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STO Dialogue:
From Parodies and Sermons Towards Art and Science

Dialogue. STO means short-term cosmetic orthodontics for adults or short-term cosmetic teeth straightening for adults. Six Month Smiles (6MS) one of the STOs, is a new dental service which is currently much needed and very popular in Lithuania. It was established in the United States of America and spread around the world within the last decade. The United States pay much attention to the presentation of new services and leading discussion with clients on the issues related to new services, information and education of clients. Such discussion meets the public interest of any country and maintains the dialogue between clients and dentists as well as increases the quality of dental services. This article is the beginning of the dialogue between clients, STO specialists and the community of the Lithuanian dentists. This publication was also prompted by the article titled Primum non nocere – first and foremost do not make harm! (or 'Short-term Cosmetic Orthodontics for Adults'), which was published in March 2013 in the journal of the Lithuanian Dental Chamber by prof. Antanas Đidlauskas, dentist orthodontist.

doctor of technical sciences

I am not a dentist myself. I represent the clients and I have the knowledge of technology, management and law. In 2000 I was invited to VivaDens and I have been consulting them on these issues. Thus, in this article I am going to review a general dental situation as well as one of the cosmetic orthodontics for adults in Lithuania and worldwide from client’s perspective. My experience, education and scientific activity facilitate the situation because I have been deepening the knowledge of advanced dentistry application. In addition, I have taken a wide interest and researched and even developed VISUS-4D, a computer-based system for eye alignment which has been widely used in the world. Taking a deeper look, one may see that the straightening of the teeth and the eyes, which are closer to the soul, have the same general principles and even practical steps. For the convenience of dentists and persons concerned, here are the comments of specialists on STO issue.

Cosmetic dentistry. Dentist Ingrida Ivancë is the pioneer of minimally invasive direct esthetic restorations in Lithuania. Direct esthetic restorations have been carried out at VivaDens, Esthetic Dentistry Center since 2000. Until then the most renowned Lithuanian dentists did not provide such a service, because they did not consider it to be important, and some of them even asserted that such a service was not needed at all. Besides, the persons more concerned even threatened that both materials and technologies in Lithuania are probably not sufficiently certified and hardly all possible administrative permits have been obtained. It is a fact that at that time Lithuania was not a member of the European Union and such ‘regional reminders’ were based on certain grounds. However, such grounds were only ‚regional‘, because global science and application of its results are the same everywhere. Only habits and beliefs are regional. If scientific and technological method comes to be appropriate in one part of the world, it is also applicable and suitable in the other parts of the world. If it is appropriate for the USA or UK, then it is suitable for Lithuania too.

Life has shown that when there is public demand and interest as well as excellent quality and price ratio of service, it overcomes administrative hurdles. Particularly, when both parties do not avoid a dialogue. Now not only the services of direct esthetic restoration, but also indirect esthetic restorations and overall esthetic dentistry, which includes the esthetics of soft-tissue, hard facial and jaw tissues, are on the dental service lists of many renowned dental clinics.

It is known from general sciences and real life that everything what has evolved is natural and beautiful. Therefore, any field of medicine, including dentistry, must not only be healthy, but esthetic as well; unless in the beginning it could only be functional or pain-relieving. Unfortunately, in the traditionalist countries, where corruption, habits and beliefs prevail, the services and items may remain non-esthetic even longer.

Need for STO and its birth. Short-term cosmetic ortho for adults, as well as conventional ortho, was much needed even before establishment of VivaDens. Firstly, in order to save the highest degree of teeth tissue and its function, and later due to esthetics. After the advancement of esthetic dentistry, STO has become an urgent need, as it does not seem to be acceptable to ‘drill-off’ a tooth because of esthetics in cases when it is possible to move or turn it. However, there was a huge lack of orthodontists, more effective treatment methods, and the list of services as well as quality-price ratio were not acceptable to clients and dental clinics. Time consuming and insufficient esthetics contributed to avoidance of conventional orthodontics. The only way to find and spread any new suitable services and apply STO treatment was to take an active part in different scientific and practical courses as well as conferences, which demand a lot of financial resources, time and energy. STO, as direct and indirect esthetic restorations, implant surgery, started to become increasingly popular among clients and dentists. According to the law on appropriate application of STO and having a dentist’s knowledge and license, a dentist needs to undergo special courses, which is true for direct and indirect esthetic restorations, implant surgery and endodontics. A client, however, needs to review the service, and in case he/she likes it, to order such a service. The term of STO is six months on average. It is several times shorter, the braces placed on teeth are less visible and the price is similar to conventional orthodontics. Besides, in all cases it must be taken into account that conventional comprehensive orthodontic treatment and STO are unfinished dental treatments, or according to prof. Antanas Đidlauskas, STO is merely unfinished treatment. It seems that the professor is partial in referring such a statement only to STO. In both cases it is because of existing tensions in muscles, teeth lesions, lack of teeth, form, color, gingival diseases and the need for endodontics and implant surgery, etc.

