As a new pediatric dentist having just graduated from UNC-Chapel Hill, | took over the practice of a pediatric dentist who was leaving for an orthodontic residency, planning later for us
Trang 1Clinical articles © management advice *® practice profiles ¢ technology reviews
PROMOTING EXCELLENCE
Using lingual appliances
for optimal esthetics and
minimal compliance issues
Drs John R “Bob” Smith and
CREDITS PER YEAR!
November/December 2016 — Vol 7 No6
Trang 2INTRODUCTION
Considering a dual pediatric-
orthodontic practice?
Ai, dual-trained pediatric dentist and orthodontist, it was
ays my goal to “quarterback” a team of pediatric dentists
and orthodontists under one roof | now operate two such
practices, which has become a distinct trend over the last several
years For tenured orthodontists, it seems an effective means
of practice growth; and for newly graduated orthodontists with
appreciable debt, it is a way to jump-start their careers without
more debt; and for the “retiring” orthodontist, it is a means to
practice without an owner's responsibility
Now with an orthodontic partner and three associate pediatric
dentists practicing in two towns, my personal goals have been Mike Mayhew, DDS, MS
achieved Coordinating our shared patients and responsibilities of
care, however, is an ongoing endeavor If you are an orthodontist considering the idea of a
dual-specialty practice, | offer a few thoughts
First to consider is the difference in patient cultures Young patients are often apprehensive
about going to the dentist and are intensely vocal about their fears They're also understand-
ably more dependent on their parents, who also, understandably, are often anxious and
inclined to attend to their fretful child chairside The open-bay concept in orthodontic offices
may not lend itself to these circumstances To any practitioner considering a dual-specialty
practice, | suggest physical separation of the two sides of the practice
Another big question is whether other GPs/pedodontists will refer to you lest they lose
a patient to your pedodontist | have very carefully nurtured relationships with our referring
general dental and pedodontic practices to be certain they trust our commitment to them
We pledge always to send referred patients back to their general dentist/pedodontist for
routine care We even include a reward for patients who have their teeth cleaned with them
To ensure the dentist/pedodontist is aware of our efforts, we have the dentist return a signed
card to us for verification
If you're considering forming a dual-specialty practice, there's no better way to explore
issues you'll likely encounter than through connecting with fellow professionals at meetings
— regional society meetings, study club groups, and seminars offered by companies such
as Ormco | have enjoyed networking and sharing my knowledge with as well as learning
from colleagues at these conferences, including The Ormco Forum The social and engaging
atmosphere at these conferences makes them a perfect place to chat face-to-face with
people who've already been down this road and can help guide your way
My own journey to a dual-specialty practice took a circuitous route As a new pediatric
dentist having just graduated from UNC-Chapel Hill, | took over the practice of a pediatric
dentist who was leaving for an orthodontic residency, planning later for us to work together
under one roof That dream vanished when the new orthodontist decided not to return
It took several years to finalize my decision, hire another pediatric dentist to maintain the
practice, then pursue my own dual training and build that practice dream myself I'm now
pleased to have combined the two specialties that share young dental patients in providing
comprehensive care
ul
Dr Mike Mayhew
Mike Mayhew, DDS, MS, received his dental education at the University of North Carolina with specialty degrees in
pediatric dentistry and orthodontics He is board certified in both specialties and operates a dual-specialty practice in
Boone and North Wilkesboro, North Carolina Dr Mayhew has lectured nationally and internationally on the Damon™
System, CAD-CAM digital orthodontics, indirect bonding, and office utilization of CBCT He is on the Sports Medicine Team
at Appalachian State University, is an adjunctive clinical professor at the UNC School of Dentistry, has held leadership
