Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 28

Let's Talk About That

breathing? Are there subtle smile and facial
asymmetries noted prior to treatment? These are
just a few questions that we need to investigate
prior to treatment. We all have had experiences
in which those subtle findings surfaced and
become more obvious during treatment. Sometimes these unexpected occurrences require
extended treatment time, an alteration of the
original treatment plan, and/or even an unexpected result.
The second component is a clear vision of our
expected outcome. Is there visualization for the
occlusion, facial balance, and smile attractiveness? Will treatment enhance or detract from
facial esthetics? And of course, for completeness
we need similar visualizations for periodontium,
jaw joint, and airway health.
The third component is organized mechanic
sequencing. All orthodontists have their approach
to efficient mechanics. As an educator, when a
student brings a case to me that may have finishing challenges, I often view it as a diagnosis problem or an unreasonable expectation.
PT: Can you describe your protocols for achieving
treatment efficiency?
SR: Our office has protocols for a complete diagnosis, techniques to visualize the expected outcomes (using Visualized Treatment Planning
software), and a direction for efficient mechanical sequencing.
In the fixed appliance treatment for the growing
patient in the permanent dentition, the first step
is accuracy of bracket placement.
After the brackets are placed, treatment sequencing begins. Each clinical staff member and I see
what must be done at each office visit and know
what to expect from the outcome from that visit.

28

Treatment is divided into three stages; each stage
has specific objectives and a timeline of expectations. Stage 1 is primarily leveling and aligning
the brackets. However, we also look to initiate
midline corrections and begin closing open bites.
Stage 2 is the working stage, when A-P, transverse, and vertical changes are made. We have
specific expectations for achieving these
changes. If not, there might be patient cooperation issues and/or misdiagnosis of facial growth
expectations.
Stage 3 is the finishing stage- or, as we learned
in school, "detail and retain." This used to be very
tedious, with ad nauseam wire bends and a timeline of six to nine months. However, with preadjusted bracket systems, initial use of flexible
wires, and alert and timely bracket repositions
at the end of Stages 1 and 2, Stage 3 should only
take three to four months. If not, I was inefficient
in Stages 1 and 2.
In addition to an attentive office crew who makes
every office visit meaningful, there are other
modifiers for clinical efficiency such as welldesigned bracket prescriptions, self-ligating
brackets, office motivational techniques, and the
use of accelerated tooth movement techniques.
My passion for efficiency was demonstrated in
four cohort studies of 100 consecutively started
patients over 15 years, and graded by an independent orthodontist. These cohort studies
documented that the three above efficiency
components reduce treatment time and produce
better occlusal outcomes, as scored by the independent graders.
Time limits all the protocols we use; however, if
any of your readers would like more information,
they may email me at straty.er@gmail.com, and
we can set aside time to discuss.

PCSO Bulletin  Winter 2017



Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2017

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