Ortho Tribune U.S.

Ortho surgery and esthetics (entree) / Systems thinking rather than linear thinking / International Cone beam institute: educating - training - connecting / Ortho surgery and esthetics (part1) / Ortho surgery and esthetics (part2) / One spark / Practice makeover — Dr. hardy’s first successes are impressive / Internet marketing do or die: how to test your visibility on search engines / Why orientation is more important than you think / So where are all those starts? / Weak economy - strong practice / The TRAINER System in the context of treating malocclusions / Industry / Collaborative software connects dental professionals on a global scale / Nite-Guide: an interceptive first-phase ortho procedure for the 5- to 7-year-old / Cadent celebrates 10 years of OrthoCAD iCast digital models / Products / Those who see the ‘big picture’ gather for two days of 3-D education

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Table of contents

OrthO tribunE
the World’s Orthodontic newspaper · u.s. Edition

AUGUST/SEPTEMBER 2009

www.ortho-tribune.com

VOL. 4, NOS. 8 & 9

Change the world

test your Web site

new products

One student’s journey
to orthodontics

If you own a practice,
you’ll want to read this

Powders, brackets and
lights make their debut

Page

Last chance
to win free
practice
makeover!
Apply by sept. 30

I

f you are ready to grow your
orthodontic practice, apply now
to win the second Levin Group
Total Ortho Success™ Practice
Makeover. The deadline to apply
is Sept. 30, which means there are
only a few weeks left to win one
full year of free Levin Group Total
Ortho Success™ Management and
Marketing consulting programs.
When was the last time you
took a close look at your practice’s
systems? Whether you are in the
beginning stage of your career or
already experienced and successful, growth is always within your

12

Page

17

Page

28

Ortho surgery
and esthetics
reach — even in this economy.
The winning orthodontic practice will experience improvements in every aspect of running
a practice. This free, one-year
management makeover will be
a customized approach based on
the orthodontic practice’s unique
needs, goals and potential.
To apply, go to www.levingroup
ortho.com or www.ortho-tribune.
com. For more information, contact Lori Gerstley, professional
relations manager at Levin Group,
at (443) 471-3164 or lgerstley@
levingroup.com.
Check out how last year’s winner, Dr. Brian Hardy, has grown
his practice since he started the
makeover process at www.ortho
-tribune.com and on page 14. OT

By Prof. Nezar Watted, Prof. Josip Bill, Germany
& Dr. Ori Blanc & Dr. Benjamin Schlomi, Israel

O

rthodontic treatment generally
follows esthetic, functional,
and prophylactic objectives,
where individual aspects of isolated cases are accorded varying
importance as they arise. Increasing
esthetic expectations and awareness of modern dental treatment
options disseminated by the media
have resulted in increased interest
and greater willingness of adults
to consider orthodontic treatment.
Esthetic orthodontics is thus primarily adult orthodontics.
g OT page 4

Fig. 1: Diagrammatic representation
of the osteotomy lines on the outer
(continuous line) and the inner
compacta (dashed line) of the
mandible; 4 = inner saw cut above
the N. mandibularis.

Celebrities embrace braces

AD

By Fred Michmershuizen, Online Editor

Who says braces are just for kids?
More and more adults are getting
them — even celebrities. Actors,
professional athletes and pop stars,
such as San Antonio Spurs player
Manu Ginobili, actor Tom Cruise

and singer Gwen Stefani, are putting hardware in their mouths to
improve their smiles. And these
high-profile ortho patients are being
noticed, as well.
“These adults are successful,
g OT page 3
AD

Dental Tribune America
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Suite #801
New York, NY 10001

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PAID
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[2] =>

2

From the Editor

Ortho Tribune | August/September 2009

Systems thinking rather
than linear thinking
By Dennis J. Tartakow, DMD, MEd, PhD,
Editor in Chief

L

inear thinking can be defined
as simplistic, cause-effect thinking. According to Ollhoff and
Walcheski (2002), most individuals think in straightforward, causeeffect and short-term fashion; it is
called linear thinking, or attention
to content over process.
Understandably, there is a great
deal of reinforcement that must
transpire in order to not think linearly. This is because work ethics
and patterns typically remain the
same. It is difficult to change one’s
thinking, especially because most
of us are preoccupied with content

and objectives taking center stage
in our minds.
These interactive patterns can be
seen everywhere, and most people
think and act on a linear level,
considering only the end-point of
the content rather than the process.
Once we are pressed to consider the
process of differentiation including
both functions (relationship development and integration), we better
understand our own social behaviors and with greater appreciation.
Of course, most individuals never
associate their learning process with
systems thinking, but unconsciously
live their lives systematically.
By breaking down the concept of
a system and its variations, we begin
to identify with our impressions of
how this is integrated within our
practices. When the system is interdependent, all parts of the system
can be interrelated with all other
parts. Systems can vary, such as:
(a) open systems, where the system
shares information with its environment; and (b) closed systems,
where the system is self-contained.
Other key concepts in complex systems include (a) homeostasis, where
the push of the system is to stay the
same; (b) anxiety, where the feeling
of dread or inadequacy exists toward

a particular issue; (c) differentiation,
where you have your own goals and
can define yourself, but are still able
to stay in relationships, even with
individuals of differing opinions; (d)
emotional triangle, when two people
are in disagreement and draw in a
third to stabilize the conflict (This is
not mediation, attempting to solve
the conflict); (e) forces of togetherness, which is the push to think alike,
to reduce creativity and the diversity of thought; and (f) identifying the
patient, or the scapegoat.
In summation, the most important thing to remember is to recognize the differences between (a)
linear thinking, considering only
the content; and (b) systems thinking, considering the processes and
the interactions.
Of course, this is not to imply
that linear thinking is bad or wrong,
but rather that it is only one level of
thinking that is not seeing the big
picture of the world and reality that
is our environment.
To paraphrase the words of philosophers Edmund Burke (17291797) and George Santayana (18631952): Individuals who ignore
history are doomed to repeat it;
individuals who study history are
doomed to know it is repeating. OT

Book review: ‘The Practitioner’s Credo: 10
Keys to a Successful Professional Practice’
By Gregg A. Tartakow, Associate Editor

D

r. John B. Mattingly, a practicing orthodontist for four decades,
was concerned that orthodontic residents and young practitioners were
not exposed to what it takes to conduct a successful practice. Motivated
by a sincere commitment and genuine dedication to the “new-bees”
of orthodontics, Mattingly provides
a cookbook approach to the basic
principles of office management by
presenting the following 10 keys to a
successful practice:
• The first key — practice leadership
• The second key — enthusiastic,
effective staff
• The third key — practice ethics
• The fourth
key —
pursuit
of excellence
• The fifth

key — positive practice image
• The sixth key — cutting-edge
technology
• The seventh key — working environment
• The eighth key — essential and
non-essential expenses
• The ninth key — marketing your
practice
• The 10th key — “Ego”: Don’t get
the big head
In addition to these 10 keys, four
appendices are used to demonstrate
the values of the (a) office manual, (b) sexual and environmental
harassment policy, (c) exit survey
prototype and (d) explanation and
letters related to association [AAO]
membership revocation.
“The Practitioner’s Credo: 10
Keys to a Successful Professional
Practice” is interesting reading,
stimulating reflection and an enjoyable reference source for postgraduate orthodontic residents and seasoned teachers alike; it integrates
theory and practice with regard to
the art of thinking. The book is quite
useful to beginning instructors as
well as experienced teachers who
are attempting to improve their
thinking perspectives or reconsidering their approaches to pedagogy.

Several themes are repeated
throughout the book, which I think
is positive reinforcement. OT

Information
Mattingly, J.B. (2009). The practitioner’s credo: 10 keys to a successful professional practice. Garden
City, NY: Morgan James Publishing.
143 pages. ISBN: 978-1-60037-556-9.

Image courtesy of Dr. Earl Broker.

ORTHO TRIBUNE
The World’s Orthodontic Newspaper · U.S. Edition

Publisher & Chairman
Torsten Oemus
t.oemus@dental-tribune.com
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Peter Witteczek
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Chief Operating Officer
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Group Editor & Designer
Robin Goodman
r.goodman@dental-tribune.com
Editor in Chief Ortho Tribune
Prof. Dennis Tartakow
d.tartakow@dental-tribune.com
International Editor Ortho Tribune
Dr. Reiner Oemus
r.oemus@dental-tribune.com
Managing Editor/Designer
Ortho Tribune & Show Dailies
Kristine Colker
k.colker@dental-tribune.com
Managing Editor/Designer
Implant & Endo Tribunes
Sierra Rendon
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Online Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
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Published by Dental Tribune America
© 2009, Dental Tribune International GmbH.
All rights reserved.
Dental Tribune makes every effort to report
clinical information and manufacturer’s
product news accurately, but cannot assume
responsibility for the validity of product claims,
or for typographical errors. The publishers
also do not assume responsibility for product names or claims, or statements made by
advertisers. Opinions expressed by authors are
their own and may not reflect those of Dental
Tribune International.

