Download Decreasing Duration of Orthodontic Treatment

Decreasing
Duration of
Orthodontic
Treatment
Bringing Orthodontics into the
Digital Age
Exceptional advances in 2D and 3D
imaging help give a more complete picture
of root and bone structure and advanced
computer software uses these images to
help the orthodontist more accurately
predict how teeth will move. The time has
come for the modern orthodontist to
combine these advances into a less timeconsuming treatment procedure.
Decreasing Duration of Orthodontic Treatment
PEOPLE HAVE ALWAYS WANTED STRAIGHT TEETH
Even early thinkers such as Aristotle and Hippocrates contemplated
ways to straighten teeth and correct various dental conditions.
Numerous mummies have been found with metal brackets and experts
theorize that catgut was the world’s first orthodontic “wire.” Early
dentist Etienne Bourdet, dentist to the King of France in the 18th century,
was the first to recommend the extraction of premolar teeth to reduce
crowding and improve jaw growth. Early 20th century American,
Edward H. Angle devised a system for classifying malocclusions that is
still in use today. Angle made many other significant contributions to
modern orthodontics including founding the first college and school of
orthodontics, founding the first orthodontic journal, and organizing the
American Society of Orthodontia, which later became the American
Association of Orthodontists. This tradition of inquiry continues today
and it is time for orthodontists to make another advance in treatment
options.
MODERN ORTHODONTIA
An attentive orthodontic patient will quickly understand that the science
of tooth alignment involves a lot of guesswork. Because of the extra two
to three years of training an orthodontist must receive, this is highly
educated guesswork, but guesswork nonetheless. As one orthodontist
puts it, modern conventional orthodontic treatment is like “driving a car
by looking in the rearview mirror.” (Moles, 2007) A smart orthodontist
learns not to make definitive promises regarding treatment duration and
resulting tooth placement.
In conventional orthodontics, the doctor uses a plaster model and a 2D
x-ray of the patient’s mouth to determine a general treatment plan. In a
more technologically current office, the doctor may also use digital xrays of the mouth and specialized software to aid in this process. The
doctor must see the patient frequently to monitor how the teeth are
moving and make adjustments based on how the teeth have already
moved. These visits generally occur every four to six weeks and often
involve wire replacement, chair-side bending of wires, movement of
brackets and can last twenty minutes or longer. Archwires are bent by
hand during each appointment and require repeated readjustment over
the course of treatment. Due to the necessity of constantly finessing the
wires and brackets, the finishing stage of treatment, where the fine
alignments occur, can take as long as the major adjustments that occur at
the beginning of treatment.
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Factors such as patient age and type and severity of misalignment cause
treatment duration to vary across a broad timeline. A mild case of
malocclusions may take as little as six months of time in braces to
achieved the desired result while a severe case of malocclusions in an
older patient could take as long as six years to align the teeth
satisfactorily. Most dentists plan for at least 24 months treatment time.
For many people, especially the young adults who make up a large
portion of an orthodontist’s clientele, this can seem like an eternity filled
with pain and all sorts of inconveniences. Pain results not only from the
pressure exerted to achieve tooth movement but from mouth sores
triggered by irritations to the flesh inside the mouth from the various
components of the braces. Because braces can be easily damaged, the
patient must endure inconveniences such as the necessity of wearing a
mouth guard during sports, the avoidance of certain sticky or hard foods
such as raw carrots, pretzels, and taffy. Finally, a patient wearing braces
must be hyper-vigilant about oral hygiene practices because plaque
easily forms when food gets stuck around brackets, which occurs often.
MOVING ORTHODONTIC TREATMENT INTO THE DIGITAL AGE
Many dentists and orthodontists already rely heavily on computers and
digital imaging technology to expedite the work that must occur in their
offices. However, the digital age has much more to offer the orthodontic
practitioner. By applying advances in 3D image capture technology, 3D
image manipulation software, and precision robotics, an orthodontist
can travel into the 21st century sitting face-forward in the driver’s seat
rather than frequently looking in the rearview mirror trying to predict
where to go.
FROM 2D TO 3D: THE DIFFERENCE BETWEEN A MAP AND A GLOBE
FIGURE 1: A 2D PANOREX X-RAY
One of the beginning steps in the braces process is the
records appointment at which the patient’s mouth is xrayed and molds and impressions are made. The
orthodontist then has a 2D record of the patient’s teeth
positioning in the form of the x-ray and a 3D record in
the form of a plaster model. Unfortunately, the x-ray
image is spatially distorted and the plaster model is
static, unable to be manipulated by the orthodontist and can therefore
only be used as a reference. Because of recent advances in 3D image
capture an orthodontist can now user either a white light scanner or cone
beam computed tomography (CBCT) to create a digital and easilymanipulated virtual model of the patient’s mouth.
