CASE STUDY Precision and acceleration: utilizing advancements in orthodontic technology to achieve optimal results Dr. Edward Lin discusses efficient and effective digital innovations arlier this year, I followed the ground- These two case studies highlight tech- is much more effective when patients are Ebreaking thought leadership that came nologies that have had a major imprint diagnosed and treated at an early age, so out of the Davos World Economic Forum in on delivering more predictable and I encourage orthodontists to leverage this Switzerland, and I found that the theme of desirable results. Technologies such as advanced CBCT technology and collaborate the event, “Mastering the Fourth Industrial AcceleDent®, i-CAT™ FLX, 3D printers, with their local pediatricians and dentists. Revolution,” was an accurate description temporary anchorage devices (TADs), and of my treatment philosophy. The fourth in- the suresmile® digital software have evolved Digital impressions and 3D printing dustrial revolution is the notion of blurring the way that I practice orthodontics. I’ve My colleagues and I have been striving the boundaries that separate physical, studied each of these individually and how toward 100% digital-impression dentistry. It’s digital, and biological spheres. Typically, they work in tandem with each other to better for patient comfort, there’s no powder, patients want orthodontic treatment be- deliver precise results the first time. and it’s not messy. With our intraoral scanner cause they are seeking the perfect smile (3Shape TRIOS®), there’s never a need for or long-term relief from health challenges CBCT retakes, which creates efficiencies by saving such as sleep apnea, TMJ pathology, oc- Precision starts with having a very chair time. It also offers enhanced preci- clusal breakdown, or worn dentition as a clear picture at the beginning that dictates sion. Patient 2 in this case study was one result of patients living longer. It’s obvious where you want and need to end. Without of our aligner patients who benefitted from that these scenarios touch on the biologi- a doubt the i-CAT FLX has revolutionized this efficiency and precision. Since we have cal and physical spheres, and now we have digital treatment planning through cone our own EnvisionTEC Perfactory® Micro and digital innovations that enable orthodontists beam computed tomography (CBCT) that Perfactory® Vida 3D printers, we upload the to better deliver quality results efficiently and involves the shortest scan time and lowest digital intraoral scan to the suresmile cloud, effectively. radiation dose. CBCT 3D imaging gives us create the virtual digital occlusal treatment I practice alongside three orthodontists the most comprehensive views for evalu- plan, and then send to our in-house lab to at two practices in Wisconsin — Orthodontic ating airway, TMJ imaging, eruption paths, 3D print the aligner trays. This all happens Specialists in Green Bay and Apple Creek bone and nerve anatomy, and root positions in-house. It’s a major efficiency that allows us Orthodontics in Appleton. Together we’ve that we just cannot see and evaluate with to save on shipping costs, lab material, and beta tested and have been early adopters 2D imaging. In my opinion, I believe that payroll expenses, and it also helps ensure of innovative, disruptive, and transformative 3D imaging should be the standard of care, continuous patient engagement and motiva- technologies that have changed our profes- especially with the availability of low-dose tion from the consult to their start date. sion. My passion for technology stems from CBCT scanners. my enthusiasm to create healthy and beau- Cone beam technology is invaluable Accelerated treatment tiful smiles for patients and to far exceed when evaluating patients who have the risk When we talk to patients about all of the their expectations of orthodontic treatment. for obstructive sleep apnea syndrome (OSA) technologies that we use in our office for their The key to this is constantly evaluating new as is the case with Patient 1. Orthodontists orthodontic treatment, they are impressed, technologies that are introduced to ortho- are seeing an increase in patients who have but they still want to know how long is it dontics on the basis of safety, effectiveness, potential airway restriction. An American going to take, and if it’s going to hurt. They and how seamlessly they integrate into my Journal of Orthodontics and Dentofacial are intrigued and excited when we tell them current standard of care in clinical practice. Orthopedics article detailed how CBCT about AcceleDent and how the device’s can assess the dimensional changes of the SoftPulse Technology® has been clinically Edward Lin, DDS, MS, is a respected orthodontic upper airway in patients whose maxillary proven to speed up orthodontic treatment lecturer who practices at Orthodontic Specialists constrictions are being treated with rapid by as much as 50% while also relieving dis- in Green Bay, Wisconsin, and at Apple Creek 1 2,3 