There have already been many clients who have first tried conventional comprehensive orthodontics (TO) and then short-term orthodontics. One of them is Vitalija T., VivaDens and STO client. She has kindly shared treatment specifics and results with us.

Orthodontics is unfinished treatment. 'I have tried conventional comprehensive orthodontics with removable orthodontic appliance. I was wearing such orthodontic appliances for two and a half years since I was 14, and I could see no result. At the beginning I was promised that my bite would be restored in two years. In order to have my teeth straight and aligned I would need to have two of my back teeth extracted. But two years later I saw no change. I experienced much pain as the removable appliance interfered with my eating and speaking. They caused much discomfort. After two years they took out the removable appliances and offered that I have braces which would need to be worn for another four years. At that time I was disappointed with the dentist who did not help me achieve the promised result with removable appliances. Other orthodontists talked the same. Why should I trust in their recommendations again?'

The professor’s accusation of STO and its providers of it being unfinished treatment is suitable to all the orthodontic treatment. In general, only an informed client may decide which treatment method is to be chosen.

Let’s have a look at other reproaches of prof. A. Đidlauskas to clients and dentists who provide STO services.

Preaching or dialogue? The professor attributes the following adverts to the STO providers: 'Perfect smile in 6 months', 'Straight teeth within unbelievably short time', 'New treatment method with braces', but one could not find such adverts in Google, or to put it simply, by googling.

The professor also presents some scientific reasoning 'It needs to be acknowledged that these adverts are intriguing and I start asking myself, how is it possible that I have heard nothing about such 'miraculous' treatment methods in neither European nor global congresses of orthodontists? Thus you cannot help but open a website. It flows with plenty of comments of young widely smiling people who are thankful to their dentist for a dream which came true! You review all the photos presented and you do not find a single correct bite'.

After reading professor’s comments one may have the impression that the professor and his colleagues have plenty of examples displaying correct bites and parameters of their assessment. And, of course, photographs. Unfortunately, I did not succeed in finding any of such examples. We will supplement this article if we find or receive such photos from our readers. Let’s have a look at what aforementioned client Vitalija says about the bite treated by conventional orthodontics. "There was no photo registration for me or my friend. Conventional orthodontists did not perform any objective bite measurements. Here (in VivaDens) they told me that I would have to wear braces for half a year. The next month after the placement of braces I saw visible results, and my teeth were not extracted, in fact I did not experience pain and discomfort. The tooth, which was not in its place for all my life, returned to its place after three months. All the people around were surprised and shared happiness with me. Now it has already been one year since STO and my teeth are in place, I feel wonderful, and my bite is much better. Now I can feel that a tooth touches another tooth, something I could not feel before."

The majority of clients say the same. There is nobody for whom the anticipated results would be much different from those received. If they are different, they are usually more positive ones. Many clients come from abroad.

In the picture you fill find the teeth photos after the conventional comprehensive orthodontic treatment (on the left), we do not assert that this is a common result, and nearby (on the right) after STO treatment.

Vitalija’s T. smile and teeth after 2.5-years
of conventional comprehensive orthodontic treatment with removable appliances

Vitalija’s T. smile and teeth after 5 months of STO.

It is clear that clients need the dialogue with dentists who provide TO and STO services. For comparison of their treatment results, dialogue and informing clients and respective dentists, prof. A.Đidlauskas should present, at least on the website, the before and after photos of the clients treated in his own or other dental clinics as well their evaluation results, including the results with percentage. In such a case it would not be a sermon, but science and dialogue. We agree that all the dental clients and general public need answers, information and results.

Besides, we agree with the statement of prof. A.Đidlauskas that STO is unfinished dental treatment, but conventional comprehensive orthodontics is the same. STO is an additional service for clients which may be chosen at their own discretion. STO is orientated towards the teeth in the esthetic zone and aims at making the smile more esthetically attractive and correcting the bite as much as possible within the period of six months on average. Dentists are aware that the bite of the majority of people is not perfect, however, it functions properly. Nevertheless, all the cosmetologists and doctors work within a rather narrow scope.

