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

Dental Tribune Middle East & Africa Edition | September-October 2015 27ortho tribune < Page 26 case with a higher level of un- derstanding and accuracy and hence be more successful with its application. My experience has been that clinicians who regularly submit Insignia cases are more successful with it than those who start only a few cases and wait to see how they work out. My skills improved sub- stantially through the first 10 to 20 cases, and like using any other new appliance, it takes a bit of time to learn the nuances. I also strongly recommend doc- tors initially select easier cases, and then add more challenging cases when they become famil- iar with the software and clinical protocols. In late February, 2008, in a one- chair operatory at Ormco’s In- signia manufacturing facility in Glendora, California, I bonded all 41 patients over a five-day period. This intensive week of bonding proved to be my first in- sight into the potential efficien- cies of Insignia’s direct view/in- directbondingprocess.Afterjust the first few patients my bonding technique using the placement gauges significantly improved and during the balance of the week, the bonding appoint- ments averaged less than one hour, including preparing the teeth, bonding the brackets, placing bite turbos, engaging the wires, attaching the elastics and reviewing the patient instruc- tions. And all without the help of a clinical assistant! We all know the importance of placing brackets correctly, but few of us can consistently and quickly place each bracket pre- cisely where it needs to be. With Insignia, you design the final oc- clusion and the customized ap- pliances will be fabricated with custom torques, custom bases (in-out) and custom wires. You specify your bracket position- ing preference (e.g., center of the tooth, more gingival or more incisal) so that the custom ap- pliances are designed to your specifications; thus, it is possible for your Insignia SL appliances to clinically match the place- ment of your direct-bonded ap- pliances. To transfer the Approver-de- signed appliances to the mouth, Insignia provides customized placement gauges that place the brackets in the right spot with- out need for adjustment (Fig. 4). The precision built into the brackets is matched by the ac- curacy of the placement gauges that offer the benefit of a di- rect view with the precision of planned indirect bonding. The major challenge in con- ducting this clinical evaluation was logistics. Managing treat- ment from so far away was a daunting experience at first; however, the process reinforced the importance of good clinical decision making and its impact on clinical efficiency. Gone was the luxury of shortening pa- tients’ appointment intervals to accommodate case manage- ment alternatives when we need to make clinical decisions based on how a patient responds. It was thus incumbent upon me to create mechanical systems that would withstand the eight- to ten-week appointment cycle of my West Coast trips. At six months, the first pa- tient finished treatment and by December 2009, after just 21 months, the 41st patient had his appliances removed. To deter- mine the value of customized Insignia SL for my own prac- tice, I initially compared the results of this evaluation with my previous seven years of ex- perience treating patients with direct-bonded Damon System appliances. This comparison helped me evaluate customized Insignia SL with what I used to do in my office—direct bond- ing. These 41 customized Insig- nia cases treated in an average time of 12.5 months — a full five months (28%) shorter than my estimate of 17.5 months (Fig. 5). I based the estimates on my pre- vious seven years of experience with the Damon System appli- ance but before I had had any experience with Insignia. In my opinion, this difference alone attests to the efficiency of cus- tomized Insignia SL treatment. Another value indicator was the number of repositioned brackets needed to finish the customized Insignia SL cases, which was 50% less than my cases with direct-bonded stock Damon Sys- tem appliances. After completing the evalua- tion, I compared the results with comparable patients I later treated with Insignia using stock Damon appliances. This second comparison assisted me in plac- ing a value on the patient-specif- ic customized torques of the cus- tomized Insignia SL appliance. The 41 customized Insignia SL cases in the evaluation finished in 22% shorter treatment time (at 12.5 months) than the next consecutive 41 cases using In- signia with stock Damon brack- ets that I treated in my private practice (16.1 months). The av- erage number of appointments for the 41 Insignia stock Damon cases was 10.2 versus 8 appoint- ments for the 41 customized In- signia SL cases. In terms of quality, a subjective evaluation I grant you, I feel that my customized Insignia SL cas- es finish with quality that equals or exceeds my direct-bonded Damon System cases or my In- signia cases using stock Damon brackets yet in less time and with significantly less effort. I have felt confident enough with the customized Insignia case results to have shown them in presentations around the world and have been so pleased with the results that I now treat 70% of my cases with customized In- signia SL appliances. I still treat 30% of my patients with direct- bonded stock Damon appli- ances, primarily those who start treatment in late mixed denti- tion, but for all those cases for which customized Insignia SL applies, it is now my appliance of choice. This article highlights a few of Fig. 4. Insignia customized placement gauges offer the benefit of direct view bonding, putting the brackets in the right place without adjustment. Fig. 3. The digital model of each patient’s lower occlusion shows the shape and size of the cortical limits of the mandibular bone. Dr. Kozlowski obtained his DDS degree in 1996 and a certificate in or- thodontics at State University of New York at Buffalo in 1998. His prac- tice, Kozlowski Orthodontics, has locations in New London and East Lyme, Connecticut. He has lectured extensively all over the world, in- cluding for the AAO and its various constituent societies and universi- ties and study clubs as well as annually at the US Damon Forum and European Damon Symposium. His topics include efficiency and excel- lence in orthodontics, early treatment and facial esthetics. He has also been published in several orthodontic journals, including Seminars in Orthodontics and the Journal of Clinical Orthodontics. A fitness advocate, he has completed five Ironman Triathlons, more than a dozen Half-Ironman Triathlons and numerous marathons and endurance cycling events, including the grueling Mt. Washington Bi- cycle Hill Climb seven times. He and his wife, Amy, a pediatric dentist, have two children: Amelia and Jake. About the Author Your Practice. Our Priority. Register on our websites www.ormcoeurope.com www.ormco.com 2ND MENA SYMPOSIUM DUBAI - DECEMBER 3rd to 5th - 2015 Couv 16P Ormco with QR 2015_Mise en page 1 01/06/15 10:42 Page1 the patients I treated in the clini- cal evaluation, demonstrating the quality of the results and ef- ficiency of treatment. Fig. 5. Breakdown of 41 Cases in Clinical Evaluation Class I – 19 Cases » 5 were Class I, div 2 Class II, div 1 – 11 Cases Class II, div 2 – 5 Cases Class III – 6 Cases » 3 were Class I with Class III tendency » 3 were full Class III Couv 16P Ormco with QR 2015_Mise en page 101/06/1510:42 Page1

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