Orthodontic

REVIEW
SHAPING THE FUTURE
HOW RMO® IS APPLYING INNOVATION & TECHNOLOGY IN ORTHODONTICS

DENTAL ®
RMO :YOUR BFF
MONITORING
TM
THE IMPORTANCE OF
THE AGE OF THE APP QUALITY MANAGEMENT
SYSTEMS

NEW RMO®
PRODUCTS
INNOVATION AND
TECHNOLOGY

SWLF
®

CHANGING SHAPING THE FUTURE

THE GAME OF ORTHODONTICS
ONE PATIENT AT A
IMPROVING ORTHODONTICS
THROUGH TECHNOLOGY
TIME
 CHANGING THE GAME
IMPROVING ORTHODONTICS THROUGH TECHNOLOGY

It is the time of the year where excitement and enthusiasm build as we prepare to participate
in our 83rd AAO. At RMO® we begin preparing for the AAO a year in advance and this
year has been no different. We look forward to all of the activities that come with the
Annual AAO Session.

It is AAO Annual Meeting time!

We would also like to take this opportunity to thank you for your confidence, business, trust
and most of all your contribution to orthodontics. Daily we witness the quality of treatment
you deliver to your patients. Thank you!

We at RMO® are always trying to deliver an easier, simpler, and better experience for both
the patient and the doctor to receive and deliver the best treatment options available.
This year, to continue with our technology tradition, we are partnering with the state
of the art company, Dental Monitoring™, which is the world’s first mobile monitoring
solution in orthodontics. This game changer in Orthodontics is brought to you by RMO®
in collaboration with our European partners in France! This is big benefit of being an
international company for over 60 years.

The Dental Monitoring™ solution is designed to help you:

1. Control the position and treatment of your patient’s teeth remotely and continuously
2. Utilize the most advanced technology available today in orthodontics
3. Work with the most common treatment plans in orthodontics today
Stop by the RMO® booth (#421) and learn about this very exciting system and enjoy the
best experience on the show floor!

As we dedicate this Clinical Review to technology, I’d like to focus on yet another game
changer brought to you by RMO® from Spain: the Straight Wire Low Friction technique,
more commonly known as SWLF®.

SWLF® is not just a technique involving a bracket; we have attempted to incorporate all the
recent technological advances in orthodontics into an extremely simple therapeutic protocol
and system of biomechanics. The technological changes affecting modern orthodontics,
which have led to the creation of the Straight Wire Low Friction (SWLF®) technique, are
super-elastic wires, the latest generation of titanium-molybdenum wires, friction selection
brackets. The SWLF® technique was created in conjunction with Dr. David Suarez many
years ago. We have had a great journey together and look forward to years of working
together.

As we have spent millions of dollars to automate our factory using robotic arms and up
to date machinery to prepare for the future and to be able to expand our horizons and
grow all over the world, we are proud to be able to bring you the previously mentioned
game changers. We at RMO® are looking forward to the upcoming AAO in Orlando as we
continue to partner with the AAO in many ways. We are happy to be the proud sponsor for
the International Reception again this year as well as the longest-standing exhibitor at the
AAO annual session.

Tony Zakhem
Chairman & CEO
RMO, Inc

2 CLINICAL REVIEW
TABLE OF CONTENTS

06
06 10

34 48
FEATURED ARTICLES

06 RMO : YOUR BFF

®

Dr. Leon Laub

10 SWLF : SHAPING THE FUTURE

®

of Orthodontics One Patient at a Time

Dr. David Suarez Quintanilla

34 QUESTION AND ANSWER

With Dr. David Suarez Quintanilla

48 DENTAL MONITORING TM

Age of the App

Dr. Louis-Charles Roisin

ORTHODONTICPUBLICATION 3
 rocky mountain orthodontics
®

ALTITUDE SL TM

Low Friction Self Ligating Bracket

Ball hook

Smooth rounded
slot lead-in
Twin bracket for easy
ligation if desired

Laser etched
palmer notation Two options for easily
on base opening the door

80 gauge mesh foil

base for maximum Low profile
bond strength smooth-round
contours
Patented rail design

BENEFITS:
■ Smooth-round contours and ball hook for added patient comfort
■ Patented rail design provides reliable, stable door retention
■ Effortless door activation and optimal sliding mechanics
■ Easy wire placement and insertion for quicker wire changes
■ Molded for high strength and rigidity

650 West Colfax Avenue, Denver, Colorado 80204

P 303.592.8200 F 303.592.8209 E sales@rmortho.com
Synergistic Solutions for Progressive Orthodontics
®

800.525.6375 | www.rmortho.com
CONTRIBUTORS

LEON LAUB DAVID SUAREZ LOUIS-CHARLES

M.S., Ph.D. QUINTANILLA ROISIN
D.D.S., Ph.D. M.D., Ph.D.
Leon’s major focus at RMO® is to Dr. Suarez is the Director of the Dr. Louis-Charles Roisin graduated
advance RMO®’s Intellectual Property Department of Orthodontics at the with a specialty in Dento­Maxillofacial
portfolio through writing or facilitating University of Santiago de Compostela, Orthopedics in 1988 in Paris. He then
new patent applications and trademarks. Spain. In addition to his Graduate Specialty embarked on an unconventional, self-
Leon promotes RMO®’s education Degree in Orthodontics he also holds a PhD taught path: diploma under the supervision
and teaching initiative as a lecturer at in Medicine. Dr. Suarez is the developer of Jean Delaire in Nantes, EPGET and
orthodontic residency programs in the of the SWLF® Technique (Straight Wire Tweed Foundation with Alain Decker, Club
U.S. and Canada. Several programs Low Friction). This technique involves TTD with Pierre Planche and the courses
invite him back yearly to lecture on the principles of reduced friction, lighter of Didier Fillion and Dirk Wiechmann. A
orthodontic materials (UIC, Stony Brook, force wires, clinical efficiencies and former private attending physician in the
Tufts, Montefiore, U of Alberta). He reduced treatment time. He has given maxillofacial surgery wards of the Foch,
actively assists orthodontic residents set- many courses in Europe, the United States Saint Louis, Percy and Necker hospitals,
up research studies and theses protocols. and Latin America. Dr. Suarez is an active he attended numerous oral & facial, and
Leon has presented courses internationally member of the EOS, AAO and WFO. later craniofacial surgeries with Daniel
in Europe, Asia, and Latin America. He is the author/co-author of 12 dental Marchac. He has been a consultant in
Leon’s education includes: Ph.D., Materials and orthodontic textbooks. He has also the multidisciplinary team of the Centre
Science & Engineering, Northwestern published numerous articles. of Reference for Craniofacial Dysostosis
University; M.B.A., Colorado State and Neurosurgery at Necker hospital for
University; M.S., Columbia University; 20 years. In 2008, he obtained an expert’s
B.S. New York University. He learned degree in maxillofacial and oral­ dental
Dental Materials as an NSF Fellow at health. In 2002 he became one of the first
Northwestern University Dental School. and very enthusiastic users of Invisalign.
Prior to coming to RMO®, he worked at Since 2013, he has been sharing his
the ADA in dental materials research and time between his private office and
the ADA Standards Program; and held clinical direction of a new project:
positions in dental industry at Teledyne Dental Monitoring.
Getz and Water Pik.

ORTHODONTICPUBLICATION 5
 RMO -YOUR BFF
® product in bulk to U.S. distributors that package them. These
products are often not registered with the FDA; their quality and
THE IMPORTANCE OF QUALITY MANAGMENT SYSTEMS safety is questionable, but the price is right. Labeling may read:
BY DR. LEON LAUB “Packaged in the U.S.,” which is a warning sign to look closer
at the product. “Packaged” does NOT mean “Made in the
Today the English language is changing quickly, converting words U.S.” Wording may be similar but the product itself may not be
to initials. RMO® has certified ALL its products to sets of initials biologically safe (it can
that give the doctor assurance that RMO® products and services contain heavy metals PACKAGED DOES
meet the most rigid worldwide standards. If RMO® does not that were incorporated NOT MEAN MADE IN
certify to use certain sets of initials, its ability to sell worldwide is during processing,
drastically limited. THE U.S.
such as: Chromium);
biological compatibility testing usually is not done, and cleanliness
To obtain certification requires not just paying fees, but of the product is questionable. Most often, these products have no
creating a controlled manufacturing environment (Quality traceability by their manufacturer; no production lot is recorded;
Management System) that documents design of new and no Research & Development is behind the products. For
products, writes instructions for its work force on how to the times when a product fails in the mouth, traceability becomes
make products, monitors production, assures packaging and essential to protect the patient from any harm due to toxic/
labeling are correct, and should there be a customer issue carcinogenic elements in the product from either its composition
with a product – will investigate complaints and respond or manufacturing process. This information is not available.
back to the doctor and regulatory agency with the results
of its investigation. In contrast, RMO® certifies each of its products with the FDA. All
products that RMO® imports are also registered with the FDA.
Why does RMO® choose to do this? Because at its core, RMO® has FedEx checks imports before it delivers them; without FDA
always been internationally known as the “Quality Orthodontic registration of international products, FedEx will return the
Company” and will give its doctors the best products and services package to the sender. RMO® adheres to all import requirements,
that they expect. and pays duties on all imported products. RMO® labeling and
packaging clearly states where a product is made, if it is not made
Many orthodontic supply companies are happy to sell you in the U.S. When RMO® puts its name on packaging, RMO® is
products at low prices. But, the sale stops there. Should considered the “manufacturer” and has all the obligations and
a doctor have questions or complaints on product design, reporting requirements as if the product was internally produced.
materials, or usage – the doctor needs to find answers
elsewhere. There are manufacturers overseas that sell

