Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 38

Clinical Practice
Let's Talk About That
Same-Day Active Aligners
Dr. Matt Nisco
Fountain Valley, CA
Dr. Nisco is a Diplomate of the American Board of
Orthodontics, a member of the Cleft and Craniofacial
Team at Children's Hospital of Orange County and
Kaiser, and belongs to the American Dental Association,
California Dental Association, and American
Association of Orthodontists. Dr. Nisco has maintained
a part-time faculty appointment at the UCLA
School of Dentistry since 1986, where he teaches
biomechanics to residents and dental students.
Dr. Patrick K. Turley
Manhattan Beach, CA
PCSO Bulletin Editor-in-Chief
Patrick Turley (PT): How did you get started, and
how long have you been using in-house aligners?
Matt Nisco (MN): My initial exposure to in-house
aligners (IHA) was in 1987 with Dr. Mike Rains, who
had preceded me as a UCONN ortho resident with
Drs. Burstone and Nanda and in teaching biomechanics
in the Orthodontic Department at UCLA with Drs.
Chaconas and Turley. Dr. Rains was performing analog
IHA therapy inspired by Dr. Lloyd Truax and had
presented his work internationally. It was incredibly
labor intensive but successful. He called his system
the STAR Appliance (Serial Trutain Appliances Rains
Prescription). Lacking computer software, he relied on
his orthodontic training, experience, and clinical judgment
to produce batch sequences of trays to move
teeth with plastic, duplicating how he'd performed
tooth movement with wires and brackets.
In 2010, I collaborated with Dr. Todd Ehrler who
was developing an IHA system that evolved into
Orchestrate 3D. Todd had been caught in the battle
between Align and OrthoClear and suddenly had
lost support for his ongoing aligner patients. Todd
researched available computer-aided design/
PT: As a former resident of both Charlie Burstone
and Ravi Nanda, did your training and experience
with biomechanics help you master the use of clear
aligners?
MN: When I trained at UCONN, Dr. Charles Burstone
was chairman and Dr. Ravi Nanda was clinic director.
Dr. John Morton (current vice-president, technology
fellow at Align) worked in Burstone's lab,
and Dr. Rohit Sachdeva (developer of SureSmile)
was on faculty. I was blessed to have established
strong professional and personal relations with
each of them. Over the past 12 years, I have had
conversations with each of them that have impacted
the utilization of aligners in my practice.
Dr. John Morton is still spearheading the evolution
of Invisalign biomechanics, and Dr. Ravi Nanda is
exploring applications for direct-print aligners while
lecturing internationally on biomechanics applied
to fixed and aligner therapy. I maintain communications
with both. We are all still incredibly grateful to
Dr. Burstone for his contributions to us personally as
well as the world of orthodontics.
My IHA mechanics are different than the typical
corporate system, where an ideal result is produced
digitally, and the total number of trays required are
estimated and then fabricated. I perform sequential
movements staging each sequence in a manner
that parallels fixed appliances. I treatment plan each
case individually and create a mechanics plan for
each case that produces consistent-forces systems
to optimize the efficiency of tooth movement for
each stage.
Dr. Nisco has practiced orthodontics in Fountain
Valley, California since 1986 and in Lake Arrowhead
since 1988. He was born in Massachusetts
and moved to Fountain Valley in 1971. Dr. Nisco
graduated from the University of California, Irvine
with a degree in biology, received his doctorate of
dental surgery from the University of California, Los
Angeles (UCLA) School of Dentistry, and underwent
his orthodontic specialty training at the University
of Connecticut (UCONN).
computer-aided manufacturing technology,
scanners, and 3D printers and began producing
probably the very first digital IHAs. I met again
with Dr. Rains who was still using analog IHA in his
practice and replicated his system digitally. Over the
past 12 years, I have treated a handful of Invisalign
cases with nice results but have treated 2500 IHA
cases. These include relapse-minor alignment cases,
hybrid fixed-aligner cases, and extend to comprehensive
IHA cases with extractions.
38
PCSO Bulletin Spring 2023
Pacific Coast Society of Orthodontists Bulletin Spring 2023

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2023
