Patient information

1. What is the purpose of this information?

In the following, we tell you how our transparent braces (known as ‘aligners’) and our ceramic veneers work, what they are made of, how comfortable they are to wear and what result you can expect from them. You also learn how to use and maintain our products, how long a treatment lasts on average and what potential risks can occur when wearing them. Furthermore, we also explain what additional services bestsmile offers, how they work and what advantages and risks they bring.

2. Aligner

In the following section, we tell you how our transparent braces (known as ‘aligners’) work, what they are made of, how comfortable they are to wear and what result you can expect from them. You also learn how to use and maintain our aligner, how long a treatment lasts on average and what potential risks can occur when wearing them.

2.1 How do the aligners work?

Aligners are used to treat misaligned teeth. The misaligned teeth are corrected in several steps; individually adapted aligners are made for each of these steps. The gentle pressure that the aligners exert on the teeth and the natural dentition directs and moves the teeth into the desired ideal position.

2.2 How long does the aligner therapy last and what course of treatment can you expect?

We will discuss the results that are possible with you at the start of the treatment. However, everyone has a very individual response to dental braces – how they respond depends on the health of the teeth and the degree of the misaligned teeth, to name but two examples. Therefore we cannot guarantee that the treatment will be a success. The misaligned teeth may not be corrected. For optimal treatment, it is important that you use the aligners as soon as possible after receiving them, stick to the treatment plan and wear the aligners for at least 22 hours each day.

How long treatment lasts is individual and depends particularly on the degree of the misaligned teeth. Generally speaking, treatment lasts between three and twelve months.

To secure and stabilise the achieved tooth position, we will send you a retainer aligner along with the aligners. You should wear it every night for six months once treatment is complete and then at least three nights a week so that your teeth remain in their new position.

Not following the instructions of your bestsmile dentist, wearing the aligners for less than the required number of hours per day, having poor oral hygiene or wearing broken aligners can affect the treatment time and the quality of the final result. In addition, any medication you are taking and your general health condition may also have an influence on the treatment. Unusually shaped teeth can affect the treatment, e.g. short clinical crowns can cause problems with aligner retention and slow down or prevent teeth movement.

2.3 Usage and care instructions for aligners

Chewing, drinking hot, acidic or alcoholic drinks or smoking can deform or discolour the aligners, which is why they should be removed beforehand.

If you consume sugary, cloudy liquids or food, you should clean your teeth afterwards before using the aligners again.

Rinse the aligners under cold running water as much as possible every time you take them out – preferably several times a day. You can also gently clean the aligners with a toothbrush. We also recommend regularly soaking the aligners in a special cleaning agent that you can get from the pharmacy.

If you do not clean your teeth and aligners properly, you are at a greater risk of developing caries, periodontitis or gingivitis.

Grinding can damage the aligners, as the masticatory muscles work with greater bite force than in normal chewing.

2.4 What are the aligners made of?

The aligners are made of thin transparent plastic. They are made of medical PET (polyethylene terephthalate) / PU (polyurethane). They do not contain any plasticisers and are therefore free from bisphenol A (BPA).

2.5 How comfortable are the aligners?

The aligners are generally very comfortable to wear as they are very thin and easy to remove at any time.

Unfortunately, we cannot guarantee that they will be completely comfortable to wear. Despite everything, the aligners are foreign bodies that are placed on and exert gentle pressure on the teeth. Please arrange an appointment with us if the aligners are not sitting as desired. This will allow us to check how we can make them even more comfortable to wear.

2.6 Slicing/Stripping

Slicing/stripping is used for moderate crowding. The tooth enamel is minimally ground down to create space so that the teeth can be brought into the desired position.

Where the enamel is to be reduced and by exactly how much is calculated with the 3D scan and recorded in the treatment plan.

Slicing takes place when the first aligner is used for the first time and, depending on the quantity, is also divided among the other aligners (usually the next two). The enamel is ground manually (using stainless steel strips) and/or by means of oscillation (with Oscident Strips). The gaps are then polished and fluoridated with Elmex Fluid so that the enamel surface is smooth again and predilection sites for caries are prevented.