6 CLINICAL REVIEW
Approximately 80% of the products offered in RMO®’s catalog The dental profession has been the leader in the medical
are manufactured in Denver, CO. RMO® does NOT outsource devices arena, with the establishment of written standards for
its core products to other countries. Brackets, tubes, bands, pre- 100 plus products. The standards program has been a long-
welds, metal appliances have been manufactured for over 80 term collaboration between the ADA Division of Science at the
years at its facility in downtown Denver, contributing jobs to the ADA Headquarters
economy of Colorado and the U.S. (Chicago, IL) and the
MANUFACTURER
Standards program CERTIFICATION TO ADA
RMO®'S GOAL IS TO BUILD LONG at the National STANDARDS IS VOLUNTARY,
TERM RELATIONSHIPS WITH ITS Bureau of Standards BUT DOCTORS ARE AWARE
DOCTORS, AND ALWAYS SUPPORT ( W a s h i n g t o n , OF THE VALUE TO BOTH
DOCTOR NEEDS AND QUESTIONS. D.C.). The ADA PATIENT AND DOCTOR,
now administers its
TO USE ONLY CERTIFIED
To achieve this goal, RMO® invests in internal resources, both standards program
money and staff, to make the highest quality products because through ANSI,
PRODUCTS.
it considers its partnership with doctors as the only way to do American National Standards Institute, and the standards are
business. identified as ANSI/ADA. Manufacturer certification to ADA
standards is voluntary, but doctors are aware of the value to both
FDA, GMP, ANSI, ADA patient and doctor, to use only certified products.
What about those initials? It starts with the FDA. The FDA
has guidelines called GMP – Good Manufacturing Practices, ADA Specification No. 7 Dental Wrought Gold Wire Alloy was
and manufacturing companies, such as RMO®, are required to first developed in the early 1960s, with the last reaffirmation in
register all its products with the FDA through filing a 510(k). 1989. When the U.S. de-controlled the price of gold (around
Evidence has to be provided to the FDA identifying specific 1968) which had been $35/ounce, very predictably, gold alloy
product use, biological safety of the products, and should any wires were no longer price competitive. By then, RMO® was
adverse patient issue arise, it will be investigated and reported to in the forefront of product innovation in orthodontics, having
the FDA. Orthodontic products are considered Medical Devices introduced stainless steel products (1930s) and Elgiloy® wires
by the FDA and are subject to all the stringent requirements for (1960s) as alternatives to gold. Nickel-Titanium wires found
a medical device. an application as orthodontic wires (1970s) and in the 1980s,
Beta-Titanium wires completed the range of orthodontic wires
currently used by doctors. By the 1990s, the specification for gold
orthodontic wires was ancient history and there was little interest
in a new ADA Specification No. 32 for Orthodontic Wires,
although the standard was developed in 1989.

Around the year 2000, international interest in developing

new standards for orthodontic materials arose among member
countries of ISO (International Organization for Standardization).
U.S. orthodontic manufacturers were concerned that if they did
not have a voice in writing the new standards, they would be
left with the necessity, among other outcomes, to make all new
tooling for producing brackets if ISO were to require bracket
slot sizes in metric units, rather than inches. Instead of .018” and
.022” bracket slot sizes, brackets might be required to be sold as
slot sizes of 0.46 and 0.56 mm! At the national level, a new U.S.
group was formed to write orthodontic product standards, under
the administration of the ADA. New standards were written for
orthodontic wires, brackets & tubes, and elastomeric materials,
which became ISO Specifications. Today, the ADA and ISO
Specifications for orthodontic materials are identical.

ORTHODONTICPUBLICATION 7
 ISO & MDD In contrast, orthodontic distribution companies do NOT
Several countries began to protect its citizens from importing certify products or incur these costs. The value a doctor
inferior orthodontic products by imposing import requirements, receives as an RMO customer, is that RMO “has your back.”
with a major obstacle – all imports needed to meet new country RMO is your partner for the long term.
certification requirements. Several countries developed their
own certifications, instead of adhering to ISO Specifications.
A DOCTOR CAN BE ASSURED THAT
As a result, U.S. manufacturers were compelled to be certified in
MULTIPLE WORLDWIDE EYES HAVE SCRUTINIZED
multiple countries or they could not sell in those markets.
RMO’S QUALITY MANAGEMENT SYSTEM
WITH THE AUDITOR’S OUTCOMES THAT RMO
In the EU, the Medical Device Directive, MDD, was issued to
MANUFACTURES TO A VERY HIGH LEVEL OF
require all imported orthodontic products to carry the CE Mark.
PRODUCT QUALITY.
In Canada, Health Canada requires all orthodontic product to be
registered and certified to its standards. The Pharmaceuticals and
Medical Devices Agency (PMDA) certifies and monitors product
safety for imported products to Japan. More countries will follow You can check out RMO’s current certifications:
this lead. 1. FDA QSR (Quality Systems Regulation)
2. ISO 9001:2015: Quality management systems -
RMO holds certification in all the countries mentioned above. Requirements
What is not visible to our doctors is the internal cost in personnel 3. ISO 13485:2016: Medical devices – Quality management
and fees required to certify and maintain certification for these systems – Requirements for regulatory purposes
countries. RMO is scrutinized not only by the FDA, but multi- 4. EU Medical Device Directive (93/42/EEC)
country regulatory agencies. Typically, specific country certification 5. Health Canada: Canadian Medical Devices Regulations
follows a process to have its own country auditors travel to Denver (CDMR)
to do an on-site audit of product manufacture which includes 6. MHLW Ministerial Ordinance No. 169 – Standards for
inspecting manufacture documentation, observation of RMO Manufacturing Control and Quality Control for Medical
manufacturing, systems for product traceability, and packaging. Devices and In-Vitro Diagnostic Reagents. (Japan Ministry
Costs are paid by RMO. With multiple country audits, total costs of Health, Labor and Welfare (MHLW); Pharmaceutical and
have rapidly increased. Medical Devices Agency (PMDA); Pharmaceutical Affairs
Law (PAL))

8 CLINICAL REVIEW
 THE WORLD’S FIRST MOBILE
MONITORING SOLUTION IN
ORTHODONTICS
allows you to control the position and
shape of your patients’ teeth remotely and continuously

combines the most advanced research in

machine vision with patented algorithms in order to create the first
self-monitoring system in orthodontics
-
is designed to work with most treatment
plans or post-treatment follow-ups, from regular brackets to
lingual appliances or removable pre-planned aligners

650 West Colfax Avenue, Denver, Colorado 80204 Synergistic Solutions for Progressive Orthodontics®
P 303.592.8200 F 303.592.8209 E sales@rmortho.com 800.525.6375 | www.rmortho.com
 SHAPING
THE FUTURE
OF ORTHODONTICS ONE PATIENT AT A TIME
BY DR. DAVID SUAREZ QUINTANILLA

The orthodontic profession is currently being shaped, and will was known of the current advances in orthodontics (3D digital
continue to be shaped, by changes of three different kinds: imaging, dental virtual reality, microimplants and TADs, new
conceptual, technological and socio-economic change. With elastomeric materials, osteodistraction devices, etc.) and when the
respect to conceptual changes, Evidence-Based Orthodontics properties and behavior of shape memory wires, the first NiTi
(EBO) ensures that our diagnoses, treatment and clinical wires, were far removed from the highly effective and superelastic
activities are based on proven scientific evidence rather than and thermoelastics alloys we have today.
subjective opinions, individual experience and biased personal
interpretations. EBO sets the clinical standard and represents Unlike classical nickel-titanium wires, the new Thermaloy® wires
the future of this profession. Although admittedly limited, recent are not subject to the usual laws of physics. Deformation and load
advances in our knowledge of the biology of dental movement and/or force generated by the wire is independent. Furthermore,
highlight the need for the forces employed in our treatments to if some practitioners have kept abreast of developments
be intermittent, light, constant and prolonged. concerning the new wires and how to handle them, why should
we continue to use a bracket design which is over seventy years
Many of the best-known and most widespread orthodontic old and which limits the effectiveness of the new materials?
techniques were invented and developed at a time when nothing

10 CLINICAL REVIEW
 DIAGNOSTIC SELECTION OF
BIOMECHANICS
PROTOCOLS ARCH WIRES

NEW MANDIBULAR EMOTIONAL

NEW CONCEPTS
CLASS II TREATMENT ORTHODONTICS

Figure 1-6

SWLF® is not just a technique involving a bracket; we have low-friction brackets, self-ligating brackets or mixed low-friction
attempted to incorporate all the recent technological advances in brackets. RMO® opted for the selective friction control tooth by
orthodontics into an extremely simple therapeutic protocol and tooth alternative with its Synergy® bracket many years ago.
system of biomechanics (figures 1-6). The technological changes
affecting modern orthodontics, which have led to the creation of When I started to use the Synergy® bracket over eight years ago,
the Straight Wire Low Friction (SWLF®) technique, are: super- I soon realized that it was not only a low-friction bracket, but
elastic wires, the latest generation of titanium-molybdenum that it also had the capabilities of a conventional bracket and that
wires, friction selection brackets (we can control the friction and simply by modifying the ligature (materials and shape) it would be
the sliding tooth-by-tooth) and orthodontic microimplants. possible to control friction, tooth by tooth.

The SWLF® technique enjoys all the advantages of the traditional Unlike low-friction self-ligating brackets, which are excellent
straight wire approach but addresses one of its main failings: during alignment but of limited use for dental control in the
static and dynamic friction. Although friction ensures occlusal torque and finishing stages (in my experience it is not easy to
stability and three-dimensional control over the root in the last finish cases with self-ligating brackets), the Synergy® bracket
stages of treatment, it is equally true that it is also the principle allowed us to obtain friction (with elastic or metallic ligatures
obstacle to dental alignment and levelling, thereby reducing the placed conventionally or in a figure eight) when the treatment
effectiveness of super-elastic wires, decreasing the potential for requires excellent tooth control. Remember that the friction,
dental movement with these wires and, in short, complicating during orthodontic treatment, is not bad in itself. In many cases
and prolonging our treatments. With the cooperation of Rocky we need friction to move the teeth!
Mountain Orthodontics in Denver, CO (USA) we are developing
the diagnostic system, clear biomechanics and therapeutic The Synergy® bracket has all the advantages and ease of use of
protocols, brackets, wires, elastics, functional appliances, a traditional straight wire twin bracket (the orthodontist who has
microimplants and other elements of the SWLF® technique. been using other brackets does not need to familiarize himself/
herself with a “different” bracket when changing to Synergy®),
THE CONCEPT OF FRICTION SELECTIVE CONTROL but it does add certain new ingenious design features which
provide three fundamental clinical improvements by enabling:
TOOTH BY TOOTH (FSC)
Low-friction brackets are now all the rage and all the orthodontic
manufacturers are racing to improve arch/bracket sliding
mechanics. Many in the profession have opted for conventional

ORTHODONTICPUBLICATION 11
 1 Maximum Sliding In The Initial Stages
Of Treatment With Superelastic Wires 3 Individual "Tooth By Tooth" Control Of
Tooth Movement And Anchorage
The Synergy® system has 3 pairs of tie-wings rather than 2. The main advantage of the Synergy® bracket over other low-
The sides of the central tie-wings are raised in such a manner friction brackets, whether standard or self-ligating, is the ability to
that when the ligature is applied solely in the center, the contact control dental movement and anchorage tooth by tooth only by
between the wire and the ligature is minimal or non-existent, changing the ligature (figures 8-10).
thus reducing friction almost to zero and optimizing the effect
of the superelastic wires. Numerous studies have demonstrated We Can Basically Ligate In Three Ways
that alignment with superelastic arch wires in a case with pronounced • In the center "C". To achieve maximum sliding and maximum
irregularity is much swifter and effective with low-friction brackets tooth movement. We ligate in this way when we require maximum
such as Synergy® than traditional single or twin brackets (figures 7-10). displacement: in initial phases of alignment with round or
rectangular superelastic wires, for distalizing canines or lateral
sectors etc. (figure 8).

