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Tạp chí chỉnh nha OPUS tháng 03+04/2014 Vol 5 No.2
clinical articles • management advice • practice profiles • technology reviews Learn more at Sirona3D.com March/April 2014 – Vol No PROMOTING EXCELLENCE IN ORTHODONTICS Posterior occlusal guides The biology of orthodontic tooth movement, part Dr Michael S Stosich Dr Colin Gibson The use of Propel to increase the rate of aligner progression Dr Thomas S Shipley Practice profile Dr Stuart Frost PAYING SUBSCRIBERS EARN 24 CONTINUING EDUCATION CREDITS PER YEAR! Occlusal philosophy: investigating the reasons orthodontists have for occlusion preference Drs Colin M Webb and Donald J Rinchuse AAO Preview ORTHOPHOS® XG 3D ClearCorrect™ correction of a Class I impinging deep bite with crowding • Faster clinical workflow with Ortho template and “Quick Shot” mode • Unprecedented image clarity with ASTRA for 2D images • Automatic positioning for 2D pan Drs Larry W White and Kim Fretty CUSTOM: YOUR STYLE, YOUR WAY INTRODUCING THE WORLD’S FIRST BUILT-TO-ORDER CUSTOM PRESCRIPTION BRACKET You’re in the driver’s seat with Damon™ Custom For the first time, you can choose the exact prescription values you and your patients need Order a popular Rx, modify an existing Rx or create your own ENJOY THE FREEDOM OF CUSTOM LIMITED-LAUNCH SPRING 2014 Visit ormco.com to reserve your kits today! © 2014 Ormco Corporation EDITORIAL ADVISORS Lisa Alvetro, DDS, MSD Daniel Bills, DMD, MS Robert E Binder, DMD S Jay Bowman, DMD, MSD Stanley Braun, DDS, MME, FACD Gary P Brigham, DDS, MSD George J Cisneros, DMD, MMSc Jason B Cope, DDS, PhD Neil Counihan, BDS, CERT Orth Eric R Gheewalla, DMD, BS Dan Grauer, DDS, Morth, MS Mark G Hans, DDS, MSD William (Bill) Harrell, Jr, DMD John L Hayes, DMD, MBA Paul Humber, BDS, LDS RCS, DipMCS Laurence Jerrold, DDS, JD, ABO Chung H Kau, BDS, MScD, MBA, PhD, MOrth, FDS, FFD, FAMS Marc S Lemchen, DDS Edward Y Lin, DDS, MS Thomas J Marcel, DDS Andrew McCance, BDS, PhD, MSc, FDSRCPS, MOrth RCS, DOrth RCS Mark W McDonough, DMD Randall C Moles, DDS, MS Elliott M Moskowitz, DDS, MSd, CDE Atif Qureshi, BDS Rohit C.L Sachdeva, BDS, M.dentSc Gerald S Samson, DDS Margherita Santoro, DDS Shalin R Shah, DMD (Abstract Editor) Lou Shuman, DMD, CAGS Scott A Soderquist, DDS, MS Robert L Vanarsdall, Jr, DDS John Voudouris (Hon) DDS, DOrth, MScD Neil M Warshawsky, DDS, MS, PC John White, DDS, MSD Larry W White, DDS, MSD, FACD CE QUALITY ASSURANCE ADVISORY BOARD Dr Alexandra Day BDS, VT Julian English BA (Hons), editorial director FMC Dr Paul Langmaid CBE, BDS, ex chief dental officer to the Government for Wales Dr Ellis Paul BDS, LDS, FFGDP (UK), FICD, editor-in-chief Private Dentistry Dr Chris Potts BDS, DGDP (UK), business advisor and ex-head of Boots Dental, BUPA Dentalcover, Virgin Dr Harry Shiers BDS, MSc (implant surgery), MGDS, MFDS, Harley St referral implant surgeon PUBLISHER | Lisa Moler Email: lmoler@medmarkaz.com Tel: (480) 403-1505 MANAGING EDITOR | Mali Schantz-Feld Email: mali@medmarkaz.com Tel: (727) 515-5118 ASSISTANT EDITOR | Elizabeth Romanek Email: betty@medmarkaz.com Tel: (727) 560-0255 EDITORIAL ASSISTANT | Mandi Gross Email: mandi@medmarkaz.com Tel: (727) 393-3394 DIRECTOR OF SALES | Michelle Manning Email: michelle@medmarkaz.com Tel: (480) 621-8955 NATIONAL SALES/MARKETING MANAGER Drew Thornley Email: drew@medmarkaz.com Tel: (619) 459-9595 PRODUCTION MANAGER/CLIENT RELATIONS Adrienne Good Tel: (623) 340-4373 Email: agood@medmarkaz.com PRODUCTION ASST./SUBSCRIPTION COORD Jacqueline Baker Email: jbaker@medmarkaz.com Tel: (480) 621-8955 MedMark, LLC 15720 N Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Tel: (480) 621-8955 Fax: (480) 629-4002 Toll-free: (866) 579-9496 Web: www.orthopracticeus.com SUBSCRIPTION RATES year (6 issues) years (18 issues) $99 $239 © FMC 2014 All rights reserved FMC is part of the specialist publishing group Springer Science+Business Media The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it The views expressed herein are those of the author(s) and not necessarily the opinion of either Orthodontic Practice US or the publisher Orthodontic practice AAO consumer messaging impacts adults’ orthodontic treatment decisions In today’s image-conscious world, professional adults who did not have the opportunity for treatment while they were growing up are flocking to orthodontic offices These new orthodontic patients are happy with their results posttreatment, according to a recent American Association of Orthodontists (AAO) survey of individuals who, as adults, had orthodontic treatment provided by orthodontists: • Of adults surveyed, 75% reported improvements in career or personal relationships, which they attributed to their improved post-orthodontic treatment smiles • Citing newfound self-confidence, 92% of survey respondents say they would recommend orthodontic treatment to other adults The AAO recently debuted a public relations initiative, the Adult Patient Hall of Fame The Hall of Fame celebrates the choices of adult professionals who have compelling stories and who pursued orthodontic treatment from AAO member orthodontists Inductees include Amielle Zay Abshire, a private jet pilot in her early 30s who flies celebrity and high-profile passengers around the world and wanted to greet them with a wonderful smile Another inductee, Dr Steven Couch, is an ophthalmologist affiliated with Washington University in St Louis, one of the most prestigious medical centers in the country Dr Couch did not have orthodontic treatment as a youngster, and in his early 30s felt the time was right The number of adult orthodontic patients increased 14% from 2010 to 2012, to a record high of 1,225,850 patients ages 18 and older More men are also opting for orthodontic treatment As of 2012, 44% of adult patients were male, a 29% increase as compared to 2010 survey results These data are from the 2012 AAO’s “The Economics of Orthodontics” survey The AAO is working to ensure that all adults who are candidates for orthodontic treatment seek out qualified orthodontists when they are ready to begin The AAO Consumer Awareness Program, which began in 2006, has utilized national advertising in all types of media, as well as public relations campaigns and social networking initiatives, to educate the consumer as to the orthodontist’s unique qualifications In 2012, the Consumer Awareness Program expanded its focus beyond reaching parents of children and teens to messaging and media placements intended for adults who could benefit from treatment Ads from the 2012-2013 My Life My Smile My Orthodontist.® campaign appeared in national media outlets in the United States and Canada and regional outlets in Puerto Rico The ads continued the core message that orthodontists are specialists with advanced training in straightening teeth and aligning jaws, with many of the ads showcasing adult patients The 2013-14 My Life My Smile My Orthodontist.