Tạp chí chỉnh nha OPUS tháng 01+02/2014 Vol 5 No.1

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A Force to Be Reckoned With
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clinical articles • management advice • practice proles • technology reviews
January/February 2014 – Vol 5 No 1
PROMOTING EXCELLENCE IN ORTHODONTICS
Life happens
Justin Harding
Efficiency
by design
Dr. Mark McDonough
Practice profile
Dr. Jerry R. Clark
Book review
The Master’s Guide
to Interproximal
Reduction (IPR)
Dr. Randol Womack
New study may
change the face
of orthodontics
Dr. Juan-Carlos Quintero
Corporate profile
suresmile/OraMetrix
© 2014 Ormco Corporation
See it live or to hear from Dr. Alpan
visit:
iChooseLythos.com

I choose the Lythos
TM

Digital Impression System because of the state
of the art technology
that it brings to
my offi ce. It lets my patients and referring dentists
know how interested I am in technology and in the

accuracy of that technology. I think that it’s
defi nitely
cutting edge and the wave
of the future.
“
“
Dr. David Alpan, DDS, MDS
Beverly Hills, CA
Ormco-OrthoPrac-Lythos-Jan2014.indd 1 1/6/14 2:56 PM
January/February 2014 - Volume 5 Number 1
EDITORIAL ADVISORS
Lisa Alvetro, DDS, MSD
Daniel Bills, DMD, MS
Robert E. Binder, DMD
S. Jay Bowman, DMD, MSD
Stanley Braun, DDS, MME, FACD
Gary P. Brigham, DDS, MSD
George J. Cisneros, DMD, MMSc
Jason B. Cope, DDS, PhD
Neil Counihan, BDS, CERT Orth
Eric R. Gheewalla, DMD, BS

Dan Grauer, DDS, Morth, MS
Mark G. Hans, DDS, MSD
William (Bill) Harrell, Jr, DMD
John L. Hayes, DMD, MBA
Paul Humber, BDS, LDS RCS, DipMCS
Laurence Jerrold, DDS, JD, ABO
Chung H. Kau, BDS, MScD, MBA, PhD, MOrth, FDS, FFD,
FAMS
Marc S. Lemchen, DDS
Edward Y. Lin, DDS, MS
Thomas J. Marcel, DDS
Andrew McCance, BDS, PhD, MSc, FDSRCPS, MOrth RCS,
DOrth RCS
Mark W. McDonough, DMD
Randall C. Moles, DDS, MS
Elliott M. Moskowitz, DDS, MSd, CDE
Atif Qureshi, BDS
Rohit C.L. Sachdeva, BDS, M.dentSc
Gerald S. Samson, DDS
Margherita Santoro, DDS
Shalin R. Shah, DMD (Abstract Editor)
Lou Shuman, DMD, CAGS
Scott A. Soderquist, DDS, MS
Robert L. Vanarsdall, Jr, DDS
John Voudouris (Hon) DDS, DOrth, MScD
Neil M. Warshawsky, DDS, MS, PC
John White, DDS, MSD
Larry W. White, DDS, MSD, FACD
CE QUALITY ASSURANCE ADVISORY BOARD
Dr. Alexandra Day BDS, VT

Julian English BA (Hons), editorial director FMC
Dr. Paul Langmaid CBE, BDS, ex chief dental officer to the Government
for Wales
Dr. Ellis Paul BDS, LDS, FFGDP (UK), FICD, editor-in-chief Private
Dentistry
Dr. Chris Potts BDS, DGDP (UK), business advisor and ex-head of
Boots Dental, BUPA Dentalcover, Virgin
Dr. Harry Shiers BDS, MSc (implant surgery), MGDS, MFDS, Harley St
referral implant surgeon
PUBLISHER | Lisa Moler
Email: Tel: (480) 403-1505
MANAGING EDITOR | Mali Schantz-Feld
Email: Tel: (727) 515-5118
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consequence arising from it. The views expressed herein are those of the
author(s) and not necessarily the opinion of either Orthodontic Practice US or
the publisher.
As I have transitioned my life to dental education, I have observed that my students (graduate
and undergraduate) want simple solutions to diagnosis and treatment as graduates starting
private practice. They are looking for a “cookbook” approach.
As you read through this journal in 2014, as well as others, I will give you the same
message as I give my students. Avoid the cookbook concept. Use critical thinking every day in
your practice, adapt to change, and understand that the way you practice today will not be the
way you practice in the future.
So, as you evaluate the articles not only in this journal, but also in others, the following

New Year’s resolutions might apply to you.
• Allpatientsarenotthesame.Don’ttreatthemasthoughtheyare.Forexample,children
should be treated differently than adults orthodontically. As Dr. Vince Kokich, who was a
transcendent orthodontic and dental educator (and who is sorely missed), said, “Orthodontic
treatment in children should be ideal … in adults realistic.” He meant simply that in children
having no history, all considerations should be addressed, but in adults with a longer dental
history, don’t fix what isn’t broken by forcing “ideal” treatment on them. All patients are
individual and special. Don’t pigeonhole them.
• Don’tforgetthatyouareadentistrst.AsDr.Kokichalsosaid,“Mytreatment(adult
orthodontics) has been influenced greatly by my association with restorative dentistry and
periodontics.” Don’t assume that referring general dentists have performed a complete
examination. Do your own. Also, form an interdisciplinary team in your community that will
provide the synergy and increased scope of treatment that will not only expand your practice
horizons but also be beneficial to your patients.
• Don’tbetherstonyourblocktoadoptnewtechnologyinyourpractice,butcertainlydon’t
be the last! In my 35 years of practice, I have filled my “dental museum” with technology
costing thousands of dollars, now collecting dust. Be critical; is the technology evidence-
based? Will the technology improve your diagnosis or treatment outcomes? Will the expense
add to your bottom line? Will the technology help promote your practice? Most importantly,
does it have a track record? On the other hand, patients expect their doctors to be up-to-
date. For example, make sure your imaging is current (to address radiation concerns). Utilize
new anchorage techniques and approaches that can decrease treatment time safely.
• Constantlyeducateyourself.Dr.WilliamOsler,atrailblazerinmedicaleducationandauthor
of the renowned textbook, The Principles and Practice of Medicine, once said, “The greater
the ignorance, the greater the dogmatism.” Learn to question and be critical of all information
presented no matter what the source. You will be surprised at how this also helps you better
educate your patients and increases treatment acceptance. As an educational exercise, I
purposely give my graduate students articles that completely contradict each other so that
they can discern what is scientifically valid.
• Youdon’thavetodoeverything!Butdowhatyoulike,anddoitwell.Today’seconomyand

