Perspectives. Capability. Technology. Orthodontic. Efficiency. Vol XIX No. 2. Clinical Information for the Orthodontic Professional OCTOBER 2012

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1 Orthodontic Perspectives Vol XIX No. 2 Clinical Information for the Orthodontic Professional Technology. Capability. Efficiency. Dr. Shawn Miller Dr. Gustav Horsey James D. Hansen Featuring: Aesthetic Accelerated Treatment with the Incognito Appliance System by Dr. Shawn Miller D igital Orthodontics: Technology in the Modern Practice by Dr. Gustav Horsey C reating Digital Setups for the Incognito Appliance System by James D. Hansen and Ralf Paehl, 3M Unitek OCTOBER 2012 Ralf Paehl Dr. Robert Waugh Nicole Wagner 3 T op Ten Finishing Advantages of SmartClip SL3 Self-Ligating Brackets by Dr. Robert Waugh 15 8 S martclip Self-Ligating Appliance System Treatment Efficiency Survey by Nicole Wagner, 3M Unitek 19 11

2 Orthodontic Perspectives is published periodically by 3M Unitek to provide information to orthodontic practitioners about 3M Unitek products. 3M Unitek welcomes article submissions or article ideas. Article submissions should be sent to Editor, Orthodontic Perspectives, 3M Unitek, 2724 South Peck Road, Monrovia, CA or call. In the United States and Puerto Rico, call (800) ext In Canada call (800) and ask for extension Or, call (626) Copyright 2012, 3M. All rights reserved. No part of this publication may be reproduced without the consent of 3M Unitek. 3M, APC, Clarity, Forsus, Incognito, SmartClip and Unitek are trademarks of 3M. Other trademarks are property of their respective holders. Visit our website at Message from the President Bill Cruise President This is an exciting time to be in orthodontics. Worldwide, growing numbers of people are seeking treatment, and these new prospective patients will have the benefit of more options for their treatment than ever before. Innovations are being introduced more quickly than ever, and we find an eagerness throughout the industry to discover the advantages that these new products and services offer. Despite, or possibly because of, the ongoing global economic uncertainty, orthodontists are actively seeking more efficient and effective ways to improve their practices. Increasingly, they are discovering the benefits of products that merge modern technology into the exacting requirements of orthodontic treatment. The tools of the profession available to today s practitioner are quite simply a quantum leap ahead of those offered just a decade ago. This issue of Orthodontic Perspectives highlights some 3M Unitek products that are the direct result of 3M innovation and technology working together for you. Our lingual Incognito Appliance System is a prime example, offering predicable and effective aesthetic treatment using customized low-profile brackets and robotically bent wires. In our opening article, Dr. Shawn Miller describes the versatility and capability of the system to provide accelerated treatment timetables when combined with Periodontically Assisted Osteogenic Orthodontics (PAOO). Orthodontists can also benefit from the addition of the new Unitek Treatment Management Portal TMP software platform to their practice. Unitek TMP offers advanced digital model management and streamlined treatment planning tools. If used with the Incognito System, it also offers efficient automated ordering. Our thanks to Dr. Gustav Horsey, who shares his experience with Unitek TMP and describes the benefits that this digital technology offers for the modern practice. To round out the issue, we have two articles on our 3M Self-Ligating Appliances. Uniquely designed, these brackets offer features and treatment advantages that traditional brackets, and, as Dr. Robert Waugh points out, competing self-ligating brackets, are unable to match. In a concluding report, a survey of SmartClip Self- Ligating Bracket users will show that time savings and treatment time reduction are tangible benefits of these brackets. Thank you once again for the opportunity to provide the 3M Unitek products and services you need to move forward confidently. 2

3 Aesthetic Accelerated Treatment with the Incognito Appliance System by Dr. Shawn Miller Dr. Shawn L. Miller is in private practice in Orange, CA and Aliso Viejo, CA. He lectures locally on PAOO, Incognito Appliance System and Interdisciplinary Orthodontic Treatment. He is Board Certified by the American Board of Orthodontics, Incognito System Certified and Wilckodontics Certified. Identifying the fundamental apprehensions of patients seeking orthodontics is usually fairly straightforward, especially in dealing with adult treatment. The three most basic and common inquiries our adult patients ask are: 1. Aesthetic Appliance Options 2. Length of Treatment 3. Cost of Treatment Modern society runs at a faster pace and with more emphasis on aesthetics than ever before. How can you satisfy a patient who just doesn t request, but demands, fast and invisible care? Offering traditional labial metal brackets for months to many of our young adults and professionals is really just not an option. In the past, many of these patients did not accept treatment or settled on compromised limited treatment plans. But now, with the advent of Periodontally Assisted Osteogenic Orthodontics (PAOO) and the Incognito Appliance System, we are able to offer comprehensive invisible treatment in 6-9 months on average. In today s challenging economic and orthodontic landscape, practice differentiation has become one of the most critical factors in acquiring and sustaining a robust patient base. Referrals from general dentists and other specialists are considerably declining, in part due to increased competition among orthodontists and in part due to general dentists delivering orthodontic care. For any growing orthodontic office, internal and external marketing plans are crucial to attract new patients. However, there still needs to be something unique about the office to be the focal point of marketing efforts. Exceptional quality care, modern facilities, a friendly staff and a caring doctor are wonderful attributes to have, but are just the starting point. We have found that providing Incognito for our patients not only gives us a slight edge on our competition, but also maintains our strong relationships with our referring dentists who demand high-quality, finished occlusions. Certainly, many dentists provide clear aligner therapy in their own offices, so when they do make a referral to us, they are looking for us to provide treatment beyond what they feel they may be able to deliver with clear aligners. Aesthetic options for our patients include clear aligner therapy, Clarity Ceramic Braces and Incognito Braces. Of the three options, truly Incognito Braces is the most invisible choice. While clear aligners are a treatment option that we utilize in some minor cases, we are most comfortable doing aesthetic braces to reach our functional occlusal goals. For clear aligners, attachment discoloration and visibility of the trays are two aesthetic aspects our patients sometimes are concerned with, and patient compliance is an uncontrollable factor that the doctor often has to deal with. Clarity Brackets are a great option for many patients, however, sometimes the patient demands something even more aesthetic. In those cases, where the patient wants something truly invisible, we suggest Incognito Braces. 3