2.7 Attachments

Attachments are tooth-coloured composite abutments (knobs) that may be necessary to perform certain tooth movements more efficiently. Where the anatomical shape of the teeth does not allow sufficient force to be transmitted from the aligner to the tooth, attachments provide an additional point of attack for more targeted force transmission and thus the desired tooth movement.

Attachments are glued to the teeth before treatment starts and they remain there throughout the aligner treatment. At the end, they are polished from the teeth without leaving any residue.

The following must be observed during treatment with attachments:

  • When inserting and removing the aligners, greater care must be taken to ensure that the attachments are not removed. If an attachment is lost, it can be reattached to the tooth at a check-up appointment.
  • If you attend a dental hygiene appointment during aligner treatment, the dentist/hygienist must refrain from polishing the attachments.

2.8 Bleaching

If you decide to treat both jaws, a free home bleaching (teeth whitening) is included in the price. The bleaching allows you to whiten your teeth by a few shades. To whiten your teeth, fill the bleaching gel in your individual aligners and place them on your teeth. For best results wear the aligners overnight (approx. 8 hours). If you do not have any attachments, you may bleach your teeth at any time during the aligner treatment. However, if in your case attachments have been applied, bleaching can only be started after the final check-up with the retainer aligner and after removing the attachments. After whitening your teeth, they might be temporarily sensitive to hot and acidic drinks. Avoid colouring foods and drinks during the first two weeks, as the enamel is a little rougher during this time and can therefore take on colour more easily.

3. Veneers

In the following section, we tell you how our ceramic veneers work, what they are made of and what result you can expect from them. You also learn how to maintain your veneers, how long a treatment lasts on average and what potential risks can occur.

3.1 How do veneers work?

Dental veneers are used to correct minor defects and discolorations and are mainly applied to the anterior teeth. The treatment is carried out in several steps during which we will produce custom-fitted veneers for you. The masking effect of dental veneers covers up unwanted gaps between your teeth, minor defects, irregularities, cracks and discolourations, thus improving the appearance of your teeth.

3.2 What does the treatment with veneers look like and what procedure can you expect?

At the beginning of the treatment, we will make a detailed examination of your teeth and discuss with you whether you are a candidate for veneers and what results you can expect. We will show you the possible outcome of the treatment with the help of a simulation. However, the final result depends, among other things, on the health of your teeth, on the degree of tooth discolouration and on the degree of the misaligned front teeth. Therefore we cannot guarantee that the treatment will be a success. It is possible that – from a visual point of view – the result may slightly differ from the desired and previously seen final outcome.

In a second step of the treatment, the teeth on which the veneers will later be applied have to be prepared. This requires to remove a approx. 0.3–1.0 millimetre thin layer of enamel on your front teeth that need to be treated under local anaesthesia. Please note that the removal of enamel is an irreversible procedure. This means that the enamel is removed permanently and that it cannot regenerate. The shape and function of the tooth will thus be permanently changed. The ground teeth may react more sensitively to temperature fluctuations during the initial period. In order to reduce this feeling, temporary synthetic veneers will be applied to your teeth, which allow you to get a first impression of the final result. The temporary veneers are not as durable as the final ceramic veneers. It is therefore important to avoid hard foods and biting down strongly while wearing your temporary veneers. During your final appointment, the final ceramic veneers will be permanently attached to your teeth under local anaesthesia. In order for the treatment to be a success and the result to look beautiful for as long as possible, it is important that you maintain an impeccable dental hygiene. Eating or drinking strongly colouring foods or beverages or smoking can discolour your teeth, especially around the adhesive edge. In isolated cases veneers can also be damaged by extreme stress.

3.3 Care instructions and safety advice for veneers

If you consume sugary, cloudy liquids or food, you should clean your teeth afterwards to ensure the longevity of your veneers.

If you do not clean your teeth and veneers properly, you are at a greater risk of discoloration and developing caries, periodontitis or gingivitis, especially around your veneers.

