Download Cliniclan`s Comments : Minor tooth movement

Cliniclan's Comments : Minor tooth movement
Straight talk for GPs
Slenderizing teeth for orthodontic aligner therapy is fast, comfortable, and accurate with a
lowspeed, high-torque handpiece and a specialized reducing strip. By Cynthia Brattesani, DDS
As a general dentist, my goal is to help my patients formulate a plan of care for their dental health. Often, their
dental wish list includes minimal orthodontic procedures. Thanks to new techniques in orthodontics and stateof-the-art equipment, I can provide the “straight talk” that my patients want. While many patients want
straighter teeth, they don’t want the esthetic drawbacks that come with wearing traditional bands and wires. As
an alternative, I offer the tooth movement system Invisalign®, which is a series of clear trays, called “aligners”
that are easily removable and invisible.
General dentists who want to provide these additional services to patients must
complete a course and obtain certification for the Invisalign process.
The process begins when the dentist sends the impression and a prescription to the
company, Align Technology Inc. (www.invisalign.com). In turn, Align sends back
three-dimensional graphic models of the teeth during the various stages of the process
as well as computer-generated, see-through plastic trays. These trays represent the
entire system, packaged and numbered for the total treatment plan. I send patients
home with enough trays so that they can change every two weeks. They return in six
weeks so that I can monitor their progress.
To provide enough space to incrementally move the teeth into the desired position,
Dr. Cynthia Brattesani
some teeth need to be “slenderized,” or minimally filed, to create the extra space (the owns a private practice in
San Francisco where she
implements new
technologies to better
that involved manually flossing a small metal interproximal sanding strip in a backserve patients. She was
and-forth motion in between the teeth. The manual filing process did not inspire
awarded the prestigious
confidence. Patients want assurance that the dentist is preserving the tooth structure ADA Golden Apple New
Dentist Leadership Award
in the most efficient way.
in 1996. An enthusiastic
Rather than time consuming hand filing, I now use a specialized reducing strip (AXIS™ member of organized
dentistry, she has held
Intensiv Ortho-Strips, www.axisdental.com) in conjunction with my electric low speed, positions at the local,
high-torque handpiece (KaVo ELECTROtorque TLC®, www.kavousa.com) to make the state, and national levels.
Dr. Brattesani is a
process faster, more predictable, and more comfortable (Figs. 2 and 3). There are five
graduate of University of
different styles/grits of strips. I particularly favor the one-sided strips, so that I have
California at San Francisco,
School of Dentistry. You
total control over the stripping process. The innovative attachment turns 360° and
may reach her at
allows one strip to perform at any angle, for lower teeth, bicuspids, interior teeth, or
[email protected].
pre-op view of an exemplary case is shown in Fig. 1) . In the past, I used a process
overlapping teeth. In the past, I had to use different strips at different angles. In some
cases, I used a wooden wedge to separate the teeth before the strip could be inserted. With this attachment
and the KaVo handpiece, preps are more controlled and thus feel smoother. My handpiece allows the strip to
enter the interproximal sections of the teeth very easily.
CONTINUED ON PAGE 2
Whether I am slenderizing tooth enamel or porcelain crowns, the combination of slow speed and high torque
does not allow the attachment to bind. The strips slightly bend to the contour of the teeth, for optimum control,
so that I don’t over-reduce, or reduce in the wrong area (Fig. 4 shows the teeth just after stripping). Patients
do not have to worry about the strip slipping and hitting their gums, and they do not feel the discomfort of the
manual “sawing” movements.
Before beginning treatment, my patients completely understand the Invisalign process. We show them a
computer graphic video of the proposed plan for their teeth, so they understand how the teeth are moved and
why slenderization is involved. They appreciate that extractions are unnecessary. The whole procedure using
the KaVo handpiece, AXIS strips, and the Invisalign trays (shown being worn in Fig. 5) is fast and efficient for
the dentist. Patients appreciate the comfort and convenience. They don’t have to “brace themselves” for going
to a specialist for minimal tooth movement. They can stay in my office and I can set them straight myself. Fig.
6 shows the case after completion.
PREPARING FOR ALIGNERS
(top) The pre-operative view. (left, right) A low speed, high-torque handpiece and specialized reducing strips provide
comfortable, conservative tooth reduction.
READY FOR ALIGNERS
(4) Space is created to allow sufficient tooth movement without extractions. (5) Aligners in place are virtually invisible. (6)
Post-treatment view shows the improved smile.