The Invisible Orthodontist (TIO) is a network of UK specialist orthodontists dedicated to growing private orthodontic practices’ case starts through its digital marketing and practice consultancy services. It also offers ‘The Community’ - an exclusive online study club which convenes regularly to allow members to collaborate and discuss complex cases as a group - as well as an annual congress and a private clinical retreat each year. The result is that its members are able to treat a broader range of orthodontic cases with more confidence.
Sunil is the recent 2023 winner of the British Orthodontic Society’s Maurice Berman Award for Clinical Excellence. Sunil said, “This is a once-in-a-lifetime achievement and is the highest honour one can receive for one's work in clinical orthodontics from the British Orthodontic Society (BOS). Over the last 20 years, seven people have won it. A number have failed. I am now the eighth recipient of this prestigious prize. You can only enter if you have been a specialist for at least 10 years.
“To achieve this, three cases are presented with full records, including post-treatment records. The case complexity and variety has to be difficult and you are tested on your biomechanical skills, treatment outcome and stability. Two of my cases were treated with lingual orthodontics. All three cases involved extractions and mini-screws. I am very pleased about achieving this.”
Sunil’s four-hour magnum-opus was a high point for the specialist orthodontists attending TIO’s UK congress, which took place in Edinburgh. This was the first palatal TADs Masterclass of its kind to be run in the UK and was created exclusively for experienced orthodontists who are part of the TIO. At the start of his session, Sunil outlined some of the more common palatal TADs in use, showing placement from first principles and discussing the differences when selecting conventional fixed orthodontic appliances and aligners. He also examined the anatomy of placement sites and advantages and disadvantages of these sites, plus showed the mechanics of facilitating controlled tooth movements in the sagittal, transverse and vertical dimensions.
Crucially, there was a hands-on component of the course, which required all the Masterclass participants to practice placing TADs in the anterior palate, giving them both the practical skills and, importantly, the confidence to start using them immediately.
TADs have become a mainstay of contemporary clinical practice, offering virtually guaranteed control of anchorage for both routine and complex tooth movements. Palatal TADs offer a success rate of some 95 per cent Sunil is aware, however, that while many orthodontists understand the theory of using TADs, they shy away from incorporating them into treatments because they have so little hands-on experience with them (usually none).
Sunil commented, “Many outstanding clinicians have come from other countries – particularly Germany, South Korea or Japan, and shown the concept, but its very theoretical. It’s normally a PowerPoint presentation, and that’s where the journey ends…Orthodontists are practical people, they use their brain, their eyes and their hands all the time, so we had to tap into that and do something to ensure they didn’t leave the workshop until they’d performed the technique on a phantom head or a set of dental models to give them some basic skills on which to build.”
He stressed that his aim was also to ensure the orthodontists leaving his masterclass fully understood the history, evolution, design, placement, and clinical use of palatal TADs, how to incorporate them into treatment planning and patient care, how to select, place, and utilise palatal TADS in orthodontic treatment and had a clear understanding of the different protocols for using them with conventional fixed appliances and clear aligners.
His journey to using TADs began some 15 years ago. After reviewing numerous presentations, he decided he would seek help from the best practitioners. “That meant I was flying all over the world to learn from some of the best, but I knew that the investment in time and resources would pay dividends, and it has.”
He believes that many orthodontists are reluctant to use TADs because they are nervous about using a needle to give anaesthetic injections, plus they do not have anyone by their side to guide them the first time they place the TADs. “In addition, they’re worried about what happens if it goes wrong. The answer is they need practical training from someone who’s been doing it. I tell orthodontists if they need me in their clinic when they’re placing TADs for the first time, I can be there, and if they need me a second or third time until they get the hang of it, that’s fine too - I can be there with them.” This is a massive confidence booster, especially when using intricate parts that connect to each other.
The advantages of TADs, according to Sunil are numerous. He added, “Aligners can’t do everything; there are biomechanical limitations, so they cannot consistently achieve 100 per cent of all tooth movement. TADs allow almost impossible or very difficult tooth movements to be possible in combination with aligners. At the same time, the orthodontic market is being flooded with general dentists. Orthodontists, I’m afraid, have to distinguish themselves and must evolve with more advanced techniques or they are standing still. And if you are standing still in my world, you are moving backwards. So Orthodontists must raise their game.”
He pointed out that if approached correctly, patients are receptive to TADs. “The worst thing you can do is say to any patient, ‘We’re going to put some screws into your mouth’ because what comes into their mind is a six-inch screw bolted through their head like a Frankenstein! Once you’ve lost the confidence of the patient, they will no longer commit to and provide consent. The trick is to say you’ll be placing some ‘small studs’ in the roof of their mouth or gum, which allows for optimal treatment results not possible without them.”
He added that treatment, such as closing the gap of a missing upper lateral incisor, could be achieved using TADs in a much shorter time period or much more easily than with conventional fixed appliances and elastics.
Sunil said, “I want orthodontists to know that skeletal anchorage is their friend…It’s about pushing boundaries of care, aiming for excellence doing their best for the patient and giving them ideal or near ideal results. If they don’t embrace a course on skeletal anchorage or shy away from it, in my opinion, it’s very foolish and they will never improve.”
Delegates attending the Masterclass were unanimous in their appreciation of both the expert insights Sunil offered into using TADs and the opportunity for the practical skills for placing them under his expert guidance. As Anjli Patel of No1 The Orthodontic Specialists commented, "Sunil ran an inspirational TADs workshop and showcased a series of fantastically treated, complex cases. He shared the problems he has faced when using TADs and also how he has changed his philosophy over time. It was evident he was so passionate about orthodontics and had studied extensively to achieve orthodontic excellence. I was so pleased I made it to the workshop and am energised to follow suit."
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