Tuesday, September 11, 2018

Digital Orthodontics

Digital Orthodontics? Today you see "digital" and "virtual" everything.  In a previous post, I discussed an epiphany I had a few years back relating to the direction of orthodontic care.  Since then, we've implemented some amazing technologies which promise to keep us the leader in orthodontic technology in our practice area.

After a long search, we acquired an intraoral scanner.  An intraoral scanner takes thousands of pictures of the teeth in order to create a virtual 3d image of the mouth.  3d models of the mouth have been around for a long time.  In fact, we've been using 3d models in our office for over 16 years.

What's different now?  We can use the digital scans to create a virtual smile.  We know exactly the smile we're going to get ahead of time.  Orthodontist have been doing that in their heads for a long time. Not to discount what an experienced orthodontist can do, because proper application of digital orthodontic treatment absolutely requires clinical experience.  A newly minted orthodontist will not have a knowledge of how teeth move in the real world. Experience counts.

Saturday, February 6, 2016

The Best Job in the World

We've all heard the comment "I've got the best job in the world". Sometimes you can hear a touch of sarcasm in that statement. But what I can claim is that I do have the best job in the world, and I can prove it!
I'm an orthodontist. I put on braces. I improve smiles, but most of all I change my patient's attitude about themselves.  I help my patients feel more confident in themselves.  My job is truly rewarding in so many aspects.
Oh, I said I could prove it.  Annually US News and World Report releases their rankings of the best jobs.  I bet you can guess which job ranked #1 for 2016.  See,"the-100-best-jobs" (opens in new window".
Does that make you want to become an orthodontist?  See my previous blog post about becoming an orthodontist.

Monday, January 25, 2016

Is this e-mail a scam?

I know this isn't an orthodontic post, but I have to get a few words in about this.
We all get e-mails that sound threatening.

  • Your account will be locked. 
  • You must update your information or you will be unable to access you bank account, 
  • Update mandatory
No one wants to lose the privilege of using on-line accounts, but how do you know if that e-mail is a scam? I make a quick video of how to evaluate that e-mail.

Tuesday, January 12, 2016

So you want to be an orthodontist?

How to get into orthodontic school.

I'm an orthodontist. I love what I do.  My life has been blessed beyond measure. I've been asked by countless patients about what it takes to become an orthodontist.  Here's a few tips.
Young people want to be orthodontists do so for many reasons:

  • You've had braces and you love your orthodontist.  
  • You like the idea of helping people get great smiles. 
  • You want to earn lots of money, you can.  
  • You want to be a 'doctor'. 
  • You don't want to be on call, deal with blood, pain, sickness or disease.
  • You like working with your hands.
  • You want to be your own boss.
First let me say this.  Their is no magic formula for getting into an orthodontic residency. It is extremely competitive and there are many hurdles along the way.  We'll talk about these in this article.

The Path: 

Starting in High School take college prep classes. Your goal is to get into a good 4 year college program that offers the prerequisites to dental school.


Most dental schools require a year each of Chemistry, Organic Chemistry, Biology and English.  A bachelor's degree is nice, but not required. (several of my dental classmates only had 2 years of undergraduate school and no degree).  You don't have to major in a science, but it makes sense.  The worst advice on going to dental school was given to me by my undergraduate college's "pre-professional advisement center".  I was to told to take chemistry for chem majors and physics for physics majors.  What a crock!  It's better to have a high GPA than to compete with the geeks in their own major. Think about to which dental schools you are applying and find out what they recommend/require. The goal is to get a dental school interview. You have to meet whatever minimum cut off the school of your choice may have.
Those will be based on:

  1. Taking the prerequisite courses
  2. Having above the threshold GPA
  3. Scoring above the cutoff in your DAT score.

If I were applying to dental school today I's want to find out the average grades/scores in these metrics.
To improve your chances of getting accepted once you've gotten an invitation to interview you need to make yourself stand out.  Dental school Academics love research- do some research in undergrad school.  Demonstrate that you are a good person- volunteer to help those in need. Do what you can to help kids, the elderly or the handicapped. Get letters of recommendation from significant people.  Every applicant has a letter from their dentist telling how you kept your teeth clean and are a good person.  Try to go beyond that.  A personal connection with someone the committee knows pulls more weight.