positions in organized dentistry, and serves as the director of the North Carolina/South Carolina Damon Study Club He
was inducted into the American College of Dentists in 2010 and the International College of Dentists in 2013
S Jay Bowman, DMD, MSD Stanley Braun, DDS, MME, FACD Gary P Brigham, DDS, MSD
George J Cisneros, DMD, MMSc
Jason B Cope, DDS, PhD Neil Counihan, BDS, CERT Orth Bradford N Edgren, DDS, MS, FACD Eric R Gheewalla, DMD, BS Mark G Hans, DDS, MSD William (Bill) Harrell, Jr, DMD John L Hayes, DMD, MBA Paul Humber, BDS, LDS RCS, DipMCS
Laurence Jerrold, DDS, JD, ABO
Chung H Kau, BDS, MScD, MBA, PhD, MOrth, FDS, FFD, FAMS
Marc S Lemchen, DDS Edward Y Lin, DDS, MS Thomas J Marcel, DDS Andrew McCance, BDS, PhD, MSc, FDSRCPS, MOrth RCS, DOrth RCS
Mark W McDonough, DMD Randall C Moles, DDS, MS Elliott M Moskowitz, DDS, MSd, CDE Atif Qureshi, BDS
Rohit C.L Sachdeva, BDS, M.dentSc Gerald S Samson, DDS
Margherita Santoro, DDS Shalin R Shah, DMD (Abstract Editor) Lou Shuman, DMD, CAGS Scott A Soderquist, DDS, MS Robert L Vanarsdall, Jr, DDS John Voudouris (Hon) DDS, DOrth, MScD Neil M Warshawsky, DDS, MS, PC John White, DDS, MSD Larry W White, DDS, MSD, FACD
CE QUALITY ASSURANCE ADVISORY BOARD
Dr Alexandra Day BDS, VT Julian English BA (Hons), editorial director FMC
Dr Paul Langmaid CBE, BDS, ex chief dental officer to
the Government for Wales
Dr Ellis Paul BDS, LDS, FFGDP (UK), FICD, editor-in- chief Private Dentistry
Dr Chris Potts BDS, DGDP (UK), business advisor and ex-head of Boots Dental, BUPA Dentalcover, Virgin
Dr Harry Shiers BDS, MSc (implant surgery), MGDS, MFDS, Harley St referral implant surgeon
expressed herein are those of the author(s) and not necessarty the opinion of
either Orthodontic Practice US or the publisher
Volume 7 Number 6
Trang 3TABLE OF CONTENTS
Financial focus
Are high 401(k) fees putting
your retirement at risk?
Tom Zgainer discusses how hidden fees can drain money from your
COE án guiccnotoeceiiaoscbuaoiakcasvses 18
Case study
Maintaining clearly defined treatment objectives: part 2 Drs Domingo Martin and Jorge Ayala illustrate treatment using the FACE
concept of orthodontic treatment
h
Striving to be successful and significant Dr Bill Dischinger discusses how his
personal Herbst experience led to
development of a comfortable and efficient appliance - 26
Orthodontic concepts
Reframing orthodontics:
Designing accelerated orthodontics by managing error
— the BioDigital way: part 3
Dr Rohit C.L Sachdeva discusses
the journey of error management in
Clinical praGlce sissies ee: 30
Trang 4Dr Thomas Wilson discusses an
effective technique that can minimize
the extent of surgery to repair cleft
palate in newborns 42
Laboratory link
3D printing in orthodontics
James Bonham and Arlen Hurt review
innovations in 3D-printing technologies
Practice development
What you need to know about
online reviews for your practice
lan McNickle, MBA, discusses
the importance of a strong online
Dresence .- S 49
6 Orthodontic practice
Continuing education
and minimal compliance issues
Drs John R “Bob” Smith and Mario Paz discuss the development and use of a square-siot, passive self-ligating, straight-wire lingual appliance
Global Diagnosis: A New
Vision of Dental Diagnosis
and Treatment Planning
J William Robbins, DDS, MA,
and Jeffrey S Rouse, DDS
ASSISTANT EDITOR | Elizabeth Romanek Email: betty@medmarkaz.com
MANAGER - CLIENT SERVICES | Adrienne Good Email: agood@medmarkaz.com
CREATIVE DIRECTOR/PROD MGR | Amanda Culver Email: amanda@medmarkaz.com
WEBSITE MANAGER | Anne Watson-Barber Email: anne@medmarkaz.com
E-MEDIA PROJECT COORDINATOR | Michelle Kang
Trang 5CASE STUDY
Maintaining clearly defined treatment objectives:
part 2
Drs Domingo Martin and Jorge Ayala illustrate treatment using the FACE concept of orthodontic treatment
l the September/October 2016 issue
of Orthodontic Practice US, we intro-
duced the FACE (Functional and Cosmetic
Excellence) concept of orthodontic treat-
ment and its importance in achieving func-
tion and esthetics We also explained the
treatment goals and the key factors that
make up the goals
After the introduction to the FACE treat-
ment philosophy, we explained that the
FACE Evolution bracket* was developed
by some of the key members of the FACE
