Professional Documents
Culture Documents
Dr. Fillion on
the Lingual
Orthodontic
Resurgence
Page 2
Dr. Drake on
Budgeting
Page 10
Dr. Burk
on the
Express-Nance
Page 14
Dr. Mayes
on the MMBJ
Page 16 Dr. Fillion
The Resurgence of Li
The Orthodontic Specialty Responds to
by Didier Fillion, D.D.S. Introduction
Paris, France “Toto, I have a feeling we’re not in Kansas
anymore.” Today’s orthodontist can
readily relate to Dorothy’s apprehension as
our specialty competes in an increasingly
Oz-like arena. It’s not the Wicked Witch
of the West and her minions. It’s the
harsh, ever-changing marketplace realities
that have disturbed the relative tran-
quillity enjoyed by orthodontists in past
decades. And nowhere are these changing
conditions more in evidence than in the
USA, where MSOs, dental managed care
plans, blatant advertising, and increased
competition from nonspecialists are
exacting a heavy toll on traditional
practices. Changes are going on through-
out the world and they will intensify.
Figure 2. Measuring the distance between Figure 3. Compensating for different tooth Figure 4. Bonding with unfilled resin: resin
labial surface and bottom of bracket slot. thicknesses at laboratory by varying thick- pads have the same forms as those devel-
ness of custom resin pads. oped at the laboratory.
which I attended all their European tice characteristics. I set up five basic ob- molar and bicuspid brackets and having
courses from 1984 to 1989. Wanting to jectives, essential ones that I still pursue: patients wear thermoplastic splints that
extend my lingual practice, I left Saumur 1. Use the most esthetic and comfortable provide coverage of the teeth and brackets
for Paris, where I made the decision to appliance. make this adaptation process much easier.
practice lingual orthodontics exclusively. I 2. Treat all kinds of malocclusions. For better esthetics and greater comfort,
had been attracted by esthetics at each 3. Reduce treatment time. I finally stopped using auxiliaries such
level of my life, so I could appreciate 4. Avoid extractions. as labial buttons, labial brackets and
the fact that adults are becoming more 5. Obtain the same results as with the transpalatal arches. Nothing is visible on
desirous of a better appearance and, labial technique. the labial surfaces except white elasto-
more specifically, a nicer smile. Therefore, meric chains around rotated teeth, the
I was delighted to be able to offer them a How Can These Objectives most rapid and efficient way to correct
perfect esthetic appliance. By 1987, the Be Reached? rotations.
era of unesthetic appliances for adults Using Seventh-Generation Ormco
was definitely over for me. Brackets Bonded to Both Arches Using a Simple But Highly Accurate
For All Patients Laboratory Technique
The American lingual orthodontic experi- I have found these brackets to have three I prefer to bond lingual brackets directly
ence in the early eighties was a failure for principal advantages: to the initial model and to use the
most orthodontists (mediocre results, a • The bite plane of the bracket represents T.A.R.G. (Ormco) technique to position
threefold or more increase in chairside an incomparable advantage for correct- the teeth in space (virtual setup) and to
time, longer treatment). By 1987, few ing a great number of malocclusions, be able to position brackets to specific
American orthodontists were practicing especially deep-bite and crossbite cases, heights. I added to it a tooth thickness
the lingual technique, so my decision to with immediate bite opening obtained measurement system in order to compen-
use lingual appliances exclusively was a by lower incisor contact with the biting sate for the differences in thickness with
challenge. It proved to be an even greater surface of the lingual bracket. the addition of a composite pad. This
challenge than I had anticipated, and I • Gingival hooks facilitate quick ligation. resin pad is perfectly adapted to the
knew that for a while I would have to • Sufficiently wide bracket slots allow for lingual surface and forms part of each
solve many problems in order not to correction of rotations. bracket base. Thus, each bracket becomes
regret my chosen path. unique by virtue of its resin pad and its
The adaptation phase following lingual orientation to the labial surface of the
First of all, I had to define how I would bracket placement takes 8 to 20 days. The tooth (Figures 1-4).
work and what would be my lingual prac- use of light-cured protection paste around continued on following page
3
Dr. Fillion
continued from preceding page
Figure 10. DALI program: initial position. Figure 11. DALI program: shape of archwire Figure 12. Shape of the archwire corre-
to be used for retraction is provided by sponding to the final position.
computer.
though all can be used successfully, the ment alternatives for this 10 percent: arch form in two dimensions on the
best way to retract anteriors and close • Avoid lower extraction as much as screen and to simulate the tooth move-
extraction spaces is to use the sliding possible in order not to aggravate the ment to an ideal position. For each treat-
mechanics designed and taught by the initial dental relationship and because ment sequence, one can obtain a very
Ormco task force in the early eighties. of the high risk of excessive lingual accurate drawing of the specific archwires.
