Orthodontic Practice US Winter 2023 Vol 14 No 4

Lasers / Practice Management n 4 CE Credits Available in This Issue*

Winter 2023 Vol 14 No 4

NEW!

orthopracticeus.com

Innovation driving practice growth Drs. Todd Bovenizer and Christopher Baker

Dr. Melissa D. Shotell

CO2 lasers in orthodontics Dr. Sabrina Dragan

The synergy of orthodontics and myofunctional therapy Dr. Maria Sokolina

DIGITALLY POWERED CLINICAL EXCELLENCE

Implementation of 3D printing: more than just buying a printer

LEARN MORE ON PAGE 8

PROMOTING EXCELLENCE IN ORTHODONTICS

Driving the Future of Orthodontics

Power your practice with the latest innovations inspired by doctors.

SPARK APPROVER WEB Use powerful Spark Approver software features in and out of the office with convenient, secure web-based access.

OPTIMIZED OPEN PLATFORM WITH DEXIS IOS INTEGRATION Easily submit aligners with one-click captures of patient data, automatic case creation, and quick access to STL files.

GAME-CHANGING CLINICAL AND WORKFLOW UPDATES Enjoy enhanced control and versatility with Flexible Material Choice, Integrated Hook Updates and Real-Time Approval with Passive Aligners Editing Tool.

“Ormco has a legacy of continuous, doctorinspired innovation.

And it shows in this new release. As an Ormco insider, I can attest to the fact that Spark is listening to us doctors and I am thrilled with the direction that we’re going together.”

– Dr. Jeff Summers 1

*Data on file.

Dr. Jeff Summers is paid consultant for Ormco.

The opinions expressed are those of doctor Jeff Summers. Ormco is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own judgment when treating their patients.

Patient results may vary.

1

Explore Spark Aligner’s complete clinical and workflow enhancements at:

go-orm.co/op-r14

MKT-23-1085

INTRODUCTION

Progress over perfection Winter 2023 n Volume 14 Number 4 Editorial Advisors Lisa Alvetro, DDS, MSD Daniel Bills, DMD, MS Robert E. Binder, DMD S. Jay Bowman, DMD, MSD Stanley Braun, DDS, MME, FACD Gary P. Brigham, DDS, MSD George J. Cisneros, DMD, MMSc Jason B. Cope, DDS, PhD Bradford N. Edgren, DDS, MS, FACD Eric R. Gheewalla, DMD, BS Dan Grauer, DDS, Morth, MS Mark G. Hans, DDS, MSD William (Bill) Harrell, Jr, DMD John L. Hayes, DMD, MBA Laurence Jerrold, DDS, JD, ABO Marc S. Lemchen, DDS Edward Y. Lin, DDS, MS Thomas J. Marcel, DDS Mark W. McDonough, DMD Randall C. Moles, DDS, MS Elliott M. Moskowitz, DDS, MSd, CDE Rohit C.L. Sachdeva, BDS, M.dentSc Gerald S. Samson, DDS Margherita Santoro, DDS Shalin R. Shah, DMD Lou Shuman, DMD, CAGS Scott A. Soderquist, DDS, MS John Voudouris (Hon) DDS, DOrth, MScD Neil M. Warshawsky, DDS, MS, PC John White, DDS, MSD Larry W. White, DDS, MSD, FACD CE Quality Assurance Board Bradford N. Edgren, DDS, MS, FACD Fred Stewart Feld, DMD Gregori M. Kurtzman, DDS, MAGD, FPFA, FACD, FADI, DICOI, DADIA Justin D. Moody, DDS, DABOI, DICOI Lisa Moler (Publisher) Mali Schantz-Feld, MA, CDE (Managing Editor) Lou Shuman, DMD, CAGS

© MedMark, LLC 2023. All rights reserved. The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems. While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it. The views expressed herein are those of the author(s) and not necessarily the opinion of either Endodontic Practice US or the publisher.

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n the modern world, digital treatment planning has been embraced for creating aligners. There is an immense, unmet potential in using those same digital workflow technologies for treatment with braces.

Pre-dating aligners, a small team of our colleagues worked on digital treatment processes to improve orthodontic treatment using braces. Those initial processes took some interesting twists through various professional conflicts, dramatic ownership questions, and intense legal battles, resulting in what we perceived as an aligner revolution.

Tim Bandeen, DDS, MS Aligner technologies flourished while braces seemed left behind; however, in the background, efforts to bring braces into dentistry’s digital workflow continued.

Previously, when teeth started moving in unintended ways, we had to react to the failings of our “clinical judgment” by repositioning brackets and bending wires.

For our practice, that is a fable from a different era. We know that, just as ships move people, braces move teeth. Steer a ship without a compass or navigation system, and see what happens. The same is true for braces. It’s sad how so much time, money, and effort is spent on trying to compensate for poorly placed braces rather than focusing on having the braces in the right spot in the first place.

We have dedicated our professional efforts to master digital treatment with braces. When using Ormco™ Digital Bonding (ODB), we use Ormco’s Spark Approver™ software for both aligners and braces. We can see the desired treatment goals and then work backward to reverse-engineer the placement of our braces.

Teeth straightening should be on autopilot from having been planned well so that we can focus on the essential parts of treatment, such as improving smile arc, addressing impacted canines, correcting anterior-posterior occlusal discrepancies, etc. The statement, “This is only going to take 12 months,” is laughable without good planning. Orthodontists have been acting as though we’ve been doing our best while ignoring relevant systems that have been available for years.

Along the road to acceptance of any technology is a pile of excuses for waiting.

Our practice started using Ormco’s Insignia for orthodontic digital workflows for braces in 2008 as our standard of care 15 years ago! Ormco’s release of ODB in September 2023 addressed many topics that kept our colleagues on the sidelines.

One of our core values in our practice is “Progress Over Perfection.” Waiting for a perfect system would mean waiting forever. We asked ourselves if moving to a digital workflow for braces would allow us to be better. Looking back on the last 15 years, the answer is yes. We chose not to settle for failing to develop while the world passed us by. Every morning, I walk past a sign in my house that reads, “Do not be afraid of change. Be afraid of not changing.” It’s time to step into the processes that have been available for years.

Those processes are better than ever and are improving daily.

Dr. Tim Bandeen

Tim Bandeen, DDS, MS, and his wife, Emily Bandeen, DDS, work together at their multi-location orthodontic practice in Southwest Michigan. Passionate about orthodontic digital treatment planning, they have provided more care for Ormco’s Insignia Custom Smile Design process than any other practice worldwide and now use Ormco Digital Bonding as their standard of care. When not caring for orthodontic patients, they enjoy spending time with their four children and four dogs.

ISSN number 2372-8396

orthopracticeus.com

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Volume 14 Number 4

TABLE OF CONTENTS

PUBLISHER’S PERSPECTIVE

Choose faith over fear Lisa Moler, Founder/CEO, MedMark Media............................... 6

8

COVER STORY

Innovation driving practice growth

Drs. Todd Bovenizer and Christopher Baker discuss keeping up with the latest advancements in orthodontics Cover image of Drs. Todd Bovenizer and Christopher Baker courtesy of Ormco.

CASE REPORT

Whiten, align, and shine: whitening with aligners Dr. Brigham Stoker illustrates a combination of treatment over 4 years.................................................18

ORTHODONTIC CONCEPTS

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Revolutionizing orthodontic care: bringing together AI and gamer technology to improve patient outcomes

Dr. Maria Sokolina discusses a game-changer in long-term stability

Khamzat Asabaev talks about combining technologies that can transform orthodontic workflows .............................................................. 20

CLINICAL

The synergy of orthodontics and myofunctional therapy and sleep apnea treatment

Orthodontic Practice US

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Volume 14 Number 4

Clearly

Transformative The Clear Collection™ Instrument Line Has Expanded Our ever-growing Clear Collection™ Instruments are designed to accent, individualize, and optimize the biomechanics of the “invisible” clear aligner experience with no heat required.

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Multi Punch

678-813 Creates a cut out on the tough to access occlusal aspect of clear aligners

Discover the Clear Collection Hu-Friedy Mfg. Co., LLC, 1666 E. Touhy Ave., Des Plaines, IL 60018 | HuFriedyGroup.com All company and product names are trademarks of Hu-Friedy Mfg. Co., LLC its affiliates or related companies, unless otherwise noted. [Third-party attribution statements.] Marks not registered in all jurisdictions. ©2022 Hu-Friedy Mfg. Co., LLC. All rights reserved. 1123

The Bite Plane

TABLE OF CONTENTS

DIGITAL DIGEST

Enhancing orthodontic marketing with automation: a digital revolution

CONTINUING EDUCATION

Implementation of 3D printing: more than just buying a printer

Jeff Slater discusses how automation can keep your on-line presence active........................... 33

PRACTICE DEVELOPMENT

Five ways to effectively measure your practice’s performance TECHNOLOGY

Dr. Sabrina Dragan discusses an innovative tool with multiple benefits for the orthodontist and the multidisciplinary practice .........................................................28

Sleep apnea among military veterans Claire Szewczyk discusses “the silent battleground” ..................... 36

Dr. Melissa D. Shotell discusses factors that should be considered before adding 3D printing to the orthodontic office...................... 24

CO2 lasers in orthodontics

MILITARY MATTERS

Referrals — from a pad of paper to a technology-filled smart card Dr. Steven Semaan talks about the importance of referrals and a new technology that promises to change and improve the process. .........................................................34

Oliver Gelles offers reliable metrics to gauge production and efficiency ........................................... 38 PRODUCT PROFILE

The case for limited treatment Dr. Leon Klempner discusses growing your practice with high value-per-visit treatment.......... 40

*Paid subscribers can earn 4 continuing education credits per issue by passing the 2 CE article quizzes online at https://orthopracticeus.com/category/continuing-education/

www.orthopracticeus.com READ the latest industry news and business WATCH DocTalk Dental video interviews with KOLs LEARN through live and archived webinars RECEIVE news and event updates in your inbox by registering for our eNewsletter CONNECT with us on social media Connect. Be Seen. Grow. Succeed. | www.medmarkmedia.com

Orthodontic Practice US

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Volume 14 Number 4

PUBLISHER’S PERSPECTIVE

Choose faith over fear

I

’m sitting at my computer on a beautiful day, writing my winter message, and Billy Joel’s song, “Keeping the Faith” started playing. It started me thinking of the past and the future and how sometimes, it seems easier to stay “lost in let’s remember” than move forward and face an often scary unknown.

One of my most meaningful mantras is “faith over fear.”

It is so easy to keep to the same schedule, keep the same business protocols, and the same way of doing things, in a safe comfort zone. MedMark publications are meant to help you break out of that habit. We want you to not only Lisa Moler read about the expanding opportunities for every aspect of Founder/Publisher, MedMark Media your practice, but also to have the foresight to bring these innovations into your practice for your patients and your own success.

After almost 2 decades of dental publishing, I have seen many advancements revolutionize dental specialties. I remember when dentists were wary of finding a new use for their darkroom space and welcoming digital imaging into the practice.

Now, not only X-rays, but a myriad of digital technologies connect every aspect of the practice, from X-rays, to practice management, to marketing, and connecting with patients. Even AI has found its way to the dental office. AI is constantly evolving, so all of you brave “early adopters” should be excited about the prospects!

No matter your specialty, innovations have transformed the way dental professionals practice — choices for clear aligner materials and 3D printing for orthodontists, new implant technologies for implant-focused dentists, and files and equipment to clean the root canal space for longer-lasting endodontic results. I have a personal involvement in many important breakthroughs affecting and saving the lives of those who suffer from sleep-breathing disorders. We are honored to bring you all of the latest clinical and business options.

In our winter issue, here are some articles that will help you to fulfill your ambitious and enlightened goals. Our cover story by Drs. Todd Bovenizer and Christopher Baker talks about how Ormco has brought meaningful, clinically focused orthodontic advancements, like Spark Clear Aligners, to their practice. Our CE by Dr. Melissa Shotell takes a systematic look at what it takes to add a 3D printer to your practice, for faster implementation and smoother workflow. Dr. Sabina Dragan’s CE explains the benefits and various uses for CO2 lasers in the multidisciplinary orthodontic practice. Subscribers who pass the CE quiz can receive 2 CE credits! Dr. Maria Sokolina points out the connection between myofunctional therapy and orthodontics in the treatment of sleep-breathing disordered patients.

We can do the research, but you have to take the leap of faith. Billy Joel’s song has the right idea about honoring the past but propelling ourselves into the future: “You can get just so much from a good thing You can linger too long in your dreams Say goodbye to the oldies but goodies ‘Cause the good ole days weren’t always good And tomorrow ain’t as bad as it seems.”

Don’t linger too long while others take initiative. Choose faith over fear to flourish personally and professionally!

To your best success, Lisa Moler Founder/Publisher MedMark Media Orthodontic Practice US

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Volume 14 Number 4

Published by

Publisher Lisa Moler lmoler@medmarkmedia.com Managing Editor Mali Schantz-Feld, MA, CDE mali@medmarkmedia.com Tel: (727) 515-5118 National Account Manager Adrienne Good agood@medmarkmedia.com Tel: (623) 340-4373 Sales Assistant & Client Services Melissa Minnick melissa@medmarkmedia.com Creative Director/Production Manager Amanda Culver amanda@medmarkmedia.com Marketing & Digital Strategy Amzi Koury amzi@medmarkmedia.com eMedia Coordinator Michelle Britzius emedia@medmarkmedia.com Social Media Manager Felicia Vaughn felicia@medmarkmedia.com Digital Marketing Assistant Hana Kahn support@medmarkmedia.com Website Support Eileen Kane webmaster@medmarkmedia.com MedMark, LLC 15720 N. Greenway-Hayden Loop #9 Scottsdale, AZ 85260 Tel: (480) 621-8955 Toll-free: (866) 579-9496 www.medmarkmedia.com www.orthopracticeus.com Subscription Rate 1 year (4 issues) $149 https://orthopracticeus.com/subscribe/

96% OF PATIENTS DEVELOP ORAL DISEASE DURING 1 ORTHODONTIC TREATMENT

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Brown, et al (2015) The Angle orthodontist. 86. 10.2319/041515-249.1.

