Treating 66% of Patients in 24 Months or Less, Using Mostly Two Arch Wires and Seeing the Patients Every 6 to 8 Weeks - Three Year Study

Michael Alpern, DDS. MS

If you read Worth or Success magazines or The Wall Street Journal to determine in which companies to invest your savings, you quickly see that most consultants advise investment in companies stressing two key phrases: "New Knowledge" and "New Technology". Applying this successful business technique to orthodontics will have similar results.

New knowledge from marketing, metallurgy, and TMJ Orthopaedic Surgeons has changed every aspect of my practice - from attracting new patients to diagnosis and retention. This new knowledge yielded new technology. Video "Office Welcome" presentations, interactive CD-ROM's, video imaging/diagnosis, Polaroid technology, combined with Dr. Roger Levin's "Patient Relations Technique" assured my practice not only survival, but success.

New orthodontic technology has changed my clinical practice, significantly shortening treatment time¹, increasing clinical chair time, and improving patient satisfaction. In an SSO presentation, Lyle Johnston referred to Lagar² who stressed that the pre-existing cusp fossa interlock is what kept a malocclusion stable. In order to achieve a more efficient correction, Lager and later Hamilton³ stressed unlocking the cusp fossa interdigitation to permit orthpaedic and orthodontic changes. Current TMJ orthopaedic surgical thought⁴ stresses TMJ vertical unloading to prevent injury to the fibrocartilage which lacks the proteoglycans of hyaline cartilage.

A new development of one type of nickel titanium wire (BioForce^TM with IONGUARD^TM*) presented orthodontics with an arch wire in which force was idealized and individualized for centrals through molars. Central incisors receive 100 grams of force, gradually increasing through the molars at 320 grams. Thus, for the first time, each tooth receives the ideal amount of force.

BioForce wire presents the orthodontist with an initial wire permitting near full bracket engagement in nearly every tooth with an .018 x 025" ideal force, super flexible wire in an .018 X .025" slot. A special technique of icing the arch wire before and during insertion assists in comfortable, effective steel ligation. (See photos)

Cusp fossa unlocking and TMJ vertical unloading are achieved using bonded and semi-removable splints which, when combined with the effect of the arch wire, create the same effect as a full time, full arch, flat plane bite splint. Orthodontic cusp fossa unlocking permits the super efficient arch wire and bracket system (with maximum inter bracket width) to achieve orthodontic correction more comfortably, quickly, and efficiently.

A fixed/functional splint system is utilized combining an easily removable rapid palatal expansion bite plane appliance system and associated orthopaedic correctors achieving near simultaneous skeletal and more harmonious skeletal an dental correction. The BioForce wire's low friction IONGUARD treatment and vertical unloading splints permit sliding mechanics and near immediate use of sagittal, Class II, and other elastics.

RESULTS:

In a five-year retrospective study, we found that my orthodontic team and I currently treat 66% of all patients in two years or less using mostly two arch wires, and seeing most patients every 6 to 8 weeks. The initial BioForce arch wires are usually changed only after 6 to 9 months. They are replaced with individualized .016 X .022" stainless steel wires which usually remain until debanding. The time previously spent by my staff in tying and untying multiple arch wires is now utilized in constantly building our patients' self image and improving oral hygiene, diet control instructions, and internal marketing.

From 1992 to 1995, case completed in 0-18 months increased from 24% to 35%. Cases completed in 19-24 months climbed from 22% to 31% - an increase of 9%. Most importantly from 1992-1995, cases requiring 25 or more months declined from 54% to 34% - a decrease of 20%.

Patient Statistics 1992-1995 (See Chart)

Additional advantages include fewer broken appliances, less rebonding, more comfortable and satisfied patients, and more time to take records and perform other patient related and required duties.

SUMMARY AND CONCLUSIONS:

New knowledge and the resulting New Technology permit today's orthodontist to offer more effective and comfortable treatment in less time. The increased time available to the orthodontic staff can be put to use promoting a more beneficial total result to the patient. The author has found that the combination of all of these factors has resulted in an increase in the total number of patients treated, better results, and a more successful and satisfying practice.

The author is indebted to Denise Smith Lee, C.D.O., for her tireless collection and collation of the data.

Dr. Michael C. Alpern is an Adjunct Professor of Orthodontics, School of Dentistry, Marquette University, and is in private practice in Port Charlotte, Florida.

REFERENCES

1. Johnston, L.: Presentation to the Southern Society of Orthodontists Annual Meeting, September 1985, Boca Raton, FL.
2. Lager, H.: "The Individual Growth Pattern and Stage of Maturation as a Basis for Treatment of Distal Occlusion with Overjet", Trans. Europ. Orthod. Soc. 53 Congr. 137-145, July, 1967.
3. Hamilton, D.: Personal Communications, May 1996 Beaver Falls, PA.
4. Nuelle, D.; Alpern, M.: Operative Arthoscopy, Second Edition, McGinty, J.B., Chapter VIII, "The Temperomandibular Joint: Anatomy and Treatment," Lippincott-Raven Publishers, Philadelphia-New York, 1996. Pages 1173-85.

*GAC International, Inc., 185 Oval Drive, Central Islip, NY 11722