Decreasing Duration of Orthodontic Treatment



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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 time-consuming treatment procedure.














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 x-rays 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.



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 Globe2dpanorama.png



Figure : 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 x-rayed 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 easily-manipulated virtual model of the patient’s mouth.


Figure : A 3D model created from a WLS
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. orascan.png


Figure : A 3D Model created from a CBCT scan
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 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. cbct.jpg



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 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 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





Full Fee

Mo. In TX

#TX Appts

#ER Appts

Total Appts

$/TX Appts

$/Total Appts

Average Non SureSmile

N=120

$4989

28

20

5

25

$249

$199

CL I(50)

$4829

26

17

4

21

$284

$230

CL II (57)

$5049

28

21

6

27

$240

$187

CL III

$5303

29

21

5

26

$252

$204

Average SureSmile

N=100

$5056

13

10

3

13

$506

$389

CL I (47)

$5021

12

10

3

13

$502

$386

CL II (39)

$5020

15

12

3

15

$418

$335

CL III (14)

$5246

14

10

3

13

$525

$404


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

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-It-Work.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=419310883



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=412523976


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