Orthotown July/August 2020 - 28
Case 3
Fig. 19
Fig. 20
Fig. 21
Fig. 22
28
This patient called me several years after I had treated
him with non-extraction as a teenager (Fig. 19). He'd had
a vertical growth tendency but looked exactly like his
parents-neither of whom had extractions associated with
their orthodontic treatment-so I was unable to convince
them that removing teeth would make sense.
About eight or nine months ago, the patient called
me up to discuss what was going on. He now lived in San
Francisco working for a tech startup and was starting to
have trouble chewing but he wasn't sure why, so he made
an appointment to see a local orthodontist.
The doctor told him he had an anterior open bite and
jaw surgery was the only way to correct it. My patient
didn't understand how this could have happened and didn't
believe surgery was the only solution. His parents still lived
in Chicago, so he made arrangements to come home to get
my take on what I thought was going on with his occlusion.
When the patient arrived I took a cone beam and looked at
his growth pattern (Figs. 20 and 21).
What I found was no different from what I saw when
he was an adolescent: He still had the same vertical growth
pattern. He did not open up any more vertically than when I
saw him as a teen. I do believe that he experienced late-onset
mandibular growth; I saw a mild Class III malocclusion
with an edge-to-edge anterior bite. Most importantly, I did
not believe that this had to be a surgical solution. His joints
were not quite seated, and he had no symptoms.
After discussing his situation, I suggested he try our
in-office digital workflow. Because he lived out of town,
we could scan his teeth and build some custom removable
aligners. I asked that he wear Class III elastics with the
trays to correct the AP overgrowth. I would likely need to
see him a few times, but I could monitor his progress via
telemonitoring.
The clincher for him was that I offered a same-day start.
I proposed to scan him, design his case and build the first
few trays that day. I figured if I could place attachments
and deliver the fi rst few weeks' worth of trays while he
was with me, I could mail out the remaining trays as we
completed them.
We used 3Shape to scan his teeth and the tooth alignment
was engineered in uLab. Models were printed on a SprintRay
Pro and our work process was tracked from start to finish
with EasyRx. Our aligners are produced on Drufomat scans
from Dentsply using Bay Materials' Zendura FLX. Because
the patient lives 3,000 miles away, he automatically gets a
VPro+ to help the aligners to fit and seat better. He checked
in biweekly via cellphone (Fig. 22).
JULY/AUGUST 2020 // orthotown.com
OT0720_Warshawsky_Acceleration_MM.indd 28
7/14/20 10:02 AM
http://www.orthotown.com
Orthotown July/August 2020
Table of Contents for the Digital Edition of Orthotown July/August 2020
Orthotown July/August 2020 - Cover1
Orthotown July/August 2020 - Cover2
Orthotown July/August 2020 - 1
Orthotown July/August 2020 - 2
Orthotown July/August 2020 - 3
Orthotown July/August 2020 - 4
Orthotown July/August 2020 - 5
Orthotown July/August 2020 - 6
Orthotown July/August 2020 - 7
Orthotown July/August 2020 - 8
Orthotown July/August 2020 - 9
Orthotown July/August 2020 - 10
Orthotown July/August 2020 - 11
Orthotown July/August 2020 - 12
Orthotown July/August 2020 - 13
Orthotown July/August 2020 - 14
Orthotown July/August 2020 - 15
Orthotown July/August 2020 - 16
Orthotown July/August 2020 - 17
Orthotown July/August 2020 - 18
Orthotown July/August 2020 - 19
Orthotown July/August 2020 - 20
Orthotown July/August 2020 - 21
Orthotown July/August 2020 - 22
Orthotown July/August 2020 - 23
Orthotown July/August 2020 - 24
Orthotown July/August 2020 - 25
Orthotown July/August 2020 - 26
Orthotown July/August 2020 - 27
Orthotown July/August 2020 - 28
Orthotown July/August 2020 - 29
Orthotown July/August 2020 - 30
Orthotown July/August 2020 - 31
Orthotown July/August 2020 - 32
Orthotown July/August 2020 - 33
Orthotown July/August 2020 - 34
Orthotown July/August 2020 - 35
Orthotown July/August 2020 - 36
