ROHIT SACHDEVA

2011-09-02T14:30:00.000-05:00

JOIN THE EXCLUSIVE ORTHODONTIC COMMUNITY

ÚNETE A LA COMUNIDAD ORTODONCIA EXCLUSIVA

タスク参加排他的矯正コミュニティにおける

Treten der exklusiven Gemeinschaft kieferorthopädischen

E-mail/correo electrónico/メール/: improveortho@gmail.com

REINVENTING ORTHODONTICS TABULA RASA, 23rd AOC. Perth, Australia (10-14 February, 2012)

2011-09-02T14:17:00.000-05:00

SMART Orthodontics. SureSmile Conference. Gold Coast, Australia (11-12 November, 2011)

2011-09-02T14:14:00.002-05:00

SureSmile in a Multiverse world Israel (September 2011)

2011-09-02T14:10:00.001-05:00

Propelling towards the Age of Singularity in Dentistry. Fukuoka, Japan (Aug 30, 2011)

2011-09-02T14:08:00.001-05:00

Yame dental Group

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Driving Orthodontic Quality with Digital Treatment. AAO Annual Session. Chicago (May 13-17, 2011)

2011-05-04T13:57:00.000-05:00

SureSmile Users Conference, Orlando, Fl (March 3-5, 2011)

2011-02-05T12:53:00.000-06:00

Organizing High Reliability Practices: The role of Clinical Decision Support Systems and Robotically Assisted Orthodontics. Houston, Tx (March 18-20, 2011)

2011-02-03T18:28:00.000-06:00

45th Indian Orthodontic Conference, Mangalore, India (17-19 Dec, 2010)

2010-10-13T10:46:00.000-05:00

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Minimum Interventional Orthodontics, Guadalajara, Jalisco (29-30 Oct,2010)

2010-10-12T16:01:00.000-05:00

Link: click here

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Orthodontic Meeting. Catanzaro, Italy (29-30 Sep, 2010)

2010-10-01T11:27:00.000-05:00

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DEBUNKING SURESMILE MYTHS

2010-08-10T16:41:00.000-05:00

Dr. Sachdeva has prepared this small presentation to help clarify the misunderstandings around SureSmile. Please feel free to provide comments.

If you would like to get a copy of this presentation please contact Dr. Sharan Aranha @ improveortho@gmail.com

MYTH #1 SURESMILE IS PUSH BUTTON ORTHODONTICS

MYTH #2 SURESMILE MOVES TEETH FASTER

MYTH #3 SURESMILE CAUSESROOT RESORPTION

MYTH #4 NO EVIDENCE THAT SURESMILE IMPROVES TREATMENT TIME AND QUALITY

MYTH #5 FASTER TREATMENT IS BAD FOR THE PATIENT

MYTH #6 SURESMILE MECHANICS IS ALL ABOUT THE WIRE

Click here to download file

Article-Interview with an innovator: SureSmile Chief Clinical Officer Rohit C. L. Sachdeva (AJO-DO, Aug 2010)

2010-08-10T12:51:00.000-05:00

ARTICLE OPEN FOR DISCUSSION AND COMMENTS

Link To Full article: click here

Transforming Clinical Orthodontics through Hindsight, Insight and Foresight : A Personal Journey

2010-08-09T12:55:00.000-05:00

Patient DD: Class I Progress (7/12/10-1/25/11) DEBONDED 6 months !

2010-08-09T08:59:00.000-05:00

- Submitted by Dr. Rohit Sachdeva and Dr. Jeff Johnson

TREATMENT PLAN

SMART BRACKET PLACEMENT

PROGRESS NOTES (8/12/10):

Dear colleagues,

These are the latest intraoral images taken on patient DD. Please note that lingual power chain has been placed to derotate the incisors. I do not believe this will be effective until additional space is gained with IPR. Also the fanning of the lower incisors is seen as a result of the bracket geometry of the lower laterals. This should work out with a heavier wire or as the incisors derotate. Again note that the overjet at the cuspid level is minimal adding to substantial constraints. Selective and strategic IPR are paramount in achieving successful alignment in a timely fashion in this particular situation. Best Rohit.