Chewing on hard foods or materials (e.g. pens) or biting down carelessly might also damage your veneers, just as it might otherwise damage your teeth. Unconscious grinding at night can damage the veneers, as the masticatory muscles work with greater bite force than in normal chewing.

3.4. What are the veneers made of?

The veneers are made of lithium disilicate. Glass ceramics are very similar to the natural appearance of the teeth thanks to its natural colour and ideal optical properties.

3.5 Preparation

In order to apply the veneers, the preparation requires to remove an approx. 0.3–1.0 millimetre thin layer of enamel. The thickness of the enamel that needs to be removed varies from patient to patient and depends on your tooth position and tooth colour. Please note that the removal of enamel is an irreversible procedure. This means that the enamel is removed permanently and that it cannot regenerate. The shape and function of the tooth will thus be permanently changed. Your bestsmile dentist will discuss the necessary steps and the associated risks with you personally.

3.6 Temporary veneers

Until your final ceramic veneers are attached, temporary synthetic and protective veneers will be applied to your teeth, which allow you to get a first impression of the final result. On the basis of your 3D scan we will produce an aligner, which shows your final result. The aligner is filled with a synthetic material and shaped. The temporary veneers are not as durable as the final ceramic veneers. It is therefore important to avoid hard foods and biting down strongly while wearing them.

4. Additional services

bestsmile offers a range of additional products and services that optimally complement the aligner treatment. In the following, we will introduce these and explain how they work and what advantages and risks they bring.

4.1 Finishing

The bestsmile finishing includes tooth contouring and reshaping as well as dental bonding. It is carried out at your last appointment as the final step of the aligner treatment. Finishing allows to correct minor tooth imperfections while improving the overall appearance of your smile and your oral hygiene.

Tooth contouring and shaping involves removing tooth enamel to reshape your teeth into the desired form. As enamel is mainly made up of minerals and there are no blood vessels or nerves underneath, this layer is not susceptible to any sensation. Therefore, no painkillers or anaesthetics are required during the treatment. However, in rare cases the sensitivity of your teeth may be temporarily increased.

Dental bonding allows to repair chipped, cracked or discoloured teeth with tooth-coloured resin. It involves applying a transparent bonding agent and then tooth-coloured resin, which is shaped and polished by your dentist to match the surrounding teeth. Tea, coffee, cigarette smoke and similar substances might discolour the resin used in bonding. Please avoid such foods, drinks and substances for the first 48 hours after a bonding procedure to prevent or reduce discolouration. Also be careful when biting down. The resin used for bonding is not as strong as a tooth. Biting your nails, ice cubes or a pencil, for example, in rare cases may cause the resin to break.

Finishing improves the overall appearance of your end result, which you can maintain as long as possible by brushing your teeth at least twice a day, flossing daily and having regular dental and oral hygiene check-ups.

4.2 Memotain® wire retainer

Our transparent aligner treatment also includes a retainer aligner, which you should continue to wear at night after completing your treatment in order to maintain the achieved tooth position. Alternatively, if it is suitable for you, you may opt for a Memotain® wire retainer, which is available for an extra charge. The Memotain® wire retainer is made of the memory metal NITINOL®. Your Memotain® wire retainer is made in two steps: first of all, your dentist scans your teeth at the final check-up appointment. If it is suitable for you, the wire retainer will be custom-made for you based on your digital impression. We will inform you when your retainer arrives at our practice and is ready to be applied. At the final appointment, the wire retainer will be attached to the back of your front teeth. In this case, you do not need to wear the retainer aligner at night. In very rare cases, the Memotain® wire retainer may break, in which case there is a risk of injuring the oral cavity or swallowing parts of the wire. In this case, contact your bestsmile dentist immediately so that the appropriate action can be taken and a new wire retainer can be made.