® campaign is taking a similar approach and will reach nearly 350 million consumers by this summer Adult patients are also profiled in a series of professionally produced testimonial videos that the AAO makes available for member use and are showcased on the AAO consumer website — mylifemysmile.org Data indicate that the My Life My Smile My Orthodontist.® campaign is having a positive impact on adult patient decisions about orthodontic treatment In 2010, Millward Brown, a research company retained by the AAO, began conducting consumer research designed to track consumer decisions about orthodontic treatment before and after the launch of the My Life My Smile My Orthodontist.® campaign in 2012 Adults wearing braces and receiving treatment from orthodontists increased from 76% in 2011 to 83% in the third quarter of 2013 Adults utilizing clear aligners and receiving treatment from orthodontists increased from 56% to 59% during the same time period The Adult Patient Hall of Fame and other current initiatives were designed to help expand these positive trends Materials from the My Life My Smile My Orthodontist.® campaign are not just for use by the AAO They are also available to develop customized advertising for member practices and/ or for use on member websites and social media pages Many AAO members use association materials in local promotion of their practices Dr James “Jep” Paschal, current chair of the AAO Council on Communications, recently offered some insightful remarks on this topic “The value of the Consumer Awareness Program (CAP) program for the individual orthodontist is more than just marketing your practice, although the materials are often very effective for that purpose,” said Dr Paschal “It provides an opportunity to reinforce the AAO’s national campaign and help shape the thinking of the public so that when people think of orthodontic treatment, they automatically think of an orthodontist.” To learn more about the AAO Consumer Awareness Program and customizable marketing materials, visit the AAO member website www.aaoinfo.org Dr Gayle Glenn Gayle Glenn, DDS, MSD, has an orthodontic practice in Dallas, Texas, and is president of the American Association of Orthodontists Volume Number INTRODUCTION March/April 2014 - Volume Number TABLE OF CONTENTS Clinical Posterior occlusal guides Drs Larry W White and Kim Fretty discuss simple, inexpensive, and patient-friendly supplements to the Class II corrector armamentarium 18 Practice profile Dr Stuart Frost Research Evaluating the diagnostic value of lateral cephalogram radiographs Drs Jay V Patel, Harold Slutsky, Jeffrey Godel, Jie Yang, and James J Sciote study the necessity of lateral cephalograms for orthodontic diagnosis 28 Technology, creativity, and patient care are hallmarks of Dr Frost’s practice Occlusal philosophy: investigating the reasons orthodontists have for occlusion Drs Rohit C.L Sachdeva, Steve Moravec, and Takao Kubota discuss the application of SureSmile® technology in the management of patients presenting with Class malocclusions preference Drs Colin M Webb and Donald J Rinchuse delve into functional occlusal schemes 32 Orthodontic concepts Management of Class non-extraction patients: part ON THE COVER Cover photo courtesy of Dr Thomas S Shipley Article begins on page 52 Orthodontic practice Volume Number - TO FINISH ted Trus uct Prod s - - FROM START - RT-STA OM FR - FINI TO SH How you define innovation? If We Toss Innovation Around Like We Own It…It’s Because We Do When you think GAC and innovation, you probably think of our In-Ovation brackets But at GAC, innovation is so much more • Innovation is GCARE reshaping the educational landscape • Innovation is GACPowered.com giving you the ability to grow your practice • Innovation is the UOBG harnessing the power of group buying So the next time you think of innovation in orthodontics, think beyond the bracket Think GAC 800.645.5530 newdentsplygac.com TABLE OF CONTENTS Case study ClearCorrect™ correction of a Class I impinging deep bite with crowding Dr Colin Gibson presents a case that previously would need fixed-appliance therapy 37 Banding together Thu’s story After decades, a postcard from a former patient proves to Dr Jerry Clark that changing a smile also changes a life 40 Product profile New innovations from Ormco Corporation .42 Continuing education Buccolingual inclinations of maxillary and mandibular first molars in relation to facial pattern Drs Lindsay E Grosso, Morgan Rutledge, Donald J Rinchuse, Doug Smith, and Thomas Zullo investigate buccolingual inclinations of patients with dolichofacial, brachyfacial, and mesofacial vertical facial growth patterns 43 The biology of orthodontic tooth movement part 3: the importance of magnitude Dr Michael S Stosich delves into the clinical consequences of force magnitude 50 Orthodontic practice 43 Buccolingual inclinations of maxillary and mandibular first molars in relation to facial pattern Product insight The use of Propel to increase the rate of aligner progression Dr Thomas S Shipley discusses increasing the bone remodeling rate for more rapid aligner progression .52 Practice management reasons you need to re-evaluate your digital marketing strategy Diana Friedman discusses ways to keep online marketing strategies fresh .60 Service profile Industry news Who is ”minding the store” of your practice? 58 Groundbreaking clinical trial evaluates faster tooth movement with clear aligner treatment using AcceleDent® OrthoAccel® Technologies, Inc., enrolls first patients to start 12-week orthodontic evaluation 64 Materials & equipment .59 Volume Number 3SHAPE ORTHODONTICS™ DIGITAL SOLUTIONS FOR CLINICS AND LABS EASY DIGITAL IMPRESSIONS IN COLORS ONE-STOP ANALYSIS TOOLBOX CAD DESIGN OF APPLIANCES TREATMENT PLANNING & ANALYSIS CAD DESIGN OF ALL TYPES OF APPLIANCES 3Shape Orthodontics™ 2013 3D scanning, archiving, treatment planning & analysis, patient management, communication tools, and CAD appliance design 3shapedental.com/orthodontics PRACTICE PROFILE Dr Stuart Frost What can you tell us about your background? My father was a dentist, and my twin brother and I would go down to his office when we were teenagers and fool around in his dental lab We knew we would be dentists when we graduated from high school I have three brothers-in-law that are dentists as well After graduating from dental school at the University of the Pacific School of Dentistry (UOP), I worked with my father for years before going back to school I spent a year doing a TMJD fellowship in Rochester, New York I learned how to read MRIs and make splints to treat patients who suffered from acute and chronic pain After that, I completed my orthodontic residency at Eastman Dental Center I have been in practice for 13 years, and my passion is creating beautiful smiles Why did you decide to focus on orthodontics? I have always had a fascination with the creating process, especially in dentistry I loved cosmetic restoration cases as a general dentist, but I wanted more I wanted to be able to create a beautiful smile without grinding the teeth down and adding porcelain to create the smile The other motivation for me to go into orthodontics