group This bracket was developed by clini-
cians for clinicians In the article, we gave
the many reasons for the development of a
new bracket system In retrospect, the main
reason was the need for a bracket system
that took function into account, and this is
the first of its kind
In the second part of the article, we will
further explain the necessity for changing
the original Roth prescription The rationale
for the many changes in the prescription
makes sense to experienced clinicians
We also introduce the concept of “working
tube,” something that many clinicians will
like, and more importantly, the need for this
type of bracket in our toolboxes We also
announced the “working bracket” and its
multiples uses, and why we need this in
many instances to obtain our functional and
esthetic occlusal goals
Prescription for work and pre-
scription for finish
FACE Evolution incorporates a new
concept into orthodontic biomechanics:
Figures 12A-12C: Three vertical guides enable the placement of the tube more mesially, more distally, and a central framework
to achieve three different anchorages (14°, standard, and -6° of rotation) with the same tube
working prescription and finishing prescrip- tion The work prescription consists of using specific tubes and brackets for their tempo- rary use in certain situations with the purpose
of attaining certain aims (Figure 11A)
The prescription for finish is obtained with the use of the standard FACE Evolu- tion prescription — a good finish in a high percentage of cases — without needing
to bend the arches In some situations, because of minor anatomic variations, the necessary adjustments should be performed (Figure 11C)
Working tubes
By varying the mesiodistal position
of the tubes, we can modify the rotation values and the anchorage values to tackle
Dr Domingo Martin has a BA from the University of Souther California and an MD and DDS from the University of
the Basque Country in Spain He also earned a Master in Orthodontics from the University of Valencia in Spain He
has a diploma in orthodontics by the FACE/Roth Williams Center for Functional Occlusion and has postgraduate work
in Bioesthetic Dentistry from the OBI Foundation for Bioesthetic Dentistry Dr Martin gives courses and conferences
all over the world, and he has a private practice limited to orthodontics in San Sebastian, Spain He is also a FACE
cases of minimum, medium, and maximum anchorage Therefore, the tube will have three vertical guides (Figure 12) that enable
us to locate the tube more mesially for cases
of maximum anchorage, or more distally, for cases of minimum anchorage, and a central framework for cases of medium anchorage and finishing stage These guidelines will coincide with the main vestibular sulcus
as indicated Tubes with markings became available in 2016 (Figures 12A-12C) With the same tube, we can therefore attain three different anchorages (standard, +4°, and —4°), simply and efficiently; the necessary inventory is also simplified, so this
is like having three different prescriptions in the same tube
As its name indicates, the prescription for work is the one with which we can perform specific actions — for example, distalization
or retrusion of the six anterosuperior teeth or mesialization of the posterior segments — by increasing or reducing the anchorage Once the required aim is obtained, in this case closure of the spaces, we will switch to the prescription for finish by positioning the tubes in the usual way
Dr Jorge Ayala has a medical degree from the University of Chile with a specialty in Orthodontics and Maxillar Orthopedics from the
University of Chile He is Director of the FACE/Roth Williams Center for Functional Occlusion from Latinoamérica and a professor of
the FACE/Roth Williams Center for Functional Occlusion in California He runs a private practice limited to orthodontics in Santiago
de Chile He is the author of numerous articles and publications and speaker at national and international courses and conferences 3
Working brackets
For cuspids, the working bracket with 20° positive torque will enable us to place
Disclosure: Drs Martin and Ayala are consultants for Forestadent
20 Orthodontic practice Volume 7 Number 6
Trang 6these teeth in the required position to be
subsequently replaced with the standard
