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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.