As with any sliding mechanics, this tech- inclination of lower incisors. The position of the first order bends
nique may produce undesirable side • Plan anchorage preparation at the lab between cuspids and bicuspids and
effects, such as slowed retraction caused stage during bracket positioning. between bicuspids and molars is perfectly
by frictional forces and changes in the • Use Class II elastics. predictable and reproducible for all arch-
dental arch form in the cuspid-bicuspid • Use a removable labial archwire wires. Therefore, occlusal interferences
area caused by the “bowing effect” (which (anchorage enhancer) at nighttime can be avoided during treatment, an
is preventable). Nevertheless, sliding with Class II elastics (Figure 8). automatic coordination of the upper
mechanics are the easiest lingual tech- and lower arches can be obtained and
nique to implement and reactivate, as The first two alternatives must be planned treatment archwires can be prepared
well as affording more comfort to the before beginning treatment, whereas the ahead of time by the practitioner or his
patient. Furthermore, it allows good last two can be employed during the staff. This software program called DALI
control of the vertical and transverse course of treatment. (Dessin de l’Arc Lingual Informatise,
dimensions if used with Ormco brackets computerized drawing of the lingual
with their incorporated bite planes. Using the Help of Computer Science arch), used in my practice since 1989,
With digital imaging of brackets bonded is essential for me to reach the preplanned
A study of my treated cases showed that to the malocclusion model and informa- ideal tooth position and to decrease
only 10 percent (all with a dental Class II tion such as bracket width and thickness chairside treatment time (Figures 9-12).
relationship before treatment) required total noted for each tooth by the lab technician,
anchorage control. There are four treat- it is possible to visualize the initial dental continued on following page
5
Dr. Fillion
continued from preceding page
What are the results obtained (Copper Ni-Ti™) at the first treatment nized or understood.
in my office today? stage, torque control can be achieved • Bonding quality was often inadequate.
Chairside Treatment Time Quite without having to change archwires. It • Orthodontists were insufficiently trained.
Similar to Labial Treatment was difficult to adapt the prior nickel Today laboratory steps and bonding
Requirements – How Is It Possible? titanium wires used in the labial tech- procedures are greatly improved, and the
In France, the dental hygienist profession nique to lingual orthodontics because most harmful sliding mechanics side
does not exist and, furthermore, dental of the first-order bends required and effect, bowing, can easily be controlled.
assistants cannot work in the patient’s due to the narrow lingual arch form. Also, the adaptation of shape-memory al-
mouth. Since I’ve had to do all the treat- It is now possible to treat the Copper loys to lingual orthodontics makes the
ment procedures myself, you can imagine Ni-Ti archwires to modify the shape alignment stage significantly shorter.
the intensity of my motivation to improve memory designed by the manufacturer
swiftness and efficiency. Once again, in order to create a new shape adapted It is essential to note that the quality of
necessity proved itself to be the mother of to each arch form. the final result and the amount of chair-
invention: • At last, with DALI software, archwire side time are directly dependent on the
• One can place lingual archwires more design is facilitated and the archwires quality of the laboratory phase and on
quickly by using specifically-adapted can be prepared ahead of time. the precision of the bracket positioning
instruments and by reducing the need on the plaster model. One must be aware
for metal ligatures in the anterior region. Without a doubt, France is the country that any system that tries to simplify the
• The indirect bonding technique that I in which the restrictions to practice lab phase and does not pay due respect
have developed is faster than direct orthodontics are the most severe. In to these precision requirements will
labial bonding and equivalent to indirect more favorable environments, where increase chairside time (to correct align-
labial bonding techniques. With the specially trained auxiliaries can perform ment or resolve torque problems), lead-
systematic use of microblasting, bond most of the treatment tasks, the ortho- ing to regression of the lingual treatment
failures have decreased significantly. dontist should spend no more time progress.