was the fact that patients want to be at the orthodontist They love braces, and it is fun to see them so excited about improving their smiles Going to work each day is a pleasure! Not a downer! How long have you been practicing, and what systems you use? I have been practicing for 13 years with the Damon™ System Who has inspired you? I have been inspired by Dr Dwight Damon and Dr Tom Pitts I learned early on in my career which orthodontists had the most beautiful cases Dwight and Tom are two of the best orthodontists in the world What is the most satisfying aspect of your practice? The most satisfying aspect of my practice is the end result It is very satisfying when Orthodontic practice The most satisfying aspect of my practice is the end result It is very satisfying when treatment is finished, the final shaping of the smile and teeth are done, and seeing the patients so happy with their new smiles treatment is finished, the final shaping of the smile and teeth are done, and seeing the patients so happy with their new smiles Professionally, what are you most proud of? System to streamline our workflow and eliminate PVS impressions, which has helped us enhance the patient experience and make our practice a state-of-the-art digital environment for efficient treatment I love teaching, especially love to teach the residents at UOP in the orthodontic department I am also very proud of being able to teach other orthodontists how to be better at using the Damon System and share what I have learned over the past 13 years What has been your biggest challenge? What you think is unique about your practice? What would you have become if you had not become a dentist? Our practice treats about 50 percent adults We pride ourselves on communicating with them Additionally, we are now using Ormco’s Lythos™ Digital Impression I would have become a plastic surgeon I love helping others make positive changes in their lives, and I could have enjoyed that The biggest challenge in practice is the business side of orthodontics Also, working with staff members and assembling the right team players and keeping them motivated to succeed Volume Number I still believe that the future of dentistry as a whole is bright The future of orthodontics lies in technology Patients are willing to pay for technology, and they recognize the practices that continually are striving to keep up on the latest advances in orthodontics What are your top tips for maintaining a successful practice? The most important tip for maintaining a successful practice is patient care Not just being good at straightening teeth, but taking care of the patient from the initial phone call to the day the braces come off What advice would you give to budding orthodontists? I would encourage young budding orthodontists to ask themselves three questions What kind of an orthodontist you want to be? What kind of orthodontics you want to do? Where you want to be in years? Write it down! What are your hobbies, and what you in your spare time? I enjoy going to the lake and wake surfing I love to golf, ride mountain bikes, and motorcycles In my spare time, I like to watch football OP Top Ten Favorites Beautiful smiles Damon™ Q brackets i-CAT® cone beam 3D imaging Lythos™ Digital Impression System G25 Nautique wakeboard boat Cancun First-class seat Titleist ProV1x™ golf balls Mexican food 10 Oversized recliner Volume Number Orthodontic practice PRACTICE PROFILE What is the future of orthodontics and dentistry? ORTHODONTIC CONCEPTS Management of Class non-extraction patients: part Drs Rohit C.L Sachdeva, Steve Moravec, and Takao Kubota discuss the application of SureSmile® technology in the management of patients presenting with Class malocclusions Introduction The Class malocclusion does not simply manifest itself as a sagittal problem of the craniofacial complex Its etiology and manifestation is a result of a blending of a complex of elements that also have a temporal and functional component Careful dissection, planning, and management of the contributing factors, and the three-dimensional recognition of the morphological and spatial components of the presenting malocclusion play a significant role in the efficient and effective care of these patients Table provides a list of high-level factors that need to be considered in formulating a plan of care for a Class patient The focus of this paper is limited to discussing the application of SureSmile® technology1-10 in the management of patients presenting with Class malocclusions by discussing specific patient histories Table 1: Considerations in the management of Class patient treatment II Application of SureSmile in treatment of patients with Class malocclusion In general, SureSmile technology provides five major functionalities in aiding the orthodontist in managing the care of Class patients (Sachdeva) These are: Rohit C.L Sachdeva, BDS, M Dent Sc, is the co-founder and Chief Clinical Officer at OraMetrix, Inc He received his dental degree from the University of Nairobi, Kenya, in 1978 He earned his Certificate in Orthodontics and Masters in Dental Science at the University of Connecticut in 1983 Dr Sachdeva is a Diplomate of the American Board of Orthodontics and is an active member of the American Association of Orthodontics He is a clinical professor at the University of Connecticut, Temple University, and the Hokkaido Health Sciences Center, Japan In the past, he held faculty positions at the University of Connecticut, Manitoba and the Baylor College of Dentistry, Texas A&M Dr Sachdeva has over 80 patents, is the recipient of the Japanese Society for Promotion of Science Award, and has over 160 papers and abstracts to his credit Visit Dr Sachdeva’s blog on http://drsachdevaconference.blogspot.com All doctors are invited to join the “Improving Orthodontic Care” discussion blog Please contact improveortho@gmail.com for access information Orthodontic practice Table 2: Strategies for using SureSmile targeted precision therapeutics to manage the correction of a Class condition in a patient (Sachdeva) A Decision support with 3D simulations These simulations provide a visual interface for the orthodontist to understand the severity of the presenting a problem in 3D Furthermore, it augments the doctor’s ability to plan the nature of Class correction This may be orthopedic and or dentoalveolar in nature The magnitude of the correction designed in the simulation is based upon the doctor’s mental model, reality, research findings, patient’s expectations, and expected participation in care, and also the doctor’s skills Recognition of the contributory factors that potentially aid in the correction of the malocclusion and the directionality of Volume Number PRODUCT INSIGHT The use of Propel to increase the rate of aligner progression Dr Thomas S Shipley discusses increasing the bone remodeling rate for more rapid aligner progression T he use of clear aligners has gained broad acceptance as an alternative way to orthodontically move the dentition As the orthodontic community becomes more