Orthotown May 2023 - 41

How do you think clear aligner
therapy will look in a decade?
I've had a keen interest in aligners
over the years and also try to keep my
finger on the pulse of innovation. If I
had to make a prediction, I envision a
combination of direct aligner printing
(as opposed to 3D-printing the models
first) and shape-memory polymers.
The treatment planning will largely
be driven by artificial intelligence,
though I still believe in the role of
human oversight or supervision.
I predict a consolidation of the
aligner manufacturers, because there
are currently too many product offerings.
I anticipate that aligner cases
will continue to grow in expanding
markets, but the American market
will begin to level off with the advent
of digital custom braces options.
You've invented a companion
product used with clear aligners.
How did that start and where are
you now with the product?
I came up with the idea for the Precision
Aligner Buttons a few years after
graduating. At the time, orthodontists
were taking components intended for
braces and adapting them for wearing
elastic bands with Invisalign to
correct malocclusions. I was working
for several different practices in New
Jersey and I recognized they were all
encountering the same problem of
frequent emergency visits for broken
attachments, whether they were using
lingual buttons, molar tubes or Caplin
hooks. I thought there had to be a
better solution!
One day I asked Dr. Richard Kaye
of Morrone and Kaye Orthodontics in
Moorestown, New Jersey, a question:
" What if there were an orthodontic
button that would fit inside the cutout
windows from Invisalign just like a
puzzle piece? "
The button would have a larger
bonding pad for a stronger bond
strength to the tooth and would be
properly contoured to be attached at
the gum line. Dr. Kaye and I agreed to
partner on the idea and began working
with a coaching/consulting company
called inventRight to make the product
a reality.
Precision Aligner Buttons were
launched by MidAtlantic Ortho
(MAO) at the AAO meeting in 2018.
DynaFlex acquired MAO a year later
and worked with us to expand the
product line to include a clear version
for canines and premolars. DynaFlex
released our next-generation product
at AAO in Chicago this year, which
includes new design improvements
as well as a Mini version that we are
super excited about.
Dr. Kaye and I also recently created
an instrument with HuFriedyGroup
that has been included in its special
line of aligner instrumentation called
The Clear Collection. These are some
handy aligner-modification instruments
to have in the office developed
by Dr. Jay Bowman. Our Precision
Aligner Punch will create the exact
shape of a metal Precision Aligner
Button in any clear plastic aligner,
and is particularly useful for in-house
aligner fabrication.
When it comes to facial aesthetics,
what are some considerations
you-and other docs should-
keep in mind?
I was recently introduced to the
concept of a broad smile, with upright
buccal segments instead of lingually
MAY 2023 | 41 | ORTHOTOWN.COM
inclined crowns. I suppose some
might refer to this as a " Damon smile, "
but it is a look that many patients
seem to be requesting.
We have been incorporating
Norris Extra Broad archwires from
DynaFlex into our LightForce and
KLOwen Stride custom braces cases
with beautiful results. Patients seem
to love a fuller smile with minimal
buccal corridors. Of course, it goes
without saying that it's imperative
to assess whether the patient has the
periodontal support for this lateral
expansion.
You love digital workflows. What
are some digital adjustments
you've made that led to positive
outcomes? Any tips for those still
living in an analog world?
When digitally planning orthodontic
treatment, whether for aligners or
custom braces, it's important to pay
attention to smile gradation.
While most orthodontists are now
quite attuned to smile arc, smile
gradation refers to the concept of seeing
each progressive tooth from the
canine back to the second premolar
or first molar. Essentially, the smile
arc pertains to the vertical dimension,
while smile gradation is a transverse
consideration. These are smile
design concepts that many cosmetic
dentists pay attention to and have
been popularized in orthodontics by
Dr. David Sarver.
If a canine or first premolar is inadvertently
positioned too prominently
to the buccal, it won't be possible
to see each successive tooth when
smiling. This is particularly important
with aligners and custom braces,
because the thickness of the bracket
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