4 Periodontally Assisted Osteogenic Orthodontics (PAOO) PAOO is a revolutionary procedure that has transformed our office and our treatment philosophy over the past decade. Only recently, have we begun to utilize Incognito with the PAOO procedure. In our office, employing PAOO has not only allowed us to shorten treatment times by two-thirds, but has allowed us to expand the envelope of movement of the dentition, beyond what is capable with traditional care. For our patients, PAOO means less orthognathic surgery, less extractions and more predictable correction for challenging adult Class III cases, Class II cases, open bites, crossbites, and many other situations. Details of the PAOO procedure can be found in other sources and the scientific background is well established. In general, through selective corticotomies and bone augmentation, our goal is to accelerate tooth movement and provide a new bone matrix to expand our dentoalveolar envelope of movement. The PAOO is performed under intravenous sedation by trained Periodontists or Oral Surgeons, and involves corticotomies to accelerate tooth movement and bone grafting (demineralized freeze-dried bone allografts and Bio-Oss ) to enhance bone volume after remineralization. The corticotomies can be done in localized areas of interest, or generalized to entire arches, as prescribed by the orthodontist. Treatment progress is accelerated and condensed, so frequent wire changes are necessary, elastics are given much earlier, and finishing procedures are instituted much sooner. There is approximately a 6-9 month window of opportunity before remineralization occurs, in which the accelerated movement subsides. The following two cases utilized PAOO with the Incognito System. While these cases are certainly nowhere near our most severe or complex PAOO cases, they were the first ones where we used Incognito Appliances, and we were very pleased to obtain fast and excellent results. 1A 1B 1C 1D Figure 1A-E Robert Robert is a very successful young entrepreneur who enjoys living life to the fullest. He came to our office after seeing numerous other dental professionals (orthodontists, surgeons and cosmetic dentists). Opinion ran the gamut, from aligner therapy to Orthognathic Surgery. He was never quite satisfied with their treatment plans and options. He was looking for something very aesthetic and equally important, something fast. He did not want his orthodontic care to have an impact on his life for the next months. Our diagnostic concerns for Robert were his anterior and posterior crossbite (partially edge-to-edge in some areas), Class III dental and skeletal malocclusion, narrow maxillary arch, anterior attrition and midline discrepancy (Figure 1A-E). After some discussion with Robert and his general dentist, we decided that he would be a great candidate for PAOO and the Incognito System, to be followed with 1E extensive restorative care (mostly anterior veneers). The diagnostic wax-up for the Incognito system was a critical component in planning for the cosmetic restorative care. Incognito Braces were placed and archwires inserted, and on the following day, Robert had the PAOO procedure done on his entire maxillary arch by a trained Periodontist (Figure 2A-E). The procedure and post-op was unremarkable. We proceeded through our regular non-extraction archwire sequence, and bite opening for crossbite correction was facilitated through half-occlusal pads on the lower molars. At various timepoints intraoral elastics were used, including Class III elastics, vertical elastics and crossbite elastics. Clear composite buttons on the buccal of posterior teeth were used as needed for attachments. 4

5 2A 2B 2C 2D 2E Figure 2A-E Very little IPR was prescribed and preformed our goal was to advance the maxillary dentoalveolar complex and not retract the mandibular anteriors. At 10 weeks post-surgery, we had already progressed into our SS archwires. At 16 weeks, all crossbites were corrected, so the dentist was able to put temporary composite bonding on the anterior teeth for interim aesthetic improvement. Just over seven months into treatment, after a brief period of finishing elastics, Incognito treatment was completed (Figure 3A-E). Clear vacuformed retainers were fabricated and delivered immediately. 3A 3B 3C 3D 3E Figure 3A-E 5

6 Immediately following orthodontics, the restorative phase was started with smile wax-ups and mock-ups to evaluate aesthetics. Five weeks after the removal of the lingual braces, definitive restorative dentistry was initiated. After a period of temporization and cosmetic adjustments, final veneers and restorations were delivered (Figure 4A-D). Approximately 10.5 months after starting orthodontics, the entire case was finished, complete with final restorations. Jessica Jessica is a senior college student who wanted to improve her smile prior to graduation (Figure 5A-F), while not having visible braces. We felt that proper torque control of her maxillary anterior 5A Figure 5A-F 4A Figure 4A-D 5B 4B 5C 4C 5D 4D We were quite pleased with the outcome, and so was the cosmetic dentist. The patient is ecstatic. The functional occlusion and esthetics are improved, and the long-term periodontal and dental health should be enhanced. 5E teeth could only be accomplished with braces, and not with aligner therapy. We debated between full Incognito Appliance System treatment and partial 4-4 Incognito Brackets. In the end, we felt her slight Class III dental relationship and lack of overbite and overjet 5F 6

7 would be better addressed with arch form development with full Incognito Braces (Figure 6A-B) to achieve our functional guidance objectives. Although non-surgical treatment estimates would have been only 12 months, due to her upcoming graduation, Jessica wanted to accelerate her care with PAOO. 7A Figure 7A-F 6A 6B Figure 6A-B After we approved the Incognito System setup and bonded the brackets, Jessica had PAOO performed the following day on her maxillary arch (only first premolar to first premolar) by a trained Periodontist. After two weeks of healing, we began our standard non-extraction archwire sequencing. At various time points, Class III elastics and vertical elastics were utilized, along with clear composite buttons to help seat the occlusion. We were in SS archwires for torque control at 3.5 months and our final TMA finishing wires at 5.5 months. We finished her treatment in 6.5 months and provided clear vacuformed retainers (Figure 7A-F). Overall, we were satisfied with the occlusion, esthetics and treatment timing. Most importantly, we were able to complete her care before her college graduation. The patient is periodontally healthy and thrilled about her new smile. 7B 7C Conclusions Although we are only just beginning our journey up the learning curve with PAOO in conjunction with the Incognito System, our vast experience with both entities separately has allowed us to deliver efficient care with excellent results. We look forward to continuing the use of both PAOO and the Incognito system, together or separately, on more challenging functional and aesthetic cases. Our patient population appreciates our leading-edge approach to care, which allows us to differentiate our practice in our community. Acknowledgements Marlene A. Miller, DMD, M.Med.Sc., Board Certified Periodontist, Private Practice, Tustin, CA Andrew Spath, DDS, General Dentist, Newport Beach, CA Case photos provided by Dr. Shawn Miller. 7D 7E 7F 7

