During the past several decades, orthodontic practices have increasingly recognized the inherent efficiencies of the digital workflow for aligners. As a result, orthodontists have made
significant investments in digital equipment such as scanners and 3D printers, in digital workflow education for the doctor and staff, and in aligner lab fees. These investments have increased practice efficiencies and patient experience, but data shows that fixed braces are still the appliance of choice for up to 70% of patients in orthodontic offices.
“If you put the braces in the right place, the case treats itself,” a mantra I’ve heard myriad times, is false. For 10 years, I explored digital solutions to perfect bracket positioning and unlock the benefits of true straight-wire mechanics. After trying 16 unique digital braces systems that allowed for measurement down to 0.01 millimeter, I discovered that digital indirect bonding (IDB) and perfect bracket positioning does not allow straight-wire treatment. While ideal bracket positioning did allow me to get the second order where it needed to be, this technology alone lacks control in first and third order. Also, I still needed to make second-order adjustments to align marginal ridges when the real issue was inadequate third-order control.
Digital on its own is not enough; it gets us to only 33%, even with perfect with bracket positioning. A straight-wire solution must be digital and custom.
Imagine if aligners gave us only a single prescription (MBT, Damon, Andrews, etc.) for every case: Teeth would inevitably end up in an incorrect position because a one-size-fits-all system
does not truly fit anyone perfectly. With aligners, the optimal tooth position for the individual patient dictates the prescription as recognized through digital technology. Because of these
experiences, we know it is digital bracket placement with the custom prescription that contributes to success.
The digital custom braces that I tried during my first years in practice taught me much about where to look for optimal solutions. On the surface, it seems like those modalities should have already replaced conventional analog bracket systems. However, there were critical roadblocks with early custom digital solutions:
The key takeaways as I moved to develop the KLOwen Custom Braces System were:
- The capital and labor intensity to manufacture these appliances created a prohibitively expensive price tag (typically $700+ more than conventional twin brackets).
- The workflow required a considerable time to fabricate and deliver to offices (often four to eight weeks).
- Many systems did not adequately support slot-filling mechanics and required significant wire bending or repositioning to achieve optimal clinical results.
The system offers 100% custom positioning of each tooth through 27 brackets with variations in torque and in thickness. Software selects the best-fit bracket (first and third order) for each tooth once the doctor has positioned the teeth in the program; the second order is handled by the IDB tray. If seven degrees of torque is necessary, a five-degree bracket is selected, and the final two degrees is built into the composite base at the bonding appointment.
- We need to fill the slot with a custom prescription for excellent, efficient results.
- The IDB trays must be accurate.
- Less-expensive solutions with faster turnaround are imperative for scale in our practice.
The IDB tray allows orthodontists to determine how much adhesive is needed. The first order will always maintain a distance of less than 0.2 mm between the tooth surface and the bracket base. This assures that with proper technique, the debond rate will be on par with direct-bonded cases. The tooth does not know the difference between 0.05 mm thickness of
composite vs. 0.5 mm; it simply reacts to the force applied at the bracket wire interface.
KLOwen offers a custom solution 7–7 (or even 8–8) at a $400 price point (for brackets, full lab service and software) with a two-week turnaround time from lab to office. Knowing the future is in-house digital workflow control, it is also the only digital custom bracket solution that allows practices to bring the printing of the IDB trays in-house and reduce the cost/case to $350. In-house turnaround to patients in less than a week.
The company has several providers who are already implementing in-house printing to realize results for their practices and patients. Same-day starts are possible with KLOwen. If you decide to bring the entire workflow in-office (training an in-house digital technician to do the setup), this custom digital solution can be completed in a few hours at a low price point.— Dr. Brandon Owen