Moreover, by using a transfer tray treating lingual cases than he does treat-
made out of very rigid silicone material ing labial ones. Discovery of an Easier Approach to
(85° Shore), one can reuse it for rebond- Treating Some Malocclusions
ing in 80 percent of the cases. The Lingual Treatment Duration The bite plane of the seventh generation
rebonding procedure is, therefore, very Similar to Labial Ormco brackets causes an immediate
quick, taking only three to five minutes For the first half of the eighties, lingual posterior open bite, therapy routinely
after archwire removal. orthodontic treatment was much longer indicated for the deep-bite cases so
• Since the differences in tooth thickness than that required for labial. Why? frequently seen in the occidental popula-
are compensated for during the bonding • Bracket positioning was not as accurate tion. Altounian, Fillion and Sorel made
procedures at the lab stage, archwire and there was no system to compensate a study in 1994 of 30 cases showing
bending is reduced or even eliminated for the different thicknesses of the teeth, an overbite greater than 4 mm that
for most of the treatment (except for making the finishing phase a very long revealed results similar to those found
cuspid-bicuspid and bicuspid-molar one. in previous studies. Contact of the lower
bends), which saves a lot of time. • Sliding mechanics side effects with incisors with the upper incisor brackets
• With the use of shape-memory alloys lingual brackets were not well recog- causes the greatest tooth movement in
Figure 13. Crossbite case: pretreatment. Figure 14. Crossbite case: one month later. Figure 15. Crossbite case: nine months into
treatment.
the anterior region: 1.5 mm lower incisor to open the bite for patients undergoing inherent advantage for correcting open
intrusion, 0.9 mm upper incisor intru- labial treatment) attests to the effective- bites. Nevertheless, one can obtain
sion, 0.2 mm upper molar extrusion and ness of these mechanics (see Case 1). very good results with the appropriate
0.5 mm lower molar extrusion. As far as Moreover, there is no technique other mechanics:
I know, there is no equivalent technique than lingual to easily correct dental cross- • Modification of the bonding heights of
(labial or lingual) that can correct severe bite in the posterior region (because the brackets in order to obtain a 3 to
deep-bite cases as quickly (six months or of the posterior open bite) as well as in 4 mm differential between the anterior
less) as the lingual orthodontic technique the anterior region (a single tooth/bracket and posterior regions of both arches.
with Ormco brackets. Ormco’s recent contact of one incisor or a lower cuspid is • Vertical intermaxillary elastic wear
highly successful introduction of Bite enough to open the bite) (Figures 13-15). (spaghetti style); elastics attached
Turbos (modified slotless lingual brackets Unlike their particular facility for opening to lingual brackets restrain tongue
bonded to the lingual of upper incisors deep bites, lingual brackets have no continued on following page
Brackets bonded on malocclusion model with T.A.R.G. and thickness-measuring system. Full size
wire engaged in brackets after tooth separation shows the efficiency of this system. Extraction
angulation and anchorage preparation were prescribed for this case.
7
Dr. Fillion
continued from preceding page
Four months later: posterior disclusion is Retraction with sliding mechanics. Lower arch alignment.
almost corrected.
Posttreatment: deep bite and gummy smile have been corrected after a 24-month treatment.
8
thrust, so their vertical effect is quicker nique was as efficient as labial orthodon- what you have done for them.
(see Case 2 on page 20). tics. Today 47 percent of my patients are
referred by general practitioners, 24 per- The Vital Role of Lingual
Increased Number of Patients cent by orthodontists who don’t practice Orthodontic Training
Benefiting from experience, I’ve been able the lingual technique and 29 percent by I was very pleased with the attendance
to double the number of patients under- treated patients. Seventy-four percent of and response at the two lingual courses
going treatment in my practice five years the patients are women and 26 percent I conducted this past October in New
ago, even though I have to handle all the are men (the male percentage twice that of Orleans and San Diego. I received my
clinical tasks personally. Like the situation five years ago). Most of these patients had lingual education from three U.S. practi-
in the United States, lingual orthodontics wanted to improve their smile for many tioners with wonderful clinical and teach-
in France suffered from a bad reputation years but did not want visible appliances. ing skills: Craven Kurz, Jack Gorman and
for many years. Many lectures and papers Once treatment is accomplished, lingual Bob Smith. These pioneers started from
were necessary to prove that the tech- orthodontic patients are really grateful for continued on page 20
must be factored in. Compare “apples to * Evaluate new starts over the past four years to decide on
a growth rate. Adjust percentages to fit your practice.
apples” when establishing your criteria. ** National Brand 45-603 Nine-Column Premium
10 Remember, too, that published numbers Analysis Pad
rhead Control
Purchasing Accountability
Because staying on budget is highly corre-
lated to purchasing, I recommend that you
assign accountability for specific line items
to one or more clinical and clerical staff
members (Figure 2). Review both past
spending trends and inventory to project
future costs. Staff members are often more
continued on following page
11
Dr. Drake
continued from preceding page
Shot Down in a ently with the idea. If not, they’ve matured and would proba-
bly put a new spin on an old plan. Perhaps the environment is
now right. You’re not in the same place you were a few years
New York Minute ago. Nor is your referral base. Nor is your marketplace.