COVER STORY

Innovation driving practice growth Drs. Todd Bovenizer and Christopher Baker discuss keeping up with the latest advancements in orthodontics

I

nnovation and technology are fundamental values we strongly believe in at Bovenizer and Baker Orthodontics. We believe that is crucial. From serving on the advisory board for Carestream, where we helped to improve and innovate their practice management software, to participating in Ormco Insiders (a group of handpicked top clinicians who work with Ormco on product research and development), innovation has been a top priority for us.

We live by the saying, “What gets measured gets improved.” Every morning, we look at statistics from Gaidge and OrthoFi™ before coming into the office, meet with the treatment coordinators and financial coordinator on goals for the day, and review pending patients who would be a good fit for the practice. It is essential to maintain high patient conversion to Drs. Christopher Baker, Keri Kenning, and Todd Bovenizer have an efficient new patient process and not “waste” appointments.

Over the past decade, as our practice has grown, we intro3D printing and utilized uLAB software to help with minor tooth duced another like-minded doctor who believes in innovation movements on our patients. and excellence. Dr. Keri Kenning, who has Damon™ brackets When we started our practice, we were dabbling in clear and clear aligner experience, has helped with numerous clinical aligners and using 3D-printed models for patients at debond to and administrative tasks to help further modernize our practice. ensure a top-notch outcome. We were only using clear aligners Our collective experience led us to partner with Ormco, a about 5% of the time. This has now increased to about 20% of manufacturer that offers meaningful, clinically focused orthocases to capture a broader adult market and older teens. This has dontic innovations that are hard to find elsewhere. been a great way to grow our practice.

After experimenting with various products, we landed on Ormco’s Damon self-ligating brackets and brought in digital Spark Clear Aligners orthodontics like Spark™ Clear Aligners. We also worked with Spark Clear Aligners are continuously evolving, which includes start-to-finish improvements in the Spark Approver™ software. We get back what we want with one or fewer modifications from the initial submission in the Approver system.

There’s less need for doctors to adjust the treatment plan because the team at Spark has listened to doctors. They’ve built protocols for specific tooth movements, giving us the flexibility and control we need to treat our patients.

Our initial prescription gives the Spark team (overseen by a doctor) what we are looking for, and the setup returns what we want. We still change or add specific attachments, but it’s far less than what we used to do with other aligner products.

With new features from Spark Release 14, we can make more adjustments and easily detail the case. Real Time Approval has allowed expanded capability with instant changes and the ability to approve instantaneously. This has resulted in many cases being approved without having to be sent back to the Spark technician team. One of our favorite features we have seen in aligners in the past 5-plus years are the Integrated Hooks used for elastics. They have made it easier for the patient to place the

Todd Bovenizer, DDS, MS, graduated from Virginia Tech with his Bachelor’s in Biology and West Virginia with his Master’s in Orthodontics and Doctor of Dental Surgery. He is a Board-certified Orthodontist from the American Board of Orthodontics. Dr. Bovenizer is part of Damon’s Mentor Program and lectures nationally on the Damon System. He serves on Ormco Insider’s product development team, where he meets with top clinicians to discuss product research and development.

Christopher Baker, DDS, MSD, is a Board-certified Orthodontist in Cary, North Carolina. He partnered with Dr. Bovenizer in 2014. He is a past President of the North Carolina Association of Orthodontists and is currently the North Carolina captain for the AAOPAC. He and his wife of 15 years have two energetic boys, and they all love spending time together, especially boating in the waters of their favorite islands in the Caribbean.

Disclosure: Dr. Bovenizer is a paid consultant for Ormco. The opinions expressed are those of Drs. Bovenizer and Baker. Ormco is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment in treating their patients. Teeth images have not been altered. Patient results may vary. Images are courtesy of Bovenizer & Baker Orthodontics.

Orthodontic Practice US

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Volume 14 Number 4

COVER STORY

elastics. In our practice, we previously used either buttons that were always coming off or slits in the posterior which were hard for the patients to use. We noticed this caused a lot of broken elastics and unseating of aligners, even with attachments on those teeth.

We have encountered that Spark TruGEN™ material has proved to be more effective for teeth movement compared to the leading aligner material. Fewer refinements have led to us finishing cases more efficiently than a couple of years ago and under our estimated completion dates without compromising finish quality.

Patients have also really enjoyed the more transparent clarity of the plastic and have asked for these aligners.

Figure 1: Initial photos

Case No. 1 The 29-year-old patient presented with an anterior open bite, did not like her smile, and had difficulty eating some foods (Figure 1).

Her initial exam revealed an open bite of 2 mm at the laterals, narrow and rolled-in arch in the premolar area, contributing to bilaterally excessive gum display in that region.

Our treatment goals were to close the anterior open bite with some posterior intrusion and expansion in the Figure 2: Progress photos premolars and extrude and rotate the maxillary lateral incisors. We felt we could help with the gum display in the premolar region by expansion. We estimated 12 months of Spark Aligners treatment with good aligner-wear compliance.

The patient was highly compliant wearing Spark Aligners (Figure 2).

After one refinement to mainly tweak some black triangles in the lower and seat the posterior, we completed treatment in 10 months, after five total visits. We were pleased with the final result (Figure 3). Individual results and treatment lengths may vary.

Figure 3: Final photos of the 29-year-old patient When treated correctly, this is a relatively straightforward case. The initial Approver setup automatically Damon Ultima System placed the sash attachments (Figure 4), our preferred choice for Our practice always looks to improve performance and stay extrusion and rotation of laterals. up-to-date with the latest best practices and innovations. That’s This is an excellent example of how a small amount of doctor why we incorporated multiple iterations of the Damon™ selftime and tweaking comes to life because our doctor’s preferligating bracket, including Damon 3MX, Q, Q2, and now ences in the Approver software are set, and the Spark team autoDamon Ultima™ System. matically puts them into place. Specifically, the premolar region Ultima has allowed us to not only up our performance on expanded to our preferred Damon arch form for the desired result (Figure 5). the patient level but also improve efficiency and continue to

Figure 4: Initial Approver software setup

Figure 5: Final Approver software desired result orthopracticeus.com

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Volume 14 Number 4

COVER STORY

drive our clinical expectations of fuller smiles with smile arc and expanded buccal-segment arch forms.

Case No. 2 We’ve used the newly re-engineered Damon Ultima bracket for 2-1/2 years. It has greatly enhanced our finishing and has increased our efficiency. All three doctors want the finish at the highest standard and have smiles characteristic of a Bo/Baker Smile. When we can do this while improving efficiency, it is a win-win!

The patient presented with a Class II dental occlusion, severe deep overbite, and severe mandibular crowding (Figure 6).

We used procline brackets on the maxillary incisors, and due to the deep overbite, we bonded the maxillary arch first. We like to do this to increase patient comfort from larger bite turbos.

At the second appointment, we placed an increased Curve of Spee on the maxillary arch to prepare for lower bonding, for which we used retrocline torque on the mandibular arch. We achieved first-order control with rotational correction at the 0.14 x 0.0275 wire and began interarch elastics (Figure 7).

We also started seeing very nice arch-form development. This transitioned into our 0.18 x 0.0275 for more arch-form progression and gave us a torquing couple with this newly engineered system with a rounded rectangular wire in a new parallelogram slot. This makes correction easier by allowing our centrals to get to 7 degrees and then having protection not to dump the incisors as we were used to in our older versions of passive self-ligation. This is very important in finishing; instead of using torqued wires, we can use a larger wire to achieve higher torque. This is even more important in the mandibular arch to prevent excessive proclination of the lower incisors in Class II cases, which makes finishing very tough. To avoid this, we have a torquing couple with the new design (Figure 8).

We have a locked-in occlusion from his finish, including canine and anterior guidance. There is a great smile arc, and the arch form presents Figure 7: Progress photos itself from anterior to posterior with no excessive dumping of the teeth in the posterior, which would make the smile less than optimal by not being as upright. OP

Figure 6: Initial photos

Figure 8: Final photos Orthodontic Practice US

10 Volume 14 Number 4

NEW!

DIGITALLY POWERED CLINICAL EXCELLENCE Streamline your practice efficiency with Ormco Digital Bonding, Powered by Spark Technology. Ormco Digital Bonding allows doctors to achieve customized bracket positioning by combining the best-in-class Damon Ultima™ brackets and the powerful Spark Approver Software.

EXPERIENCE ORMCO’S NEWEST INNOVATION With Ormco Digital Bonding, we’ve leveraged our premiere orthodontic technologies to provide orthodontists with even greater flexibility and more treatment options.

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Driving the Future of Orthodontics MKT-23-1441

CLINICAL

The synergy of orthodontics and myofunctional therapy Dr. Maria Sokolina discusses a game-changer in long-term stability and sleep apnea treatment Abstract

Orthodontic treatments often face challenges related to longterm stability. This article discusses the connection between orthodontic relapses and orofacial myofunctional habits, especially among sleep-breathing disorder patients. Recognizing this link, the author integrated myofunctional therapy (MFT) into orthodontic treatment. The combination of clear aligners and MFT not only improves orthodontic outcomes but also addresses related issues, notably in sleep-breathing disorders treatment.

This holistic approach offers potential for enhanced orthodontic results and overall patient well-being.

Introduction

Having embarked on a journey in orthodontics with clear aligner therapy since 2002, I’ve had the privilege of witnessing numerous cases and their outcomes. Over time, I observed a recurring theme that left me both intrigued and concerned — the long-term stability of orthodontic treatments.1 Some patients adhered rigorously to retainers and still experienced relapse or changes in teeth position after several years, while others seemingly defied the odds, maintaining their results without retention.2 This inconsistency in outcomes piqued my curiosity.

Orofacial myofunctional therapy (OMT) has a rich history dating back to the early 1900s. It emerged as a response from the orthodontic field to restore normal muscle function, alleviating unintentional pressure on dental structures. OMT was initially developed by orthodontists with the goal of enhancing orthodontic outcomes and preventing relapses.

The roots of OMT trace back to the late 1800s when Dr. Edward Angle made a pivotal observation — he recognized that

Maria Sokolina, DDS, is founder and CEO of Harmony Dental Arts. She emigrated from Russia with her first medical degree and later received her DDS degree from New York University College of Dentistry. Upon graduation, Dr. Sokolina pursued specialized skills in different areas of dentistry such as implants, cosmetic dentistry, full mouth rehabilitation, and orthodontics. As part of her practice, Dr. Sokolina became an active explorer of the world of Dental Sleep Medicine, treating sleep apnea with dental appliances and myofunctional therapy. Dr. Sokolina is a lecturer and Diplomate of American Academy of Dental Sleep Medicine and a Board member of the American Academy of Dental Sleep Medicine as well as TEDx. Dr. Sokolina spends much of her professional time trying to spread knowledge with lectures about sleep, breath, and wellness among the general population as well as in the medical community. She may be contacted through her website at https://www. harmonydentalarts.com/.

Orthodontic Practice US

issues such as mouth breathing and improper tongue resting posture played a primary role in hindering orthodontic results.

However, the turning point came in the early 1900s with the pioneering work of Dr. Alfred Rogers.

Dr. Rogers, born in 1873 and a prominent orthodontist, made significant contributions to the field. He acknowledged not only the impact of dental issues but also the role of soft tissue dysfunction on the oral skeletal system. He was a distinguished figure, serving as the President of the American Association of Orthodontists (AAO) and playing a pivotal role in the formation of the American Board of Orthodontics.

Dr. Rogers was among the first to develop a treatment program focusing on orofacial muscular exercises. This therapy aimed to stimulate desirable growth in the maxillofacial region, which he termed “Myofunctional Therapy in Orthodontics.” As early as 1918, he began disseminating this concept through articles and presentations, including the annual meeting of the AAO. Dr. Rogers emphasized that orthodontists should not solely concentrate on straightening teeth but must also consider the function of oral facial muscles. He asserted that alterations in the functional activity of the oral cavity could lead to malocclusion, thus highlighting the profound impact of muscular functioning on oral facial growth, development, and overall whole-body health.

This historical perspective underscores the enduring significance of OMT and its role in understanding the influence of orofacial myofunctional habits, including mouth breathing, on orthodontic outcomes and overall well-being.

The turning point in my exploration came when I delved into cases related to dental sleep medicine. During my initial evaluations of sleep apnea patients, I noticed a striking connection between their orthodontic history and their malocclusions.

Issues such as crowding, spacing, open bites, Class II, and Class III malocclusions were prevalent among these patients.3 What intrigued me even more was the correlation between their malocclusions and their tongue, lip, and cheek function, especially during swallowing, as well as their breathing patterns. Most of these individuals weren’t even aware of how they breathed, and it became evident that their orofacial myofunctional habits were closely linked to their orthodontic relapses and the success of my sleep-breathing disorder treatment plans.

The myofunctional connection

As I delved deeper into this intriguing correlation, I began to understand the profound influence of orofacial myofunctional habits on the longevity of orthodontic treatment results. It was clear that addressing these myofunctional issues was paramount

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CLINICAL

to ensuring the stability of orthodontic outcomes. Furthermore, I realized that integrating myofunctional therapy into orthodontic treatment4 could offer a holistic solution to not only enhance the results of orthodontics but also to address a range of other concerns.

Embracing myofunctional therapy

To equip myself with the necessary skills and knowledge, I decided to pursue a myofunctional5 course from Myomentor Sarah Hornsby. Armed with this additional expertise, I could now offer my patients orthodontic treatment in conjunction with myofunctional therapy. This innovative approach aimed to increase the longevity of orthodontic treatment results,7 correct orofacial myofunctional habits, and tackle various related issues head-on.

Figure 1: Swallowing with tongue trust

Case presentation

Patient J, a 39-year-old female, (Figures 1, 2, 3, 4, 5, 6) came to the office with concerns about difficulties chewing food and experiencing dry mouth upon waking up in the morning. Additionally, her partner was disturbed by her snoring. Upon examination, several issues came to light: 1. An open bite in the anterior region and a posterior crossbite 2. Breathing through the nose 10% of the time.