The Shullman Smile Seminar Series (June 3, 2010) Patient 3-EF- (1/25/10-8/31/10)Debonded!

2010-04-28T10:00:00.000-05:00

Dr. Howard Shullman demonstrates treatment of patient with Class I malocclusion in real time with SureSmile technology.

isit 1: Initial Records (1/10/10)

a. Took initial photos

b. Took CBCT Scan

Treatment Simulations

a. Initial model vs plan

b. Plan bracket placement

Visit 2: Bonded braces upper and lower - All Teeth – 7—7 (1/25/10)

a. GAC Innovation-C brackets U/ 5—5

b. GAC Innovation-R brackets L/ 3—3

c. Placed composite buildup on lower 1^st molars to open bite and allow correction of crossbite of UR3.

Visit 3: Emergency Visit (2/13/10)

– hooks on U/L 7’s removed due to tissue irritation

Visit 4: Progress Photos (2/23/10)

Visit 5: Progress Photos (3/15/10)

a. Placed 018 NiTi Upper and Lower back to 7’s

b. Placed stops mesial to upper and lower 6’s.

c. Placed button on the lingual of the UR3, patient will wear 3/16 4oz crossbite elastic

d. IPR lower 3—3 and distal to UR3.

Visit 6: Progress Photos (4/1/10)

a. Power Chain U2-2

b. Cont x-bite elastic on the right side only, photos

Visit 7: Progress Photos (4/19/10)

a. Inserted new UAW (20 x 20 Bioforce)

b. Power Chain U2-2

C. Cont x-bite elastics on the right side only, progress photos

Visit 8: Progress Photos (5/10/10)

a. Insert U 17x25 N, PC U2-2, bonded buttons lingual UR3-4

b. Changed elastics to x-bite/box: lingual UR3-4, buccal LR3-4

C. Added stops mesial of U/L 6's

Fig. Wire1

Fig. Final wire (17x25)

Fig. Upper Torque

Fig. Final Archwire (19x25)

Fig. Torque wire (without expansion)

Fig. RCOS (Expansion)- 19x25

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Visit 9: SureSmile wire Insertion (6/3/10)

a. Inserted U/L SureSmile wires U/ 17x25 Copper NiTi with 6.0 expansion and 3 mm curve of spee, L/ 17x25 Copper NiTi with 6.0 expansion and 4 mm curve of spee.

b. IPR mesial/distal LR2-LL3 , PC L6-6,

c. Removed lingual buttons, discont. x-bite elastics, changed to Class II box (Rt side: U3-4 - L45, Lt side: U3-4 - L56)

Visit 10: Progress (7/12/10)

a. Insert U/L aw's - 19 x 25 CuNiti-Niti (3mm RCOS & 6mm expansion)

b. PC U6-6

c. Changed elastics to short Class II on both sides (U3-L4, U4-L5), 3/16 H elastics

d. Removed bite turbos from L6's

e. Progress Photos

Visit 11: Progress (7/27/10)

a. Insert U/L Final 19x25 Copper-Niti aw's (without RCOS or expansion)

b. IPR mesial/distal UL2, distal of LR3, LR2, LL3, & LL2

c. PC U/L 6-6

d. Bonded bite turbos mesial/buccal of L6's (open bite approx 1mm)

e. Changed elastics to Class II on both sides (U3-L6)

f. Enameloplasty LR3

g. Progress Photos

Visit 12: Progress (8/17/10)

She still looks slightly class II ish on the left and for sure not interdigitated. She has a slight space, light contact, distal to UR2 and also distal to UL1, so powerchained her on the upper to close last remaining space. Her lower anteriors are not in contact with the lingual of the upper centrals, about .5mm space between, so should have enough overjet to close remaining upper space. I continued her on class II elastics for 2-3 weeks and hope to place sectional wires with zig-zag elastics for a few days prior to debonding.

Visit 13: Progress (8/31/10)

Sect UAW 2-2 and Sect LAW L3-3, laced U/L 6-6, removed occlusal bite turbos, changed elastic wear to short Class II (U3-L4, U4-L5, U5-L6) on both sides, 3/16M elastics, progress photos. Patient will be debonded in one week.

