Products in Practice: Dentsply by Lori Trost, DMD


by Lori Trost, DMD
Dr. Trost maintains a contemporary aesthetic practice in Columbia, Illinois. She has authored a wide variety of articles and also consults to many dental manufacturers about product development and direction.

It's just another typical day in the dental office when you hear your patient, Mrs. Smith, say, "I had braces, but I didn't wear my retainer." As you look onto her mandibular arch and view her relapsed centrals (Fig. 1), does your discussion progress to the possibility of treatment? What possibilities do you offer to correct her misalignment? Just how often do you see an arch that could benefit from refinement or an enhanced cosmetic improvement?

Routinely, we see adult patients—up to 50 percent1—who present with common minor anterior misalignments that can now be predictably treated. Rather then referring these types of "social six" cases out, you now have the ability to expand your practice services by offering convenient orthodontic treatment.

MTM Clear Aligner is a simple orthodontic solution focused on guiding teeth easily and naturally into their corrected position by utilizing a unique open pathway architecture that allows for a greater range of tooth movements while making use of specifically designed force points. This system is not only very effective and affordable, but offers excellent treatment versatility. It's available in two solutions: in-office (chairside) and most recently, service center (lab). The MTM Clear Aligner Service Center enables a customized treatment approach to each individual case. Its affordable, flat-fee pricing includes unlimited aligners needed for case completion, and it even offers a free refinement if needed. The MTM Service Center option allows you to partner with a technician who proposes a customized and properly staged treatment plan for your approval.

My patients have benefited from the distinctive features that MTM Clear Aligner offers. The unsightly bonded attachments are simply gone, creating an invisible treatment. Patients find the aligner insertion much easier, and obviously, as a dentist, I enjoy the reduced chair time that comes from not having to bond attachments.

Without having to bond or remove attachments, enamel can remain in a more pristine and aesthetic condition. Ultimately, these clear aligners create a minimally invasive treatment approach to correcting alignment.

MTM Service Center case submission is straightforward. First, become a provider by contacting MTMclearaligner.com, request a starter kit that contains educational information and patient marketing, and then complete a one-hour training.

As with any potential orthodontic treatment under consideration, case selection is critical for success. Treatment parameters and recommendations are clearly listed—as well as any contraindications—for case selection. Next, the patient's digital photographs and radiographs can be uploaded, as well as a digital intraoral scan if the clinician so chooses. Simple PVS impressions and a bite registration can also be submitted. A technician will create a customized aligner proposal with respect to your treatment goals that will require your approval before any aligner fabrication begins.

Approximately four weeks from case submission, all the fabricated aligners—individually numbered and packaged—will arrive, as well as the specifically prescribed treatment sequence, ready for patient delivery. Aligners are to be changed out every three weeks to insure and renew the proper intentional forces that create a maximum of 0.3mm movement per tray that will result in corrected alignment.

This system also allows the dentist to authorize the creation of a final maintenance retainer as well, thus complementing and respecting a treatment timeline.

Service center case
A 34-year-old female patient presented with excellent oral health, but in need of slight alignment correction. She gave a history of undergoing extractions of first premolars and traditional orthodontic treatment when she was starting high school. However, it had been years since she wore any retainer or maintenance appliance. She expressed a desire to get her teeth "straight again." After clinical evaluation and reviewing the treatment guidelines for MTM Clear Aligner, this patient was deemed an ideal candidate for the service center product.

PVS impressions, bite registration, pictorial landscape and a panorex were made (Fig. 2) The patient's information and treatment goals were submitted online while the impressions and bite were mailed in the provided case-submission box. Once the patient's information was received, a technician created a treatment plan. The technician was able to stage alignment to meet the patient's goals and sequence the movement without any interproximal reduction (IPR). This customized plan was sent for my review, changes or approval. Once approved, individual aligners were created and numbered to match their treatment plan summary, then sent to our office for patient insertion.

In this specific case, only three aligners per arch were needed to create proper alignment and incisal edge correction, totaling a nine-week treatment timeline. The first aligner set was delivered and instructions for wear were given. The patient was scheduled to return in three weeks. When the second aligner set was delivered the patient stated she was pleased with the progress and also she found the aligners for both arches to be comfortable and very aesthetic (Figs. 3 and 4).

In-office clinical case
A 28-year-old male patient with excellent oral hygiene presented with a chief complaint of wanting his lower teeth straightened. He was deemed a good candidate according to MTM guidelines. The necessary orthodontic work up of impressions, radiographs and photographs was taken (Fig. 5; see p. 105).

By determining that the case could be completed using the in-office choice, a working model was created. This model was prepared so that specific force points were balanced with block-out. Essex ACE plastic of 0.4mm (Dentsply, Raintree Essix) was thermoformed over the working model using a Drufomat thermoforming machine. The aligner was removed from the model, trimmed and polished, then made ready for patient insertion.

The patient was seen four weeks after delivery. Continued force points using Hilliard Thermoplier pliers (Dentsply, Raintree Essix) were applied to continue or even finalize alignment. After two months, the patient's alignment was completed (Fig. 6).

Conclusion
5 In both cases—whether performed in-office or submitted to the service center—this alignment system offers a clinically demonstrated benefit to patients and dental practices. The ability to orthodontically correct anterior misalignments in a minimally invasive approach with the use of proper staging, force points, and open pathway architecture allows for a more natural tooth repositioning. Earlier schools of thought would have mandated traditional wires and brackets to correctly align the malposed teeth. However, with current technology and improved plastic materials, this alignment system creates for patients a highly customized and versatile orthodontic option that promotes improved oral hygiene, compliance, and long-term aesthetics. It's a win-win for everyone!


References
  1. Proffit, W. (1998). Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey. International Journal of Adult Orthodontics and Orthognathic Surgery, 13(2), 97-106.





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