8 Digital Orthodontics: Technology in the Modern Practice by Dr. Gustav Horsey Dr. Gustav Horsey is a native of Chesterfield, Virginia and maintains a private practice in Henrico, VA. He received all his training at the University of North Carolina at Chapel Hill (UNC), receiving his undergraduate degree in Biology, next completed the dental program (DDS), and then was awarded a Master of Science in Orthodontics (MS). Dr. Horsey developed his passion for orthodontics after his own treatment was completed as a teenager. He is committed to excellence in patient care and enhancing his patient s oral health, aesthetics, and function. Dr. Horsey is dedicated to continued education and training for himself, as well as his staff. The integration of technology is essential to the success of any orthodontic practice seeking to increase efficiency and communication. The globalization of all aspects of society, including orthodontics, allows us to now have access to the best resources available to deliver high quality orthodontic treatment in our own communities. The Unitek Treatment Management Portal TMP is a complete software solution to integrate digital model storage, orthodontic treatment planning, and customizing the Incognito and Incognito Lite Appliance Systems for your patients. Unitek TMP enhances the ability of the orthodontist to diagnose and treatment plan cases using the high resolution graphics and model analysis measurements. Communication tools allow the orthodontist to interact with the 3M Unitek lab using s, annotation boxes, and images. Digital Model Storage Digital model storage is progressively being adopted by many orthodontic offices as a method to reduce stone model storage needs, increase communication with patients and other dental professionals, and improve treatment planning for the orthodontist. In our practice, we decided to start digital right from the start-up in order to take advantage of these benefits. After testing several of the digital model systems on the market, we chose the Unitek TMP software system for all of our model needs. The system scans the actual orthodontic impression instead of a stone model poured from the impression which helps eliminate possible errors obtained during the stone model fabrication. The advantages of the Unitek TMP system for model storage are its superior detail in model fabrication, ease in communication with 3M Unitek support, and management of patient files including integration with practice management software (Figure 1). Having used other 1 Figure 1 systems on the market for digital model storage, I have found that the accuracy converting the impression we send into a digital model is the best with the Unitek TMP system. Also, the occlusion and precision of measurements is calibrated well in the system allowing the models to be an important tool in treatment planning as well as case presentation (Figure 2). 8

9 2 Figure 2 100% Customized Orthodontics One of the biggest advances in modern orthodontics is the utilization of technology to deliver customized brackets, wires, and treatment forecasts to enhance patient results through more effective and efficient treatment methods. The other big push in the field of orthodontics is patient s desire for aesthetic or invisible orthodontic treatment, especially as more adults seek care. After studying all the customized orthodontic systems on the market, we found that only the Incognito Appliance System can truly deliver all three levels of customization and aesthetics. Lingual orthodontics also has the advantage of eliminating the incidence of labial decalcifications during orthodontic treatment. 3 Figure 3 Digital Work Flow for the Incognito Appliance System Initial Workup The Incognito System begins with an accurate two-phase PVS impression and bite registration that you will send to the lab. Unitek TMP replaces the need for traditional paper lab forms to be mailed with the case and allows total digital customization and effective communication with 3M Unitek. Digital photographs can also be uploaded from practice management software to allow enhanced communication. The custom prescription for the brackets, wires, and all treatment planning goals are entered to ensure full utilization of the Incognito system (Figure 3 and 4). 4 Figure 4 9

10 5 Figure 5 The orthodontist first chooses all customized treatment objectives for the patient s case including: occlusal, aesthetic, and alignment considerations. Next, the custom fixed appliances are carefully selected from a library of brackets, bands, and additional attachments. The visual cues now available with the Unitek Treatment Management Portal TMP system allow the orthodontist to see the full scope of the setup and rotate the template (Figure 5). Then, the wire sequence is selected from an array of wire sizes and materials with a Wire Sequence Guide to aid in case specific considerations (Figure 6). 6 Figure 6 7 The Incognito system lab then sets up the case using these specifications and taking into account anatomical and biological limitations. The case is mounted on an articulator and the setup is digitally scanned and placed in Unitek TMP for review by the orthodontist. The enhanced communication tools now available in Unitek TMP allow visual cues and measurements to be used to create the most accurate representation of the orthodontist treatment goals. Advanced features like the overlay button give the user visualization of initial vs final setup in all planes of space (Figure 7). Figure 7 Setup and Fabrication The power of the technology behind Unitek TMP and the Incognito Appliance System truly shows in the digital setup and fabrication of the 100% customized brackets and wires. CAD/CAM software is used to construct the pattern for each individual bracket taking into consideration anatomical and access considerations based on the prescription specified by the orthodontist. Once the case is setup to the final result, the wires are then constructed to achieve the required mechanics. All the necessary archwire bends are determined in the CAD/CAM software and bent robotically to ensure precision. Using this method, movement towards the final position of the teeth is achieved from the first wire through the entire wire sequence. Throughout the entire setup and fabrication process, communication between the lab and orthodontist is available through messaging within TMP. Utilizing current technology, the Unitek TMP system integrates digital models, customized wires and brackets, and digital treatment planning and setup in an interactive format to achieve maximum patient results. 10

11 Creating Digital Setups for the Incognito Appliance System by James D. Hansen and Ralf Paehl, 3M Unitek James D. Hansen, PhD is Vice President of Research and Development for 3M Unitek. He has been working in dental and orthodontic product development at 3M for 21 years. His academic training is in Material Science, with a PhD from Northwestern University and a BS from the University of Minnesota. Ralf Paehl leads the R&D department at TOP-Service for Lingualtechnik GmbH, a 3M Unitek company (Bad Essen, Germany). With his group he develops both mechanical and software solutions for custom lingual orthodontics. He received his diploma in aeronautical engineering in 1992 in Braunschweig, Germany, and joined TOP-Service in Introduction The last decade has brought a revolution to the world of dentistry in the form of digital technology. Software has allowed the modeling and simulation of clinical situations, while computer controlled mills enable anatomical restorations cut from new materials like ultra-tough zirconia. Similarly, Internet connectivity has dramatically increased the speed and depth of communication between the dental professional and laboratory, while further facilitating low-cost file storage of digital records that can be retrieved instantaneously across global networks. Digital technology has enabled the creation of the Incognito Appliance System by allowing the design and manufacture of brackets individually customized to each tooth and coordinated across the arch to set the precise custom arch form. However, until recently, all Incognito System cases have relied on the traditional wax and plaster diagnostic setup to create the target position for the teeth. Placed in the hands of skilled technicians, this time-tested approach physically replicates the dentition, and allows the technician to craft the desired target occlusion. The precision of the Incognito setup is critical, since studies show the Incognito System is proven to deliver the target result for patients. 1,2 As the world moves toward digital technologies, big questions loomed for Incognito System development: Could software be created to deliver a virtual setup meeting these exacting standards? And, could the additional benefits of enhanced communication and digital storage be realized for Incognito System customers? In a multi-year effort, 3M software and setup experts collaborated to build digital setup software capable of consistently producing digital setups of Incognito System quality. While sophisticated 3D software tools for creating setups are increasingly available, a key challenge faced the team how to create an Incognito System setup digitally that had the same quality as the wax and plaster setups that had established Incognito as the lingual custom appliance of choice. The path to success lay in creating a tightly knit team of software experts and Incognito System setup technicians to replicate the physical setup process using state-of-the-art software algorithms. The steps to produce a wax/plaster setup and digital setup are similar. Both start with high-quality impressions which are converted into a positive plaster model. The teeth are identified and marked. This is followed by segmenting the teeth from the gingiva. For plaster, the teeth are physically cut from the model. In software, sophisticated algorithms identify the tooth margin and make a digital cut. One of the first benefits realized in the digital world is the ability to undo a mistake, while a mistake with physical tooth separation results in a re-pour and restart of the process (Figure 1A-D). 11