Visit 14: Progress (9/7/10)

Debonded U/L arches, removed composite, prophylaxis. Bonded fixed retainer lingual L3-3. U/L imps for essix retainers & final study models. Final photos and pano.

AAO 110th annual Session, Washington, DC (April 30-May 4, 2010)

2010-03-12T10:21:00.001-06:00

View the Lecture(Videos included): click here

(Due to the file size the download could take approximately 5 mins. Please let the download complete in order to view the pdf file.)

Seminars at University of Hokkaido Health sciences, Japan (Apr 3, 2010)

2010-03-10T14:55:00.000-06:00

Southwest Dental Conference Center for Knowledge 2010: Orthodontic Treatment with SureSmile (10-27-09- 2/16/10)

2010-03-09T14:18:00.000-06:00

7LIVE DEMONSTRATION OF ORTHODONTIC TREATMENT WITH SURESMILE

Link to the Blog: http://suresmileliveblog.blogspot.com/

The purpose of this blog is to provide the participants at the South West Dental Conference 2010 an overview of the SureSmile process and its application in the treatment of orthodontic patients. The treatment of a patient with SureSmile will be demonstrated "live" from start to finish and regular updates of the progress of the patient's care will be posted.The patient will also share perspectives on his care experience on this blog. We welcome questions and comments from you. We look forward to your active participation on this blog and highly recommend you to read both the PATIENT and the DOCTORS posts. You will also have the opportunity to see this patient at the conference.

[DISCLOSURE: RS has financial interest in SureSmile and patient JL works for OraMetrix. JJ is the care provider]

Visit 1: Initial Records (10-20-09)

Patient JL initial photos and scan with CBCT.

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Interactive Virtual Treatment Plan (10/24/09)

Diagnostic simulations performed to plan treatment.

Virtual consult with patient using the web tool http://www.gotomeeting.com/

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Visit 2: Bonding and Initial archwire (10/27/09)

Progress Photos

Therapeutic Scan- 11/17/09

IPR Performed on Upper and Lower anteriors

12/29/09 Progress Notes:

The straight archwire phase of treatment is now complete. The patient now enters the SureSmile Therapeutic phase of treatment. A therapeutic customized prescription is being designed by Dr. JJ and a virtual 3D set up will be designed based upon this prescription. Using SureSmile robotic technology a customized archwire will be fabricated and inserted live at the SouthWest Dental meeting. The entire lab process will be shown next week.

Patient JL Activity Log (10-27-09 to 2-16-10)Finish!

2010-03-07T14:42:00.000-06:00

About me

I would consider myself to be most comfortable in the outdoors as I love to hunt, fish and camp. I also enjoy sports. I will be running my 3^rd marathon this December. I am blessed with a wonderful wife and three beautiful children ages 5, 3 and 1.

My educational background is in engineering and I also have an MBA degree. I am currently employed with OraMetrix since Aug 2008.

My decision for braces

I never actually wanted or thought I needed braces when I was a teenager. I have never had any major dental work done other than restoring my left front tooth with a veneer, in fact I do not have any cavities.

At a routine dental checkup my hygienist alerted me of recession in my upper gum line that is being aggravated by a cross bite. It is my hope that by fixing this problem with braces, that it will help to stop from further aggravating my gums.

Besides…I know firsthand from patient feedback that my expectations such as shorter treatment time and quality of care will be met with SureSmile technology.

Visit 1: Initial Records (10-20-09)

My pre-treatment photographs and X-rays were taken. I opted to go with CBCT scan for my X-rays. The scan time was only 30 secs with this device. I was instructed to stay still during the capture to prevent shaking of the image. This was a smooth visit and took only 30 minutes of my time.