3. Lips and cheek muscles actively helping with swallowing food and drinks 4. Lips open 100% of the time 5. Tongue cannot maintain position on a spot, moves between teeth upon swallowing 6. Tongue thrust 7. Weak control over soft palate Muscle tension around the temporomandibular joint (TMJ) was also evident5 as well as mandibular bilateral lingual torus as response to constant occlusal pressure applied during bruxism.

To address her concerns and provide comprehensive care, I presented a treatment plan that combined clear aligners with Myofunctional Therapy (MFT). The main goals of MFT for Patient J were as follows: • Improving oral functionality: One of the primary aims of MFT was to enhance Patient J’s oral functionality. This included improving her ability to chew food effectively.

By addressing any dysfunctional orofacial muscle patterns, we aimed to help her achieve more efficient and comfortable chewing.

• Alleviating dry mouth: Patient J’s complaint of dry mouth in the morning was a concerning symptom that could be related to mouth breathing during sleep.

MFT would focus on retraining her to breathe through her nose, promoting better oral and nasal hygiene, and potentially reducing dry mouth symptoms.

• Reducing snoring: Snoring can be associated with improper tongue and airway positioning during sleep.

MFT aimed to address this issue by working on tongue posture, lip seal, and overall orofacial muscle tone.

These improvements could contribute to a reduction in snoring, potentially improving her partner’s sleep quality and overall well-being. I recommended that the patient orthopracticeus.com

Figure 2: Anterior view before treatment

Figures 3 and 4: 3. Right side before treatment. 4. Left side before treatment

Figures 5 and 6: 5. Upper arch before treatment. 6. Lower arch before treatment

proceed with a sleep study to eliminate the possibility of sleep apnea, but the patient refused to proceed with my recommendations.

• Correcting open bite and crossbite: The clear aligners were a crucial component of the treatment plan, primarily focusing on the correction of the open bite in the anterior region and the posterior crossbite. MFT would complement these efforts by ensuring that the corrected bite alignment was maintained through improved tongue and muscle function.

• Relieving muscle tension: The muscle tension observed in the TMJ area needed attention to prevent further dis-

13 Volume 14 Number 4

CLINICAL

Figure 7: Digital view of right side before treatment

Figure 8: Digital anterior view before clear aligner treatment

Figure 9: Digital view of left side before treatment. Anterior open bite

comfort and complications. MFT would involve exercises and techniques to relax and balance the orofacial muscles, reducing tension in the TMJ region.

• Enhancing overall quality of life: Ultimately, the goal of this comprehensive treatment plan was to enhance Patient J’s overall quality of life. By addressing her functional issues, improving her sleep quality, and correcting her bite problems, we aimed to provide her with a more comfortable and satisfying daily experience.

By combining clear aligners with MFT and tailoring our approach to address Patient J’s specific concerns and goals, we aspired to provide her with a holistic treatment that would not only enhance her oral health but also contribute to her overall well-being and happiness.

Here’s a concise summary of the treatment plan for Patient J: MFT sessions were scheduled every two weeks, totaling 12 sessions. After each session, the patient received videos of exercises and detailed instructions for continued practice.

1. Active exercise: 5 minutes in the morning, 5 minutes during the day, and 5 minutes at night of active breathing exercises. During these sessions, the patient should practice controlled nasal inhalation and exhalation while using a mirror to monitor her progress.

2. Passive exercise: Introduce passive exercises using orthodontic elastics to help improve tongue position and encourage proper tongue posture on the roof of the mouth. Start with 5 minutes a day and gradually increase the duration to 1 hour over time.

3. Nose breathing: The treatment plan focused on establish-

Our orthodontic goals were the following: 1. Expand upper arch, correct crossbite 2. Close anterior open bite 3. Correct crowding Patient J was prescribed a series of 43 aligners, with each aligner being worn for 20 hours a day for 1 week.

This comprehensive approach combining aligner therapy and MFT aimed to correct oral dysfunction, enhance breathing patterns, and ensure the long-term stability of orthodontic treatment. It combined clear aligners with MFT to address both the esthetic and functional aspects of the patient’s oral health.

Figure 10: Anterior view with elastic buttons to close open bite in conjunction with clear aligners

Figure 11: Right side with elastic buttons for treatment in conjunction with clear aligners

Orthodontic Practice US

ing nose breathing through exercises, nose rinses, and conscientious breathing for at least 30 minutes a day.

The use of Mute inserts (a soft, pliable polymer stent that dilates the nose) may have been recommended to assist in promoting nasal breathing.

4. Lip seal: To ensure that the mouth remained closed during both daytime and nighttime, the patient was guided to establish a proper lip seal with different exercises to improve muscle strength of lips, self-applied massages and stretching exercises.

5. Tongue posture: The plan included training the tongue to rest on the roof of the mouth, encouraging proper tongue posture.

6. Swallowing pattern: The patient was coached to develop a swallowing pattern that relied solely on tongue movement without assistance from the lips or cheeks.

Clear Aligner Therapy (Figures 7, 8, 9)

14 Volume 14 Number 4

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CLINICAL

Treatment progress

Figure 12: Anterior view upon the completion of active treatment

Patient J wore her aligners for 20 hours a day, using the lingual edge of the aligners as a guide for her tongue position. However, when it came to her exercises, she found it challenging to adhere strictly to her routine. Due to this difficulty, I observed that even though progress was made in improving her swallowing pattern without requiring her to forcefully push her tongue through her teeth on the left side, she still pushed it on the right side. To address her open bite on the right side, I introduced elastics (Figures 10, 11) in addition to clear aligner therapy. During each MFT session, I asked the patient to grade the percentage of time she achieved Breathing Through the Nose (BTN), Tongue on a Spot (TOS), and Lips Together (LT).

Treatment results

Figures 13 and 14: 13. Right side upon the completion of active treatment. 14.

Left side upon the completion of active treatment

Upon completion of MFT and active treatment phase with clear aligners (Figures 12, 13, 14, 15, 16), the patient revealed that snoring significantly reduced, her partner does not complain anymore, and she is breathing through the nose 75% of the time.

The patient is holding her lips together 75% of the time and is able to keep her tongue on the spot 50% of the time.

I recommendeded that the patient wear her retainers every night, continue with her MFT exercises, and have recall visits for MFT every 3 months to continue to improve her tongue strength, lip seal, and nose breathing capabilities.

Conclusion

Figures 15 and 16: 15. Occlusal view upon the completion of active treatment.

16. Lower occlusal view upon the completion of active treatment

The synergy of orthodontics and MFT has been transformative in my practice. It has not only provided long-term stability7 to orthodontic treatments but has also become a valuable asset in addressing a myriad of concerns, particularly in the context of sleep apnea treatment. This journey has reinforced the notion that the holistic approach of combining orthodontics and MFT can indeed be a game-changer, leading to healthier,9 more stable, and happier smiles for my patients. OP REFERENCES

Figure 17: Smile upon the completion of active treatment

Table 1 Before treatment

Upon final exam, session 12

Tongue on a spot

0%

50% of the time

Lips together

0%

75% of the time

Breathing through the nose

10%

75% of the time

Orthodontic Practice US

1.

Takahashi O, Iwasawa T, Takahashi M. Integrating orthodontics and oral myofunctional therapy for patients with oral myofunctional disorders. Int J Orofacial Myology. 1995 Nov;21:66-72.

2.

Smithpeter J, Covell D Jr. Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy. Am J Orthod Dentofacial Orthop. 2010 May;137(5):605-614.

3.

Benkert KK. The effectiveness of orofacial myofunctional therapy in improving dental occlusion. Int J Orofacial Myology. 1997;23:35-46.

4.

Daglio S, Schwitzer R, Wüthrich J. Orthodontic changes in oral dyskinesia and malocclusion under the influence of myofunctional therapy. Int J Orofacial Myology. 1993 Nov;19:15-24.

5.

Mills CS. International Association of Orofacial Myology History: origin - background - contributors. Int J Orofacial Myology. 2011 Nov;37:5-25.

6.

Magnusson T, Syrén M. Therapeutic jaw exercises and interocclusal appliance therapy.

A comparison between two common treatments of temporomandibular disorders.

Swed Dent J. 1999;23(1):27-37.

7.

Toronto AS. Long-term effectiveness of oral myotherapy. Int J Oral Myol. 1975 Oct;1(4):132-136.

8.

Ohno T, Yogosawa F, Nakamura K. An approach to open bite cases with tongue thrusting habits with reference to habit appliances and myofunctional therapy as viewed from an orthodontic standpoint. Int J Orofacial Myology. 1981;7(1):3-10.

9.

Daglio SD, Schwitzer R, Wüthrich J, Kallivroussis G. Treating orofacial dyskinesia with functional physiotherapy in the case of frontal open bite. Int J Orofacial Myology. 1993 Nov;19:11-14.

16 Volume 14 Number 4

INDUSTRY NEWS

Tops launches Tops DPX, a one-stop solution for streamlined orthodontic patient engagement

OraQ™ announces launch of commercial operations

Orthodontic practices now have a single solution to elevate patient engagement and provide streamlined, personalized care.

Tops has debuted Tops DPX, a fully integrated digital patient engagement platform designed to simplify communication.

Tops DPX integrates several essential communication services, including texting, appointment reminders, patient reviews, and email messaging. This provides a consolidated, cost-effective solution to enhance both staff efficiency and patient satisfaction.

Leveraging Tops DPX, orthodontic practices gain several ways to effectively engage patients: • Immediate HIPAA-compliant two-way texting for secure staff-patient conversations • Customizable automated appointment reminders that reduce no-show rates including family recall, voice reminders, and birthday greetings • A straightforward way to gather and share patient reviews on platforms like Google and Facebook • Pre-built email templates for effortless and informative newsletters • Custom email or text messaging by appointment type For more information, visit topsortho.com/tops-dpx.

OraQ announced the official launch of commercial operations in North America, offering dentists a state-of-the-art clinical decision support system that harnesses the analytical power of artificial intelligence and machine learning. Unlike other Artificial Intelligence platforms available today, OraQ’s FDA and Health Canada-approved platform is a comprehensive treatment planning technology that analyzes the complete patient profile to uncover treatment opportunities that might otherwise be missed.

The software harnesses the power of AI to provide useful insights to clinicians and patients. With its interactive patient portal, dentists are finding improved patient engagement through enhanced trust and transparency.

For more information, visit www.OraQ.ai.

Ormco announces the Canadian launch of Ormco™ Digital Bonding Doctors can now streamline daily workflow and achieve customized bracket positioning by leveraging Damon Ultima™brackets and the Spark Approver Software. Ormco Digital Bonding makes bracket bonding consistent. Orthodontists can use their digital workflows for all patients and easily make choices across multiple treatment options in the software. The introduction of Spark Clear Aligners Release 14 provided web-based access to the Spark Approver platform, among other benefits.

Key features of Ormco Digital Bonding include: • One case submission portal for Ormco Digital Bonding cases and Spark Clear Aligner cases.

• Digital treatment planning and digital bracket placement interface with Spark Approver Software provides one easy-to-use software platform for Ormco Digital Bonding cases and Spark Clear Aligner cases.

• Damon Ultima Brackets have been re-engineered to virtually eliminate play for precise control of rotation, angulation, and torque (wires not included).

To learn more, visit https://go-orm.co/odbdigitalbonding.

orthopracticeus.com

Braces On Demand announces integration with EasyRx Braces On Demand, a bestin-class online 3D printing platform for in-office production of orthodontic fixed appliances, and EasyRx, a leading provider of universal lab prescription, digital workflow, and 3D software solutions, have joined forces to help orthodontic practices gain significant workflow efficiencies. Braces On Demand received FDA-approval in 2020. Created with the purpose of developing a web application that would allow orthodontists to easily 3D print customized brackets and fixed appliances in their office, Braces On Demand also delivers cases to orthodontic practices that don’t have 3D printers. EasyRx is a revolutionary universal system that allows orthodontists and dentists to design, create, manage, and submit their patients’ appliance prescriptions online to any orthodontic or dental laboratory in the world or in-house lab. Its full suite of design tools allows doctors to manage and create their appliance prescriptions in one single digital location, improving efficiency and evolving toward a paperless environment. For the orthodontic or dental lab, it provides a robust set of tools to manage the lab, from tracking cases, invoicing, and production metrics, to providing and storing all the lab’s prescriptions digitally.

To learn more, visit easyrxcloud.com or https://bracesondemand.com, or call 516-447-8377.

17 Volume 14 Number 4

CASE REPORT

Whiten, align, and shine: whitening with aligners Dr. Brigham Stoker illustrates a combination of treatment over 4 years

A

chieving the bright, confident smile our patients desire can often take a combination of treatments to attain. In this case, the patient was seen over the course of roughly 4 years — he initially sought teeth whitening and eventually embraced aligners to get the smile he wanted. Walking bleach (internal), whitening gel, and aligners were used during the course of the treatment.

Figure 1: Initial Smile, taken November 19, 2018. Patient came into the office as a regular new patient, mostly asking about whitening his front tooth (No. 8). He was moderately interested in straightening his teeth, but we didn’t start aligners until a few years after this

Figure 2: After walking (internal) bleach, this photo was taken on January 22, 2019. This was immediately after completing a walking (internal) bleaching on tooth No. 8. We whitened it whiter than the surrounding teeth, knowing it would fade slightly, which it did as you can see in the next photos Figure 3: First shade, taken January 28, 2021. At this time, the patient decided to move forward with aligners and whitening, using the aligners during treatment. We started at an A3 shade

Figure 4: Mid-shade 1, was taken March 18, 2021. Most of the whitening happened in the first 2 months of the patient using Opalescence PF 10% whitening at night, placing the whitening gel inside his aligners while he slept.

You can see that we are already almost at an A1. He used the whitening gel anywhere from 2–3 times per week during this time frame

Figure 5: Mid-shade 2. This photo was taken May 6, 2021

Brigham Stoker, DDS, attended the University of Utah where earned his bachelor’s degree in Physics and Mathematics Education followed by a master’s degree in Instrumentational Physics. He attended the University of North Carolina at Chapel Hill for dental school, and then returned home to start up his private practice in Salt Lake City where he has practiced for 12 years. He has hundreds of hours of continuing education in all aspects of dentistry, including implants, orthodontics, Invisalign, lasers, and oral sedation. When not practicing dentistry, he enjoys time with his wife and 4 children, or riding his mountain bike somewhere in Utah.