Price of STO. The professor smiles in a preaching manner: "Several photographs of a smiling patient for the sake of advertisement on the website, invoice for the sum of LTL 5000-8000 (EUR 1450-2319), hand shaking and 'short-term orthodontic treatment' is finished. It looks as if everyone is pleased." Here one needs to believe that everything is much better in conventional orthodontics.

After two years of conventional orthodontics Vitalija says: "I paid LTL 600 (EUR 174) for orthodontic removable appliances, I was charged additionally for every appointment, the appliances would break frequently, and again I had to pay the sum of LTL 50-100 (EUR 15-29). In the beginning I was not informed about prices, and I was not told that I would be charged for every additional appointment. The appointments were scheduled every two weeks, each month. The appliances would break 4-6 times a year.

When I was offered braces, they told me that their placement would cost LTL 5000 (EUR 1450), and they did not tell me that I had to come for an appointment once a month. It appeared that each time I had to pay additionally, and it was not included into the amount of LTL 5000. My friend was wearing braces for three and a half years.

The teeth of my friends who had braces for three or more years and finally failed to get retention, i.e. the wires fixing teeth in the final position, returned to their old position. My friend’s mother found out and realized that the retention had to be placed. Somehow nobody offered that to her." We do not state that such price of a several-year treatment is too high. Let an informed client choose and make up his/her mind. However, this and other examples found in the media show that the client does not get enough information. Good criticism is fair and benevolent; it provides fair and sufficient information as well as encourages dialogue.

Law. Finally, the third argument of a respectable professor: "A patient has a right to choose. A patient may choose a treatment institution, a doctor, one or the other treatment method. However, he/she must be provided with all information about advantages and disadvantages of such treatment, and must also receive all information about 'short-term orthodontics'.

A dentist may also choose to do what he/she knows and is authorized to do, or take the risk by going beyond the limits of his/her competence because of doubtful financial benefit or other reasons."

It seems it sounds fine. However, the client noted earlier that she was not sufficiently informed about the price and results. Besides, the results anticipated by the doctor were not achieved. At VivaDens we prepare STO documents very carefully, inform clients in great detail and we continue to improve that. Having provided STO services to many clients, we have not faced any misunderstandings so far. Rather on the contrary. Clients are looking for STO, examining received results, the number of which, contrary to TO cases, is high enough and clients choose the treatment. The majority of STO clients are former TO clients or individuals who know TO treatment results. Such provision of information and right to choose corresponds to the Civil Code of the Republic of Lithuania as well as to medical science and practice in Lithuania and worldwide.

VivaDens client speaks about the provision of information and STO payments: "When STO was introduced to me, I was immediately told the price and that I would have to pay half of the amount in the beginning and later, within three months, I would have to pay the remaining sum. That proved to be true. Upon arrivals for my appointments I did not have to pay anything extra. Before STO, everything, including the need for oral hygiene, was explained to me. I had not received such information before I had the orthodontic appliances.

When my friends saw that in five months I achieved the result they could not reach in three years, they became discontented. Moreover, my braces were beautiful, esthetic, invisible at a social distance, whereas they had metal braces which were clearly visible at a distance. Now after STO I even do not know what else I could wish for. I feel comfortable, a tooth finds another tooth and I bite with all my teeth’. The teeth and bite of the client are still to be treated and beautified, though; STO stage provided comfort to her, self-trust and confidence in doctors as well as improved the quality of her life. That encourages her and her friends to value life, birthplace and work here, create for their own well-being as well as for welfare of others. There are also other responses about STO services at VivaDens, however not very good ones with respect to specialists of conventional orthodontics. Many of them would need to be verified. Clients do not need criticism and sermon, but practice, science and dialogue instead.

From parodies and sermon towards dialogue and science. We discovered STO in 2011 at the conference of the American Academy of Cosmetic Dentistry (AACD). Dental science, art and practice are united at most by the academy worldwide. State and academic establishments of the USA aim at reaching a client and customers as soon and as fast as possible. That bears good and beautiful fruit. STO, which was established in the USA, today is used not only in homeland, but in Europe, China, Australia, apparently in all advanced countries, where it increases the quality of life and brings joy. Such is the result of science and dialogue.