Interactive Virtual Treatment Plan (10/24/09)

I was really amazed to see how perfectly my tooth and root anatomy was captured by the scan. I had an opportunity to discuss my treatment plan closely with my doctors over the web. I was able to visually understand the whole process of virtual simulations with different treatment scenarios and also the possible risks. In addition, I was given a chart with estimated treatment progress to be expected during the course of my treatment. This was pretty impressive and I felt more confident to go with the decision of wearing braces. I plan to take my pictures to track my progress against the estimated weekly treatment scenarios.

Below are the charts that were provided to me to monitor the progress for my initial alignment. I will be receiving more charts to monitor my treatment progress over the course of my treatment.

INITIAL ALIGNMENT PHASE

Visit 2: Bonding (10/27/09)

Dr. Johnson had planned the bracket placement using simulation and was using this as a guide to place brackets. Brackets were bonded to my upper and lower teeth. Interproximal Stripping (IPR) was performed to create space between my teeth, lingual buttons were inserted and turbos were placed on my lower molars to facilitate tooth movement. Finally, upper and lower NiTi wires were tied to the brackets. The pressure from the wire insertion was pretty forceful. But, I experienced no pain at this point. The whole process lasted approximately 2 hours. Following the bonding I was given instructions on how to maintain oral hygiene, placing elastics, pain management and what foods to avoid.

MY ACTIVITY LOG:

Day 1 (10/27/09):

I did not have actual teeth pain (scale 2) but I did have a mini panic attack after trying to eat for the first time. I really wanted to rip off everything and enjoy my food. I had soup and a milkshake for the first day. I tried to eat pizza but I would say that it is like eating with two marbles in my mouth. I believe the turbos bother me the most. I also had difficulty putting on elastics for the first time as I would have expected. I was so tired from the whole process that I actually slept fairly well.

Day 2 (10/28/09):

I woke up this morning and my cheeks and tongue were extremely sore from all the new appliances in my mouth. I would say that my pain level would be scale 4. I took some ibuprofen and applied topical gel for temporary relief. I also used some wax on the brackets and buttons which has really helped.

On my new day with braces I was unable to eat breakfast and it took me much longer to brush and floss my teeth. I started to feel some pressure on the teeth which did not exist the day before. I had soup for lunch. I am hoping I feel better as I get used to the foreign material in my mouth.

The night hasn’t gotten any better as I am still trying to lessen the impact that the brackets/ buttons are having on my tongue and cheeks. I managed to eat sparingly this evening.

Day 3 (10/29/09):

I have had enough of trying to pick the food out of my teeth. Some advice that I have received from a colleague was to invest in a waterpic. I bought one yesterday and I tried it out this morning. Even though I brushed very well the night before, I was surprised to find the amount of food left over in my teeth from the night before. Good investment!

I am actually starting to get really used to the elastics and in fact I have tried to insert them without a mirror but ended up putting the rubber bands onto the wrong teeth. This has led me to wonder what would happen to the movement of my teeth if the bands were continually misplaced.

Soup seems to be the main course for me for lunch and dinner.

Day 4 (10/30/09):

While the pain is beginning to subside from the rubbing of the appliances on my cheeks/gums, I am starting to feel more pressure on the teeth. I consider myself to have a high threshold for pain and would say that I am still at a 4 on the pain scale. The pressure is noticeable but certainly not unbearable.

Interestingly, I am noticing more pain on the front left tooth with the veneer than I have on any other teeth. Not sure what the reason would be for this phenomenon.

Even though I have had to avoid many of the foods that I love, I am slowly getting used to eating with the turbos. For obvious reasons, the best foods I have found to eat are eggs, yogurt, oatmeal and soup.

Day 5 (11/1/09):

It is Halloween, no trick or treating for me tonight but my kids will enjoy eating all the candy they obtain. I have been trying my best to be compliant with the braces by not eating from the “foods to avoid” list. However, I tried eating popcorn today and managed to capture 70% of everything that I ate …thank you Water pik!

Pressure and pain has slowly subsided to a scale 3.

I forgot to insert my elastics today – not sure if this will affect my treatment times but I will certainly try to make this an exception.

Day 6 (11/2/09):

Move, move, move. I realize that I am a long way from my prescribed results – as shown from the virtual simulations - but I have noticed (from the pictures that have been taken) some movement on my bottom teeth from when I first started. That is a very encouraging sign. It is definitely a valuable tool to be able to monitor the movement of my teeth and see where I am at in comparison to the weekly treatment plan.

