that we need to do orthodontic treatment correctly. Dentists need the education to understand what orthodontists could provide to patients as an alternative. When we teach ABB, dentists learn when aligning teeth what we can do, but they must also understand what they are not providing. Aligning may not always be the appropriate thing to do.
We often view align, bleach and bond as a form of cosmetic dentistry. And it probably started out as a way of doing cosmetic dentistry in a more minimally invasive way. But we also soon realised that actually if you do this properly and have a long term view, that it is something that can help patients improve the appearance and function of their teeth, whilst offering better long-term occlusal stability. This is a lifetime approach.
Has ABB evolved with your recent partnership with Philips? If so, what are the benefits both for dentists and their patients?
I have been using Philips’ Zoom Daywhite for some time and have seen the product change and improve over the years. I find it very predictable to use and a product I trust. IAS has also developed a tooth whitening tray based on a concept I have used for a few years.
We conducted a randomised study to make sure it was the most comfortable tray and one that the patient is happiest with. Now we can provide a whitening tray as part of the ABB process and it is very reliable, predictable and repeatable. It helps us to achieve consistent results and without any potential issues.
Why not other whitening brands?
Zoom Daywhite has always worked well for me. There are so many companies selling tooth whitening materials on the internet. However, no one really knows what they are buying. By contrast, when you see a brand like Zoom whitening, you know what’s going to be in it, and it is going to be safe and well tested. I think it is the best whitening brand – and as a result it’s one of the biggest brands in the world.
There are some good whitening materials out there, but patients don’t really know what the brand is. By contrast, when I put a Philips whitening kit in front of a patient they see the word Philips and they immediately feel reassured. They have bought other Philips products for years and trust the name. That’s the first reason; it really works for me and my patients.
The second reason: as a result of using the product for years, I know it works extremely well. I get literally no cases of sensitivity, particularly now because of the new tray system we developed. It is also a predictable result and I find that it is a product that patients are happy to use again and again. Something which we don’t often speak about: you need an at home treatment to be simple to use as well as effective, so patients can get good results with ease. If you go to a very highly complex whitening protocol, to then try and keep it topped up isn’t the easiest thing to do. Whereas when patients buy a Daywhite kit from us as part of the ABB process, they all keep whitening their teeth, they have invested in the idea, and then become long-term customers, which is a good thing.
Ethical, honest and high quality dentistry seems to be recurrent terms linked to IAS.
Is this what The Aesthetic Connections is all about?
IAS has always been focused on doing the right thing for the right patient at the right time. Those are the words we strongly believe in. At times, it is important to say no and turn treatment away. Similarly, when we do the treatment, we do it as well as we can for the right reasons.
Quality dentistry also means having a long-term objective and a long-term responsibility to the patient. Aesthetic dentistry should not just be a frivolous treatment you complete and then say goodbye to your patients. That is the wrong approach. The right approach is you basically aim at acquiring a lifetime patient. IAS brings all these concepts together in a day programme symposium and helps dentists outside IAS and also within IAS to get a picture of that lifetime approach. We are always focused on trying to do better. We should not have the continual worry about telling the patient about the difference between private and the NHS. The focus should always be on the very best long-term outcome for the patient.
What can you tell us about the Great Ortho Restorative Debate?
A lot of dentists out there don’t provide orthodontics. Equally lots of orthodontists providing treatment think restorative dentistry is totally separate and their work ends with the successful alignment of their patient’s dentition. These two areas are far more interlinked than many dental professionals think.
There are some dentists who carry out treatments on the front teeth and don’t have any idea about orthodontics or how teeth move over time and how the anterior occlusion changes due to crowding. These people are compromising their patients. We have seen examples of many facing repeated chipping front teeth. Their dentist deals with the situation with a crown or veneer and we believe that in many cases, a crown or veneer is not needed.
Minor orthodontics and bonding, which last for a much longer period of time, would be the right protocol to follow. The debate is to try and help dental professionals understand that the whole idea that orthodontics is one subject and restorative dentistry is another one is completely wrong. They are the same thing. And we believe that our profession is not really serving the public as well as it could.
During ‘The Great Ortho Restorative Debate’, we will answer a whole variety of questions. Is pure orthodontics the better approach or is restorative the better approach? Speakers will present cases that went well, cases they would have treated differently with hindsight, and cases which they may not have treated, and what we might do now. Or more importantly how we think patients’ teeth may change.
Dentists look at what they see now, but don’t think about where the teeth are going 15 years down the line. There is no long-term foresight. We think about periodontics, tooth decay and missing teeth, but there’s literally no structured education about the combination of tooth wear and tooth movement and how it is likely to change the patient’s occlusion, appearance, function over 10, 15, or 20 years. So this debate is going to be about opening people’s eyes to a more dynamic picture. We have a lot of interest already and we hope to run it near September 2020.
How do you see the link between the Great Ortho Restorative Debate and Philips supporting the project/campaign?
It is very appropriate that Philips is supporting this. Orthodontics, restorative dentistry, tooth whitening, oral hygiene are all extremely important elements to achieving the best long-term results for patients. Interestingly, restorative dentistry would not be what it was without the bleaching element. I have had a lot of people who had their teeth straightened and whitened, and only then did they come to realise how good they actually looked, which prompted them to have the restorative part done. The whitening has become a key part of the patients’ journey.
I have also had many patients who thought they wanted veneers. After straightening their teeth, they still wanted veneers. After whitening their teeth, veneers were no longer necessary. The bleaching is indisputably an important part of the whole concept. It helps patients see the very best in their own smile. This is absolutely critical for anyone who thinks they want cosmetic dentistry to bleach their teeth first. It totally changes the perception of patients once their teeth change colour.
We read a lot about high-end cosmetic cases in the press. However, your approach seems to be about making cosmetic dentistry achievable by any GDP. Would you be able to expand on this?
Any dentist trying to develop their skills is likely to see high end cases in magazines showing the full mouth restorations or multiple veneers. Realistically only 0.5% of the population can easily afford that sort of treatment plan.
Dentists seem to think that somehow they need to turn their practice into a sort of spa to attract people with that kind of money. In truth, many people can actually afford treatment, but at a lower price bracket. You – you can comfortably give the equivalent of that same visual result for less money, with less damage. That moves the treatment into a larger demographic of patients.
What dentists should do is take their average patients, show them what is likely to happen to their teeth slowly over time. You educate them and get them to make that decision by explaining that the treatment will probably be a lot cheaper and less invasive than in 10 years’ time.
I often ask my peers whether they have photographic evidence of their patients 10 years ago to see how their teeth have moved. Not one hand will go up. By demonstrating cases slowly changing you can save people a lot of money.
How has working with Philips helped you in the way you deliver dentistry?
I have never had a patient questioning Zoom Daywhite as we get good, reliable results. Since developing the whitening tray, we have rolled it out internationally too. It is exciting and reassuring to have a product we know works and proves more comfortable for our patients.
How do you see your relationship with Philips long term?
Our plans are hopefully to have more global involvement with our ABB courses. We already run courses in Australia, Europe and the Middle East. We would like Philips to have an integral role to play in these too.
The whole concept of ABB is so beneficial to both patients and dentists and also clearly beneficial to the product manufacturers, since their products are used in the right and ethical way to keep patients’ teeth look good for longer. We believe we can change large groups of dentists on a global scale. We are already teaching large corporates such as Mydentist, who are keen to get their dentists upskilled with the ABB concept. I am thrilled we are working alongside Philips who organise these programmes. It is really beneficial for everybody.
We will issue more details about the Great Ortho Restorative Debate including the date in due course. For more information and to register your interest please email [email protected] in the first instance.