Pacific Coast Society of Orthodontists Bulletin Winter 2019 - 41

Presentation Summary

Doctors

Making Orthodontics Fun Again
Dr. Alan Kai
PCSO Bulletin Contributor

Dr. Tom Pitts
OC Orthodontics

Presented by Dr. Tom Pitts at the PCSO Annual Session, Oct 3, 2019
In the past, we as orthodontists were taught to
treat patients toward occlusion, health, and stability. Now we know that "nothing is stable." Arches
collapse with or without extractions. For orthodontics to survive, there needs to be a change in
mentality about esthetics needs. The mission is to
prevent bad treatment by implementing esthetics
into each case. There were times when we compromised patients' esthetic potential, but it is time for
a fresh look at esthetics.
One area of concern is aging. As patients age,
their upper lips thin and lengthen, making a less
toned lip. Knowing this, we can treat patients
to postpone the aging process. Anticipating the
effects of the upper lip, we can keep and finish
the patient slightly protrusive.
A "nice" and "ordinary" smile is no longer going
to differentiate your smile from the rest; we need
to be able to achieve an "excellent" smile. How
do we do this? We can show patients and parents
before-and-after contrast photos before they start
treatment. We can use simulation tools to project
the potential soft-tissue changes after treatment.
Traditionally, orthodontists have bonded brackets
that are more incisal which flattened the smile
arc and intruded the upper smile line. Instead, we
should strive for excellent esthetic/finishing, accelerated treatment (simplicity), and control overhead (efficiency), ultimately saving our specialty. Essentially,
we should treat our cases including comprehensive
esthetic orthodontics to maximize each patient's
facial attributes. Before, we referred the patient to
their restorative dentist and periodontist to create an
esthetic smile, but we can save the patient money by
creating the smile through orthodontics.
People don't know what they want
until we show them what they want.
-Steve Jobs
Dr. Pitts talked about his smile design. It includes
full incisor display on full smile, 1 to 1.5 mm of
gingival tissue on females, a curve of the incisal

Winter 2019

PCSO Bulletin

edges and gingival margins consonant with the
lower lip, and we should strive for smile arch
protection (SAP). Depending on how much vertical
incisal display (VID) is desired, Dr. Pitts has three
concepts for maxillary bracket position: SAP/VID,
SAP/VID+, and SAP/VID++, in which the upper
central incisor position is at 6.5 mm, 7 mm, and 7.5
mm, respectively. This position will tip the occlusal
plane in a clockwise direction to create an esthetic
incisor display and position the inclination perpendicular to the basal bone. It is also important to
pay attention to the microesthetics to maintain
tooth proportionality by paying attention to the
width-to-height ratio (75%-80%), long connectors,
proper tooth shape, gingival contours, wide arch
shape, facial/smile esthetics, and consonant smile.
This results in a more youthful smile.
Techniques to address efficiency and save money
include having four working wires, fewer appointments, and faster treatment. Dr. Pitts's wire
sequence includes 0.014-in NiTi, then 0.018 ×
0.018-in Ultra-soft Thermal Activated NiTi. After
repositioning of brackets, go back into 18 × 18
Ultra-soft, followed by 20 × 20 TA NiTi. Then, on
the upper, go to a 20 × 20 SS and finish in a 20
× 20 Beta Ti. The lower should go to a 19 × 19 SS
and then finish in a 19 × 19 Beta Ti. Speeding up
treatment with fixed appliances can be done with
fewer wires with a wide arch form, case management, proper disarticulation, proper light elastics
from day 1 (2.5 oz) and repositioning early.
All the different corporations, aligner companies,
competition from general practitioners performing orthodontics, teledentistry, and the general
orthodontic saturation are making it difficult for
us as orthodontists. The key to our survival is to do
esthetic work and to outperform our competitors.
Give patients a total service with optimal treatment
plans, which includes taking all records, analyzing
the airway, taking into account the periodontium,
taking before-and-after pictures, creating a "wow"
smile, taking studio photographs after treatment,
tissue removal, creating beautiful composite buildups, and bleaching. Dr. Pitts concluded with a quote
by Denzel Washington: "Don't aspire to make a
living, aspire to make a difference."

Pacific Coast Society of Orthodontists Bulletin Winter 2019

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2019