I would consider pain to be a 2 on the scale today with noticeable pressure on my teeth.

My next goal is to eat normally again – meaning, I don’t want to have to think about having to chew my food.

Of note, is that I am still consistently wearing my elastics. I was thinking that it would be a hassle trying to wear the bands consistently, but it hasn’t been.

Day 7 (11/3/09):

Today I celebrated my 1 week anniversary with braces. I am at the point now where I don’t need to apply wax as my tolerance for the brackets has increased. Still a 2 on the scale but that is a good thing considering where I was last week.

I am really looking forward to having my SureSmile scan in the next week or so.

Week 2 (11/4/09-11/11/09):

I would consider the first 2 weeks being the ‘adjustment phase’. I am feeling less discomfort at this point compared to the previous week. I would say my pain scale is down to 1 now. That is the positive part – the negative part is that my teeth can’t move fast enough. I am still not to the point yet where my braces have become a part of me and I am not thinking about them constantly. My notion is that it will feel natural at the point when I am finally braces free.

I am able to eat most of the food that I want. Having a sweet tooth I miss having chocolates one of the many restricted foods for those of us in braces.

My kids are curious as to what my teeth will look like after treatment and I show them the simulations which they are following with me.

I am really looking forward to my scheduled OraScan appointment next Tuesday (11/17/09)

Week 3 (11/12/09-11/19/09):

It has already been 3 weeks and today is the day I have been anticipating. I am scheduled to complete the Ora-Scan today.

In order to carry out the scan, the old wires were removed in order to apply Sure White, which coat the teeth so that the scanner can reflect and capture the shapes and contours of each tooth.

I must say that even though I was virtually pain free at this point, I was still immediately relieved when the old wires were removed.

After gargling with Listerine for about 5 minutes, I was ready for the application of Sure White. I would compare this part of the process to painting the teeth with liquid white out. Going section by section within the mouth, the entire scan in itself was a very quick process and the experience of the staff made the entire process go very smoothly.

After the scan, IPR was initiated to help with the further movement of my teeth. For me personally, this wasn’t a painful process but it is still unnerving knowing that my teeth were being filed.

Now I was ready for the insertion of the new wire, which was a slightly thicker version than the previous wire. Similar to last time, putting the wire in was a very forceful process. It helped though to have been through the process once before so I knew what to expect. I am glad that’s over with.

The new wire is now in and I can really feel the pressure on my teeth. Going back to the pain scale as a reference, I would consider it to be a 5 to 6, which is basically saying it is more painful than the previous time. Chewing food is more difficult because my teeth and roots are much more sensitive. I am sure it will get better soon.

Week 4 (11/20/09-11/27/09)

It is now officially my 1 month anniversary with braces. Is it too soon to ask for them to be removed?

It has been a week since the new thicker wire was inserted and I have been able to adjust to it quite well. I consider the second week after wire insertion to be an adjustment phase because it is very similar to week 2 after I received the initial treatment and had to adjust to the initial discomfort. The force of the new wire has put much more pressure on my teeth but I have become accustomed to the feel. Pain has subsided to a level 2 on the scale and I am able to eat quite freely now.

In addition to the new wire, I am also required to put 8 rubber bands onto my teeth. I am certainly used to putting in the rubber bands into my mouth at this point. My children continue to ask me why I have rubber bands on my teeth and since they want to be like Dad, they also want to wear the bands also.

My lower teeth have rotated quite nicely to this point and I am also able to view a noticeable difference in movement on my upper teeth from when I first had braces put on. It definitely appears that I am on track with respect to the virtual treatment plan.

Week 5 (11/28/09-12/5/09)

After 5 weeks in treatment I have really been able to not only see the movement in my teeth but feel the movement as well. After enjoying some time off over Thanksgiving, I was scheduled for another orthodontic appointment this week. During this visit, I was scheduled to have a bracket repositioned on one of my lower teeth to help facilitate movement. In addition, I was to have two new sets of wires inserted.

