Do you appreciate how much orthodontics has evolved over the past 50 years? You should! Are you aware of the latest trend of self-manufacturing your brackets and aligners in your own office? Maybe this pearl can help you put the pros and cons of the changing face of orthodontics into prospective.
Over the 50 years that I’ve been organizing orthodontic practices there has been many changes, some pros and some cons; nothing comes without a price tag. In Part-I of this three-part series we will discuss the pros and cons of the changing face of orthodontic appliances. In Part-II we will discuss the cons of the changing face of your competition. In Part-III we will discuss the pros and cons of the changing face of your TC procedures.
First there were pinch-fabricated bands and simple brackets that you weld to them, then came preformed bands, some with brackets attached, and finally just cemented brackets—both metal, plastic and ceramic. Then brackets were offered that had specific characteristics to better align teeth – it seemed that brackets were attaining perfection.
At first heavy stainless steel archwires were used. Then came the “Bio-Progressive” technique using lighter forces with lighter, fabricated wires that Dr. Carl Gugino promoted worldwide. This light-wire technique lead to using “Twist-Flex” wire and eventually to heat-activated specialty archwires that applied these lighter forces over months instead of weeks. And of course there were many auxiliary appliances invented that improved treatment results.
A major change came with plastic aligners that at first needed brackets to finish the cases, but eventually worked on their own for those who learned to use them well. But much of this came with a dollar, Tx quality and practice growth/decline price tag. This will be covered in detail in Part-II of this series.
The Pros & Cons of Archwires:
The con of heavy stainless steel archwires was that they slowed tooth movement and required many appointments. The pros of heat-activated archwires are that they provide lighter force, required fewer archwire changes and allow for much more time between appointments, saving much chairtime. The cons are that they are expensive and that they lure orthodontists into thinking that they can go 12 weeks or more between appointments, causing problems with lost Tx time do to undiagnosed problems requiring increased chairtime and many more months of chairtime to correct. It seems that the most realistic timeframe is: 8-10 weeks between appointments for unraveling, 6-8 weeks between appointments for most tooth movements, and 4-5 weeks between appointments for final detailing/finishing the case.
The Pros & Cons of Bands and Brackets:
A pro of switching from bands to brackets was the savings in chair time and the decrease in unattractiveness, especially with clear ceramic or plastic brackets. The con was that it increased the bracket cost many fold. But the pro was the savings in chairtime that recouped the extra bracket cost. Another pro was that these new brackets could be specially created to make treatment faster and more precise.
The newest face of orthodontic brackets:
Recently, a company called “Braces on Demand” allows you to order customized individual plastic brackets that can be 3-D printed and mail to you or a file emailed to you to print on your own in-house 3-D printer. The pros and cons of this new technique are still to be determined as to their structural integrity, adaptability, bonding adherence, etc. This company gives you the ability to design your own individual brackets for each tooth and 3-D print them in your own office (or they can print them for you and mail them to you). Of course, there are companies that allow you to design of your own indirect bracket bonding systems (using specific bracket systems), but you need to be comfortable using bracket trays to bond them to the teeth, something many doctors find too difficult to do. See the management pearl “Is Indirect Bonding for You?” for a better explanation of indirect bracket bonding. Also see the management pearl “Do-It-Yourself Plastic Aligners” indicating the cost of setting up a system for printing your own appliances.
Braces on Demand says that it provides ability to 3D print devices in-office is a novel workflow for the orthodontic field, allowing doctors to customize braces for their patients and print them on-demand, enabling a more convenient and personalized patient experience. The Braces On Demand web application allows orthodontists to use Formlabs’ Denture Teeth Resin to 3D print brackets, molar tubes, and a host of other orthodontic appliances. This specialized material is strong, stable, and available in multiple shades to enable custom tooth tone aesthetics. The web application allows doctors to reduce inventory and provide incredible customization to their patients with over 8 million prescription options. If interested in this service go to: bracesondemand.com
I hope that you will benefit from this discussion.
Part-II of this series will deal with how aligners have changed the face of orthodontics.
