Orthotown May 2019 - 36

for the first several years of my practice.
This process eliminated the flash cleanup
problem because the flash is more easily
controlled one bracket at a time. However,
it's often difficult to maintain a dry field
for the duration of placing and positioning
brackets. The banding appointment also
required more of my time and more of the
patient's time in lip stretchers.
With both of these systems, however,
the rest of the orthodontic process was very

similar because the brackets were placed
relative to the incisal edge of the teeth
instead of in relation to a final treatment
goal. Adjustments to correct an occlusal
cant, a gingival margin discrepancy or a
premature occlusal contact were made along
the way by either repositioning the bracket
or bending the archwire.
With the advent of 3D manipulating
software, such as Orchestrate 3D, these
problems can be avoided.

A digital setup
for a rapid finish

Fig. 4

Fig. 5

Fig. 6

36

MAY 2019 // orthotown.com

Now that you have a shopping list
and some background, let me walk you
through the steps. I begin by positioning
the central incisors relative to the face and
smile in the software (Fig. 1, p. 35). This is
what the patient will focus on and it allows
me to have a landmark for the setup. I use
the photos to determine the ideal position
and the CBCT to ensure that the ideal
placement is biologically feasible, then I
correct the malocclusion in the software
(Figs. 2 and 3, p. 35). I can align marginal
ridges regardless of incisal wear and place
the opposing cusps in the fossa. I make sure
that my canines are symmetrically rotated
and torqued. I do the same for my laterals
and centrals-deciding whether to align the
incisal edges or gingival zenith. I determine
how much overbite and overjet are ideal for
each tooth. On a patient with a Bolton's
discrepancy I can measure the amount of
space I will leave for buildups or the amount
of interproximal reduction required. This
takes 3-5 minutes on the computer.
Once I am satisfied with the final occlusion, I can communicate this treatment goal
to the patient and the patient's dentist. Then,
I place the brackets, one of the keys to the
accuracy. You don't place brackets until after
the teeth are in the correct positions. At this
point, you could decide which measurement,



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Orthotown May 2019

Table of Contents for the Digital Edition of Orthotown May 2019

Orthotown May 2019 - Cover1
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