Dental School

Once you get into dental school you will have to repeat the same process to get into an orthodontic residency, only this time the competition is even greater.  Hopefully you rank in the top 5 (first or second is best) in your dental class.  The advantage you now have is that you can focus on getting to know the orthodontic faculty.  Because you're at a dental school you have a great chance to get them to know you.

My recommendations:

Be smart, get good grades. Test well.
Be well rounded.
Demonstrate good character.
Make connections.

Many apply, few are chosen.


Friday, November 7, 2014

How do braces work? How do teeth move?

You're probably not an orthodontist, but if you ever wondered how braces work, this info is for you.

Teeth "float" in the socket, held in place by the periodontal ligaments.  The periodontal ligament acts as shock absorber for your teeth.

Applying pressure to a tooth causes it to move.  If the pressure on a tooth is intermittent or short lived the movement is temporary.  Chewing won't cause a tooth to change it's position.   When the pressure on a tooth is gentle and consistently applied, the body react to this pressure by activating the cells which cause bone to remodel. Thumb sucking or a tongue thrust will cause the teeth to move because the pressure is gentle and consistent.

If the pressure on the tooth is too heavy, the tooth will resist movement.When heavy pressure is applied to a tooth, the blood which surrounds the tooth in the periodontal ligament is forced out. Some cells build bone, some cells resorb bone.When there is no blood flow in the periodontal ligament the result is pain (ischemia related) and the cells needed for movement can't function properly.

Any given tooth has an ideal force which will promote its most rapid movement.

This basic biology is important because orthodontic treatment has to be consistent with these 'rules'.
Braces are the handles that are attached to teeth.  The wires which connect the braces provide the force needed to apply the pressure needed for tooth movement.

We'll talk more about the importance of wires and bracket design in a later post.

Sunday, February 23, 2014

Intraoral Scanner

I'm a gagger.

I struggle to keep it together when I get impressions. Thankfully, I haven't needed to have a lot of impressions, but sometimes they are unavoidable. Until now.

An intraoral scanner can make an exact copy of the mouth without goop, trays or fuss.

Intraoral scanners have been around for a few years.  They use a beam of light or a laser to capture a series of images which a computer converts into a 3d digital image.  Software is then used to manipulate the image.  In orthodontics we can use the images to analyze the way the teeth fit together, make a physical print, or digitally manipulate the teeth into a better smile. Let's take a look at what this means.

We've been using digital models for years, but we took traditional moulds of the teeth and then have them scanned by a service to create a virtual model.  These were great because they were easy to store electronically and we could take simple measurements of teeth.  Their drawback was in being unable to move from the virtual world to the real world.  They were a great diagnostic tool but that's where it ended.

Digital prints are a game changer.

A digital print is a physical copy of a virtual model.  Today we can print an exact copy of the mouth. In it's simplest form, we can make a retainer from a digital scan.  Taking the process to it's highest level means creating a virtual smile, then use CAM to achieve that ultimate smile in the real world. (I'll talk about that in my next blog)

Why alginate impressions are passé.

In the past, taking a mould of the mouth meant a bunch of steps in the process.  During any one of those steps, errors could be introduced which resulted in retainers or appliances not fitting.  The digital scans are more accurate than any impression. The other thing that happened with the plaster models of yesterday was that, most of the time, a model was a one use item.  The plaster model got destroyed in the fabricating process.  A scan can be re-used countless times.

We started using our intraoral scanner in October 2013. About the same time, our lab got a digital printer.  Karma, Fate, God's love? For whatever reason, everything fell into place.  It's hard to imaging going back to using impressions.

Here are a few real examples of how digital orthodontics has helped us solve problems:

We have a young boy of about 6 in our office.  He had a problem with his bite which needed prompt intervention.   Despite being a really cute kid, he did not have the ability to cooperate with getting a model of his teeth.  We were able to scan his mouth without incident and begin treatment.  We see patients at all ages breathe big sighs of relief when we tell them no impressions.

