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What About Aligners?

June 6th, 2018

Clear aligners, Invisalign… What exactly is it and how does it work?

I should preface this blog post with… aligners are not for everyone!! Many factors play into why braces or other devices may be substantially more effective for a specific patient.

Choosing the correct orthodontic appliance for a specific patient is critical to achieving the best results possible.

How do clear aligners move the teeth?

Dr. Aron Dellinger - Orthodontic Specialty Services | Clear Aligners

Clear aligners fit over the teeth, snapping over their convexities. A series of aligners is required to move teeth orthodontically. Each aligner has a slight change in its shape as compared to the previous one. This small change causes the aligner to flex a tiny amount as it goes over the teeth. That slight flex puts pressure on the teeth that will, over about two to three weeks of full time wear, move an individual tooth about .25mm.

Computer software and a 3D scan of the dental arches are used to specify where each individual tooth should move to create a “set-up” of the desired finished outcome. This set-up can be evaluated to determine which type of tooth movement is required to get the teeth from their starting positions to the projected outcome. Calculating the movement in millimeters and degrees provides the necessary data to determine the number of aligners required in the series to complete the case. More complex cases with lots of change in tooth position will require more aligners in the series, and thus treatment will take longer to complete.

Dr. Aron Dellinger - Orthodontic Specialty Services | Clear Aligners

Are there different types clear of aligners?

Yes…Invisalign (a clear aligner) is a product just like Kleenex (a facial tissue). There are several companies that produce aligners for tooth movement. Invisalign simply has such excellent brand recognition, very few people distinguish between the name brand and the actual device.

Invisalign is a clear aligner product marketed, by Align Technologies, a multi-billion dollar a year international company. Align Technologies was the first company to deliver a system of clear aligners that could be used for comprehensive tooth movement. I was very early on the scene with Invisalign and became certified in the technique 20 years ago.

In every market there are advantages and disadvantages to choosing a specific brand of product. Invisalign has some very attractive features. The process of using Invisalign is very much about the service. An intra oral 3D scan or impression of the teeth is sent to Invisalign along with a “treatment preferences” form. Invisalign uses the scan or impression to make a virtual model of the teeth, and then manipulates the model to accommodate the “treatment preferences” determined by the doctor. About 3 weeks after sending in the case, a file is sent to the doctor for approval to see if the doctor likes what is shown. By clicking okay the whole series of aligners from start to finish is made and shipped. They usually arrive after another 2 or 3 weeks. So it takes about 6 weeks to get the aligners to the patient, and that’s a bit longer to get started than most consumers would like.

However, there are a few drawbacks. Very little direct doctor involvement is required to achieve a set up using Invisalign. What if, out of a 20 aligner series, at aligner number 7 the computer model didn’t accurately simulate how the teeth would move? The answer…aligner number 7 doesn’t go in properly. So, what happens now? Aligners number 8 through number 20 will also not go in properly. The whole package of aligners from aligner number 7 forward is now a bag of trash...(At $160/pair, if you’re counting top and bottom together)...That's pretty expensive trash, $2240...Ouch!  As a practitioner, not only is the risk of wasted aligners a concern, but also what it adds to time in treatment.  Basically the “mid-course correction” process involves another scan and another 6 weeks waiting for new aligners to arrive.  Also, there is the “mid-course correction fee”...another ouch! I cannot speak for other professionals but I don’t charge my patients extra when appliances don’t fit. I eat the extra cost and lose money on those cases. So, if you’re wondering why Invisalign is so expensive everywhere…The risk of wasted aligners, and “mid-course correction” factors into case cost.

Dr. Aron Dellinger - Orthodontic Specialty Services | Clear Aligners

I actually stopped using Invisalign and started using another system called “Orchestrate” about four years ago. Orchestrate is a highly interactive clear aligner system. The system is similar to Invisalign regarding how the aligners are derived…except instead of having the company do the set up, I do the set up myself. Rather than treatment preferences that are generic to how I want to finish…I personally set up each specific case as I want the teeth to be moved at every stage of treatment. Also, instead of printing all of the aligners at once,  I print models of the teeth at the various stages and make the aligners in my own lab. I also only print three models in the series at any given time, so if there is an error in the predicted tooth movement very little waste of material, money and time has occurred.  Another advantage to Orchestrate is that I can see a patient for an exam, take a scan of the teeth, and give the first set of aligners to that patient in only three weeks, half the wait time of Invisalign!

What about DIY aligners?

