Tooth rail: Perfect smile made by yourself, ZEIT ONLINE


  1. Page 1 – With do-it-yourself to straight teeth?
  2. Page 2 – “Only a few photos are not enough”

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The fact that the patients take their own impressions, however, causes skepticism among experts. As early as May 2017, the German Dental Association published a statement calling for the elimination of business models based on self-treatment. The position paper states that treatment is the sole responsibility of dentists and orthodontists and should not become a playing field for commercial providers. This point of view is not completely selfless, after all, the start-ups are competing with the doctors.

But there are also technical reasons for the position. If a patient only sends in impressions and pictures, other dental problems such as caries between the teeth, inflammation in the gums or jaw joint problems may not be detected. “In the practice, the patient is thoroughly interviewed, examined and the whole thing is confirmed by an X-ray image,” says Gudrun Lübberink. She is a member of the board of the German Orthodontic Society and runs her own practice in Düsseldorf. “Just a few photos and an impression taken by the patient, i.e. the layman, are not enough. That’s a medical error.”

If there is no visit to the doctor, other reasons for the treatment may also remain undiscovered. For the German Society for Aligner Orthodontics (DGAO) – i.e. for orthodontics with splints – two questions are particularly important: Does the patient have a cosmetic problem, does he simply not find his teeth beautiful? Or is there a medical reason for the therapy because the wrongly positioned teeth cause pain and damage the gums or other teeth? To differentiate these questions is often not so easy, says Lübberink. “If a patient comes with a cosmetic problem that he or she sees as cosmetic, often the crooked front teeth, the examination often reveals that there are reasons behind it that require urgent medical treatment,” says the expert. However, such problems are not apparent without a visit to the doctor.

Incorrect treatment threatens tooth loss

The German Dental Association therefore warns that, in the worst case, individual teeth could be lost by splints without orthodontic treatment. For a healthy tooth, the pressure exerted by the splints is not a problem: the tooth is shifted and grows into the new position by itself. However, if the gums and the periodontium are inflamed, the pressure becomes dangerous: the inflamed periodontium continues to decline. Then the tooth does not grow firmly again and in the worst case even falls out.

And even if everything goes well at first and the teeth are straight after a few months of wearing the splints, something may have gone wrong. “Some problems do not come to light until many years later,” says Lübberink. For example, teeth that have grown together with the jawbone and are moved with the tooth splints sometimes stand crooked in the gums and have contact with teeth that they should not actually touch. They rub each other’s teeth or cause pain and tension in the temporomandibular joint. An expert would see that, but the patient probably doesn’t.” As a doctor, I can only take a critical look at this Do-It-Yourself orthodontics without a thorough preliminary examination at the dentist,” she says.

SunshineSmile founder Khalil replies to the criticism: “If the therapy fails, the patient usually did not cooperate, i.e. did not follow the instructions. The company does not treat all types of malocclusion, and according to the website, it only deals with minor problems such as overlapping front teeth or teeth that are too tight. The start-up company does not treat children and adolescents because their teeth have changed too much.

Due to the problems with pure online therapy, other online providers are relying on stronger cooperation with orthodontists and dentists. So for example Dr. Smile. Dentist Aylin Selcuk, who specializes in orthodontics, works as medical director for the start-up, a competitor of SunshineSmile, and says: “We clearly distance ourselves from procedures in which the patient is not examined at least once by a dentist.

Your company offers dentists the opportunity to distribute the splints themselves. After patients have filled out a short questionnaire online, it refers them to treatment centres. There, as with Invisalign, images of the jaw and a treatment plan are prepared. As with SunshineSmile, the splint is sent to the patient’s home and must document the progress in the app. But: At least once during the six-month therapy, the patients have to go to one of Dr. Smile’s partner practices for a check-up appointment. The start-up approach is clear: it is not possible without medical expertise.

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Christina Cherry
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