torque bracket or bracket with the final
prescription
For the mandible, the molar torque of
-—30° operates efficiently in most cases,
although at times not in the case of second
molars Indeed, in a lower percentage of
cases, the second lower molar “tips” toward
the lingual region, especially in those cases
with an accentuated curve of Spee
The explanation appears to reside in the
fact that when attempting to access these
molars and given that the apices are in rela-
tion to the compact bone of the external
oblique line, this undesired effect would
occur, which is difficult to resolve Therefore,
FACE Evolution proposes a working tube with
O° of torque, which once the molar torque
has been corrected, should be replaced with
the prescription’s standard finishing tube
Active system and hybrid system
It is difficult to come to an agreement
in regard to which self-ligating system has
more advantages and less disadvantages
Order No Order No
Rechts Lieks Rechts Ueks
739-0323 738-0323 739-0321 738-0321 748-831! 748-821! 748-832! 748-872!
Table: Working brackets and working tubes for FACE Evolution system
Various papers conclude that sliding mechanics are favored for the use of
passive self-ligating brackets, but control
of the root position could be comprised
They also confirm that the sliding resistance (SR) is necessary when we have to produce torque and correctly position the root for correct finishing
The wish to minimize resistance to fric- tion should be moderated because of the need to control movement of the teeth In the new FACE Evolution, we have opted to take the advantages of both parts by means
of two versions: the active system and the hybrid system
The active system gives us more control:
During subsequent treatment stages, sliding resistance (SR) increases along with the size of the arch This provides better three- dimensional control and fills the sulcus to
produce a torque force that correctly posi- tions the root and the crown
The hybrid system provides the clinician with the best combination of low friction and control, especially in cases with extractions
A recent study performed by Dr Douglas Knight on 400 finished patients concluded that the duration of treatment and number
of appointments of 200 patients treated with the hybrid system reduced by 15%
Clinical cases
A 13-year-old female presented with severe space deficiency, and with her skeletal anatomy, we decided to extract four bicus- pids and close spaces, maintaining her upper teeth forward, not retruding the upper lips, and obtaining a good functional occlusion
Figures 13A-13B: 13A Before and 138 after correction with
working bracket; the apex is seen inside the bone
Trang 7Figures 17A-17C: We start the aligning and leveling phase in the upper arch with a 020" Figures 18A-18C:
x 020" BioTorque® archwire with a 019" x 025" BioTorque® in the upper and lower arch.We are closing spaces in the upper
and lower arch preparing for the working phase We place a transpalatal bar for vertical control
The rationale for the
Figures 19A-19B: We are now in the working phase in the upper and lower arch with a 019" x 025" TMA T-LOOP Double
keyhole loop archwire that gives us torque control, creates a moment for incisor control, helps us loose anchorage, controls
m akes S Đ nse to the canine in the three dimensions, and will correct the curve of Spee — all with one archwire
the prescription
experienced clinicians
» — —-_ 5 “ `_ LỆ _ on
Figures 20A-20C: We are now in the finishing stage with the curve of Spee aligned, spaces almost completely closed, torque
of the upper anteriors achieved, and good arch form in the lower and upper arch We can resort to Class Il elastics in this phase if necessary
Figures 22A-22F: Posttreatment intraoral pictures
22 Orthodontic practice Volume 7 Number 6
Trang 8Figures 27A-27C: Posttreatment intraoral pictures
Trang 10A Herbst® journey
Dr Bill Dischinger discusses how his personal
Herbst experience led to development of a
comfortable and efficient appliance
had a Herbst® as a teenager How are my
memories of that time in my life? Well
not exactly great Although as an adult, |
look at the results it gave me compared to
the upper bi extraction cases that were the
norm back then, and | know it was worth
it But
The second Dischinger to have a Herbst