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FIGURE 2: A 3D MODEL CREATED FROM A WLS
FIGURE 3:
White Light Scanner (WLS): A WLS is a device for measuring
the physical geometrical characteristics of an object.
The WLS utilizes back to basics image capture methods
and the power of modern high-speed computers to
acquire a vast amount of surface information. A WLS
designed especially for dental practice uses flashing
white light to take digital images of each tooth,
documents the exact shape of the tooth, and records
the position of the tooth in relation to the teeth around
it. All of this data instantly transfers to a computer and
creates a 3D model of the patient’s mouth. An
orthodontic technician trained specifically in WLS
scanning can perform one in about twenty minutes.
Orthodontic white light scanners are fairly compact and
portable.
Cone Beam Computed Tomography (CBCT): Just one CBCT
scan can provide an orthodontist with 3D images of not
only the teeth, but also of the patient’s bone structure,
TMJ, sinuses, nasal cavity, alveolar nerve canal and all
related anatomy. A CBCT scan allows the doctor to
more precisely analyze the orientation and position of
the patient’s teeth and roots because it shows the detail
between different tissue types such as bone, teeth,
nerves, and soft tissue. A CBCT scan can show the
location and shape of unerupted teeth and even
measure bone density so that an orthodontist can
A 3D MODEL CREATED FROM A CBCT SCAN
accurately assess the amount of bone available for
tooth movement. A CBCT scan takes about thirty seconds for
image capture and another 30 seconds for data transfer. CBCT
technology is not new by any means but is just now advancing to
the point where a CBCT scanner is sufficiently compact and
radiation exposure has been reduced significantly enough that a
CBCT scan is a viable option for orthodontic professionals. Even
if an orthodontist does not have an in-office CBCT scanner, a
CBCT scan can likely be obtained from a local medical imaging
center.
USING THE SOFTWARE BEFORE INSTALLING THE HARDWARE
An orthodontist can use the completely digital 3D model of the patient’s
mouth together with advanced treatment planning software to create a
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treatment plan that will move the teeth in the most direct path possible
to the desired position. Because the treatment planning software allows
the orthodontist to view a patient’s teeth from any angle and assess how
the teeth fit together, the orthodontist can visually experiment with
several different treatment options and decide on the one most
appropriate.
The last step is for the orthodontist to use the treatment planning
software to create a prescription for a robotically formed shape memory
alloy archwire. By using treatment planning software in companion
with 3D digital models of a patient’s mouth, the orthodontist can try
several treatment scenarios without the expense of time and discomfort
to the patient. Because target tooth position is pre-planned a patient can
see a 3D model of the expected treatment outcome, avoiding
miscommunication between dentist and patient. The orthodontist can
also use the treatment planning software to digitally evaluate a patient’s
progress and order a new archwire if needed.
PRECISELY-BENT SHAPE-MEMORY ALLOY ARCHWIRES
Shape memory alloy, also known as smart metal or memory metal, is an
alloy that “remembers” its original cold-forged shape. Shape memory
alloy wires commonly come in two forms, one-way and two-way
memory. One-way memory alloy wire can be bent or stretched while in
its cold state and when heated to a predetermined temperature, or
transition temperature, will revert to its original state. Two-way
memory alloy wire can remember two different shapes, one at high
temperatures and one at low temperatures.
Orthodontists have employed shape-memory alloy archwires in their
practices for the last decade but are unable to utilize them to the
maximum benefits due to the limitations of manually bending the wires
in-office.
In-office wire bending cannot be done at the high
temperatures needed to create two-way memory wire. Even if
orthodontists could bend the shape memory alloy archwires under the
temperature conditions needed, they would still be unable to bend the
wires as precisely as a wire-bending robot could. A state-of-the-art six
axis robot can make bends in the wire at a temperature of 1000°F that
are accurate to a tenth of a millimeter, an exactness unmatched by even
the most experienced and dexterous orthodontist.
Shape memory alloy archwires robotically bent to a patient-specific
prescription are much more effective at moving teeth to a desired,
predetermined position because when activated by the patient’s own
body heat they exert constant tooth-moving forces on the teeth in the
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Decreasing Duration of Orthodontic Treatment
direction decided upon by the orthodontist with the aid of the treatment
planning software.