Figure 7

Figure 8

2 Early Use Of Rectangular Archwires

One of the problems caused by use of traditional • Standard “O”. We ligate the corner wings just like a
brackets, which have slots ending in 90º angles, is the conventional twin bracket, thus achieving maximum control of
biomechanical difficulty of inserting rectangular wires at the rotations and a medium amount of sliding. The friction created
beginning of treatments and the need to employ “laceback” or by contact between the ligature and wire will aid in the degree
“tieback” ligatures to achieve distal movement of the canines of tooth movement. We use the low friction ligatures when we
(in many techniques the use of “laceback” ligatures depends need, low friction and control of the rotations at the same time
on the design limitations of the classical straight wire brackets (figure 9).
rather than the limitations of the biology of orthodontic dental
movement).

The Synergy® brackets provide an ingenious response to these

difficulties, with rounded arch slot openings to allow for quick
insertion of the superelastic rectangular arch wires and making
Figure 9
“tieback” ligatures obsolete in the process. Slots which are rounded
both on the floor and at the ends avoid the adverse effects of the early
insertion of rectangular arch wires, Synergy® presents simple, but • In a figure of ‘8’. In this particular case, we produce close wire-
very ingenious new design features that improve the biomechanical ligature-slot contact, thus obtaining total expression of the wire
effectiveness of the wires, and shorten and simplify treatment, given on the bracket and maximum control of the root. Thus, we ligate
that less wires, less chair time and less visits are needed. the teeth where we want to have perfect control over the three
planes, where we need to maintain or recuperate torque and/or
There are also other self-ligating low friction brackets with similar we want to obtain tooth anchorage through fiction (figure 10).
characteristics to Synergy®, but for me, they are more difficult
to handle. They are too bulky, pliers and special instruments are
necessary for their handling, on occasions the cap can break, the
colorful ligatures which children like so much cannot be put into
place without losing part of their biomechanical effectiveness. Also
traditional SL brackets cost four times more and the patient does
not like to pay more for metallic brackets. Figure 10

12 CLINICAL REVIEW
CLINICAL CASE I (figures 11-16)
BEFORE AFTER

Figure 11 Figure 12

Figure 13 Figure 14

Figure 15

ORTHODONTICPUBLICATION 13
 Figure 16
PRESCRIPTION
With the benefit of hindsight, since the initial Andrews Isn’t a significant part of the ‘battle of the prescriptions’ a
prescription, we are aware that the only novelty in many of the question of marketing rather than science? Is there such a
earlier techniques was a small, clinically insignificant, variation great difference in the outcomes between one prescription
in angulation and/or torque. The SWLF® technique would not and another? Which has most bearing on the outcome; a
have merited any attention if it had solely offered yet one more few degrees of torque or dental anatomy and the variations
prescription. Although we believe that pre-adjusted brackets between each individual patient and each malocclusion?
help to simplify treatment, we do not feel that small variations
in the average in/out, tipping and torque figures, are determining We have used these simple and clear ideas as the basis for a
factors when choosing one technique over another. prescription which aims to approximate itself to the average
values in the most popular prescriptions while leaving the canines
The scientific literature we have consulted in respect to and incisors with standard values (figures 17-18). We believe it is
prescriptions confirms our views and reveals that many of these important to overcorrect the torque in the upper central incisors
prescriptions are little more than marketing exercises. Small (17º) due to their tendency to lose torque during retraction with
modifications of a few degrees, particularly when the largest thick rectangular arch wires. In relation with the Roth prescription
caliber wires used by the majority of practitioners are those which we have reduced the overcorrection of the torque and rotation of
still allow for a considerable degree of free space on the inside of molars and the inclination of the upper canine by up to 8º; where
the slot (.017" x .025" in a .018" slot and .019" x .025" in a .022" the use of conventional brackets means that distal shift of the
slot), have no noticeable clinical effect at the end of treatment. canine is less likely than with SWLF®.

The evident commercial side to prescriptions (their use to The same philosophy has led us to opt for the standard
differentiate the brackets of one author from those of another) prescription in the lower incisors, where negative radicular torque
will be clear to the practitioner who analyzes the ‘torque in play’ of only a few degrees can create undesirable contact between
between a ‘thick’ .019" x .025" wire in a .022" slot. The freedom the fine roots of the incisors with the thick cortical vestibular
of movement (the degree to which the wire is able to turn on and give rise in certain patients with little inserted gingiva or an
itself within the bracket) is over 20º! Are a few degrees variation unfavourable periodontal biotype to radicular reabsorption and/
in an incisor so important? or gingival recession.

Figure 17 Figure 18

14 CLINICAL REVIEW
Modifying lower incisor torque is very often more the wish of traditional stainless steel RMO® wires for the finishing and
the orthodontist than a clinical reality; which frequently comes up detailing stage and NiTi arch wires using the curve of Spee for
against the limitations imposed by the gingiva and/or the cortical levelling. We have also added new .015" and .017" caliber wires
bone. One of the most fascinating aspects of orthodontics is that which are better adapted to the requirements of alignment, both
no two patients, or their mouths, are ever the same. Practitioners for .018" and .022" slots.
are aware that the values given by the distinct prescriptions are no
more than approximations to the ideal and individual prescription The new Thermal NiTi SWLF® wire is characterized by a high
for each of our patients, with the result that when we reach degree of elasticity and the generation of very light forces,
the stage of finishing and detailing the occlusion, we have to independent of the amount of arch wire deformation. The
‘individualize’ our prescription with some 1st, 2nd and 3rd order patient’s intraoral temperature aids the phase change (from
bends in the arch wire. martensite to austenite and vice versa).

For this purpose we recommend the use of Beta Titanium III as The new thermal NiTi SWLF® wires produce light, constant and
final arch wires. Beta Titanium III allows us to create bends inside prolonged forces, they optimize dental movement during the
the mouth, without removing the arch wire, in order to make our initial alignment process and allow the patient’s best arch shape
prescription more precise and tailored to the patient. to ‘express itself ’ through the stimulus it gives to the formation
of alveolar bone. Figures 19-22 represent a patient with both
BIOMECHANICAL ADVANTAGES OF THE NEW upper canines included in the maxillary bone, we treated her with
SWLF WIRES Wilson 3D Quadhelix and Thermal SWLF® wires. We use .019" x
The team of engineers at RMO® Denver has developed new .025" stainless steel to control the negative torque of the canines.
high-tech arch wires for the SWLF® technique, particularly for
the alignment stages (Thermoelastic wires) and the finishing and
detailing stage (Beta Titanium III Wires). We made use of the

BEFORE TREATMENT AFTER

Figure 19 Figure 20 Figure 21

Figure 22

ORTHODONTICPUBLICATION 15
 In the Thermal NiTi SWLF®, the force is predetermined by the
manufacturer and, strictly speaking, remains the same whatever
the degree of deformation applied to the arch wire when
inserting it into the brackets in order to align the teeth. The
fact that the forces are predetermined and constant,
particularly when they are located in the light to
medium band (between 50 and 100 grams),
heightens the effect of dental movement on
the physiological force levels and prevents
the creation of intense forces in the case
of particularly uneven arches.

One practical effect is the ability

to create severe deflections in
the arch wire, as when aligning
canines in high vestibular
position, without generating the
excessive, even iatrogenic forces
formerly produced by traditional
NiTi wire, which obeyed Hooke’s
Law and generated huge forces
when deformed, creating a risk of
periodontal necrosis, ankylosis and/or
root resorption and loss of anchorage
and stability in neighbouring teeth.

It is very important to divide treatment into

two phases, in figures 23 and 25, the patient’s main
problem is a supernumerary tooth and the lack of space in
the arches. After the extraction of the supernumerary tooth and
the use of a removal active plate, and after a rest period, we started
with thermal SWLF® arch wires, finishing with Orthostripping
(you can see the treatment and the results in figure 24).

As its name indicates, the edgewise technique, from which our

own technique is derived, draws its principal therapeutic effect
from rectangular steel wires. As a result, our aim is to align and
level the arches as soon as possible in order to arrive at these arch
wires swiftly, while employing the minimum number of wires to
do so.

As the new rectangular superwires come in varying pre-set force

levels, we can clinically reduce the number of prior round arch
THE FACT THAT THE FORCES ARE wires (we do not see why it should be necessary to use square
PREDETERMINED AND CONSTANT, arch wires). As a result, in most of our treatments we reach .019"
PARTICULARLY WHEN THEY ARE x .025" stainless steel arch wires in a .022" slot after the use of
LOCATED IN THE LIGHT TO MEDIUM BAND, just one or two prior arch wires.
HEIGHTENS THE EFFECT OF DENTAL MOVEMENT.

16 CLINICAL REVIEW
CLINICAL CASE II (figures 23-29)
BEFORE AFTER

Figure 23 Figure 24

Figure 25 Figure 26

TREATMENT

Figure 27 Figure 28 Figure 29

ORTHODONTICPUBLICATION 17
 The new wires have a longer average activation period than It is very important to maintain the control of the arch form,
traditional NiTi arch wires. We are therefore obliged to amend figure 33 represents this very well. The patient has Brodie
our practice of seeing patients once a month in order to change syndrome, a bilateral scissor bite (figure 30), we change the arch
arch wires and ligatures, and to allow the wires to act and express form (figure 34) and you can see the results (figure 31) and the
the prescription for 6 to 8 weeks. The properties of thermo- follow up, years later (figure 32).
elastic wires alter in response to the change in temperature from
the austenite to martensite phase. Ligatures, elastic chains and elastic modules play an extremely
important role in this technique, and some of these items, as
Given that intraoral temperature is a constant, at 36.5º celcius, with the new crimpable hooks and pliers system, have been
the metallurgical industry is conducting research into new wires specifically designed by RMO®. When the Synergy® bracket is
capable of precise adjustment of their phase change to this ligated in the center, and also in the conventional position, it is
constant working temperature. Differential heat treatment also advisable to use special low-friction ligatures in order to control
enables one single wire of uniform caliber to contain distinct rotations. The SWLF® technique is excellent at producing light
levels of elasticity/rigidity in the anterior-incisor, premolar and forces, for example moving the upper incisor of figures 35-37.
posterior molar regions, which brings us yet closer to E.H. RMO® has developed some excellent low-friction ligatures coated
Angle’s dream of one single wire for the whole treatment process. with a polymeric film which increases their ability, compared to
conventional ligatures, to slide when they come into contact with
We use the SWLF® Beta Titanium III wire in the finishing phase. saliva. We employ RMO®’s Energy ChainTM for closing adjacent
It is a titanium-molybdenum wire with the best elastic properties spaces and the new elastic SWLF® modules for ‘remote’ traction,
among nickel-titanium wires and the conformation ability of e.g. from the canines or posts in .019" x .025" closing loop arches.
steel. This is the ideal wire for final detailing of the occlusion We feel that modules are more hygienic as well as effective and
and is highly effective when combined with short and strong provide us with a greater degree of control over the force applied.
elastics and the special SWLF® step pliers (for 0.5 and 1.0 mm)
for intraoral correction of small defects in first, second and third At the current time, we are designing a new traction
order compensations when we are concluding the treatment. system for space closure achieved either conventionally
or in combination with TADs, based on elastic modules,
superelastic springs and new crimpable hooks.