12 1A 1B Measurements from the maloccluded model are made to determine changes in intercuspid and intermolar width in the setup. Physical templates are used to align the occlusal plane and prescribed arch form in the wax and plaster setup. The toolset in the digital world includes all of the traditional tools, but new ones as well, like overlay views and geometric tools for precisely tailoring the arch form (Figure 3). 1D 1C Figure 1A-D: Manual and Digital separation performed by the setup technician. Once separated and marked, the alignment process begins within each arch. Malleable wax is used to support the plaster teeth as they are arranged in the prescribed arch. Digital teeth are manipulated in 3D virtual space with a mouse or joystick (Figure 2A-B). 3 Figure 3: Overlay view as seen by the setup technician. 2A Bringing the two arches together to form the final occlusion is one of the greatest challenges. In both worlds, the arches are mounted in an articulator. In the physical world, the occlusion is adjusted by feel as the two arches are brought together. In software, high-speed computation now allows this to be simulated by detecting contact between teeth, and then iteratively adjusting the position of teeth (Figure 4A-B). 2B Figure 2A-B: Setup technician positioning teeth manually and digitally. 4A Figure 4A-B: Physical and Digital Articulator used by the setup technician. 4B However, the software only gives a first approximation; the final occlusion is manually obtained by adjusting the teeth and using the cross section tools and occlusal maps to optimize the contacts. These new digital tools allow the Incognito Appliance System technician to view and adjust the final occlusion via cross sections that are not available in the physical world (Figure 5). 12

13 5 Figure 5: Measurements and viewing of the cross section as the technician adjusts final occlusion. Once the final occlusion is obtained, an optional setup review is available for the doctor. For wax and plaster, photographs are taken of the setup. Much more is available to the doctor with the 3D digital setup, including use of some of the measurement and viewing tools that are available to the setup technician. According to data collected from customer evaluation, the digital visualization also allows efficient communication and documentation of the intended treatment plan to the patient. In addition, orthodontists preferred viewing superimposed setup and malocclusion models in the 3D image display to photos of stone models (Figure 6A-D, Figure 7). 6A 6B 6C 6D 7 Figure 7: Setup Review: Digital Setup 3D-Display. Figure 6A-D: Setup Review: Manual Setup Photos from predefined views. 13

14 So how do we know that the digital setups are equal to or better than plaster model? As part of the project, digital setups were printed and scored with the same quality checks used for many years to assess Incognito Appliance System physical models or setups (Figure 8A-B). They met or exceeded all historical standards for Incognito System setups. 8A More critically, many hundreds of Incognito System cases made with digital setups have been placed in treatment with experienced users, and the Incognito System with Digital Setup has been preferred by the evaluators. Earlier this year, digital setups were rolled out to Global Incognito System users as part of the Incognito Lite Appliance System, launched in Spring 2012 for mild to moderate misalignment cases. Digital setups for full cases are becoming available now, with the rollout schedule depending on region of the world. Doctors can choose between a traditional wax and plaster setup or a digital setup for their Incognito Appliance System. All the advantages of the digital technology revolution are now available for users of the Incognito Appliance System. References 1. Grauer, Dan and Proffit, William R.. Accuracy in tooth positioning with a fully customized lingual orthodontic appliance. AJO/DO, 2011 Volume 140, Number Thalheim A, Schwestka-Polly R., Clinical realisation of a setup in lingual orthodontics. Inf Orthod Kieferorthop, 2008; 40: B Figure 8A-B: Occlusion checks during the validation process. Incognito Appliance System 2013 Users Meeting March 1-2, 2013 San Francisco, California JW Marriott Union Square Visit 3MUnitekTraining.com for additional information about this meeting as well as other upcoming certification and advanced training courses. 14

15 Top Ten Finishing Advantages of SmartClip SL3 Self-Ligating Brackets A Comparative Analysis of Damon Q and SmartClip SL3 Self-Ligating Brackets by Dr. Robert Waugh Dr. Robert Waugh practices orthodontics full-time in Athens, Georgia. He graduated from Georgia Health Sciences University (formerly the Medical College of Georgia) in 1987 with both a DMD and an MS in Oral Biology, and was elected to OKU dentistry s honor society. Dr. Waugh earned his Masters in Orthodontics at Baylor University in 1989 and became certified by the American Board of Orthodontics in Dr. Waugh is an Assistant Professor of Orthodontics at Georgia Health Sciences University, a nationally-known lecturer on current orthodontic topics, and a seminar speaker for 3M Unitek. Introduction Practitioners using passive self-ligating brackets have reported many advantages in areas such as shorter treatment duration, 1,2,3 quicker dental arch changes, 3,4,5 more efficient space closure 6, handling efficiency 1,2,7,8 and a higher level of comfort. 5 But now that treatment deficiencies of certain passive self-ligating brackets are being more thoroughly investigated, 9,10 many orthodontists are becoming more aware and are even somewhat disenchanted with the apparent inefficiency of some brackets in finishing cases. I have personally experienced finishing difficulties with the Damon System, and despite over seven years of teaching and recommending this system, I longed for a better way to treat and finish my cases with fewer bends. Reaching outside the Damon circle of influence, I learned that the initial wave of popularity of the Damon System (Ormco, Glendora, CA) had already yielded to improvements found in newer, more effective designs, like the third generation SmartClip SL3 Self-Ligating Bracket and its aesthetic counterpart, the Clarity SL Self-Ligating Bracket. This article highlights my clinical observations in my transition from the Damon System to the more efficient SmartClip SL3 Self-Ligating Appliance System. Background Self-ligation and, more specifically, passive self-ligating bracket systems have been embraced by many practitioners like me because of the many clinical advantages seen in the efficient movement of teeth with light, comfortable forces. The early pioneers who were the first to leave traditional ligated systems started a manufacturing Self-Ligation Evolution aimed at creating the perfect appliance. The difficulties encountered with these first attempts probably slowed their acceptance but also provided the foundation for the eventual improvement of these systems. I have a tremendous respect for the individuals who invested in the revival of passive self-ligation concepts and treatment systems, because they openly welcomed a new generation of orthodontists to join them in advancing the art of self-ligation. When I began teaching the Damon System for Ormco in 2005, I was tasked to create the first In-Office course sanctioned by inventor Dr. Dwight Damon; so, I became invested in the purest form of his technique. This undertaking became the foundation of my first experience in passive self-ligation and influenced my thinking, ultimately changing my treatment philosophy. Soon after, my education company, intellident solutions, Inc., offered an online curriculum and even an educational continuum called the Damon Journey which further solidified my understanding of this system. I was also empowered with teaching it to the orthodontic residents at Georgia Health Sciences University. After teaching regularly at the annual user meetings and in Advanced Courses, and with some ideas of my own, the foundation was set for my transition to the next level in the advancement of self-ligation SmartClip SL3 and Clarity SL Self-Ligating Brackets. 15

