Orthotown September 2022 - 29

coordinator (TC) for patients who
schedule online. This allows a minimal
outlay of resources to ensure:
* The patient is serious about
treatment (because they
showed up on time for their
virtual appointment).
* The patient has seen their
dentist within the past year
and has clean teeth that are
free of caries and periodontal
disease.
* All insurance paperwork,
medical history and personal
information has been received
and is accurate.
* The TC can establish a relationship
with the patient and provide them
with some cursory information based
on a virtual " look-see " of the patient's
occlusion. Our experience is that
once a relationship is established,
the patient is much more likely to
attend an in-person comprehensive
new-patient examination, where
photographs, radiographs, CBCT
and airway analysis are prescribed
and explained.
Another key element to the newpatient
exam is that all decision-makers
in the family need to be present-either
in person or virtually-so in the event the
patient is ready for treatment, a decision
regarding treatment can be made immediately
and a same-day start can ensue with a
scan for aligners or braces.
Starting with
restored teeth
In cases where braces will be used to
treat the patient, any worn teeth should
be provisionally restored to their natural
length and ideal anatomy with composite
resin before braces are placed (Figs. 1a-1c).
This systematic approach is called preorthodontic
bonding, and it provides a
three-dimensional blueprint for communication
between the orthodontist and restorative
dentist.
Provisionalizing the patient's dentition
to an ideal anatomy eliminates any guessing
as to how much intrusion or extrusion
is needed for the fi nal restorations, and
orthodontic treatment can be completed
much more quickly and effi ciently. Any fi -
nal restorations are completed at the end of
orthodontic treatment.
Indirect bonding
using the Norris
20/26 System
Indirect bonding (IDB) is a standardized
procedure we've done since our practice
opened in 1998 because it requires
zero doctor chair time (DCT)-the most
valuable commodity in the practice.
With IDB, bracket positions can be
accurately assessed and placed without the
encumbrances of the lips, tongue, cheeks
and saliva. Whether performing this task
virtually or the old-fashioned analog way
of in-house manual bracket positioning,
doctor time tends to be only a few minutes
and can be accomplished between patients
or after hours, so DCT is not utilized.
Through years of trial and error and
Figs. 1a-c
standing on the shoulders of great
teachers who have come before, a
bracket placement guide for
the
Norris 20/26 System (DynaFlex)
has been developed that emphasizes
the importance of the smile arc.
One systematic element of the
Norris 20/26 System is its passive/active
self-ligating door. The
door remains passive during the
fi rst two wires (0.014-inch and
0.018-by-0.018-inch nickel titanium)
and becomes active as soon as
an 0.019-by-0.025-inch wire is engaged
in the 0.020-by-0.026-inch
slot. It remains an active bracket
system, providing excellent 3D control
until treatment is complete.
The self-ligating feature of the bracket
eliminates variability in steel-tying an
archwire by clinical assistants (CA) who
are inconsistent with leaving the pig-tail
mesially or distally, occlusally or gingivally,
and loose or tight. Opening and closing
a dependable, well-crafted self-ligating
door with a reciprocal opening mechanism
is also much faster than placing and removing
a wire ligature tie or O-ring.
Another protocol during the bonding
process includes placing anterior bite turbos
to disarticulate the patient and free up
the two arches to start aligning immediately,
without the constraints of interocclusal
interferences and contacts.
Even during the preparation of the
teeth there are systems in place. Colorcoordinated
microbrushes are used for
their corresponding bonding agents-
green is for etchant, yellow is for sealant
and purple is for porcelain bonding agent.
Yet another consistent method during
the initial bonding appointment is to trim
and cinch the 0.014-inch NiTi archwire
distal to the second premolars. This prevents
comfort visits caused by the wires
sliding and poking the patient.
orthotown.com \\ SEPTEMBER 2022 29
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Orthotown September 2022

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