OT Editorial Advisory Board
Jay Bowman, DMD, MSD
(Journalism & Education)
Robert Boyd, DDS, MEd
(Periodontics & Education)
Earl Broker, DDS
(T.M.D. & Orofacial Pain)
Tarek El-Baily, BDS, MS, MS, PhD
(Research, Bioengineering & Education)
Donald Giddon, DMD, PhD
(Psychology & Education)
Donald Machen, DMD, MSD, MD, JD, MBA
(Medicine, Law & Business)
James Mah, DDS, MSc, MRCD, DMSc
(Craniofacial Imaging & Education)
Richard Masella, DMD (Education)
Malcolm Meister, DDS, MSM, JD
(Law & Education)
Harold Middleberg, DDS
(Practice Management)
Elliott Moskowitz, DDS, MSd
(Journalism & Education)
James Mulick, DDS, MSD
(Craniofacial Research & Education)
Ravindra Nanda, BDS, MDS, PhD
(Biomechanics & Education)
Edward O’Neil, MD (Internal Medicine)
Donald Picard, DDS, MS (Accounting)
Howard Sacks, DMD (Orthodontics)
Glenn Sameshima, DDS, PhD
(Research & Education)
Daniel Sarya, DDS, MPH (Public Health)
Keith Sherwood, DDS (Oral Surgery)
James Souers, DDS (Orthodontics)
Gregg Tartakow, DMD (Orthodontics)
& Ortho Tribune Associate Editor

[3] =>

Ortho Tribune | August/September 2009

News

International Cone Beam Institute:
educating, training, connecting
Organization wants every dental professional to become a cone-beam expert

he International Cone Beam
Institute (ICBI) is an independent organization of conebeam computerized tomography
(CBCT) experts who provide the
highest level of education, training
and product information for 3-D
technology to dental professionals
worldwide at www.ExploreCone
Beam.com.
As a vendor-neutral organization,
this is an industry first — where a
company is providing information
to the dental professional, future
imaging centers and the vendor on
an international level.
General information such as
the different cone-beam scanners
available in the United States and
international markets, as well as
general information about available
third-party software, is available
to everyone without charge. ICBI
provides in-depth and customized
vendor analysis to help practitioners understand this comprehensive technology.
ICBI’s educational faculty has
the industry expertise to consult
with dental professionals looking to incorporate CBCT into their
practices, and to ensure that every
question is answered during the
decision-making process, including
questions about medical billing and
ROI (return on investment). For
those who are already CBCT users,
ICBI provides training to maximize
the power of this technology and to
help them achieve an expert level of
confidence.
ICBI Web site members are
able to review case studies and get
advice from CBCT experts.

f OT page 1

beautiful and total metal-mouths
and brace-faces,” blogger Lindsay
Mannering recently wrote.
“And they don’t care who knows
it!” Mannering, who was stressed
out about an upcoming visit to
the dentist, posted a slideshow of
famous people with braces on The
Huffington Post.
The trend is not just for Americans, either. The British Society of
Orthodontists is reporting a significant rise in the number of adults
seeking orthodontic treatment.
“The British are supposedly
famous for having ugly, snaggled
teeth, which perhaps explains why
people are seeking aesthetic
improvements in greater numbers
— we now spend £360m a year on
cosmetic dentistry,” the British
newspaper The Guardian wrote
recently. OT

In addition, ICBI offers a connection to oral-maxillofacial radiologists who can provide reading
services to aid in the interpretation of CBCT scans. ICBI also has
a blog where users can exchange

case studies, ideas and techniques
about how to capture the highest
quality images.
ICBI members have access to
special consulting services, online
training and training seminars.
The International Congress of
Oral Implantologists (ICOI), the
world’s largest implant education
organization, fully endorses the
ICBI. Additional partners of ICBI

include Dental Tribune International (www.dental-tribune.com) and
Dental Tribune Study Club (www.
DTStudyClub.com).
The ICBI wants every dental professional to become a CBCT expert.
Upcoming seminars include Atlanta
on Sept. 25–26, and Charlotte, S.C.,
on Oct. 9–10. For more information
about these seminars, visit www.
ExploreConeBeam.com.
AD

[4] =>

news & trends

Align, Ormco
end patent
dispute, plan
to collaborate

lign Technology, manufacturer and marketer of Invisalign,
has reached a settlement with
Ormco, a subsidiary of Danaher, to end all pending litigation
between the parties and to begin
a new strategic collaboration.
As part of the settlement, Align
will make a cash payment of
approximately $13 million to
Ormco and issue approximately
7.6 million shares of Align’s common stock to Danaher, which
after issuance will be equal to
approximately 10 percent ownership interest in Align. The value
of the shares is approximately
$77 million (based on the closing
price of Align’s common stock on
Aug. 14).
Align and Ormco also have
agreed upon an exclusive collaboration over the next seven years
to develop and market an orthodontic product that combines
the trademarked Invisalign system with Ormco’s trademarked
Insignia orthodontic brackets
and arch wires system to treat
the most complex cases. Each
party will retain ownership of
its pre-existing intellectual property.
(Sources: Align Technology
and Danaher Corp.) OT

OrthO tribunE | August/sEptEmbEr 2009

f OT page 1

A peculiarity of orthodontic treatment in adults compared with pediatric or adolescent orthodontics is
the age-associated involution of the
connective tissues that leads to a
reduction in cell density, thickening of the fibre bundles, delayed
fibroblast proliferation and reduced
vascularisation.
These are the causes of slower
dental movement and delayed tissue and bone reactions.
Absent sutural growth, the age
of the periodontium, specific periodontal diagnoses and tissue atrophy also make treatment in adults
particularly challenging.
As a rule, esthetically oriented
adult orthodontics therefore has
an interdisciplinary inclination.
Occlusion, function and esthetics
are considered to be equivalent
parameters in modern orthodontics
and particularly here in combined
orthodontic-maxillofacial surgical
treatment.32,33
This was achieved through optimisation of diagnostic tools and further development and increasing
experience in orthopaedic surgery.4
Nowadays, treatment of adult
patients with dental malposition
and mastication impairment is
one of the standard tasks of the
orthodontist. If the discrepancies
in spatial allocations of the upper
and lower dentition are particularly
pronounced and where the cause
is primarily skeletal and not only
dentoalveolar, conventional orthodontic therapy is limited, and combined orthodontic-surgical therapy
is indicated for remodelling of the
jaw bases.

Fig. 2a

Fig.
2b

Figs. 2a, b: Lateral view of the 25-year-old male patient, showing lower
facial retrusion diagonally forward. The frontal view shows the right-sided
deviation due to the laterognathia. The upper-lip vermillion is relatively
weakly developed (b).
Treatment for a skeletal dysgnathia (Class III) using combined
orthodontic-maxillofacial surgical
correction is discussed in this article.

Development of maxillofacial
surgery of the mandible

The first orthodontic-maxillofacial surgical procedure on the mandible described in the literature was
that of the American surgeon Hullihen in 1848.13 This procedure was a
segmental osteotomy of the anterior
mandible (a posterior shift [retrusion] of a protruding mandibular
alveolar process, following a burn
injury).
Toward the end of the 19th century, the method of orthodonticmaxillofacial surgical correction

of dysgnathias by surgical retrusion or protrusion of the mandible
was revisited. Jaboulay14 described
resection of the Processus condylaris and Blair4, osteotomy on the
Corpus mandibulae.
The continuity resection in the
horizontal branch by Blair was the
first surgical prognathism procedure.
The patient first visited the dentist Whipple in St. Louis in 1891
and was referred to the then most
renowned orthodontist Dr Edward
Hartley Angle2, who ultimately recommended the surgical procedure
mentioned above.
Six years later, the procedure in
this osteotomy on the Corpus mandibulae was also published by the
Hamburg surgeon Floris.11

[5] =>

trends

OrthO tribunE | August/sEptEmbEr 2009
Parallel with this development in
the United States, Von Auffenberg3
in Europe conceived a step-by-step
osteotomy for correcting a mandibular retrusion, which was performed by Von Eiselberg in 1901.
The era of orthodontic surgery
in Europe began only after World
War I. The experience gained there
led to a substantial extension of the
indications for orthodontic-maxillofacial surgical procedures, as well
as to the transferral of this surgical
technique to the area of elective
procedures.5,6,16–18,24
In the early 1920s, Bruhn and
Lindemann set transversal osteotomy of the Ramus mandibulae as the
standard method at the time for the
surgical correction of mandibular
prognathism. This method, which
continued to have many adherents
well into the 1960s, is today known
as the Bruhn–Lindemann procedure.1,6,25,45
g OT page 6

www.ortho-tribune.com
missed the last edition of
Ortho tribune? You can read
some of its content online!
Digital treatment: A look at two
SureSmile cases — high quality,
less time (Part 3 of 3)
www.ortho-tribune.com/articles/
content/scope/specialities/section/
case_reports/id/390
Ethical and moral scenario
planning for orthodontics
(Part 3 of 3)
www.ortho-tribune.com/articles/
content/scope/politics/region/usa/
id/387

here’s some other online
content that might be of
interest …
Utilizing fixed orthodontics
to prepare cases for aligners
www.ortho-tribune.com/articles/
content/scope/specialities/section/
case_reports/id/347
Dr. Arthur Wool reflects on his
career
www.ortho-tribune.com/articles/
content/scope/specialities/section/
interviews/id/338
Orthodontists practice what they
preach
www.ortho-tribune.com/articles/
content/scope/news/region/usa/
id/399
MRC celebrates 20 years of
ingenuity
www.ortho-tribune.com/articles/
content/scope/business/region/usa/
id/337

Fig. 3a

Fig. 3b

Fig. 3c

Figs. 3a–e:
Clinical
situation before
the start of
treatment.

