Earned Placement: The Quest for Orthodontic Excellence by Dr. C. Colby Gage

Who doesn’t want to be Indiana Jones?

by Dr. C. Colby Gage

• Seek the optimal blend of effective and efficient treatment. Intentional daily actions lead to extraordinary experiences and results for our patients.
• Leverage time with technology. We need to be able to accomplish more in the same amount of time while avoiding decision fatigue and increasing our ability to plan treatment.
• Consistent training and systems for my team to perform at their best. High turnover in orthodontic o­ffices is likely here to stay, so we need better training and tools to decrease the learning curve to teaching and maintaining excellence.
• Create life-changing smiles by striving for superb patient results. Our profession and practices thrive on the energy created by these beautiful results.

Fig. 1: The Damon Ultima System is available with neutral, retrocline and procline bracket options for enhanced torque control. Brackets are designed from the center point of the slot to line up with the FA point to express the desired torque and provide easier and more precise placement.

• Fast and familiar. Traditional IDB trays require multiple steps, from model fabrication, application of a separating medium, placement of the brackets by the clinician, and processing and fabrication of the trays. Digital systems for IDB tray fabrication have a distinct advantage in this area, because the fabrication time can be outsourced or reduced with software. ODB specifically uses the same Spark Approver Software and platform we use for our aligner cases, which is intuitive and easy for my team to visualize and fast for me to program and approve (Fig. 2).
• Highly accurate. STL fi les taken after bonding and overlaid with the software-generated bracket positions show high fidelity and proof of concept for this model of delivery (Fig. 3).
• Less flash. An IDB transfer tray must transfer the bracket precisely from the model to the patient’s mouth. Unfortunately, this usually means that the corners of the bracket base are usually not accessible until after curing, which can lead to excessive flash. Ormco’s custom bonding jigs technology is designed so that the “cap” wraps the tooth buccally and lingually and leaves the gingival mesial and distal surfaces of the pad accessible to clean up with an explorer and microbrush (Fig. 4).
• Doctor time flexibility. In many jurisdictions, indirect bonding can be delegated to a dental assistant or hygienist, freeing up significant chair time for the doctor and creating a large doctor time window, allowing the office to flow smoothly through longer appointments.

Fig. 2: Digital treatment planning and digital bracket placement interface with Spark Approver Software provides one platform for Ormco Digital Bonding (ODB) cases and Spark Clear Aligner cases.

Fig. 3: Precise placement of the brackets is predictable with the ODB system. These STL overlay images show the fidelity between bracket placement in the software and actual placement intraorally. Figure courtesy of Dr. Mike Mayhew and Ormco.

Fig. 4: The initial bonding jig is sectioned into sextants and designed to fit buccally and lingually over the tooth, making it stable when seating the jigs intraorally. The gingival, mesial and distal surfaces of the bracket pad are accessible during placement.

• Freedom to change torques. ODB gives me the flexibility and information needed to individualize my treatment for my patients. The Approver Software will detect movement changes in tooth position between T1 and T2 and automatically select the torque that encourages these movements. If I want to change torques midtreatment, the center-slot lineup of the bracket allows me to use the same single-tooth anterior jig with a different bracket, so I don’t need to step down the wire.
• Create an accurate plan for IPR. Because the 0.014-by- 0.0275-inch CuNiTi Ultima wire is slot-filling in the horizontal dimension with the Damon Ultima System, IPR and anterior space closure 3–3 can be undertaken at this step in treatment and maintain horizontal control. We reach this stage in treatment by four to six months after bonding and pull up the ODB case Spark Approver Software chairside when the patient is ready for this important step.
• Visualize black triangles. The advantage of planning IPR on the Approver Software is the real-time visualization of the effects on the dentition. IPR can positively affect the alignment with a straight wire, especially in instances of occlusal wear. Black triangles are often hard to detect chairside in patients with plaque-induced gingival hypertrophy. Now, I can plan and discuss these stages of treatment ahead of time with my team and the patient (Fig. 5).

Figs. 5a-5e: Images of a patient treated with Damon Ultima and ODB. Fig. 5a: bonding day; Fig. 5b: twomonth images; Fig. 5c: five-month images; Fig. 5d: seven-month images; Fig. 5e: Final (11-month) images.

Disclaimers
1. The regulations regarding delegation of tasks vary by jurisdiction. Follow your local regulations when delegating tasks.
2. The opinions expressed are those of Dr. C. Colby Gage, who is a paid consultant to Ormco. Ormco is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment in treating their patients. Individual patient results may vary.

Dr. C. Colby Gage is a board-certified orthodontist who received his dental degree from Western University of Health Sciences and his orthodontic certificate from A.T. Still University. Gage serves as orthodontic faculty at his dental school alma mater, sits on several clinical advisory boards, lectures on digital orthodontic systems and practice management topics, and is a former Spear Study Club Leader. He is also an Ormco Insider and a paid consultant for Ormco.