16 Leaving one passive system for another, I entered this transition with a considerable bias for the Damon System. I deliberately did not adjust my treatment planning regarding its ability to treat severe crowding in a non-extraction manner so I could fairly evaluate the SmartClip SL3 Self-Ligating Bracket s performance. My comparative findings follow, along with a chart of my personal comparative analysis at the conclusion of the article (Table 2). Finishing Advantage #1: Bracket Positioning Nothing tops bracket positioning when it comes to reaching an excellent and timely orthodontic finish. Medium size brackets, like SmartClip SL3 and Clarity SL brackets, with exposed slots and rhomboidal design are easier to see and position on teeth than minibrackets. With better consistency in positioning, orthodontists gain a huge advantage in finishing efficiency. Using the metal clips as a visual cue is helpful in directing the tooth-colored Clarity SL bracket along a tooth s long axis. The same is not true for the metal-free Damon Clear bracket. Additionally, most orthodontists don t realize the sides of a ceramic Damon Clear bracket are not parallel and cannot be used as a visual cue for the long axis (Figure 1A-B). In the comparative analysis, the SmartClip SL3 bracket has tighter labio-lingual limits (.0275") than Damon (.028"). Although this difference (.005") seems insignificant, it turns out to be huge in terms of fewer bends and better finishing efficiency. Now, combine these bracket depth tolerances with the ease of selective ligation and the SmartClip bracket becomes the better finisher. Finishing Advantage #3: Variable Bracket Width Damon Q brackets are designed with the same widths for all teeth (exception lower incisors). A variety of bracket widths for a variety of tooth widths are provided by 3M Unitek in the SmartClip SL3 and Clarity SL bracket series to give a distinct element of control to the orthodontist. For example, the upper central incisor in the SmartClip SL3 bracket is.130", compared to the narrower Damon bracket at.110" (Table 1). Consequently, the SmartClip SL3 bracket offers better control due to extended rotational and tip holding points for larger teeth. Upper Central Brackets Damon Q In-Ovation R SmartClip SL3 M-D Width.110" 2.8 mm.116" 2.9 mm.130" 3.3 mm Table 1: A comparison of mesial-distal widths of selected Upper Central Brackets. 1A Figure 1A-B: SmartClip SL3 and Clarity SL Self-Ligating Brackets feature parallel mesial and distal sides that aid in bracket positioning. 1B More specifically, there is a total of only 2 of rotational play with a SmartClip bracket on a finishing wire on a central incisor (Figure 2A), compared to 8 of play with the Damon bracket (Figure 2B). This difference results in better efficiencies in achieving complete rotational and tip correction and in space closure. This design difference can be confusing for practitioners whose eyes are conditioned to the metal bracket s parallel sides. Although, more miniature Damon brackets are provided with placement jigs, I always found the jigs cumbersome, interfering with the gingiva and often distorted from the packaging process. Now that I can actually see what I m positioning with SmartClip and Clarity SL brackets, I seem to be a better bracket placer. Imagine that! 2A 2B Finishing Advantage #2: Slot Depth Slot depth determines the degree of labio-lingual play between a self-ligating bracket and the wire. Many experienced Damon doctors know that when placing an up or down bend, they must also place an in or out bend. This exaggerated labio-lingual play complicates treatment, requiring compensating bends to avoid inadvertently throwing the wire to the front or back of the slot. In finishing and detailing, fewer bends translates into fewer visits to line up the contact points of teeth and establish both aesthetics and a functional occlusion. I have found that these first-order compensating bends are not necessary with SmartClip brackets. Figure 2A: SmartClip SL3 Self-Ligating Bracket Tight rotational control with only 1 loss per side (2 total) with a archwire. Figure 2B: Damon Self-Ligating Bracket Difficulty with rotation control due to more than 4 loss per side (8 total) with a archwire. Finishing Advantage #4: Tie-Wings Addressing the specific needs of patients from visit to visit can be difficult without the basic physical requirements of bracket design available. SmartClip SL3 and Clarity SL brackets are designed with deep tie-wing undercuts which allow single or multiple attachments to be added at will (Figure 3A-D). Stainless steel ligatures, elastic chain, elastic ligatures, and coil springs may all be employed in a 16

17 cleansable delivering finishing advantages to SmartClip bracket users over Damon bracket users. Plus, a cooperative patient with fixed hooks has fewer emergencies over bent or missing drop-in hooks. 3A 3C Figure 3A-D: Side profile comparisons of 3M Self-Ligating Brackets (L) and Damon Self-Ligating Brackets (R). The deeper under tie-wing area of 3M Self- Ligating Brackets allows for easier ligation. variety of binding and non-binding configurations to complement treatment. Damon Q brackets have reduced undercut areas that make it difficult to tie or chain, especially in its clear version. Without the flexibility to handle multiple ties and attachments, an efficient finish is compromised. The ease of being able to seat the wire into the base of the slot with SmartClip bracket tie-wings is the key to labio-lingual positioning and efficient finishing. Finishing Advantage #5: Fixed Hooks The advent of a drop-in hook was an attractive option regarding hygiene, but in practical use they are too weak for elastic forces. Consequently, extended treatment due to compromised elastic wear even more adversely impacts hygiene. Simple attention to hygiene and returning to fixed hooks on upper and lower canines and first bicuspids in the SmartClip SL3 brackets have been a welcomed change (Figure 4A). Damon Q uses a convenient vertical slot for a drop-in hook, only it is located on the lingual side of the slot, which makes it difficult to place and access (Figure 4B). Fixed hooks on the labial side of the slots are more accessible, durable, and 3B 3D Finishing Advantage #6: Pre-Coated Brackets Having assurance that the adhesive is uniformly pre-applied to SmartClip brackets is a measurable advantage in bonding. Applying glue from a syringe system to a Damon bracket pad without remembering to butter it into the mesh can introduce qualitative and quantitative errors that could affect bond strength and bracket position. Most orthodontists generally agree that adding unnecessary procedures can introduce new variables that upset the bonding process. Moreover, the possibility of contamination increases with each new step. 3M Unitek s bracket pre-coating (APC Adhesive Coated Appliance System) combines the best adhesive with the best bracket for direct and indirect bonding. Since I was already using 3M adhesives on my Damon brackets when I made my transition, it was a comfortable move for me to trust the performance of the pre-coated brackets from 3M. Now I have the best of both worlds! Finishing Advantage #7: Ceramic Bracket Removal For a busy practice, the removal of ceramic brackets can be predictable or unpredictable. The Damon removal tool places an occlusogingival shearing force on the bonds, torqueing the teeth and adding undue strain on the enamel. These forces can leave the bracket bases intact while fracturing the weaker door mechanisms, forcing the practitioner into a difficult clean-up (Figure 5A). Alternately, the Clarity SL bracket is pre-scored to collapse in a mesio-distal direction without stress for the patient or practitioner, ending in a comfortable and predictable procedure (Figure 5B). 4A Figure 4A-B: Images of hooks for the SmartClip SL3 Bracket and Damon Self-Ligating Bracket. 4B 5A Figure 5A-B: A Damon Clear Bracket after fracturing (L) and Clarity SL bracket (R). 5B 17

