Orthotown October 2023 - 12

A VOICE IN THE ARENA
unrelated to alignment/prescription
(tooth position) problems, and include
(but are not limited to): waiting on
an impacted or late-erupting tooth;
purposely staging certain movements
after ideal alignment when needed;
chasing ideal occlusion; properly
timed IPR or other aesthetic detailing;
or some other case-specific component
of AP, transverse or vertical.
Again, these issues are not related to
inefficiency in achieving ideal alignment/prescription
with a noncustom
digital appliance.
Except for unusual circumstances,
pano/repo is completed by the sixmonth
mark (typically repositioning
zero to two brackets on average immediately
while chairside in less than five
minutes). By the 12-month mark, the
patient has already been in their fullsize
finishing stainless steel wires for
two to four months, and the necessary
one to three detail bends (on average)
to complete ideal alignment/prescription
have already been placed in one
appointment (the appointment after
the placement of those finishing wires)
where I am chairside for less than
five minutes.
Ideal alignment/prescription is
achieved in four to six appointments
in eight to 12 months. For a simple
Class I case with alignment problems,
this is the treatment duration I expect.
Again, even for moderate or complex
cases, ideal alignment/prescription
is not often something I'm chasing
after that amount of time. For me, the
benefit of using a custom digital appliance
is not as valuable as it might be
for orthodontists who find themselves
continuing that chase significantly
longer than that.
The point of discussing my protocols
here is not to propose how everyone
should be practicing or to claim mine
is a superior way of treating. Without
a doubt, there are those reading this
who are more ninja-like than I am
in their mastery of noncustom fixed
appliances. The point I'm trying to
make is that for the large majority of
your cases, if timed right (don't start
too early), planned correctly and
with appliances applied (positioned)
accurately, there should be few occurrences
of needing to continue to chase
ideal alignment/prescription after the
one-year mark. High efficiency for me
comes from an accurate and intentional
initial diagnosis and treatment
plan, custom bracket positioning, use
of early elastics and use of bite turbos
that are unique in their position
and shape.
Keep learning and improving
For perspective, I will add that you
don't need to limit yourself to a small
boutique practice or spend 20 minutes
chairside with each bonding to
achieve this level of efficiency. With
a mastery of noncustom fixed appliances
and efficient systems, I have
found this very possible even in a large
practice. To be fair, though, I will also
add that if you are seeing well over
100 patients per day, the value of any
degree of efficiency offered by custom
digital appliances likely starts to
become more practical.
While my opinions are biased by
my own experiences and prejudices, I
don't view myself as a chronic skeptic
of technology or late adopter of
new advances in our field. Though
I still make use of some old-school
OCTOBER 2023 | 12 | ORTHOTOWN.COM
techniques that remain efficient and
effective-for example, I still dust off
a set of headgear a handful of times
per year-I would submit that much of
my view on clinical orthodontics, and
particularly aesthetics and efficiency,
are pretty progressive.
Again, I practice much differently
than I did five years ago. I'll definitely
acknowledge that my opinions on
everything I've said above could be
much different in another five years.
I hope they are! I love that about
orthodontics. However, I can promise
you that whatever revolutionary
change comes knocking next, I will
make sure I'm a master of the skill set
it's there to disrupt, so I can fairly and
more accurately judge its disruptive
claims relative to what I can already
deliver in a more cost-effective or otherwise
better manner for my practice.
Whatever your opinion or path you
are on, I hope you're practicing the
best orthodontics of your life with the
best still yet to come. Set your navigation
toward mastery and always be a
student in your practice and learning.
Expect neither a guru nor a product to
deliver it to you, and keep both curiosity
and skepticism as your buddies on
the road trip that we're all so lucky to
be on. Cheers! OT
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Orthotown October 2023

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