For Orthodontics, the Times They Are a-Changin’
I've seen many changes over the years in the world of orthodontics. When I began my journey in dental school, we had very limited exposure to tooth movement. My biggest concern was whether the Hawley retainer was polished enough to pass the ortho clinical requirements! This lack of training would become apparent in private practice, where many of us considered the referral pad our most valuable orthodontic treatment option.
"Our approach has been to offer our patients the very best care and value for their dental treatment."
I learned early in my career that I wanted to be a technology disrupter and be proficient in all disciplines of dentistry. That included tooth movement and, by a quirk of fate, I was fortunate to add a satellite dental practice to my primary practice that presented with more than 100 unfinished ortho cases. Realizing my need for education, I took the United States Dental Institute’s orthodontic education program. Soon, with the help of many mentors, I developed an orthodontics-only GP practice.
My primary movement tools were fixed bands and brackets, but I also explored different aspects of tooth movement, including the use of acrylic, functional, and thermoplastic appliances. I discovered many interesting and novel ways to move teeth successfully. Notably, clear thermoplastic aligners made in-house looked like an attractive alternative to bands and brackets.
The Changing Marketplace
In 1999, when Align Technology introduced Invisalign, I was the first GP in my area to submit cases, and I soon became one of the first to offer Align’s certification training. The company introduced segmentation software, which creates individual dies of teeth. Based on physics, orthodontic principles, and empirical evidence, tooth movement can be applied and visualized on a computer. Stages are created for the movement, and a virtual model representing the surface morphology of the final tooth positions for each stage can be sent as an STL file to 3D printing software. A 3D-printed plastic model can then be created to serve as the matrix for a thermoplastic appliance or clear aligner.
Today, the marketplace for tooth movement offers many options both for patients and dentists. Do-it-yourself (DIY) systems allow a patient to be treated without a face-to-face consult with the treating doctor. On the other hand, with the advent of easy-to-use, affordable segmentation software, GPs can compete directly with these low-cost DIY services. Technologies such as 3D printers are now in many practices and can be used to create in-house clear aligners. Lower lab costs give dentists the competitive edge to offer profitable, lower-cost treatment options to patients, who may feel more comfortable knowing that their regular dentist is supervising the treatment.
A Profitable Workflow
Our approach has been to offer our patients the very best care and value for their dental treatment. Our workflow is: 1) patient clinical exam and records, 2) intraoral digital scan, 3) segmentation software, 4) 3D-printed models, 5) vacuum-formed aligner using thermoplastic material, and 6) finish and polish.
With in-house segmentation software available to create virtual tooth movement—and a 3D printer to provide physical plastic models on which vacuum-formed thermoplastic aligners can be easily made—this workflow can be a profitable approach to tooth movement. Today’s GP can deliver in-house clear thermoplastic aligners that provide the very highest level of care to their patients.
Perry E. Jones, DDS, MAGD, IADFE
Perry E. Jones, DDS, MAGD, IADFE is a graduate of Virginia Commonwealth University School of Dentistry, where he serves as an Adjunct Faculty Associate Professor. He is co founder of the American Academy of Clear Aligners (AACA) and Founder/President of Mobile Imaging Solutions, an onsite CBCT imaging service. He maintains a general practice in Richmond, VA.