was none other than Terry Dischinger himself
We treated him when he was in his late 50s
He had always been a Class II open bite
that would have required surgery Eventu-
ally, he developed a modified Herbst appli-
ance that intruded the maxillary molars while
the Herbst was correcting the Class Il The
results are similar to what we see in today’s
technology using TADs to intrude the maxil-
lary molars and autorotate the mandible He
claims his experience was an easy process,
but my dad is kind of that way It sure beat
surgery though, but in watching from the
other side, it didn’t look all that comfortable
Shortly after finishing his treatment, we
decided to see if we could make a smaller
Herbst appliance Our purpose in attempting
this design change was to improve the
comfort of orthopedic Class II treatment for
our patients | was two boys into my now
current four-boy family, and it was obvious
they were following the Dischinger growth
pattern and would require Class II correction
Selfishly speaking, | wanted my kids’ experi-
ence to be better than mine, my dad’s, and
all my previous and current patients So we
set off on a journey, and let me tell you, it was
ORTHODONTIC INSIGHTS
a journey much harder and more frustrating than we had dreamed When | was in my residency, | had a classmate that sat down at the bar with me one night, grabbed a napkin and pen, and said, “Let’s invent an appli- ance.” Well, it isn't quite that easy We had the design idea, but making that work from
an engineering perspective is a little harder than most people would think Thanks to the hard work of some amazing engineers at Ormco, we slowly started putting out some prototypes We worked with these proto- types for a few years until we felt we had
a design that worked consistently with great results
AdvanSync™ was launched shortly thereafter Early on, it was widely adopted
by many based on the features that other doctors also recognized were beneficial
to their practices and patients Like many initial concepts, once the product was
Bill Dischinger, DMD, of Lake Oswego, Oregon, received his dental degree from Oregon Health and Science University
School of Dentistry in 1997 and his certificate in orthodontics at Tufts University in Boston in 1999 His B.S degree
is from Oregon State University In private practice with his father, Dr Terry Dischinger, Dr Bill Dischinger has
taught at their in-office comprehensive courses and used the Damon® System for over 15 years He is an Adjunct
Professor in the Orthodontics Department at the University of the Pacific in San Francisco and one of 12 certified
Damon instructors who has taught and lectured extensively on passive self-ligation with the Damon System He has
also lectured nationally and internationally on a variety of subjects, including functional jaw orthopedics, indirect
mass-produced, we began to see several flaws surface We then went to work on the second generation with manufacturing and design changes that would resolve the issues Thus came AdvanSync 2 with modi- fied enhancements, and this is the product
we are still using today and have been for nearly 5 years
As stated, our goal was to improve the comfort of orthopedic Class II treatment for our patients AdvanSync™ 2 is almost half the size of the miniscope appliance that we had been using and half of the size of the flip-lock design we used prior to that It is well over half the size of what | had as a kid, which
| can assure you Because of the smaller size,
it fits more in the posterior of the mouth Most
of the sores we saw patients experiencing were in the lower premolar area from the screw housings This has been minimized with the enhancements of AdvanSync 2 The appliance also does not show in the mouth like previous Herbst designs, so patients are more accepting to wear it
A bonus that came out of the smaller design was the ability to bracket every tooth forward of the appliance In the past, we were unable to bracket the lower premolars, and at times, we would not bond the maxil-
bonding, and practice management from a team approach
Dr Dischinger has written articles published in Orthodontic Products, Orthotown, and Ormco’s Clinical Impressions and is actively
involved in national study clubs that address the latest treatment techniques He is also a member of the American Association of