PUTTING IT ALL TOGETHER
Texas-based company, OraMetrix combines these three solutions under
the umbrella of the SureSmile proprietary digital orthodontic system.
Orthodontists use an OraScanner, a white light scanner created
specifically for capturing oral images and data, or CBCT to acquire a 3D
digital model of a patient’s mouth and possibly the bone and tissue
structures surrounding the mouth depending on the image acquisition
method. The orthodontist then uses SureSmile treatment planning
software to view the digital 3D model of the patient’s mouth to simulate
and formulate treatment plans. After choosing the treatment plan most
appropriate for the patient, the orthodontist sends the shape memory
alloy archwire prescription to OraMetrix where a robot bends the
archwire. Upon receipt of the archwire from OraMetrix, the orthodontist
installs it in the patient’s mouth and the SureSmile portion of the
patient’s treatment begins.
Although the SureSmile orthodontic system offers numerous benefits to
both patient and orthodontist, the biggest benefit is the reduction of
total treatment time by an average of 40%. While most orthodontists
increase treatment fees by an average of 10%, the cost/benefit analysis
below is from one dentist who didn’t appreciably increase fees and was
still able to increase profit and drastically reduce treatment times.
COST/BENEFIT ANALYSIS OF SURESMILE TREATMENT
Average Non SureSmile
N=120
CL I(50)
CL II (57)
CL III
Average SureSmile
N=100
CL I (47)
CL II (39)
CL III (14)
Full
Fee
$4989
Mo.
In TX
28
#TX
Appts
20
#ER
Appts
5
Total
Appts
25
$/TX
Appts
$249
$/Total
Appts
$199
$4829
$5049
$5303
$5056
26
28
29
13
17
21
21
10
4
6
5
3
21
27
26
13
$284
$240
$252
$506
$230
$187
$204
$389
$5021
$5020
$5246
12
15
14
10
12
10
3
3
3
13
15
13
$502
$418
$525
$386
$335
$404
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DISCLAIMER
This white paper was not authorized by SureSmile or its parent
company, Orametrix. This white paper was written for academic
exercise only. This white paper may possibly contain incorrect
information or data for which SureSmile and OraMetrix cannot be held
responsible.
CONTACT
To receive more information about the SureSmile system and how your
orthodontic practice can benefit from it, contact OraMetrix one of the
following ways:
www.suresmile.com
www.orametrix.com
1.888.672.6387
OraMetrix, Inc.
2350 Campbell Creek Blvd.
Richardson, TX 75082
972.728.550
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BIBLIOGRAPHY
Lin, E. Y., Phillip, G., Wilke, K. J., Huang, I. M., & Bialkowsk, L. S. (2008).
SureSmiles Applies CBCT to Custom Orthodontic Therapy . Richardson, Texas,
USA.
Lohse, J. (2007). Redefining Orthodontic Care With SureSmile. Peer2Peer:
Shared Learnings from High Performance Practices , 1 (1), pp. 2-4.
Moles, R. C. (2007). Transforming to an All-Digital Practice With SureSmile.
Peer2Peer: Shared Learnings From High Performance Practices , 1 (2), pp. 3-6.
OraMetrix. (n.d.). FAQs. Retrieved March 20, 2011, from www.suresmile.com:
http://www.suresmile.com/FAQs.aspx
OraMetrix. (n.d.). How It Works. Retrieved March 20, 2011, from
www.suresmile.com: http://www.suresmile.com/I-am-a-Doctor/How-Does-ItWork.aspx
OraMetrix. (n.d.). Why SureSmile. Retrieved March 20, 2011, from
www.suresmile.com: http://www.suresmile.com/Why-SureSmile.aspx
Wikipedia contributors. (2011, March 20). Dental braces. Retrieved March 20,
2011, from Wikipedia, the Free Encyclopedia:
http://en.wikipedia.org/w/index.php?title=Dental_braces&oldid=419755529
Wikipedia contributors. (2011, March 17). Shape memory alloy. Retrieved March
20, 2011, from Wikipedia:
http://en.wikipedia.org/w/index.php?title=Shape_memory_alloy&oldid=41931
0883
Wikipedia contributors. (2011, February 7). White light scanner. Retrieved
March 20, 2011, from Wikipedia, the Free Encyclopedia:
http://en.wikipedia.org/w/index.php?title=White_light_scanner&oldid=412523
976
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