Australasian Dentist Magazine March April 2021

Category 108 Australasian Dentist Orthodontic Clinicians’ Corner Welcome to our first edition of Orthodontic Clinicians’ Corner. I welcome all questions related to orthodontics and look forward to answering them and hopefully breaking down many of the myths that have been taught in your undergraduate years or by other practitioners. Please feel free to email me with any of your questions (geoff@orthoed.com.au ). columnists By Dr Geoff Hall Dr V of Melbourne asks, “I usually fabricate my own bonded lingual wires in the mouth as I find this can save me time and money, but I have been told by some people that this should not be done – can you please give me your opinion on this?” Dr V, I would highly recommend that you cease making your own bonded lingual retainers – as it is absolutely essential that these bonded retainers are made in a passive state (without any activation at all), as any activated wire will actually cause an orthodontic tooth movement to occur – which is obviously unacceptable in the retention phase of therapy. There are many people who advocate using different materials such as bond-a- braid retention wire which I have utilised this in the past. I have had significant relapse occur as these wires tend to roll around and cause unwanted flaring of an incisor or in particular the lower canine region. My professional recommendation is to always take an impression or a scan prior to the removal of the braces and send this to an excellent technician to fabricate a passive bonded lingual wire. In our practice we use .0175” gold pentatwist retainer wire that is purchased from Gold ‘n Braces in the United States and I have found this to be the best form of retention. However, it is essential that this wire is fabricated in a passive state and is also bonded correctly to the anterior teeth with composite placed on each tooth. In previous and current times there are many orthodontists who still utilise a bonded retainer that extends from the lower canine to canine with pads bonded solely on the 33 and 43– without any adhesion to the individual lower incisors. The theory with regards to this type of retention regimen is that we need to maintain the inter-canine dimension, however, without adhering the wire to the lower incisor region, the lower incisors are still free to rotate or move labially or lingually, hence providing an inadequate form of retention. v v v Dr P of Queensland asks, “Should I be investing in an intraoral scanner?” This is a very interesting question and one that has been asked of me many, many times – and my answer would be a resounding “YES”. There are many reasons to invest in an intraoral scanner at this time – and if you are performing any type of aligner therapy, I believe it’s essential that you utilise an intraoral scanner for purposes of accuracy and time management. Many dentists have said that intra oral scanners are too expensive to warrant the cost – but today I believe that’s a nonsensical argument. One can purchase scanners from $18,000 up to $80,000 – but let’s say a dentist purchases a scanner for $40,000 which from a leasing point of view would equate to approximately $1,000 per month, which would equal the cost of materials for 10 PVS impressions per month, let alone the significant time saving and increase in accuracy resulting from using an intraoral scanner. In addition to this, there are many packages available now (only utilised with an intraoral scanner) demonstrating instant simulations to patients the likely outcome of treatment which is a wonderful marketing tool – and in fact I have many clients using the intraoral scanner to market themselves as an impressionless practice. There is no question in my mind that every practice should be utilising intraoral scanning technology – and it’s now just a question of time as to when every practice will have intraoral scanners– not too dissimilar to the original decision of whether to implement computers in one’s practice, digital radiography and even digital photography – in other words, an intraoral scanner will become a standard of care for each dental practice. Other benefits of intraoral scanning is the ability to delegate scanning to auxiliary staff members and also reduce storage of traditional plaster models that take up significant space without having any use on a day to day basis (but are obviously required from a medicolegal point of view). These digital files can be stored in the cloud and recovered whenever necessary. v v v Dr C of Perth writes, “I have heard you speak about different fee schedules in one’s practice – and I really don’t understand how this can be done” Dr C, I like to compare dentistry to any professional business. I find it quite absurd that a young dental graduate enters an established practice run by an experienced practitioner, and hence inherits a very good fee structure. If the assistant/associate dentist is on a percentage commission, the only reason the principal dentist earns more than the younger assistant is because he or she is more efficient than the assistant/associate Dr Geoff Hall