18 Finishing Advantage #8: Selective Ligation Once the alignment of teeth is achieved, it is generally time to selectively ligate the wire to the base of the slot for control and finish. Damon practitioners later lose this alignment to the side effects of elastics forces. In SmartClip SL3 and Clarity SL Self-Ligating brackets, low-force, low-friction mechanics are used early without ligatures, and when it comes time to reduce the play between the wire and slot, they can easily be bound with elastomeric ligatures. Once bound to the base of the slot, play is removed and elastic forces may be distributed to the arch without individual teeth yielding. The efficiency of selective binding is available to SmartClip bracket users through the selective use of its clips and tie-wings. Ask yourself what your most common bend in your Damon practice is, and why? I suggest to you that it might be due to the inability to selectively bind. Finishing Advantage #9: Space Closure Fudging bracket positions for me is a thing of the past now that I have moved to SmartClip brackets. Before SmartClip brackets, I found the trick to space closure in Damon was to exaggerate your bracket placement in the direction of the space to be closed. For example, a central diastema closure requires an exaggerated position in order to converge the roots appropriately due to excessive play between central incisors (Figure 6). This see-saw tipping play is also seen in extraction site closure and generally seen in closure of large amounts of space. With SmartClip brackets, I am now routinely positioning the brackets accurately for the individual teeth and having great success closing spaces predictably and efficiently. 6 Figure 6: Tip bends placed to counteract the lack of tipping control with Damon brackets for diastema closure. Finishing Advantage #10: Synergy of Additive Advantages When the list of Finishing Advantages is combined, there is a synergistic effect that takes place in patient care. The list is summarized in Table 2 and serves as an exclamation point on my experience with the SmartClip SL3 and Clarity SL bracket systems. Bracket Characteristics Table 2 Damon Q Damon Clear SmartClip SL3 Clarity SL Slot Depth.028".028".0275".0275" Debonding Acceptable Difficult! Acceptable Superior Rotation Control Difficult! Difficult! Superior Superior Tie-Wings Limited Limited Superior Superior Tip Control Difficult! Difficult! Superior Superior Bracket Width Narrow Narrow Wide Wide Cues for Visual Positioning Rhomboid Trapezoidal Rhomboid Rhomboid Early Alignment Comparable Comparable Comparable Comparable Finishing Control Selective Binding Difficult! Difficult! Superior Superior Difficult! Difficult! Superior Superior Conclusion In my experience, the design considerations employed by 3M Unitek for both SmartClip SL3 and Clarity SL Brackets provide all of the advantages of passive self-ligation with the added benefits of predictable finishing. I welcome your comments and opinions regarding my experiences and look forward to sharing more in the near future on related archwire principles and the application of lateral development mechanics. References 1 Eberting JJ, Straja SR, Tuncay OC. Treatment time, outcome, and patient satisfaction comparisons of Damon and conventional brackets. Clin Orthod Res 2001; 4: Harradine NW. Self-ligating brackets and treatment efficiency. Clin Orthod Res 2001; 4: Pandis N, Polychronopoulou A, Eliades T. Self-ligating vs conventional brackets in the treatment of mandibular crowding: a prospective clinical trial of treatment duration and dental effects. Am J Orthod Dentofac Orthop 2007; 132: Franchi L, Baccetti T, Camporesi M, Lupoli M. Maxillary arch changes during leveling and aligning with fixed appliances and low-friction ligatures. Am J Orthod Dentofac Orthop 2006; 130: Scott P, T DiBiase A, Sherriff M, Cobourne M. Alignment efficiency of Damon3 self-ligating and conventional orthodontic bracket systems: a randomized clinical trial. Am J Orthod Dentofac Orthop 2008; 134: 470. e Deguchi T, Imai M, Sugawara Y, Ando R, Kushima K, Takano-Yamamoto T. Clinical evaluation of a low-friction attachment device during canine retraction. Angle Orthod 2007; 77: Shivapuja PK, Berger J. A Comparative studyof conventional ligation and selfligation bracket systems. Am J Orthod Dentofac Orthop 1994; 106: Berger JL, Byloff FK. The clinical efficiency of self-ligated brackets. J Clin Orthod 2001; 35: Turnbull NR, Birnie DJ. Treatment efficiency of conventional vs self-ligating brackets: effects of archwire size and material. Am J Orthod Dentofac Orthop 2007; 131: Miles PG, Weyant RJ, Rustveld L. A clinical trial of Damon 2 versus conventional twin brackets during initial alignment. Angle Orthod 2006; 6: Badawi H, Toogood RW, Carey JPR, Heo G, Major PW. Torque delivery of selfligating brackets. Am J Orthod Dentofac Orthop 2008; 133: Case photos provided by Dr. Robert Waugh. 18

19 SmartClip Self-Ligating Appliance System Treatment Efficiency Survey by Nicole Wagner, Senior Technical Service Engineer, 3M Unitek Nicole Wagner is a Senior Technical Service Engineer at 3M Unitek. She received her B.S. in Chemistry from the State University of New York at Stony Brook. Her M.S. and Ph.D. are in Mechanical Engineering from the University of Minnesota, where her research focused on synthesis, characterization, and reaction modeling of hard, wear-resistant ceramic materials. She has been at 3M since Users Report Enhanced Efficiency When Using SmartClip Self-Ligating Brackets Objective: To evaluate treatment times for traditional and self-ligating orthodontic brackets and determine if the use of SmartClip Self-Ligating Brackets improve orthodontic treatment efficiency. Methodology: More than 1,000 orthodontic practitioners were surveyed in the United States, Canada and Europe with responses based on their experience using SmartClip Self-Ligating Brackets from 3M Unitek. The survey was completed by 266 participants who responded to how long they have been using SmartClip Brackets; if the use of SmartClip Brackets reduced their average treatment time; how many office visits they have been able to eliminate from their overall treatment time; if they were able to extend the office appointment interval for patients and reduce chair time; and if they observed significant improvements in treatment efficiency. Results: Of the 266 respondents, 86% used SmartClip Brackets for one or more years. Eighty percent responded that the use of SmartClip Brackets reduced their average treatment time, and 62% were able to eliminate three or more office visits from their overall treatment time. For 68% of respondents, office appointment intervals for patients were extended and 79% experienced a reduction in chair time when using SmartClip Brackets. Overall, 70% perceived that they achieved clinically significant improvements in treatment efficiency when using SmartClip Brackets. Conclusion: SmartClip Self-Ligating Brackets provide orthodontists with significant improvements in treatment efficiency through the reduction of average treatment time, elimination of unnecessary office visits, extension of the time between patient appointments, and reduction of patient chair time when compared to traditional ligated brackets. Introduction Self-ligating orthodontic appliances have become increasingly popular over the last two decades. A number of different advantages of self-ligating brackets have been discussed in orthodontic literature, including reduced friction, 1, 2, 3 anchorage conservation, 4 improved oral hygiene, 5 reduced chair time, 5 and shorter treatment times. 6 Several different passive or active self-ligation systems are currently available on the market. The 3M Unitek SmartClip SL3 Self- Ligating Appliance System was designed to provide orthodontists with a passive self-ligation bracket system featuring clips on the mesial-distal bracket edges with no need for doors or latches. The SmartClip Bracket (Figure 1) allows the archwire to move freely in 1 the bracket slot, while maintaining the control required throughout Figure 1: SmartClip SL3 treatment. The design of SmartClip Brackets is also aimed to Self-Ligating Bracket provide efficient treatment with better hygiene, without the need for ligatures, ligating doors or latches that could trap food particles or build up calculus. 19