Orthodontic Practice US

18 Volume 14 Number 4

CASE REPORT

Figures 6 and 7: 6. Mid-shade 3, and 4. This photo was taken June 17, 2021.

7. Mid-shade 4. This photo was taken July 16, 2021. The changes here are more subtle. The patient was happy with the shade, and as a result, he wasn’t using his whitening treatment as frequently as he was prior. He used the whitening gel 1–2 times per week at this point

The transformation of a smile is not just about a change in esthetics; it’s about the boost in confidence and self-esteem that follows. The journey can often be winding, with multiple treatments needed before the patient is able to achieve his/her goal smile.

In this case, the use of aligners in combination with teeth whitening allowed the patient to achieve a stable A1 shade, maintaining the shade months after the treatment concluded. OP

Figure 8: Final shade was taken April 20, 2022. The patient had moved out of state after the mid-shade 4 photo, but I sent him with the rest of the aligners and some additional whitening gel. He came back to my office to finalize treatment and fabricate his retainers. He wasn’t whitening very much during this time (he said, “every once in a while”). Even without regular usage of the whitening gel, the color remained after 8–9 months

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ORTHODONTIC CONCEPTS

Revolutionizing orthodontic care: bringing together AI and gamer technology to improve patient outcomes Khamzat Asabaev talks about combining technologies that can transform orthodontic workflows

I

ncorporating AI and gamer technology in orthodontic treatment planning software will usher in a new era of care and drastically improve how patients receive treatment. What will it mean to marry these two technologies? Let’s break it down.

AI presents the capability to automate repeatable, tedious, and time-consuming tasks. It also makes way for more accurate and faster results that reduce human error. Utilizing gamer technology in treatment planning software means translating patient scans into life-like and beautiful graphics akin to today’s latest animated movies — the more realistic the graphics, the more likely the patient will get more accurate treatment planning.

The result? The combination of these two technologies is nothing short of extraordinary for the orthodontic industry and will transform orthodontic workflows as we know it, especially for clear aligner treatment planning.

Figure 1: Automated staging — a customized treatment plan with specific movements at each stage is generated

Where gamer technology meets precision in orthodontics It is an exciting time for AI in the world, but I’d argue it’s even more exciting through the lens of orthodontics. The inception of leveraging AI and gamer tech together emerged from a pragmatic need for a high-precision solution to navigate 3D dental data.

Most solutions available today are designed by programmers with little to no doctor input, making them inconvenient and challenging to use. Using video gaming technology’s flexible tools and comprehensive frameworks is an optimal choice to correct this issue.

Drawing inspiration from video game design principles, the latest digital treatment planning software can now provide doctors with a highly realistic interface that enables them to view

Khamzat Asabaev is CEO and co-founder of Softsmile, a technology company focused on delivering best-inclass orthodontic treatment. Khamzat’s mission is to make orthodontic care more accessible and affordable, and he is committed to prioritizing patients over profits. As the leader and visionary, he focuses on advancing the AI-driven capabilities of SoftSmile’s flagship software, VISION, with the goal of empowering doctors to provide higher quality clear aligners at a fraction of the cost. Before starting SoftSmile, Khamzat was an mergers and acquisitions attorney at Linklaters for more than a decade, and along the way, he founded and co-founded a number of startups, most notably a braces producer in Switzerland (3D Med) and a car-sharing company in Dubai (Motor).

Orthodontic Practice US

Figure 2: Elastics — used to analyze the effects of different types and sizes of elastics on the movement of the teeth

Figure 3: The sculpting feature includes instruments such as smooth, extrude, intrude, remove, patch, and extend to aid in model correction

20 Volume 14 Number 4

ORTHODONTIC CONCEPTS

Figure 4: Interproximal reduction (IPR) in viewport — plan and simulate the IPR procedure as part of the overall treatment plan

Figure 5: Overcorrection — predict the final position of the teeth after the completion of treatment

patients’ teeth and gingiva in unprecedented detail. This level of visuals leads to increased precision and more effective treatment planning, resulting in improved patient outcomes.

Beautiful graphics are one part of driving precision in treatment planning. The second part is leveraging AI capabilities — specifically neural networks based on machine learning that take out the guesswork and limit human error (more on how this works later). Neural networks are at the forefront of revolutionizing treatment planning. Orthodontists or technicians using AI-driven software can reduce treatment planning time by 95% without compromising quality — from around 90 minutes to 5 minutes.

Saving time creates cost-savings from both a practice and patient standpoint. By automating the labor-intensive processes, orthodontists or technicians can now complete treatment planning in a fraction of the time it previously required. AI-driven treatment planning software has the potential to drastically reduce the cost of clear aligners.

My hope is that this efficiency translates into significant cost savings for both doctors and patients by ultimately driving down the expenses associated with aligner treatments. AI streamlines the aligner creation process and contributes to a ripple effect that lowers patient costs across the entire orthodontic industry. As a result, orthodontic care becomes more accessible to a broader demographic.

This transformative shift breaks down longstanding access barriers, ensuring that orthodontic care is no longer confined to a select few, but becomes a viable option for more people

around the world, taking care costs from thousands of dollars to mere hundreds of dollars.

Figure 6: Cutting — the cut line is used to divide the digital model into sections that will be used to create the aligner

orthopracticeus.com

How does the AI actually work?

Circling back to the concept of neural networks, while it might sound complicated, in essence, neural networks are simply a way for AI to mimic how the human brain works. In the case of orthodontics, they complement human expertise by automating complex tasks in orthodontic treatment planning. This type of AI, emulating biological neurons, refines its knowledge through supervised learning, ensuring accuracy.

Now that we understand the basics of neural networks, let’s discuss how this technology was built. First, doctors or technicians had to manually label components like bones, teeth, and soft tissue during the segmentation process. After collecting the input data on hundreds of cases, the manual input human doctors provide is fed into the AI to train the neural network, which is an arrangement of artificial neurons.

This supervised learning effectively teaches the network how to identify and label specific elements in the mouth scans (for instance, what is the lower jaw and upper jaw). Then over time, the neural network becomes proficient in automating the segmentation process, significantly enhancing the efficiency and accuracy of treatment planning. When the network makes a mistake, it’s explicitly told what the correct outcome should be.

This feedback loop is crucial for the neural network’s learning process.

Figure 7: Adjust height of the gingival base. Users can make adjustments to the gingival height base in a more precise and accurate manner

21 Volume 14 Number 4

ORTHODONTIC CONCEPTS

Through backpropagation and gradient descent — fancy words for AI optimization — the network adjusts its internal parameters, effectively fine-tuning its understanding. This refinement ensures that in future segmentation, the network is less likely to make errors, particularly in complex tasks like aligner treatment planning.

In fact, some solutions even learn a doctor’s specific preferences and will adapt future treatment plans based on the input the system receives to customize a doctor’s future cases. Continuous AI training ensures evolving, cutting-edge solutions will be available on the market. As more doctors adopt this type of treatment planning, software will only get better and more precise as time goes on.

Addressing ethical concerns Ethical concerns regarding AI are a hot topic, but in the case of orthodontic treatment, it doesn’t need to be. I feel strongly that as long as doctors remain in control of the process, ethical issues shouldn’t be a concern.

Concerns should arise when everything is unquestioningly entrusted to AI. But fortunately, that is not the case. The tech on the market today only involves AI selectively, making it crucial to clarify the type of AI being used and how it is being used. AI in orthodontic treatment planning is all about augmenting what a doctor is already doing and in no way, shape, or form is poised to replace human input.

With how AI is used in today’s treatment planning, it ensures that doctors and specialists retain absolute control throughout the entire process. The utilization of AI serves as only an aid, rather than a replacement, for human expertise.

While AI plays a pivotal role in automating certain aspects of treatment planning, it does not dictate the overall course of treatment. Doctors identify key points and make informed decisions, maintaining a crucial role in the process. This ensures that the final say always rests with the human expert, preventing any potential ethical dilemmas.

Figure 8: Jaw displacement — forecast the movement of the jaw during treatment and make any necessary adjustments before treatment begins

The future of aligner technology: a paradigm shift Looking ahead, the orthodontic landscape is quickly moving toward a paradigm shift. Braces and aligners are evolving to become commodities, with a growing number of practitioners producing aligners in-house more quickly and affordably with comparable quality to well-established brands. This shift promises two significant changes.

First, aligners will become more accessible to patients in remote and underserved areas, as prices plummet and doctors are able to print aligners on the spot within 30 minutes. This democratization of access will redefine the practice of orthodontics. Secondly, the role of the doctor will gain prominence, with more patients able to visit skilled specialists who offer tailored solutions more quickly and efficiently than ever before.

The fusion of AI and gamer technology is reshaping the orthodontic industry, heralding a future where quality care is more accessible, efficient, and cost-effective. This is just a glimpse into the transformative potential of the future of orthodontic treatment. OP

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22 Volume 14 Number 4

AUTHOR GUIDELINES

How to submit an article to Orthodontic Practice US Orthodontic Practice US is a peer-reviewed, quarterly publication containing articles by leading authors from around the world.

Orthodontic Practice US is designed to be read by specialists in Orthodontics, Periodontics, Oral Surgery, and Prosthodontics.

ance in the text. The majority of references should be less than 10 years old. Provide inclusive page numbers, volume and issue numbers, date of publication, and all authors’ names. References should be submitted in American Medical Association style. For example:

Submitting articles

Journals: (Print) White LW. Pearls from Dr. Larry White. Int J Orthod Milwaukee.

2016;27(1):7-8.

Orthodontic Practice US requires original, unpublished article submissions on orthodontic topics, multidisciplinary dentistry, clinical cases, practice management, technology, clinical updates, literature reviews, and continuing education.

Typically, clinical articles and case studies range between 1,500 and 2,400 words. Authors can include up to 15 illustrations. Manuscripts should be double-spaced, and all pages should be numbered. Orthodontic Practice US reserves the right to edit articles for clarity and style as well as for the limitations of space available.

Articles are classified as either clinical, continuing education, technology, or research reports. Clinical articles and continuing education articles typically include case presentations, technique reports, or literature reviews on a clinical topic. Research reports state the problem and the objective, describe the materials and methods (so they can be duplicated and their validity judged), report the results accurately and concisely, provide discussion of the findings, and offer conclusions that can be drawn from the research. Under a separate heading, research reports provide a statement of the research’s clinical implications and relevance to orthodontics. Clinical and continuing education articles include an abstract of up to 250 words. Continuing education articles also include three to four educational aims and objectives, a short “expected outcomes” paragraph, and a 10-question, multiple-choice quiz with the correct answers indicated. Questions and answers should be in the order of appearance in the text, and verbatim. Product trade names cited in the text must be accompanied by a generic term and include the manufacturer, city, and country in parentheses.

Additional items to include: • Include full name, academic degrees, and institutional affiliations and locations • If presented as part of a meeting, please state the name, date, and location of the meeting • Sources of support in the form of grants, equipment, products, or drugs must be disclosed • Full contact details for the corresponding author must be included • Short author bio • Author headshot

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(Online) Author(s). Article title. Journal Name. Year; vol(issue#):inclusive pages.

URL. Accessed [date].

Or in the case of a book: Pedetta F. New Straight Wire. Quintessence Publishing; 2017.

Website: Author or name of organization if no author is listed. Title or name of the organization if no title is provided. Name of website. URL. Accessed Month Day, Year. Example of Date: Accessed June 12, 2011.

Author’s name: (Single) (Multiple) Doe JF Doe JF, Roe JP

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Written permission must be obtained by the author for material that has been published in copyrighted material; this includes tables, figures, pictures, and quoted text that exceeds 150 words. Signed release forms are required for photographs of identifiable persons.

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Authors must disclose any financial interest they (or family members) have in products mentioned in their articles. They must also disclose any developmental or research relationships with companies that manufacture products by signing a “Conflict of Interest Declaration” form after their article is accepted. Any commercial or financial interest will be acknowledged in the article.

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All clinical and continuing education manuscripts are peer-reviewed and accepted, accepted with modification, or rejected at the discretion of the editorial review board. Authors are responsible for meeting review board requirements for final approval and publication of manuscripts.

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23 Volume 14 Number 4

CONTINUING EDUCATION

Implementation of 3D printing: more than just buying a printer Dr. Melissa D. Shotell discusses factors that should be considered before adding 3D printing to the orthodontic office

O

rthodontics has long been on the cutting edge of digital technology in the dental field, and 3D printing is rapidly becoming an integral part of many orthodontic practices. There are many questions to be asked prior to purchasing a 3D printer, including evaluating what the office would like to 3D print, the software that will be used to design appliances, and what type of 3D printer and materials to purchase. Each of these questions can take substantial time to evaluate and answer for the individual practice. However, once the printer and materials are selected, the work toward implementation of 3D printing has just begun. The logistics of implementing 3D printing often becomes an overwhelming task if the orthodontist, team, and office space are not ready for this new technology. Taking a systematic look at several factors including the size and location of the 3D printing laboratory space, team training, and office workflow, can lead to faster implementation and long-term adoption of new workflows.1

3D-printing laboratory space In many orthodontic practices prior to the use of 3D printing, the in-office laboratory was predominantly used for making stone models and minor repairs of appliances. For years, the practice trend was to send out stone models to commercial labs for fabrication of appliances, and with this, the laboratory often became small to allow for more clinical space. Now, with the implementation of 3D printing, larger laboratory spaces are required to house not only the 3D printing equipment, but laboratory storage of materials and appliances is required as well (Figure 1).

There has been a long-held misconception that adding 3D printing to an office is simply the act of buying a 3D printer.

When 3D printing with many of the commercially available desktop-size 3D printers, post-processing of the dental mod-

Educational aims and objectives

This self-directed educational course for dentists takes a look at various factors that can lead a practice to faster implementation and long-term adoption of new workflows in 3D printing.

Expected outcomes

Orthodontic Practice US subscribers can answer the CE questions by taking the quiz online at orthopracticeus.com to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can: • Identify how space in the orthodontic office needs to be prepared for 3D printing implementation.