State officials and lawyers in Lithuania should take this into consideration. Here is a similar specific example:

State Consumer Rights Protection Authority (CRPA) of the Republic of Lithuania contacted VivaDens with various demands, the main of which was targeted against the fee of dental visit preparation costs, which encourages a client to treat an appointment in a responsible manner. Doctors come to appointments even from abroad and, besides, dental treatment requires quite an expensive preparation. Often an order is placed for special instruments and materials which are appropriate only to a particular client. Non-arrival of a client causes huge losses. They need to be shared between a clinic and a client. We felt that it is not likely that CRPA did not have understanding, but it exaggerates care for clients. The fee of preparation for service or appointment is usually included in the service price of hotels, airlines, banks and the price of other services, which means that in case a client fails to arrive at a hotel or cancels his/her arrival not in a timely manner, he/she will have to pay the costs incurred by a hotel, usually amounting to one day’s fee. Airlines follow a similar rule. A passenger may buy a cheaper ticket and take the risk of losing it in the event of inability to travel or he/she may buy a more expensive ticket with a right to change flight time. That is a matter of certain risk and agreement. CRPA came up with the idea that this applies for everybody, except VivaDens.

CRPA and later a district court demanded that standard-form agreement, which is acceptable everywhere else, does not suffice for VivaDens, and entire liability for non-arrivals of clients must be assumed by the clinic, which must be included into general costs of services. Not only CRPA, but also 1st District Court of Vilnius City, were preaching persistently.

The main mistake of their demands was that the costs of irresponsible clients are transferred onto responsible clients and the clinic. According to them, responsible clients must pay for irresponsible ones and, of course, the number of such clients would increase. The same way as weeds in a garden if not got rid of. The Supreme Court of Lithuania also supported such strange logic. The decisions based on such strange beliefs surely burden work and life of responsible employers and clients. Besides, it is obvious that following their footsteps, the number of irresponsible clients would increase, the service price would rise; therefore, responsible clients, the clinic and its employees would suffer. That has already been experienced. Bankruptcy is also possible. A few irresponsible clients and systematic corruption were beyond this case.

However, of course, the Sun does not disappear even in the darkest night. Moreover, the longest nights are not eternal. Because of strange decisions taken in respect of VivaDens, we had to change internal procedure regulations and warn our clients that the Consumer Rights Protection Agency and the Lithuanian courts require additional considerations particularly from VivaDens and them. We asked that our clients read several additional clauses of the contract and either agree with them and receive services at VivaDens or disagree and look for services somewhere else. Surprisingly, this unnecessary case and its results also have advantages. The number of irresponsible clients has decreased, whereas the number of responsible clients and employees has risen. Such is a good and beautiful result of the dialogue among responsible people in the setting of science, irresponsible agencies and courts.

Results of science and dialogue. So far only short-term cosmetic ortho for adults has been used in Lithuania and worldwide. For children, in the future it will probably become not only short-term, but also esthetic procedure. All the more so children eye straightening or treatment of their squint is already known. Straight sight is not only more functional, but it also creates a basis for stereovision and is also more esthetical. A special binarimeter was created in Moscow by prof. Igor Rabichev for restoration of stereovision and its training. It is wonderful that in Russia Mr Rabichev, not being an ophthalmologist, received a permit to straighten eyes for children and adults, and achieved brilliant results. He straightens eyes and creates space or stereovision for patients from 5 to 50 years of age. Over 6000 patients have already been cured. The ophthalmologists in Russia and Lithuania straighten eyes and only occasionally achieve stereovision. Lithuania has even had better possibilities because Visus 4D, a more advanced computer stereovision and stereoactivity system, which was created by me and serves for this purpose, can be used. It has much wider possibilities than the binarimeter of Igor Rabichev. Earlier, Visus4D was used in Lithuania and abroad rather narrowly, because the Ministry of Health of Lithuania refused to support its research. However, now when I attained financial and scientific independence, I have started continuing its research and improvement and we intend to apply Visus4D not only for restoration of space vision of the Lithuanian children, but also for research of stereoactivity in Lithuania and worldwide.

There is a saying 'Bend a tree while it is young'. It is quite true. It would be better to say 'Straighten a tree while it is young'. The same can also be said about teeth and eyes of people. But science and dialogue show that it is possible to straighten teeth and eyes in a short term for adults as well. That is already beyond the past as we know it, it is, however, the possibility of science, dialogue and practice. Our actions and wisdom will determine whether we implement it. We would rather continue a dialogue and improve services for the benefit of clients and society and even for the sake of our own interests. Then not only clients, but also dentists and other specialists will not run away from Lithuania, but instead, they will return here. They will return to live and make themselves more beautiful. From teeth to eyes and from body to soul.

Mecislovas Vrubliauskas, VivaDens advisor, doctor of technical sciences



Dentistry Specialists talk about Conventional Orthodontics and Short-Term Orthodontics for Adults


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