20 In this survey, the efficiency of an orthodontic practice was evaluated through a survey administered to more than 1,000 orthodontic practitioners in the United States, Canada and Europe. There were 266 respondents to the survey which asked about their experiences with the 3M Unitek SmartClip Self-Ligating Appliance System. There are many components to having an efficient orthodontic practice. The survey aimed to gather input on how the SmartClip Self-Ligating Appliance System affected these components, including: (1) reducing the average treatment time for patients, (2) completing treatment in a reduced number of office visits, (3) extending the time between office visits, and (4) reducing chair time for each patient. Since most cases require at least a couple of years to complete, survey data was evaluated for responding doctors who used SmartClip Brackets either for less than three years or for three or more years. It was found that the data for the doctors who used SmartClip Brackets for three or more years was comparable as for those doctors who used SmartClip Brackets for less than three years. The overall data for both sets of doctors is therefore given throughout this paper. Reduced Average Treatment Time To better interpret the experience that the respondents had with SmartClip Brackets, they were asked for the length of time they had used the brackets. Figure 2 shows the distribution of respondents based on the number of years that they used SmartClip Brackets. Forty-nine percent had used SmartClip Brackets for three or more years, while 86% of the respondents used SmartClip Brackets for one or more years. expected to see a reduction in average treatment time. Figure 3 shows the reduction of average treatment time among survey respondents when using SmartClip Brackets compared to traditional ligated brackets. 3 Figure 3: Months that respondents were able to reduce their average treatment time when using SmartClip Self-Ligating Brackets when compared to traditional ligated brackets. The reduction in average treatment time observed by the survey participants is believed to be influenced by the reduced resistance to sliding in the SmartClip Appliance System. In the passive self-ligating design of SmartClip Brackets, the clips on the mesial and distal edges of the bracket provide reduced resistance to sliding on the archwire compared to that created by an elastic ligature. The reduced resistance to sliding allows for more efficient tooth movement throughout treatment. Testing was done by an assistant of Dr. Hugo Trevisi (Presidente Prudente, Brazil) using a gauge to measure resistance to sliding on patients wearing either SmartClip Brackets (Figure 4A) or conventional brackets with elastic ligatures (Figure 4B). The gauge showed that the resistance to sliding created by elastic ligatures was nine times greater than that measured on SmartClip Brackets. 4A 2 Figure 2: Years that respondents have been using SmartClip Self-Ligating Brackets. Survey participants were asked how much they were able to reduce their average treatment time when compared to traditional ligated brackets, based on their best estimate and experience with SmartClip Brackets. More than 80% of the survey respondents stated that they were able to reduce their average treatment time. Specifically, 57% reported that they were able to reduce their average treatment time by three or more months when compared to traditional ligated brackets. Therefore, based on those doctors who responded to this question (253), a statistical analysis shows that with 95% confidence, more than 80% of all doctors could be 4B Figure 4A-B: Resistance to sliding measurements on patients wearing (a) SmartClip Self-Ligating Brackets and (b) traditional brackets with elastic ligatures. In addition to the reduced resistance to sliding experienced between the bracket slot and the archwire, SmartClip Brackets are designed with an open slot. This design also provides improved oral hygiene when compared to traditional ligated brackets by minimizing plaque buildup throughout treatment. 20

21 Eliminated Unnecessary Office Visits A key aspect of enhancing orthodontic office efficiency is to eliminate unnecessary office visits. In the conducted survey, respondents were asked how many office visits they were able to eliminate from their overall treatment time with SmartClip Brackets when compared to traditional ligated brackets. Eighty-five percent of respondents replied that they were able to eliminate office visits by using SmartClip Brackets. Sixty-two percent stated that they were able to eliminate three or more office visits throughout their overall treatment time with SmartClip Brackets. Based on those doctors who responded to this question (253), a statistical analysis shows that with 95% confidence, more than 84% of all doctors could be expected to eliminate office visits by using SmartClip Brackets. Figure 5 shows the breakdown of the number of visits that each percentage of survey respondents could eliminate from their overall treatment time. 5 Figure 5: Number of office visits respondents were able to eliminate from their overall treatment time when compared to traditional ligated brackets. Extended Time Between Appointments In addition to reducing the number of visits, another key aspect for enhancing office efficiency is to extend the time between patient appointments. By using SmartClip Brackets, 68% of respondents were able to extend the office appointment interval for patients. Based on those doctors who responded to this question (260), a statistical analysis shows that with 95% confidence, more than 63% all doctors could be expected to extend the time between patient appointments by using SmartClip Brackets. The main attribute believed to extend the time between appointments, as seen by the survey respondents, is the ligating mechanism. For traditional ligated brackets, the main purpose for scheduling office appointments in 4-6 week intervals is to change the elastic ligatures, since they become stained or lose their elasticity over time and no longer provide effective pressure to the archwire to maintain controlled movements between the archwire and the bracket slot. By eliminating the need to replace the elastic ligatures, orthodontists can schedule appointments with longer intervals, allowing a particular archwire to work fully before seeing the patient again to change it. The extended time between appointments is beneficial for both the orthodontist and the patient, since this means that there are usually fewer appointments throughout treatment, allowing orthodontists to focus on other aspects of their practice, and for patients to take less time away from school or work to attend an appointment. Reduction In Chair Time The last key aspect of orthodontic treatment efficiency is to reduce patient chair time. Of the survey respondents, 79% experienced a reduction in chair time when using SmartClip Brackets. Based on those doctors who responded to this question (257), a statistical analysis shows that with 95% confidence, more than 76% of all doctors could be expected to reduce their chair time by using SmartClip Brackets. A hypothesis on the reduction in chair time, as observed by the survey respondents, can be the reduced time needed for archwire insertion and removal. For self-ligating brackets, an elastic ligature does not need to be removed and replaced, so chair time mainly consists of removal of the current archwire and insertion of a new archwire in the orthodontist s selected wire sequence. In addition, without the need to move a ligating mechanism out of the path of the archwire, as needed with self-ligating door designs, SmartClip Brackets can save additional chair time.* To facilitate faster archwire insertion and removal, hand instruments have been designed for use throughout treatment with the SmartClip Appliance System. The SmartClip Appliance Wire Insertion Instrument (Figure 6) permits rapid insertion of the 6 Figure 6: SmartClip Appliance Wire Insertion Instrument. archwire into each bracket, without the need to separately move a ligation mechanism or add an elastic ligature. When using small round archwires in the early phase of treatment, archwires can be inserted into the bracket using one s fingers as well. *A comparison of the time required for archwire changes can be seen in videos of an assistant using each of these bracket system types at portal/3m/en_us/orthodontics/unitek/products/sl/smartclip/). 21