Sometimes old ideas – at least in concept – are still good ideas.
Critiquing Ideas Prematurely Defeats Your Goals They deserve revisiting from time to time to see if an aspect of
ajor issues require defined agenda time to be addressed. them still shows vital signs.
13
The Express
F U R T H E R S T R E A M L I N I N G A N
by Saul Burk, D.D.S., M.S. recommended, giving a few seconds
Gaithersburg, Maryland between each burst to allow for cooling
of the acrylic as necessary. Create the size
The Nance holding appliance has been button you feel is appropriate. I have
associated with orthodontics for many found that the more anchorage you want,
years. When extraction methodology was the bigger the button should be.
a popular treatment approach, a Nance
holding appliance was used in cases that Figure 2 shows the wires bent and secure
required anchorage control. Today the in their respective lingual attachments.
Nance holding appliance has renewed ap- Notice three bends per side. The wires
peal. The use of a molar distalizing appli- are at least 3.0 mm from the soft tissue.
ance (e.g., Pendulum and Kickplate) may Figure 3 shows the acrylic placed and
require a holding appliance after distaliza- cured. Figure 4 shows the wires placed
tion of the molars has been completed. in an inflamed palate. This is not a con-
traindication for placing an Express-Nance
A holding appliance that is inserted at unless extreme tissue irritation is present.
the same time the distalizing appliance is However, notice that Figure 5 shows the
removed is ideal. The Express-Nance can placement of acrylic is away from the
be made chairside in ten minutes or less. palatal irritation. Though some of the
I use Ormco prefabricated .032 stainless acrylic is on inflamed tissue, I have not
steel Nance arches (Figure 1). The medi- experienced a problem, because the
um size (#2) is the most commonly used. appliance is passive. You will notice the
“The Express-Nance However, I use #1 and #3 as necessary. It tissue is within normal limits by the next
takes too long to modify the large #3 for appointment.
can be made all applications, so maintain a minimum
inventory of all three sizes. I always cut Benefits of the Express-Nance:
chairside in ten the Nance arch in half. The key is to make 1. Simple to construct
only three bends per arch side using a 2. Eliminates a lab procedure
minutes or less.” three-prong plier. Position both sides in 3. Takes one appointment
their respective lingual attachments. Then 4. Conserves maximum molar
place light-cure acrylic (Triad®) under the distalization
wires and roll it around the ends of the 5. Excellent patient acceptance
Nance legs. Use a curing light to set the
acrylic. Explain to the patient that the
Nance button will get warm as it cures. Dr. Saul Burk received his D.D.S. from the
University of Maryland and his M.S. and
We ask the patient to raise their hand
certificate in orthodontics from Georgetown
when the button gets warm. We then University. He was an assistant professor of
remove the light to let it cool. The patient orthodontics at Georgetown University for
will usually raise their hand every 10 11 years. Dr. Burk is in private practice in
seconds during the first 30 seconds. After Gaithersburg and Olney, Maryland.
Figure 1. Use preformed Quick-Nance Figure 2. Make three bends with a three- Figure 3. Place Triad® light-cure acrylic
arches cut in half for easier placement prong plier and secure the wires in their under the wires and roll it around the ends
and adaptation. lingual attachments. of the Nance legs before curing.
Figure 4. Wires in place. Note inflamed tis- Figure 5. Express-Nance appliance in place.
sue; Express-Nance can still be used unless Note that placement is away from inflamed
irritation is extreme. tissue.