A teenage girl lost her retainer.  She was afraid to tell her mother and the girl's teeth moved. Because
we captured a digital image of at the end of treatment, we were able to make a duplicate retainer and quickly resolve the issue.

The father of a family of 4 kids we treated came to see me.  He was bothered by a lower tooth which had move slightly.  He didn't need or want braces and Invisalign was too expensive.  We created a virtual correction of the tooth, then had the set-up 3d printed.  We made him a clear retainer from the printed model.

A college student quit wearing his retainers. Over about 3 years, they moved to the point at which he decided he wanted them straight again.  We did a virtual set-up to a perfect smile, then had the software make a series of 4 aligners.  We did limited aligner treatment in the office.

We have an adult patient who wants a great smile, but has lots of crowding and bite issues. Treatment options included extracting teeth and/or jaw surgery.  He would prefer neither.  We did a few virtual set-ups which show the resulting smile and bite we expected. Seeing the result ahead of time helped him make a more informed decision about the option which would work best for him.

In my next blog I'll explain how digital orthodontics can get a better result in less time.

Monday, May 20, 2013

Looking forward

Digital Orthodontics, the Future is Now!

I was in Ann Arbor for an orthodontic symposium in March, The Moyers Craniofacial Growth Symposium.  My orthodontic colleagues just call it Moyers. What I learned at the Moyers Symposium was a wake-up call for me.

This was the 40th year for the Symposium and represented a milestone.  It's theme was a reflection on the recent history of orthodontics as represented by the Moyers Symposium. The Symposium has always attracted the best and brightest of evidence based scientists. The Moyers is more academically oriented than many orthodontic meetings, which tend be more 'commercial' in nature.  By 'commercial' I mean things like practice management  and gadgets for an office.  The Symposium is more scholarly and attracts academics and students.
Jim McNamara is the force behind the Symposium and he is an amazing talent in orthodontics.  I was blessed to have him as my orthodontic chairman during my residency at Michigan.  He has been the key influence on my development as an orthodontist and is a inspiration to me on a personal level. So when he asked me to attend this year's Moyers Symposium, I readily accepted. (I need to do a post about the influence Dr. Moyers had on me, but that will have to wait for later.)

When I finished my orthodontic residency in 1991, I thought I had all the tools I would ever need to be an outstanding orthodontist, boy, was I wrong.  I had attended the best dental school in the world, Michigan, and finished at the top of my class. Then I completed a 3 year residency at the best institution for orthodontic education in the world under the most prominent faculty.  

I have never been an early adopter of the latest fad in orthodontics.  I have always been content to wait until a new technique or gizmo had been proven before investing the time and energy into something which would not give our patients either the best care possible or shorten their treatment time. And believe me, everyone's goal is better care in less time.  The orthodontic vendors know this too.  I remember a few years ago when everyone was jumping on the self-ligating bracket bandwagon. Each supplier had their bracket-du-jour with promises of shorter treatment time and too-good-to-be-true advantages.  I tried a revolutionary style of brace in my office which promised orthodontic nirvana.   It turned out that the hype had failed miserably; in almost every way.  Those braces caused more discomfort for our patients and actually prolonged treatment time.  That experience only reinforced the natural skeptic in me.

At Moyers this year, most of the speakers reflected on a career filled with change, and most looked to the future for further enlightenment.  I was struck with several powerful insights:
  1. I was trained during the "golden age" of orthodontics, by faculty whom have all made major contributions to the knowledge base of my profession. Most who left U of Michigan became either a dean or a chairman elsewhere.
  2. I was fortunate enough to have professors who recognized that evidence based data collected through randomized clinical trials was the only way to evaluate clinical data, and trained me to do so.
  3. The future of orthodontics is moving in a digital direction.
  4. The practice of orthodontics will continue to take advantage of new technologies.
  5. Orthodontic practices who don't adopt new ideas will fade into obscurity.
So what do those insights mean to me?  I will be making some major changes to way we practice orthodontics. In particular, I made a huge investment in technology. I'll be sharing those technologies on these pages as we implement them. Stay tuned for updates.