Orthotown May 2023 - 54

such as labial braces (Lightforce,
KLOwen, Braces on Demand) and lingual
appliances (InBrace, Brava) allow
orthodontists to minimize some inherent
inefficiencies of stock prescription
brackets and standard archwires.
Digital custom solutions aren't totally
new, but new technology and materials
have led to improvements in areas that
lacked in previous options.
With this new generation of custom
appliances come excellent advantages
that benefits everyone involved-doctor,
team and patient. Remote monitoring
(Grin, DentalMonitoring), for
example, turbocharges what we can
do in terms of patient satisfaction and
fewer visits. When we bring patients
into the office only for impactful
appointments-wire changes,
refinement scans, etc.-the additional
clinical time lets us do more with the
patients who are scheduled.
Here are a few specific values of a
completely or mostly digital orthodontic
office.
More detailed review of
records and treatment goals
Digital treatment planning forces
orthodontists to follow important
steps in the diagnosis and treatment
planning process. It's easy to
get comfortable with having a basic
treatment plan and to become reactionary
throughout treatment. This is
what I typically did with traditional
stock appliances, but the cases I took
time to thoroughly diagnose and
treatment-plan turned out better.
When using custom appliances,
forms have to be submitted, which
means I have to put a better effort into
establishing my treatment goals and
mechanics on every case.
Treatment planning in a
prescriptionless platform
Another aspect of digital appliances
is digital treatment planning in which
preprogrammed prescriptions of tip,
torque and ins/outs are irrelevant. The
ability to put teeth where they belong
and have each individual tooth have
its own prescription is something that
previously had been available only
with clear aligners but now is doable
with fixed appliances as well-and
without the patient compliance issue.
When we bring patients
into the office only for
impactful appointments-
wire changes, refinement
scans, etc.-the additional
clinical time lets us do
more with the patients
who are scheduled.
With digital treatment planning,
the ability to see occlusograms and
cross-sections of the teeth to evaluate
overbite and overjet, or to place a grid
to evaluate symmetry and view the
teeth and occlusion from any angle,
is unmatched. Analyzing Bolton
analysis and using superimposition
to evaluate dentoalveolar changes
are just a few examples of the amount
of detail that can be gleaned from
digital treatment planning. Simulating
multiple treatment plans, such as
restorative or extraction cases with
multiple possible extraction patterns,
is powerful not only in helping us
MAY 2023 | 54 | ORTHOTOWN.COM
create the proper treatment plan
but also in educating patients and
referring doctors. The adage says,
" A picture is worth a thousand words, "
but a dynamic digital model that can
be shown from different angles and
narrated by the treating doctor to
explain their thoughts has to be worth
at least a million!
Consistency among
assistants and doctors
Variation of skill sets among assistants
can have a huge impact-favorably
or unfavorably-on the efficiency
of a case. Differences in placing brackets
or other analog appliances can lead
to treatment time being extended.
Digital appliances, meanwhile, have
a treatment plan that's established
before physical treatment begins, so
the clinical mechanotherapy can be
simplified because all of the major
treatment planning decisions have
already been mapped out. Treatment
simplification gives the best chance of
repetitive and reproducible results.
The advent of digital orthodontics
has flattened the learning curve for
inexperienced assistants. From their
perspective, the procedures for all the
digital custom options are essentially
the same: Start with records and a
scan, and after the doctor completes
the setup, some sort of indirect bonding
procedure is performed. From
the attachment trays for aligners to
the transfer trays for custom lingual
or labial braces, it's the same workflow,
which means it's easier to get
assistants up to speed. A lot of other
procedures still have to be learned,
but the ones that keep the practices
growing-exams and starts-are
essentially not affected.
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