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Digital Makes Learning New Procedures Easier

by Dr. Mike DiTolla, on 1/24/19 9:46 AM

For the first 20 years of my career I was reluctant to surgically place an implant. One reason is that when I became a dentist, root form implants were not commonplace in the US, it was all about subperiosteal implants. After the patient’s mandibular tissue has been opened from second molar to second molar, a cast titanium frame was fitted to the mandible, like a saddle on a horse, and the tissue was closed with multiple titanium posts protruding through the gingiva to support the restoration. None of us GP’s saw that procedure and thought “I’d like to try that next week.”

Once root form implants began to grow, the surgical portion of the procedure became much simpler, but I still couldn’t get myself to try one. I took multiple hands-on courses where we would place implants into a styrofoam jaw, but that never gave me the confidence to place one in a human jaw. But then digital technology showed up in the form of a surgical guide. The guide was designed to control the position, angulation and depth of the implant. It was the training wheels I was looking for.

Orthodontics with fixed appliances (brackets, arch wires, etc…) might not seem as intense as surgically placing an implant, but for a GP who has never done ortho before, the anxiety of doing a clinical procedure for the first time that you didn’t do in dental school, is just as stressful as your first implant, apico, or crown lengthening.

Enter digital technology.


Much like a surgical guide, Six Months Smiles now uses digital technology to place the brackets on the master model in the precise position to most efficiently move the tooth into its final position. A custom bonding tray is fabricated on this model to ensure the brackets end up in the same position on the teeth. Simply etch and rinse the teeth, place the adhesive on the tooth and the cement on the bracket, and seat the tray like a bleaching tray. It’s the orthodontic version of a surgical guide, and like the surgical guide, it removes the stress from performing a new clinical technique.

If you were able to do your first ortho case with an orthodontist standing next to you, talking you through it, it would be an anxiety free procedure. The Six Month Smiles team of orthodontists use digital technology to plan your case and determine optimum bracket placement position. That information is digitally transferred to the laboratory where the bonding trays are fabricated and sent to your office. It’s a as close as you can get to having an orthodontist stand next to you, and I think it’s the best way to learn a new clinical skill.

When I learn a new clinical technique, my biggest fear is always getting in over my head with a difficult case. It’s embarrassing to have to send the patient to a specialist to finish a case you shouldn’t have started. The Six Month Smiles digital treatment planning is called CONFIDEX 360™, and importantly, it contains a Case Complexity section. The Six Month Smiles orthodontists assign a degree of difficulty to you case ranging from 0 to 35 based on the difficulty of movements required to achieve a successful esthetic result. If you decide you want your first 10 cases to be relatively simple with a high chance of success, you can decide to only treat cases that are a complexity of 15 or less, for example.  More importantly, you will always know when a case might be too difficult for your level of experience. It’s a great feeling to know there aren’t any surprises waiting for you around the corner.

Digital technology has ushered in a new era for GP’s looking to expand their range of clinical skills. Being able to confidently move teeth in the arch will open up a whole new world of esthetic possibilities for you and your patients. Whether it’s just orthodontic treatment, or short term ortho being done in conjunction with minimal prep veneers, you will love your new ability to deliver minimally invasive esthetic results!

Dr. Mike DiTolla
Dr. Mike DiTolla

Topics:Six Month SmilesCONFIDEXGuided Orthodontics


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