Orthotown September 2023 - 35

* There are oral hygiene instructions,
motivational speeches and elastic-wear
guidance.
* There are instruments to sterilize and a
chair to disinfect after every appointment.
It's a lot! Furthermore, let's consider the
fact that more appointments equate to
longer treatment times, and thus are often
associated with iatrogenesis such as root
resorption, white spot lesions, carious
lesions and gingival infl ammation.3
In fact,
longer-than-expected treatment time is one
of the major causes of patient dissatisfaction.4
There
is also the issue of profi tability
within the practice, which wanes with each
additional appointment.
Precise fi nishing
Therefore, I implore my orthodontic colleagues
to consider anything and everything
that might decrease treatment times and,
perhaps more importantly, the number of appointments
required to achieve orthodontic
fi nishing excellence. When we consider the
three phases of orthodontic treatment-
leveling and aligning, working and fi nishing-
it's typically not the leveling and aligning
phase that takes much time and eff ort. Using
light NiTi wires, most patients can be levelled
and aligned within six months, or three or
four appointments. And the working phase is
often combined with the alignment phase via
the use of early light elastics.
Usually, the fi nishing phase takes the most
time, attention and adjustments. This is often
because of inaccurate bracket positions
and " slop, " or excessive play between the
wire and the bracket slot. More than 80% of
orthodontists in the world use an 0.022-inch
bracket slot, yet less than 1% of orthodontic
archwire sold is " full-sized, " or 0.021 by 0.025
inches in dimension. Therefore, most doctors
are using a wire that does not fully express
the bracket prescription, which leads to variation
in all three planes of space: torque, tip
and rotation.
SEPTEMBER 2023 | 35 | ORTHOTOWN.COM
Fig. 5: At the second appointment, second molars were bonded
and 0.018-by-0.018-inch Norris Extra Broad NiTi wires were placed.
Short Class II (¼-inch, 2-ounce) elastics were prescribed.
Fig. 4: At the first appointment, Norris 20/26 brackets and anterior bite turbos
were placed, along with 0.014-inch Norris Extra Broad NiTi wires.
Fig. 6: At the third appointment, Norris Extra Broad 0.019-by-0.025-inch
NiTi wires were placed, and Class II elastics were continued.
Fig. 7: At the fourth appointment, Class I canine was achieved on
the right side, so Class II elastics were continued on the left side.

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Orthotown September 2023

Table of Contents for the Digital Edition of Orthotown September 2023

Orthotown September 2023 - Cover1
Orthotown September 2023 - Cover2
Orthotown September 2023 - 1
Orthotown September 2023 - 2
Orthotown September 2023 - 3
Orthotown September 2023 - 4
Orthotown September 2023 - 5
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Orthotown September 2023 - Cover3
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