I have come to quickly realize that putting in new wires is a strong indication of more initial discomfort. However, if this means that I will get out of braces sooner then so be it.

During this appointment, I was pleased to hear that everything was falling into place in terms of the initial treatment plan. This basically means that I am still on track to finish at the prescribed timeframe.

INITIAL ALIGNMENT PHASE

The appointment went off without any problems and as expected there was enough initial discomfort to reach a 5 on the pain scale. By the next day though, I was able to quickly adapt to the discomfort and dial the scale down to a 1 or 2.

Of note, it is very interesting to compare notes from the treatment plan to actual pictures. As you can see from the before and after, my teeth have really taken form and are well on the way to perfect occlusion.

In the meantime, I will continue to maintain compliance and wear the elastics, which is now up to 8 at one time. But like I said before – whatever it takes to finish sooner.

Week 6-8 (12/6/09-12/29/09)

As the holiday break approaches I was presented with an early gift today. Today’s doctor appointment was a clear indication that my teeth are aligning on schedule. The turbos that help to keep space between my lower and upper arch was shaven down to a fraction that it once was and the lingual buttons that covered my teeth were removed. A power chain was also inserted on the lower arch to help further the movement of my lower teeth.
My sincere thanks goes out to both the doctors and staff, who helped me to understand the progress that I have made to this point and what I should expect next. Typically, I can anticipate some level of discomfort when I am in the practice for a follow-up visit but today was a pleasant surprise. After having the lower wire inserted along with the power chain, my level of discomfort is near a 0 on the scale. As an added bonus, I was told that I would not need to continue wearing the elastics that once covered the inside of my mouth. It was a very good day indeed.
My next visit will in all likelihood be the insertion of the SureSmile wire, which I have been looking forward to for the past several weeks.

Week 9 (12/29/09 – 1/6/10)

A noticeable difference can be seen after 2 months of treatment in the straight wire to both the lower and upper arches. The leveling of my teeth on the upper arch is very apparent while the crowding in the lower arch is substantially less due to IPR and realignment.

I am right on schedule based on the virtual treatment plan that was developed for me prior to treatment:

At this point in time, there is very little discomfort and I haven’t been applying any wax on the brackets for several weeks now. So, other than maintaining compliance with elastics, I am responsible for wearing elastics from my canines to my first molars, I just have to wait until my next appointment to have the SureSmile wires inserted.

Weeks 10-11 (1/6/10 – 1/19/10)

Finally, the moment that I had been waiting for arrived. My customized SureSmile archwires have been created both digitally and robotically. I have witnessed the robots bending SureSmile wires for other patients but it was definitely a meaningful experience for me to see my wires created firsthand. Once the wires were robotically bent they were then placed in a quality control machine to gauge the accuracy of the robot to the actual digital treatment plan. After passing inspection, the wires were placed through a laser marking process to help the doctor position the wire accurately. Finally, the wires were packaged and ready to ship, which in my case, was a hand delivery.

FIGURE 1. SURESMILE UPPER & LOWER ARCHWIRE PACKAGING

The SureSmile wires were inserted on Friday afternoon and though I was anticipating an increase in discomfort, I was surprised to experience no change from the wire insertion. Similar to the previous straight wire insertions, it wasn’t until the next day that I felt any discomfort. Based on the same pain scale, my discomfort was elevated to a 5, which again, is similar to the previous wire insertions.

I have already adjusted to the new wires after only 2 days since the SureSmile wires were inserted. My level of discomfort is minimal, perhaps a 1 on the pain scale. More importantly there has already been significant movement in my teeth. The gap between my upper right teeth has closed significantly and the lower teethe have rotated and are now lining up. Even my smile seems much broader than it did prior to treatment. I am not exactly sure how much longer my teeth need to be in braces but from the untrained eye, I don’t feel that it will be much longer <knock on wood>.