Orthotown July/August 2020 - 37
Orthotown July/August 2020 - 38
Orthotown July/August 2020 - 39
Orthotown July/August 2020 - 40
Orthotown July/August 2020 - 41
Orthotown July/August 2020 - 42
Orthotown July/August 2020 - 43
Orthotown July/August 2020 - 44
Orthotown July/August 2020 - 45
Orthotown July/August 2020 - 46
Orthotown July/August 2020 - 47
Orthotown July/August 2020 - 48
Orthotown July/August 2020 - 49
Orthotown July/August 2020 - 50
Orthotown July/August 2020 - 51
Orthotown July/August 2020 - 52
Orthotown July/August 2020 - 53
Orthotown July/August 2020 - 54
Orthotown July/August 2020 - 55
Orthotown July/August 2020 - 56
Orthotown July/August 2020 - 57
Orthotown July/August 2020 - 58
Orthotown July/August 2020 - 59
Orthotown July/August 2020 - 60
Orthotown July/August 2020 - 61
Orthotown July/August 2020 - 62
Orthotown July/August 2020 - 63
Orthotown July/August 2020 - 64
Orthotown July/August 2020 - 65
Orthotown July/August 2020 - 66
Orthotown July/August 2020 - 67
Orthotown July/August 2020 - 68
Orthotown July/August 2020 - 69
Orthotown July/August 2020 - 70
Orthotown July/August 2020 - 71
Orthotown July/August 2020 - 72
Orthotown July/August 2020 - Cover3
Orthotown July/August 2020 - Cover4
https://www.nxtbook.com/farran/orthotown/orthotown-januaryfebruary-2025
https://www.nxtbook.com/farran/orthotown/orthotown-december-2024
https://www.nxtbook.com/farran/orthotown/orthotown-november-2024
https://www.nxtbook.com/farran/orthotown/orthotown-october-2024
https://www.nxtbook.com/farran/orthotown/orthotown-september-2024
https://www.nxtbook.com/farran/orthotown/orthotown-july-august-2024
https://www.nxtbook.com/farran/orthotown/orthotown-june-2024
https://www.nxtbook.com/farran/orthotown/orthotown-may-2024
https://www.nxtbook.com/farran/orthotown/orthotown-april-2024
https://www.nxtbook.com/farran/orthotown/orthotown-march-24
https://www.nxtbook.com/farran/orthotown/orthotown-january-february-2024
https://www.nxtbook.com/farran/orthotown/orthotown-december-2023
https://www.nxtbook.com/farran/orthotown/orthotown-november-2023
https://www.nxtbook.com/farran/orthotown/orthotown-october-2023
https://www.nxtbook.com/farran/orthotown/orthotown-september-2023
https://www.nxtbook.com/farran/orthotown/orthotown-july-august-2023
https://www.nxtbook.com/farran/orthotown/orthotown-june-2023
https://www.nxtbook.com/farran/orthotown/orthotown-may-2023
https://www.nxtbook.com/farran/orthotown/orthotown-april-2023
https://www.nxtbook.com/farran/orthotown/orthotown-march-2023
https://www.nxtbook.com/farran/orthotown/orthotown-january-february-2023
https://www.nxtbook.com/farran/orthotown/orthotown-december-2022
https://www.nxtbook.com/farran/orthotown/orthotown-november-2022
https://www.nxtbook.com/farran/orthotown/orthotown-october-2022
https://www.nxtbook.com/farran/orthotown/orthotown-september-2022
https://www.nxtbook.com/farran/orthotown/orthotown-july-august-2022
https://www.nxtbook.com/farran/orthotown/orthotown-june-2022
https://www.nxtbook.com/farran/orthotown/orthotown-may-2022
https://www.nxtbook.com/farran/orthotown/orthotown-april-2022
https://www.nxtbook.com/farran/orthotown/orthotown-march-2022
https://www.nxtbook.com/farran/orthotown/orthotown-january-february-2022
https://www.nxtbook.com/farran/orthotown/orthotown-december-2021
https://www.nxtbook.com/farran/orthotown/orthotown-november-2021
https://www.nxtbook.com/farran/orthotown/orthotown-october-2021
https://www.nxtbook.com/farran/orthotown/orthotown-september-2021
https://www.nxtbook.com/farran/orthotown/orthotown-july-august-2021
https://www.nxtbook.com/farran/orthotown/orthotown-june-2021
https://www.nxtbook.com/farran/orthotown/orthotown-april-2021
https://www.nxtbook.com/farran/orthotown/orthotown-march-2021
https://www.nxtbook.com/farran/orthotown/2021JanuaryFebruary
https://www.nxtbook.com/farran/orthotown/December2020
https://www.nxtbook.com/farran/orthotown/2020November
https://www.nxtbook.com/farran/orthotown/2020October
https://www.nxtbook.com/farran/orthotown/2020September
https://www.nxtbook.com/farran/orthotown/2020JulyAugust