15
The Molar-Moving
Bite Jumper
(MMBJ)
by Joe H. Mayes, D.D.S., M.S.D. tack welding facilitates the soldering
Lubbock, Texas procedure) (Figure 11). Most of the
second type of appliance can be premade
The MMBJ was developed to assist with with Ormco Cantilever Bite Jumper (CBJ)
the correction of dental and skeletal prob- components to simplify and speed the lab
lems. The appliance works exceptionally procedures (Figure 12). Both appliances
well correcting skeletal Class IIs and use CBJ upper molar crowns with pre-
closing missing lower 2nd bicuspid space. attached axles, but the second one uses
We have used the appliance unilaterally, the lower CBJ with preattached cantilever
bilaterally and with asymmetric cases. on the side opposite the one with the
The appliance works equally well with all missing lower 2nd bicuspid. This opens
these dental and skeletal problems and is the bite slightly, allowing the other lower
a valuable adjunct to our skeletal Class II 1st molar to move mesially more rapidly.
corrections. As the molars are moved In either case, the D/4 bands are rein-
forward by the appliance (Figures 1-10), forced “à la Jim Hilgers.” In other words,
mesial crown tip is totally eliminated by bulk up the band with solder when
the use of .045 lingual molar tubes with soldering the axle to the band (Figure 13).
an .045 lingual bar. There are two types The solder goes completely around the
of MMBJ. One employs stainless steel band to make a very rigid anchor of the
crowns on the D/4s bilaterally. The .045 lower arch.
lingual bar extends distally through an
.045 tube soldered to the lingual of the Since many Class II malocclusions require
bands, unilaterally or bilaterally (prior widening of the upper jaw, take an extra
upper impression at the first visit so that
the upper expander can be fabricated
A native of Crane, Texas, Dr. Joe H. Mayes
prior to the patient visit. When the patient
received his B.S. from Texas Tech University,
followed by his D.D.S., M.S.D. and certificate
returns for the expander, take a lower
in orthodontics from Baylor College of impression, pour in lab plaster and sepa-
Dentistry. Dr. Mayes is engaged in the rate the lower. If an E is still present in
private practice of orthodontics in Lubbock, the missing 2nd bicuspid site, refer the
Texas, and has been actively involved in patient for extraction so that the molar
new product development. can be moved mesially. Trim the upper
16 continued on page 18
Figure 1. New patient exam – Class II mixed Figure 2. Occlusal view of lower arch. Patient Figure 3. Lateral view of MMBJ. Lower
dentition. is missing both lower 2nd bicuspids. molars may be moved forward with springs,
power thread or chains.
Figure 4. Occlusal view of MMBJ. Figure 5. Lateral view at end of Phase 1. Figure 6. Occlusal view at end of Phase 1.
Approximately 3 mm of space closure has Note Class III molars. There will still be 1-2 mm of space closure
occurred in 7-8 weeks. needed with full appliances.
Figure 11. Occlusal view of Basic MMBJ. Figure 12. Occlusal view of MMBJ with CBJ Figure 13. Note solder extending all
components and soldered bicuspid band. the way around the band and the .036
stainless steel hook.
17
Dr. Mayes
continued from preceding page
and lower models around the 1st molars two halves are then sticky waxed in place Check the fit of the upper and lower parts
as well as the D/4 on the side of the lower to hold the separation (I sticky wax the of the appliance in the mouth. Microetch
arch with the missing 2nd bicuspid halves on a tile used for soldering) the inside of the bands and crowns if this
(Figure 14). Cut the upper model down (Figure 18). Place the upper CBJ crowns was not done previously. Crimp the mesial
the midpalatal suture line with a die saw (previously fitted in the mouth) on the and distal of the crowns, attach the tubes
(Figure 15). This allows the two halves model after the expander is removed. (already cut to correct length) to the
of the model to be positioned after the Fabricate an .045 stainless steel upper crowns and cement the appliance
desired expansion has occurred. transpalatal bar and solder and polish with glass ionomer cement (Figures 22-
(Figure 19). It can be removed at the 23). Attach a 9 mm 150 gm Ni-Ti spring
When the patient returns for the third next visit, approximately 12 weeks away. to the hooks on the labial of the D/4 and
visit, remove the lower spacers and the the 6 (Figure 24). Check the rods to see if
upper expander. Fit a band on the lower Next fabricate the lower part of the appli- shims are needed for midline correction
1st molar and on the D/4 on the side with ance. Tack weld a 4.5 mm length .045 or lower jaw advancement and then attach
the missing bicuspid, and fit a CBJ crown tube to the lingual of the lower molar the screws with Ceka Bond®. Now give the
on the opposite molar. Use CBJ Fit Kit band for ease of soldering; or you can use patient instructions on possible problems
crowns for trial fitting to avoid damaging an .045 inconel Ormco tube tack welded and how to care for the appliance. Also
the more expensive crowns with attached to the band (Figure 20). Soldering is advise the patient that as the molar
cantilevers. Then place the CBJ crown essential for sufficient strength of the at- comes forward, the lower lingual bar may
with attachment. Follow the same proce- tachment. Fit the CBJ crown on the model impinge on the tongue. The bar will be
dure to fit crowns on the upper 1st as well as the molar and bicuspid bands. trimmed at regular visits with a handpiece
molars. Remove the band on the D/4 and Place the .045 lingual bar (that was unless required more often.