Fig. 3d

Fig. 3e
AD

[6] =>

Trends

Ortho Tribune | August/September 2009

f OT page 5

In 1935, Wassmund, who saw its
drawbacks in a possible dislocation of the proximal segment by the
muscles inserted there, described
a modification of the Bruhn–Lindemann surgical technique.26 In the
early 1950s, a new era in orthodontic
surgery of the mandible was begun
with Kazanjian’s resumption12,15,23 of
the technique of transverse, oblique
severing of the ascending ramus,
first performed by Perthes in 1922.22
Shuchard modified this method
in 1954 by enlarging the bony insertion surface, and in 1955 Obwegeser
introduced sagittal splitting at the
horizontal ramus of the mandible.
He shifted the buccal osteotomy
line obliquely from the last molar
to the posterior margin of the jaw
angle.19–21
In 1959, Dal Pont moved this
buccal osteotomy line from the last
molar to the inferior margin of the
mandible.8,9 Since then, this method
of sagittal split at the mandible has
been called sagittal split according
to Obwegeser–Dal Pont (Fig. 1).
Epker10 developed the incomplete
sagittal split into a routine method.

Fig. 4: The cephalometric X-ray shows the disharmonious arrangement in the vertical axis.
The lower face shows an approximately 60 percent enlargement in relation to the upper face.

Fig. 5: Orthopantomographic image before the
start of orthodontic treatment. An apical lucency at
tooth 31. Pronounced maxillary-antrum expansion
between teeth 25 and 27. Orthodontic closure of the
gap is difficult.

Fig. 6b

Fig. 6a

Clinical case presentation:
history and diagnosis

A 25-year-old patient presented on his own initiative. He complained of functional (impairment
of mastication and jaw joint pain)
and esthetic impairment (sunken
face with facial asymmetry). He had
undergone orthodontic treatment
between the ages of 8 and 15 and
reported pain in the area of the
anterior mandible.
The lateral image showed a
retrusive lower face inclined forward with mid-facial hypoplasia — regio infraorbitale — a flat
upper lip and an elongated lower
face compared with the mid-face
— 47%:53% instead of 50%:50%29
(Table I; Fig. 2a).
Owing to the negative sagittal
overjet, there was a positive lower lip
step. The frontal image shows mandibular deviation (laterognathia) to
the right, which can be traced to
growth asymmetry in the jaw (Fig.
2b). In addition, there was a Class
III dysgnathia angle with conspicuous mandibular midline deviation
to the right, frontal and right lateral
crossbite, anterior mandibular labial
tilt and a steep anterior mandible.
Tooth 26 had been missing for some
time (Figs. 3a–e).
FRS analysis (Table I, II) clearly

Fig. 6c

Fig. 7a

Fig. 7b

Fig. 7c

shows the strongly sagittal and relatively weak vertical dysgnathia both
g OT page 8

Fig. 7d

Fig. 7e

Figs. 6a–c: Situation after orthodontic preparation
for the surgical procedure.
Figs. 7a–e: Occlusion at the end of treatment; there
is a neutral stable occlusion with physiological
anterior bite in the sagittal and vertical axes and
a correct midline (a–c). Monitoring images of
the upper and lower jaws. A ceramic bridge was
made in the lower jaw (d & e).

[7] =>

[8] =>

Trends

Ortho Tribune | August/September 2009

f OT page 6

in the soft-tissue profile and in the
skeletal region.
The parameters indicated a
mesiobasal jaw relationship and a
growth pattern with an anterior
course: the vertical grouping of
the soft-tissue profile showed a
disharmony between the mid-face
and the lower face (G’-Sn:Sn-Me’;
47%:53%).
This was relatively weakly
expressed in the bony structures
(N-Sna:Sna-Me; 44%:56%).
In the region of the lower face
there was also mild disharmony
(Sn-Stm:Stm-Me’; 31%:69%).
Complementary assessment of
the mandible showed that the area
from the subnasal-labral inferius to
the soft-tissue chin (Li-Me’), which
should have been 1:0.9, was shifted
AD

Fig. 7c

Fig. 7a

Fig. 7b

in favor of the Li-Me’ part (0.9:1; Fig.
4).The panoramic image showed a

Fig. 7d

Figs. 8a–d: The extra-oral treatment results.
The sagittal, vertical and transverse were
corrected (a, b). Change in the oral profile:
left pre-op, right post-op (c, d).

lucency of teeth 31 and 41. A root
canal procedure followed by root

apex resection was thus performed
(Fig. 5).

Therapeutic objectives
and treatment planning

The objectives of this combined
orthodontic-maxillofacial surgical
treatment were:
1. The establishment of neutral, stable, and functional occlusion with
physiological condylar positioning;
2. The optimisation of the facial
esthetics;
3. The optimisation of the dental
esthetics, considering the periodontal situation;
4. The assurance of the stability of
the results achieved;
5. Meeting the patient’s expectations.
The improvement of the facial
esthetics, not only in the sagittal
axis in the region of the lower face
(the mandibular region) but also in
the region of the mid-face (hypoplasia) and in the transverse axis,
should be noted as specific treatment objectives. The change in the
region of the mid-face was intended to affect the upper lip and the
upper-lip vermillion. These treatment objectives were achieved by
two procedures:
1. A dorsal extension of the mandible with lateral sweep to the
left for correction of the sagittal
and transverse defects, as well as
occlusion and the soft-tissue profile.
2. Bone augmentation in the midface for harmonization of the
face. It would not have been possible to achieve the desired treatment objectives with respect to
function and esthetics using orthodontic procedures alone.27

Therapeutic procedure
Correction of the pronounced
dysgnathia was done in six phases:28,30–33
1. Splint therapy: a flat bite guard
splint was installed for six weeks
in order to determine the physiological condylar position or centrics before the final treatment
planning. By doing this, the forced
bite could be demonstrated to its
full extent.
g OT page 10

[9] =>

[10] =>

Trends

f OT page 8

2. Orthodontics for forming and
adjusting the dental arches relative to each other and decompensation of the skeletal dysgnathia
(Figs. 6a–c).
3. Splint therapy for determining the
condylar position. This was performed in the four to six weeks
prior to the surgical procedure.
The objective was registration of
the jaw joint in a physiological
position (centrics).
4. Oral surgery for correction of the
skeletal dysgnathia: after model
operation, determination of the
transposition path and production
of the splint in the target occlusion, the surgical mandibular
translocation using sagittal split
according to Obwegeser–Dal Pont
was done. Augmentation in the
mid-facial region was done using
autologous bone.
5. Orthodontics for fine adjustment
of occlusion.
6. Retention: 3-3 retainers were
cemented in the mandible.
Mandibular and maxillary plates
were used as the retention appliance. Prosthetic care was provided
after six months.

Ortho Tribune | August/September 2009
Parameter

Mean

Before treatment

After treatment

G‘-Sn/G’-Me’

50 %

47 %

50 %

Sn-Me’/G’-Me’

50 %

53 %

50 %

Sn-Stm/Stm-Me’

33 % : 67 %

31 % : 69 %

33 % : 67 %

Sn-Li/Li-Me’

1 : 0.9

0.9 : 1

1:1

Table 1: Proportions of soft-tissue structures before and after treatment.

Parameter

Mean

Before treatment

After treatment

SNA

82°

90°

SNB

80°

93°

90°

ANB

2°

- 3° ( indl. 4,5°)

0° ( indl. 4,5°)

WITS-Wert

± 1 mm

- 8 mm

- 3 mm

ML-SNL

32°

20°

NL-SNL

9°

4°

ML-NL

23°

16°

Gonion-<

130°

120°

SN-Pg

81°

93°

90.5°

PFH/AFH

63 %

74 %

76 %

N-Sna /N-Me

45 %

44 %

Sna-Me/N-Me

55 %

56 %

Table 2: Proportions of skeletal structures before and after treatment.

References
1.

Results
Figures 7a–e show the situation
after the conclusion of treatment
and after extraction of tooth 31 and
subsequent prosthetic treatment,
neutral occlusion and correct midline with physiological sagittal and
vertical bite.
The extra-oral images show a
harmonious profile in the vertical
as well as in the sagittal axis (Figs.
8a, b).
The oral profile is harmonious.
The upper-lip vermillion is distinctly visible in comparison to the original situation (Figs. 8c, d).
The FRS shows the changes in
the parameters that arose as the
result of the displacement of the
mandible. There is harmonization
in the vertical arrangement of the
bony and soft-tissue profile. The
disharmony in the lower third of
the face has been corrected (Fig. 9;
Tables 1, 2).
The OPG shows the positioning
screws in both jaw angles and the
fixation screws of the augmented
bone in the mid-face (Fig. 10). OT

Fig. 9: The cephalometric image
after conclusion of treatment
shows a harmonious ratio
between the skeletal structures, as
well as in the sagittal axis and the
vertical axis, and harmonisation
in the soft-tissue profile between
the upper and lower face.