• Recognize what types of training are necessary to ensure the long-term success of implementing clinical 3D printing technology.

• Realize how workflow changes with implementation of 3D printing.

• Realize some parameters for supplies for 3D printing.

2 CE CREDITS

Figure 1: In-office laboratory with dedicated digital lab space for 3D printing Melissa Shotell, DMD, MS, is a Board-certified orthodontist practicing in a multi-specialty practice in Sonora, California and focusing on the interplay of orthodontics and restorative treatment. After completing dental school, Dr. Shotell practiced as a restorative dentist for several years, then returned to school to complete a certificate and master’s degree in orthodontics from Loma Linda University. Dr. Shotell considers education to be her passion. She presents nationally and internationally on dental technology, is part-time clinical faculty at the University of Nevada, Las Vegas orthodontics department, and teaches in the CE department for the University of Alberta. Dr. Shotell also is the co-founder and chief clinical officer of Plus Orthodontics. Dr. Shotell shares tips and tricks on orthodontics and clear aligners on social media as alignerbee.

Orthodontic Practice US

els is required prior to use for the fabrication of orthodontic appliances. After the models complete the 3D printing process, they are typically removed from the 3D printer and rinsed in a series of alcohol rinses to remove uncured liquid resin from the models (Figure 2), and then the models are light-cured to complete curing of the model resin (Figure 3).2-3 This process requires additional specialized laboratory equipment beyond the 3D printer such as a wash station, curing box, and potentially vacuum-forming machine. Further, the laboratory must have the logistical space to support a 3D-printing ecosystem of equipment to both 3D print and post-process orthodontic models (Figure 4).

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Figure 2: Models that have completed 3D printing with excess uncured resin prior to post-processing

Figure 3: Light curing of orthodontic models

Team training and 3D printing When adding a new clinical technique or clinical technology to an orthodontic practice, a large amount of focus is given to team training. This attention to training is important to ensure the long-term success of implementing clinical technology, so equipment does not end up going unutilized. It is equally as important to give this same Figure 4: 3D printing ecosystem with 3D printer and post-processing equipment amount of attention to team training in the 3D-printing laboratory. It is very easy to find many 3D printers collecting dust on a laboratory countertop because it is fast and simple to go back to the laboratory procedures with which all team members are familiar. Some practices will choose to utilize only a few team members in the 3D printing laboratory, and their training is critical for the success of 3D printing implementation. Cross-training and redundancy of staff members remains a critical part of workflow management.

The step-by-step procedure for 3D printing and post-processing should be covered for the printer system selected. Training in the 3D printing laboratory should consist of the proper handling techniques for uncured resin, and each printer system will have specific parameters for the curing of different resins. It is important to follow the post-processing directions closely to avoid introducing uncured resins into orthodontic appliances being fabricated.

When following best practice recommendations of each printer system, there will be recommended routine calibration of the 3D Figure 5: Fabrication of same-day orthodontic appliances printer to maintain accuracy, along with routine cleaning and while other team members may enjoy the fabrication of orthomaintenance. Team member training should focus on skills of 3D dontic appliances including clear aligners and retainers (Figure printing, but also the importance of maintaining the laboratory 5). Utilizing these natural preferences can help the team member to ensure proper functioning of the 3D printer system. Key to to engage in the laboratory workflow, and can utilize their skills management of the laboratory and digital machinery is mainteto improve the quality of lab appliances. nance of the calibration of the 3D printer to ensure consistent As an office expands the number of appliances they are faboutput for patient appliances. Further, ensuring expiration dates ricating, a system of laboratory organization can be utilized to of 3D-printing resins is also an important part of this maintenance ensure the appliances are completed on time for the patient’s that many easily overlook, and some resins absolutely cannot be appointment. Multiple software options are available for tracking used beyond their expiration date. lab work, but there are also simple organizational techniques such Many team members may find that they are drawn to one paras having a white board or clip board with cases that need to be ticular area of the laboratory process. Some may enjoy running 3D printed or appliances fabricated.4 Laboratory storage can be and maintaining the 3D printer and post-processing equipment, orthopracticeus.com

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a challenge in high-volume labs, and a system of lab case pans or hanging files can save space and keep individual patient cases organized. Determining a laboratory system of organization and assigning different team members to different areas of the laboratory can improve efficiency and optimize the laboratory workflow.

Office workflow After the 3D printing laboratory has been set-up, and team members are comfortable with the basic laboratory procedures, the focus should become implementing 3D printing into the daily office workflow.5 Often the clinical aspect of a patient’s treatment will remain the same, but the timing of receiving appliances and the types of appointments scheduled may change. In the past, when sending appliances out to a traditional orthodontic laboratory, there may be several days from a patient’s initial appointment until receiving an appliance. As a result, many clinicians focus their use of 3D printing for same-day or next-day expedited orthodontic appliances. This allows for a streamlined clinical workflow and less work juggling or moving patient appointments because a laboratory had delays in production. To fabricate appliances quickly, however, there must be a seamless integration from taking records in the clinical space, to sending the appliances to production in the in-office laboratory (Figure 5). Assigning key team members to oversee the process of transferring records from the clinic to the laboratory and then initiating the laboratory workflow, will avoid delays between the patient’s records appointment and appliance delivery.

Summary When evaluating to see if 3D printing is a good fit for an orthodontic practice, there are many factors to consider. 3D printing can greatly reduce the time that patients wait to begin treatment by bringing the laboratory process into the orthodontic office.

However, there are physical size space requirements for equipment, and a new aspect of laboratory management that must be implemented. To ensure long term success of this workflow, it is important to consider many of the factors of team training both in the laboratory and clinical spaces and workflows. It is important to properly implement 3D printing to avoid the printer sitting idle on a countertop because there is not a workflow within the office to incorporate the use of 3D printing. OP

REFERENCES 1.

Tian Y, Chen C, Xu X, Wang J, Hou X, Li K, Lu X, Shi H, Lee ES, Jiang HB. A Review of 3D Printing in Dentistry: Technologies, Affecting Factors, and Applications. Scanning.

2021 Jul 17;2021:9950131

2.

Scherer MD, Al-Haj Husain N, Barmak AB, Kois JC, Özcan M, Revilla-León M. Influence of postprocessing rinsing solutions and duration on flexural strength of aged and nonaged additively manufactured interim dental material. J Prosthet Dent. 2022 May 19:S0022-3913(22)00222-0.

3.

Panayi NC. Directly Printed Aligner: Aligning with the Future. Turk J Orthod. 2023 Mar 21;36(1):62-69.

4.

Eliliwi M, ElShebiny T, de Menezes LM, Stefanovic N, Palomo JM. Comparing virtual setup software programs for clear aligner treatment. J World Fed Orthod. 2023 Apr;12(2):50-55.

5.

Revilla-León M. We Are A 3D Printing Generation. J Prosthodont. 2022 Mar;31(S1):3.

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Continuing Education Quiz Implementation of 3D printing: more than just buying a printer SHOTELL

1. In many orthodontic practices prior to the use of 3D printing, the in-office laboratory was predominantly used for ________. a. making stone models b. minor repairs of appliances c. making HIPAA-compliant calls d. both a and b 2. Adding a 3D printer to an office is simply the act of buying a 3D printer. a. True b. False 3. After the models complete the 3D-printing process, they are typically removed from the 3D printer and rinsed in a series of ________ rinses to remove uncured liquid resin from the model , and then the models are light-cured to complete curing of the model resin. a. alcohol b. salt water c. dish soap and water d. chlorhexidine 4. The laboratory must have the logistical space to support a 3D-printing ecosystem of equipment to _______. a. 3D print appliances b. post-process orthodontic models c. house a larger computer d. both a and b 5. Training in the 3D printing laboratory should consist of the proper handling techniques for uncured resin, and each printer system will have _______. a. only one parameter for all cured and another one for all uncured resins b. the same parameters no matter what resin is being cured c. specific parameters for the curing of different resins d. an automatic setting for parameters 6. When following best practice recommendations of each printer system, there will be _________ to maintain accuracy, along with routine cleaning and maintenance. a. recommended routine calibration of the 3D printer b. automatic recalibration every few days c. no need to repeat calibration d. calibration only when an error message is received 7. ______ can improve efficiency and optimize the laboratory workflow.

Each article is equivalent to two CE credits. Available only to paid subscribers. Free subscriptions do not qualify for the CE credits. Subscribe and receive up to 16 CE credits for only $149; call 866-579-9496, or visit https://orthopracticeus.com/ subscribe/ to subscribe today. n To receive credit: Go online to https://orthopracticeus.com/continuingeducation/, click on the article, then click on the take quiz button, and enter your test answers.

AGD Code: 370 Date Published: December 28, 2023 Expiration Date: December 28, 2026

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a. Determining a laboratory system of organization b. Assigning different team members to different areas of the laboratory c. Only allowing the owner to operate and maintain the 3D printer d. both a and b 8. (When implementing a 3D printer into the practice,) Often ______, but the timing of receiving appliances and the types of appointments scheduled may change. a. the clinical aspect of a patient’s treatment will remain the same b. the clinical aspect of the patient’s treatment will not stay the same c. the clinical aspect of the patient’s treatment will become more complicated d. none of the above 9. _________ to oversee the process of transferring records from the clinic to the laboratory and then initiating the laboratory workflow, will avoid delays between the patient’s records appointment and appliance delivery. a. Assigning key team members b. Assigning one team member only c. Assigning only the dentist d. Hiring a special employee 10. To ensure long term success of this workflow, it is important to consider many of the factors of team training both in the laboratory and clinical spaces and workflows. a. True b. False

To provide feedback on CE, please email us at education@medmarkmedia.com Legal disclaimer: Course expires 3 years from date of publication. The CE provider uses reasonable care in selecting and providing accurate content. The CE provider, however, does not independently verify the content or materials. Any opinions expressed in the materials are those of the author and not the CE provider. The instructional materials are intended to supplement, but are not a substitute for, the knowledge, skills, expertise and judgement of a trained healthcare professional.

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CO2 lasers in orthodontics Dr. Sabrina Dragan discusses an innovative tool with multiple benefits for the orthodontist and the multidisciplinary practice

M

odern technology has perfected the instrument that has become almost synonymous with minimally invasive dentistry — the dental laser. While lasers have been utilized in dentistry for over 40 years, their use has been limited in orthodontics. Within the orthodontic practice, there are numerous instances where the orthodontist calls upon the periodontist, the pediatric dentist, or the oral surgeon to solve mucogingival problems that interfere with ongoing therapy or that complicate the therapy itself. Using a laser, the orthodontist can intervene quickly and easily with a minimally invasive treatment for oral and mucogingival surgery.

Knowledge of a laser device’s capabilities is essential for patient care and for making a satisfactory return on investment by the provider. Lasers have emerged as vital tools, revolutionizing the way oral health is managed and treatments are delivered.

These precise and versatile devices offer numerous advantages, including faster operating time, reduced pain, minimized intraand postoperative discomfort, faster healing, and improved quality of results, all of which contribute to a faster completion of the orthodontic therapy.1 In addition to their benefits in soft-tissue procedures, lasers are instrumental in cavity prevention and cavity preparation.2,3 Their analgesic effects often eliminate the need for local anesthesia, making dental visits more comfortable for patients. This narrative review serves to introduce the benefits and principles of lasers to orthodontic therapy, a field where it has yet been fully applied.

Many clinical scenarios may benefit from lasers, either by their analgesic or biostimulating effects before and after orthodontic therapy, including: • Closure of a midline diastema between upper central incisors in the presence of an abnormal or hyperplastic frenum • Problems related to ankyloglossia with a short lingual frenum and low positioning of the tongue

Sabrina Dragan, DMD, is a board-certified pediatric dentist and Fellow of the American Academy of Pediatric Dentistry. She is the owner of a multidisciplinary practice with both pediatric dentistry and orthodontics limited to children and adolescents in Dallas, Texas. She graduated magna cum laude from the UNLV School of Dental Medicine in Las Vegas, Nevada and earned her specialty certificate in pediatric dentistry from the Texas A&M Baylor College of Dentistry in Dallas, Texas. Dr. Dragan is also a member of the American Academy of Physiological Medicine and Dentistry, International Affiliation of Tongue-Tied Professionals, and the Academy of Laser Dentistry.

Disclosure: Dr. Dragan is a key opinion leader (KOL) for Convergent Dental but did not receive any financial compensation for this article.

Orthodontic Practice US

Educational aims and objectives

This self-directed educational course for dentists delves into the benefits of a carbon dioxide laser in orthodontic practice and covers how laser technology can be used to improve orthodontic outcomes and the patient’s experience. Basic laser physics will be reviewed, as well as the application for different types of soft-tissue and all-tissue lasers.

Expected outcomes

Orthodontic Practice US subscribers can answer the CE questions by taking the quiz online at orthopracticeus.com to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can: • Identify the different types of lasers that are available for soft- and hard-tissue procedures and how they impact the ability to complete common dental/orthodontic-related procedures.

• Recognize key differences between conventional treatment protocols and using laser technology to complete common procedures.

• Realize how to use laser technology to eliminate delays in care and improve the patient experience for procedures that have been conventionally referred out of the orthodontic practice.

2 CE CREDITS

• Soft-tissue or bony-impacted ectopic teeth that are unerupted or partially erupted • Gingivectomy during treatment to improve hygiene by debulking hyperplastic tissue or post-ortho to improve esthetics • Orthodontic debonding of ceramic brackets

A primer on laser technology Light Amplification by Stimulated Emission of Radiation, or laser, is a term involving the physics of light that is amplified by stimulated emission.4,5 A laser consists of three components: the laser medium, the pump source, and the optical cavity or optical resonator.5 Because the medium is the active element, the medium determines the wavelength of the laser. A laser device’s wavelength is important to its applications in hard tissue versus soft tissue applications and the chromophores (i.e., water, plastic, collagen, hydroxyapatite, etc.) that it seeks. The optical cavity is a compartment of mirrors that contain the medium and the optical resonator. It amplifies the light energy released as it is reflected by the mirrors where it may then be amplified by stimulated emission before exiting onto the target tissue.6

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Figure 1

Figure 2: Absorption coefficients of primary chromophores in dentistry

The laser light is monochromatic, meaning that it is one color and one wavelength. Laser light waves all travel in the same direction and without diffusion (collimation). This is important to understand because since the laser beam travels as a single line without diffusion, the operator is able to reach distant areas in the mouth that would otherwise be difficult to reach.5

A dental laser would be a logical technology pillar to integrate into a forward-thinking practice.