tack weld an axle to it. Also, tack weld premade on this model) into the molar
an .036 hook in place before soldering. tube. Make any necessary adjustments to If an in-house lab is not available, an
Ni-Ti™ springs can be attached to the the bar and make a mark approximately excellent alternative would be Allesee
hook to connect the D/4 and 1st molar in 3 mm distal to the D. This will allow the Orthodontic Appliances, Inc., (AOA).
order to bring the molar forward. Flow attachment of a stop on the lingual bar to I have worked very closely with them on
solder around the axle base and the band. prevent the molar from completely closing the designs of all the appliances I use.
Place the band back on the tooth (Figures the space of the missing E. Remember, an However, this is a rather simple appliance
16-17). Measure the interaxle distance E is 10 mm mesiodistally and the lower and can be done in a lab in the office with
with the lower jaw pushed forward in an 5 is 7 mm mesiodistally. Therefore, we minimal equipment.
edge-to-edge position. This enables the need to leave a little space when closing.
lab personnel to cut the rods and tubes This is not necessary if the cuspid and As a variation of the CBJ, the MMBJ has
to the correct length before cementation. 1st bicuspid are present. Hold the lingual proved itself a reliable and easy solution
The bands and crowns that were fitted bar in place with sticky wax and solder for the correction of a skeletal Class II
in the mouth are taken to the lab, along to place on the lingual of the CBJ crown with the dental deformity of a missing
with the removed upper expander. and the lingual of the D/4 (Figure 21). unilateral or bilateral lower 2nd bicuspid.
Since the molar will move forward on the The appliance helps with our overall goal
The upper expander is placed on the two .045 lingual bar, the bar must not be bent of having braces on our patients for the
halves of the upper lab model, and the distal to the D/4, or the molar will bind. shortest possible time.
Figure 14. Lower model with teeth relieved Figure 15. Upper model sectioned through
18 and premade .045 stainless steel lingual bar. the midpalatal suture and molars relieved.
Figures 16-17. Lower appliance trial fitted and ready for cementation. Figure 18. Removed upper expander placed
on upper model halves for positioning and
waxing to soldering tile.
Figure 19. Crowns fitted in mouth placed on Figure 20. Ormco inconel tube (.045 lumen). Figure 21. Finished lower part of MMBJ
upper model and .045 stainless steel ready for trial fitting in the mouth.
transpalatal bar ready to solder.
Figures 22-23. Cemented appliance ready for fitting of the rods to be checked. Figure 24. Final delivered appliance with
Ni-Ti spring in place to bring the molar
forward.
If you prefer to use your own lab, you can order the essentials
Figure 25. Patient R.F., age 12 Figure 26. Patient R.F., age 23
years 7 months, missing both years 5 months. She was treated
from Ormco: CBJ Kits, CBJ Fit-Kits, CBJ components, spacers,
lower 2nd bicuspids. with an MMBJ and full appliances .045 inconel tubes, lower D and 1st bicuspid ss crowns,
and has been in retention approxi- and 9 mm .010 x .030 light force Ni-Ti® closed coil springs
mately nine years. (see page D of the Center Section).
Dr. Fillion
continued from page 9
scratch and established the foothold world are taking note, and it is hoped that are close to reaching this goal. In fact, I
necessary for lingual orthodontics to other resident and continuing education am convinced that lingual orthodontics
overcome the many initial limiting factors programs will be developed. will someday replace labial orthodontics
and setbacks and to evolve into its current for adults.
advanced and continuing-to-improve Today’s orthodontist need not reinvent
state. I am glad to follow in their foot- the wheel or suffer through the extended There is a need to learn and practice the
steps and join other lingual orthodontic learning curve our specialty confronted lingual technique because:
clinicians in accelerating the growth of in the early years of lingual orthodontics. • this intellectually stimulating technique,
this technique in the U.S. for the benefit State-of-the-art training can be found with some practice, is almost as easy to
of the public and specialty alike. throughout the world, and established use as the labial one.