Week 12 (1/19/10 – 1/26/10)

As a patient, there are signals that have made me aware that I am nearing the end of treatment. For example, the turbos that were once part of my daily routine have now been removed. Last week, only minor adjustments were made to help further facilitate the alignment of my teeth. Finally, k-hooks were inserted in order for me to properly wear my elastics. Without an anchor point, I was unable to use the rubber bands and these hooks now allow me to wear elastics to complete the final mile of treatment.

Also of note, I was able to help both Dr. Sachdeva and Dr. Johnson as they presented a live case study at the Southwest Dental Conference last week. My role was to act as the live person in a demonstration of a SureSmile scan. My case was also presented from beginning of treatment through current time.

On a personal note, I wanted to include that being a part of this blog has helped me to truly understand the treatment process as well as to visually track the progress of my treatment plan. It is very easy to overlook the subtle changes that have occurred on a daily basis but thanks to the countless pictures that we have taken it is truly remarkable to witness the gradual changes that have been captured over time.

Week 16 (2/16/10)

I have to imagine that anyone in braces feels like the final appointment is unsurpassed by any other appointment. This is how I felt knowing with great certainty that my braces were going to be coming off. I realize that I was only in braces for 16 weeks or a better way to say it is a total of 119 days but I am literally tired of picking out food and wearing elastics.

So with a great deal of enthusiasm, I headed to the office for my last appointment. It was nice to hear the doctor say that I was indeed ready. Admittedly, some of the brackets came off my teeth much easier than others. I was actually surprised at how persistent these brackets wanted to stay on my teeth. Perhaps the brackets themselves had grown accustomed to my mouth. Regardless, with a bit of force and some discomfort the brackets were finally removed. I figure any discomfort that I experienced is better felt in 16 weeks than in 104 weeks.

With the brackets removed I was actually startled to see the results. When you have braces on you just don’t realize how your teeth actually look. I was actually amazed at the appearance of my new smile and certainly was pleased with the results.

Before being able to quickly exit the doctor’s office and show off my new smile, I was fitted with a nighttime retainer as well as a permanent retainer on the top and bottom of my front teeth. As I have come to find out – your teeth are always moving even as an adult. So my goal is to continue wearing my retainer so I don’t have to go through another 119 days of treatment time.

By the way, I have received nothing but compliments, which is reassuring to hear and know that I made the right choice by getting braces in the first place.

Patient LJ: Class I Initial and Treatment progress (11/18/09-3/7/11)Debonded !

2010-02-09T16:00:00.000-06:00

- Submitted by Dr. Darrell Schmidt

DEMOGRAPHICS/APPLIANCES

Diagnosis/Plan:

Patient was seen initially on 10/26/09 with a chief complaint of crowding and a poor bite. She had a class 1 and a bilateral posterior cross bite, and significant maxillary crowding . There is an anterior cross bite as well. # 10 and 22 hit in CR and the mandible postures forward into CO. There is a bilateral TMJ crepitus audible and palpable. There was a possibility of orthognathic surgery, TADS, and/or reverse pull headgear and class 3 elastics to improve the anterior cross bite explained to the patient and parent. There was a possibility of removing permanent teeth or at least IPR to gain space explained. The success of the proposed palate split was dubious because was 12 ½ when I started the expander. The objectives were to occlude the teeth without a major CR shift, and correct all cross bites with an initial non-extraction treatment.

Visit (4/7/10)

There was a 20x20 Bio-Force Senalloy left in the lower anteriors since 12/28/09. They are basically aligned except for the bracket placement errors that are visible in the latest film. The next visit will be to re-position the brackets that are in error. We are awaiting the eruption on # 29 and the alignment of the upper teeth which includes an impacted canine. The first wire was placed 11/18/09.

Visit (6/24/10)

20x20 Bioforce wire placed in the lower arch and was rescheduled in 6 weeks.

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“Dynamic” Simulation by Dr. Rohit Sachdeva

I have run a dynamic simulation of the correction of the malocclusion based upon mechanics used. Please note that most of the space for the alignment of the canine has been achieved by the advancement of the upper incisors and distal movement of the upper right buccal segment as a result of using the coil spring. My current belief is that little space was gained through expansion of the upper arch. Once we have the therapeutic scan we will superimpose it against the predictive model to assess how valid my assumptions are in the simulation of the dynamic model. Please note that I have not brought the upper right canine to it’s final position since my simulation only accounts for the current state of correction.

