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Dental Tribune Middle East & Africa Edition No. 5, 2015

26 Dental Tribune Middle East & Africa Edition | September-October 2015ortho tribune > Page 27 By Jeffrey T. Kozlowski, USA A true straight-wire appli- ance would necessitate patient-specific appli- ances based on an individual’s anatomy. Now, with advances in computer software and digital scanning and fabrication, that idea is a reality and a practical consideration for your prac- tice. Customized Insignia™ is the first true straight-wire ap- pliance. It involves two compo- nents: customized appliances— brackets, wires and placement gauges—and 3D real-time vir- tual treatment planning soft- ware. The 3D software enables clinicians to design the patient’s final occlusion on-screen before initiating treatment, then pre- scribes the fabrication of patient- specific appliances to achieve the planned result. This con- cept is quite different from how clinicians customarily practice orthodontics. Traditionally, we choose appliances with specific torque values to have certain ef- fects, then react to those effects by repositioning brackets and making wire bends to guide the teeth into the desired positions. With Insignia, we begin with the end in sight and drive directly towards the desired end result. Over 20 years in development, customized Insignia appliances offer the only comprehensive patient-specific solution avail- able. The treatment planning process begins with accurate PVS impressions. New clinical methods and materials make this procedure quick and easy. From the impressions, the pre- treatment malocclusion (T1) is digitized into a precise math- ematical model of the patient’s skeletal and dental anatomy and the proposed setup (T2) de- signed (Fig. 1a-b). See Dr. Craig Andreiko’s discus- sion. The setup is loaded to the Insignia web portal where, ased on clinical experience, func- tional and esthetic preferences and intimate knowledge of the patient’s specific orthodontic needs, the clinician can easily customize it using the Insignia Approver software (Fig. 2). The included software offers clini- cians unprecedented control in determining accurate tooth position and in their ability to make changes directly to the 3D models without relying on an operator’s interpretation of in- structions. Insignia does not determine treatment mechanics nor pre- scribe tooth movements and it allows clinicians to use the me- chanics and adjuncts of their choice. As doctors modify the desired final outcome in the Ap- prover software, they can view in “real time” how the changes affect the opposing occlusion. Once the clinician finalizes the ideal setup, the Insignia soft- ware engineers the customized brackets, wires and precision bonding placement gauges to the exact prescription required to deliver the designed end re- sult accurately and efficiently. My experience with Insignia is with both the customized pas- sive self-ligating appliance (In- signia custom SL) and Insignia using stock Damon® System appliances. The Insignia soft- ware can be used to fabricate patient-specific conventional twin brackets and aligners as well. You can also use Insignia software with stock appliances (Orthos®, Inspire ICE™ and, as I mentioned, Damon). The difference between custom- ized Insignia and Insignia using stock brackets is the third-order customization (torque) that is engineered into the customized brackets. This difference saves considerable treatment time and effort over using a “best fit torque” stock appliance. Having treated with both customized Insignia SL and Insignia using stock Damon brackets, I can at- test to the superior value of the customized appliances. The Clinical Evaluation My initial experience with cus- tomized Insignia SL began in 2007 when I conducted an ex- tensive clinical evaluation by treating 41 patients to comple- tion. The only limitations on the selection criteria were that pa- tientshavenomissingorimpact- ed teeth, no pending restorative needs, and must not exhibit poor oral hygiene. The criteria were limited in these ways simply because it wouldn’t have been feasible for me to coordinate the ancillary procedures from across the country. At the time, I was in the process of opening my new office in Connecticut and the clinical evaluation was to be conducted at Ormco in California—nearly 3000 miles away. For operator consistency, I played the roles of doctor and assistant, performing the diag- noses, treatment planning, ini- tial bondings and wire changes, providing all mechanics for 100% of treatment. Full records were taken of each patient, in- cluding PVS impressions and iCAT® scans (Imaging Sciences, International, Hatfield, PA) for diagnostics and treatment plan- ning using the Insignia interac- tive Approver software. Based on my previous experience with Damon System appliances, I es- timated that treatment time for the 41 patients would average 17.5 months. While I wouldn’t recommend selecting this many patients to begin treating with customized Insignia SL for the first time, I am convinced that the best way to learn Insignia is to submit cases regularly. Regular case submission allows the clinician to relate what is designed in the digital environment to the clini- cal experience and final results. This positive feedback loop of learning will help the clinician design each successive Insignia A new era in digital orthodontics Fig. 1a-b. T1 and T2 with brackets Fig. 2. The Insignia Approver soft- ware gives clinicians unprecedented flexibility and control in designing case outcomes. Henry Schein Dental, Dr. Ghassan Nasser Hussein, Sales and Marketing Director (Henry Schein) Middle East and North Africa, Mobile: +971 50 4813292, Tel: +971 6 5252842, Fax: +971 6 5531291 E-mail: ghassan.nasser@henryschein.com Ritter Concept GmbH, Germany, Christian Findeisen Sales and Key Account Manager, Middle East/ Africa Ritter Concept GmbH, Mobile: +971 56 9578689 E-mail: christian.findeisen@ritterconcept.com www.ritterconcept.com *** Exclusively distributed by Henry Schein Middle East *** l Reliable, stable and flexible Ritter unit l Synchronized patient chair with seamless upholstery l Electronically driven instruments l Very interesting in price and efficiency, can also be fully equipped with multimedia/monitor & camera ULTRA Perfomance E Modern designed flexible patient chair, synchronized Solution with a chair mounted X-ray device Ritter made in germany Middle East and North Africa, Mobile: +971504813292, Tel: +97165252842, Fax: +97165531291 Ritter Concept GmbH, Mobile: +971569578689

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