lingual orthodontic societies and study • it is a great way to uncover adults who
The Eastman Dental Center at Rochester clubs offer ongoing support. are desperate for a nice smile but adverse
and Indiana University continue their to visible appliances, thus increasing
vital roles as academic centers for the Conclusion one’s potential number of patients.
technique in the U.S. In October 1996, a Today, I do not regret my 1987 decision. • this technique makes it easier and faster
lingual orthodontic program was created By and large, I have reached the objectives to treat certain kinds of malocclusions
at the University Rene Descartes of Paris V that I set for myself, and my enthusiasm than is possible labially.
by Dr. Alain Decker, chairman of the for the technique continues to grow. • and last but not least, patients will soon
Department of Orthodontics. Dr. Gerard Many areas of lingual orthodontics have have the awareness and rationale to
Altounian and I are coaching this two- yet to be explored and a great number criticize the orthodontist who does not
year program. Six orthodontists (includ- of improvements are at hand. Moreover, offer this technique.
ing three foreigners) participate in this I am continuously elated and inspired
didactic but essentially clinical program by the happiness of my patients with their The rewards that I enjoy everyday from
that will develop the necessary skills to invisible braces. In 1991, I wrote in a practicing lingual orthodontics are such
conduct a large-volume lingual practice. French orthodontic journal that “this that I want to stay on the same road.
With the increasing interest in lingual decade will make lingual orthodontics as I have come a long way and now I wish
orthodontics, other schools around the easy to use as labial orthodontics,” and we to share the road with others.
20
Case 2: Open-Bite Case
Vertical elastics on lingual brackets push Vertical elastics worn at night like spaghetti.
tongue back from teeth.
Posttreatment: correction after a 19-month treatment. Permanent retention with .0175 Respond® bonded to lingual surfaces.
21
Brainstorming
continued from page 13
better ideas. What stalls the process and ideas you’ll have. To get really serious Until you can throw ideas out quickly, go
dampens the creative spark is making about the brainstorming process, you around the room. One person – one idea.
value judgments about ideas as soon as need some equipment. A flip chart. Squirt Next person – next idea. Keep it moving.
they’re uttered. If we’re gonna rock and guns. And somebody with chutzpah. Quick. Quick. Quick. If it’s not going fast,
roll in the idea arena, we must silence you’re evaluating too much. It should
the initial nit-picking. There’s a carping Flip Chart look like a great game of charades or
critic in each of us; granted, there’s more So first, we gotta hang the judge. On a flip Pictionary. (Have someone write the ideas
in some people than in others (no finger- chart, list all the critical things you and on a flip chart. They’re not part of the
pointing). But whatever the percentage, your teammates are likely to say when process, either. This also keeps things
exacting assessment of ideas is crucial to new ideas make your eyes roll. “Been there; moving.) If someone doesn’t have an idea,
prudent decision making. It keeps us from done that.” “The doctor won’t go for it.” have them pass. Encourage people to say
making rash judgments, playing the fool “What would our patients think?” “People’d anything – to say the first thing that pops
or making costly mistakes. We must seg- think we’re nuts.” Whatever. Get everything into their mind. Crazy ideas sometimes
regate the brainstorming segment of the down. Don’t leave anything out. Then aren’t all that crazy. The orthodontist who
problem-solving process from the segment raise your hand and take the pledge. “I set up a limousine service for pickup and
in which we actually decide on a plan of (your name) promise never to utter these re- delivery paid for it in the first year. (You
action. If we don’t keep the steps separate, marks or anything like them in our meet- can imagine how eyes rolled the first time
we can get confused, because we think ings.” Read the list. Everybody in unison. that suggestion was aired.) What you
that to run with a crazy idea for a while is Keep the list in full view every time you throw out in jest can often get to the crux
foolhardy. Someone in the group might meet. Remind yourselves before each of an issue. In a recent problem-solving
actually get the idea that you’d implement meeting: “And what are we not going session on improving efficiency, someone
this plan, but you’re just talking. Talk is to say today?” (It works best if you get the blurted out, “Keep the doctor off the phone.”
cheap; you haven’t decided anything. appropriate Mr. Rogers intonation.) It was said as a joke, but dozens of staffers
You’re just taking a little jaunt down the in the audience groaned – the doctor did a
“what if” lane on the highway of life. A Squirt Guns heads up. (And we later came up with a
good problem-solving format encourages Laws must have teeth. That’s where couple of ideas to make it work.)
you to run with a number of ideas before the squirt guns come in. They’re your
you begin making determinations about enforcer. At the beginning of the first Get stuck? Ask for ideas from industry.