I have a phrase for this one… “Don’t DIY healthcare!" There are so many things wrong with mail order aligners that it’s hard to find a starting point. First… no x-rays or CBCT imaging is used, meaning, you don’t know what is going on under the gums. Teeth can move where there is bone, and if you move them out of the bone they will be lost! Simply put you do not know if there is any bone around those teeth. Without x-rays there is no way to tell! Is there a disease process at work under the gum tissue that would compromise the health of the teeth if they are moved? Again, no way to tell without x-rays.

Moving your teeth, even a small amount, affects your bite, tooth wear, your facial muscles, and your jaw joint. Every day, I meet a new patient who has a very small concern, and we have a consult to discuss something like closing a small space between the upper front teeth. I take photographs, x-rays, look at the tooth charting and gum tissue probing depths sent from the dentists’ office, perform a range of motion analysis of the jaw joint, and then we discuss our findings. Interestingly, it almost never is as simple as just sliding the two front teeth together and done. The space got there somehow, and there is something making it stay. “Just a little cosmetic touch up” without big picture perspective almost always leads to excess tooth wear, damage to the enamel, sore muscles, and sore teeth.  Orthodontists have on average twelve years of college, and sometimes we get fooled by an easy looking case… DON’T TAKE CHANCES WITH YOUR HEALTHCARE!

The Road to ABO Certification

January 11th, 2018

The American Board of Orthodontics (ABO) was established in 1929 and is the oldest specialty board in dentistry. The ABO is the only certifying board in the specialty that is recognized by the American Dental Association (ADA). The board's purpose is to elevate the quality of orthodontic care for the public by promoting excellence through certification, education and professional collaboration. Not all orthodontists are board certified. All orthodontists must be licensed to practice, however board certification is a voluntary achievement that all orthodontists do not choose to pursue.

In December 1998, I completed my orthodontic residency at Saint Louis University (Masters in Specialized Dentistry-Orthodontics). I started work at OSS immediately after completing my comprehensive exams and defending my thesis. I took those exams in Saint Louis, packed up my stuff, drove back to Fort Wayne and started work with my father, brother, and uncle in private practice at OSS the very next workday. At that time very few orthodontists in the state of Indiana were ABO certified (in Northern Indiana maybe only four). The ABO certification process has proven to be incredibly valuable to me by changing the way I look at case results.

How to become ABO certified...

The ABO exam is a three-part exam. The first part is a written exam, similar to the SAT, but it only focuses on orthodontic related science. The second part is the board case records exam, which is a face to face oral examination involving clinical case records. Its purpose is to test the candidate's ability to diagnose and identify various orthodontic problems, and his or her knowledge of possible treatment options for correcting those problems. The third part of the exam is the clinical exam. This exam involves presenting cases treated by the candidate with extensive measurement and documentation of the pre and post-treatment results. Most orthodontists who complete the ABO process spend about 10 years in private practice accumulating case records and developing skills prior to taking the clinical exam (part three).

I began the ABO certification process as a resident by passing the written portion of the exam. After completing my Master’s Degree, I started to collect case records in preparation for the clinical portion of the ABO exam. I was tracking the progress of specific cases that would qualify for the various categories that the ABO required candidates to present. About a year and a half later some of those cases were coming to completion and I began the arduous task of measuring models, tracing and measuring x-rays and scoring the cases to see how well they finished. I felt confident that all of the cases I finished were excellent examples of skilled orthodontic treatment, and that they would score very well….I was wrong!

The cases displayed wonderful before and after results. They looked great and the teeth fit well in the bite. X-rays and photos indicated that all of the major aspects of health function and aesthetics were super. BUT when I started measuring, looking at smaller discrepancies, adding up all of the minor imperfections, and critically assessing more detailed aspects of the finished result, many of the cases I was most proud of did not “measure up” to the ABO standard of excellence. What I discovered was that only about twenty percent of the cases that I hoped would serve as ABO cases for a specific category were really the type of case that the ABO would find excellent.

During the process of measuring every detail of many, many cases I started to identify patterns of imperfection. I found areas in treatment results that consistently were NOT finishing as well as they could. Without spending countless hours literally “measuring imperfection” and critically reviewing my own case results, I never would have discovered there were imperfections that I could eventually PREDICT AND CORRECT BEFORE a case was even treated! I discovered that in certain patients the braces would produce rotations or tipping of the roots in x-rays. I learned to take progress records during treatment and also learned precisely where to look for discrepancies, identifying them earlier in treatment, improving both treatment time and results.

You may be asking what is required to maintain ABO certification?

Re-certification of ABO status is a relatively recent development and the requirements for re-certification are constantly changing. When I took the written exam it was explained to us that we would be the first class of orthodontists taking the ABO exam that would be subject to continual re-certification. In 1996 it was announced that all candidates taking the written exam would be required to re-certify every 10 years. Prior to this re-certification was not required for orthodontists who took the written exam.

