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The Future is Here by Dr. David Richter

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Categories: Orthodontics;
The Future is Here 

Custom braces, virtual monitoring and an outline of an archwire sequence to maximize control and efficiency

by Dr. David Richter

In my 30 years of clinical orthodontic practice, I’ve seen many technologies come and go—some useful, most falling short, much of it reimagined concepts from the 1970s. Today, however, the analog era is behind us, and digital orthodontics is here to stay. In this article, I’ll share how I’ve leveraged digital tools to achieve better finishes consistently, reduce treatment times and significantly lower labor costs, directly improving practice profitability.

I used self-ligating brackets for most of my career and appreciated their early treatment efficiency. However, finishing with a .022 slot and a .019x.025 TMA wire remained a challenge. I avoided thoroughly filling the slot because of concerns about pushing roots into cortical bone, but that came at the cost of limited first- and third-order control. I often improvised multiple bracket repos, detailing, vertical elastics and round wires in the lower arch to regain occlusion, sacrificing rotational control and falling short of ideal finishes.

Custom self-ligating braces, powered by digital technology and a custom prescription, completely change the game. Unlike aligners, the digital setup you design is nearly identical to the final treatment outcome—no need for overcorrections in the transverse, deep bites or other areas. What you see is truly what you get.

Why? Because the custom wire nearly fills the slot, leaving only three or four degrees of play. In contrast, conventional systems can have up to 20 degrees of slop, as much as 40 degrees when factoring in adjacent teeth. And concerns about pushing teeth out of bone? With digital setups, you can visualize exact root positions, and with the KLOwen Software I use, CBCT integration makes that even more precise. Problem solved.

Over the past five years, I’ve started 1,300 cases using the KLOwen custom bracket system. Practices utilizing this system have observed up to a 41% reduction in treatment time and saved an average of seven or more appointments compared to conventional methods.

I use virtual monitoring selectively, focusing on cases where compliance directly impacts outcomes, such as elastic wear, space closure and oral hygiene. While some practices apply it more often, I’ve found it most valuable when patient adherence is essential.

Below, I’ve outlined my archwire sequence and appointment schedule—the treatment plan comes to life with control and efficiency.


Archwire sequence Class I/II/III mild crowding:
  • Initial bonding: U/L .016 NiTi (Tandem .012 NiTi), Grin, light Class II/II elastics
  • U/L 14x25
  • 19x25 TMA
  • Detail
  • Detail
  • Debond
  • Six total appointments

Archwire sequence extractions:
  • Initial bonding: U/L .016 NiTi (Tandem .012 NiTi), Grin, light Class II/II elastics
  • U/L 14x25
  • 17x25 SS with 10 degrees of buccal crown torque, 3-3, cotie 3-3, Class I NiTi springs for space closure
  • 19x25 TMA
  • Detail
  • Detail
  • Debond
  • Seven total appointments
As you can see from these cases, the goal is to reduce treatment to just six or seven appointments. Trusting the system is one of the most essential principles, especially with self-ligation. If you’re like me, you’re used to intervening every six weeks. However, with custom self-ligating systems, the wires are designed to work over time. Let them sit for 12 weeks before making a change.

Now consider the impact: If you’re used to seeing patients every six weeks, shifting to 12-week intervals drastically changes your schedule. We went from 80 patients a day, booked six to eight weeks out, to 40 patients a day, booked just two weeks out—still seeing patients four days a week. That could easily shift to three days.

The result? A potential 50 percent reduction in patient visits and a 50 percent reduction in clinical labor. That’s not just time saved—it’s a significant increase in profitability and EBITDA. You just gave yourself a considerable raise.


Pearls
Start light elastics early and set clear expectations from the very first exam. Emphasize to the patient and parents that successful treatment depends on their compliance—it’s a critical part of the plan. This proactive approach helps avoid the need for Class II or Class III springs, which are costly, prone to breakage and can disrupt your schedule.


Extraction space closure
I prefer NiTi springs for closing extraction spaces and typically don’t bring patients back until the space is closed unless a wire needs clipping. During space closure, I continuously tie in 3-3 and cut the wires distal to the sixes, not the sevens, to minimize emergency visits. Class I elastics can also be effective, but NiTi springs remove the compliance variable. They’re far more reliable and less prone to breakage than inter-arch springs.


Virtual monitoring and aligners
I use Grin for its simplicity and ease of integration. For aligner patients, I have them submit weekly videos before switching to their next tray. At this stage, we’re solely monitoring tracking. Patients receive the complete set of aligners up front, and based on their weekly videos, we advise whether to proceed or pause. If tracking issues arise, they use chewies and wait until tracking improves before advancing. This allows us to monitor care weekly without in-office visits—patients finish treatment with fewer appointments and the practice runs more efficiently. It’s a true win-win.

Maintain consistent wire progression in both the upper and lower arches throughout treatment. Avoid jumping into a .019x.025 TMA in the upper arch while working with a .016 in the lower, for example. Keeping wire stages aligned improves efficiency and makes appointments more streamlined.

Over the years, I’ve seen countless technologies make big promises but fall short. I consider myself fortunate to have stayed open-minded enough not to miss out when truly impactful innovations came along.

Custom braces and virtual monitoring are among the few that have delivered tangible, measurable value. At around $500 per case—about half the cost of some alternatives—these tools allow us to achieve significantly better finishes, reduce treatment times and cut down on in-office visits. It’s a win-win for both patients and practices.


Conclusion
Like anything worth doing, success requires commitment. If you’re going to adopt this technology, don’t dabble. Start with at least 10 cases a month to truly see the benefits. Anything less, and you may not realize its full potential. I hope I’ve earned your trust and given you the confidence to explore this approach. The future is here—and it can elevate both patient care and practice performance. I encourage you to be part of it.
Author Bio
Dr. David Richter Dr. David Richter is in private practice in Greeley, Colorado, and has been named a Top Dentist by 5280 magazine every year since 2014. Richter is a scientific advisor for KLOwen and a member of the American Association of Orthodontists, the Rocky Mountain Society of Orthodontists, the Spear Study Club, the Mountain West Dental Forum and the Seattle Study Club. He also holds a patent for a visual articulator, which allows dentists to navigate 3D data to help correct jaw movement, and has a patent pending for an advanced retainer design.



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