Dental News – Horses versus cars and an orthodontic debate

Which is better: a horse or a car? While at first glance it seems like this is a stupid question that most can easily dismiss, the more you think about it, the question can lead to endless discussions.

Since many more people drive rather than ride, it might be tempting to respond with the idea that the popular choice must be the right answer; However, we know that popularity does not necessarily equal quality. Debates probably pop up in your head about the cost, maintenance, reliability, availability, ease of use, and realism of using a horse versus a car as transportation. Although both are modes of transportation, they are significantly different from each other, which makes such debates rather humorous and academic.

When it comes to orthodontics, the horse-car concept can be projected onto the issues of braces/aligners or the discussion of twin/self-ligating brackets. The current diversity of opinion on what constitutes “good orthodontics” ranges from the over-the-counter braces and bands of the 1950s to the latest technologies on the market today. At that time, one of my mentors told me that he didn’t care if we used “a ball of thread and a tin can to straighten teeth” as long as we did our job well, and then we discussed the best method.

When presenting the horse-car debate in our practice, our team places great emphasis on the patient experience. Since we were able to purchase an intraoral scanner in 2013, we stopped taking impressions for records. We stopped casting plaster models to make orthodontic retainers when we were able to introduce 3D printing to print plastic models.

We began using Ormcos™ Insignia Custom Smile Design as our standard of care in 2009 to improve the patient experience. We have found that a digital treatment plan to reverse engineer ideal bracket positioning and create a system to accurately place brackets as planned can shorten treatment time by reducing adjustment appointments. Ormco’s Insignia improved the patient experience. Our anecdotal findings about efficiency while maintaining quality have been confirmed by peer-reviewed research¹.

Insignia was a step in the right direction for patient care, but it could have been better. In some ways it was a car because it automated care, but in other ways it was a horse because it required additional care during the process. There was a lot of debate about which method was better: manual placement of braces in a chair or digital treatment planning in advance with Insignia. Regardless, we found that the benefits of Insignia far outweighed the disadvantages, and we have used Insignia for the success of our practice.

From 2009 (when our practice began using Insignia) to 2024, orthodontics has changed. There are now new “transportation methods” that we can evaluate. Today, we use Ormco Digital Bonding (ODB) as our standard of care in our practice. ODB combines Ormco’s Damon Ultima™ brackets with Ormco’s Spark™ Clear Aligner software.

The components of Ormco Digital Bonding

Let’s explore the components of ODB, starting with Ormco’s Spark Approver software. Spark Approver software is quick and easy, features a web-based approver for assessment, and has the tools to get the job done well. In addition to the web browser-based version, the Approver software offers a desktop program for Mac and Windows.

We use the desktop version of ODB’s Spark Clear Aligner Approver software to model smile and occlusion treatment goals. It works the same as if we were setting a final target for aligners. However, when planning bracket bonding for braces treatment using Spark Approver software, the treatment projection looks like an aligner series with only two points in time – the pre-treatment and the end goal.

Spark Approver software is the vision/navigation system that allows us to see what we want to do and allows us to identify challenges to avoid. Orthodontics has been using the possibilities of computer simulation of aligner treatment for decades. Spark Approver software scheduling technology can now be used for braces through ODB’s bracket bonding capabilities. One of the coolest things about using Spark for aligners and ODB is that all of our aligner AND braces submissions are done on a single platform using the same technology.

The second component of ODB is the Damon Ultima System. We have been using the Damon System since approximately 2006 and have seen numerous improvements in our treatments and those of our colleagues worldwide.

From what we’ve seen, extensive research and development has always been the foundation of the Damon system. Damon Ultima is not just a polished version of previous Damon system brackets, but a ground-up redesign of a new bracket system that overcomes the limitations of previous designs.

The Damon Ultima mount slots are different from previous versions of the Damon system, and this difference in design is essential to function. Instead of having a flat top and bottom to the bracket slot, the Damon Ultima System’s bracket slots in the procline and retrocline positions make contact where needed to activate the torque coupling. The round, rectangular wires fill and fully engage the front and back of the bracket slot (when the passive self-ligation door is closed). The contact points of the wires on the bracket slots are where they need to be without the unwanted pinching that occurs with other, more traditional designs.

There are numerous training opportunities to learn how the Damon Ultima System works and how to best use it effectively for patient care. It’s worth investing time in the training process to learn how to drive this “vehicle” properly because it drives differently than what you’ve driven before.

After the Ultima 0.014 x 0.0275 Round-Rectangle Wire has been in the Damon Ultima System brackets for a few months, the twists should disappear (assuming the brackets were placed well). After the .018 x .0275 round-rectangle wire has been in place for a few months, torque control should be achieved.

You will hear from Ormco that “The Damon Ultima System is the first true full-expression orthodontic system designed to reduce wire bending during treatment for faster, more precise finishing.”².”

After learning from the designers, seeing cases, and receiving training from our colleagues, I fully believe in this statement because the system’s unique design, rotation control, torque control, and other critical aspects of care are recognized early in the process .

Although we truly appreciate the excellence of the Damon Ultima system, there is one major problem when using the system: the brackets must be well placed. In fact, the bracket placement issue is a common problem across all bracket systems and is not unique to the Damon Ultima system. Although we believe the Damon Ultima System is the best bracket we can use today in a head-to-head comparison, any bracket system can crash if placed poorly. When placed well, Ultima can provide elegant, easy handling, which is why we use Ormco Digital Bonding.

The jig/template systems with ODB (Fig. 6) allow us to place the struts where we planned them. If a patient loses a brace because they were suddenly attacked by a bag of sticky candy, we can put the brace back exactly where it belongs. We can have our team assist us with the bonding process as we have already made the clinical decisions about where the brace should be placed at the time of bonding. When applying the braces, we can focus on proper bonding technique rather than trying to make 28 consecutive guesses about a restless patient exhibiting superhuman saliva production powers.

The complexity of the ODB design process has led to a simplification of treatment delivery for us. After the bonding date, we know that well-placed brackets allow treatment with fewer smaller sized bends. In some systems, computers respond by bending wires to compensate for scheduling. Unlike bending a wire, which looks like a rollercoaster ride, it can be elegant to simplify a complex procedure by planning the treatment before it begins. Additionally, roller coaster rides caused devastating damage to the treatment mechanics.

Simply put, Ormco Digital Bonding helps us provide a better patient experience by providing a realistic way to plan treatment in advance. We have an answer to the orthodontic version of the horse-car debate. We prefer a vehicle that can provide us with excellent clinical results, that is realistic to drive and that helps us provide the patient experience we would want ourselves if we were receiving treatment._

References

Am J Orthod Dentofacial Orthop 2015;148:1067-74
Data on file with Ormco Corporation

Editorial note:

Disclaimer: Dr. Bandeen is a paid consultant for Ormco. The opinions expressed are those of Dr. Bandeen. Ormco is a medical device manufacturer and does not provide medical advice. Physicians should use their own professional judgment when treating their patients. The dental images were not changed. Patient results may vary.