Fig. 10: Orthopantomogram
after conclusion of the orthodontic
treatment and before the prosthetic
care.
AD

Alemann O: Ny operation för progeni
(facies progenaea). Svensk Tandläk
Tskr 4: 181–185, 1921.
2. Angle E H: Double resection of the
lower maxilla. Dent Cosmos Philadelphia. 40:, 635–638, 1898.
3. Auffenberg F von: Osteoplastische
Verlängerung des Unterkiefers bei
Mikrognathie, Langenbeck´s Arch.
klin Chir 79: 594–605, 1901.
4. Blair, V P: Report of a case of double
resection for the correction of protrusion of the mandible. Dent Cosmos Philadelphia. 48: 817–819, 1906.
5. Bruhn, Ch., Über die Beseitigung
der Progenie durch chirurgische und
zahnärztlich-orthopädische Maßnahmen, Dtsch. Zahnheilk., Sonderheft (Walkhoff-Festschrift), Leipzig
S.: 1–65, 1920.
6. Bruhn Ch: Über die Beseitigung der
Makrognathie und Mikrognathie des
Unterkiefers. Dtsch Mschr Zahnheilk 39: 385–409, 1921.
7. Carlson D S, Ellis E, Dechow P C:
Adaptation of the suprahyoid muscle
complex to mandibular advancement surgery. Am J Orthod 92: 134–
143, 1987.
8. Dal Pont G: L`osteotomia retromolare per la correzione della progenia.
Minerva chir 18: 1138–1141, 1959.
9. Dal Pont G.: Die retromolare Osteotomie zur Korrektur der Progenie, der
Retrogenie und des Mordex apertus.
Öst Z Stoma 58: 8–10, 1961
10. Epker B.N.: Modification in the sagittal osteotomy of the mandible. J Oral
Surg 34: 157–159, 1977.
11. Floris F: Korrektur einer Progenie
durch chirurgischen Eingriff. In:
Verhandlungen des V. Internationalen zahnärztlichen Kongresses,
Band II: 363–366, 1909.
12. Hogemann K-E: Surgical orthopaedic correction of mandibular protrusion. Acta chir Scand 159: 58–129,
1951.
13. Hullihen, S.R. Case of elongation of
the under jaw and distorsion of the
face and neck, caused by a burn.
Dent.Cosmos, Philadelphia. 42: 287–
293, 1900. (Reprintdes Artikels von
1849).
14. Jaboulay, M. et aI. Bérard, Traitement chirurgical du prognathisme
inférieur. Presse med Paris. 6: 173–
176, 1898.
15. Kazanjian V H: The treatment of
mandibular prognathism with special reference to edenzulous patients.
Oral Surg Med Path 4: 680–691, 1951.
16. Lexer E: Die gesamte Wiederherstellungschirurgie. 2. Aufl., Leipzig:

140–152, 1931.
17. Lindemann A: Die Wehrchirurgie
des Gesichtsschädels — Nachbehandlung und Nachoperation. Dtsch Z
Zahn Mund Kieferheilk 3: 105, 1936.
18. Lindemann A., Hofrath H: Die Kieferosteotomie. Chirurg. 10: 745–770,
1938.
19. Obwegeser, H., Trauner, R.: Zur
Operationstechnik bei der Progenie
und anderen Unterkieferanomalien.
Dtsch Zahn Mund Kieferheilk 23: H
1 und 2, 1955.
20. Obwegeser, H.: The surgical correction of mandibular prognathims
and retrognathia with consideration
of genioplasty. J Oral Surg 10: 687,
1957.
21. Obwegeser, H.: The indication for
surgical correction of mandibular
deformity by sagittal splitting technique. Br J Surg 1: 157, 1963.
22. Perthes G: Operative Korrektur der
Progenie. Zbl Chir 49: 1540–1541,
1922.
23. Peterson R G Bilateral osteotomy of
the mandibular rami for correction
of prognathism in an edentulous
mouth: report of case. J Oral Surg 4:
203–206, 1946.
24. Pichler H: Über Knochenplastik am
Unterkiefer. Vjschr Zahnheilk. Berlin 33: 348–385, 1917.
25. Robert E: Surgical correction of mandibular protrusion. Dent Cosmos,
Philadelphia 75: 1112–1117, 1933.
26. Wassmund M: Lehrbuch der praktischen Chirurgie des Mundes und
der Kiefer; Bd. I, Leipzig S.: 245–308,
1935.
27. Watted, N.: Behandlung von Klasse
II-Dysgnathien- Funktionskieferorthopädisch Therapie unter besondrer Berücksichtgung der dentofazialen Ästhetik, Kieferorthop 13:
193–208, 1999.
28. Watted N, Bill J, Witt E:Therapy
Concept for the Combined Orthodontic-Surgical Treatment of Angle
Class II Deformities with Short Face
Syndrome New Aspects for Surgical Lengthening of the Lower Face.
Clinc. Orthod. Res. 3: 78–93, 2000.
29. Watted N., Teuscher T,, Wieber M.:
Vertikaler Gesichtsaufbau und Planung kieferorthopädisch- kieferchirurgischer Kombinationsbehandlungen unter besonderer Berücksichtigung der dentofazialen Ästhetik,
Kieferorthop 16: 29–44, 2002.
30. Ästhetische Aspekte der kieferorthopädisch-kieferchirurgischen
Behandlung
sagittal-vertikaler
Anomalien am Beispiel des ShortFace-Syndroms, Journal of Orofacial
Orthopedics 63: 129–142, 2002.
31. Watted N., Wieber M., Teuscher
T., Bill J., Reuther J.: Chirurgische
Untergesichtsverlängerung bei der
Therapie von Patienten mit Klasse
II-Dysgnathien und skelettal tiefem
Bi – “short-face-Syndrome.” Eine
kontrollierte klinische Studie zum
“Würzburger Konzept,” Mund- Kiefer- und Gesichtschirurgie 6: 415–
420, 2002.
32. Watted N., Teuscher T., Reuther J.:
Die interdisziplinäre Zusammenarbeit im Rahmen der kieferorthopädischen Therapie: Kieferorthopädie
und Kieferchirurgie, ZMK 19:314–
326, 2003.
33. Watted N., Teuscher T., Bill J.: Die
Rehabilitation der dento-fazialen
Ästhetik bei Erwachsenen Patienten
ist eine multidisziplinäre Aufgabe,
ZMK 21: 218–229, 2005.

OT About the author
Prof. Nezar Watted
Wolfgangstrae 12
97980 Bad
Mergentheim,
Germany
E-mail:
nezar.watted@gmx.
net

[11] =>

[12] =>

Student Corner

Ortho Tribune | August/September 2009

One spark
By Bita Moalej, fourth-year dental student,
University of Southern California

t first glance, the Pacific Palisades in Southern California
looked like heaven. Blanketed
with luxurious movie star homes
built on top of mountains overlooking the crashing waves of the Pacific
Ocean, it felt like a dream. But like
any good dream, it had to end … or
did it?
In 1990, the Moalej family left
their homeland of Iran to immigrate
to America. Uncle Kian had finally
convinced Dad that a better life
awaited his family. Dad had always
wanted to give his children the hope
and opportunities he never had, and
America would give that chance
for success, prosperity and, most
importantly, education.
Upon arrival, we lived with Uncle
Kian in the Pacific Palisades, one of
the most affluent and rich districts
of Los Angeles, a far cry from the
former world in Iran. While on
the outside the surroundings were
beautiful and the land seemed like
paradise, I quickly learned that not
everything was as it seemed.
Unbeknownst to anyone in the
family, my brother Pouya was born
with a Class III malocclusion. As a
child growing up in Iran, this would
not have been an issue. However,
in Pacific Palisades, being “normal,”
if not perfect, was the standard in
order to be included among his
peers, and the teasing and exclusion was unmerciful.
Pouya spent years after immigrating to the United States not fitting in
with his fellow classmates, whose
perfectly engineered smiles were
absolutely beyond Dad’s financial
circumstances. He woke up every
day dreading school — not because
the teachers were unfriendly or the
curriculum was exceptionally difficult, but because he had immigrated to a society in which a Class III
malocclusion was reasonable cause
for being teased.
Children can be cruel. That’s a
simple fact of life. When one comes
from a distant country and has
teeth that do not resemble everyone else’s, they can be even crueler. When one’s teeth are not as
white and seemingly perfect as the
rich, privileged elite classmates of
the school, that individual will hear
about it — over and over.
Thus began a daily tumultuous
cycle of abuse for Pouya. Teased
and mocked for his “subnormal”
physical appearance, he found it
hard to adjust and feel comfortable, losing a bit of his inner pride
each day. Pouya’s transformation

Bita Moalej, center, on a volunteer
mission to El Salvador.