familiar with this modality of treatment, questions arise as to best clinical practices to achieve optimal results One area of interest is how often to change aligners The Invisalign® System suggests the optimal time to change from one aligner to the next, with good patient compliance, is weeks The aligner system and the amount of movement prescribed in each aligner determine how frequently the patient is required to change aligners in the sequence Changing aligners at a faster rate than the velocity of tooth movement would be one cause of aligners not “tracking” over time This rate of aligner change is a limiting factor in the overall case completion time In more difficult cases, the number of aligners prescribed may reach as many as 40 to 60 aligners, with even more in the most difficult cases To the patient, who can quickly the math, and to the clinician, who knows “refinement” or “auxiliary treatment” has not even been accounted for yet, the future of the orthodontic treatment becomes daunting In these cases, or with any case, where increased velocity of tooth movement is desired, a way to change aligners at a more rapid pace becomes attractive The rate of tooth movement is dependent on the rate of the physiologic process of bone remodeling.1,2 If this rate of bone remodeling is increased, then the rate at which aligners should be changed increases also Failing to change the aligners fast enough to coincide with the velocity of tooth movement would be equivalent to placing intermittent orthodontic forces on the dentition, which could actually slow the overall progress of the movement Increasing the rate of bone remodeling is the key to being able to change aligners at a more rapid pace, therefore, decreasing overall treatment time A female patient presented at age 21 with a mild Class II, Division malocclusion Moderate upper and lower dental crowding existed with a 60% deep bite and negatively inclined upper incisors The patient’s chief concern was the rotation of the upper left lateral incisor The CBCT showed good root parallelism and normal development of the dentition (Figures 1-7) Figure Figure Thomas Shipley, DMD, MS, received his Bachelor of Science degree in Business Management from Brigham Young University and went on to earn his doctorate from the University of Kentucky College of Dentistry Dr Shipley completed a master’s program in orthodontics at West Virginia University He maintains a full-time private practice in Peoria, Arizona, and is an Adjunct Professor at Arizona School of Dentistry, Department of Orthodontics in Mesa, Arizona Dr Shipley maintains membership in numerous professional organizations, such as the American Dental Association, the Arizona Dental Association, the American Association of Orthodontics, the Pacific Coast Society of Orthodontists, the Comprehensive Care Continuum Study Club; and he is the coordinator of the International Dental Ed Continuing Education Study Group for the Northwest Phoenix area He is board certified by the American Board of Orthodontics 52 Orthodontic practice Figure Figure Figure Volume Number Volume Number Figure PRODUCT INSIGHT The treatment plan was developed to use clear aligners in conjunction with Class II elastics to resolve the dental crowding, slightly procline the upper and lower incisors, correct the deep bite, and improve the Class II dental relationship Once the treatment plan was finalized, the resultant prescription for aligners was 43 upper and lower aligners The aligners consisted of 43 active maxillary aligners, and 23 active lower aligners, followed by 20 lower passive aligners (Figures 8-9) Cuts were made in the upper aligners near the maxillary canines to create hooks for Class II elastics and cutouts in the lower aligners in the buccogingival area of the lower second molars to allow for Class II button hooks to be bonded (Figure 14) No interproximal reduction was prescribed The patient desired to finish treatment faster than 86 weeks! The clinician was concerned that this treatment did not allow much time for refinements and detailing which may be needed Both agreed that Propel would be an appropriate way to speed the orthodontic treatment Propel is a technique performed with the patented FDA Registered Class 5(10k)-exempt disposable medical device that creates Micro-Osteoperforations (MOPs) These MOPs stimulate a cytokine response in the patient’s alveolar bone during orthodontic treatment (Figures 1011).3 MOPs reduce overall orthodontic treatment time by harnessing the body’s own biology to increase the rate of tooth movement and release challenging movements.4 This in-office technique can be performed chairside in minutes during a patient’s regularly scheduled office visit and can be used in conjunction with any type of fixed or removable orthodontic appliance Micro-Osteoperforations with Propel can be used to advance the treatment of any malocclusions, including, but not limited to, crowding, space closures, molar uprighting, rotations, intrusions, and extrusions Aligners and were delivered at the initial appointment The patient was told to wear each aligner for weeks and return in weeks for placement of attachments At the 4-week return appointment, aligner was delivered, attachments were placed, and Class II elastics commenced No Propel was used for the first weeks of treatment A regular tray progression of weeks per tray was used There are several advantages to starting at this pace The patient has ample time to adapt to wearing the trays and to learn how to be compliant Figure Figure Figure Treatment progressed at a slower pace, not to overburden the patient with learning to wear the trays, having attachments placed, beginning elastic wear, and Propel all at the same time In addition, the clinician is given an opportunity to gauge patient compliance before beginning Propel The enhanced cytokine response with the MOPs would be of little benefit without good patient compliance Six weeks into treatment, Propel was initiated The use of local infiltration anesthesia (2% Lidocaine with 1:100,000 epinephrine) was employed “Profound” Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Orthodontic practice 53 PRODUCT INSIGHT topical anesthesia may instead be used The patient rinsed twice with chlorhexidine gluconate and expectorated MOPs were placed inter-radicularly using the Propel device as follows: Three MOPs mesial and distal of the maxillary lateral incisors, and two MOPs mesial and distal of the lower incisors (Figures 12-13) She stated that there was little discomfort of the procedure other than mild pressure between the teeth in a few areas A post-Propel CBCT was taken, which shows the location of the maxillary left MOPs (see image) The patient rinsed again with chlorhexidine gluconate after the procedure and was asked to wear the aligners at a progression of days each With such a rapid pace of aligner progression, close monitoring by the clinician is needed to ensure patient compliance and good aligner “tracking.” If the rate of aligner progression exceeds actual