Mechanism of laser action The light energy that is produced by a laser can have four different interactions with target tissue: reflection, transmission, scattering, and absorption.5 When a laser is absorbed, it elevates the temperature and produces photochemical effects, depending on the water content of the tissues. When the water temperature surpasses 100 degrees Celsius, vaporization of the water within the tissue occurs — a process called ablation. Absorption requires targets to absorb light at specific wavelengths. These targets are called chromophores. The primary chromophores in dentistry are water, melanin, hemoglobin, and hydroxyapatite (Figure 2).7 Because chromophores have different laser wavelength coefficients, ease of use and procedural success is dependent upon laser wavelength.

Types of lasers in dentistry Lasers in dental practice today can be classified by the lasing medium being used (such as a gas or solid laser), the tissue applicability (all-tissue versus soft tissue), or by their wavelength range.5

Carbon Dioxide Laser The CO2 laser has a high affinity for water and hydroxyapatite, and therefore, results in rapid soft tissue removal and best hemostasis with a very shallow depth of penetration. It has the highest absorbance of any laser. CO2 lasers can be further divided into soft tissue versus all-tissue lasers. The Solea® All-Tissue Dental Laser from Convergent Dental is a CO2 laser orthopracticeus.com

with a novel 9.3 µm wavelength that is highly absorbed into the tooth structure, vaporizing enamel rather than slowly chipping it away. This laser can equally treat both soft tissue and hard tissue. Applications that are particularly relevant to orthodontic practice include, but are not limited to cavity preparation, caries, restorative removal/ceramic bracket removal, bony removal for exposures of unerupted teeth, laser etching with bonding, treatment of dentinal hypersensitivity, and prevention of demineralization of enamel and dentin.

Neodynium Yttrium Aluminum Garnet Laser The Nd:YAG wavelength is absorbed by pigmented tissue making it effective in coagulating soft tissues for hemostasis and for surgical laser cutting. Nd:Yag lasers operate with a 1.064 µm wavelength and were the first types of true pulsed lasers to be marketed exclusively for dental use. These are primarily used for periodontal treatments.

Erbium Laser Erbium lasers operate with a 2.79 to 2.94 µm wavelength and are both hard- and soft-tissue capable.

Diode Laser Diode lasers operate with an 0.83-1.064 µm wavelength and work only for soft tissue.

Application of laser technology for common orthodontic procedures Laser technology creates numerous opportunities for orthodontists and fosters a collaborative approach to care that ben-

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efits both dental providers and patients.

The following is a review of six common procedures that affect orthodontic therapy, and a discussion of how laser technology can positively influence practice protocols and patient outcomes.

Ectopic eruption of maxillary molars Ectopic eruption of the permanent first molars occurs due to the molar’s Figure 3: Uncovering of unerupted teeth with Solea® All-Tissue Laser: pre-op and immediate post-op. abnormal mesioangular eruption path, (Case images from Joshua Weintraub, DDS) resulting in an impaction onto the distal prominence of the primary second molar’s pediatric dentists often receive from the orthodontist. Families crown. This occurs in roughly 3% of the population and is more and patients will appreciate this collaborative approach because common in children with transverse and sagittal crowding and 8-10 it saves time due to fewer appointments and it reduces costs. those with cleft-lip and cleft-palate. Sixty-six percent of ecto11 pic first permanent molars will self-correct by 7 years old. For the one third of cases that do not self-correct, delaying orthoUncovering unerupted and partially erupted teeth dontic intervention may ultimately result in space loss due to An all-tissue laser allows dentists to uncover an impacted or partially erupted tooth (Figure 3) so it can be exposed for bondearly loss of the primary second molar.11 Pediatric dentists are ing. With conservative tissue removal and immediate hemostatrained to assist in de-impacting a maxillary molar as soon as sis, the CO2 laser allows an orthodontist to bond a bracket or possible to prevent external root reabsorption of the primary tooth, which can lead to further complications. This treatment is button on the same day as the tissue removal. A 9.3 µm waveconventionally done with an orthodontic separator, a de-impaclength laser alters the chemical structure of teeth by increasing tion or “Arkansas spring,” a brass ligature wire, or a Halterman the ratio of calcium to phosphorus and converting the carbonappliance.11 With some exception of the Halterman appliance, ated hydroxyapatite to the purer hydroxyapatite of enamel and dentin.12 Not only does the purer hydroxyapatite resist the caries the other orthodontic methods can only be utilized if there is access to the ectopic permanent molar, sometimes resulting in a process, but this altered molecular state also possesses enhanced delayed intervention. Conversely, a laser-savvy pediatric dentist bond strength with resin.12 Because the laser removes microns can utilize this technology to quickly and effortlessly uncover of enamel at a time, the precision of the laser traveling from the permanent molar, allowing access to where it is ledged on overlying soft tissue and possible cortical bone poses little risk the primary second molar. This access will allow the placement to exposure of the tooth underneath. The nature of a 9.3 µm of a distalizing orthodontic appliance such as a brass wire or wavelength laser also has low risk of thermo-damage to the dende-impaction spring. tin-pulp complex due to the shallow depth of heat absorption.12 Orthodontists should be aware of this treatment option, as general dentists may refer patients to them if this scenario arises Maxillary labial and lingual frenectomies in their practice. Orthodontists who utilize laser dentistry have As new and emerging research from Soroush Zaghi, MD, the potential to expand their procedural scope and treatment is published regarding the proper technique and correction of approach, or they may choose to collaborate with a pediatric prominent maxillary labial frena and mandibular lingual frena, dentist colleague who uses laser dentistry in their practice. the dental community is realizing the need for a collaborative This less invasive correction to a common orthodontic issue approach to deliver optimal results for dental practitioners and is a successful alternative to the common extraction order that patients. Collaboration between the release provider, a myo-

Figure 4: Lingual frenectomy with Solea® All-Tissue Laser: pre-op and immediate post-op. (Case images from Lawrence A. Kotlow, DDS)

Orthodontic Practice US

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functional therapist to address tongue tone, and an orthodontist to address tongue space are essential pieces to the airway puzzle.13 Research also supports the idea that the most suitable surgical resolution is the use of laser devices because they produce a bloodless field, shorter surgical times, and faster wound healing.14

Gingivectomy

Figure 5: Gingivectomy around bracket with Solea® All-Tissue Laser: pre-op and immediate post-op.

While conventional gingivectomy is asso(Case images provided by Convergent Dental) ciated with pain and bleeding, orthodontists may benefit from integrating a laser into optimal gingival esthetics at the conclusion of comprehensive orthoREFERENCES dontic treatment. The precise pen-like grip of a CO2 laser device 1. Kotlow L. Lasers and pediatric dental care. Gen Dent. 2008 Nov-Dec;56(7):618-627. allows the practitioner to complete smile design and gingival 2. Tavares JP, da Silva CV, Engel Y, de Freitas PM, Rechmann P. In situ Effect of CO2 contouring with precision and without local anesthetic.

Laser (9.3 μm) Irradiation Combined with AmF/NaF/SnCl2 Solution in Prevention and In addition, transient tissue hypertrophy and hyperplasia, Control of Erosive Tooth Wear in Human Enamel. Caries Res. 2021;55(6):617-628. such as gingival overgrowth due to poor oral hygiene, overgrown 3. Silva CV, Mantilla TF, Engel Y, Tavares JP, Freitas PM, Rechmann P. The effect of CO2 9.3 μm short-pulsed laser irradiation in enamel erosion reduction with and without tissue on temporary anchorage devices, or overgrown gingiva fluoride applications-a randomized, controlled in vitro study. Lasers Med Sci. 2020 over buttons can be excised in the orthodontic office without a Jul;35(5):1213-1222. referral to a specialist (Figure 5).

4. Convissar RA. The biologic rationale for the use of lasers in dentistry. Dent Clin North Am. 2004 Oct;48(4):771-94, v.

Orthodontic debonding

Laser energy provides less force application and less photothermal activity during bracket removal by softening the adhesive resin used to bond brackets.15 Debonding with lasers is especially useful for ceramic brackets by reducing shear strength without increasing intrapulpal temperature.15

Airway and sleep disorders According to Johns Hopkins Medicine, about 45% of adults snore sometimes and 25% snore regularly.16 Meanwhile, parasomnia can affect up to 50% of children.16 The Solea laser features an additional handpiece that integrates into the 9.3 µm wavelength CO2 laser software allowing dentists to target superficial and deep collagen bundles in the soft palate and uvula, thereby shrinking these floppy tissues and decreasing upper airway resistance. Emerging research indicates that this therapeutic approach is promising for adults when collaborating with other care providers in the sleep arena, such as otolaryngology, myofunctional therapists, and allergists.17-19 The integration of laser technology into dentistry across general and specialized practice areas has, and will continue to, create new business opportunities for practitioners, while transforming the patient experience and influencing the future of oral care.

Because orthodontists are known for embracing technology, they often find themselves at the forefront of new practice protocols. As a result, a modern orthodontic office may feature advanced devices like CBCT, intraoral scanning, and 3D printing. A dental laser would be a logical technology pillar to integrate into a forward-thinking practice. With the right education and training, a laser system enables dentists to increase patient comfort and decrease chair time, thereby increasing profits and productivity. It is also a great marketing vehicle for dental and orthodontic practices alike. OP orthopracticeus.com

5.

Convissar, RA. Principles and Practice of Laser Dentistry. 3rd Ed. Elsevier; September 2022.

6.

Coluzzi DJ. Fundamentals of dental lasers: science and instruments. Dent Clin North Am. 2004 Oct;48(4):751-770.

7.

Demirsoy KK, Kurt G. Use of Laser Systems in Orthodontics. Turk J Orthod. 2020 May 22;33(2):133-140.

8.

Barberia-Leache E, Suarez-Clúa MC, Saavedra-Ontiveros D. Ectopic eruption of the maxillary first permanent molar: characteristics and occurrence in growing children.

Angle Orthod. 2005 Jul;75(4):610-615.

9.

Salbach A, Schremmer B, Grabowski R, Stahl de Castrillon F. Correlation between the frequency of eruption disorders for first permanent molars and the occurrence of malocclusions in early mixed dentition. J Orofac Orthop. 2012 Aug;73(4):298-306.

English, German.

10. Carr Ge, Mink Jr. Ectopic Eruption Of The First Permanent Maxillary Molar In Cleft Lip And Cleft Palate Children. J Dent Child (Chic). 1965;32:179-188.

11. American Academy of Pediatric Dentistry. Management of the developing dentition and occlusion in pediatric dentistry. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:466-483.

12. Xue VW, Zhao IS, Yin IX, Niu JY, Lo ECM, Chu CH. Effects of 9,300 nm Carbon Dioxide Laser on Dental Hard Tissue: A Concise Review. Clin Cosmet Investig Dent. 2021 Apr 30;13:155-161.

13. Zaghi S, Valcu-Pinkerton S, Jabara M, Norouz-Knutsen L, Govardhan C, Moeller J, Sinkus V, Thorsen RS, Downing V, Camacho M, Yoon A, Hang WM, Hockel B, Guilleminault C, Liu SY. Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases. Laryngoscope Investig Otolaryngol. 2019 Aug 26;4(5):489-496.

14. Bilder A, Rachmiel A, Ginini JG, Capucha T, Ohayon C, Weitman E, Emodi O. A Comparative Study of Mucosal Wound Healing after Excision with a Scalpel, Diode Laser, or CO2 Laser. Plast Reconstr Surg Glob Open. 2023 Aug 4;11(8):e5150.

15. Macri RT, de Lima FA, Bachmann L, Galo R, Romano FL, Borsatto MC, Matsumoto MA. CO2 laser as auxiliary in the debonding of ceramic brackets. Lasers Med Sci. 2015 Sep;30(7):1835-1841.

16. Johns Hopkins Medicine. Why Do People Snore? Answers for Better Health. Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/wellness-and-prevention/ why-do-people-snore-answers-for-better-health (accessed November 13, 2023).

17. Kakkar M, Malik S, Gupta B, Vaid N, George R, Singh S. Use of Laser in Sleep Disorders: A Review on Low Laser Uvulopalatoplasty. Sleep Disord. 2021 Feb 28;2021:8821073.

18. Lv K, Liu H, Xu H, Wang C, Zhu S, Lou X, Luo P, Xiao S, Xia Z. Ablative fractional CO2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study. Burns Trauma. 2021 Jul 27;9:tkab023.

19. Huai D, Dai J, Xu M, Cao Y, Song H, Wang S, Wang H, Yin M, Cheng L, Zhang Y, Zhou X, Wang J. Combination of CO2 laser-assisted uvulopalatopharyngoplasty and nasal cavity expansion enhances treatment of obstructive sleep apnea-hypopnea syndrome.

Int J Clin Exp Med. 2015 Oct 15;8(10):19764-19774.

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Continuing Education Quiz CO2 lasers in orthodontics DRAGAN

1. Lasers are precise and versatile devices that offer numerous advantages, including faster operating time, reduced pain, minimized intra- and postoperative discomfort, faster healing, and improved quality of results, all of which contribute to a faster completion of the orthodontic therapy. a. True b. False 2. ________, or laser, is a term involving the physics of light that is amplified by stimulated emission. a. Light Amplification by Stimulated Emission of Radiation b. Light Addition by Stimulated Emission of Radiation c. Lasting Amplification by Stimulated Emission of Radiation d. Light Amplification by Simulated Emission of Radiation 3. The laser light is _________. a. achromatic b. monochromatic c. triadic d. tetradic

Each article is equivalent to two CE credits. Available only to paid subscribers. Free subscriptions do not qualify for the CE credits. Subscribe and receive up to 16 CE credits for only $149; call 866-579-9496, or visit https://orthopracticeus.com/ subscribe/ to subscribe today. n To receive credit: Go online to https://orthopracticeus.com/continuingeducation/, click on the article, then click on the take quiz button, and enter your test answers.

