Excellere 2018: Differentiate your practice!

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Excellere 2018: Differentiate your practice!


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Over 300 orthodontists attended 3M’s congress in Madrid. (Photograph: José Alberto Puertas)
3M Oral Care

By 3M Oral Care

Thu. 18. October 2018


MADRID, Spain: With change comes opportunity—this is true also for the orthodontic business, which is changing rapidly owing to altering patient demands and thanks to the availability of advanced planning and production technologies. The latter enable manufacturers like 3M to develop, produce and offer appliances that are more aesthetic. Moreover, digital technologies help orthodontists turn treatment planning into a more precise discipline, increase the efficiency of orthodontic procedures and facilitate communication in an interdisciplinary team. All these capabilities serve one ultimate goal: to that highly aesthetic treatment outcomes are obtained.

Ideas on how to leverage the benefits resulting from the ongoing changes were shared by the speakers at the 3M Excellere 2018 congress, held on 21 and 22 September in Madrid, which attracted more than 300 participants. On the first day, the programme focused on the many aspects of aesthetics, stressing the importance of interdisciplinary treatment approaches. On the second day, digital technologies that support clinical excellence took centre stage.

Many faces of aesthetics

In aesthetic orthodontic treatment, it is essential to consider interdisciplinary approaches when selecting suitable treatment options based on the individual needs of the patient. This was the key message delivered by the speakers on the first day of the congress, which was chaired by Dr José Chaqués Asensi from Seville in Spain.

In his lecture, Dr Federico Hernández Alfaro from Barcelona in Spain focused on aesthetic improvements achieved with ortho-facial surgery. He said that many patients presenting in his office had never heard about this option from their orthodontist. Some of them had successfully completed orthodontic treatment, but their facial aesthetics had been compromised. As a result, such patients are often disappointed with the treatment outcome, which might be avoided by assessing facial aspects before initiating orthodontic treatment. According to the speaker, five factors need to be considered to determine whether facial harmony exists: symmetry, vertical normalisation, anterior divergence, facial convexity and transverse relations. If any imbalance is detected, the patient should be informed about surgical treatment as an option for aesthetic improvement. Using several patient cases as illustration, Hernández Alfaro revealed how digital technologies facilitate surgical treatment planning and enable the use of minimally invasive surgical techniques that lead to predictable results.

Subsequently, Dr Juan Carlos Pérez Varela from Santiago de Compostela in Spain gave several examples of solving complex cases with simple mechanics. The focus was on the correction of an open bite with temporary anchorage devices (TADs). The speaker was able to show that TADs work for cases with a mild to moderate open bite, but lead neither to a facial improvement nor to an improvement of the upper airway. If these aspects are relevant, surgery should be considered. Owing to advances in technology, a minimally invasive surgical intervention can often be carried out under local anaesthesia and sedation.

Examples of interdisciplinary orthodontic and periodontal treatment were presented by Drs Silvestre Ripoll Cabo (from Seville in Spain) and Chaqués Asensi. As shown by the periodontist and the orthodontist, it is important to plan the treatment of patients with periodontal disease or mucogingival risk factors in a team approach. In patients with periodontal disease, scaling and root planing or periodontal surgery should be carried out prior to orthodontic treatment, which needs to apply light forces only. When gingival recession is present, aesthetics can often be restored using connective tissue grafts or suitable alternatives, and tunnel techniques demonstrated using clinical cases. In this context, the participants were encouraged not to be hesitant to treat patients even with severe periodontal problems, as careful planning and treatment can lead to very good results.

Digital technology supporting clinical excellence

On the second day of the congress, various speakers demonstrated how they make use of digital technologies and aesthetic appliances to differentiate their practices. The combination also allows them to offer treatments tailored to the individual needs of their patients.

In his aesthetically oriented orthodontic office in New York in the US, Dr Adam Schulhof uses three different aesthetic appliances to treat his patients: 3M Clarity Aligners (currently only available in the US), 3M Clarity Advanced Ceramic Brackets and the 3M Incognito Appliance System. In order to determine the most appropriate solution, he first assesses the patient’s needs with respect to comfort, aesthetics, lifestyle, cost and time. The information is considered for the development of a customised treatment plan, which often involves the combination of different appliances in the upper and lower arches or even at different points in time.

Dr Riccardo Riatti from Reggio nell’Emilia in Italy explained how he uses digital smile design in orthodontic treatment planning. Smile Design Software allows him to develop the desired aesthetic treatment outcome and virtually blend it into a photograph of the patient’s face. In this way, he is able to start with the end in mind: he uses the virtual result to develop the orthodontic set-up and additional surgical or restorative measures if necessary. Afterwards, he uses the Ortho Analyzer software (3Shape) to plan the ideal bracket positions and design an indirect bonding tray for production in the laboratory and then bonds the brackets as desired.

“Reinvent your business before it is too late,” Dr Itamar Michael Friedländer from Barcelona advised the participants. He focused on the benefits of the new Digital Flash-Free Indirect Bonding System. This system incorporates five simple steps. Initially, a digital impression is taken with an intraoral scanner. In the second step, the brackets and archwires are selected from the library, a set-up is created and ideal bracket positions are planned using 3Shape software. Step three comprises the computer-aided tray design and production. Friedländer uses a semi-rigid flexible material (NextDent Ortho IBT) for tray production with a 3-D printer. In step four, the brackets are inserted vertically, and finally, the tray is placed and the adhesive is light-cured through the tray, which is then easily removed. There is no adhesive flash.

According to the speaker, the new product allows for particularly efficient and predictable bracket bonding, as well as improved ergonomics. This leads to increased comfort for the orthodontist and the patient. For these reasons, the innovative solution helps users to differentiate their offices.

Dr Skander Ellouze from Tunis in Tunisia stressed that lingual treatment is an important part of the aesthetic solutions portfolio and should not be replaced by other aesthetic appliances. If the user adheres to the protocol, predictable results can be obtained with the 3M Incognito Appliance System. The speaker presented diverse patient cases to illustrate how he retains control from start to finish, through the use of TADs, for example.

Dr Robert Lawson from Edinburgh in the UK focused on interdisciplinary treatment planning with Incognito. He uses the Unitek Treatment Management Portal and the digital set-up for planning and communication with the whole interdisciplinary team from the onset. This way, it is easily possible to plan space opening for implants, predict gingival recession and reduce it by mandibular incisor torque correction, and assess the need for orthognathic surgery.

Finally, Dr Leandro Fernández from Malaga in Spain revealed how it is possible to gain total control with the Incognito Appliance System, which is preferred by him in cases with high demands regarding aesthetics and mechanical control. According to him, the most important differentiating factors of this system are the digital set-up, 3-D printed transfer tray and slot precision, which is further increased thanks to a new manufacturing technique.

In-depth information on products and procedures

The opportunity to obtain more in-depth information on innovative products and procedures was offered in breakout sessions for Spanish-speaking participants and in the exhibition area. Here, 3M experts were happy to share information about the new 3M Clarity Ultra Self-Ligating Brackets and the Digital Flash-Free Indirect Bonding System, as well as the Incognito Appliance System.

The organisers received overwhelming feedback from the participants. They returned to their offices with many fresh ideas on how to differentiate their businesses by placing a stronger focus on aesthetic orthodontic solutions.


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