Earned Placement: Advances in Orthodontics

Earned Placement: Advances in Orthodontics 

A conversation about digital and custom bracket bonding

Indirect bonding (IDB) is rapidly evolving in the orthodontics industry, with substantial advancements in digital and custom IDB options. Three companies in particular are playing significant roles and gaining traction within the market. We recently spoke with Steven Gardner, president of OrthoSelect, as well as Dr. Brandon Owen, president and founder of KLOwen Braces, and Colin Corey, CEO of Braces On Demand, to get the latest developments in the world of digital indirect bonding, aka “digital bonding.”

Steven Gardner
Steven Gardner
President, OrthoSelect

Tell us about yourself and OrthoSelect.
I’ve been working in the orthodontic industry for nearly 30 years, starting off as a lab technician. Since then, I’ve gone down the entrepreneur road and started three companies in the orthodontics space. More than a decade ago, it became obvious the industry was going digital, so I began transforming OrthoSelect into a fully digital player. While we still provide orthodontic lab services, we are primarily focused on orthodontic software with our flagship product, Dibs AI.
OrthoSelect DibsAI
What is Dibs AI and how has it evolved over time?
Dibs AI is a digital platform designed to provide extremely accurate bracket placement through artificial-intelligence-driven software. It has evolved to include a largely automated case setup process where orthodontists can approve their cases within 12 to 24 hours. We then 3D-print high-resolution IDB trays that hold each bracket in its ideal position for placement on the teeth.

How does a digital approach to bonding differ from a direct approach?
The two pros of a digital approach focus on accuracy and speed. Our software does a great job of identifying the ideal location for each bracket on each tooth, while the 3D-printed trays place the brackets typically within 0.1 mm of where the software places them virtually. This results in shorter bonding appointments and shorter overall treatment times.
The biggest con is that it can require orthodontists to change their bonding protocols. However, we’ve found that overcoming the initial learning curve is achieved by including staff in the training/learning process.

What is unique about Dibs AI?
Naturally I’m a bit biased, but I feel we have the best and most affordable digital IDB platform on the market. Additionally, our turnaround times for case setups and printing of trays are unmatched in the industry, with cases ready for doctor review and approval usually the same day they’re submitted.

What challenges have you faced along the way?
Developing software that makes things simple for the end user is not easy. We have been working on refining Dibs AI for several years to get it to where it is today. Fortunately, we have a great team of supportive doctors who provided guidance and feedback along the way to make improvements, fix inevitable software bugs and create a more user-friendly platform.

What does Dibs AI offer your partners and their customers?
Our software platform is incredibly flexible, so our partners and their doctors can use any STL scanner, any bracket prescription and even custom prescriptions for next-level bracket placement. This flexibility also makes it easy for our partners to integrate Dibs AI into their own systems. Additionally, we work closely with our partners to make sure the user experience flows seamlessly for their customers.

What do you see for the future of digital indirect bonding?
As with other areas of orthodontics, the bonding process is going digital. This shift frees up a doctor’s time to focus on other areas of patient care and to grow their practice. My passion is making “digital bonding,” as I like to call it, the standard of care in orthodontics, and it’s gratifying to play a role in what I believe to be a significant transition in the industry.

Dr. Brandon Owen
Dr. Brandon Owen
President and founder, KLOwen Braces

Tell us about yourself and KLOwen Braces
I’ve been an orthodontist since 2006, practicing in Colorado for about 15 years, and recently moving to Austin, Texas. KLOwen Braces has been in the works since 2012. We set out to make custom treatment with a quick turnaround that’s also affordable. From that goal, we developed Stride Custom Braces. For the same price as a premium self-ligating bracket, we can offer true custom braces for every patient, resulting in significantly elevated outcomes for practices.
What makes Stride Custom Braces unique?
Just like a shoe manufacturer, we have multiple shapes and sizes so every tooth gets the right bracket, and then we fill the slot to get the perfect fit. By making the braces ahead of time, we provide a custom fit at a fraction of the price. We also manufacture our own wires to complement our brackets to achieve better true-torque expression than any other system on the market. Further, we offer metal, clear and self-ligating clear brackets all with one digital platform.