tooth movement, it will be apparent due to poor aligner fit Aligner progression may be slowed, if needed, based on how the patient presents on follow-up visits The patient was seen weeks later and was now beginning aligner As shown in the photos, the aligners were fitting the dentition perfectly (good “tracking”) This Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 indicated that the progression at days per aligner was appropriate for this patient (Figures 16-18) In addition, the soft tissue had completely healed with no signs of trauma at weeks (Figures 19-20) The patient was seen again weeks later (4 weeks post-Propel) At this time, she was just beginning tray 14, and a CBCT was taken that shows the MOPs slightly smaller, but still present (Figure 21) Again, the “tracking” of the aligners was still excellent A 4-week interval was now chosen, continuing at days per aligner Four weeks later, the patient was wearing the 23rd aligners The aligners were Figure 21 Figure 22 54 Orthodontic practice Figure 23 Figure 24 Volume Number PRODUCT INSIGHT still “tracking” perfectly, and treatment was completed on the lower arch Complete resolution of the lower dental crowding was achieved as prescribed using 23 aligners over a period of 14 weeks No refinement or detailing was needed for the lower arch More aligners were delivered, and Class II elastics were continued The patient returned every weeks forward until completion of treatment of the maxillary orthodontic treatment The aligner progression continued at days per aligner The patient continued to change the lower passive aligners at the same pace At 23 weeks, treatment was completed on the upper dentition after the use of 43 upper aligners No refinement aligners were needed Attachments were removed, and retainers with similar Class II elastic hooks and cutouts were fabricated The bonded buccal hooks on the lower 2nd molars were left for months, for the continued use of class II elastics for 12 hours per night as part of the retention protocol Otherwise, the clear removable retainers were worn according to the clinician’s normal retention protocol Evaluation of the final records shows adequate inclination of the upper and lower incisors to allow for better anterior guidance, which was achieved by upper anterior labial crown torque and lower Figure 25 Volume Number Orthodontic practice 55 PRODUCT INSIGHT incisor proclination aided by the use of Class II elastics In addition, the overbite was corrected to an appropriate 30% The patient’s chief concern of the rotated upper left lateral incisor was completely corrected to her satisfaction, along with complete resolution of the remaining upper and lower dental rotations The post-treatment CBCT, taken months post-Propel, shows the MOPs almost complete healed (Figure 25) The final results show that Propel is a good approach to increasing the rate of clear aligner progression by increasing the rate of bone remodeling Treatment time was reduced over 70% in this case as compared to a typical week interval aligner case The overall amount of appointments were reduced from 20+ to More research is needed to gain a better understanding of the exact rate of tray progression that should be used A clinician new to this treatment modality should consider starting at a slower progression than that shown with this case, such as days per aligner Close monitoring should be employed, and adjustments may be made to the rate of progression based on the clinical results for each patient OP Table 1: Treatment progression References Henneman S, Von den Hoff JW, Maltha JC Mechanobiology of tooth movement Eur J Orthod 2008;30(3):299-306 Krishnan V, Davidovitch Z On a path to unfolding the biological mechanisms of orthodontic tooth movement J Dent Res 2009;88(7):597-608 Teixeira CC1, Khoo E, Tran J, Chartres I, Liu Y, Thant LM, Khabensky I, Gart LP, Cisneros G, Alikhani M Cytokine expression and accelerated tooth movement J Dent Res 2010;89(10):11351141 Khoo E, Tran J, Raptis M, Teixeira CC, Alikhani M, Abey M Accelerated Orthodontic Treatment [research paper] New York: New York University; 2011 56 Orthodontic practice Volume Number A faster way to deliver orthodontic success As a practitioner, the most important thing is achieving the best clinical outcome Propel’s chairside technique can be done in minutes in conjunction with any orthodontic modality Our patented, disposable device is redefining treatment protocol without sacrificing patient comfort or the desired finish Propel Orthodontics – a faster way forward propelorthodontics.com/excelleration | (855) 377-6735 at th B S e oo to AA t p O h by to le 59 ar n m or e Excelleration SERVICE PROFILE Who is ”minding the store” of your practice? T he actual practicing of orthodontics is just one of the items that require the orthodontist’s time This also pertains to attracting new patients, improving case acceptance, working smarter, completing treatment on time, keeping current with technology, and maintaining profitability The orthodontist’s ability (and availability) to manage the business of the practice while simultaneously serving as practitioner can be overwhelming There never seems to be enough hours in the day even though “minding the store” is crucial to the practice’s success With the demands of day-to-day operations, it’s easy to neglect the business of information And when you don’t have the information you need, you can’t identify problems or make decisions to alter your course This accountability piece, the information to measure the health of the practice, is only as important as the action that follows in order to foster real growth Gaidge provides a unique solution to solve both sides of this equation: instant access to critical orthodontic practice information, as well as the insight to know what issues require what solutions Gaidge, a web-based software platform, is equal parts “practice performance monitor” and “orthodontic practice management tool.” By bridging directly to most orthodontic management software, Gaidge automatically generates accurate, daily assessments of the practice’s “health.” Using industry standard benchmarks, Gaidge alerts the practice to specific areas or departments that are lagging, providing guidance to understand and remedy the “blip” before it becomes a trend Consider, as an example of what Gaidge provides to the practice, the means by which you attain similar metrics, and how you would seek remedy: • Is the phone ringing? Are new patients continuing to call our office? Are we engaging them in a way that assures they will attend the exam? Are we converting patients who have had treatment recommended into starts? • What is our case acceptance rate, and how does it compare with the same month over the past years? How does it 58 Orthodontic practice Gaidge provides a unique solution to solve both sides of this equation: instant access to critical orthodontic practice information as well as the insight to know what issues require what solutions compare with other similar practices in my region? • Can