patient expectations often push practitioners into doing treatment they are uncomfortable
with. For example, I teach diagnosis and management of temporomandibular disorder (TMD)
and orofacial pain to my students, but I emphasize that many orthodontists prefer not to
deal with these patients. Some orthodontists love treating just children and have successful
practices without getting overly involved with adult orthodontics. In other words, be yourself;
but at the same time, if you aren’t getting the results you want, further education is the
key to improvement. However, don’t ignore new trends and procedures that can be easily
and productively introduced into your practice. For instance, it is my opinion that every
orthodontist should include making sleep appliances for their patients (as long as risks and
benefits are explained).
In conclusion, as you browse journals, be critical, especially of dentists and manufacturers
that offer cookbook, quick-fix, “turnkey” systems. Make sure that the journal is peer reviewed
(as the clinical and CE articles in this one are). Make sure that any new changes in your
practice have withstood the test of time.
But just as importantly, be willing to change and adapt, evaluate the individual needs of
your patients, and finally — enjoy your practice! My best wishes to all for success and a happy
new year!
Dr. Harold Menchel
Harold Menchel, DMD, is a dentist in Coral Springs, Florida, who limits his practice to TMD, orofacial pain, and
sleep-disordered breathing. Dr. Menchel teaches undergraduate and graduate education in TMD and orofacial
pain at Nova Southeastern School of Dental Medicine in Fort Lauderdale, Florida. He is the director of orofacial
pain at Larkin Community Hospital, one of Florida’s 12 statutory teaching hospitals, in Miami and lectures both
nationally and internationally. He is a fellow of the American Academy of Orofacial Pain, a Diplomate of the
American Board of Orofacial Pain, and a member of the American Academy of Dental Sleep Medicine.
New Year’s resolution: throw away
the cookbook!
1 Orthodontic
practice
Volume 5 Number 1
INTRODUCTION

TABLE OF CONTENTS
2 Orthodontic
practice
Volume 5 Number 1
Orthodontic
concepts
BioDigital Orthodontics:
Management of space closure in
Class I extraction patients with
SureSmile: part 7
Dr. Rohit C.L. Sachdeva, and
Drs. Takao Kubota and Kazuo
Hayashi discuss management of
space closure in patients requiring
extraction therapy 14
Research
A survey of orthodontic
practitioners regarding
the routine use of lateral
cephalometric radiographs in
orthodontic treatment
Drs. Matthew McCabe and Donald
J. Rinchuse uncover the latest trend
in the use of lateral cepahlometric
radiographs 24
Practice profile 6
Dr. Jerry R. Clark: Reflections on faith, hope, and orthodontics
Inspired by faith, Dr. Clark strives to work hard, provide the finest care for his
patients, and have some fun along the way.
Corporate profile 10

OraMetrix
Now cloud-based, new suresmile 7.0 eliminates the need for in-office servers
while providing orthodontists powerful and coordinated tools for diagnosis,
treatment planning, archwire design and reduced treatment times.
ON THE COVER
Cover photo courtesy of Dr. Juan-Carlos
Quintero. Article begins on page 41.
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A Force to be Reckoned With
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4 Orthodontic
practice
Volume 5 Number 1
Industry news 30
Continuing
education
Efficiency by design
Dr. Mark McDonough discusses
increasing efficiency through proper
treatment decisions 32
The biology of orthodontic tooth
movement part 2: modulating

tooth movement via nitric oxide
and prostaglandin production
Dr. Michael S. Stosich reviews the
markers of bone cell activity that are
intrinsic to the complex process of
bone modeling and remodeling 38
Book review
The Master’s Guide to
Interproximal Reduction (IPR)
by Dr. Randol Womack 40
Efficiency by
design
32
TABLE OF CONTENTS
Technology
New study may change the face of
orthodontics
Dr. Juan-Carlos Quintero discusses
how 3D imaging is evolving with more
applications and lower radiation 41
Stability, longevity, and
predictability in your practice
management technology
Drs. Shalin R. Shah and Ryan K.
Tamburrino discuss the benefits of
a high-quality practice management
system 44
Product profile
Great Lakes offers a complete
3D orthodontic solution for

orthodontists and their labs 50
Practice
development
Automated patient appointment
reminders — the data is in
Diana P. Friedman shows the
significant impact on no-shows,
practice efficiency, and production
52
Practice
management
Life happens, and big screen TVs
go on sale: a look at solution-
based selling
Justin Harding reminds practitioners
to address patients’ wants and needs
54
Diary 56
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What can you tell us about your
background?
I grew up in Philadelphia, Pennsylvania, and
after high school attended the University of
North Carolina for 8 years, completing my
undergraduate work and receiving a BS
degree and then obtaining my DDS from
the UNC School of Dentistry. After dental
school, I entered the U.S. Navy as a dentist
and served a 2-year tour of duty at Naval
Air Station (NAS) Oceana in Virginia Beach,
Virginia. After that, I became an associate
in a dental practice in Greensboro, North
Carolina, for 2 years practicing general
dentistry. In 1973, I entered orthodontic
school at St. Louis University, and in 1975,
received my Masters in Orthodontics. In
1975, I returned to Greensboro and opened
my own private orthodontic practice, and
since then I have been actively practicing
orthodontics in Greensboro.
Why did you decide to focus on
orthodontics?
While growing up, I was fortunate enough to
have my orthodontic treatment performed
by Dr. Paul Reid, former chairman of
the Department of Orthodontics at the
University of Pennsylvania. Dr. Reid also
served a term as president of the American

