Riolo Orthodontics has just acquired the first True Definition orthodontic intraoral scanner on the west coast. This revolutionary hardware can be seen in figure 1; it enables us to “scan” our patient rather than take traditional intraoral impressions. These scans are used to submit digital models to the lab at 3M Unitek to create custom “Incognito braces” that are places behind the teeth.
We also use these digital models to record the the bite before treatment and they can be compared to the digital model made after the teeth are straight. Appliances such as retainers can also be ordered and fabricated using the 3-D model data from third party laboratories. The “digital models” can be sent via encrypted email or dropbox to the laboratory who fabricates the appliance and ships the appliance directly to our office.
When a new patient contacts our office we set them up with an initial consultation with Dr Riolo. At their initial appointment the patient is given information about the orthodontic problem and treatment options to address their chief complaint. The patient is also given the exact cost of treatment; we also check insurance benefits and present all of the information at the initial new patient consult.
The second appointment consists of initial orthodontic records which are used to refine the orthodontic treatment plan and to develop the orthodontic setup if Incognito braces behind the teeth are going to be used to straighten the teeth. These initial orthodontic records consist of photos of the teeth and face, two digital xray images; a panoramic xray and a cephalometric xray and the digital models of the teeth (see figure 2) that are acquired using the true definition intraoral scanner.
When Incognito braces are ordered Dr Riolo and the patient develop a “digital setup”. Frequently the patient’s general dentist and other specialists are consulted when post orthodontic restorative work is planned (such as dental implants, crowns, or veneers). The original digital malocclusion model is used as a starting point and the setup is developed. We have precise control over the amount of expansion with these custom appliances. The digital setup model is then used to design and manufacture the actual custom braces that are placed behind the teeth.
After the initial records are collected Dr Riolo begins the process of developing the setup models, these digital setup models are shown in figure 3. Once we have the initial setup developed, we sit down with the patient and discuss the setup and any possible treatment options. Frequently alternative setups are developed in order to determine the best course of action the for the unique circumstances of each patient.
When the final fit of the teeth is established and the brackets design is finalized the brackets are manufactured in the lab and shipped directly to our office. The bracket themselves are tailored individually for each patient. An example of the a typical bracket design is shown in figure 4. The brackets arrive in an indirect transfer tray (see figure 5). This transfer tray is used in order to insure that we have precise bracket placement at the braces delivery appointment.
The actual bracket delivery is a surprisingly simile procedure; they are literally cemented to the back of the teeth using a special dental cement. After bracket delivery the wires are place and instructions are given to the patient regarding care and maintenance of their new invisible orthodontic brackets.