we set and track both short-term and long-term goals for achievement levels on a daily basis? The Gaidge “Leader Board” tool does exactly this • Do we suffer from costly interruptions to my schedule (forcing me to work more days and lose profitability), and to what extent? o Are there a high number of noshows? o Are there excessive emergency repair visits? o Are there too many retention visits? o What is the real expense of having too many patients go over their estimated completion date (the most costly issue there is to your practice)? The above is not meant to send you into a panic attack The point is that having immediate, daily access to this information, as well as a tool set to manage any “blips,” can be a gamechanger for the orthodontist, the team, and their consultant While most orthodontic management platforms can produce a myriad of “two-dimensional” reports, the process of gathering and assembling them into accurate, actionable elements would require a full-time statistician with significant orthodontic prowess Gaidge makes the ability to “mind your store” vastly easier, faster, and more manageable Your “store” does not have to be so overwhelming To discover how Gaidge can assist your practice in moving to the next level, visit www.gaidge.com or call (800) 2873396 to schedule a demonstration for you and your team OP This information OrthoBanc was provided by Volume Number MATERIALS lllllllllllll & lllllllllllll EQUIPMENT DENTSPLY Raintree Essix announces the launch of MTMđ ClearãAligner DENTSPLY Raintree Essix, a division of DENTSPLY International, has announced the U.S market launch of its new clear aligner service center treatment, MTM® (Minor Tooth Movement) Clear•Aligner The treatment is backed by more than a decade of development and clinical testing and combines proven chairside techniques with advanced digital modeling to provide clinicians with a streamlined solution for treating minor anterior misalignments MTMđ ClearãAligner is uniquely engineered to deliver the space and force needed to accomplish tooth movement It utilizes a proprietary “open pathway” architecture that allows teeth to move easily into the desired positions And unlike many other aligner systems, MTMđ ClearãAligner does not require the clinician to bond unsightly attachments to the patient’s teeth to accomplish movement Instead, it uses integrated “force points” in the aligner to provide a greater range of tooth movements, while making aligner placement and removal easy for the patient For more information, visit www.essix.com tops Software Releases topsOrtho™ 6.0 D7 Matrix™ Analytics allows doctors to pinpoint every patient tops Software has released the latest version of its practice management software topsOrtho 6.0 comes with several new features, including topsChecklist (which allows a practice to create customized checklists) and a new backup mechanism that automatically saves practice data each hour It also includes redesigned treatment notes topsOrtho 6.0 also marks the debut of D7 Matrix™ analytics With D7 Matrix, orthodontists can view statistics such as the following, all in one place: • Where each patient is in his or her treatment (for example, how many patients are in active treatment, and how many are in retention) • Profitability by type of treatment • Conversion rates, broken down in various ways (such as during a specific time frame or by treatment coordinator) • Treatment times, depending on treatment method or type of patient For more information, visit www.topsOrtho.com or call 770-627-2527 Volume Number 3Shape’s new Splint Designer™ CAD software opens new business opportunities for dental labs 3Shape recently released a groundbreaking software tool for CAD design of common dental appliances, such as splints, night guards, and protectors, all ready for output using 3D manufacturing machines and materials 3Shape is offering this attractive tool to Dental System™ Premium subscribers for free 3Shape Splint Designer overview: • CAD design of splints, night guards, protectors, and similar dental appliances • Splints and appliances can be ordered directly through the Dental System™ order form • An intuitive workflow guides users through the design steps: open the bite with a virtual articulator, create a shell, add a bar profile on top, combine both parts, and optionally “cut” the design with the antagonist in the included virtual articulators • Option to engrave ID tags in the appliance for patient identification or branding of the lab • Included free of charge for all 3Shape Dental System™ Premium subscriptions Please contact your local 3Shape supplier, or visit www.3shapedental.com Carestream Dental signs integration agreement with Intuit Demandforce Carestream Dental, provider of industry-leading imaging, CAD/ CAM, software, and practice management solutions for dental and oral health professionals, announced an integration agreement with Intuit Demandforce Under the terms of the agreement Carestream Dental will develop integration for Demandforce services in its CS OrthoTrac, CS WinOMS, and Windent practice management software products In addition, Carestream Dental will provide technical assistance to Intuit Demandforce for their existing CS SoftDent and CS PracticeWorks practice management software integrations For more information, call 800-944-6365 or visit www.carestreamdental.com For more information on Demandforce, call 800-210-0355 or visit www.demandforce.com Ortho Classic, Inc teams-up with OrthoVOICE Ortho Classic, Inc has teamed-up with OrthoVOICE and will be holding their annual H4 Forum during the days prior to the opening party for OrthoVOICE Both events will take place at the Planet Hollywood Resort and Casino in Las Vegas, Nevada The H4 Forum will run on September 17 and 18 and lead directly into OrthoVOICE and their opening party on the evening of September 18 OrthoVOICE will then continue on September 19 and 20 with the opening of their exhibit hall and group of seminars For more information, call Ortho Classic at 866-752-0065 or visit www.orthoclassic.com Orthodontic practice 59 PRACTICE MANAGEMENT reasons you need to re-evaluate your digital marketing strategy Diana Friedman discusses ways to keep online marketing strategies fresh A s a successful orthodontist, you understand that the processes and procedures used to treat your patients are under a constant state of evolution You realize that many of the treatment approaches that worked so well just a few years ago are no longer considered state of the art As a result, you routinely evaluate the latest advancements in your field to find new and innovative ways to offer superior treatment Diana P Friedman, MA, MBA, is president and chief executive officer of Sesame Communications She has a 20-year success track record in leading dental innovation and marketing Throughout her career, Friedman served as a recognized practice management consultant, author, and speaker She holds an MA in Sociology and an MBA from Arizona State University 60 Orthodontic practice Have you ever