Orthotown November 2020 - 47

CASE 3
Dr. Wassim Bouzid of Constantine, Algeria, used Pitts protocols to accomplish
extremely efficient progress on this patient (Figs. 21-25). He began with SAP
bracket placement of Pitts 21, inverting the four upper incisor brackets, and
placed bite buttons on the upper second bicuspids to disarticulate.
His initial wires were Pitts Broad .014 TA NiTi, and from day one he had the
patient wear short, light, through-the-bite Class III elastics (3/16, 2.5-ounce)
from the lingual of the upper second bicuspid to the labial of the lower canine.
At four weeks, he moved to .018 wires and kept the Class III elastics full time.
After four more weeks, he repositioned brackets; at the fourth appointment, in
another four weeks, he moved to .018x.018 Ultra Soft Pitts Broad NiTi.
By the fourth month (Figs. 26-28), he would have been ready for transitioning
into in-house aligners if desired, but the patient decided to leave the brackets in
place to finish the treatment. You can see that with proper bracket placement,
the bite is socked in very well. (Grafting on tooth 25 will be done by a periodontist
in the future.)
Fig. 21

Fig. 22

Fig. 23

Fig. 24

Fig. 25

Fig. 26

Fig. 27

Orthodontists are not compelled to
enter an inevitable decline cycle; in fact,
the future is bright for aesthetically capable
orthodontists. Adopting the proven strategies
that have been applied in cosmetic dentistry,
embracing the communication approaches
of visual artists and improving the ability to
effectively present aesthetic case potential to
patients and peers can help ensure success.

Implementing time-saving
strategies
An important part of differentiation is
shortening treatment times while attaining
aesthetic goals with fixed treatment.
When necessary, we now can offer
treatment strategies that begin with fixed
appliances, then transition to clear aligners.
We consider this square-wire therapy our
breakthrough weapon because we can
approach aesthetic smile and width development earlier in treatment-four to eight
appointments-before moving into aligners
that are made in-house, eliminating any
delays related to factory-created models.
(We use uLab in-house aligner technology.)
Aesthetic differentiation with high
efficiency can be enhanced with this "fixed
first" strategy using highly efficient fixed
appliances, followed by in-house aligners
to further shorten treatment times in fixed
appliances.
Using treatment planning software that
starts with the patient's smile and identifies
bracket positions to deliver optimal aesthetic
smiles will provide further efficiencies. We
now offer a "combo" treatment that begins
with P21 fixed appliances, then transitions
to clear aligners that are made in-house.
We've also been working with uLab on
a bracket positioning project that will have
the software start with the patient's smile
and where to best position brackets for
the ultimate aesthetic smile, then provide
measurements the orthodontist can use for
indirect or direct bonding.

Fig. 28

Conclusion
We believe in a future where orthodontists thrive in an aesthetically driven
marketplace, working collaboratively with
other dental providers to achieve the best
aesthetic and occlusal results for our patients.
We are excited to be a part of the future! n
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Orthotown November 2020

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