Association of Orthodontists (AAO). Dr.
Reid really enjoyed orthodontics, and it
showed. I had never seen anyone enjoy
his or her profession more than Dr. Reid.
While undergoing treatment, we discussed
orthodontics as a career, and he strongly
encouraged me to consider being an
orthodontist.
How long have you been prac-
ticing, and what systems do you
use?
I began my orthodontic practice in 1975.
Over the years, it has been our privilege
to create thousands of beautiful smiles.
With new techniques and technology, it is
always a challenge to keep up and ensure
that we are providing the very finest care
for all of our patients. Today our practice
utilizes virtually all the technical advances
at our disposal. We use 3D imaging,
aligners, TADs, the fantastic and easy-
to-use Picasso
™
Lite soft tissue laser
(AMD Lasers), Dentsply GAC’s Sentalloy
®

and BioForce
®
heat-activated archwires,

and most importantly, we use Dentsply
GAC’s In-Ovation
®
(Dentsply GAC) self-
ligating brackets and the Complete Clinical
Orthodontics (CCO) system of treatment.
Over the past few years I have been
actively involved with Dr. Antonino Secchi
and a group of leading orthodontists from all
over the world in developing and promoting
the Complete Clinical Orthodontics
treatment system. CCO is the intelligent
integration of the best concepts provided
to us by our predecessors: Tweed,
Andrews, Roth, and Damon, to name a
few, combined with the most efficient and
effective technologies available today.
This group is open to every orthodontist
interested in improving his or her clinical
skills, and we invite all orthodontists to join
us at any of our future CCO meetings.
These advances have allowed us
to reduce patient discomfort, decrease
treatment time, decrease chair time, and
decrease the number of patient visits
necessary to complete treatment while at
the same time improving the consistency
and quality of our treatment results.
What training have you undertak-
en?

Every year, I attend the AAO meeting which
affords me the opportunity to continually
monitor what is new in our profession.
I also usually attend at least four or five
courses that will allow me to obtain a more
in-depth knowledge of topics of interest
to me and my patients. I regularly attend
state, local, and alumni meetings, and
have attended the meetings of the Damon
Forum, the Gorman Institute, and took the
Post-Graduate Week Residency Program
at the University of Washington. For over
20 years, I have subscribed to the great
series, Practical Reviews in Orthodontics,
which monthly gives me a critical review
of the literature and the important topics
involving the orthodontic practitioner.
Who inspired you?
My faith inspires me. I have a profound
belief that we have been placed here to
help others and leave this place better for
those who come after us. Our practice is
committed to providing the very finest care
for each and every patient we have the
privilege to treat. My family inspires me also
to be the best that I can be at everything I
do. My parents insisted that I get the best
education possible. When I was a teen,
my orthodontic treatment was performed
by Dr. Paul Reid, former chairman of

the Department of Orthodontics at the
University of Pennsylvania and former
Dr. Jerry R. Clark
6 Orthodontic
practice
Volume 5 Number 1
PRACTICE PROFILE
Reflections on faith, hope, and orthodontics
CCO group
PRACTICE PROFILE
Volume 5 Number 1 Orthodontic
practice
7
president of the AAO. His love for
orthodontics was contagious, and I thought
as a teen that orthodontics would be a
great profession. In orthodontic school at
St. Louis University, Dr. Leo Mastorakos
inspired me to carefully examine every
detail in my approach to treatment and
to accept nothing but the finest treatment
results.
What is the most satisfying aspect
of your practice?
What a privilege it is to daily work with our
patients to provide them with beautiful
smiles and a dental occlusion that will last
them a lifetime. Every day, patients are
excited about getting their braces on, and
other patients are excited about getting

their braces off. During their treatment,
we have the opportunity to change our
patients’ lives, not only with the way their
teeth and smiles look, but also to be
involved in their lives hopefully always in a
positive fashion. Our patients become our
friends.
Professionally, what are you the
most proud of?
The close relationship our staff has with
each other and all of our patients. We strive
to make every patient encounter a positive
one. We have developed a huge family of
patients and friends who truly make every
day fun and exciting. I am proud to be
board certified and to have the ability to
provide outstanding orthodontic care for
every patient who enters our practice.
I am also very proud of the company
I started over 20 years ago to provide
practice valuation and transition services
to the orthodontic profession. Today,
Bentson Clark & Copple is regarded
as the premier orthodontic practice
transition company exclusively serving the
orthodontic profession.
What do you think is unique about
your practice?
We love providing Ritz Carlton-type service
for each and every individual who enters

our practice. We do everything we can to
make every patient comfortable and feel
well cared for in our office. We are not only
providing orthodontic care; we are provid-
ing care for the entire individual. We try to
not just be the patient’s orthodontist; we
want to create a comfortable atmosphere
of fun and excitement centered on the pa-
tient’s treatment.
What has been your biggest
challenge?
Time management has probably been my
biggest challenge. Having four children and
a wonderful wife, I find it is sometimes very
difficult balancing family time along with the
demands of managing and running a busy
orthodontic practice, in addition to being
actively involved in the community and with
my church.
What would you have become if
you had not become a dentist?
A major league baseball player, but I
couldn’t hit the curve ball. Or a professional
golfer, but I couldn’t break par. Initially, I
Dr. Clark’s team Bentson Clark and Copple Principals
Hope Academy
8 Orthodontic
practice
Volume 5 Number 1
PRACTICE PROFILE

wanted to be an architect; I really enjoyed
mechanical drawing and design work.
When I entered college, I enrolled as a
business major and thought about working
in the public relations part of the business
world. However, after three semesters
in the business school, I decided that
dentistry was the career that I wanted to
pursue.
What is the future of orthodontics
and dentistry?
I see a bright future for our profession. The
orthodontic supply companies continuously
come out with newer and better technology
and appliances to make the treatment
of our patients quicker, easier, and more
comfortable for them. I feel privileged to be
a Key Opinion Leader for Dentsply GAC and
having the opportunity to work closely with
their Research and Development team in
developing the next generation of products
to improve the quality of orthodontic care
for our patients. I see significant changes
in bracket design, treatment techniques,
archwires, and aligners; and most of all,
I believe the new digital technology along
with 3D imaging will help to revolutionize
the way we provide orthodontic care.
However, the key to great orthodontic care
will continue to be the proper diagnosis