I completed the board certification process in 2005, and I found the entire process of studying, gathering case records, measuring results, and receiving critical feedback from the examiners to be one of the most valuable learning experiences of my whole career.

How and Why You Should Choose an Orthodontist

October 30th, 2017

Recently I’ve had questions from acquaintances and friends asking how to choose a provider and/or a treatment method for their orthodontic needs.

MY STANDARD ANSWER IS TO LOOK FOR AN AAO ORTHODONIST

There are many myths about orthodontists and orthodontic treatment, and finding an AAO orthodontist is the easiest way to identify that the provider is in fact a specialist in orthodontics. Not all providers of orthodontic services are orthodontists.

Orthodontists have completed four years of dental school, AND an additional two to three years of full-time university training specifically in orthodontics. That full-time training involves intensive study of facial growth and development, bone physiology, functional relationships of the teeth and jaws, and a variety of treatment techniques...with and without the use of braces. An AAO orthodontist will know which techniques are best suited to your specific health and cosmetic needs.

Many states, including Indiana, do not require the additional years of training in orthodontics for providers to practice orthodontics. ONLY providers who have completed the two to three extra years of training are eligible to display the AAO logo. If the AAO logo is not displayed, specifically ask your provider: “Have you completed a full time university program in specialized orthodontics?”  (If so.. they will have a masters degree or certificate of residency completion from that university…usually proudly on display). This additional two to three years of university training defines what it means to be a specialist.

DON’T BE FOOLED- a certificate of intensive course completion from a corporation IS NOT a degree in orthodontics! (I get about three of these training certificates each year. All that is required to obtain those is to pay for a course, sit, and listen.)

There are many treatment techniques in the marketplace that I refer to as “packaged services”, clear aligners being the most common. Clear aligner companies often generate a predicted treatment outcome for the practitioner and then provide appliances which can approximate the predicted outcome. These “packaged services” are frequently offered as the only option by the non-specialist, because the treatment course can be set by the manufacturer of the appliance, requiring little knowledge of how orthodontic tooth movement works on the part of the health care provider. There are even companies that directly market appliances to consumers, leaving the dentist/orthodontist supervision out of the equation. Realize that the “appliance” (braces or aligners) is not the treatment!  Proper diagnosis of the underlying cause of your orthodontic problems is necessary to determine the most effective, healthy, and stable way to correct them. Only an orthodontist has the formal training to offer you a complete variety of treatment options which consider your health and your personal preferences. There are also “packaged service” options offering quick treatment using braces, typically six-month treatment promising to align and correct your crooked smile. Some orthodontic problems are completely correctable with aligners, and/or with six months of braces...great news! But BEWARE that providers that ONLY offer clear aligners and or six-month treatments are not likely specialists! These quick fix offerings are easy to sell, provide great profitability for the healthcare provider, and require very little training to implement (one weekend hotel course and you’re a “certified” provider).

True specialists also have specially trained staff to assist in your treatment. Ask your provider about the training of their staff in addition to your questions about specialty training of the doctor. All of the clinical technicians in my practice are Trapezio AOA (Academy of Orthodontic Assisting) Gold Certified.  This certification demonstrates clear knowledge of a variety of orthodontic techniques and orthodontic treatment principles. In a specialist’s office, staff are expertly trained and highly skilled in performing orthodontic appliance adjustments. These skilled assistants save you time in the chair at each visit, and provide more comfortable and efficient appointments. An orthodontic assistant in a specialist’s office will perform more orthodontic appliance adjustments in one year than a typical non-specialist dentist will in a whole career!

Breast Cancer Awareness

October 4th, 2017

Breast Cancer Awareness is something that is near and dear to our hearts at OSS. For many years we, with the help of our patients, have been raising money during Breast Cancer Awareness Month and this year is no exception!

We will donate $1 to Breast Cancer Research for each patient that wears pink to their regularly scheduled appointment during the month of October. As an added bonus, we will award 5 extra points to each patient's Smile Rewards Card!

Last year $189 was raised and donated to Breast Cancer Research through a similar fundraiser, and we are hoping to beat that amount this year! Help spread the word by sharing this post!

AAO AOA Team Certified Gold ABO SmartClip SL3 CareCredit

Patient Rewards

Patients will be rewarded points, redeemable for prizes! Successful orthodontics is a team effort and YOU are our key player! We have created the Smile Rewards card to recognize your accomplishments and congratulate your winning achievements. Our Smile Rewards card is an incentive program based on your compliance. You set the bar...every visit is an opportunity to earn points and cool prizes. Learn More

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