Many clinicians talk about “impression less” solutions.
Do we need such a solution?
Typical conversation as from discussion is as follows:
A: Has anyone attempted the impression-less practice yet? If so, do you have any feedback on labs you have used, turn around time on appliances, or any other useful feedback.
B: We get our vac retainers and removable appliances from laboratory XXX in YYY city. He is the cheapest and has the fastest turnaround time. He uses a fairly low resolution printer but it seems to be adequate for what we are doing.
C: Indirect bonding has been our biggest problem. O. is committed to indirect bonding and also committed to conventional twin brackets which has made finding a good digital indirect bonding system a problem. I’ve done about 25 insignia cases but unfortunately those self ligating brackets are not universally appreciated in our practice.
D: We’ve tried using our traditional indirect bonding lab setup procedures on printed models but to date we haven’t found a separator that works adequately. We seem to be having some success with hobby glue rather than traditional separating mediums. I don’t think that trying to do a traditional indirect bonding setup on printed models is the future so I haven’t been as enthusiastic about finding a solution for the problems as I could be.
E: We’re now using a company called ZZZ who have links to the old HHH system that seems to have been buried by align. We’ve done about 20 cases. We’re not really comfortable with the bonding system at the moment.
The bracket bases are clean like an insignia bracket but are positioned in traditional full arch, dual layer trays rather than rigid insignia jigs.
Our bond strength has suffered in the last 18 months which is frustrating.
We could accept paying more for our lab bills if we felt that we had a good, reliable, accurate bonding system with the potential to reduce treatment time but at the moment this has eluded us.
We’re still on the quest to find a digital indirect bonding system that we’re happy with.
A large part of our decision to head down the digital outsourcing pathway is the size of our practice, staffing levels and physical plant.
It was very interesting to learn about your experience with different Indirect bonding systems, something that I have been doing as well for a number of years. Whilst lecturing abroad, I came across a Polish company, who have spent the past 12 years developing software (DDP Ortho) based around digital diagnostic models, which enables you to place the brackets digitally. Plaster models/digital models/intra oral scans are turned into digital diagnostic models through post processing: ensuring the occlusion is correct, measuring the widths and heights of the teeth etc. The digital diagnostic model enables you to do your diagnostics and treatment planning using built in analysis and various tools in the software. The bracket placement is fully in your control with no involvement from a technician, which not only means that you are making all the decisions, but also decreases the turnaround time and the cost compared to some other indirect bonding systems. The files containing the bracket positions, prescribed by you, are e-mailed back, jigs are 3D printed according to your prescription and brackets are inserted. This is then posted back – ready to bond.
The jigs themselves come as a whole arch but have got grooves separating the teeth, which makes it quite easy for you to segment the jig so you can bond sections, to your own preference.
The brackets pads come clean, so you can use your preferred bonding materials. The system is not dependant on a specific bracket system, and a library of brackets are held within the software.
Here is a the website containing a short video on how the system works for a bit more info: https://ortodonta.com/area-doctor/
A: Sounds like what we’ve been looking for.
The system does allow you to do a diagnostic setup. You actually choose the wire size and shape and the software will marry the wire and the bracket by selecting a tick box. You then move the teeth in relation to the” fixed wire and bracket structure.”
During the initial bond up, the brackets are placed digitally on the model and you can move them in 3 planes of space. There is also a possibility to view the setup in 3D with 3D glasses. This makes the digital “bond up” more realistic for my patients. Others choose not to use it.
They arrange a webex with you if you want to see more.
Clinician Software DDP-Ortho is for free and we are looking for local labs for clinician’s service.