and treatment planning of cases.
What are your top tips for main-
taining a successful practice?
Continuous continuing education is
necessary, not only in the technical field
of orthodontics, but also with the practice
management side of the practice. “Raving
Fans” customer service (from the book
of the same name by Ken Blanchard and
Sheldon Bowles) is essential to maintaining
a successful practice. Keeping up with
referral patterns is critical, and today the
proper use of “social media” is essential
in maintaining an active practice. A strong
marketing program within the practice
is important to maintaining contact with
referring doctors and our patients. It is very
important to be involved in civic activities
in order to give back to the community.
Twenty-eight years ago I founded the Make-
A-Wish Foundation of North Carolina, and
to date the organization has granted over
5,000 wishes to children under the age of
18 suffering from life-threatening illnesses.
What advice would you give to
budding orthodontists?
Be a constant student and keep up with
all the changes that are occurring in our
profession. Work hard, and provide the
finest care for your patients — but most of

all, have fun. Orthodontics is a wonderful
profession that is highly gratifying and
fulfilling. Enjoy your patients and staff, and
take pride in the quality of care you provide.
What are your hobbies, and what
do you do in your spare time?
I really enjoy reading and learning. My
favorite hobby is golf, which allows me
to spend hours outside and enjoy nature.
My wife, Regina, and I love to travel and
experience the wonderful adventures that
travel provides. I am also a big sports fan
and enjoy almost every sport both as a fan
in the stands and as a spectator watching
on television.
Make-A-Wish wizard
Dr. Clark and wife, Regina, at Pebble Beach
UNC football with family
Top Ten Favorites
1. Reading — every kind of reading —
scientific, mystery, suspense, historical, and
most of all, my Bible.
2. Golf — this is my relaxation. I have had the
privilege of playing some of the world’s finest
courses.
3. Travel — my wife, Regina, and I love to travel
and experience new adventures. We have
visited most of the U.S. national parks and
traveled all over the world — our bucket list
now includes a trip to New Zealand. Anyone

from New Zealand reading this, we would
love to come visit you.
4. University of North Carolina athletics —
our family has season tickets for the North
Carolina football and basketball teams,
and we also go to some of the other UNC
sporting events.
5. My practice — after all these years, it is
still a wonderful privilege to go to the office
every day and have the opportunity to create
beautiful smiles and impact the lives of our
patients in a positive fashion.
6. New technology — it is so much fun to learn
about and utilize most of the new technology
that continues to allow us to provide better
and better care for our patients: TADs,
the laser, 3D imaging, new brackets and
archwires, and so on.
7. Volunteering for the Make-A-Wish
®
Central
and Western North Carolina — I have been
involved with Make-A-Wish Foundation
since I helped found the organization over
28 years ago. It is a constant source of
inspiration and strength to me to be able to
work with the children and families who are
going through such difficult times.
8. Involvement with my church — for over
15 years, I have been volunteering every

Wednesday night at our church to help feed
and work with the homeless people of the
Greensboro community. I volunteer every
Monday and Tuesday during the school year
to tutor children in our church’s after-school
tutoring program. I also drive the church
van to take the children home after tutoring.
I also have a handicapped friend whom I
mentor and take to church on Sundays.
9. Nat Greene Kiwanis Club — I have been a
member of this civic organization for over
30 years and have made many close and
lasting friendships as we help to better serve
and care for the children of our community.
10. Hope Academy — a faith-based, private
school for inter-city middle school children
of Greensboro. My wife, Regina, started this
school in 2012 to help provide a first-class
education to children living in the inter-city
who had few education options. I have had
the privilege of watching, and helping in
some small ways, as this school has grown
from a dream to a reality.
OP
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The smiles that dreams are made of.
suresmile 7.0 from OraMetrix is designed
to help clinicians achieve that goal more
predictably and efficiently than ever before.
Not only has treating patients digitally
gotten dramatically more sophisticated,
it’s also more cost-effective. Now cloud-
based, new suresmile 7.0 eliminates the
need for in-office servers while providing
orthodontists powerful and coordinated
tools for diagnosis, treatment planning,
archwire design and reduced treatment
times. suresmile doctors use advanced
3-D imaging, virtual simulations and
robotically-bent archwires customized for
each treatment plan — all while continuing
to use their bracket system of choice.
Chuck Abraham, CEO, suresmile/
OraMetrix, said, “suresmile 7.0 was
designed by our team to advance the
digital revolution within our specialty.
Taking it to the cloud was essential and the
result of comprehensive re-engineering,
but the design goal for 7.0 was simple and

focused: to build an even better way for
our users to realize their treatment plans
for each and every patient.”
“There is a technology convergence
in orthodontics now. Advances in CAD/
CAM technology, 3D scanning, advanced
robotics, 3D printing, and the cloud have
all helped us to take suresmile 7.0 to new
levels of performance and efficiency,”
Abraham continued. “We’ve developed
the suresmile system to become a true
treatment management platform, enabling
our doctors to meet the esthetic demands
of a growing adult patient population by
offering lingual, lingual/labial, and even a
hybrid treatment of braces and aligners
with the same treatment efficiency and
excellent results our doctors have always
achieved.”
The move to the cloud makes 7.0
easier to integrate into the practice. “The
cloud acts as your ‘server in the sky,’
meaning that digital file storage is much
more convenient, and the system is
easily accessible, regardless of the user’s
location,” commented Phillip Getto, Chief
Technology Officer, suresmile/OraMetrix.
“You don’t have to be in the office to
access a case via internet connectivity —
you can be at home or a Starbucks. All