18 CLINICAL REVIEW
CLINICAL CASE III (figures 30-34)
BEFORE AFTER FOLLOW UP

Figure 33

TREATMENT

Figure 30 Figure 31 Figure 32 Figure 34

CLINICAL CASE IV (figures 35-37)

BEFORE AFTER

Figure 35 Figure 36

TREATMENT

Figure 37

ORTHODONTICPUBLICATION 19
 SELECTION OF PROPER ARCH WIRES IN THE
DIFFERENT PHASES OF TREATMENT
There is a Chinese proverb which states, “Give a man a fish and
you feed him for a day. Teach a man to fish and you feed him for
a lifetime.” When teaching staff in training courses or introducing
students to a specific technique, instructors are often prone to
hand out fish rather than teach students to fish. This leads to
teachers choosing wires as if from a recipe, which is highly
unsatisfactory given that there is no incentive to change to new
wires and clinical advancement is blocked. The criteria we use to
choose wires is simple and ready to embrace the developments
which orthodontic manufacturers will undoubtedly produce in
the future. One of the keys to achieving a high degree of clinical
effectiveness in orthodontics, i.e. quick treatments with only a
few short visits, is the appropriate selection and use of the arch
wires. We should use a small number of high quality wires which
are able to generate light, constant forces over long periods. The
new alloys allow us to reduce the number of wires used in the
different stages of treatment.

The choice of arch wires must be practical and versatile, and

cannot simply be a recipe which becomes obsolete upon the
invention of new and better alloys. On the other hand, it is not an
easy or realistic task to program each and every one of the arch
wires to be used in a specific treatment from the very beginning.
In the SWLF® technique, we have decided to select the preformed
arch wires at each phase or stage of treatment independently,
having regard to clearly established criteria which are nevertheless
open to the diagnostic skill of individual practitioners. After
completing each stage, and before commencing the next, we will
assess the results achieved thus far and, of great importance, we
will ask ourselves whether or not we could achieve more and
improved results with the arch wires the patients already have
inside their mouths. We should not be in a rush to change arch
wires. We must be able to ‘squeeze’ the most out of the new super
elastic wires used by this technique.

It should not be forgotten that in the SWLF® technique the

way in which the ligatures are used with Synergy® (at the center,
conventionally, in a figure of eight, etc.) opens up new possibilities
in comparison with other techniques. It is not always necessary to
complete all the stages; sometimes the malocclusion might not
WE SHOULD NOT BE IN A
require levelling (where the overbite and the Curve of Spee in RUSH TO CHANGE ARCH
the arches are normal) or space closure. It is not unusual with the WIRES. WE MUST BE ABLE TO
SWLF® technique to complete many treatments with two arch
wires per arch. ‘SQUEEZE’ THE MOST OUT OF
THE NEW SUPER ELASTIC WIRES
USED BY THIS TECHNIQUE.

20 CLINICAL REVIEW
 01
THE FOUR ELEMENTS OF
04
04
02

03
ALIGNMENT
Clinical details
1 • How to ligate. In general, all teeth are initially
ligated in the center tie wing to avoid friction and
Aims
thereby guarantee maximum sliding. On teeth
• Initial periodontal awakening with light forces.
furthest away from the arch we recommend using steel ligatures.
• Crown alignment and straightening control of rotation.
As the wire is thermoelastic we cool it to ease insertion. Care
• Dentoalveolar expansion and development.
should be taken to ensure that the wire remains ‘unimpeded’,
• Expression of the optimum arch form for this patient.
i.e., that it can slide smoothly when we pull on it from behind
the tube. If appropriate, at a second appointment, with the same
Selection criteria
arch, now reactivated, we recommend ligating in the conventional
• Irregularity index is the sum of the distances between points of
manner to control rotations.
contact of adjacent teeth. The higher the index (high irregularity),
the greater the elasticity and the lower the caliber required of
• When to ligate distally. In general, when we do not
the initial alignment arch wire. When irregularity is low, we can
wish to see a marked increase in the arch length,
commence treatment, thanks to the design of the Synergy®
we recommend ligating the wire distally (either
bracket’s slot with its rounded ends, with the ligature in the center
by burning it at the ends or bending it with special pliers). In
and with the use of rectangular wires. It must be considered
general, we ligate distally in upper and lower Class I cases with
whether the irregularity is localized or generalized.
biprotrusion, only on the upper distal in Classes II/1 and solely
• Skeletal-dental discrepancy (SDD) or crowding.
on the lower distal in Class III.

Arch wires
• Allow the wire to “express” itself. THERMAL NITI is an
• We require super elastic wires that generate light, constant
excellent wire and needs time to take effect. Allow it to act over 6
and prolonged forces. We use the THERMAL NITI, a nickel-
to 8 weeks before assessing its effects. THERMAL NITI can be
titanium thermoelastic wire with shape memory which undergoes
‘reactivated’ by removing it from the mouth and expanding it with
a reversible process upon changing phase (austenite phase to
by facilitating its phase transformation. In many cases with dental
martensite phase) as a result of the patient’s intraoral temperature.
collapse, we combine our NiTi expansion wires (.014" CuNiTi
THERMAL NITI is offered in a range of new calibers (.013" ,
or .015"-.017" SWLF® Thermaloy®) with functional appliances,
.015" and .017"). The caliber is chosen in accordance with the slot
like buccal shields, to control the muscles of the Tomes corridor
(.018" or .022"), the irregularity index and the SDD.
(Figures 38 to 44).

ORTHODONTICPUBLICATION 21
 CLINICAL CASE V (figures 38-44)
BEFORE AFTER

Figure 38 Figure 39
TREATMENT

Figure 40 Figure 41

Figure 42 Figure 43

22 CLINICAL REVIEW
 2 LEVELING
Aims Clinical Details
• To correct vertical problems. • We recommend that the decision as to which wire and
• To correct the curve of Spee in each arch. biomechanics we intend to use in levelling should be delayed
• To correct increased or decreased overbite according to until after initial alignment, as the initial alignment and expansion
the facial biotype and the growth tendency. notably modifies overbite and the vertical relationships. The use
of an apparatus to distalize molars (coil-spring with crimpable
Selection criteria hooks, Wilson® 3D® Maxillary Bimetric Distalizing Arch, HP
• In patients with increased overbite (>2/3) we must evaluate Spring-Gear® or Ortoflex- Pendulum) improves the incisal
the degree of dental-gingival exposure with posed smile, the relationship in patients with increased overbite.
facial biotype and the lower facial height. In general, we use NiTi
Curve of Spee arch wires in order to intrude incisors and extrude • It is essential to determine the origin of the overbite or
molars. We use posterior elastics to increase posterior extrusion open bite and its distinct components (excessive anterior
in patients with limited gingival exposure, brachyfacial patients intrusion/extrusion or excessive posterior intrusion/
and those with a diminished lower third. extrusion). The degree of dento-gingival exposure, the
facial biotype and the growth tendency are three elements
• Where patients have OPEN BITE (< 1/3) and to simplify to be kept very much in mind. Open bite usually requires
the biomechanics, we use the same arch wires but with anterior a different and more precise diagnosis than is the case
elastics (strong and short) for 14 hours per day. This achieves a with overbite and occasionally requires more complex
posterior intrusion vector which strengthens the action of the biomechanics which are beyond the scope of the issues
other intrusion mechanisms (Palatine Bar, High Pull Traction, discussed here.
etc.). In many patients with severe open bite and posterior
vertical excess we prefer to combine the NiTi Curve of Spee (in a Clinical Cases:
reverse way) with mini-implants at the level of the molars. • Clinical Case VI: Figures 47-52
• Clinical Case VII: Figures 53-56
Arch wires • Clinical Case VIII: Figures 57-61
• For mixed dentition we employ the traditional Elgiloy® Utility
Arches by R.M. Ricketts. For permanent dentition we use nickel-
titanium preformed Curve of Spee arch wires. We differentiate
the biomechanics of incisor intrusion and molar extrusion from
that of incisor extrusion and molar intrusion by the differential
use of elastics (figures 44-46).