Are there any disadvantages to custom braces?
The biggest disadvantage is for offices that want a same-day start, though I think that will soon be on the horizon. The other challenge is overcoming inertia for how doctors practice. However, the treatment time savings (average of seven fewer visits) and superior outcomes more than offset any challenges of changing their approach.

What feedback do you receive from your doctors?
Offices that consistently use Stride find their number of repositions and wire bends decrease by 50%–80%. They also find they have much more time on their hands to see more patients with less staff or fewer days in the office.

What is the workflow process?
It really mirrors aligner workflow. We’ve worked with OrthoSelect to set up the software to work with our custom solution, and our lab team is trained so that it requires almost no adjusting by the doctor. Once the doctor approves, we print the IDB trays and load with the appropriate custom brackets. Doctors can then usually delegate the bonding appointments to staff.

What role does Dibs AI software play in your process and what has been your experience with that platform?
It is really the critical element for us. The AI dramatically reduces the amount of time required to modify each case. It allows us to give doctors an experience where they realize the benefits without giving up their nights and weekends sitting in front of a computer.

What does the future hold for digital custom braces?
Digital custom appliances will totally displace the standard approach. It creates a better doctor, staff and patient experience. Less time in braces, less time in the chair. The doctor will no longer be the bottleneck. A recent whitepaper indicates that doctors are seeing fewer wire bends, fewer repos and fewer loose brackets, thus are getting better patient outcomes with our custom digital bonding.

Colin Corey
Colin Corey
CEO, Braces On Demand

Tell us about yourself and Blueprint.
I am a nerdy engineer at heart. As the founder of Braces On Demand, I have been eating, sleeping and breathing orthodontic device design for the past decade. We designed Blueprint as a fully custom, digital bonding bracket system using patient-specific 3D-printed brackets. We created a new, parametrically driven bracket that satisfies millions of prescriptions. With this new technology, we developed a way to make the perfect bracket for each tooth.
Braces On Demand
What makes Blueprint unique?
We start by creating our brackets from the base up, where the bonding surface is perfectly contoured to the tooth morphology based on the digital bonding location for that bracket. From there, the Dibs AI algorithms calculate the exact prescription needed, based on the selected finishing wire. We then run the Blueprint software to create the perfect bracket for each tooth for the full arch (7–7). The brackets are then 3D-printed in aesthetic, biocompatible resin for outstanding clarity and toughness.

What advantages do you see for orthodontists and their patients with 3D-printed brackets? Any challenges?
The biggest advantage for an orthodontist using Blueprint is the efficiency gained with this digital workflow. Orthodontists love that they can make fewer repositions and fewer detailing bends. The custom-contoured base, combined with our unique lightning bolt undercuts, provides superior retention over stock brackets. For patients, the comfort and aesthetics of the brackets are standouts. Our biggest challenge is our brackets are so clear, they are hard to position perfectly without a digital bonding system like Dibs AI.

What is the process for your customers to use your custom solution?
There are no set-up fees or contracts. Simply scan, submit, review and approve, and it gets delivered.  We provide 24-hour case setup turnaround, and the beauty of completely custom brackets is that the cases are ready to approve without multiple iterations. Once approved, orthodontists can expect their digital bonding trays with preloaded brackets to arrive within seven days.

How does Dibs AI fit together with your system and what has been your experience using their platform?
Braces On Demand could not have found a better partner than Ortho- Select and Dibs AI. They are the leading manufacturer of digital indirect bonding trays, with more than 30,000 cases produced to date. The software is extremely powerful in both ease of case setup and calculations for idealized prescriptions. In addition, their technical specialists are incredibly well trained, they have excellent customer support, and their turnaround times are best in class. Most importantly, their trays fit perfectly over the teeth and hug the brackets just right.

What does the future hold for your 3D-printed, custom approach?
I think we are just scratching the surface of what can be done with a 3D-printed custom system. I think as much as the previous 10 years have seen innovations in this space, the next 10 will dwarf them considerably.

To learn more about Dibs AI, visit dibsai.com.
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