Enes Yusuf Gönül

The most striking sentence at our first consultation was: "I have actually wanted treatment for a long time, but I thought it was too late." There was marked crowding in the upper front region, irregularity in the lower front teeth and some bite problems. But what really brought the patient to the clinic was not just how the teeth looked: they avoided smiling in photographs, felt the need to cover their mouth while speaking, and had been hiding their smile for years.

After the first examination we assessed not only the alignment of the teeth but also the bite, the jaw relationships and the long-term stability of the treatment. One of the most important points for the patient was that treatment should disturb daily life as little as possible; so we went through the options in detail and built a plan around those expectations. Throughout, one of our priorities was not merely making the teeth "straight", but achieving a result in harmony with the face, functional and as stable as possible.

Over the months the alignment changed step by step. At the check-ups we followed not only the clinical change but also how the patient felt about the process. At one visit they told us: "I no longer hold myself back from smiling in photographs." That sentence was one of the most meaningful outcomes of the treatment for us. What changed at the end was not only the position of the teeth; the patient’s relationship with their own smile had changed too.

This case reminded me once again that orthodontics is sometimes not just about moving teeth. Sometimes it is about bringing back a smile someone has hidden for years. Every patient’s dental structure, expectations and treatment course are different, which is why an orthodontic plan must be prepared individually, after a detailed clinical assessment.

A 60-year-old patient from Istanbul had long been unhappy about a missing tooth in their smile and the irregularity of their teeth, yet had never seriously considered orthodontic treatment; to them, orthodontics seemed to belong to the world of the young. "It is too late for me now," they said.

When we carried out a detailed examination and radiographic assessment, the story turned out to be quite different. The tooth they had waited years to see had never erupted into the mouth: it lay impacted inside the jawbone. When we looked at the radiograph together, the patient’s first reaction was: "So my tooth was there all along…"

We planned the treatment by assessing not only the alignment but also tooth and gum health, the bone structure and the impacted tooth’s relationship with the surrounding tissues. We then spoke openly about the options and the patience the process would demand; this was not a case of "fit the braces and be done in a few months". The impacted tooth had to be moved in a controlled way, brought into the right position, and all of it done without harming the existing structures. There were moments of impatience along the way; my answer was always the same: "A little more patience. Your tooth has been waiting there for years; we need to give it some time."

And then the day we had been waiting for came: the tooth that had sat inside the jawbone for years began to show in the mouth for the first time. I still remember the astonishment on the patient’s face at the mirror: "I never thought I would see this at sixty." When treatment was complete, more had changed than the alignment of the teeth; the patient had achieved something they had long written off as "too late for me". This case reminded me once more that age is rarely the barrier to orthodontic treatment we assume it to be. What matters is usually not when you start, but the moment you decide to. Some smiles have no age.

When oral hygiene is not yet adequate and the patient cannot yet take on the responsibility the treatment demands, I prefer to postpone. Orthodontic treatment is not only about the forces the orthodontist applies; the patient's cooperation in daily care and check-ups is an essential part of it.

Sometimes a patient comes in over a small aesthetic detail. If the risk or burden of treating that minor irregularity outweighs the benefit, I prefer to say "I do not think you need this" rather than "we can treat it". In adult patients this matters even more: planning treatment around a purely aesthetic goal, without assessing bone and gum health, existing restorations, root condition and general oral health, is not right.

Another important point is unrealistic expectations. If the patient’s goal is not biologically achievable, it must be explained openly rather than promising a result that cannot be reached within healthy limits. Sometimes the most correct treatment decision is not to start treatment at all. To me, being a good orthodontist is not only knowing which treatment you can perform; it is also knowing in which patient, at which time and in which situation you should not.