patient-identifying information is encrypted,
including photos, X-rays, and patient
names. All communication between your
browser and the servers is also encrypted,
as are the servers, which, by the way, are
Amazon servers, amongst the most secure
in the world.”
Since 1998, when OraMetrix developed
the suresmile system, this revolutionary
digital technology has empowered
orthodontists with a powerful diagnostic,
treatment, and monitoring tool to deliver
the most precise, customized orthodontic
care available. In fact, suresmile has been
shown to reduce treatment time by an
average 30%, based on a February 2011
comparison of more than 40,000 patients.
Since 2004, suresmile has been used for
over 125,000 patients by orthodontists in
the United States, Australia, New Zealand,
the European Union, Canada, and Japan.
suresmile 7.0 was developed to enhance
the system’s efficiency while achieving
new levels of precision planning. With the
ability to view both bone and roots, it now
makes case planning more predictable in
achieving roots in the bone. The simplified
user interface is more intuitive for the user,
reducing the time required to set-up cases.
The single-most significant advance in

technology that empowers suresmile from
its inception is robotic wire production.
Patient-specific wire sequences are
calculated by computer and optimized by
the orthodontist to achieve the desired
treatment goal. There is 100% control,
tooth-by-tooth or by shape, at any point
during treatment. suresmile currently
Cloud-based suresmile 7.0 from
OraMetrix takes digital orthodontics
to an entirely new level
10 Orthodontic
practice
Volume 5 Number 1
CORPORATE PROFILE
suresmile/OraMetrix
Executive Management
Team from left to
right: Phil Getto, Chief
Technology Officer; Glenn
Lyon, Vice President, New
Business Development;
Jerry Metz, Vice
President, Operations;
Rohit Sachdeva, Chief
Clinical Officer; Chuck
Abraham, Chief Executive
Officer; Jay Widdig, Chief
Financial Officer; Bob
Davis, Director, Marketing

suresmile’s new interface is designed to be more intuitive
CORPORATE PROFILE
Volume 5 Number 1 Orthodontic
practice
11
produces over 18,000 wires per month,
each one of them optimized to achieve a
specific treatment goal for that patient,
making it truly the only system for fixed
appliances that can provide proactive
management of treatment objectives and
appliance design. A suresmile archwire
can be refined at any time, and suresmile
software provides tools for analysis of
results and decision-making support
throughout the course of treatment.
“There is a misperception in our
profession that suresmile is just a
finishing archwire,” commented Dr. Rohit
Sachdeva, Co-Founder and Chief Clinical
Officer, suresmile/OraMetrix. “In fact, the
strength of the software is the ability to
treatment plan cases in advance, which
allows the doctor to anticipate and avoid
common clinical problems that arise during
treatment. The ability to visualize patients’
roots and bone is a profound advance for
us in putting roots in their proper position.
Even with this advanced planning, we
know that patient compliance and biology

can impact our best-made plans. One of
the true strengths of the suresmile system
is that the doctor can modify the original
plan at any time, order modified archwires,
and still achieve an excellent result.”
suresmile empowers the orthodontist
to see tooth anatomy in ways never before
possible, while providing the ability to
visualize and simulate multiple diagnostic
set-ups and design archwires accurate
to .1 mm. Clinical decisions and their
interdependencies are calculated across
all teeth simultaneously, calculating
archwire designs needed to accomplish
your objectives, precisely and predictably.
Several independent university studies
have confirmed reduced treatment times of
up to 30% over conventional and improved
quality treatment scores.
Real-time treatment simulations
make it possible for the treating clinician
to know, precisely, where each case is
going, and serve as a dynamic patient
communication tool. Writing in a recent
issue of Orthodontic Practice US, Dr.
Randall Moles commented on this aspect
University
Studies
Recent studies show that
suresmile achieves better

or equal quality finishes in
30 percent less time while
effectively achieving desired
tooth movements. Information
available upon request.
suresmile/OraMetrix Firsts
• 3Dimaging,full-archintraoralscanning
• CBCTintegration
• Robotically-assisted,patient-specific archform production
• 3Darchwireprescriptionshapememory alloys
• Fullyintegratedimagingplatform
• Integrated2D-3Dimaging
• Workowautomation
• Integratedsurgicalplanning
• Integratedrestorativeplanning
• Blendedappliances:lingual,labial, aligners
• User-driven3Dtoothadjustment
• Totalpatientmanagementsystem: communication, dx planning, appliance
design, quality assurance
• Automaticcasequalityscoring
12 Orthodontic
practice
Volume 5 Number 1
CORPORATE PROFILE
of suresmile: “The digital systems facilitate
information transfer so much more easily
and effectively. Treatment proceeds
quicker (there is no need to reposition
brackets) and more easily for both them
and us. Along the way, they can see our

proposed targets and even be involved in
their development. Finally, after appliance
removal, we can create digitally-formed
retainers, which are also aligners, to make
any post-treatment adjustments.”
1
In his article, “The Optimized Digital
Practice,” Dr. Bruce Goldstein puts it like
this: “suresmile is the only comprehensive
system that blends the best diagnostics
available with accurately prescribed
therapeutics. suresmile technology
provides the practitioner with the tools
needed to treat patients with greater
efficiency and accuracy.” (suresmile clinical
report No. 1).”
2
Dr. Jeff Johnson, concludes his article,
“Treating an Asymmetric Class II Case with
suresmile,” with this summary:
“1. Have confidence that dramatically
reduced treatment times are possible and
not for isolated patients, but for all patients
in general…We must be willing to step
outside our orthodontic boxes while still
trying to adhere to timeworn orthodontic
principles.
2. The confidence that can be conveyed
to patients is most often our greatest
motivating factor. We basically discuss

with them that we all have our jobs to do…
and are able to backup these claims by
telling them that 65-70% of all our patients
complete their treatment in 15 months or
less.
3. Our planning becomes very transparent
and allows the patients to be an integral
part of their treatment to the degree they
desire…
4. We are able to create a target that, for all
intents and purposes, has been optimized
during the mid-treatment planning process.
This allows us to monitor treatment more
efficiently and not try to achieve what likely
is not possible with the given conditions.”
(suresmile clinical report No. 2).
3
There is more to come.
“2014 will be an exciting year for the
suresmile team,” commented Bob
Davis, suresmile/OraMetrix’s Director
of Marketing. “We have entered into a
joint marketing agreement with Specialty
Appliances to offer labial indirect bonding
service and lingual case design exclusively
powered by suresmile software. Indirect
bonding setups are digitally designed using
suresmile software, which enables greater
accuracy of bracket placement and case
design, as they will have access to our

