Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 39
Let's Talk About That
My initial sequence will be 10 to 15 trays to
establish movements paralleling the initial 20 to
30 weeks of fixed appliance therapy. I level and
align the arches, relieve crowding, and plan for
mechanics to achieve class I buccal segments. I
monitor tooth movement and perform interproximal
reduction (IPR) where and when indicated just
as with fixed appliances. I place buttons or bonded
loops for elastic wear as needed. I use attachments
on approximately 25% of my cases and direct
bond and shape my attachments chairside. I have
them scanned with the new attachments in place
and cut windows in the previous trays. I anticipate
when to start elastics, place attachments, perform
IPR, and see those patients as they are inserting
their last tray in a given sequence. They wear this
tray one to two weeks and then either pick up the
next sequence or have it mailed to them. I will use
different thickness trays and trim trays or block out
models selectively to optimize force expression. I
have Orchestrate 3D software at every chair in my
office and can review clinically as needed.
Finishing sequences are designed chairside with
patients involved in the final objectives discussing
function, health, stability, and esthetics. Interproximal
contacts are checked with floss and the final
sequence designed, fabricated, and delivered.
Two sets of passive retainers are delivered upon
completion (one is saved as a backup and inserted
if initial retainers are lost or broken). During active
IHA therapy, patients are seen at 10-week intervals
and photos are taken at each visit to provide close
monitoring of treatment progress and patient
communication. Having 2500 cases with photos
taken every 10 weeks has provided an education on
efficacy and efficiency that I cherish.
PT: What situations might lend themselves to being
able to deliver same-day active aligners?
MN: There are multiple scenarios that lend themselves
to same-day delivery of in-house aligners, including:
◾ Patients studying or working across the United
States and internationally who are in town for
brief time periods. We assess their progress
via text, email, FaceTime, or Dental Monitoring
Units while away. As needed, we place attachments,
bond buttons for elastics, and scan/
print/fabricate/deliver their next trays the same
day while they are in town.
◾ Patients who lose or break trays can have new
trays fabricated and delivered the same day.
◾ Patients receiving multidisciplinary care can see
us the same day as extractions, implant placement
or restoration, anterior esthetic dental
procedures, or full-mouth rehabilitation to have
new aligners or retainers delivered.
◾ Patients with upcoming special events such as
weddings, graduations, and so on can have a
same-day start as is commonly done with fixed
appliances.
PT: How would the process go; what steps would
occur to get you from the intraoral scan to the delivery
of the appliance?
MN: We use our in-house lab to fabricate both passive
and active appliances, with the steps outlined
below:
Passive appliances for retention or night guard:
1. Intra-oral scan taken and exported to EasyRx
(three minutes)
2. Scan processed for 3D print (five minutes)
3. 3D-printed model (25 minutes)
4. Postprocessing of model (20 minutes)
5. Fabricate and deliver appliance (15 minutes)
While the total time to fabricate and deliver a
passive retainer might be greater than an excellent
registered dental assistant (RDA) taking an alginate
impression, pouring plaster, and fabricating/delivering
a tray, there is actually the same or less staff
time involved. During the 3D printing and postprocessing,
the assistant is not involved. Once there is
a dedicated 3D lab in house, the passive appliance
is incorporated seamlessly into the normal flow
without a need for the RDA except for the scan and
delivery of appliance.
Spring 2023 PCSO Bulletin
39
Pacific Coast Society of Orthodontists Bulletin Spring 2023
Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2023
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 1
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 2
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 3
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 4
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 5
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 6
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 7
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 8
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 9
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 10
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 11
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 12
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 13
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 14
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 15
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 16
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 17
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 18
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 19
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 20
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 21
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 22
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 23
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 24
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 25
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 26
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 27
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 28
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 29
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 30
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 31
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 32
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 33
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 34
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 35
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 36
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 37
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 38
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 39
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 40
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 41
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 42
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 43
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 44
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 45
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 46
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 47
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 48
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 49
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 50
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 51
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 52
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 53
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 54
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 55
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 56
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 57
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 58
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 59
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 60
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 61
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 62
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 63
Pacific Coast Society of Orthodontists Bulletin Spring 2023 - 64
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