AGD Code: 135 Date Published: December 28, 2023 Expiration Date: December 28, 2026

2 CE CREDITS

enamel and dentin. a. 0.84 µm b. 1.069 µm c. 2.64 µm d. 9.3 µm

4. When the water temperature surpasses ________, vaporization of the water within the tissue occurs — a process called ablation. a. 25 degrees Celsius b. 50 degrees Celsius c. 75 degrees Celsius d. 100 degrees Celsius 5. _________ has the highest absorbance of any laser. a. The CO2 laser b. Neodynium Yttrium Aluminum Garnet Laser c. Erbium laser d. Diode laser 6. _________ of ectopic first permanent molars will self-correct by 7 years old. a. Twenty-three percent b. Forty-five percent c. Sixty-six percent d. Seventy-six percent 7. (Regarding uncovering unerupted and partially erupted teeth) A _______ wavelength laser alters the chemical structure of teeth by increasing the ratio of calcium to phosphorus and converting the carbonated hydroxyapatite to the purer hydroxyapatite of

8. Because the laser removes microns of enamel at a time, the precision of the laser traveling from overlying soft tissue and possible cortical bone ________. a. poses little risk to exposure of the tooth underneath b. increases the risk of exposing the tooth underneath c. increases the risk of thermo-damage to the dentin-pulp complex d. decreases the need for a brass wire or de-impaction spring 9. Research (on prominent maxillary labial frena and mandibular lingual frena) supports the idea that the most suitable surgical resolution is the use of laser devices because they produce ________. a. a bloodless field b. shorter surgical times c. faster wound healing d. all of the above 10. Debonding with lasers is especially useful for __________ brackets by reducing shear strength without increasing intrapulpal temperature. a. stainless b. ceramic c. gold d. cobalt-chromium

To provide feedback on CE, please email us at education@medmarkmedia.com Legal disclaimer: Course expires 3 years from date of publication. The CE provider uses reasonable care in selecting and providing accurate content. The CE provider, however, does not independently verify the content or materials. Any opinions expressed in the materials are those of the author and not the CE provider. The instructional materials are intended to supplement, but are not a substitute for, the knowledge, skills, expertise and judgement of a trained healthcare professional.

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32 Volume 14 Number 4

DIGITAL DIGEST

Enhancing orthodontic marketing with automation: a digital revolution Jeff Slater discusses how automation can keep your on-line presence active

I

n today’s digital age, where social media platforms like Facebook and Instagram dominate our daily lives, orthodontic practices must adapt to stay competitive and thrive. Leveraging automation in your marketing strategies is one of the keys to success, as it can save time and money while making your practice appear more professional to prospective patients scrolling online. In this article, we’ll explore the importance of incorporating automation in your orthodontic marketing efforts.

Automation tools can help maintain a consistent and professional image. With scheduled posts, you can ensure a steady flow of engaging content, such as educational articles, patient success stories (and photos), promotions, giveaways, contests, and more! Automation also prevents lapses in posting, helping you stay active and relevant in the eyes of your audience – and the fickle algorithms that decide who sees your content.

Time and cost efficiency

Patient reviews are among the most valuable assets in digital marketing. Positive reviews on platforms like Google can build trust and credibility, influencing potential patients to choose your orthodontic practice.

Automation can play a pivotal role in acquiring these reviews.

Automated text reminders requesting Google reviews from satisfied patients can be a game-changer. These reminders can be sent right after an appointment, making it easy for patients to leave feedback while your excellent treatment and staff are still top of mind.

In a digital world filled with potential patients scrolling through social media and online reviews, orthodontic practices must take full advantage of automation to thrive. Content marketing schedulers that integrate with social media platforms can save you time and money while elevating prospective patients’ perceptions of your practice. Additionally, automated text reminders for Google reviews can help boost your online reputation and credibility.

By embracing the technological tools available, orthodontic practices can unlock their full potential and grow their business. Automation isn’t just a convenience; it’s a strategic necessity in the modern world of marketing. So, don’t hesitate to implement automation in your orthodontic marketing strategy. It’s a step towards a more efficient, professional, and successful practice. OP

Marketing an orthodontic practice can be a time-consuming and costly endeavor. Juggling patient appointments, administrative tasks, and managing an online presence can be overwhelming. This is where automation comes to the rescue!

Content marketing schedulers that seamlessly integrate with platforms like Facebook and Instagram allow you to plan and post content in advance. Improving your social presence AND saving time? Yes, please.

Professionalism and credibility First impressions matter, especially in the digital realm. When potential patients visit your practice’s Facebook or Instagram profiles, a polished and professional online presence can significantly impact their perception of your orthodontic services.

Jeff Slater is a Vice President of Operations at Kaleidoscope, a digital marketing agency specializing in the orthodontic profession. He is an Internet marketing expert, lecturer, and author with more than 12 years of hands-on experience in website development, SEO, local business search, reputation management, social media management, and digital advertising. Jeff offers a unique perspective on how to market effectively in today’s highly competitive online environment.

orthopracticeus.com

Online reviews, a vital asset

33 Volume 14 Number 4

TECHNOLOGY

Referrals — from a pad of paper to a technology-filled smart card Dr. Steven Semaan talks about the importance of referrals and a new technology that promises to change and improve the process.

R

eferrals are one of the most powerful ways that orthodontic practices connect with new patients and expand their reach. With social media, the internet, and word of mouth as modern ways for patients to find an orthodontist, it is important that your referring GP has a technology-based and easy way to steer patients to your door.

The challenge that orthodontists face with traditional paper referrals is that they are extremely ineffective. Once the patient leaves the office, the paper referral can be lost, crumbled, thrown away, and basically ignored. Both the GP and orthodontist give up all control after handing the patient that piece of paper. The orthodontist has no idea when a patient is referred, who the patient is, if they called, or even plan to. On the business side of practice development, paper referrals can’t track how active their referral network actually is, or how many patients are told to call but never take action to make an appointment. Besides the orthodontist, the paper referral doesn’t do the GP any good either.

It doesn’t provide any follow-up to find out if the patient ever got to the orthodontist. That’s an important aspect if the GP is waiting for the orthodontic consult to continue a treatment plan.

Paper referrals provide no information to the patient other than the orthodontist’s name. Patients obviously would want to have more information on this specialist with whom they will spend the next few years. They must do an internet search trying to find the information on this new doctor (Dr. What’s His Name — I can’t find the paper the GP gave me!). It’s just another hassle in their already busy lives.

Technology has provided some improvements with software that links orthodontists with their GPs. Software is better than paper, but then the GP must be amenable to learning whatever software the specialist uses — and considering that each orthodontist may have their own preferred software — this is actually a pretty big request from a specialist.

Steven Semaan, DDS, MS, is the founder and principal orthodontist of Clear Smiles Orthodontics. He obtained his Dental degree from Sydney University and his Master of Dental Science in Orthodontics degree at the University of Western Australia. He is a member of The Australian Society of Orthodontics (ASO), the American Association of Orthodontics (AAO), and the World Federation of Orthodontists (WFO). He is the founder and principal orthodontist of Clear Smiles Orthodontics in Queensland, Australia.

Dr. Semaan has year-over-year premier Invisalign status, has held numerous dental and orthodontic board seats, academic achievements, and teaching/ speakerships.

Disclosure: Dr. Semaan is an early adopter of Bright Referral.

Orthodontic Practice US

Figure 1: A doctor taps the Bright Card to a patients phone to make a referral

Since May 2023, I have been using a new system called Bright Referral. With no need to download or buy a new software system, Bright Referral replaces the paper referral with a smart card that the patient taps on their phone. With this tap, up pops a custom experience exactly right for the patient being referred from that GP to me. The patient can learn about our practice, see our locations, schedule an appointment, save contact information, call or text, understand insurance policies, and even ask for follow-up. They don’t have to plod through the internet to do research on their own (and possibly find another orthodontist during their search).

Plus, as the doctor receiving the referral, we see all of this happening in real time and can plan, prep, and follow-up with this new patient immediately.

I love being an early tech adopter, and referral tracking is a problem I knew we had, but couldn’t solve. Setup of Bright Referral took 5 minutes. All I had to do was log-in on the website and enter my info. Since starting, smaller referrers are referring more, because it is so easy and, frankly, cool to use. The system keeps metrics and charts on how effective my referral network is, so over time, so I can make decisions, plan, and update my processes as needed. I’m strengthening relationships with referring offices based on data and insight, and getting referrals in the door more consistently and more quickly. I have had 94 referrals in the past 5 months, and this with only a handful of referral sources rolled out.

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TECHNOLOGY

From the GP perspective Dr. Roy Krengel (@krengeldental) is a general dentist in the Minneapolis metro area who has been using Bright Referral cards since January 2023. He is usually skeptical when a specialist approaches him with a new technology because it means retraining his staff or learning a new software. He finds it too much work for his staff to change things up for just one specialist office. He describes, “After the demonstration, I was floored. We really didn’t have to change anything at all. In fact, it made the referral process easier, faster, and cooler. Something that patients loved. Instead of finding a pen and scrawling notes on the referral slip, I tap the Bright Card to the patient’s phone and use the voice memo to talk through any notes.”

Tap and talk The voice memo is a new and very useful feature in the system. The GP can share a voice memo note by just tapping on the record button and talking about what the patient may need. The patient then submits, and the orthodontist receives the voice memo within the system so they can hit play any time they want.

Depending on the size of the practice, a small GP office can refer to 20 different specialist offices, and orthodontists can have between 20 and 80 GPs referring to them. That’s a lot to keep track of. Studies consistently cite between 30% and 55% of referrals never follow-up with the next doctor. With that amount

Figure 2 (left): The patient gets all of the information about a new doctor at the moment of a referral. Figure 3 (above): The orthodontist gets the referral data in real time. They can easily track and follow-up with patients, along with their entire referral network

of influence on your patient care and practice growth, referrals need to be encouraged, followed up on, tracked, and even analyzed to fulfill their fullest potential. Bright Referral makes all that easy and considers the needs of the specialist, GP, and patients in providing a service that at this time, no other referral methods are able to achieve. OP

ANNOUNCING

a new YouTube series: Nexus Connexus. This series will embody our Nexus Dental Systems’ vision and mission WATCH NOW to inspire others https://www.youtube.com/ to take action and @NexusDentalSystems be informed.

We are all extensions of this great cause and your efforts can benefit so many!

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35 Volume 14 Number 4

MILITARY MATTERS

Sleep apnea among military veterans Claire Szewczyk discusses “the silent battleground”

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hen we think of our brave military veterans, we often visualize valiant soldiers fighting battles on distant shores. Yet, there’s another battle many veterans face at home, in the silence of the night — sleep apnea. Dental practices can provide a beacon of hope to our military heroes.

Sleep apnea is a medical condition where an individual stops breathing temporarily during sleep.1 These interruptions can happen several times during the night and can lead to a range of health complications if left untreated.

While anyone can develop sleep apnea, our veterans have unique risk factors due to their service experiences. From exposure to certain environmental factors to the physical and emotional tolls of service, the brave men and women of our armed forces have distinct vulnerabilities to this sleeping disorder.

Understanding sleep apnea

Sleep apnea is characterized by repeated stops and starts in breathing during sleep.2 These interruptions can range from a few seconds to more than a minute, usually followed by startling chokes or snorts upon resumption.

Types of sleep apnea There are distinct variants of sleep apnea.

• Obstructive Sleep Apnea (OSA), the most prevalent form, occurs when the throat muscles intermittently relax and block the airway during sleep.

• Central Sleep Apnea (CSA) emerges when the brain doesn’t send the necessary signals to the muscles controlling breathing.

• Complex Sleep Apnea Syndrome (CSAS) or treatment-emergent central sleep apnea, is when OSA and central sleep apnea happen simultaneously.

Diagnosis Sleep apnea’s detection usually involves a sleep study, or polysomnogram, that observes multiple body functions during sleep such as brain electrical activity, eye movement, and muscle activity. Some might undergo home sleep tests, where primary metrics like heart rate and oxygen levels are gauged.

Dental exams are an often-overlooked avenue for recognizing this condition.3 Dentists might spot symptoms, like teeth

Claire Szewczyk is a Digital Content Coordinator for Hill & Ponton, PA in Florida. She was a former US Air Force civilian employee, who worked at Hill Air Force Base, in Layton, Utah as a flight testing administrator. She has also spent several years working with the Department of Veterans Affairs audiology programs in Salt Lake City, Utah and Pocatello, Idaho. She enjoys working with the veteran population as well as those who provide health care for veterans, and keeping them up to date with information they need the most.

Orthodontic Practice US

grinding or throat inflammation from pronounced snoring, hinting at sleep apnea. This underscores the importance of a dental sleep practice visit both for detection and potential treatment options.

Symptoms and health risks Many symptoms and health risks are associated with sleep apnea. Some of the more common ones include: Symptoms • Loud snoring • Gasping for air during sleep • Waking up with a dry mouth or morning headache • Sleep interruptions • Daytime drowsiness • Daytime focus difficulties Health Risks • High blood pressure, and its complications4 • Strokes • Heart issues • Diabetes • Metabolic syndrome to liver problems Early detection can drastically influence a veteran’s quality of life.

The connection: military veterans and sleep apnea Members of the military face a greater susceptibility to sleep apnea. They are frequently exposed to various environmental factors, unique stressors, and traumatic experiences. This cumulative effect, combined with physical injuries or the mental toll of combat, can indirectly or directly increase sleep apnea risk.

Post-traumatic stress disorder (PTSD) and sleep apnea PTSD, prevalent among veterans, exhibits a substantial link with sleep apnea.5 PTSD doesn’t just harm one’s mental state; it also has physical implications. Stress-induced ailments or conditions like bruxism (teeth grinding) can escalate throat and airway

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MILITARY MATTERS

inflammation. PTSD-induced nightmares and sleep disturbances can also exacerbate or even trigger sleep apnea episodes.