4.3 Relax retainer (mouth guard for teeth grinding)

Teeth grinding, especially at night, can damage the substance of your teeth. It is a condition in which you grind or clench your teeth together with great pressure and the masticatory muscles work with greater bite force than in normal chewing. If you grind your teeth, we recommend our relax retainer, which is specifically designed for these cases. This retainer is custom-made for you after we make the final 3D scan of your tooth position. During the last appointment, the relax retainer is fitted to your teeth and, if everything fits, you can take it home with you. You may wear the relax retainer both at night and during the day. The relax aligner is generally very comfortable to wear because it is made of a softer plastic and can be removed easily at any time. Unfortunately, we cannot guarantee that it will be completely comfortable to wear. Despite everything, the relax retainer is a foreign body that is placed on and exert gentle pressure on your teeth. Please arrange an appointment with us if the relax retainer is not sitting as desired when you are wearing it. This will allow us to check how we can make it even more comfortable to wear. Rinse the relax retainer under cold running water as much as possible every time you take it out. You may also gently clean the retainer with a toothbrush. We also recommend regularly soaking the relax retainer in a special cleaning agent that you can get from the pharmacy. If you do not clean your teeth and relax retainer properly, you are at a greater risk of developing caries, periodontitis or gingivitis. Problems that cause joint pain, discomfort, headaches or ear problems can also occur in the temporomandibular joint – but these are extremely rare. Please inform your bestsmile dentist of such problems immediately so that we can give you the best possible advice.

5. Risks and side effects

If you experience pain when wearing the aligners, or if other health problems occur, discontinue using the aligners. Please contact us immediately if you experience any problems so that we can arrange an appointment immediately.

The following risks and side effects may occur:

Aligner:

  • The aligners exert pressure on your teeth to change their position. This may cause pain or be unpleasant.
  • It is possible that the bestsmile Aligner has a small influence on your pronunciation. This only occurs for a short time and disappears quickly. It rarely happens that this leads to an impairment over a longer period of time.
  • It is possible that the bestsmile Aligner leads to an increased salivation or dry mouth. Certain medications can increase this. In this case we recommend that you drink more water.
  • In individual cases the treatment time may exceed your bestsmile dentist’s estimate. Not following the instructions, wearing the braces for less than the required 22 hours per day, lack of oral hygiene or damaged aligners can have an influence on the duration of the treatment and thus affect the quality of the final result.
  • Unusually shaped teeth can prolong the treatment time. For example, short clinical crowns can cause problems with aligner retention and slow down or prevent tooth movement.
  • Caries, periodontitis, decalcification (permanent tooth marking) or inflammation of the gums can occur if proper oral hygiene is not consistently maintained.
  • Wounds and irritation of the soft tissues of the mouth (gums, cheeks, tongue and lips) are possible, but rarely occur when wearing braces. In this case please inform your bestsmile dentist or contact your bestsmile practice.
  • In cases of crowding (teeth partly on top of each other) an interproximal reduction (adjustment of the thickness of the enamel; slicing) may be necessary to create enough space for tooth movement.
  • Also, certain medications or the general health of the patient have an influence on your dental correction with the bestsmile Aligner.
  • Allergic reactions to the material are not known and very unlikely when wearing the bestsmile Aligner.
  • During the treatment, you may experience an increased sensitivity of teeth and oral mucosa, especially at the beginning of the treatment and during the transition from one aligner to the next.
  • Wearing aligners can affect your dental health. Although this is rare, additional dental treatment such as endodontic treatment or other restorative treatments may be required. The life span of your teeth can be shortened, and in extremely rare cases teeth may be lost.
  • The quality of existing fillings as well as crowns and bridges can be affected by wearing aligners. These can become loose and may require re-cementing or, in a few cases, a new production. Contact your bestsmile dentist before replacing or repositioning fillings, crowns and bridges, as these changes can affect the fit of your aligners.
  • Root resorption (loss of tooth substance in the area of the tooth root) can also occur in natural, untreated dentition, but is above all a regular side effect of orthodontic treatment. These root resorptions partially repair themselves, but larger defects can remain after the treatment. Most root resorptions are so small that they are not even visible in panoramic x-rays and never will be the cause of any damages. Minimal changes can be seen in the panoramic x-ray of only 20% of the treated patients. Even these only very rarely become clinically significant. Although tooth loss due to root resorption is theoretically conceivable, it is extremely rarely described in the entire scientific literature.
  • If you start your treatment with several missing teeth, it is more likely that the aligners will break. In case of a fracture, you should contact your bestsmile dentist as soon as possible to replace them.
  • Since the aligners are worn in the mouth, accidental swallowing or aspiration of the aligner - completely or partially - can occur. In order to avoid this, the condition of the aligners should be checked regularly. Please do not wear damaged aligners under any circumstances.
  • Problems in the jaw joint can occur, causing joint pain, discomfort, headaches or ear problems - but these are extremely rare. Inform your bestsmile dentist immediately about such problems.
  • When taking an X-ray, the risks involved must be considered.