Figure 44

Figure 45 Figure 46

ORTHODONTICPUBLICATION 23
 CLINICAL CASE VI (figures 47-52)
BEFORE AFTER

Figure 47 Figure 48

TREATMENT

Figure 49 Figure 50

Figure 51 Figure 52

24 CLINICAL REVIEW
CLINICAL CASE VII (figures 53-56)
BEFORE AFTER

Figure 53 Figure 54

TREATMENT

Figure 55

Figure 56

ORTHODONTICPUBLICATION 25
 CLINICAL CASE VIII (figures 57-61)
BEFORE AFTER

Figure 57 Figure 58

Figure 59 Figure 60

Figure 61

26 CLINICAL REVIEW
 rocky mountain orthodontics®

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®

ORTHODONTICPUBLICATION 27
 3 SPACE CLOSURE
Aims Clinical Details
• Close the gaps generated by expansion, distalization • One of the traditional problems of the straight wire technique
procedures and extractions in the optimal manner and is the difficulty of closing spaces with sliding mechanics. SWLF®
sequence in view of the final objectives in the case in resolves the difficulty by improving the system by which the
question. brackets slide along the arch wire and vice versa.
• Achieve optimal points of interdental contact with
sufficiently paralleled roots and good periodontal health. • The intraoral positioning of hooks is simpler and more versatile
than the purchase of a large stock of arches with pre-soldered
hooks. With the SWLF® technique, the clinician can place the
Selection criteria crimpable hooks in accordance with the location and number
• One of the aims of the SWLF® technique is to encourage the of spaces to be closed and the preferred level of control of
development of the shape of the patient’s potential arch and to anchorage. In some cases, the hooks may be placed asymmetrically
avoid extractions whenever possible. As in other Low Friction (e.g. in order to correct midline problems) or be used as stops
techniques the SWLF® technique drastically reduces the number on the arch. Intramaxillary and intermaxillary elastic elements
of extractions thanks to the effectiveness of thermal NiTi for may be fitted to the hooks. This system, which has been widely
initial expansion (light and intermittent forces stimulate the covered in orthodontic literature, is simple to use, very ergonomic
growth of the alveolar bone) in conjunction with the use of and is clinically very efficient.
Functional Appliances (functional intermittent forces), the 3D
control and distalization of molars and Orthostripping. Many • It is important to know how to ligate each of the brackets at
of the spaces we have to close are those previously achieved by this stage: normally in a figure of eight on the incisors and in the
molar distalization techniques. The combination of the Synergy® center on canines and premolars. The hook is most frequently
bracket with steel rectangular arch wire and hooks from which placed distally on the laterals. This is very important in the lower
to obtain traction with chains, modules or springs provides arch of Class II Treatments.
surprisingly good results in respect of space closure. We designed
a new kind of multipurpose crimpable hook that we use to • One of the most important elements of our therapeutic
distalize molars and open or close the space. philosophy is the new approach to the mandibular Class II
malocclusions. In our protocol we combine, at the same time and
Arch wires in the same phases of treatment, functional and fixed appliances.
• Rectangular stainless steel arch wires onto which we intraorally Normally we start with the alignment of the incisors (with
place hooks, have been specially designed for the SWLF® brackets and thermal wires) and upper molar control (quadhelix,
technique by means of special pliers. We are introducing the new head gear, palatal bar, etc.) and just after, and at the same time,
Fast Closing “T” loops in Beta II Titanium for patients with large we place a functional appliance (like Ortoflex Class II® by
overjet and deep bite (figure 62). Santiago G Ferrón, Frankel Regulator, Bionator or Twin Block)
that the patient uses only during the night and at home. With the
functional appliance we are “jumping the bite” and afterwards,
we use short and heavy intermaxillary Class II elastics to engage,
and fit, the occlusion. Now, the dental occlusion is the “new”
functional appliance, so we have a lot of time to stimulate the
growth of the mandible. We don´t have research about this idea,
but we have a lot of clinical cases with very good results. You can
see our excellent results with this technique in two clinical cases:

Clinical Case VIII : Figure 63-70

Clinical Case IX : Figure 71-74.

Figure 62

28 CLINICAL REVIEW
CLINICAL CASE IX (figures 63-70)
BEFORE AFTER FOLLOW UP

Figure 63 Figure 64 Figure 65

Figure 66 Figure 67 Figure 68

Figure 69 Figure 70

ORTHODONTICPUBLICATION 29
 CLINICAL CASE X (figures 71-74)
BEFORE AFTER

Figure 71 Figure 72

Figure 73

Figure 74

30 CLINICAL REVIEW
 4 FINISHING
Aims Arch wires
• To consolidate the results achieved in the previous therapeutic • Beta Titanium III arch wires, a high quality titanium-molybdenum
stages. alloy specifically created for the SWLF® technique.
• To close spaces completely, parallel the roots and control • Stainless steel 8-strand braided arch wires, as an alternative to
radicular torque. the above.
• To correct all the positional anomalies of the teeth and to
establish definitive points of contact. Clinical Details
• Detailing and final intercuspidation should be as close as • It is the final detailing and finishing which distinguishes one
possible to the ideal occlusion. orthodontist from another. Mistakes at this stage of the treatment
cannot be disguised and are clearly noticeable to the patient, and
to other practitioners. Some of the time we have saved by using
Selection Criteria the SWLF® technique for alignment and space closure must be
• The arch wire of choice for final detailing of the occlusion is spent on final detailing.
undoubtedly Beta Titanium III, a cutting-edge high-tech wire • It should be considered whether or not the patient or
which combines the best of nickel-titanium and steel. The wire malocclusion tend towards natural intercuspidation in order to
allows for bends and final compensation corrections without decide which type of archwire to use (braided when the answer
removing the wire from the brackets and, somewhat surprisingly, is ‘yes’ and Beta Titanium III when the answer is ‘no’ and there is
without causing discomfort to the patient. Although we could still a lot of ‘work’ to do).
routinely use it at this particular stage, we actually use it when • We must combine intraoral detailing with ample use of short
we require a range of final detailing steps (in-set and off-set and strong elastics which help to settle the occlusion. If necessary,
correction, inclinations and vertical problems) or we wish to and the requirements of the anterior and posterior groups are
retain torque and the patient’s biology hinders the finishing quite distinct, we can cut the upper arch into three segments and
process (periodontal patients, combined treatments, etc). apply elastics differently.
• For final posterior occlusal settlement in the last two months of
• As a second choice, in very favorable circumstances, we employ treatment, we recommend using the ‘free’ wire, i.e., ligated at the
stainless steel 8-strand braided arch wires. center on the premolar and canine premolars.

ORTHODONTICPUBLICATION 31
 IMMERSION IN BIOPROGRESSIVE
The Foundation for Modern Bioprogressive Orthodontics
and the Department of Orthodontics at the University of
Illinois at Chicago are partnering to bring you this
TWO MODULE AND ADVANCED COURSES
Package A - Two-Module Course Package B - Advanced Course
Open for general dentists, orthodontic residents or Only for orthodontist graduated from an
orthodontists who would like to learn Bioprogressive accredited orthodontic specialty program who
orthodontic diagnosis, treatment planning and have been practicing with FULL knowledge of
treatment mechanics from basic to advanced. Diagnosis and Treatment Planning using Ricketts
analysis and VTO. (JUNE 6-10, 2016)
Module 1: Startup (AUGUST 17-26, 2016)
Back to the Basic Principle and Philosophy This Advanced package also being offered to
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Package A - two module course.
Module 2: New Frontiers (APRIL 26 - MAY
5, 2017) Advancement in Bioprogressive Therapy DO NOT MISS OUR GUEST LECTURERS:
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Both guest lecturers will present new approach
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REGISTRATION FOR THIS CLASS NOW OPEN.

Anyone who has registered for Module 2 of
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Course Objectives
The participant will receive the basic knowledge to perform Bioprogressive Therapy Philosophy possibilities in their
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treatment and choose the appropriate mechanics to each case, Sectional, Segmented or Straight Wires. Additional
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A joint certificate from the Foundation for Modern Bioprogressive Orthodontics and the Department of Orthodontics,
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 rocky mountain orthodontics®

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PRE-BENT RAPID

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precise anatomical angulation for ease of
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■ Anatomical angulation allows for precise fit for every patient
PALATAL EXPANDER

Uniform expansion with substantially smaller body than competing expanders.

It features longer arms providing additional anterior support and stability to the
MICRO RAPID

patient. The Micro Expander can also be used for mandible expansion.

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 WITH DR. DAVID SUAREZ
QUINTANILLA D.D.S., Ph.D.
A LEADER IN MODERN
ORTHODONTICS

34
 Tell us a little about yourself and your background How do you see the present and the future of
in orthodontics. Orthodontics?

My name is David Suarez Quintanilla, I am 54, and You only have to walk through the incredible and huge
am the Chairman of the Department of Orthodontics commercial exhibition of the American Association
at the University of Santiago de Compostela, Spain. I am a of Orthodontists to be aware of the technological changes that
doctor of medicine and surgery, specializing in Dentistry and our specialty is undergoing. I think that our practice is going to
Orthodontics. I have dedicated my life, in addition to my 5 undergo an authentic paradigm shift, a revolution, during the
children, to orthodontics and was fortunate in presiding over the next five years, because of the definitive clinical introduction of
European Orthodontic Society and am a member of the Royal three-dimensional imaging and virtual reality.
Academy of Medicine and Surgery of Galicia. More than 15 years
ago I launched the Masters of Orthodontics at the University I don’t have the slightest doubt that the intraoral scanner will
of Santiago de Compostela (USC) and am currently the director go on to take a central place in our offices, and that it will form
of research in orthodontics and dentofacial growth in the USC the basis for a large part of the diagnostics and therapeutic
(figure 1). planning. Stereo lithographics files (STL) are going to allow
remote diagnostics, and treatment planning centers will be of
great importance (figures 2-3). Little or nothing will remain in
2020 of the dedicated orthodontist who, with his polished and
shining plaster models and classic 2D cephalometrics, bends his
back and his wires as he attempts to resolve the majority of his
patients’ malocclusions.

Figure 1 Figure 2

I have practiced orthodontics exclusively for over 25 years

and treated more than 5000 patients, mostly with the SWLF®
technique. Throughout my career I have used different types of
devices and systems and I know all major contemporary fixed
techniques, their advantages and limitations. About 15 years ago
I began to develop a therapeutic philosophy with protocols for
diagnosis and treatment in order to improve the standardization
of procedures for clinical orthodontists in training.

With the help of the RMO® engineers for over 10 years, I

incorporated one of the best and most efficient combinations of
brackets and wires existing in the market, the Synergy® bracket
and the Thermalloy® and Beta III Titanium wires, supported by
numerous scientific papers into my clinic.

Figure 3

ORTHODONTICPUBLICATION 35
 The new orthodontist has to be an expert in 3D imaging, virtual
reality and the digital treatment of images, and combine the
classic ideas of management and marketing with new concepts of
interconnectivity with the patient, neuromarketing and emotional
orthodontics. The classical orthodontist understands that his
principal objective is the treatment of malocclusions; the new
orthodontist understands that his principal objective is clinical
success, achieved through the happiness that his patients feel in
having a new smile.

Orthodontics has to open its sphere of action to other pathologies,

such as the prevention and treatment of the problems of TMJ or
Obstructive Sleep Apnea syndrome, as well as a more integrated
Figure 5
smile design. (figure 4)
In this regard, Rocky Mountain Morita Corporation®, has
launched on the market the new alloys of GUMMETAL®, that
combine the elasticity of the alignment wires with an incredible
capacity to be bent. We think that the experimental and clinical
tests that we have performed open a new horizon, by reducing and
simplifying the number of archwires needed for the treatment.
For example, we can align, level, and finish the case, making
multiple intraoral compensation bends, with the same arch. I
hope the use of GUMMETAL® will represent a new advance in
our SWLF® technique in the coming years.*
Figure 4
I think that the current fashion of trying to do the complete
In the future, what kind of devices and techniques
treatment in permanent dentition with only brackets and wires,
will be used the most?
will pass, as all fashions do, and we will return to starting many
of our treatments in mixed dentition and incorporating and
The three main groups of devices and techniques will
combining the functional appliances with the fixed. The simplicity
continue to be: the plastic aligners, multi-bracket fixed
and high efficiency of the Quadhelix 3D by Wilson, or the Utility
appliances and the functional appliances. The world of plastic
Arch by R.M. Ricketts are indisputable in my opinion, and help
aligners is going to grow exponentially due to the improvement
to prevent or simplify future treatments to the permanent teeth.
of the software for the 3D planning, virtual simulation, 3D
I am convinced that the orthopedic and functional appliances are
printing and the memory shape polymers; capable of deforming
also going to undergo a new impulse and that the orthodontic
during insertion in the mouth and then recovering their original
community will realize the importance of the treatments in mixed
form.
dentition with this type of equipment.

