We’ve been expanding our team of late, and we’re exceptionally proud of one of our latest additions: Dr Graham Tinkler, one of the most experienced Invisalign providers to be found not just in this country, but across Europe. And he was kind enough to sit with me and answer a few questions. (P.S., If you don’t fancy reading it, you can find clips of our interview across our socials.)

Okay, so if I’m correct you’re a Platinum Elite provider, is that right?

Graham: Yes

If you could explain for us the ranking system, how it works and what that signifies about your experience.

Graham: So the Platinum Elite just means that the provider starts more than 150 Invisalign cases a year. There isn’t a level above that but currently, I think last year I did about 700 cases. But it’s primarily because that’s all I do. So I got into Invisalign nearly 20 years ago. I left university, my teeth were all crowded and I thought, ‘I need to do something about it’, but I didn’t fancy wearing a traditional fixed brace so I learnt how to do Invisalign just from a selfish point of view, because I wanted it. So I was my first patient with Invisalign, and then patients would ask about it and that’s how I got into it. And then after…certainly for the last 15/16 years that’s all I’ve done. So I think when you focus on one thing, and you’re doing it day in day out, then it’s easy to get the volume, and like anything it’s quite a steep learning curve, so the more experience you have, the better the outcomes, shorter treatment times, and happier patients.

And just touching on the traditional braces, would you say, if you could be as unbiased as possible, that Invisalign is more or less effective than a traditional brace?

Graham: Yeah, I mean there’s still a place for fixed braces. I’d say 95% of things we can correct with Invisalign. But the main difference is, whilst there’s lots of things we don’t like about fixed braces, in so far as frequent visits, they’re uncomfortable, you can’t clean them – you could argue the one good thing is they’re in there all the time, the patient can’t take them out. So us control freak dentists, we know they’re working 24 hours a day, whereas Invisalign, like any removable appliance, relies on the patient to be good at wearing them. So compliance is key: we’re only as good as the patient is at wearing them. But, fortunately, with Invisalign it is designed to fit around your lifestyle, we know there’s going to be good days, bad days, we know you can’t be wearing them 24 hours a day, which is why we offer refinements. So if you got to your last set and there was something you weren’t completely happy with, we can always make a few extra sets, and those extra sets are always included in the package. Which is why we can confidently sit here and say I know we’ll get the teeth to a position you’ll be happy with, because we have the luxury of making extra sets. So, the hardest thing to put your finger on is how long it will take. The better the patient is at wearing them, the shorter the time frame.

And what’s involved in the Invisalign process?

Graham: It’s quite straightforward. When I first started doing Invisalign we used to have to use that horrible putty, that mouthful of putty, now things have moved along a little bit, now we have the Itero scanning machines. So the first stage is just to meet the patient, have a quick look, make sure they’re suitable, and then it’s the case of getting some measurements, so we get a 3D scan, get some x-rays, get some photos, all of that goes off to the States. And then we’re one of the few practices that will produce a 3D model of the patient’s teeth, I’ll have already spent some time playing around with the 3D models. So my time is best spent treatment planning. When the 3D models come back from the States, it’s just a computer – spits them out. And the mistake I used to make 16 years ago, and it would be the mistake a lot of dentists still make now, would be to accept the first thing that comes back. So I know when these models come back that’s the opportunity for me to say okay don’t do that, don’t move this, we don’t need an attachment there but put one here. So my time spent at that stage pays dividends in terms of reduced treatment time but more importantly a more predictable and better outcome. So we can send this 3d model to the patient and I’ll do a little voiceover, talk the patient through it, and try to sort of preempt any questions they might have, but then the patient and I can discuss it in a bit more detail. So all of that, that kind of comprehensive assessment and details doesn’t come at a cost to the patient, but it’s almost as important for me to plan the treatment as it is for the patient to be able to visualise the end result. You’ll know to the week how many sets they’ll need to get from A to B, so it already answers a lot of questions. So that’s probably the key part of the treatment. 

Is there any kind of aftercare that happens?

Graham: Most of my adult patients unfortunately had braces when they were younger. And back then there wasn’t maybe the emphasis on retainers. You weren’t given something or you were given something and told to wear it for a year. These days the retainer protocol is the same, it doesn’t matter how you move the teeth, whether its traditional braces, Invisalign or any other type of brace, you’d be told the same thing. Retention is lifelong. If it’s Invisalign you’ll have the Vivera lifetime retainers, so you’ll get three sets, they’re all identical, just put two away somewhere in case you lose one. But the idea is you wear it most nights, certainly to begin with, and then gradually over time you can begin to wear them less. But you’d always have to wear them, even if it’s just a couple of nights a week. It’s the only way we can guarantee the teeth don’t try to move. The other option is a fixed retainer, it’s like a little strip we can fit, its custom made, just follows the contours of the teeth, it’s usually the lower six teeth or the upper four teeth, they’re the teeth that tend to move the quickest, so we can put a fixed retainer on those teeth stops them moving independently, but even with that we’d still make a nighttime retainer to wear over the top, the difference is from day one you‘re only having to wear it one or two nights a week, so sometimes that combination works well, from a practical point of view.