“We make a living
by what we get.
We make a life by
what we give.”
— Sir Winston
Churchill
was shocking. Within weeks, a confident, bright boy had turned into a
moody recluse.
The Moalej family, like most
immigrants, had come to America with almost no money. After
years of humiliation, Dad had saved
enough money to get Pouya orthodontic care. Finally after being
miserable and hopeless for so long,
Pouya had found his light.
Once shy, self-conscious and
insecure, he soon became confident, assured and outgoing. When
the process was complete, not only
had a new man emerged, but I had
discovered a passion that would
shape my personal, academic and
professional life — access to care in
relation to orthodontics.
Pouya’s situation is not unique
and untold numbers of similar
cases exist, wherein people suffer
from unaddressed dental problems
due to financial constraints or lack
of knowledge. Perhaps one of the
greatest obstacles to treatment is
that orthodontics is considered a
luxury that can be postponed. This
is often defined by dental insurance not being universal and having
deductibles and co-pays that are so
high that families use the insurance only in dire circumstances.
The result is that beyond a basic
cleaning, not much else is covered.
Misalignments and deeper cleanings are not even considered, thus
setting the stage for a lifetime of
poor dental hygiene habits.
The responsibility of health-care
professionals does not end once
the crown is placed or the brackets
are removed. Instead, their duty
is never-ending. It is an ethic of
individual choice to assure that all
patients are cared for with benevo-

lence and equality regardless of
financial status.
In today’s society, health-care
professionals can be viewed as
members of an extended community; thus, their decisions can ultimately impact their communities.
We as health-care providers are
accountable for educating patients
as well as communities about the
impact of dental care. In this way,
orthodontists can fulfill their obligation of virtue and social justice for
the community welfare.
Social transformation can be
achieved through giving additional time to patients, advocating for
changes in dental insurance or lobbying for expanded dental coverage
to poorer patients. In this manner,
orthodontists can easily become
mentors of social justice reform for
all individuals, his or her community and society.
An orthodontist’s career provides
an opportunity to form lifelong relationships between practitioners and
patients and the ability to enhance
an individual’s self-image through
non-invasive methods. However,
being an orthodontist not only concerns aligning teeth, but also representing faithfully the needs of all
patients, including those in need of
financial or educational assistance
in achieving superior dental care.
The day Pouya walked out of the
orthodontist’s office, smiling and
holding his head high for the first
time in years, it had a profound
effect. At that moment, I vowed to
make a difference in this world,
resolving that if even one child was
protected from humiliation, all the
hard work and time entailed in
reaching that position would be
worthwhile. My goal as a future
orthodontist is to remember those
who have provided inspiration and
guidance for this challenging profession.
The spark that was ignited within
me as a young girl has continued
to burn, fueled by the patients who
have allowed me the privilege of
providing them care. In the future,
my goal will be to rely on the skills
and knowledge I have built, as well
as genuine care and commitment to
improving the lives of those patients
in the surrounding community.
The day Pouya walked into the
orthodontist’s office, timid and
scared, neither of us expected the
spark of life that would be ignited
within me. It is that spark that has
encouraged me each day of training thus far, and it is that spark that
will continue to fuel, motivate and
provide guidance throughout my
career as I witness the transforma-

tion of my patients’ lives.
As Sir Winston Churchill stated,
“We make a living by what we get.
We make a life by what we give.”
Practitioners earn their living
through monetary payments, but
true fulfillment in life arises from
what is given back to the community. Orthodontics may not only be
about making a living, but also
about making a life. OT

OT About the author

Bita Moalej is a graduate of the University of California, Los Angeles (BS)
and will graduate in 2010 from the
University of Southern California,
School of Dentistry (DDS). She has
participated in numerous research
activities and has received the following honors: Dean’s List at UCLA
and USC; Faculty Women’s Club
Scholarship; Alpha Gamma Sigma
Honors Fraternity; and Honor’s Merit
from Club Medical Honors Society.
Moalej has been involved in various
community service programs and has
volunteered in many dental outreach
programs both within the community and internationally (El Salvador),
including the Children’s Dental Center Orthodontics, a non-profit dental
facility providing care to the underserved members of the community,
in Inglewood, Calif.

OT Contact
Bita Moalej
USC School of Dentistry
925 W. 34th St.
Los Angeles, Calif. 90080
E-mail: bmoalej@usc.edu

[13] =>

[14] =>

Practice Matters

Ortho Tribune | August/September 2009

Practice makeover — Dr. Hardy’s
first successes are impressive
By Kevin Johnson & Emily Ely

otal Ortho Success™ Practice
Makeover winner Dr. Brian
Hardy of Hardy Orthodontics
in Grove City, Ohio, looked at his
monthly gross production recently
and saw something extraordinary
— his numbers were up 80 percent
from the same month a year ago.
Referrals were up 56 percent for the
same month as well.
In this economy, these are amazing results — even more so considering Hardy Orthodontics had only
completed six months of its yearlong management and marketing
consulting programs.
Obviously, Dr. Hardy is pleased
to see the first of many concrete
results. One reason for the improving numbers is undoubtedly the
work his practice has done implementing Levin Group’s Greenlight
Case Presentation™ and PowerScripting™.

Greenlight Case Presentation
When orthodontists walk into a
consult, they should always be:
• Knowledgeable
• Confident
• Motivational
That applies to every patient,
every day.
To present more effective ortho
cases, practitioners need to step
into the shoes of patients and their
parents. People come to an orthodontist because they are seeking
beautiful smiles. Orthodontists and
staff must earn their trust, validate
their desire for a more attractive
smile and guide them toward agreeing to ortho treatment.
While the desire for a great smile
is a powerful motivator, the issue of
price is a major obstacle. Most parents are well aware that orthodontic
treatment is a significant expense.
Their chief concern is how to pay
for it.
In a difficult economy, the anxiety about cost is only amplified. In
one of our earliest meetings with
Dr. Hardy, he had concerns about
parents being more reluctant to
start their child’s ortho treatment
because of the economy.
Top-producing ortho practices successfully handle the price
issue by providing several financial options so patients/parents can
choose one that is comfortable. This
is more important than ever.
Levin Group recommends these
options:
• Five percent pre-payment courtesy.
The entire treatment fee is paid
in advance, including the insurance portion. Ortho practices can
benefit by collecting the fee upfront without having to set up a
monthly payment schedule.

Levin Group Consultant Emily Ely and Dr. Brian Hardy.

Total Ortho Success

Pr actice

• In-house payment plan. Twentyfive percent of the fee is paid
as a deposit with the remaining balance divided into monthly
payments. Ortho practices must
maintain an excellent focus on
accounts receivable. Any patient
who is one day overdue for payment should receive a call that
day. The office should be careful
to have some level of flexibility to
help patients in difficult financial
situations.
• Outside financing. An outside
financing company, such as CareCredit (which Dr. Hardy works
with), approves the parent or
patient for a line of credit or
a loan. These approvals can be
achieved within minutes.

PowerScripting
When we first discussed the idea
of scripting with Dr. Hardy, he had
somewhat conflicted emotions.
Although his practice had traditional patient compliance issues that
were genuinely distressing both to
himself and the team, he was apprehensive about scripting, stating:
• “Is scripting difficult to implement?”
• “Will it involve memorizing thousands of phrases?”
It is impossible to overstate the
importance of superior verbal skills.
Every practice system in his office
— scheduling, customer service
and case presentation, to name a
few — depends on clear, effective
and consistent communication. The
better Dr. Hardy and his team communicate with patients, the more
successful his practice is likely to
become.
Scripts can be created for different aspects of the ortho practice,
but all scripts should always be
customized to maximize the capa-

bilities of team members. These
factors helped Dr. Hardy create and
implement effective scripts in his
practice:
• Consistency. Scripting provides Dr.
Hardy’s patients with consistent
messaging. One of the most frustrating experiences for patients
is hearing conflicting answers
from the staff regarding the same
question. It diminishes trust in
the practice. Such an experience
undermines case acceptance and
leads to unsatisfied patients who
aren’t likely to refer others.
• Power words. Power words are
enthusiastic words that create positive energy and are used
many times at the beginning of
sentences. Words such as great,
terrific, wonderful, fantastic, super
and awesome are examples of
power words. It is important for
Dr. Hardy and his team to be
upbeat and motivating, especially
when dealing with the practice’s
patient compliance issues.
• Customization. Scripts should
never be recited word-for-word, as
if a team member had memorized
a speech. Rather, Dr. Hardy’s staff
members are being encouraged to
use their own words, paraphrasing the scripts, so that the essential information is communicated

to patients in a natural and positive way.
• Role-playing. Team members read
over the scripts and “act them
out,” or role-play. This training
process reinforces the messages and helps staff members see
the practice through the eyes of
patients. Role-playing can take
place at morning meetings. It can
be a fun and informative activity
for the whole team.
• Positive communication. When an
orthodontist and the team use
verbal skills to present themselves in an upbeat way, patients
respond better. As a result, Dr.
Hardy, his staff and patients find
themselves more motivated and
more positive.

