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If you google ‘The Six Month Smile’ system over 35 pages of ‘documents’ including PR pieces related to this new system will be found. However, in this literature and elsewhere there does not appear to be a single citation related to scientific research of this orthodontic treatment. This includes data on potential risks, side-effects, and complications.

In an interview, Dr. Swain, a dentist involved in the training of dentists in this tooth movement ‘system’ states that ‘six month smiles’ “is a company that is focused on partnering with general dentists”… to….”help them implement our short term ortho system in their practices” http://www.theprofitabledentist.com/download/TPDSummer2010L.pdf. Dr Swain goes on to say that “short term ortho is a very patient friendly procedure and we make it dentist friendly by systemizing the process. Most of the procedure can be delegated and startup costs are extremely minimal”

To become knowledgeable about the system a dentist can take a two day seminar. According to Dr Swain, with this two day education a dentist should be able to start cases “the following week” Reportedly a clinician taking the two day course will have sufficient knowledge on numerous topics including “focused treatment planning, mechanics of tooth movement, excellent patient communication and technical skill via hands-on training” As a part of the ‘system’ the company also provides post-education case support for providers.

As noted in the above referenced article, “One of the keys to success with Six Month Smiles is the Six Month Smiles Patient Tray Kit™. The Patient Tray Kit is the backbone of the system. When a dentist submits a case to Six Month Smiles, a Patient Tray Kit is custom made for the patient and sent back to the office. The kit includes all of the items that are needed to treat that particular patient, including customized brackets, wires and custom bonding trays. Our bracket specialists set up the case by placing the orthodontic brackets in precise locations and fabricating the custom trays. The bonding trays make delivery of the brackets incredibly easy and efficient. It is as simple as seating a set of bleaching trays”

For a patient that is interested in pursuing this orthodontic treatment, information is provided on the official website of ‘Six Month Smiles, Inc.” On the site there are a variety of headings related to the product such as “what is it”, “patient stories” and “is it right for me” However, there is no section where supporting literature is displayed or citations provided related to past or ongoing research.

An individual entering the ‘is it right for me’ portal on the Web site is guided through a series of questions that are not meant to rule out patient participation based on some criteria involving known contraindications. All endorsed questions lead to the same conclusion: “Your answers indicate that you are a great fit for Six Month Smiles! Six Month Smiles will give you a beautiful final result in less time and at a lower cost than virtually every other form of cosmetic dentistry available today”
The ‘Six Month Smiles’ system appears to be an offshoot of the Invisalign system.

One of the purported reasons for the development of the ‘Six Month Smiles’ system is that the Invisalign system, based on the research, has not been found to be particularly accurate in achieving extrusion of the maxillary and mandibular incisors or in cuspid rotation or mesiodistal tipping of the maxillary cuspids using the programmed trays (Kravitz, et al, Am J Orthod Dentofacial Orthop. 2009, 135(1):27-35).

Dr Kravitz and his colleagues from the Department of Orthodontics at the University of Illinois School of Dentistry conclude that “We still have much to learn regarding the biomechanics and efficacy of the Invisalign system. A better understanding of Invisalign's ability to move teeth might help the clinician select suitable patients for treatment, guide the proper sequencing of movement, and reduce the need for case refinement”

In addition, the classic Invisalign system has been associated with potential adverse consequences including root resorption (N Brezniak, AWasserstein, Root resorption following treatment with aligners, Angle Orthod, 2008, 78(6):1119-1124).

In a case report study in the Journal of Dental Education (J Dent Educ. 72(8):948-967, 2008) that assesses the Invisalign appliance therapy for moderate to complex malocclusions, author R Boyd points out that “there have been two longitudinal clinical trials and one cross-sectional study that evaluated the Invisalign appliance. These first studies demonstrated that the use of this appliance was successful for several types of tooth movement, such as tipping, rotations of incisors, and closure of naturally occurring space. More difficult movements, such as bodily movement for extraction space closure, were less successful”

He goes on to further point out “however, these studies were done during the first four years of appliance development. The first of these studies was a study evaluating different appliance materials that are no longer used (soft versus hard material) and whether a one- or two-week interval before the patient progressed to the next aligner was more effective.

For the past eight years, the protocol for changing clear aligners has been two weeks of wear for each appliance. Invisalign appliances are now manufactured using a material with intermediate stiffness compared to the materials used in that study” A review of PubMed (pubmed.com) suggests that while prospective trials of the Invisalign system are limited and there are no randomized controlled trials, the treatment has at least been partially evaluated for over 10 years with case reports documenting its efficacy, contraindications, potential side effects, and risks.

Information of this type is important in providing guidance to the treating clinician in the decision making process. Treatment outcome is directly dependant on knowledge of what will work and not work based on patient presentation, known contraindications, risks, and the other limitations of the system. However, such scientific information appears to be absent from the available literature discussing the ‘Six Month Smiles’ system. Thus, while the technique may prove to be useful in limited situations, the clinician using (and the patient receiving) this orthodontic strategy should be aware of the lack of evidence in support of the therapy and proceed with caution.

A recent comparative study between orthodontists and general practitioners assessing the use of and opinion about the ‘Invisalign’ system suggests that while general dentists begin more cases than orthodontists there is an inverse relationship between the number of years of ‘certification’ in the system and the cases started for both groups. Further, this study showed that there was a significant difference in opinion between orthodontists and general dentists with respect to the amount of education necessary to treat cases such as the class 1 occlusion with a large diastema and the treatment of class 2 cases with the ‘Invisalign’ system (J Vicens, A Russo. Angle Orthod, 2010, 80(3):425-34).

Such differences in opinion between general practitioners and orthodontists may also be the case for the ‘Six Month Smiles’ system. If so, the general practitioner should be aware that the standard of care with respect to orthodontic treatment is based on what an orthodontist would do, not what a general practitioner might do based on his/her education about a system that does not appear to be evidence based.

Submitted by Dr Jeff Burgess, Editor in Chief