Stripping/Slicing:

  • The reduction of the enamel can lead to hypersensitivity of the teeth, increased disposition to caries and increased adherence of plaque.
  • The narrowing of the interradicular space can lead to an increased susceptibility to periodontal disease.

Attachments:

  • Attachments may temporarily interfere with harmony when biting.
  • In exceptional cases, attachment removal may also remove some healthy enamel.
  • It is possible that the attachments, or parts of them, are accidentally swallowed or aspirated.

Bleaching:

  • After whitening your teeth, they might be temporarily sensitive to hot and acidic drinks.

Veneers:

  • The application of veneers requires to permanently remove a thin layer of tooth enamel. Please note that the removal of enamel is an irreversible procedure that in rare cases may cause pain or be unpleasant.
  • The procedure for removing the thin layer of enamel and applying the final veneers is usually performed under local anaesthesia. Nowadays local anaesthesia is safe and allows efficient and painless treatment. Possible complications may include pain, haematoma and, in rare cases, nerve injury, allergic reactions, overdose with poisoning and cardiovascular events.
  • When taking an X-ray, the risks involved must be considered.
  • Your teeth may be more sensitive to heat and cold while wearing the temporary veneers as well as during the initial period after treatment. Therefore, when eating hot or cold food and drinks, a temporary unpleasant pain may occur.
  • In rare cases, veneers can become loose or break. In such cases, a new dental treatment and possibly creating new veneers may be necessary.
  • As the veneers are worn in the mouth, accidental swallowing or inhaling of all or part of them can occur. To prevent this, the condition of the veneers should be checked regularly and damaged veneers should be replaced immediately.
  • In rare cases, veneers may have a slight impact on your pronunciation. However, this usually only lasts until you get used to them. A longer-term impediment is a rare occurrence.
  • Caries, periodontitis, decalcification (permanent tooth marking) or gingivitis may occur, especially in the adhesive edge area, if oral hygiene and care of the veneers are not maintained.
  • The veneers can initially irritate the inside of the mouth (gums, cheeks, tongue and lips), which, although rare, can lead to wounds.
  • In rare cases, wearing veneers can impact on dental health and the life of the teeth may be shortened. In such cases, additional dental treatment such as endodontic treatment or other restorative treatments may be required, as may be the case with crowns.

Finishing:

  • In rare cases, removing the enamel during the contouring and reshaping may temporarily increase the sensitivity of your teeth.
  • The resin used for bonding is not as strong as a tooth. Biting hard foods or resistant materials, in rare cases may cause the resin to break.

Memotain® wire retainer:

  • In very rare cases, the Memotain® wire retainer may break, in which case there is a risk of injuring the oral cavity or swallowing parts of the wire. In this case, contact your bestsmile dentist immediately so that the appropriate action can be taken and a new wire retainer can be made.

Relax retainer (mouth guard for teeth grinding):

  • When grinding your teeth, especially at night, the teeth are pressed together with great pressure, whereby the chewing muscles work with stronger biting force than during normal chewing.
  • Problems that cause joint pain, discomfort, headaches or ear problems can also occur in the temporomandibular joint – but these are extremely rare. Please inform your bestsmile dentist of such problems immediately so that we can give you the best possible advice.
  • If you do not clean your teeth and relax retainer properly, you are at a greater risk of developing caries, periodontitis or gingivitis.