Orthotown October 2015 - (Page 25)

feature \\ case presentation Virtual Treatment Planning Reduce Frustration with The Right Sequence Jamie Reynolds, DDS, MS Virtual treatment planning that directs the fabrication of customized orthodontic appliances has been the focus of pioneers in the profession for a number of years now. One such innovator was Dr. Craig Andreiko, the inventor of bondable mesh, among many other orthodontic advancements. He told me once that the difference between customized digital orthodontics and traditional orthodontics is that with digital orthodontics, we get to put braces on straight teeth. It seems like a simple concept, but actually it is quite profound. Customarily, we place braces on crooked teeth, level and align the arches, then react to errors in bracket position and variance in dental anatomy. Dr. Andreiko's concept of digital orthodontics was to move ever closer to the ultimate straight-wire appliance that Dr. Larry Andrews first envisioned nearly 50 years ago. Regardless of the software employed, unless you have guidance, treatment planning your first digital case can be intimidating. I had no idea where to start planning my first cases. Now having treatment planned more than 1,000 cases using Insignia, the system of virtual treatment planning and customized appliances that Andreiko developed, I have established an Approver interface sequence (outlined here). When combined with appropriate mechanics and treatment planning, this sequence helps me achieve consistently accurate setups and reliable clinical finishes (Fig. 1). Fig. 1 1. 2. 3. 4. 5. 6. 7. Establish the Vertical Position of the Upper Central Incisor Address the Buccal Corridors Ensure Proper Upper Central Incisor Inclination Protect or Reshape the Smile Arc Determine Lower Posterior Torques Verify Anterior Torques Validate the Occlusion Dr. Jamie Reynolds's Insignia Advanced Smile Design Approver Sequence As with all digital models, the quality and consistency of the digital setup is of critical importance to the clinical outcome and the efficiency with which the case is treated. Using this sequence should provide the novice-and even experienced users of this platform-with improved clinical fi nishes and more predictable results. Fig. 2 Steps 1-2: Comparing the setup (right) with the patient's smiling extraoral photograph offers a general sense of the overall setup, helps establish the vertical aspect of the upper central incisors and assess the planned transverse development. Steps 1 and 2: Establish the vertical position of the upper central incisor, and address the buccal corridors Every setup needs to start somewhere. In my residency, I was trained to begin planning with the angulation of the lower central incisor; however, starting virtual treatment planning with the position of the upper central incisor position helps to achieve improved aesthetic results, while also allowing me to plan excellent functional outcomes. The first step, then, is to evaluate the smiling position of the upper central incisor side by side with the digital setup (Fig. 2). This allows me to ensure the bracket positions and planned mechanics do not lead to an unesthetic position of the upper incisor. Toggling between T1 (initial position) and T2 (final position) allows me to get a feel for the patient's smile and see if the upper incisors move as desired. The entire plan is built around the vertical positions of the upper central incisors. For this case, the vertical aspect of the upper centrals in the setup is spot-on. The same images and T1/T2 toggle are used to address the buccal corridors. Playing the embedded video between T1 and T2 also helps ensure that the vertical positions of the upper central incisors and the planned transverse development are appropriate. For this patient, I felt it was necessary to widen the buccal corridor for the best esthetics. orthotown.com \\ OCTOBER 2015 25 http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown October 2015

Orthotown.com Highlights
Embrace Progress: Changes Galore
Adhesive Message Boards
Offi ce Visit: It Takes Two
Virtual Treatment Planning: Reduce Frustration with the Right Sequence
High-Vaulted Palates
Poll
Air-Rotor Stripping Made Easy
The Real Value of an Interactive, Self-Ligating Bracket
Impacted Ur1
New Products
A Helping Hand
Class III Malocclusion Treated Non-Surgically with Invisalign, Mandibular Fixed Appliances and Mandibular TADs
Ad Index

Orthotown October 2015