library of over 20,000 brackets and buccal
tubes. Specialty Appliances will also offer
lingual case planning and setups, including
suresmile wires for lingual treatment.”
With over 125,000 patients already
benefitting from suresmile treatment
globally, suresmile 7.0 is now delivering
advanced functionality, more intuitive
and easy-to-use features, and greater
Treatment plan based on root-and-bone positionInitial CBCT scan (optional)
operational efficiency. To put it simply,
suresmile 7.0 was designed and engineered
to help orthodontists achieve their clinical
goals more precisely than ever before.
This information was provided by
OraMetrix.
REFERENCES
1. Moles, R. Treating digitally and the new
orthodontic practice. Orthodontic Practice
US.2013;4(5):46-52.
2, 3. suresmile clinical reports are available upon
request from suresmile. 888.672.6387.
OP
“ the design goal for 7.0 was simple and
focused: to build an even better way for
our users to realize their treatment plans for
each and every patient.”
— Chuck Abraham, CEO, suresmile/OraMetrix
suresmile digital images provided by Dr. Bruce Goldstein
2

suresmile case by Dr. Jeff Johnson
3
suresmile.com
to be sure.
© 2014 OraMetrix, Inc. All rights reserved. suresmile is a registered trademark of OraMetrix.
surezen.
For our most recent detailed suresmile case studies,
please call 888.672.6387.
To see is to know is to treat.
Dr. Randy Moles
Racine, WI
November 2007
Initial intraoral
July 2008
Planned result
Four bicuspid extraction
January 2009
Actual result (Final)
Yoga_Ad_Moles_OPUS_r3.indd 1 1/3/14 10:47 AM
Introduction
The purpose of this article is to discuss
the application of SureSmile
©
technology
1-6
in managing space closure in patients
requiring extraction therapy. Strategies to
optimize the use of SureSmile prescription
archwires and various Clinical Pathway
Guidelines (CPG) developed by the first

author (Sachdeva) to manage space closure
are discussed. These are highlighted with
patient histories where possible.
Space closure with SureSmile
Efficient and effective management of
patients requiring extraction therapy
requires proactive care planning, the
appropriate choice and design of
appliances driven by sound biomechanical
principles, and the vigilant follow-up of the
patient during treatment based upon a
well-designed clinical protocol.
When using SureSmile, two clinical
strategies are generally considered in
closing the extraction space, namely:
Type 1- Space Closure with SureSmile
The first involves achieving sufficient
alignment and overbite correction with
conventional mechanics followed by
closing the majority of the residual space
with sliding mechanics on a SureSmile
archwire (Type 1). An example of this is
shown in the treatment of patient A.S.
(Figures 1-6). With proper consideration to
the design of the slideline* in a SureSmile
archwire, one can plan to move teeth over
a long span with no collision between an
archwire bend and bracket (Figure 4).
Type 2- Space Closure with SureSmile
The second strategy (Type 2) involves

using conventional mechanics to close
the majority of the space followed by
using SureSmile wire. The choice of the
space-closure device is driven by the
nature of malocclusion and the anchorage
requirements. The appliance types that
a clinician may use to achieve space
closure are numerous. However, a prime
consideration in their use is driven by
anchorage considerations, the desired
nature of tooth movement, i.e., controlled
tipping or translation (Table 1), and patient
cooperation. The relative effectiveness of
various space closure devices used by
the first author (Sachdeva) in controlling
tooth movement during orthodontic space
closure is provided in Table 2.
Furthermore, it must be appreciated
that timely and effective care of a patient
with SureSmile technology warrants
BioDigital Orthodontics:
Management of space closure in Class I extraction
patients with SureSmile: part 7
14 Orthodontic
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Volume 5 Number 1
ORTHODONTIC CONCEPTS
Dr. Rohit C.L. Sachdeva, and Drs. Takao Kubota and Kazuo Hayashi discuss management of space closure
in patients requiring extraction therapy
Rohit C.L. Sachdeva, BDS, M Dent Sc, is

the co-founder and Chief Clinical Officer at
OraMetrix, Inc. He received his dental degree
from the University of Nairobi, Kenya, in 1978.
He earned his Certificate in Orthodontics and Masters
in Dental Science at the University of Connecticut in
1983. Dr. Sachdeva is a Diplomate of the American
Board of Orthodontics and is an active member of the
American Association of Orthodontics. He is a clinical
professor at the University of Connecticut, Temple
University, and the Hokkaido Health Sciences Center,
Japan. In the past, he held faculty positions at the
University of Connecticut, Manitoba and the Baylor
College of Dentistry, Texas A&M. Dr. Sachdeva has over
80 patents, is the recipient of the Japanese Society for
Promotion of Science Award, and has over 160 papers
and abstracts to his credit.
Table 1: Anchorage classification scheme developed by Burstone
7
is used by the first author
(Sachdeva) in designing his strategy for space closure mechanics
Table 2: Guideline developed by Sachdeva to assess the relative degree of control offered by
various space closure appliances
Volume 5 Number 1 Orthodontic
practice
15
avoiding any reactive care processes. One
approach to keeping the patient “on-track”
is to establish and follow clinical protocols.
The first author (Sachdeva) has developed
a number of guidelines to clinically manage

extraction patients with SureSmile (Tables
3-5). These protocols are driven by the
nature of the presenting malocclusion
and anchorage requirements. It must
be recognized that these CPGs provide
a general framework for managing the
course of patient care, and a clinician may
need to deviate from the pathway at times
to cater to the prevailing circumstances
and the patient’s response.
Patient I- A.S. (Space Closure Protocol
A CPG- Sachdeva )
Patient A.S. presented with a Class II
canine and Class I molar respectively with
a deep bite and minor upper and lower
crowding with retained upper E’s, missing
upper right 5, and ectopic erupting upper-
left first bicuspid. Based upon the treatment
plan, it was decided to extract the retained
E’s and upper left second bicispid and
treat to a Class I canine and Class II molar
relationship respectively.
The treatment pathway for patient A.S.
followed Protocol A CPG closely (Table 3).
Details of patient management are shown
with the Figures 1-6.
Figures 1A-1B: Patient I- A.S. 1A. Initial Diagnostic records Class II canine and Class I molar respectively with a deep bite
and minor upper and lower crowding. 1B. Initial lateral ceph and panorex radiographs
Figures 2A-2B: Patient I- A.S. 2A. Upper E’s were extracted and initial alignment and leveling accomplished with .016” NiTi
and .016” x .022” NiTi archwire in both the upper and lower arches. Therapeutic scan was taken at this stage of treatment.