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Visit (8/11/10)

There has been endodontics performed on her UR 1 since her last appointment due to devitalization of this tooth. LR 5 was direct bonded and the previously placed 20x20 Bioforce wire was engaged into rotated and partially un-erupted LR 5 Vertical elastics were continued on her right side to assist in the eruption of UR 3and prevent a cant tendency. As soon as LR 5 can be correctly re-bonded she will be scanned, probably after the next appointment in 6 weeks. At that time a new panorex will allow evaluation of all the 7’s positions and eruption potential or lack of it. The patient and her parents are very comfortable with the position of her upper incisors at this point. She does not think they are too procumbent and clinically they appear to me flared, but acceptable for now without any lingual crown torque that I could later add to the SS wires. I also have IPR available on numerous teeth and still an extraction option on the UR E, all of which I could use to reduce the flare of her upper centrals.
I appreciate all the great comments on the blog about this case. Interestingly I am treating her brother simultaneously and he has had one internal- resorbtion caused root canal on UL 2 which was visible and had initiated prior to ortho, and one endo on UR 2 which had an incisal communication to the pulp on an anomalous tooth treated shortly after the start of ortho. Does anyone know if devitalization and/or internal resorbtion have familial origins other than anomalous teeth.?

Therapeutic Scan

Treatment Plan

Visit (10/11/10)

Patient LJ had the first SS wires inserted today. The bracket on the UR E was removed because that tooth is ankylosed and does not appear to be moving. In retrospect I could have checked this on the SS set up as an immovable tooth but at the time I was unsure it was ankylosed. I removed the bracket on it to allow the SS wire to work without any pressure from that bracket. Class 2 elastics were to be worn bilaterally for 2 weeks with a check in 6 weeks to observe the wire progress. The patient is class 1 and the class 2 elastics need are minimal. The patient was appointed in 6 weeks.

Visit (11/22/10)

#1 SS wires were left to work . They have been in 6 weeks and she was re-appointed in 6 weeks. A power chain was placed to close the residual spaces and elastics were not worn at this point. Neither the parent nor patient wanted the ankylosed UR E altered or replaced. Accordingly the dental midlines will be not coincident due to the freeway space on the upper right side being unavailable. The lower 7’s which looked suspect have not erupted and are mesially angulated and appear impacted. The existing 8’s were scheduled for extraction ASAP.

Visit (1/5/11)

Patient was seen 1/5/11 and tooth position errors were noted. An estimated progress model was ordered and the desired correction values from the patient were reversed and transposed to the virtual order form. The progress model was now a replica of the observed discrepancies on the patient. The SS lab will reverse the values and the corrected wire will be placed at the next appointment. The desired correction values taken at chair side were copied on a prescription sheet and included so the viewer can compare my tooth position evaluation and corrective values with their own. # 1 SS wires have been in since 10/11/10 so I assume they are largely passive. The patient was re-appointed in 3 weeks for wire insertion when the revision wire will arrive.

Visit (3/7/11)

Patient was debonded. There was a space left between #10 and 11 due to a tooth mass discrepancy and the dental centerlines being coincident with each other and with the facial midline. A composite is planned to fill in the space mesial to #11.. The UR deciduous retained (at parents request) “A” is larger than the succedaneous tooth so there was a tooth size discrepancy with both an occlusal and anterior-posterior size issue. The devitalized central will be bleached and crowned and the unerupted 7’s are being regularly monitored for eruption progress and will be bonded along with the 6’s and a sectional wire added if they erupt ectopically. Both the patient and her doctor were unwilling to have her wear her appliances until the 7’s erupted. Essix vacuum retainers were made and placed after debonding.

7th Annual SureSmile Conference, Grapevine, Tx (March 4-6, 2010)

2010-02-08T09:41:00.000-06:00

TIN GRIN CUP 2009

2009-08-04T14:09:00.001-05:00

Dentistry 2009

2009-08-03T14:14:00.000-05:00