Orthodontists, Pacific Coast Society of Orthodontists, the American Dental Association, and orthodontic professional associations
that enable him to actively participate in continual education and remain current on advances in orthodontic treatment Dr
Dischinger has been married to his wife, Kari Lynn, for over 20 years, and together they have four sons
lary premolars either With this new design,
we bond all the teeth, and sometimes the
mandibular second molars as well When
we are finished with the Class II correction and the appliance is removed, most of the Class | orthodontics has been accomplished
26 Orthodontic practice Volume 7 Number 6
Trang 11
ORTHODONTIC INSIGHTS
as well, which allows us to quickly move to the end of treatment making our orthopedic Class Il cases much more efficient Since moving to the AdvanSync 2 appliance, we have dropped our average treatment time by over 6 months
Over the years of using the AdvanSync,
| have modified my treatment protocols on most of my patients | used to place the crowns, place the braces, and hook up the AdvanSync arms on every new patient the
= first day of his/her treatment Today, with
ie most of our current patients, | am waiting
For younger patients, this helps them ease
ae into treatment with less to adjust to For
Taylor Dischinger initial phase 1 leveled, particularly in Class Il, division 2
patients Although this postpones the Class
ll correction by 2 to 4 months, the end result
is that less orthodontics needs to be done after removal of the appliance Because of this, the Class II correction occurs smoothly without vertical issues, and thus, the overall treatment time is lessened
Since starting my Herbst journey over 35 years ago, | have seen a great progression in the comfort and efficiency of treating skeletal Class || patients It has been rewarding to see
my patients, especially my own children, go
through a better experience than | did [13
Taylor Dischinger initial phase 1 occlusal upper Taylor Dischinger final occlusal upper
Herbst® is a registered trademark of Dentaurum, Inc., and AdvanSync™ is a trademark of Ormco Corporation
Taylor Dischinger final
28 Orthodontic practice Volume 7 Number 6
Trang 12ORTHODONTIC CONCEPTS
Reframing orthodontics:
Designing accelerated orthodontics by
managing error — the BioDigital way: part 3
Dr Rohit C.L Sachdeva discusses the journey of error management in clinical practice
The road to wisdom?
Well, It's plain and simple to express:
The key dimensions of quality care that
drive the philosophy and practice of Bio-
Digital Orthodontics are patient centered-
ness, patient safety, and clinical effective-
ness.'* Errors committed during the delivery
of care have the highest potential of negatively
impacting these quality measures and, as a
result, treatment time Strategic approaches
to error management in clinical practice have
been substantially neglected by the orth-
odontic professionals in their pursuit of the
holy grail of accelerated orthodontic care
A culture of patient safety cannot be
practiced without confronting the causes
of orthodontic errors and their appropriate
management
This journey of error management in clin-
ical practice can only begin by recognizing
Rohit C.L Sachdeva, BDS, M Dent Sc, is
a consultant/coach with Rohit Sachdeva
Orthodontic Coaching and Consulting, which helps
doctors increase their clinical performance and
assess technology for clinical use He also works
with the dental industry in product design and
development He is the co-founder of the Institute
of Orthodontic Care Improvement Dr Sachdeva is the co-founder
and former Chief Clinical Officer at OraMetrix, Inc He received
his dental degree from the University of Nairobi, Kenya, in 1978
He earned his Certificate in Orthodontics and Masters in Dental
Science at the University of Connecticut in 1983 Dr Sachdeva
is a Diplomate of the American Board of Orthodontics and is
an active member of the American Association of Orthodontics
In the past, he has held faculty positions at the University of
Connecticut, Manitoba, and the Baylor College of Dentistry, Texas
A&M Dr Sachdeva has over 90 patents, is the recipient of the
Japanese Society for Promotion of Science Award, and has over
160 papers and abstracts to his credit Visit Dr Sachdeva's blog