2B. Mid-treatment ceph and panoramic view was taken at time of therapeutic scan
Figures 3A-3C: Patient I- A.S. 3A. Virtual Therapeutic Model (VTM). 3B. Virtual Therapeutic
Simulation (VTS) with upper space closed and prescription archwire designed. 3C. Prescrip-
tion sliding archwire viewed against VTS. Since the upper anteriors are being retracted, the
archwire appears lingual to the teeth
ORTHODONTIC CONCEPTS
16 Orthodontic
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Volume 5 Number 1
ORTHODONTIC CONCEPTS
Figure 5: Patient I- A.S. Shows simulated staged events against the archwire (A-I). Note: mesial slide planned in front of the upper right
molar and the distal slide behind the upper cuspid and bicuspid. This slide refers to the straight length of the segment between the
brackets that allows for uninterrupted movement of teeth
Figure 6: Patient I- A.S. Entire space was closed with .019” x .025” NiTi SureSmile sliding precision archwire with power chain. Note: No
collisions are seen between the archwire bends and the brackets
Figures 4A-4C: Patient I- A.S. 4A. Shows the straight archwire at the time of the therapeutic scan. 4B. Shows the Virtual Therapeutic Model and the design of the sliding SureSmile
precision archwire. 4C. Shows the SureSmile sliding prescriptive precision archwire design. The areas in green are the slide planned in the archwire. This is the straight length of the
archwire that allows unimpeded slide of the teeth during space closure
Table 3: Clinical Pathway Guideline for managing space closure in patient presenting with minimal crowding
Table 4: Clinical Pathway Guideline for managing patients with moderate crowding
Table 5: Clinical Pathway Guideline for patients requiring maximum anchorage. Note:
“C” Anchorage situations may also represent clinical situations requiring maximum an-
chorage. In such situations, the anterior teeth A-P position may need to be maintained,
and depending upon which arch is being treated, Class I or Class III elastic wear may be
required to enable a differential force system
Volume 5 Number 1 Orthodontic
practice
17
ORTHODONTIC CONCEPTS
18 Orthodontic

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Volume 5 Number 1
ORTHODONTIC CONCEPTS
Figure 7: Patient II- T.Y. Initial diagnostic records. Patient presents with a Class I malocclusion with severe upper and lower
crowding. Extraction of first four bicuspids was planned for this patient
Figures 8A-8C: Patient II- T.Y. 8A. Virtual Diagnostic Model (VDM). 8B. Virtual Diagnostic
Simulation (VDS) designed with the use of the Virtual Diagnostic Model (VDM). The upper
and lower first bicuspids have been extracted. Note: The soft tissue simulation in the lower
anterior region shows the appearance of black triangles (B-1). 8C. Comparison between
VDM and VDS. There is considerable retraction of the anterior teeth, especially of the lower
incisors. “A” anchorage of the buccal segments is planned. Note the significant arch-width
changes planned in the lower left premolar canine area
Figure 9: Patient II- T.Y. The initial phase of treatment involved separate canine retraction in both the upper arch and lower arch with sliding mechanics. The current image, 7 months from
the start of treatment, is the time at which the therapeutic scan was taken. Most of the space has been closed, and the space among the upper anteriors is being consolidated en masse
with .017” x 025” stainless steel teardrop loops in a continuous archwire. Note that the buccal segments in both arches are slightly dumped because of the lack of control of the couple-to-
force ratio
Patient II- T.Y. (Space Closure Protocol
C CPG- Sachdeva )
Patient T.Y. presented with a Class I
malocclusion with severe upper and lower
arch crowding. Based upon the treatment
plan (Figures 7B and 8B1), it was decided
to extract the upper and lower first
premolars and treat the patient to a Class I
with “A” anchorage
The treatment protocol for patient
T.Y. was very closely adhered to as shown
in the Protocol C CPG (Table 5), and the
duration of treatment for this patient was
11 months.

Figures 10A-10C. Patient II-T.Y. A. Virtual Therapeutic Model (VTM). Note the arch widths
are reasonably controlled; however, it is apparent that the buccal segments are “dumped.”
10B. Shows the Virtual Target Setup with the accompanying SureSmile archwire design.
10C. Shows the Suresmile archwire design against the virtual therapeutic model (VTM). A
full expression .017” x 025” SureSmile prescription archwire was designed. Also, note the
brackets used in this patient have a .018” prescription
Figures 11A-11E: Patient II-T.Y. Treatment re-evaluation of space closure was done at the Therapeutic stage. VTM model is in white and the “best
fit” superimposed on the VDM in green to evaluate the nature of anchorage loss. Note that most of the anchorage was lost in the maxillary buccal
segments. Also, note that about 4 months into treatment, dumping of the buccal segments becomes obvious, and at this stage of treatment,
about 50% of the space has been closed
Volume 5 Number 1 Orthodontic
practice
19
ORTHODONTIC CONCEPTS
Figures 12A-12H: Patient II- TY. Re-evaluation of the VTM against the VDM in both the upper and lower arch. The VTS is in white and the VDS in green. Note some buccal lingual
dumping of the lower buccal segments is noted. However, the arch widths at the molar level were controlled. The anchorage in the upper right buccal segment was better controlled
than that in the upper left. Maximum anchorage control was achieved in the lower arch. Also, note as the upper right canine was retracted distally, the palatally blocked upper right
lateral first moved laterally, probably as a result of the transseptal fibers, and once it was engaged with the archwire, it was tipped labially into the arch
20 Orthodontic
practice
Volume 5 Number 1
ORTHODONTIC CONCEPTS
Figures 13A-13B: Patient II- T.Y. 13A. Shows the comparison between the initial plan (VDS) in white and the initial model (VDM) which is blue. 13B. Shows the
comparison between the initial diagnostic model plan (VDS) in white and the Virtual Therapeutic Model (VTM) in green. Note the similarity in the plan movement
versus the executed
Figure 14: Patient II- T.Y. SureSmile archwires were inserted 7 weeks post Therapeutic scan. Note Check elastics are worn along with the SureSmile .017” x
025” NiTi precision archwires
Figure 15: Patient II-T.Y. Recall visit 8 weeks post
SureSmile archwires insertion. Note the Class I buccal
segments relationship and the substantial correction of