https://www.nxtbook.com/farran/orthotown/2020June
https://www.nxtbook.com/farran/orthotown/2020May
https://www.nxtbook.com/farran/orthotown/2020April
https://www.nxtbook.com/farran/orthotown/2020March
https://www.nxtbook.com/farran/orthotown/2020JanuaryFebruary
https://www.nxtbook.com/farran/orthotown/2019December
https://www.nxtbook.com/farran/orthotown/2019November
https://www.nxtbook.com/farran/orthotown/2019October
https://www.nxtbook.com/farran/orthotown/2019September
https://www.nxtbook.com/farran/orthotown/2019JulyAugust
https://www.nxtbook.com/farran/orthotown/2019June
https://www.nxtbook.com/farran/orthotown/2019May
https://www.nxtbook.com/farran/orthotown/2019April
https://www.nxtbook.com/farran/orthotown/2019March
https://www.nxtbook.com/farran/orthotown/2019JanFeb
https://www.nxtbook.com/farran/orthotown/2018December
https://www.nxtbook.com/farran/orthotown/2018November
https://www.nxtbook.com/farran/orthotown/2018October
https://www.nxtbook.com/farran/orthotown/2018September
https://www.nxtbook.com/farran/orthotown/2018August
https://www.nxtbook.com/farran/orthotown/2018June
https://www.nxtbook.com/farran/orthotown/2018May
https://www.nxtbook.com/farran/orthotown/2018April
https://www.nxtbook.com/farran/orthotown/2018March
https://www.nxtbook.com/farran/orthotown/2018February
https://www.nxtbook.com/farran/orthotown/2017December
https://www.nxtbook.com/farran/orthotown/2017November
https://www.nxtbook.com/farran/orthotown/2017October
https://www.nxtbook.com/farran/orthotown/2017September
https://www.nxtbook.com/farran/orthotown/August_2017
https://www.nxtbook.com/farran/orthotown/2017June
https://www.nxtbook.com/farran/orthotown/2017May
https://www.nxtbook.com/farran/orthotown/2017April
https://www.nxtbook.com/farran/orthotown/March2017
https://www.nxtbook.com/farran/orthotown/2017JanFeb
https://www.nxtbook.com/farran/orthotown/2016_December_Orthotown
https://www.nxtbook.com/farran/orthotown/2016November
https://www.nxtbook.com/farran/orthotown/2016October
https://www.nxtbook.com/farran/orthotown/2016september
https://www.nxtbook.com/farran/orthotown/2016august
https://www.nxtbook.com/farran/orthotown/2016june
https://www.nxtbook.com/farran/orthotown/2016may
https://www.nxtbook.com/farran/orthotown/2016april
https://www.nxtbook.com/farran/orthotown/2016march
https://www.nxtbook.com/farran/orthotown/2016february
https://www.nxtbook.com/farran/orthotown/2015december
https://www.nxtbook.com/farran/orthotown/2015november
https://www.nxtbook.com/farran/orthotown/2015october
https://www.nxtbook.com/farran/orthotown/2015september
https://www.nxtbook.com/farran/orthotown/2015august
https://www.nxtbook.com/farran/orthotown/2015june
https://www.nxtbook.com/farran/orthotown/2015may
https://www.nxtbook.com/farran/orthotown/2015april
https://www.nxtbook.com/farran/orthotown/2015march
https://www.nxtbook.com/farran/orthotown/2015february
https://www.nxtbook.com/farran/orthotown/2014december
https://www.nxtbook.com/farran/orthotown/2014november
https://www.nxtbook.com/farran/orthotown/2014october
https://www.nxtbook.com/farran/orthotown/2014september
https://www.nxtbook.com/farran/orthotown/2014august
https://www.nxtbook.com/farran/orthotown/2014june
https://www.nxtbook.com/farran/orthotown/2014may
https://www.nxtbook.com/farran/orthotown/2014april
https://www.nxtbook.com/farran/orthotown/march2014
https://www.nxtbook.com/farran/orthotown/2014february
https://www.nxtbook.com/farran/orthotown/2013december
https://www.nxtbook.com/farran/orthotown/2013november
https://www.nxtbook.com/farran/orthotown/2013october
https://www.nxtbook.com/farran/orthotown/2013september
https://www.nxtbook.com/farran/orthotown/2013august
https://www.nxtbook.com/farran/orthotown/2013june
https://www.nxtbook.com/farran/orthotown/2013may
https://www.nxtbook.com/farran/orthotown/2013april
https://www.nxtbook.com/farran/orthotown/2013march
https://www.nxtbook.com/farran/orthotown/2013janfeb
https://www.nxtbook.com/farran/orthotown/2012december
https://www.nxtbook.com/farran/orthotown/2012november
https://www.nxtbook.com/farran/orthotown/2012october
https://www.nxtbookmedia.com