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by Dr. Thomas Pitts the marketing hype and salesperson’s rhetoric. When Dr. Larry Andrews introduced his straight-wire appli- Orthodontic technology has evolved a great deal in ance in 1970, he was met with significant skepticism just the past decade alone and, like any change, it has and the technology took more than 20 years to pene- not been without some amount of criticism and contro- trate the market. That philosophy is now a standard of versy. While a healthy debate is good for the industry, care in practices all around the country. The same is there’s no doubt that some technologies are allowing cli- true of extraction practices; we now know that extrac- nicians to deliver much more sophisticated treatment to tion doesn’t improve stability of lower incisor crowding patients by eliminating the one-size-fits-all approach. to any great degree. I now find that I only need to Enhanced diagnostic tools, advanced appliance design extract on a small percentage of cases. and even personalized smile design have revolutionized Such is the case with contemporary diagnostic and treatment planning for the practitioner and results for treatment techniques. As these gain momentum, it’s the patient. Some of the most groundbreaking new crucial for practitioners to examine clinical evidence in developments in orthodontic treatment technology making the best decision for your patients and your make accurate, comfortable and fast treatment more practice. As technology evolves and we learn to exam- accessible for the patient and provider. ine new theories and systems with a critical eye, we are able to collectively and collaboratively shape the future The Need for Evolution of the industry for the betterment of our patients and As is the case in life and in business, change is our profession. Multiple case reports are good evidence sometimes difficult. When it comes to providing supe- of the advancements in technology. rior quality of care for patients, employing only the most advanced technology is paramount. Not only can Enhanced Diagnostics innovative technologies deliver outstanding results but One of the most exciting new diagnostic tools is the the use of cutting-edge techniques can become a crucial use of CBCT. In-office CT scans of the patient’s head differentiator for practitioners in an increasingly com- reveal the entire three-dimensional landscape of the petitive marketplace. skull, jaw and underlying bone structure providing vis- To be sure, there is good reason for skepticism of ibility and clarity of the dentition and related jaw/joint the “latest and greatest”; we want to make certain that situation never before possible. Where conventional X- new products and techniques offer real benefit beyond rays force the clinician to make treatment planning

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decisions based on the interpretation of two-dimen- virtually every patient, relying on his or her profes- sional shadows, a CT scan can reveal the exact position sional expertise to place these cookie-cutter appliances of impacted teeth or identify problems that would have on the patient’s teeth to get the best possible result. otherwise been hidden to the practitioner. The 3D Today, new methods of indirect bonding employ images can be manipulated and viewed from virtually the use of precision, 3D computerized models to deter- any angle, providing an incredibly powerful tool for mine optimal bracket placement well in advance, then treatment planning and evaluating results. design customized brackets and wires to deliver the pre- The use of CBCT scanners has generated some scribed results. Even better for the patient, these cus- controversy on two fronts. First, most dental radiolo- tomized braces can deliver excellent results quickly and gists insist they must interpret the results in order to comfortably compared to one-size-fits-all appliances. provide the most thorough and accurate diagnosis. For example, the Insignia system of customized This would most certainly add to the overall cost of braces (Ormco Corp., Orange, California) offers treatment, an expense most practitioners are reluctant sophisticated software for smile design that enables to incur, especially given the fact that they have inter- the orthodontist to determine the precise end-result preted 2D X-rays on their own for years. placement of each tooth in a 3D virtual model. The risk of radiation exposure to the patient has Brackets are supplied and applied using precision also given rise to critics who claim in-office CT scans placement guides that ensure accurate positioning are dangerous. The assumption here is that they based on the Insignia model and pre-determined deliver radiation on par with medical-grade scanners. treatment plan. The Insignia placement guides are In fact, the typical five-second CBCT scan for ortho- precise and can create office efficiencies such as assis- dontic purposes exposes the patient to about the same tant delegation (in states where applicable). The clin- radiation as two conventional panoramic X-rays and ician’s time can be freed for more advanced treatment far less than a full series of dental X-rays. However, the planning and new patient consultation. resulting volume of data is worth far more than any The combination of customized brackets and wires number of conventional X-rays could ever provide. is not only more convenient and efficient for the practi- tioner but also for the patient. There’s usually less need Customized Smile Design to reposition brackets during treatment, and typically Twenty years ago, braces were braces. Most practi- fewer appointments needed. This fact even affords tioners used “off-the-shelf” brackets and wires to treat greater opportunity for optimum practice efficiency. continued on page 50

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The Next Frontier during treatment, Damon Clear brackets offer the As the results we can achieve improve by leaps and same speed, convenience and comfort of Damon’s sig- bounds, we’re seeing a greater number of adult nature passive self-ligating technology in a virtually patients, as well as adolescents, who are more image- invisible bracket. conscious, expressing concern about the aesthetics of braces. Of course, they do realize that the ends justify The Ultimate Goal the means, but many still prefer more discrete treat- Ultimately, the primary goal of every practitioner ment options that don’t draw attention. and every solution is to provide long-lasting, opti- Lingual braces and clear braces that leverage the mum results for the patients with minimal discomfort latest advances in treatment technology are the next and disruption to their daily lives. Today’s orthodon- frontier. Lingual braces have long been considered tic technologies – and those on the horizon – are one of the most difficult orthodontic treatment pro- allowing us to achieve these objectives in ways that grams, simply for the challenge in proper placement many of us could have never imagined 20 years ago. of the brackets and wire changes. The STb light lin- The use of more advanced techniques, gentler forces gual system (Ormco) provides the aesthetics patients and working with the body’s own natural tendencies want with a low-profile design and low-force, low- now enable us to treat a much wider range of cases friction mechanics that make them comfortable for with a much smaller percentage of invasive surgery, the patient with minimal speech interference. This palatal expanders or extraction. system is an ideal alternative to clear aligners, pro- The move toward more comfortable, more conven- viding fast, precise treatment in a wider range of ient treatment is a big asset to the patient. As sophisti- cases and eliminating the problems of lost trays and cated technologies yield increasingly impressive results, lack of patient compliance. a growing number of patients are looking to orthodon- Recent advances in the reliability, durability and tic treatment to enhance their smile, self-esteem and stain resistance of clear brackets is also making ortho- even their overall facial appearance. As the market dontic treatment more appealing for a greater num- expands and the use of technology increases, efficiency ber of patients. For example, Damon Clear braces of treatment and practice management are critical fac- (Ormco) integrates the Damon System’s proven self- tors in the sustainable growth of any orthodontic prac- ligating bracket technology with a polycrystalline alu- tice. Just as the hydraulic lift revolutionized the dental mina bracket that is highly resistant to staining from chair, new orthodontic technologies can not only coffee, mustard, red wine and other known stain- streamline patient care but also change the way we do causing foods. Featuring a laser-etched pad on the business as they become part of the mainstream stan- bonding surface and enhanced strength for durability dard of care. n

Author’s Bio

Dr. Thomas Pitts is a practicing orthodontist in Reno, Nevada and Anaheim, California. With more than 40 years of experience, he’s treated more than 20,000 patients by employing the most advanced emergent technologies and techniques to provide the fastest, most comfortable and most precise results possible. Dr. Pitts earned his dental degree from University of the Pacific and his Master of Science in Orthodontics degree from the University of Washington. He is a member of the American Association of Orthodontists, the Pacific Coast Society of Orthodontists, the Northern Nevada Dental Society, the American Dental Association, the Nevada State Dental Association and the Progressive Study Group. He is an associate clinical professor of orthodontics at University of the Pacific Arthur A. Dugoni School of Dentistry in San Francisco.

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