Advances in the research of polymers and nanotechnology are

One of the characteristics of the success in the treatment of Class
going to improve the efficiency of the aligners and also perhaps
II malocclusions with retrognathic mandible using the SWLF®
robotics and magnets, but in particular the electronic (AcceleDent,
technique, is the simultaneous combination of multi-bracket
Aerodentis, etc.) and the microsurgery (micro-cortectomies) that
fixed appliances and functional appliances. We have eliminated
are incorporated into these systems to increase their efficiency.
the previous orthopedic phase, to combine and concentrate all-
The improved efficiency of aligners is going to increase the
in-one, significantly reducing the need for patient cooperation
demand for all types of treatment in orthodontics. Regarding
and the length of the treatment, and obtaining results that
brackets and wires, the industry will continue to develop new
would be impossible to achieve with only brackets, archwires and
alloys, such as the GUMMETAL® (figure 5).
intermaxillary Class II elastics. (figures 6-9)

*GUMMETAL® is currently only available in Japan through RMMC®

36 CLINICAL REVIEW
Figure 6

Figure7

Figure 8

Figure 9

ORTHODONTICPUBLICATION 37
 Will there be increasingly less use of brackets and our treatments and continue to offer an optimum control of
wires? What is their future? orthodontic tooth movement. Some adults may also opt for the
traditional or aesthetic brackets, but only when the treatment
Orthodontics a dental specialty with a favorable outlook, period is short. Today, that is possible thanks to the very high
due to its increasing popularity and acceptance in adults. efficiency of the new bracket designs and the super-elastic wires.
I think there is going to be a stratification and differentiation Perhaps this is the moment, in the light of scientific evidence, to
of the patients. The aligners and invisible braces are going to examine the true advantages of the new designs of brackets and
increase the number of adult patients prepared to undergo an wires, and to separate these from the propaganda.
orthodontic treatment. It is evident that these, especially those
whose malocclusions or dental problems aren’t especially We need protocols of selection and handling for the new brackets
serious, are going to opt for aesthetic and/or invisible systems. and wires, and new biomechanics better adapted to their evident
However, we must not forget that in spite of the progresses of clinical advantages. From a technological point of view, new
plastic aligners and even the lingual systems, or appliances CAD/ types of brackets will continue to be developed, with simpler and
CAM, the traditional orthodontic multibracket with the latest more ergonomic designs, adapted to the properties of the new
generation alloys, continues to be the best option, or at least the wires. The more traditional orthodontic techniques, based on the
most efficient, for children, adolescents and adults with complex Classic Straight Wire, need to be urgently adapted to the new
malocclusions. technological advances.

The new designs of brackets, in combination with the new

thermoelastic alloys, have substantially reduced the duration of

38 CLINICAL REVIEW
 In today's market, various techniques exist that by step, towards clinical success. It is true that the use of brackets,
promise faster, more efficient orthodontics without like Synergy®, for the selective control of friction, tooth by
extractions. What would you say to a young orthodontist tooth, the new super and thermoelastic alloys, the sequenced
who was thinking about the technique to choose for their Orthostripping® and the SWLF® microimplants, have meant a
practice? drastic reduction in the need to perform extractions, but we don’t
believe that indiscriminate over-expansion and lack of respect for
The skills in orthodontics can be divided into two major the limits of tooth movement, that others seem to defend, is an
groups: those that are common to every professional option that guarantees the health of our patients’ smile in the
and form the core of our specialty, and another group of skills, long term.
that are more variable and subject to technological developments.
Without a doubt, the Evidence-Based Treatment has meant a We don’t want to become known, as others are, for the “three
paradigm shift in our field and led us to abandon some of our “R” Technique” (recession, reabsorption and relapse). But just as
concepts or techniques because they lacked the necessary scientific we don’t share, in any way, the policies of indiscriminate dental
backing. In other cases, they have been reaffirmed (thinking for expansion, we also believe that you should use the most modern
example, in the association between Rapid Maxillary Expansion technologies to favor the maximum development of the alveolar
and the Facial Mask, the control of friction, the association of process.
retrognathia with sleep apnea syndrome, or in microimplants).
A very important concept in orthodontics is efficiency; obtaining
We are in a moment of crisis and paradigm shift; as the the best results with the minimum effort, time and materials. I
philosopher of science T. Kuhn would say, and we need to re- think, in all sincerity, that the clarity of our protocols help the
evaluate our concepts and techniques in the light of the scientific clinician to choose the easiest and most straightforward path to
evidence. Furthermore, the pressure of the orthodontic industry clinical success, to the satisfaction of both the patient and the
on the professional is enormous and it is not easy to distinguish professional.
between clinical reality and pure propaganda.
Furthermore, the Synergy® bracket has a similar cost to the
Naturally, the SWLF technique has, as others do, its own brackets,
®
traditional brackets, but has a series of undeniable biomechanical
wires, microimplants and accessories, but perhaps the biggest advantages derived from the special design of its three wings and
difference with many other techniques, resides in the clarity of slot with rounded corners. Simply changing the placement of the
purpose, the concept of emotional orthodontics, the important ligatures we can achieve ranges of friction from almost 0 to more
role of neuromarketing in the clinic’s success, and something that than 200 grams.
I think is very important: the creation of numerous protocols,
that are clear and easy to apply and guide the professional, step

ORTHODONTICPUBLICATION 39
 The special, unique slot design, allows us to introduce flexible What importance do microimplants and
rectangular archwires of .019" x .025" a few weeks after treatment orthostripping have in the SWLF® technique?
start. The combination of these elements increase the efficiency
of the treatments with SWLF®. You can see different clinical The SWLF® technique was one of the first to
cases (figures 10-12). incorporate and produce a protocol for the use of
microimplants. We use the Dual-Top RMO® range, which offers
I would say to the young orthodontist that he/she should review the important advantage of the button and bracket head design,
the principal and latest scientific articles on bracket design and being self-tapping and self-drilling and being manufactured with
friction and the advantages and clinical limitations between one and surgical grade titanium alloy. I cannot comprehend orthodontics
the other. This way they would see how Synergy® and our SWLF® without the use of temporary anchorage devices (TADs) both
Technique haver important scientific backing (figures 13-15). for their ease of use, safety, versatility, economy and professional
differentiation. I use them both to maintain and lose anchorage

Figure 10

Figure 13

Figure 11
Figure 14

Figure 12 Figure 15

40 CLINICAL REVIEW
and they are highly useful for vertical dental control in adults Mechanical orthostripping with files of increasing thickness
(intrusion of incisors and molars) as well as when combined (Intensive®) is an excellent option in adults to avoid extractions
with intermaxillary elastics (without affecting the arch where and give the teeth the desired morphology and size: We can easily
the microimplants are placed). In some cases, they allow us to obtain, and with no future risk for the enamel (in the form of
apply biomechanics that were unthinkable years ago, especially decalcification or increased sensitivity), up to 6 mm (canine and
in adults, and in others to reduce treatment time. We believe in incisor area) and 8 mm (if premolars are included). The amount,
their orthopedic possibilities in children, but we need more and however, greatly depends on the dental size and morphology.
better research in this respect. I think that the microimplants
represent an orthopedic alternative, particularly in open bites,
or orthognathic surgery. You can see different clinical cases in
figures 16-20.

Figure 16 Figure 17

Figure 19

Figure 18 Figure 20

THE SWLF® TECHNIQUE WAS ONE OF THE FIRST TO

INCORPORATE AND PRODUCE A PROTOCOL FOR
THE USE OF MICROIMPLANTS

ORTHODONTICPUBLICATION 41
 Rocky Mountain Orthodontics®, which makes
your SWLF® technique, has always been linked to
the improvement of breathing in children; in the words of
its president Martin Brusse, now deceased, a Breathing
Enhancement Orthodontic Company. What does this
mean to you, what is the connection with your therapeutic
philosophy?

The slogan of RMO® has more meaning today than

ever. I have had the opportunity to work on different
research projects at the University of Santiago de Compostela,
which revealed the intimate relationship between the position
of the mandible and the space in the upper airway passages.
We now know that an under-developed, atrophic maxilla, or a
retruded mandible can lead to the appearance of an Obstructive
Sleep Apnea-Hypopnea Syndrome (OSA), with the serious
repercussions that this pathology has in children (clinical profiles
of cerebral hypoxia, somnolence, inattention and educational
achievement, irritability including sudden death) and adults
(exponential increase in arterial hypertension, ictus, heart disease,
impotence, etc.).

The relationship between skeletal malocclusions and these types

of pathologies, that can potentially compromise the quality of
life and life expectancy of those who suffer from them, tells us
that orthodontic problems go far beyond aesthetics or dental
alignment. This explains our concern for the early and “on-time”
treatment of orthopedic maxillary problems. Dental Maxillary
Expansion, with Quadhelix 3D by Wilson, or skeletal (with Rapid
Expansion), or mandibular advancement in Class II malocclusions
(with Liberty Bielle or functional appliances), are characteristics
of our early therapeutic approaches. But we must not forget the
treatment of adult patients with dental expansion and mandibular
advancement, or orthognathic surgery. Cephalometric analysis
designed by Dr Ricketts already placed great importance on the
assessment of the upper airways in orthodontic treatment.

THE SLOGAN OF RMO HAS MORE

®

MEANING TODAY THAN EVER.