considered this same line of reasoning holds true for your digital marketing strategy? In a study conducted by Sesame Communications, 93% of patients stated it was more convenient to find answers online compared to calling the office.1 Given this preference and the rapidly evolving Internet technologies (e.g., smartphone and tablet adoption) and options for finding orthodontists outside Google searches, it’s likely that the online marketing strategies your practice deployed even 12 months ago may be outdated Here are three reasons it’s time to re-evaluate your digital marketing strategy: Mobile is taking over A recent study by Pew Internet showed smartphone adoption increased an astounding 21% from May 2011 to 2013.2 Another study found 90% of mobile phone searches result in a purchase or a visit.3 All you have to is look in your practice reception area to see this trend in action With this pattern of mobile adoption, re-evaluating your website, patient communications, and social media channels to ensure they are optimized for mobile viewing is more important than ever There are really two ways to accomplish this In terms of website, it is imperative that your website render optimally on any mobile device This can be accomplished by building a separate mobile site that identifies the device and presents an alternate website that will work with a limited set of devices However, the optimal way to accomplish this is to update your website to what’s known as “responsive design.” In this scenario, your website is built on a Volume Number Healthgrades® Enhanced Profiles from Sesame Get priority access to more than 20 million prospective patients looking to schedule an appointment with a dentist Enhanced Profiles Give Your Practice: Click-to-request appointments Featured Provider placement on Healthgrades.com search results for your local area Comprehensive Practice-branded doctor profiles Unique tracking phone number to monitor your ROI Removes competitive practice listings High-quality, verified patient reviews that drive higher rankings in organic search results Get More New Appointments 54% will schedule an appointment 38% schedule the same day they search Target Your Ideal Demographic 72% of users are female 52% have annual household incomes of greater than $75,000 Find out more at the AAO booth #1937 872•225•0153 sesamecommunications.com/healthgrades PRACTICE MANAGEMENT state-of-the-art platform that automatically adapts the design and content to screens of any size to ensure an optimal patient experience on virtually any device In terms of patient communications, it is imperative your patient engagement platform (often referred to as a patient portal) is mobile optimized This means your patients would be able to view their accounts, pay bills, confirm appointments, and access their records from any device If you consider 57% of users won’t recommend a business with a poorly designed mobile site, making sure your patients have a great mobile experience with your patient portal should be a top priority on your list of digital marketing initiatives friends to your practice, they also expect more from the online relationship The days of adding a Facebook, Twitter, or Google+ account and expecting it to act like a billboard for your practice are over To ensure your social media efforts pay dividends, your practice needs to plan to keep all its sites up-to-date, providing relevant and patient-directed content of interest, or to invest in a service that specializes in social engagement for dental care providers Topical search sites are on the rise Google is no doubt what comes to mind when the word “search” is mentioned However, due to the immense amount of To ensure your social media efforts pay dividends, your practice needs to plan to keep all its sites up-todate, providing relevant and patient-directed content of interest, or to invest in a service that specializes in social engagement for dental care providers We live in a “social” world Just last year 72% of Internet users ages 30 to 49 were active on social media — and by all accounts that number continues to rise Even more interesting, 47% of Americans say Facebook is their number one influencer of purchases (up from 24% in 2011).5 Social media, when done correctly, will drive new patients to your practice from referrals and foster loyalty with your existing patient community However, as consumers rely more on social media to make decisions and refer content on the larger search engines, there has been a rise in what’s known as vertical search or topical sites Basically, these are websites that cater to a specific topic or area of interest In the last half of 2012, topical sites had an 8% increase in search traffic while major search engine traffic decreased by 3% over the same period.6 Examples for successful topical sites in the consumer world include websites such as WebMD, Amazon, and eBay In the world of dental care, the best example for this is healthgrades.com References Sesame Communications Member Survey, 2010 mobile-search-statistics-showing-past-and-predictingfuture Accessed February 11, 2014 Pew Internet & American Life Project Smartphone ownership 2013.http://pewinternet.org/Reports/2013/ Smartphone-Ownership-2013/Findings.aspx Verified February 11, 2014 Vizibility 13 Mobile Stats Your Competitors Already Know http://vizibility.net/blog/13-mobile-stats-yourcompetitors-already-know-infographic/ Accessed February 11., 2014 Social Media Today 10 Mobile Search Statistics: Showing the Past and Predicting the Future http:// socialmediatoday.com/stuartwainstock/2031461/10- Bullas J 22 Social Media Facts and Statistics You Should Know in 2014 Jeff Bullas blog http://www jeffbullas.com/2014/01/17/20-social-media-facts- 62 Orthodontic practice Today more than 20 million prospective patients search healthgrades.com for a new dental care provider in their local area, and more than half will schedule an appointment when a “click-to-request an appointment” feature is present.7 Topical search sites like healthgrades.com can help your orthodontic practice in a couple of important ways First, it will provide increased practice exposure to highly qualified prospective patients and drive more of them to your practice Second, it will also provide additional exposure on the more traditional search engines A listing on a well-trafficked vertical search site in many cases will appear above your practice website on the regular search results This obviously increases the opportunity for prospective patients to engage with you online Focus your attention on those topical sites that have an area dedicated to dental care providers Given the impact this can have on new case starts, you would well to capitalize on the evolution in this particular area of digital marketing Final thoughts Technology is in a constant state of change; you realize this when it comes to caring for your patients You want to ensure that you’re always looking for the latest advancements to improve outcomes You understand this approach improves