payoffs and probabilities for success. problem-solving meeting, hand out a Orthodontists who use pagers so mom
squirt gun to every member of the team. can go shopping during long appoint-
Do it with a flourish. You’re bringing in ments probably got the idea from restau-
“The fact is that the heavy ammunition. Anyone who says rants. Or ask “out there” questions. What
anything remotely resembling the criti- would contradict history? What would be
mediocre and even cisms you’ve promised one another not the most outrageous solution? What
to say gets it. Give no quarter. This is not would get you on the cover of People, The
goofy ideas are often a theoretical construct. It works. I’ve New York Times, National Enquirer? What
the genesis of really done it – with senior executives around a
marble conference table in the boardroom
would arouse curiosity? Here’s one. What
if you were less effective?
great ideas.” of an insurance company in West LA. The
oriental rugs dried in no time. A good problem-solving formula
combines a number of elements. Brain-
One way to look at the critical aspect of Someone with Chutzpah storming is one and it’s key. Get it work-
our personality is to view it as a role. It’s Put someone in charge of the brainstorm- ing, then you’re ready to bring back the
a part of us, not our entire personality, ing process. They’re the drill sergeant; critic and hammer out how to make these
but a role we assume from time to time in they’re the cheerleader. They are not the novel ideas work.
managing the course of our everyday doctor. They are not part of the process.
affairs. Being a first-rate judge is a worth- They keep the process moving by staying
while role when it is executed at the on guard to keep you from working on a Creative problem solving was the topic of
appropriate time. Analyzing a challenge specific idea during the brainstorming, Ms. Brunner’s Gorman Institute workshop that
she conducted with the staff of Dr. Keith Black
or coming up with solution possibilities from criticizing ideas or from censoring
of Asheville, North Carolina. Ms. Brunner is
at this time may slow or stop the new yourself. “How about…no, that won’t work” manager of Ormco’s Practice Development
idea generation process. The more can get you doused as well. They’re also Seminars and Clinical Impressions Live!
ideas generated, the more good full of praise when you really start cookin’.
22 programs.
Alexander Discipline
International Symposium
Arlington Marriott Hotel, Arlington, Texas, May 21-22, 1998
Dr. Wick Alexander Extends an Invitation to ence generations of Texas heritage and enjoy a party at the West
Fork Ranch in Fort Worth. Bring your jeans and cowboy boots
ADI Members and Nonmembers to Share
for an evening of fun.
Learning Experiences and Texas Hospitality
with Orthodontists from Around the World A block of rooms at the Arlington Marriott Hotel (located in the
heart of the Metroplex entertainment district and near the DFW
For two decades, the Alexander Discipline has enjoyed continu- airport) has been reserved at special rates for symposium atten-
ous worldwide growth as orthodontists are becoming increasingly dees. You can make reservations by calling the hotel directly at
aware of this uncomplicated technique based on sound principles (800) 442-7275 or (817) 261-8200 and indicating you are with
and extensive clinical experience. Contributing to this success has the Alexander Discipline International Symposium.
been a focus on education through ADI study clubs; basic and
advanced Alexander Discipline courses; and presentations to For planning purposes, please make your hotel reservations and
graduate students, university continuing education programs, register for the symposium as soon as possible. Registration is
alumni groups and society programs. Previous worldwide easy. Simply mail a check for $100 payable to “The Alexander
symposiums sponsored by Dr. Alexander in Arlington and by Discipline” to cover the registration fee to: The Alexander
the Alexander Discipline Study Club of Japan in Osaka, Japan, Discipline International Symposium, 840 W. Mitchell Street,
proved to be exceptionally popular and productive. So plans Arlington, TX 76013-2585. Also include a note indicating if you
are well in place for the ADI Symposium to be held May 21-22, plan to participate in the golf tournament. If you are bringing
1998, in Arlington, Texas, immediately after the American guests, indicate the number who will participate in the golf tour-
Association of Orthodontists meeting in Dallas. nament and the number attending the West Fork Ranch party.
If you have any questions or need further information, contact:
The theme of the meeting will be “Vertical Problems: Open- and Ms. Brenda Horton, phone (817) 275-3233, fax (817) 277-3826.
Deep-Bite Treatment.” A panel of speakers will make 30-minute
presentations on the subject followed by open discussion. Ample
opportunity will also be provided to share your experiences,
problems, and ideas with co-disciplinarians.
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