Orthodontics in Appleton, Wisconsin. A member palatal expansion appliances (RPE). The comfort. I’ve researched other acceler- of the American Dental Association, the study demonstrates from the CBCT that ated treatment technologies, but ultimately American Association of Orthodontists, and the the cross-sectional area of the upper airway decided to continue offering AcceleDent World Federation of Orthodontists, Dr. Lin is passionate about orthodontics and being an early adopter of at the posterior nasal spine to basion level because patients say it makes their teeth technology that makes treatment more enjoyable for patients significantly gains a moderate increase after feel better.2 The reduction in discomfort that and orthodontists. He completed dental school and orthodontic RPE. Orthodontists are in a unique posi- AcceleDent gives patients is the differentiator residency at Northwestern University and has been in private practice since 1999. tion with having the opportunity to evaluate among the current accelerated technologies. younger patients who may be at a higher risk Since we’re putting AcceleDent into the Disclosure: Dr. Lin has no conflicts of interest to report. for OSA. Treatment for airway restrictions hands of the patients and asking them to 20 Orthodontic practice Volume 7 Number 5 CASE STUDY use it for 20 minutes a day throughout treat- ment, it’s important that orthodontists explain to patients the science of how it works. We underscore that AcceleDent is the first and only FDA-cleared vibratory orthodontic device that uses gentle vibrations to accelerate bone remodeling at the cellular level. The prescrip- tion-only device is cleared for use in conjunc- tion with brackets or aligners. We also explain to patients that the SoftPulse Technology employs 25 grams of force at 30 Hz, which is 200 times less force than ordinary chewing. We evaluate compliance throughout treatment with our accelerated patients by asking them to bring their AcceleDent units with them to appointments, so that we can view the FastTrac Usage Report that’s avail- able via the USB charging port. Compliance is a non-issue for these patients because they want to complete treatment as fast as possible with no pain. Blending technologies in practice The following case studies illustrate how patients treated with the latest advancements in orthodontic technologies can achieve quality Figure 1: December 4, 2012 finishes with an accelerated treatment plan. Patient 1 The patient presented at his new patient examination on December 4, 2012, as a 47-year 3-month-old adult male. He was referred to our office by his dentist due to concerns with a Class III malocclusion, gingival recession, and incisal wear, which had devel- oped as a result of a dental sleep appliance that had been made by his sleep specialist. The patient’s sleep apnea was diagnosed 10 years prior. For the first 2 years, the patient’s sleep apnea was being treated with contin- uous positive airway pressure (CPAP) therapy, which he was not tolerating well. The patient Figure 2: September 25, 2013 was concerned about his “uncomfortable” bite and that his teeth were beginning to chip. Class II and Class III cases because they bilateral TADs (8 x 1.4 mm) in the mandibular His diagnosis in my office determined that he provide us with control that we previously did arch distal to the first bicuspids. The TAD was a Class III with generalized maxillary and not have in orthodontics. TADs give us skel- was tied with a steel ligature tie to his lower mandibular spacing (Figure 1). etal anchorage instead of dental anchorage first bicuspids for anchorage in distalizing with excellent control of the direction and the L7s only not the L5s and L6s (Figure 2). Treatment plan vectors of forces utilized with them. Active open coil springs were placed distal The patient was given two options for I estimated treatment time of 36 months to the upper laterals and distal to the lower treatment. The first and ideal option consisted due to the complexity of his case, but first molars. A closed coil spring was placed of treatment with full-fixed orthodontic appli- suggested his treatment length could be distal of UL5. The patient was instructed to ances in combination with two-jaw maxil- closer to 24 months if he used AcceleDent. wear Class III elastics full time and use his lary and mandibular advancement surgery The patient chose AcceleDent to minimize AcceleDent unit for 20 minutes daily. for Class III correction and to increase his the length of treatment. His treatment was Since the patient was using AcceleDent, I airway volume for correction of his OSA. The actually completed in 21 months. let the wire express for about 8 weeks before second option consisted of treatment with I brought him in for his second appointment. full-fixed orthodontic appliances in combi- Treatment summary Before accelerated treatment, I would have to nation with temporary anchorage devices On the patient’s full-bonding appoint- wait 10 weeks before checking on hygiene, (TADs).