42 CLINICAL REVIEW
 In the Straight Wire Low Friction (SWLF®) Is the emotional factor so important in the SWLF®
Technique you talk a lot about Clinical Success and Technique?
Emotional Orthodontics. What do you mean?
In a dental appointment there are two kinds of patients:
If the SWLF® Technique was limited to the use of the the rational, who come with trouble, pain or because
Synergy® bracket, a particular number of wires and also they need a filling, and represent 80% of all patients, but only
a particular biomechanics, it would be one more technique among 20% of the income. The emotional patients, who ask us for a
those in the market. The SWLF® Technique embraces a complete radical change to their smile, a complete aesthetic improvement,
treatment philosophy, that includes a specific 3D diagnostic make-up only 20% of patients yet represent some 80% of the
system, numerous diagnostic and treatment protocols and a income for a dental clinic. The emotional patient, in contrast to
particular, and I think innovative, vision of treatments in mixed the rational, looks for something more in the dental treatment;
dentition for the Class II malocclusions, dysfunctional problems self-affirmation and happiness through the attainment of a
and TMJ disorders. However, what presides over our therapeutic spectacular smile, and they are prepared to invest their time and
objectives is the clinical success of the professional, that the money to achieve it. We have to be aware of the immense value
efficiency of the system and its results achieves the satisfaction that the smile and facial appearance have today. The orthodontic
and happiness of our patients. clinic has a high percentage of adult emotional patients and we
have to know how to respond to them; finishing many of our
This is the meaning of what we call Emotional Orthodontics: treatments with whitening procedures or veneers.
ensuring that the new smile we are going to achieve for the
patient improves their quality of life, their expectations, their One of the characteristics of our technique is the Emotional
self-realization. One of the keys of Emotional Orthodontics is Smiles Design, showing the professional how to sell emotionally
the making of a digital and/or real mock-up that convinces the and helping them to understand how our diagnosis and treatment
patient of the need to undergo the treatment that we propose to plan should be presented to the patient: how to sell convincingly,
them. There is nobody better than us, the orthodontists, to make but addressing the emotional, not the rational part of each patient.
a digital diagnosis of the smile that, through neuromarketing, How to awaken the emotion, the desire to change through our
produces the emotion and need in the patient to make a change treatment. It involves adding value to our work through the
in their life through a new smile. In the SWLF® Technique we service given and the emotional happiness of our patients. The
do not sell straightened teeth, not even smiles or health, what we Emotional Smiles Design includes a protocol of cephalometrics,
really selling are dreams and happiness. digital imaging, real and virtual mock-up, etc.

ORTHODONTICPUBLICATION 43
 What concerns do you have for the future of I think that this attempt to create a short-circuit or by pass
Orthodontics? between the professional and the general dentist, trying to ensure
that they keep the lion’s share of the added value of the products
Undoubtedly new technologies, whilst bringing new or appliances, is in the minds of many companies. Unfortunately,
advantages, will also give rise to new challenges. From an for the traditional orthodontist, the new technologies, beginning
artisan orthodontic view, where the value of the professional lays with the intraoral scanner and ending with the new memory shape
in his/her diagnostic capacity, expertise or manual skills when polymer aligners, the indirect bonding of brackets and archwires
bending wires, we are crossing the frontier toward the territory made by robotic systems, are going to change the panorama of
of digital technology where, to the vast amount of diagnostic orthodontics throughout the world. The companies are aware
information provided by the new digital and 3D radiological that the exclusive fabrication of brackets, bands and wires will
systems, must be added the appliances that are prefabricated and not be sufficient to guarantee their future and that they need to
personalized for the patient with CAD/CAM techniques. I think gamble for the new digital market.
that the orthodontic industry has seen a new business opportunity,
one that without doubt, is much better than the simple production Another problem is the relocation of the diagnostic and
and sales of brackets and wires, in the diagnosis and fabrication production centers, as well as the creation of remote treatment
of pre-adjusted appliances, and wants it to be the industry, (and planning centers. We think that both digital radiology, as well as
not the professional as before), that generates the added value of the STL 3D files that allow virtual images to be obtained that can
the appliances. then be reproduced, via 3D printers, in any part of the world. This
is going to generate a considerable increase in tele-orthodontics.
We must not forget the attempt to simplify the work of the general
dentist, with little or no training in orthodontics, to ultimately The practitioner will send his files and, in a few days, receive
replace the orthodontist in the diagnosis and treatment plan and at home the treatment plan and all the appliances and devices
supply them with the necessary appliances for the correction of necessary for the patient’s treatment, using internet and
their patient’s orthodontic problems, and the instructions for videoconferences for activation and control.
their use.

44 CLINICAL REVIEW
 According to what you have just told us, how do you I see the new professional in orthodontics as a specialist in
see orthodontics in the coming years? emotional patients; those who want to transform their lives, self-
esteem and happiness through a new smile and a new face. The
It is important to differentiate between countries, new orthodontist prepares a treatment plan, designs the patient’s
like the USA, where there is a reasonable number of new smile and face, explains to them, through the virtual, or real
orthodontists that feed off the general dentists, and there is a mock-up, how it could be achieved, and directs and coordinates
beneficial mutual interchange of patients between the specialist a specialist team (general dentists, periodontists, etc.). We think
orthodontist and the general dentist. In other countries like Spain, that the majority of the emotional patients, those who want to
the plethora of professionals has resulted in the reconversion make an important change to their smile and /or face, require,
of many specialist orthodontic clinics. In any event I think that to a greater or lesser extent orthodontic treatment, and in every
the orthodontist’s high skill set allows them to re-focus their case, a diagnosis undertaken by the specialist best qualified to do
professional practice, therapeutic philosophy, marketing strategy so: the orthodontist. It is true that with this philosophy we will
(without the need to renounce the practice of orthodontics lose referring dentists, but we have to think of what we will gain.
only) toward a practice centered in emotional orthodontics and
neuromarketing.

ORTHODONTICPUBLICATION 45
 You have been President of the European Now, from the IADR (International Association for Dental
Orthodontic Society. What is your opinion on the Research) and thanks to professor Cristina Teixeira, of New
teaching of orthodontics around the world? York University, we are going to start a new stage, boosting the
importance of the sciences and basic and clinical research in
I think that the leading international academic and Orthodontics. Unfortunately, here in, Spain, we belong to that
scientific institutions (WFO, EOS, AAO, etc.) agree on group of countries where disastrous educational planning in
the need for full-time university training for a minimum of three dentistry, has resulted in the uncontrolled setting-up of faculties
years as a guarantee of quality. The problem lies in the adaptation of dentistry, and postgraduate orthodontics that lack the minimum
of the programs and especially that of the teachers. Countries standards of quality. The business of university master’s programs
like the USA have always taken dental training very seriously and in orthodontics, can be the only explanation for the huge number
have exercised an important control over the number and quality of programs in our country. The universities and private schools
of the postgraduates. In Europe, the European Orthodontic of Spain train every year half as many orthodontists as the USA.
Society, the European Orthodontic Teachers Forum and the
Network of Erasmus based European Orthodontic Programs This plethora of orthodontists coupled with the opening of
(NEBEOP) strive to realize quality postgraduate programs. The hundreds of chains of clinics, low-cost insurance, and the
European university postgraduate exchange programs are being economic crisis, has brought us to an extreme situation, wherein
of great assistance. hundreds of young orthodontists “with their briefcase” make the
rounds of general orthodontics clinics doing the orthodontics
My colleagues at the EOS have struggled every year to improve they can, or are allowed to do. Spain, in this sense, is a good
the postgraduate training in the European universities. It is very example of what a modern, developed country that aspires to
important that the program has an important component in the have quality orthodontics should never do. From these lines I
basic sciences (anatomy, craniofacial growth, biomechanics, etc.), want to advise other countries that the plethora and unchecked
that the teachers, especially in the clinical phase, are orthodontists postgraduate training is a one-way street, that today prevents the
of recognized standing and experience and that each student majority of professionals in Spain from practicing orthodontics
starts and finishes at least 50 cases of different complexity, with dignity and minimum standards of quality and professional
employing all kinds of techniques. ethics.

46 CLINICAL REVIEW
 rocky mountain orthodontics®

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 DENTAL MONITORING
TM

AGE OF THE APP

KEEING UP WITH ADVANCING CULTURE AND TECHNOLOGY
BY DR. LOUIS-CHARLES ROISIN

“There’s an app for that” is

one of the most iconic phrases
of the early 21st century, but it
took about a decade to apply
to healthcare. Nowadays,
thanks to an extraordinary
leap in the technical advances
and affordability of high
tech, it seems that healthcare
is currently living its mobile
technology boom.

Here are some reasons behind

this rise: first, Millennials
(also known as Generation Y,
those born around the turn
of the Century) are coming
into their own as patients
and practitioners, and they’re
taking their love of everything
connected right to the heart
of the clinic. Second, with
smartphones now ubiquitous,
what was once extraordinarily
rare technology, such as
motion sensors or live data-
streaming, is now the norm.

As a result, more and more patients are looking for new ways
to get involved with their treatment and communicate with
their health care provider: a 2015 SalesForce study shows that
more than 70% of American Millennials would welcome the
use of an app provided by their doctor to manage their health,
and more than 60% would want to provide their doctor with
ongoing health data via a mobile or wearable device. The natural
consequence of that was the meteoric rise in the number of
fitness and health mobile apps, tracking everything from general
well-being to symptoms of depression or even fetal heartbeat.

70%
OF AMERICAN MILLENNIALS
WOULD WELCOME THE USE
OF AN APP PROVIDED BY
THEIR DOCTOR TO MANAGE THEIR HEALTH
What we’re seeing is the advent of ”Connected Health”, a model
where technology enables healthcare providers to deliver care
remotely with more control, less chair time and a more rational
use of resources. Connected Health aims to maximize health
resources by providing opportunities for patients to better
self-manage their ongoing treatments and easily engage with
clinicians.

48 CLINICAL REVIEW
So far, the closest equivalent in orthodontics was the occasional
patient sending a smartphone picture of their mouth through
office’s email, and that’s a pity. Orthodontic treatments are long-
term affairs, dependent on many factors, not least of which is the
cooperation of the patient and their active engagement in their
treatment. The length and success of a treatment is also affected
by the availability of relevant information.

Learning that a treatment objective like the expected value of

a maxillary expansion has been reached as soon as it happens
can save both patient and doctor the hassle of back-and-forth
between the patient’s home and the clinic. Learning of an
diastema opening soon enough can potentially save months of
corrective action. All of these factors point to a new opportunity
for Orthodontists: joining the ever-widening family circle of
Connected Health practitioners, for more confidence in the
outcome and progress of their treatment plans. As of now there’s
only one system that allows Orthodontists to remotely monitor
their patient, and that system is Dental Monitoring ™.

THIS SOLUTION IS BASED ON THREE

INTERCONNECTED PLATFORMS:
A smartphone app dedicated to the patient, that regularly
1 prompts them to take intra-oral pictures and guides
them through the process of taking quality pictures. This app
is freely downloadable on the App Store (iPhone) or Google
Play (Android) but requires the validation of the patient’s
orthodontist to function. The beauty of this system is that it
presupposes no particular equipment or skillset on the part of
the patient, instead utilizing the smartphone of the patient and
guiding them through the process of taking intra-oral pictures.