Common environmental factors Military service often involves deployment in varied environments, each presenting its challenges. For instance, veterans stationed in desert climates might inhale fine sand particles, potentially causing respiratory issues or throat irritations. On the other hand, constant exposure to high altitudes or deep-sea environments might have long-term impacts on lung capacity and breathing patterns.

address it.7 They should be encouraged to attend workshops, engage with support groups, or research reputable sources online to get a comprehensive understanding of the disorder.

Engage with VA resources The Department of Veterans Affairs offers numerous resources tailored for veterans. From clinics that specialize in sleep disorders to educational programs, make sure that they are aware of these avenues to get the support they need.

Prioritize good sleep hygiene

As sleep apnea solutions, CPAP machines are a frequent choice. While effective for some, they aren’t for everyone. This is where dental sleep practices can offer specialized alternatives tailored to individual needs, especially for veterans.

Creating a routine that promotes good sleep can alleviate some symptoms of sleep apnea. This includes: • Maintaining a regular sleep schedule.

• Keeping the bedroom dark, quiet, and at a comfortable temperature.

• Limiting screen time before bed.

The power of oral appliances

Consider lifestyle changes

Dental sleep practice: a potential solution

Oral appliances resemble mouthguards or orthodontic retainers and are custom-fitted to the user.6 By adjusting the jaw’s position slightly, these devices ensure that the airway remains unobstructed during sleep. They are particularly beneficial for those who: • Find CPAP machines cumbersome or uncomfortable • Travel frequently and require a more portable solution • Have mild-to-moderate sleep apnea For many veterans, the simplicity and non-intrusiveness of oral appliances make them a preferred option. The ease of maintenance and the ability to integrate them into existing dental routines make them even more appealing.

Personalized treatment Every individual’s journey with sleep apnea is unique, especially among veterans with varied service experiences and resulting health conditions. Dental sleep practices focus on understanding these unique needs, providing treatment options that consider the whole person, not just the disorder.

Certain habits can exacerbate sleep apnea symptoms. They should contact their health care provider to find out more about reducing their incidence of sleep apnea, including: reducing alcohol consumption, avoiding sedatives, quitting smoking, and maintaining a healthy weight to mitigate the disorder’s impact.

Stay consistent with treatment Whether your patients are using an oral appliance, a CPAP machine, or another treatment option, consistency is key. Explain that compliance for their chosen treatment as recommended will help them to reap the full benefits.

While sleep apnea poses a significant challenge, especially among military veterans, there are numerous avenues available for mitigation. From the specialized care provided by dental sleep practices to lifestyle adjustments and leveraging VA resources, veterans have many options.

Tackling sleep apnea means not only improving the quality of their sleep but also enhancing their overall health and well-being. With the right resources and determination, it’s one that can certainly be won. It’s a battle worth fighting. OP

Collaborative care Often, tackling sleep apnea requires a combined approach.

Dental sleep practices frequently collaborate with sleep physicians, ensuring a comprehensive treatment plan. From the initial sleep study to determine the sleep apnea’s severity to deciding the best intervention, this collaboration ensures that veterans receive the most effective care tailored to their circumstances.

REFERENCES 1.

Szewczyk C. VA Rating for Sleep Apnea and How to Get to 100%. Hill & Ponton Disability Attorneys website. https://www.hillandponton.com/how-the-va-rates-obstructive-sleep-apnea/ (updated October 10, 2023.

2.

National Heart, Lung, and Blood Institute. What is Sleep Apnea? https://www.nhlbi. nih.gov/health/sleep-apnea (accessed November 17, 2023).

3.

American Dental Association. Sleep Apnea (Obstructive). https://www.ada.org/en/ resources/research/science-and-research-institute/oral-health-topics/sleep-apnea-obstructive (updated January 9, 2023).

4.

Szewczyk C. Sleep Apnea and Hypertension in Veterans: Proving a Secondary Connection. Hill & Ponton Disability Attorneys. https://www.hillandponton.com/the-linkbetween-sleep-apnea-and-hypertension/ (updated September 14, 2023).

5.

Hill & Ponton Disability Attorneys. How Do I Claim Sleep Apnea Secondary to PTSD? https://www.hillandponton.com/sleep-apnea-secondary-ptsd/ (updated September 13, 2023).

6.

Cleveland Clinic. Oral Appliance Therapy for Obstructive Sleep Apnea. https://my. clevelandclinic.org/health/treatments/21129-oral-appliance-therapy-for-sleep-apnea (reviewed March 30, 2020).

7.

Mayo Clinic. Obstructive sleep apnea. https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/diagnosis-treatment/drc-20352095 (updated July 14, 2023).

Advocating for awareness Veterans, given their service and sacrifices, deserve the best care. Dental sleep practices play a pivotal role not just in treatment but also in spreading awareness about the heightened risk of sleep apnea in the veteran community. By fostering understanding and offering tailored solutions, they ensure that our servicemen and servicewomen achieve the restful sleep they deserve.

Tips for veterans battling sleep apnea Knowledge is power. The more veterans know about sleep apnea and its treatments, the better equipped they will be to orthopracticeus.com

37 Volume 14 Number 4

PRACTICE DEVELOPMENT

Five ways to effectively measure your practice’s performance Oliver Gelles offers reliable metrics to gauge production and efficiency

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n today’s challenging economic landscape, marked by factors like inflation and increased competition, the orthodontic industry faces unprecedented hurdles.

Gaidge numbers show that 2022 starts retracted by 6%, with year-to-date 2023 showing a continued decrease of 3.5%. Maximizing your production and efficiency will allow you to manage this demand decrease.

It’s clear that practices now more than ever require a set of clear, reliable metrics to gauge their performance. Let’s delve into these challenges and explore five essential ways to effectively measure your practice’s performance.

1. Kept New Patient Exam Rate The first key metric to assess is your Kept New Patient Exam Rate. Simply put, are your clients showing up for their exams? This metric holds the key to optimizing your front office efficiency. It’s akin to the art of “PREsuasion,” as coined by Brian Wright. Data indicates that potential new patients tend to contact up to five orthodontic practices before making their decision. To thrive in this competitive environment, it’s imperative to innovate your processes, attract new patients, and simultaneously reduce costs, stress, and no-shows.

2. 45-Day Treatment Recommended Conversion Rate (TRC) Next on the list is the 45-Day Treatment Recommended Conversion Rate. This metric is a game-changer in the world of orthodontics. Unlike the erratic and noisy nature of Case Acceptance, TRC offers a stable and reliable measure. OrthoFi’s 45-Day TRC, which calculates the percentage of patients’ recommended treatment in the last 45 days who converted, is a far more dependable metric. It provides a short feedback window to test fee increases while ensuring consistent conversion rates and optimizing your practice’s growth.

Oliver Gelles is widely recognized as one of the industry’s foremost strategic brand-building experts. He has over 20 years of experience in the orthodontic industry, contributing to continuing education events and technology innovation for nearly a decade. Gelles’ recently published book on practice management, Level the Curve, is a No. 1 bestseller in six categories on Amazon. With a passion for orthodontics, Gelles leverages his business acumen to lecture around the world on many of the core concepts that prompted the creation of OrthoFi. Disclosure: Oliver Gelles is the Chief Marketing Officer for OrthoFi and OrthoBanc.

Orthodontic Practice US

Several key factors influence your TRC, including the ease of your scheduling system, the number of appointments needed to apply braces, the efficiency and timeliness of your new patient processes, and the affordability of your treatment plans.

3. Same-Day Contract Rate The Same-Day Contract Rate is another pivotal metric. It measures the percentage of patients who sign contracts on the day of their initial exam. Why is this so crucial? Because the moment prospects leave your office, the chance of converting them falls dramatically. OrthoFi research shows that the likelihood of converting a patient drops by 20% the moment they step out the door and decreases by 35% for children and 45% for adults over the first 2 weeks. For many practices, follow-ups are often done in batches every other week, which cuts their chances of conversion by almost half.

The Same-Day Contract Rate also has a direct correlation with your overall conversion rate. If your fees exceed the elasticity of your local patient base, you can expect this rate to drop.

However, it’s essential to note that a drop in Same-Day Contracts doesn’t necessarily mean a plummet in your conversion rate.

Thus, focusing on Same-Day Contracts is a potent strategy to boost your practice’s growth.

In addition, getting patients to complete intake forms before their exams is essential to Same-Day Contracts. This approach ensures that you have all the necessary information to present the total out-of-pocket cost during the exam, as insurance benefits have been verified ahead of time.

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PRACTICE DEVELOPMENT

4. Aggregate Cash-Flow Management As your practice grows, it becomes paramount to manage your cash flow effectively. Expenses can sometimes outpace income, and that’s where the strategy of Aggregate Cash-Flow Management comes into play. This strategy enables you to intelligently create leverage in your business while maintaining a healthy and consistent cash flow.

With this approach, you can offer flexibility to those patients who need it, ensuring they can start treatment without financial barriers. Simultaneously, you can provide fair and enticing terms to patients who can afford to pay more upfront. The two key performance indicators for tracking your aggregate cash flow are Same Day Cash (SDC) and Payment % of Treatment Length.

Same Day Cash (SDC) measures the combination of the money you receive each day from pay-in-full (PIF) patients and down payments (DPs). The formula for SDC is (PIF + DP) divided by Total Patient Responsibility Production, where Patient Responsibility Production is Total Production minus Insurance Production. OrthoFi consultants typically suggest that 20% of patients should pay in full, while the remaining 80% of receivables come through with 17% down payments. This results in an average SDC of approximately 34% of your patient receivables, providing sufficient cash flow to meet your office’s financial obligations.

Payment % of Treatment Length monitors how closely your financing terms align with the average estimated treatment length. This approach allows you to manage risk appropriately, offering extended terms to those in need, without increasing aggregate risk or front office burden by promoting long-term payment financing across your practice.

When you effectively monitor these powerful metrics, you can confidently manage your aggregate cash flow.

5. Net Collection Rate The final key metric is the Net Collection Rate. This metric measures how effectively you collect on all accounts for new and existing patients, encompassing insurance and cash receivables.

By tracking Net Collection Rate, you can keep a watchful eye on delinquency management while expanding your patient base.

Conclusion These five key metrics empower you to assess your conversion rate in real time and over an extended period, helping you identify areas of opportunity. This comprehensive understanding of your practice’s performance allows you to predict your future more accurately. By learning from the past and applying these metrics, you can master your practice’s performance and ensure its longterm success in the ever-evolving world of orthodontics. OP

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ONE CLICK

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PRODUCT PROFILE

The case for limited treatment Dr. Leon Klempner discusses growing your practice with high value-per-visit treatment lim·it·ed treat·ment \ ‘limədəd ‘trētmənt \ n 1: Orthodontic treatment with a limited objective or scale of treatment. The objective may be limited by: not involving the entire dentition, not addressing the full scope of the orthodontic problem, mitigating an aspect of a greater malocclusion, decision to forgo comprehensive treatment.

The orthodontic market is expected to grow — is your practice?

The global orthodontic market is projected to triple by 2028, according to Fortune Business Insights, due in part to a growing adult, limited treatment market. Are you ready to capture this segment of patients interested in non-comprehensive treatment?

Is limited treatment profitable?

Absolutely. And innovative practices are offering it.

If you look at case profitability through the lens of Value Per Visit or VPV (case fee/number of visits), you will understand how beneficial these cases are. Properly priced and planned, limited treatment cases can have higher VPVs compared to comprehensive treatments. A possible pricing structure could be as follows.

Leon Klempner, DDS, a retired, board-certified orthodontist and Harvard faculty member, is the co-founder of People + Practice, a digital marketing firm and co-host of the Golden Age of Orthodontics podcast.

Example pricing structure Price

Aligners

Visits

VPV

$2,500

10

3

$833

$3,000

20

4

$750

How do I make it happen?

Your aligner lab fees must support this pricing structure.

It is clearly not feasible to offer $2,500 treatment if lab fees are $1,400. Partner with an aligner company like uLab Systems™ that offers reasonable all-inclusive mild bundles or subscription-free, a la carte aligners, and full custom packaging. With uAssist™, you can even submit your case to a team of orthodontic professionals for treatment-planning assistance.

Without marketing, prospective patients will assume you do not offer affordable limited treatment.

Launch a two-pronged marketing campaign. Communicate your limited treatment offering to the potential patients already in your practice — the parents who have entrusted their children to your care. You should also market to the adult population in the local community. Emphasize affordability, convenience, and your expertise as an orthodontist. OP This information was provided by uLab.

Orthodontic Practice US

40 Volume 14 Number 4

What’s included in your uSmile™ aligner bundle?

Choose your bundle option after seeing the treatment plan Software calculates the most economical option

uLab® Case Bundles Include: uAssist™ treatment planning assistance Custom Packaging Retainers and templates

Bundles are for 3-years of continuous treatment for one patient. uLab Systems, Inc. 7005 Appling Farms Parkway, Suite 103 | Memphis, TN 38133 | 866-900-8522 | ulabsystems.com © 2023 uLab Systems, Inc. All Rights Reserved. uLab Systems, uAssist, uView and uSmile are trademarks and uDesign and uLab are registered trademarks of uLab Systems, Inc. MAR-0001425 Rev 1

Measure clinical efficiency Optimize your treatment outcomes.

“I would never have known that a single tooth was experiencing breakage at twice the rate of other teeth without DM Insights.”

- Dr. Barry Benton* Master Smart Orthodontics.

Create your future. Contact us today.

*Dr Barry Benton - Can DentalMonitoring data improve clinical outcomes? https://dental-monitoring.com/wp-content/uploads/2022/12/AD_MON_IW_Case-studyDr_-Barry-Benton_001_01_rd_H_US_en.pdf.

DentalMonitoring is a product designed and manufactured by Dental Monitoring SAS, for Healthcare Professionals (HCPs). It is also used by patients under the mandatory supervision of Healthcare Professionals (HCPs). DentalMonitoring is designed to assist HCPs with remotely observing intraoral situations and monitoring orthodontic treatments. Refer to your HCP and/or the Instructions for Use before use. Some modules of the DentalMonitoring product are considered as a medical device (in Europe and other countries), registered as such and holding the CE mark. Product availability, claims and regulatory status may differ across countries depending on local regulations. Contact your local representative for further information. AD_MON_AD_ ad_101_01_rd_H_MF_en.