The state of the practice
At Hardy Orthodontics, things
are headed in the right direction.
In a down economy, Dr. Hardy is
seeing nearly double the number
of starts compared to a year ago.
These results are doing a great
deal to bolster the team members’
enthusiasm as they work to revamp
systems and strategies.
Dr. Hardy’s office is currently
focused on:
• Case presentation skills, scripts
and techniques.
• A concerted effort to open consult
and treatment start slots to ensure
they see as many patients as possible.
• A more efficient approach to collections. This has already yielded
results — this year they are up 38
percent.
• Better and more flexible methods for working with patients on
financial issues in this economy
without resorting to in-house
financing.
Join us in our next installment
when we explore Dr. Hardy’s accelerated practice growth. OT

OT About the authors
Levin Group Senior Consultant
Kevin Johnson has spent the last
eight years working as a Levin
Group orthodontic management
and marketing consultant. He
manages a team of consultants
and is a frequent lecturer at the
Levin Advanced Learning Institute. Johnson earned his degree
from Towson University in 1996.
With many years of marketing experience, Levin Group Consultant Emily Ely joined Levin
Group in 2005. Ely uses her unique
knowledge and experience to provide
marketing solutions for orthodontic
practices. She earned her degree in
business from Towson University.
Both Ely and Johnson are members
of the Ortho Expert Team, a specialized
group of consultants who are trained in

the needs of orthodontic practices.
For more than two decades, Levin
Group has been dedicated to improving the lives of orthodontists. Visit
Levin Group at www.levingrouportho.
com. Levin Group also can be reached
at (888) 973-0000 and by e-mail at
customerservice@levingroup.com.

[15] =>

[16] =>

[17] =>

Ortho Tribune | August/September 2009

Practice Matters 17

Internet marketing do or die: How to
test your visibility on search engines
By Mary Kay Miller

ne of the most common questions orthodontists ask me
today is, “Why doesn’t my Web
site show up on the Internet?”
The first thing I do is compliment
them. At least they’ve taken the
time to check out their Web site on
the search engines and determined
something is wrong. Unfortunately,
most small-business owners have
no idea if their Internet marketing
program is a finely tuned Mazarati
or a Hugo unavailable in the eyes of
consumers on the search engines.
When designing a Web site and
Internet marketing program, most
professionals have no clue that the
search engines, such as Google,
Yahoo and MSN (now Bing), can’t
read the written words in a Web site
or determine if it is outdated or new.
The search engines scan your site
using a sophisticated mathematical algorithm. This is where SEO
(search engine optimization), keywords and meta tags come into play.
You have to tell the search
engines who you are, what you are
all about and where you want to
target new patients in your local
demographic in order to be found.
The search engines dictate the rules
of engagement, and you must follow
them.
Does all this sound like Greek
to you? It did to me — until I spent
hundreds of hours mastering the
subject of Web 2.0 Internet marketing.
SEO and keywords relate to
the words and phrases prospective patients type into the search
engines to find you. Your Web site is
the hub of your Web 2.0 marketing
campaign. Once a new patient finds
you with keywords, you can engage
them with your marketing message
to visit your Web site or contact
your office for a new patient exam.
The focus of your Internet marketing program is to drive new

OT About the author
Mary Kay Miller
of Orthopreneur™
Marketing Solutions is an Internet
marketing coach
specializing in SEO
(search
engine
optimization) and
Web 2.0 Internet Marketing solutions.
With more than 30 years experience
in orthodontic marketing and practice
management and 10 years in Internet
marketing, she has mastered the attitudes, skills and knowledge necessary
to take your practice to the next level.
Access her free marketing e-Guide,
“Marketing Your Practice Through
Different Eyes,” at www.ortho
preneur.com. You may contact her by
e-mail at marykay@orthopreneur.com
or call toll-free (877) 295-5611 for a
complimentary demographic evaluation of your Web site.

patients to your front door. In order
to accomplish this, one hand must
wash the other with correct SEO,
engaging design and a powerful
marketing message.
How do you determine if consumers in your local area are finding your Internet marketing efforts?
Simple. Test it!
1. Go to Google and in the
search box type in patient keywords
— orthodontist [your city name and
state]. Orthodontist is the No. 1 key
word new patients use to search for
treatment providers.
2. Repeat the same steps again

with the key words braces (No. 2)
and Invisalign (No. 3).
3. Do your Web site, blog posts,
Facebook page, e-zine articles, etc.,
show up on page one of Google?
4. Does your practice name and
Web site URL show up correctly on
Local Google Maps?
5. Now go through all the steps
again, but this time, one by one
substitute the names of all the surrounding towns in your area where
you target new patients. Are you
visible?
No matter how great the design of
your Web site and Web 2.0 market-

ing program, you may be missing a
wealth of new patient opportunities
to build your practice due to limited
local visibility on the Internet. This
can translate into hundreds of thousands of dollars you may be losing
to your competitors online over the
years.
Your Web site and Web 2.0 marketing program are very powerful
marketing tools if set up correctly,
start to finish. You don’t know what
you don’t know till you know it! Find
out from an orthodontic Web 2.0
Internet marketing specialist what
you don’t know today. OT
AD

[18] =>

Practice Matters

Ortho Tribune | August/September 2009

Why orientation is more
important than you think
these areas for reference. No one
will remember it all the first time
around.
Again, these manuals take a bit of
time to create, with details and photos of tray setups, but they’re invaluable both for new hires and temps
(if the need should ever arise.)
Remember, however, these manuals are a supplement to orientation,
not a substitute for it.
Finally, be patient. Every new
staff member will have his or her
own individual learning curve, and
some of the best assistants and front
desk staff I’ve worked with took a
bit of time to get the hang of the
software and the systems.
It’s as true in offices as it is in
every other aspect of our lives — a
good foundation creates a strong
product, and a good orientation creates a great staff member.
If we take the time to build that
good foundation, we’ll have a better,
happier staff and patients who
never feel a lack of continuity or
professionalism in their office experience. OT

By Pat Rosenzweig

“S

he seemed so great at the
interview. Why didn’t she
work out?”
Lately our days are always too
short, with never enough time to
accomplish everything before it’s
time to close the laptop, get some
sleep and start all over again. This
lack of time is translating into every
aspect of our offices, including the
training of new staff members —
and that’s getting to be a real problem in many practices.
Hiring someone with orthodontic experience and knowledge of
our office software should be only
the beginning of the new employee
experience, not the entire process.
Carefully oriented and trained staff
members are able to get much more
accomplished in much shorter time
frames than those who are always
hunting around for the correct
instruments, procedures or keystrokes.
So what makes up good orientation training? We can actually sum
it all up in one word: planning.
Prior to hiring any new employee,
we need to have a clear job description for the position, preferably in
writing. We need to know what the
specific job duties are, when and
how they need to be performed
and what additional side or shared
duties are also parts of the job.
This is now our roadmap to set
up training for our new employee.
We can’t create an outline of the
exact skills and protocols that need
to be mastered to accurately perform the required tasks if we don’t
know what they are.
From there, we need to choose
the right staff member to act as a
trainer. The trainer needs to be
well-trained herself, as well as
being a good and patient teacher.
Frequently, the type of personality who makes a great lead assistant
or treatment coordinator isn’t the
best teacher, so we need to choose
the most qualified person for our
trainer — which is not necessarily
the staff member who’s been with
us the longest. This is a place where
we need to keep egos out of the mix;
training is all about teaching, not
about who has what place in the
office hierarchy.
Our trainer should discuss the
training outline with the orthodontist or office manager to be sure
she’s clear on what information and
materials we need to present and
then create a plan for training.
Ideally we should begin our
first training day on a day with no
patients. This gives time for a basic
orientation of where everything can

be found, how everything works
and what our software has to offer.
I know many trainers would disagree with me on this, as they feel
that hands-on is always the best
type of training. I’m all for hands-on
training, but when it begins on an
employee’s first day, it’s frequently
more like sink-or-swim than handson.
A first day with a full patient load
can be incredibly overwhelming,
and when a step in the training gets
missed, it’s usually gone forever.
I’ve been in many offices where one
poorly trained staff member has
trained the next and so on down
the line.
This results in huge gaps in systems and knowledge and a lessthan-stellar experience for staff and
patients.
Our training plan needs to be in
the form of a written checklist so
we can check off completed items
as we go. Also, the ideal training
plan contains frequent stops to test
or use the acquired skills on sample
patients.
While this type of training plan
sounds time consuming, it only
needs to be created once, then can
be used over and over as we add
new team members or make adjustments for staff who are leaving.
Begin orientation at the beginning. Show the new staff member
how to turn on all equipment and
what procedures we set in place at
the start of the day.
We’ve all had the experience of
wasting time going into the office on

our own for the first time and fumbling to find the light switches and
the power switches for electronics.
Use some orientation time to actually orient the new staff member to
the environment.
If you’re exposing the new hire
to software for the first time, have a
program set up to train on the software as well as the systems. Go over
the icons and procedures in a stepby-step logical fashion and allow
lots of time for note taking.
Next, do a walkthrough of the
initial phone call for desk staff or
patient seating for op staff.
Use a “cheat sheet” for the initial
call, even if the current front desk
staff usually enters patient information directly into the computer.
Having a template gives a new staff
member confidence that he or she is
getting all the information required
and gives less than perfect typists
time to gather all the information
before entering it into the software.
Patient seating for the op seems
simple enough, but every office has
its own personality and we want
our new hire to reflect who we are.
I can still clearly remember a very
low-key, quiet doctor cringing as his
newest assistant went to the edge of
the waiting area and literally bellowed out the patient’s name.
She had been taught to be “loud
and clear” in her previous office,
but it certainly wasn’t the style the
new office wanted.
Review the front desk systems
and the operatory setups. Have a
written manual in place that details

OT About the author

Pat Rosenzweig is co-founder of
Mosaic Management Professionals,
providing management and business
consulting for orthodontic offices,
as well as general dental and other
specialty offices. Mosaic Management Professionals functions on a
belief that every office is unique,
with its own special dynamic and its
own consulting and systems needs.
Mosaic is committed to creating an
individual plan for each client that
puts the office’s particular strengths
into play to keep the office at the top
of its game.