ALL OF THESE FACTORS POINT TO A NEW

OPPORTUNITY FOR ORTHODONTISTS:
JOINING THE EVER-WIDENING FAMILY CIRCLE
OF CONNECTED HEALTH PRACTITIONERS, FOR
MORE CONFIDENCE IN THE OUTCOME AND
PROGRESS OF THEIR TREATMENT PLANS.

ORTHODONTICPUBLICATION 49
 An evaluation platform that uses Activity
2 the pictures in two distinct ways. A Graph
team of orthodontists working at Dental
Monitoring ™ verifies the pictures to provide
comments, notifications or alerts on the Average
current state of the patient’s mouth: hygiene, Movement Per
occlusion, state of the appliances. Arch

For a more complete monitoring, the Time

orthodontist provides a 3D model of the
teeth of the patient (scan or impressions), and
the pictures are used to update this model
regularly, providing precise data on tooth Photo
movement, tooth shape change, treatment Browser
activity, and post-treatment stability.
Latest
The DM orthodontists also offer their Pictures
perspective on all movement calculated, to
alert doctors on additional parameters such
as unexpected movement and abrasion, so Any Earlier Set
doctors gain a better understanding of the
of Pictures
kinectics of the treatment.

The third platform is the doctor’s

3 dashboard. Entirely web-based, it Single Tooth
provides several tools for case analysis and Notification
communication with the patient.

For simple visual evaluation, the photos are

made available to the orthodontist as soon
as they’re taken. Individual
Tooth
Movement

Figure 1

The DM dashboard is the Orthodontist’s toolbox. Avoid Aggravation:

Organized from least to most complex, each tool helps you DM provides a detailed analysis for each tooth: the
gain maximum insight in minimum time. movement is quantified in all directions and the
doctor is alerted if one of these parameters reaches an
Optimize Treatment Time & Control Stability: unexpected value.
The activity graph provides you with real time evaluation
of the treatment activity, to allow for optimized and Be Warned In Time:
individualized care: To ensure that you receive the most relevant information
without having to look for it, each alert is sent via email
• Optimize treatment time with better understanding of to the doctor’s team, and listed in the dashboard’s
individual biological response notification center
• Measure impact of treatment on non-treated arch
• Verify stability of post-treatment at a glance
AS OF NOW THERE’S ONLY
Compare the current situation with similar views in the past
The patient takes regular pictures, allowing the doctor and
ONE SYSTEM THAT ALLOWS
their team to always have access to updated visuals, and ORTHODONTISTS TO REMOTELY
compare current visuals with any and all previous dates.
The photos are available immediately after they have been
MONITOR THEIR PATIENT, AND THAT
taken, providing the most efficient response time. SYSTEM IS DENTAL MONITORING™

50 CLINICAL REVIEW
 Expansion Bonding & Passive
Activation Stabilization First Archwire Archwire

Figure 2: Expansion Control

PRE-TREATMENT: MAXILLARY EXPANSION ACTIVE TREATMENT : OPTIMIZATION AND

AND TOOTH ERUPTION INCIDENT CONTROL
PHASE 1: EXPANSION CONTROL PHASE 1: OPTIMIZATION OF WIRE CHANGE
The first phase was maxillary expansion, PVS impressions were The activity graph offers precise data on the evolution of the
made and sent to Dental Monitoring ™ for scanning. The DM activity of an archwire or aligner, which is data that can be used
monitoring was started, and a request was made to the DM team to individualize care, or generalized to have true statistics of
to alert the doctor when the expansion had reached 2.3mm, activity across techniques.
saving the family of the young patient long trips to the clinic.
After receiving a notification that the expansion had reached
the desired width, the orthodontist brought the patient back in.

PHASE 2: STABILIZATION AND OBSERVATION

OF ERUPTION
The patient couldn’t be bonded until after a phase of stabilization and
the full eruption of adult teeth. The next phase of DM monitoring
included control of tooth movement to verify the absence of relapse, Figure 4: Activity Graph
as well of visual control of the eruption of the full adult dentition.As
you can see in figure 4, there was a relapse of the expansion before
the full eruption. Receiving that information before the patient
came back to the clinic allowed for a revised treatment plan that
was ready when the patient walked into the clinic.

YOU HAVE A NEW NOTIFICATION

FROM DENTAL MONITORING:
Figure 3: 3D Model of Achieved Full Expansion NOTICEABLE ALIGNER UNSEAT ON 33

ORTHODONTICPUBLICATION 51
 In the case below, the orthodontist then used the DM dashboard figure 5 shows interference between teeth and brackets on 4, 5
to send a simple message to the patient: and 6. The doctor received an alert. The 3D Matching was used
to determine whether there was any tooth wear or unexpected
“Hi there. Dental Monitoring notified us that your aligner movement and confirms that there was none. An appointment
is not tracking on your bottom right canine tooth. Try to with the patient is scheduled immediately to avoid damage and
use your "chewies" in that area to see if you can get that to bond occlusal pads, the results of which you can see on figure 6.
seat down all the way.  I would also like you to stay in your
current aligner until you take the next set of photos.”

The next photo exam showed that the tooth was now tracking
properly. And the patient was able to continue his treatment
without further incident. Catching this incident and solving it
within the week it happened rather then the next time the patient
happened to visit the clinic meant saving chair time, treatment
time, travel time to and from the clinic for patient and doctor,
for a perfectly controlled treatment outcome.

PHASE 2: INCIDENT MANAGEMENT Figure 7: Post Treatment Graph

Figure 6: Bracket Interference Side

POST-TREATMENT: CONTROL STABILITY

REMOTELY
Relapse is a universal concern. While no doctor or technique
can guarantee perfect stability, DM offers enough data to stave
off incidents before they lead to serious problems or necessitate
costly retreatments with a disappointed patient. The patient can
receive a remote analysis regularly, for as long as needed, and
without ever needing to come to the clinic. On the part of the
clinic, the work is kept minimal, since incidents are notified.
Figure 5: Bracket Interference Front

52 CLINICAL REVIEW
ALL TREATMENT PHASES: KEEP THE PATIENT MAKING HISTORY
For the first time in history, and with a little help from the
MOTIVATED. latest developments in machine vision, patients have a device
The simple fact of taking regular pictures and receiving
in their hands and their pockets that can keep them informed
notifications from the DM app helps to keep patients motivated,
of everything that is happening in their mouths in between
especially when they can see the progress of their treatment
appointments.
through their 3D matching.
Thanks to Dental Monitoring ™, that information can come to
Regular messages from the doctor when they connect to their
you in a timely manner, organized efficiently and easily accessible.
file add a personal touch that is invaluable. Showing the patient
While DM doesn’t make teeth move faster, it can ensure that you
the graphs associated with their treatment is also a great way of
have no surprises at the chair. With the time spent crafting your
keeping them informed, interested, and cooperative.
treatment plan, DM can offer a way to preserve your work by
offering the means to prevent incidents, and the information to
optimize it further!

FOR THE FIRST TIME IN HISTORY...PATIENTS HAVE A

DEVICE IN THEIR HANDS AND THEIR POCKETS THAT CAN
KEEP THEM INFORMED

ORTHODONTICPUBLICATION 53
 In the last 81 years that RMO® has been in the Orthodontic
industry, technology and innovations have improved
considerably. Patient comfort and product reliability are
two of the most important characteristics of a successful
and sustainable bracket.

This is how the FLI® Twin bracket was invented. Keeping the
patient in mind, we crafted a smooth, comfortable, and
low profile bracket. Constructing an attractive fit in the
patient’s mouth.
FLI® TWIN BRACKETS
Creating beautiful smiles is effortless when the patient is
comfortable and willing to SMILE BIG for FLI® Twin brackets.

54 CLINICAL REVIEW
 rocky mountain orthodontics®

BONDING SYSTEM

TrulockTM Light Activated Adhesive is a single

LIGHT ACTIVATED
ADHESIVE PASTE

paste resin-based, fluoride containing bracket

LIGHT ACTIVATED
ADHESIVE PASTE
adhesive that requires no mixing, resulting in reduced
REF
J04000 5g waste, improved performance consistency, and no working
RMO, Inc
650 West Colfax Avenue RMO Europe
Denver, CO 80204 USA 300 Rue Geiler de Kaysersberg
time constraints.
www.rmortho.com 67400 Illkirch, France

BENEFITS:
0483 ■ No mixing, no waste
Made in USA
262-01364/REV.–
■ Low-viscosity paste reducing likelihood of runoff
PRIMER ACTIVATED

TrulockTM Primer Activated Adhesive is a Paste-Primer orthodontic formula

ADHESIVE PASTE

designed to bond metal, ceramic and plastic brackets. The unique filler and
PR I M ER ACT I VAT ED primer combination produces an ideal bond and a smooth tacky viscosity
ADHESIVE PASTE
minimizing bracket drift or movement.
0 483 Ma d e in U SA 26

REF
J04010 14g
RMO, Inc
650 West Colfax Avenue RMO Europe
Denver, CO 80204 USA 300 Rue Geiler de Kaysersberg
www.rmortho.com 67400 Illkirch, France
USE BY
LOT
- 01 2

BENEFITS:
36
8/
RE
V.–

■ Self curing for easy use

■ Optimal viscosity to minimize drift
ETCHANT GEL/LIQUID

TrulockTM Etchant contains 37% phosphoric acid for use on

both dentin and enamel. The viscosity of TrulockTM Etchant Gel
provides ideal control to prevent the material from flowing
BONDING SYSTEM onto exposed surrounding surfaces. All formulas rinse away
LIQUID ETCHANT
3ml
clean without leaving any residue.
RMO, Inc. 650 West Colfax Avenue, Denver, CO 80204 USA
RMO Europe. 300 Rue Geiler de Kaysersberg, 67400 Illkirch, France
www.rmortho.com

0483
USE BY
BENEFITS:
Made in USA
262-01379/REV.– LOT ■ Ideal to prevent overflow
■ Dual usage on both dentin and enamel

650 West Colfax Avenue, Denver, Colorado 80204

P 303.592.8200 F 303.592.8209 E sales@rmortho.com
800.525.6375 | www.rmortho.com Synergistic Solutions for Progressive Orthodontics®
ORTHODONTICPUBLICATION 55
THE WORLD’S FIRST MOBILE
MONITORING SOLUTION IN
ORTHODONTICS
allows you to control the position and shape of your patients’ teeth remotely and continuously.
combines the most advanced technology in machine vision with patented algorithms in order to
create the first self-monitoring system in orthodontics. for more info visit www.rmortho.com/products/dental-monitoring

650 West Colfax Avenue, Denver, Colorado 80204 Synergistic Solutions for Progressive Orthodontics
®

P 303.592.8200 F 303.592.8209 E sales@rmortho.com 800.525.6375 | www.rmortho.com