the dumped segments achieved
Volume 5 Number 1 Orthodontic
practice
21
ORTHODONTIC CONCEPTS
• One system with superior 3D scans with multiple elds
of view, 2D panoramic imaging and optional one-shot
cephalometric imaging
• Optimize your image quality and dosimetry
• Cut treatment time by 30
%
with SureSmile* certication
• Experience seamless integration
To learn more about what a great image can do for your practice,
visit carestreamdental.com/cs9300 or call 800.944.6365 today.
© Carestream Health, Inc. 2013 10243 OR DI AD 0114
The CS 9300C Select is ready to work hard for your practice.

This technologically-advanced system will finally give you clarity,
flexibility and, most importantly, complete control of your image
quality and dosimetry.
It’s amazing what a great image
can do for your practice.
* SureSmile is a trademark of OraMetrix.
8765_Bundle ad-Ortho-3.8x10.7_02.indd 2 1/2/14 2:39 PM
Figures 18A-18B: Patient II-TY. 18A. Note the development of black triangles was predicted in the lower
anterior region using the Virtual Diagnostic Simulation (VDS). 18B. These are also seen in the frontal intraoral
image at the end of treatment
Figure 17: Patient II- T.Y. Shows a comparison of the initial simulation (VDS) in green versus the final model (VFM). Note the initial plan was closely adhered to
22 Orthodontic

practice
Volume 5 Number 1
ORTHODONTIC CONCEPTS
Figures 16A-16C: Patient II- TY. 16A. Debonded 4 weeks later. 16B. Final X-rays cephalogram and pano. 16C. Virtual final records achieved
REFERENCES
1. Sachdeva R. BioDigital orthodontics: Designing
customized therapeutics and managing patient
treatment with SureSmile technology: part 2.
Orthodontic Practice US. 2013;4(2):18-26.
2. Sachdeva R. BioDigital orthodontics:
Diagnopeutics with SureSmile technology: part 3.
Orthodontic Practice US. 2013;4(3). 2013;4(3):22-30.
3. Sachdeva R. BioDigital orthodontics: Outcome
evaluation with SureSmile technology: Part 4.
Orthodontic Practice US. 2013;4(4):28-33.
4. Sachdeva R. BioDigital orthodontics: Planning
care with SureSmile Technology: Part 1. Orthodontic
Practice US. 2013;4(1):18-23.
5. Sachdeva R. BioDigital orthodontics: Management
of Class 1 non–extraction patient with “Fast–Track”
©
–
six month protocol: Part 5. Orthodontic Practice US.
2013;4(5):18-27.
6. Sachdeva R, Kubota T, Hayashi K. BioDigital
orthodontics: Management of Class 1 non–extraction
patient “Standard–Track”
©
– nine month protocol:
Part 6. Orthodontic Practice US. 2013;4(6):16-26.

7. Burstone CJ. The segmented arch approach to
space closure. Am J Orthod. 1982;82(5):361-378.
8. Fontenelle A. Challenging the boundaries of
orthodontic tooth movement. In: Sachdeva RCL, ed.
Orthodontics for the Next Millennium. Glendora, CA:
Ormco Publishing; 1997: 248.
9. Sachdeva R, Bantleon H. Cantilever based
orthodontics—biomechanical and clinical
considerations. In: Sachdeva RCL, ed. Orthodontics
for the Next Millennium. Glendora, CA: Ormco
Publishing; 1997.
Conclusions
SureSmile technology, when used
appropriately within the framework of the
clinical pathway guidelines developed
by Sachdeva, offer a unique approach
to providing both efficient and effective
treatment of Class I patients requiring
extraction therapy.
Future articles will provide more
clinical patient histories to demonstrate the
benefits of using SureSmile technology in
improving patient outcomes, providing it is
driven by a skilled clinician who is willing
to follow a proactive care approach to
managing patients.
*Slideline is the length of the straight segment between
the teeth in a SureSmile archwire along which a tooth
may slide uninterruptedly.
Acknowledgments

The authors are most grateful to Con
Vanco, BDS, D Clin Dent, M Orth RCSEd,
MRACDS (Ortho), FRACDS, from Adelaide,
Australia, for sharing records of Patient
A.S. for this paper.
The authors also wish to thank Sharan
Aranha, BDS, MPA, for the invaluable
assistance she continues to provide in the
preparation of this series of articles.
Volume 5 Number 1 Orthodontic
practice
23
ORTHODONTIC CONCEPTS
CS ORTHOTRAC CLOUD
Count on us for INNOVATIVE design
to keep your practice in the forefront.
INTEGRATED software for seamless workow,
ofce to operatory.
And
INTERACTIVE products that
promote better patient relationships.
© Carestream Health, Inc. 2013. OrthoTrac is a trademark
of Carestream Health. 10243 OR DI AD 0114
Share our passion for
your practice online.
Visit www.carestreamdental.com
or call 800.944.6365.
Share our passion for
your practice online.
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SELECT
YOUR
PRACTICE.

OUR PASSION.
CS 3500
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OP