OT Contact
Pat Rosenzweig
Practice Management Consultant
Mosaic Management Professionals
5847 Kingsfield St.
Castle Rock, Colo. 80104
Pat@mosaicmanagementpro.com
www.mosaicmanagementpro.com

[19] =>

Practice Matters 19

Ortho Tribune | August/September 2009

So where are
all those starts?
By Scarlett Thomas, President,
Orthodontic Management Solutions

ith summer coming to a
close, a slower economy,
fewer starts and less than
ideal cash flow, many orthodontic
practices are wondering how they
will survive the coming months as
they approach what typically is the
slowest time of the year for business.
Many orthodontic offices have
already experienced a significant
decline, not only in their summer
starts but also in their overall production numbers for the year.
Regardless of how grim the picture might seem, there are still
opportunities for growth.
So, where are all the starts?
The starts are out there, but they
are becoming more challenging to
find and require a lot more effort to
capture. What it takes now is strategically leveraging all resources
to achieve a higher level of success
and maintain a healthy and positive
cash flow within the practice.
Most orthodontists still can experience tremendous growth within
their practice, but it will require
much more work and effort. Sitting
back and hoping for the best never
creates results. You have to be willing to do whatever it takes in harder
times to achieve your goals and stay
on track.
You also must be willing to adapt
and work differently. The practitioners who are willing to reinvent their approach to running their
practices can still achieve higher
levels of success and continue to be
at the top of their profession.
Rather than relying on the same
handful of referring general dentists, it’s time to branch out and
establish new relationships. It may
now take 15 general dentists to get
the number of referrals you would
normally get from your top five in
previous years.
The “will call back system” is
another important area to concentrate on during these challenging
times. Unfortunately, some offices
still don’t know what a “will call
back system” is. They never had a
system and never did make calls to
any of their past non-starts.
The truth is, in a healthy and
growing economy of the past few
years they did not have to. They
were meeting their objectives without putting in any extra effort.
Well, now times are different and
it will require a different approach
in order to be successful. What you

do in this area can generate a tremendous amount of revenue if the
techniques are executed properly.
For example, in one of my client’s
offices, I suggested mailing out letters to all past non-starts, offering
them a $500 “troubled economy
courtesy.”
As a result, they generated more
than 32 new contracts, signed within two months from sending out the
letter. There are ways to continue
to generate starts, but you must be
willing to think outside the box to
make it happen.
For the recall patients who are
“too young to start,” instead of waiting for a few more permanent teeth
to erupt and placing them on a
four- to six-month recall, recommend starting now. There may be
much to accomplish while you are
waiting on the eruption pattern to
be complete.
Willing to step outside the norm
is what creates positive results.
Doing the same things over and
over and hoping for different results
is the recipe for failure.
What worked 10 years ago may
not work today. Being stuck in repetitious tasks is like a hamster on an
exercise wheel that runs endlessly
but ends up right where it started.
As the market toughens, more
and more orthodontist must be
willing to reach out differently to
the prospective patients in ways
they never would have considered.
Direct mail marketing is becoming
a fast growing and effective method
of prospecting for new business.
With fewer general dentists
referring and an overall decline
in revenue, some orthodontist
are willing to try new avenues to
achieve higher levels of success.
These are the practitioners who will
survive these challenging times as
they move forward with a renewed
sense of urgency in this new age of
doing business.
Change is inevitable in the orthodontic profession, and the ones
willing to adapt are the ones most
likely to succeed.
Creating excitement within your
own practice among your existing
patients also can bring in new referrals.
Think about investing in a large,
flat-screen TV and placing it in the
reception area, offering all patients
who refer someone to the office a
chance to enter the drawing to win
the TV.
This alone will help generate
new starts and create excitement
among the existing patients.
As the year ends and the holi-

day season approaches, most orthodontic offices will experience a
much greater decline, not only in
starts but in revenue. Mailing out
a year-end appreciation letter, providing all your patients who have
an account balance a 10 percent
discount if paid in full, will help
generate additional revenue.
As the slower months for business approach, using this strategy
can help strengthen you financially
during the less than ideal times.
Creating a new mission statement with your employees that is
based on creativity, drive for success, passion for growth and unlimited levels of higher achievement
can be the beginning in finding your
new starts.
A fresh and renewed sense of
working toward a mission can motivate and energize you and your
team, paving the way for great success in the coming months and
years.
For more information on creating
new starts within your practice, I
invite you to attend my upcoming
Webinar on “Marketing For Success”
on Sept. 25. For more information
regarding this Webinar and many
others, please visit orthoconsulting.
com. OT

OT About the author

Scarlett Thomas is an orthodontic
practice consultant who has been in
the field for more than 23 years, specializing in case acceptance, team
building, office management and
marketing. As a speaker and practice
consultant, she has an exceptional
talent to inform, motivate and excite.

OT Contact
Scarlett Thomas
Orthodontic Management Solutions
Phone: (858) 435-2149
scarlett@orthoconsulting.com
www.orthoconsulting.com

[20] =>

[21] =>

Ortho Tribune | August/September 2009

Practice Matters 21

Weak economy, strong practice
By Roger P. Levin, DDS

he economy is not strong. This
is no surprise to anyone. The
problem is that orthodontists
do not typically receive training in
business, much less on how to deal
with a slow economy.
Levin Group’s expert solutions
have helped orthodontists grow
their practices by 15 percent or
more regardless of the economic
conditions.
The following action steps are
critical components of our Total
Ortho Success™ — Management and
Referral Marketing consulting programs. These practice management
principles, when properly implemented, can make the difference
between steady decline and continual growth.

Replace outdated systems
The right systems mean the
difference between growth and
decline. Implementing high-performance systems results in expanded scheduling capacity, increased
starts, decreased no-shows and
reduced accounts receivable, to
name just a few.
Updated systems are your best
defense against a fluctuating economy. If you are experiencing a slowdown, there is no better time to
replace outdated systems than right
now.

Implement an explosive
referral marketing program

Referral marketing is the best
way to grow your practice in this, or
any, economy. Levin Group clients

OT About the author

Dr. Roger P. Levin is founder and
chief executive officer of Levin
Group, Inc., the leading orthodontic practice management firm.
Levin Group provides Total Ortho
Success™, the premier comprehensive consulting solution for lifetime success to orthodontists in
the United States and around the
world. A third-generation dentist,
Levin is one of the profession’s
most sought-after speakers, bringing his Total Ortho Success Seminars to thousands of orthodontists
and ortho professionals each year.
For more than two decades, Dr.
Levin and Levin Group have been
dedicated to improving the lives
of orthodontists. Levin Group may
be reached at (888) 973-0000 and
customerservice@levingroup.com.

use a system called The Science
of Referral Marketing™ that directs
a minimum of 15 targeted strategies at both referring dentists and
patients.
In good economic times, you may
be able to do well with a majority
of referrals coming from patients.
However, in a downturn, that single
strategy can lead to a precipitous
drop in starts and production.
Highly successful practices
receive a steady stream of referrals from both dentists and patients.
These offices also run strong community programs that create awareness about the practice in local
schools.

Develop your team
Your staff is a key factor in practice success. Many orthodontists are
not investing in staff training due to
the economy.
This is a mistake. A strong team
increases efficiency, boosts production and lowers stress.
Even though we’re in a tight
economy, don’t put off team training. It’s an investment that pays
dividends immediately and for the
long-term.