22 7 Figure 7: SmartClip Appliance Wire Disengagement Instrument. The SmartClip Appliance Wire Disengagement Instrument (Figure 7) is designed to assist in disengaging all sizes of archwires. This instrument allows for archwire removal from each bracket without additional movement of a ligating mechanism or removal of an elastic ligature. For further decreased chair time, small round archwires could be cut at the midline and slid out of the SmartClip Appliance. When using the SmartClip Appliance System, archwire changes can be six times faster than with ligated brackets. Overall Treatment Efficiency The orthodontists surveyed were asked if they perceive that they achieved clinically significant improvements in treatment efficiency when using SmartClip Brackets. Seventy percent of the respondents did perceive clinically significant improvements. Based on those doctors who responded to this question (248), a statistical analysis shows that with 95% confidence, more than 68% of all doctors could be expected to perceive significant improvements in treatment efficiency by using SmartClip Brackets. To help facilitate the perceived improvements in treatment efficiency, as observed by the survey respondents, a number of key features were included in the SmartClip System. A unique feature of the SmartClip Self-Ligating Appliance System is its ability to accept tandem archwires to facilitate first- and second-order corrections. An image of tandem archwires in a SmartClip bracket slot is seen in Figure 8. By using tandem archwires the orthodontist can fill the slot and get enhanced rotation, angular, and vertical control. This can speed up the movement of teeth and shorten the length of treatment. In addition, dimpled archwires may be used to prevent archwires from walking, restricting archwire drift. The dimpled archwires could also reduce or eliminate the need to cinch the archwire behind the buccal tubes and provide a permanent visual mid-line reference for treatment. Conclusions By using SmartClip Brackets, orthodontic professionals were able to increase efficiencies in their practices. They were able to realize increased efficiencies by reducing the average treatment time for patients, reducing the number of office visits per patient, extending the time between office appointments for patients, and by reducing the amount of chair time necessary for each appointment. Respondents also stated that they perceived clinically significant improvements in treatment efficiency when using SmartClip Brackets. The rationale for the reported enhanced treatment efficiency could be attributed to the unique features that are integral to the SmartClip Appliance System. The distinct self-ligation mechanism allows for speedy archwire changes and an open, hygienic bracket. Likewise, other design features, including special instruments and the ability to use tandem archwires, complement the overall SmartClip Appliance System for an unparalleled user experience. Additional information on the SmartClip Appliance System can be found at with tutorials at References 1 Read-Ward GE, Jones SP, Davies EH, A comparison of self-ligating and conventional orthodontic bracket systems. Br J Orthod 1997; 24: Henao SP, Kusy RP, Evaluation of the frictional resistance of conventional and self-ligating bracket designs using standardized archwires and dental typodonts. Angle Orthod 2004; 74: Thorstenson BS, Kusy RP, Comparison of resistance to sliding between different self-ligating brackets with second-order angulation in the dry and saliva states. Am J Orthod Dentofacial Orthop 2002; 121: Harradine NWT, Self-ligating brackets: where are we now? J Orthod 2003; 30: Shivapuja PK, Berger J, A comparative study of conventional ligation and self-ligation bracket systems. Am J Orthod Dentofacial Orthop 1994; 106: Harradine NWT, Self-ligating brackets and treatment efficiency. Clin Orthod Res 2001; 4: Figure 8: Images of tandem wires in a SmartClip SL3 Self-Ligating Bracket. 22

23 The Digital Age Has Arrived. Experience Digital Models through Unitek Treatment Management Portal TMP Now you can harness the power of technology for your practice with Unitek Treatment Management Portal TMP, an innovative new orthodontic software platform that allows you to virtually display, analyze and archive 3D digital models for treatment planning. Increase office productivity and efficiency through digital workflows Reduce onsite storage of plaster models Manage patient data Integrate with practice management systems Whether you are looking to maximize efficiency, enhance treatment planning or simply elevate your practice, Unitek TMP brings the power of digital technology to your fingertips. Unitek TMP streamlines the use of the Incognito TM Appliance system through: Powerful tools to perform a 3D setup review Convenient case management A simple order form To get started, go to or contact customer service at (U.S.) Unitek TMP is available in U.S.A., Canada and Australia. 2012, 3M. All rights reserved. 1206

24 Upcoming Events Make Plans Now! 2013 Forsus Class II Correctors Ski Meetings January 11-12, 2013 Embassy Suites Lake Tahoe South Lake Tahoe, California February 22-23, 2013 Topnotch Resort and Spa Stowe, Vermont Featuring: Lisa Alvetro DDS Synchronized Solutions for Clinical Excellence Synchronized Solutions: Managing the Vertical Dimension November 23-24, 2012 Vienna, Austria Hilton Vienna Register online at 3MUnitekTraining.com Speakers: Dr. Tamer Büyükyilmaz, Dr. Lars Christensen, Prof. Dr. Dietmar Segner, Dr. Hugo Trevisi Tuition: 295 Contact: Synchronized Solutions: Managing the Transverse Dimension April 5-6, 2013 Las Vegas, Nevada Bellagio Visit 3MUnitekTraining.com for more information. Registration Now Open! Register Now! Space is limited. Incognito Appliance System: 2013 Users Meeting March 1-2, 2013 San Francisco, California 3M Unitek invites you to join hundreds of orthodontic professionals from around the world in the unique and breathtaking metropolis of San Francisco, California for the 2013 Users Meeting. Led by an esteemed panel of Incognito Appliance System experts, the Incognito System Users Meeting offers a unique learning opportunity with a full range of educational options for new and experienced providers and staff. Need Certification? A one-day certification course is available the day before the Users Meeting, February 28. Contact 3M Unitek for full details. Also visit 3MUnitekTraining.com for upcoming certification and advanced Incognito System courses. For more information and to register visit 3MUnitekTraining.com 3 3M Unitek Orthodontic Products 2724 South Peck Road Monrovia, CA USA In U.S. and Puerto Rico: In Canada: Technical Helpline: CE Hotline: x Outside these areas, contact your local representative. Please recycle. Printed in USA. 2012, 3M. All rights reserved