on http://drsachdeva-conference.blogspot.com Please contact
improveortho@gmail.com to access information
30 Orthodontic practice
the various types and sources of errors and then finding ways to prevent them or, at a
minimum, to develop appropriate barriers
to arrest their propagation | have found that errors in clinical practice commonly manifest
around what | term the 7 M's:
1 Miscommunication Misdiagnosis Misplanning Misprescription Mismanagement Misadministration Misaction The root cause of these is grounded in
deficits of knowledge, inadequate skills, and
the violation of rules
The objective of this paper is to famil- iarize the reader with the principles, the tools,
and the clinical practices that | use and have
developed in the service of error-proofing the
care of my patients with a focus on managing the 7 M's These practices have resulted in
shorter treatment times and, more impor-
tantly, enhanced patient safety
Principles and practice of error
proofing
“We can’t solve problems by using the
same kind of thinking we used when we created them.” — Albert Einstein
The strategic and tactical practices to
error-proofing patient care against the 7
M's that | present are based on a bedrock
of sound biomechanical principles and,
when appropriate, are enabled with the
use of 3D-imaging technologies such as CBCT, OraScan (Figure 1), and CAD/CAM technologies offered by the suresmile® total
Figure 1: Various types of images used for care design and planning Note the CBCT provides information regarding bone, crown, and roots The OraScan is limited to the crowns and gingival tissue suresmile® offers the service of merging the CBCT image with the OraScan and 2D extraoral frontal images
Volume 7 Number 6
Trang 13patient care management platform® (Figure
2) These approaches are discussed below
A) Error-proofing against Misdiagnosis
A major thrust of orthodontic diagnosis
involves the understanding and delineation
of the complex spatial interrelationships
between the various anatomical components
of the craniofacial complex Misdiagnosis in
orthodontics commonly occurs as a result
of perceptual, measurement, and judgment
errors By using 3D images and 3D virtual
models of a patient for simulations, such
errors may be minimized Clinical examples
of the use of these tools follow
High-fidelity 3D diagnostic imaging
2D images of patients, such as photo-
graphs or the panorex, are commonly used
as aids in diagnosis Unfortunately, such
images lack depth and are also prone to
projection errors.’ This limits the doctor’s
ability to perform a thorough diagnosis for his/
her patient Misdiagnosis leads to incorrect
treatment decisions and, as a result, treat-
ment time is negatively impacted 3D imaging
helps overcome these issues Examples of
both the clinical “misses” resulting from 2D
images and the benefit of using 3D images
in these situations are shown in (Figure 3)
Autoanalytics
Many of our diagnostic decisions rely
upon accurate and precise measurements
of the dentition We are often hampered
both by the limitations of the tools we use
and our perceptual biases This is primarily
due to a lack of operational definitions for
the region of interest and having no common
plane of reference to measure against This
leads to inaccurate, unreliable (inter- and
intra-operator) measures that result in
the incorrect diagnostic assessment of a
patient Autoanalytic tools overcome such
limitations and allow for more reliable diag-
nosis.° (Figure 4)
Interactive diagnosis with simdiagnostics
Currently, we measure the degree of
severity of a malocclusion by measuring
against a normative age/sex/ethnic-based
sample However, it is equally important to
measure the degree of severity of a mal-
occlusion based upon the amount and
nature of tooth displacement required to
achieve the treatment objective (Figure 5)
Assessing this measure with conventional
tools is difficult For instance, the assessment
of the severity of crowding is affected by a
Volume 7 Number 6
This is not seen on the intraoral visible in the intraoral images or from the occlusal perspective of the 3D OraScan It is clearly
visible from the lingual perspective of the OraScan 3C The panorex image does not show the dilaceration at the apex of the
lower left central incisor This is seen with the CBCT image