Pacific Coast Society of Orthodontists Bulletin Winter 2021 - 59

Practice Management

Practice Management Diary

How Good Are You? Reflections From
My SureSmile Training
Note: Please be aware that the PCSO Bulletin does
not endorse or promote any specific brands.

Dr. Jeffrey Nichelini
American Canyon, CA
PCSO Bulletin Section Editor

As a young orthodontist, I have been guilty of
thinking I am pretty good at my job . . . for my age.
Every year, I reflect on the quality of care I provide
and recognize it is better than it was, but there
is still room for improvement. As my partner
and I push forward on our path of professional
growth, we recently decided to become SureSmile providers. Now that the extensive training
process is complete, I can report that SureSmile is
an excellent tool for self-evaluation, although it is
too early to comment on results from the product
itself.
The SureSmile process starts with their technicians integrating a full series of a patient's records into a digital therapeutic model. A projected
final occlusion can be planned from this model
based on your bracket placement and ultimately,
custom archwires are developed to achieve that
final result. The process requires you to fully
evaluate every detail of your cases and prescribe
the movements necessary to get them to the outcome you want. As a result of the extensive case
evaluation process, this is what I have learned
about the treatment I provide:

▫▫ Bracket placement: Mine is not as good as

I thought. The smile arcs of my cases are
too flat because my maxillary incisor brackets should be placed more gingival and my
mandibular incisor brackets should be placed

Winter 2021 PCSO Bulletin

▫▫

more incisal. The simulated cases have been
consistently adding more distal crown tip to
maxillary canines, which is a reflection of my
tendency to bond my brackets with excessive distal root tip. Conversely, I discovered a
tendency to bond mandibular second molar
brackets with excessive mesial root tip.
Marginal ridge discrepancies and angulation
errors: The software is far more sensitive than
my vision, and the leveling and aligning of my
cases can be improved to a level beyond what
I previously thought was ideal.
Incisor flaring: Having a need to critically
evaluate midtreatment lateral cephalograms,
I have discovered that I was consistently proclining incisors more than I realized.
Occlusal interferences improved with
transverse movements: I have trained myself
to focus on first-order details and have not
appreciated the degree to which second-order
detail bends have been indicated to improve
intercuspation. This is an improvement that
will hopefully lead to better socked-in cases
and less equilibration.

These admissions are hard to disclose publicly, but by sharing them, I hope to convey that
self-reflection is an important part of professional
growth. Seeing our own shortcomings is not
easy, and even if you do not believe you possess
any, it may be productive to open yourself up to
independent criticism. You may find room for
improvement that you did not know existed.

Pacific Coast Society of Orthodontists Bulletin Winter 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2021