Orthotown March 2023 - 43

What are some other clear
aligner tips you wish you had
known or done sooner?
If I had to do it over again, I would
have embraced Phase I earlier.
I had dabbled in Phase I Invisalign
using the former Invisalign Teen product
for about 15 years with success,
but never had that " aha! " moment.
Deciding to switch my practice to all
digital would require a new way of
thinking, including designing a new
talk track for parents and retraining
our team to work with these young,
growing smiles.
All of this would require a new
mindset, which is exactly what we did.
I can emphatically say that treating
Phase I patients with Invisalign First
has been one of the most rewarding
and clinically sound decisions I have
made in my 23-year career. These
young kids are phenomenal at wearing
their aligners, which helps us remove
the traditional wire-and-bracket
issues of breakage, white spot lesions,
dietary restrictions, root shortening
and endless appointments.
Sixty percent of our Invisalign
First patients start with an upper
RPE and 20 lower aligners. We are
able to align the lower arch (expand,
align all teeth and create leeway
space around C's) while the upper
expander is executed.
The ClinCheck treatment plan
gives us a transverse analysis of how
much expansion will be needed for
the 6s and primary teeth. This is a
detailed quantitative table every doctor
has access to, to achieve precise
expansion. Once the upper RPE is
completed, a new scan of the arches
is done to create new upper/lower
aligners for the finish and detailed
stage of Phase I.
Our Phase I cases are treated
We see about 45 patients a day on
comprehensively with all three plans
of space (transverse, sagittal and
vertical) addressed. Midlines, overbite,
overjet, Class I occlusion and smile arc
are all completed to ideal standards.
This makes Phase II Invisalign down
the road more straightforward.
What types of cases
excite you the most?
Probably the most exciting clinical
cases I've been working on for the past
three years are my segmental virtual
Class II and virtual Class III cases.
This technique sets up the " sagittalfirst "
concept of moving the posterior
teeth into a Class I occlusion by segmenting
the aligners and using heavy
(8-ounce) elastics.
[Editor's note: Dr. Boschken's presentation
of one such virtual Class III case
was published in the July/August 2022
issue of Orthotown. Find a link to the
case inside the digital version of this
article at orthotown.com/magazine.]
This technique has revolutionized
my practice by finishing complex
Class II and III skeletal/dental cases in
half the customary time (often in less
than 10 months of treatment).
Patients who have heard that
surgery and/or extraction are the
only viable options can be effectively
treated using this technique.
Of course, a detailed cephalometric,
airway and smile analysis is critical to
exploring all clinical options.
Give us a rundown of your
typical day in practice.
I typically get into the office 30 minutes
before patients arrive. I like to help open
the office, which allows me to ease into
the morning. I review pending treatment
plans submitted the day before.
MARCH 2023 | 43 | ORTHOTOWN.COM
average, which includes five to eight
scheduled consultations. Most consultations
are in-office, but we still run a
virtual consult when requested, leveraging
SmileSnap and, more recently,
Align's Connect feature, which enables
prospective patients to send in photos.
My time is generally not in the
clinic, because my assistants are
delivering aligners, reviewing, checking
virtual care utilization (remote
monitoring), adding attachments,
and, when braces are required, placing
LightForce Orthodontics 3D brackets
with indirect bonding (IDB) jigs.
Our model requires our assistants
to have a comprehensive understanding
of Invisalign and LightForce
techniques to ensure our customer
experience and clinical outcomes are
executed to plan.
Let's talk team building.
What qualities make a great team?
How do you manage yours?
While I would love to claim our culture
is the result of something I have
said or implemented, I have to give
Nicole the lead on this.
Before coming on board with me
12 years ago, Nicole was the regional
manager at ADP, a payroll company,
for 15 years. Her corporate training in
marketing and sales and her innate
understanding of how people want
to be treated have been the backbone
of our office culture. She has
created an environment that expects
accountability from all team members-including
me-and pushed a
" the customer is always right " mindset.
Nicole also created our digital
ecosystem, which includes onboarding
of technology, training protocols
and an open-door policy of giving
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Orthotown March 2023

Table of Contents for the Digital Edition of Orthotown March 2023
