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The Ortho Tech Revolution: Advantages for the Practitioner and the Patient Dr. Thomas Pitts

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by Dr. Thomas Pitts

Orthodontic technology has evolved a great deal in just the past decade alone and, like any change, it has not been without some amount of criticism and controversy. While a healthy debate is good for the industry, there's no doubt that some technologies are allowing clinicians to deliver much more sophisticated treatment to patients by eliminating the one-size-fits-all approach. Enhanced diagnostic tools, advanced appliance design and even personalized smile design have revolutionized treatment planning for the practitioner and results for the patient. Some of the most ground-breaking new developments in orthodontic treatment technology make accurate, comfortable and fast treatment more accessible for the patient and provider.

The Need for Evolution
As is the case in life and in business, change is sometimes difficult. When it comes to providing superior quality of care for patients, employing only the most advanced technology is paramount. Not only can innovative technologies deliver outstanding results but the use of cutting-edge techniques can become a crucial differentiator for practitioners in an increasingly competitive marketplace.

To be sure, there is good reason for skepticism of the "latest and greatest"; we want to make certain that new products and techniques offer real benefit beyond the marketing hype and salesperson's rhetoric. When Dr. Larry Andrews introduced his straight-wire appliance in 1970, he was met with significant skepticism and the technology took more than 20 years to penetrate the market. That philosophy is now a standard of care in practices all around the country. The same is true of extraction practices; we now know that extraction doesn't improve stability of lower incisor crowding to any great degree. I now find that I only need to extract on a small percentage of cases.

Such is the case with contemporary diagnostic and treatment techniques. As these gain momentum, it's crucial for practitioners to examine clinical evidence in making the best decision for your patients and your practice. As technology evolves and we learn to examine new theories and systems with a critical eye, we are able to collectively and collaboratively shape the future of the industry for the betterment of our patients and our profession. Multiple case reports are good evidence of the advancements in technology.

Enhanced Diagnostics
One of the most exciting new diagnostic tools is the use of CBCT. In-office CT scans of the patient's head reveal the entire three-dimensional landscape of the skull, jaw and underlying bone structure providing visibility and clarity of the dentition and related jaw/joint situation never before possible. Where conventional X-rays force the clinician to make treatment planning decisions based on the interpretation of two-dimensional shadows, a CT scan can reveal the exact position of impacted teeth or identify problems that would have otherwise been hidden to the practitioner. The 3D images can be manipulated and viewed from virtually any angle, providing an incredibly powerful tool for treatment planning and evaluating results.

The use of CBCT scanners has generated some controversy on two fronts. First, most dental radiologists insist they must interpret the results in order to provide the most thorough and accurate diagnosis. This would most certainly add to the overall cost of treatment, an expense most practitioners are reluctant to incur, especially given the fact that they have interpreted 2D X-rays on their own for years.

The risk of radiation exposure to the patient has also given rise to critics who claim in-office CT scans are dangerous. The assumption here is that they deliver radiation on par with medical-grade scanners. In fact, the typical five-second CBCT scan for orthodontic purposes exposes the patient to about the same radiation as two conventional panoramic X-rays and far less than a full series of dental X-rays. However, the resulting volume of data is worth far more than any number of conventional X-rays could ever provide.

Customized Smile Design
Twenty years ago, braces were braces. Most practitioners used "off-the-shelf " brackets and wires to treat virtually every patient, relying on his or her professional expertise to place these cookie-cutter appliances on the patient's teeth to get the best possible result.

Today, new methods of indirect bonding employ the use of precision, 3D computerized models to determine optimal bracket placement well in advance, then design customized brackets and wires to deliver the prescribed results. Even better for the patient, these customized braces can deliver excellent results quickly and comfortably compared to one-size-fits-all appliances.

For example, the Insignia system of customized braces (Ormco Corp., Orange, California) offers sophisticated software for smile design that enables the orthodontist to determine the precise end-result placement of each tooth in a 3D virtual model. Brackets are supplied and applied using precision placement guides that ensure accurate positioning based on the Insignia model and pre-determined treatment plan. The Insignia placement guides are precise and can create office efficiencies such as assistant delegation (in states where applicable). The clinician's time can be freed for more advanced treatment planning and new patient consultation.

The combination of customized brackets and wires is not only more convenient and efficient for the practitioner but also for the patient. There's usually less need to reposition brackets during treatment, and typically fewer appointments needed. This fact even affords greater opportunity for optimum practice efficiency.

The Next Frontier
As the results we can achieve improve by leaps and bounds, we're seeing a greater number of adult patients, as well as adolescents, who are more image-conscious, expressing concern about the aesthetics of braces. Of course, they do realize that the ends justify the means, but many still prefer more discrete treatment options that don't draw attention.

Lingual braces and clear braces that leverage the latest advances in treatment technology are the next frontier. Lingual braces have long been considered one of the most difficult orthodontic treatment programs, simply for the challenge in proper placement of the brackets and wire changes. The STb light lingual system (Ormco) provides the aesthetics patients want with a low-profile design and low-force, low friction mechanics that make them comfortable for the patient with minimal speech interference. This system is an ideal alternative to clear aligners, providing fast, precise treatment in a wider range of cases and eliminating the problems of lost trays and lack of patient compliance.

Recent advances in the reliability, durability and stain resistance of clear brackets is also making orthodontic treatment more appealing for a greater number of patients. For example, Damon Clear braces (Ormco) integrates the Damon System's proven self ligating bracket technology with a polycrystalline alumina bracket that is highly resistant to staining from coffee, mustard, red wine and other known stain-causing foods. Featuring a laser-etched pad on the bonding surface and enhanced strength for durability during treatment, Damon Clear brackets offer the same speed, convenience and comfort of Damon's signature passive self-ligating technology in a virtually invisible bracket.

The Ultimate Goal
Ultimately, the primary goal of every practitioner and every solution is to provide long-lasting, optimum results for the patients with minimal discomfort and disruption to their daily lives. Today's orthodontic technologies – and those on the horizon – are allowing us to achieve these objectives in ways that many of us could have never imagined 20 years ago. The use of more advanced techniques, gentler forces and working with the body's own natural tendencies now enable us to treat a much wider range of cases with a much smaller percentage of invasive surgery, palatal expanders or extraction.

The move toward more comfortable, more convenient treatment is a big asset to the patient. As sophisticated technologies yield increasingly impressive results, a growing number of patients are looking to orthodontic treatment to enhance their smile, self-esteem and even their overall facial appearance. As the market expands and the use of technology increases, efficiency of treatment and practice management are critical factors in the sustainable growth of any orthodontic practice. Just as the hydraulic lift revolutionized the dental chair, new orthodontic technologies can not only streamline patient care but also change the way we do business as they become part of the mainstream standard of care.
Author’s Bio
Dr. Thomas Pitts is a practicing orthodontist in Reno, Nevada and Anaheim, California. With more than 40 years of experience, he's treated more than 20,000 patients by employing the most advanced emergent technologies and techniques to provide the fastest, most comfortable and most precise results possible. Dr. Pitts earned his dental degree from University of the Pacific and his Master of Science in Orthodontics degree from the University of Washington. He is a member of the American Association of Orthodontists, the Pacific Coast Society of Orthodontists, the Northern Nevada Dental Society, the American Dental Association, the Nevada State Dental Association and the Progressive Study Group. He is an associate clinical professor of orthodontics at University of the Pacific Arthur A. Dugoni School of Dentistry in San Francisco.
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September 2025
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