not only the experience your patient has with your practice, but also the results of the treatment If you adopt this same approach for your digital marketing strategy, you will fortify the engagement with your patients, drive new case starts, improve production, and ensure sustained growth and profitability for your practice A complete review of your current digital marketing strategy and its relevance, given ongoing technology advancements, is a great way to start Make sure you consider the evolution of mobile, patient portal, social, and topical searches as you plan your go-forward strategy OP and-statistics-you-should-know-in-2014/ Accessed February 11, 2014 ComScore, 2013 U.S Digital Future in Focus http:// www.comscore.com/Insights/Press_Releases/2013/2/ comScore_Releases_the_2013_U.S._Digital_Future_in_ Focus_Report Accessed Februrary 11, 2014 Healthgrades Use Study, 2013, http://articles healthgrades.com/about/healthgrades-solutions-foradvertisers Volume Number INDUSTRY NEWS Groundbreaking clinical trial evaluates faster tooth movement with clear aligner treatment using AcceleDent® OrthoAccel® Technologies, Inc., enrolls first patients to start 12-week orthodontic evaluation W ith first patients enrolled, OrthoAccel Technologies, Inc., announced the start of a groundbreaking clinical trial that evaluates the effect of AcceleDent on orthodontic tooth movement with aligners Manufactured by OrthoAccel, AcceleDent is the only FDA-cleared, Class II medical device that speeds up orthodontic treatment by as much as 50 percent Conducted at the University of Florida College of Dentistry, the prospective randomized controlled trial follows patients for 12 weeks during their clear aligner treatment with AcceleDent The trial’s principal investigator, Timothy Wheeler, DMD, PhD, is a distinguished researcher of orthodontic treatment with clear aligners “The purpose of this clinical trial is to evaluate how pulsatile forces produced through AcceleDent’s SoftPulse Technology® enable teeth to move faster,” said Wheeler, who is a professor at the University of Florida College of Dentistry “AcceleDent is such a groundbreaking innovation that there’s a lot of interest in this study among orthodontists who want clinical evidence showing the product’s potential benefits when used with clear aligners — faster tooth movement and reduced pain.” First introduced in the United States in 2012, AcceleDent’s technology was developed in part by Dr Jeremy Mao, co-director of the Center for Craniofacial Regeneration at Columbia University College of Dental Medicine in New York Mao’s pioneering work in the early 2000s, which was initially conducted while he was a faculty member at the University of Illinois, Chicago, was paramount in establishing the therapeutic effect of pulsatile forces in accelerating bone modeling and remodeling in the craniofacial region With many of the nation’s leading orthodontists prescribing AcceleDent to their patients, AcceleDent is now available in over 1,000 orthodontic locations throughout the U.S “As the sole provider of a noninvasive, 64 Orthodontic practice FDA-cleared medical device that speeds up orthodontic treatment, we recognize our responsibility to support orthodontists by continuing to provide clinical evidence confirming AcceleDent’s claims of accelerating orthodontic tooth movement safely and gently,” said Michael K Lowe, president and CEO of OrthoAccel Orthodontists and staff members interested in learning more about AcceleDent, or how to offer the technology at their practice, can locate an OrthoAccel sales representative at AcceleDent.com/ orthodontists or call 866-866-4919 Technologies, Inc., is a privately owned medical device company engaged in the development, manufacturing, and marketing of products to enhance dental care and orthodontic treatment OrthoAccel developed and sells AcceleDent, the first FDA-cleared clinical approach to safely accelerate orthodontic tooth movement by applying gentle micropulses via SoftPulse Technology as a complement to existing orthodontic treatment More information can be found at acceledent.com and acceledent.co.uk or requested via info@ orthoaccel.com OP About OrthoAccel Technologies, Inc This information was provided OrthoAccel Technologies, Inc by Based in Houston, Texas, OrthoAccel Volume Number PLANMECA’s ProMax has won Townie Choice Awards for its pan/ceph model 2006-2013 • Advanced imaging programs include improved interproximal pan program for better spacing and root positioning for TAD placement • Pediatric mode reduces radiation by 35% • Face-to-face patient positioning • Patented SCARA technology allows unlimited movement to accommodate complex and unique jaw shapes • Integrates with Dolphin, Ortho II, and other ortho imaging programs • Upgradable to 3D at any time For a free in-office consultation, please call 1-855-245-2908 or visit us on the web at www.planmecausa.com ORTHOPHOS XG 3D The right solution for your diagnostic needs Implantologists Endodontists Orthodontists will benefit from highquality pan and ceph images for optimized therapy planning will enjoy instantly viewable 3D volumetric images for revealing and measuring canal shapes, depths and anatomies will appreciate the seamless clinical workflow from initial diagnostics, to treatment planning, to ordering surgical guides and final implant placement The advantages of 2D & 3D in one comprehensive unit General Practitioners will achieve greater diagnostic accuracy for routine cases ORTHOPHOS XG 3D ORTHOPHOS XG 3D is a hybrid system that provides clinical workflow advantages, along with the lowest possible effective dose for the patient Its 3D function provides diagnostic accuracy when you need it most: for implants, surgical procedures and volumetric imaging of the jaws, sinuses and other dental anatomy For standard 2D images, it offers the most comprehensive selection of pan and ceph programs to meet virtually all needs, from standard panoramic programs for adults and children, to extraoral bitewing, sinus, TMJ options and many more Automatic patient positioning The new Auto-Positioner measures the exact tilt of the patient’s occlusal plane and automatically adjusts the height for an optimal panoramic image within the sharp layer, thereby preventing incorrect positioning and reducing re-takes For more information, visit www.Sirona3D.com or call Sirona at: 800.659.5977 www.facebook.com/Sirona3D ... 103.630 4. 350 6 DOLICHOFACIAL 10 104. 650 7. 158 1 BRACHYFACIAL 10 1 05. 550 5. 6086 MESIOFACIAL 10 1 05. 550 5. 6086 Total 30 104.247 5. 4387 DOLICHOFACIAL 10 124.920 5. 8719 BRACHYFACIAL 10 1 25. 790 12. 451 2 MESOFACIAL... 11.4642 Total 30 108 .59 7 7. 855 3 DOLICHOFACIAL 10 111. 25 5. 750 4 BRACHYFACIAL 10 1 05. 02 4.4 758 MESIOFACIAL 10 108.26 6 .55 54 Total 30 108.117 6.04 25 DOLICHOFACIAL 10 2.01 0.6740 BRACHYFACIAL 10 1.03... (480) 403- 150 5 MANAGING EDITOR | Mali Schantz-Feld Email: mali@medmarkaz.com Tel: (727) 51 5 -51 18 ASSISTANT EDITOR | Elizabeth Romanek Email: betty@medmarkaz.com Tel: (727) 56 0-0 255 EDITORIAL