Conclusion
It’s time to start growing your
practice again! Our Total Ortho Suc-

cess clients continue to experience
robust growth by using these action
steps.
Don’t let the recession stop you
from reaching the next level! Be
stronger, work smarter, practice
better!
Ortho Tribune readers are entitled
to receive a 20 percent courtesy on
Dr. Roger Levin’s next Total Ortho
Success™ Seminar being held Oct.
8–9 in Cambridge, Mass.
To receive this courtesy, call (888)
973-0000 and mention “Ortho Tribune” or e-mail customerservice@
levingroup.com with “Ortho Tribune Courtesy” in the subject line. OT
AD

[22] =>

Industry Clinical

Ortho Tribune | August/September 2009

The TRAINER System in the
context of treating malocclusions
By Dr. German Ramirez-Yañez, DDS,
& Pedo Spec, MDSc, PhD

properly, as well as correct the
imbalance of the force produced by
an incorrect posture of the tongue.
This document also shows scientific
evidence supporting the use of FMO
appliances and, particularly, the
scientific research gathered from
using the TRAINER System.

Part 1 of three

unctional maxillary orthopedics
(FMO), also known as dentofacial orthopedics, is the subject
in dentistry that studies the treatment of malocclusions by stimulating or inhibiting the activity of the
masticatory and/or facial muscles.
Doing so stimulates modeling and
remodeling of the maxillaries, permitting a better tooth alignment.
FMO helps to correct and treat
all the functional problems that can
be associated with incorrect positioning of the teeth (Ramirez-Yañez
and Farrell, 2005) due to erroneous
force delivered on the teeth by the
muscles (Fujiki et al., 2004). Consequently, teeth tend to position better
and to align correctly.
Therefore, the first matter that
must be understood is that FMO’s
goal is to correct the position of
the teeth, similarly to fixed orthodontics. However, traditional orthodontics only moves the teeth, and it
is expected that the entire craniomandibular system (CMS) is going
to adapt to the new position of the
teeth.
FMO, on the other hand, produces a balance between the muscles of
the CMS, followed by improving the
relationship between the upper and
lower maxillaries. Consequently,
the teeth tend to position better.
In other words, orthodontics and
FMO have the same goal — the way
that goal is achieved is totally different.
There is a huge variety of removable appliances that may be classified as FMO appliances. However,
they do not all produce the same
effect on the CMS.
Some work by increasing the
muscular activity of the masticatory
muscles by positioning the mandible forward (e.g., Monoblock and
Bionator); others stimulate the masticatory and/or facial muscles, thus
improving the relationship between
the mandible and maxilla through
increasing the lateral excursions

Modus Operandi of the
TRAINER System appliances
Fig. 1: The T4K for treatment of
developing malocclusion and myofunctional habits.

Fig. 2: The MYOBRACE for dental
alignment and arch development.

of the mandible (e.g., Bimler and
some Simoes Networks); and others work on the buccal area of the
mouth, stimulating the transverse
development of the maxillaries
while improving the position of the
mandible (e.g., Frankel’s Function
Regulator).
More recently, new appliances
have been developed that stimulate
the masticatory and facial muscles
and furthermore re-educate the
posture of the tongue, bringing the
CMS into a physiological equilibrium of the force delivered on the
maxilla mandible and teeth. Some
of these new appliances are the
Simoes Network 2 and 3, as well as
all the appliances composing the
TRAINER System™.
It is very important to understand
the modus operandi of each of the
FMO appliances that are available
to treat malocclusions. This permits
the health professional to understand the philosophy behind each
appliance, what the successes are
and what the limitations that can
be expected are when treating with
each of them.

TRAINER Lingua™ and the MYOBRACE® (Fig. 2). Although their
indications may vary, all appliances
within the TRAINER System, including the MYOBRACE, work in an
identical way.
The goal of this paper is not to
give the indications for each of the
trainers, but to explain the way that
all the appliances in the TRAINER
System produce their effect when
treating the various types of malocclusions. Those readers not familiarized with these appliances may
find the indications for each of
them and the appliances manuals
at www.myoresearch.com.
Many orthodontists tend to see
the MYOBRACE as a different appliance as it does not have the name
TRAINER attached to its name.
The MYOBRACE works similarly to
the other trainers, stimulating the
muscular balance of the facial and
masticatory muscles, as well as reeducating tongue posture.
The only difference is that the
MYOBRACE has a structure added
(inner-core) to increase the resistance of the buccal shields, therefore counteracting the force delivered by the buccinators on the
posterior teeth when the activity
in those muscles is increased. This
is further explained later. Also, the
MYOBRACE includes additional
channels at the area of the anterior
teeth, which can deliver a direct
force on the teeth improving their
alignment.
Otherwise, the MYOBRACE
maintains the specifications and
features of the other trainers, and
therefore, all the information provided regarding the modus operandi and the scientific evidence
regarding the trainers is applicable
to the MYOBRACE.
Thus, the purpose of this document is to explain how the appliances comprising the TRAINER System
produce the changes observed in
thousands of patients treated with
these appliances around the world
and to explain why the TRAINER
System appliances guide the facial
and masticatory muscles to work

The TRAINER System
The TRAINER System is composed
of various appliances that can be
used accordingly with the age of the
patient, including the Infant TRAINER, the TRAINER for Kids (T4K™)
(Fig. 1), the TRAINER for Adolescents/Adults (T4A™), the TRAINER
for Brackets (T4B™), the TRAINER
for Class II malocclusion (T4CII™),

As suggested by the name, the
appliances of the TRAINER System
just train or exercise the muscles
at the CMS to physiologically load
the bones, stimulating growth and
development in the structure composing the CMS. Through development of the maxilla, the mandible
and the dental arches, as well as by
re-educating tongue posture, the
teeth tend to position better and
align correctly.
The effects produced by the trainers on the maxilla and mandible
have been demonstrated through
scientific studies (Usumez et al.,
2004; Ramirez-Yañez et al., 2007), as
well as through clinical cases successfully treated with these appliances and reported in the literature
(Ramirez-Yañez GO and Faria P.,
2008; Kanao et al., 2009).
Currently, there is ongoing
research with the TRAINER System
appliances focusing on understanding their effect on the muscular
activity of the masticatory and facial
muscles, as well as further investigating the positive effect the appliances can have in mouth-breathing
patients and on some altered oral
functions, such as swallowing.
In the next two parts of this
article, the modus operandi of the
TRAINER System appliances will be
explained, considering separately
their effect on the three dimensions
of the mouth: sagittal, transverse
and vertical.
Scientific literature supporting
the physiological concepts involved
on the effects produced by the trainers will be presented to further support the concept that the TRAINER
System appliances (including the
MYOBRACE) are a viable alternative to treat malocclusion.
Look for Part 2 of this article in
the October issue of Ortho Tribune.
References will appear at the end of
Part 3. OT

OT About the author
Dr. German Ramirez-Yañez, DDS,
MDSc, PhD, is an assistant professor
on the faculty of dentistry, Department of Preventive Dental Science
at the University of Manitoba in
Winnipeg, Canada. Contact him at
german@myoresearch.com.

[23] =>

OrthO tribunE | August/sEptEmbEr 2009

industry 23

Overcome the economy:
time to build your practice
A

ll across the country, the
economy has been the neverending topic of conversation.
We’ve heard it all. Many orthodontists are saying this is the first time
in their practice they are struggling.
For patients, it’s no more waiting
three weeks for an appointment.
There seems to be open slots all
over the books.
Good for the patients, bad for the
practitioners.
But on the other hand, for the
practitioners willing to think outside the box and really reach out to
meet the needs of the patients, practices are thriving. Now is the time to
get creative, do some bold advertising, possibly offer additional financing options and get the attention of
perspective patients.
With so many others cutting
back, you need to take this opportunity to stand out from your competition. Invest in your practice by
keeping your name out there. Work
with a trusted ad agency or marketing firm that knows your industry,
can do all of the legwork for you and
really make you stand out.

An example of a direct-mail
postcard designed by Yourtown
Direct. (Artwork courtesy of
the AAO)

‘basically, we tell
our clients, ‘they are
getting braces somewhere; let’s make it
be from you.’’
— tamara hobbs, Yourtown
Direct, creative director

Specializing in marketing programs for orthodontists, Yourtown
Direct’s Creative Director Tamara
Hobbs states: “Using a well thought
out campaign is so important, but it
doesn’t have to be difficult.
“Done properly, a direct response
campaign, such as our postcard
mailing program, is effective,
affordable and can really breathe
life back into an orthodontic practice, especially after the effect the
slowing economy has had on so
many.
“We’ve all felt it to one degree or
another,” Hobbs said. “That’s why
we have been dedicated to providing a professional, full-service
agency experience with the professional small business budget in
mind.
“We provide a complimentary
marketing consultation with a full
description of how we can target
your market, get your name out
there and keep it in the forefront of
their minds when they need orthodontic treatment.
“Basically, we tell our clients,
‘They are getting braces some-

where; let’s make it be from you.’”
With an assortment of high quality, attention-grabbing images created by the design team at Yourtown
Direct, along with some shared by
the AAO and others, there are so
many options to choose from the
possibilities are endless.
Research proves that postcard
marketing works, and there is no
debate that in this economy direct
mail marketing with a specific callto-action generates the response so
many are looking for.
With Yourtown Direct’s postcard mailing program, everything
is included — design, copy writing,
printing and mailing, all for about
the cost of a postage stamp. It’s no
wonder it has been the marketing program of choice for so many
doctors, dentists and orthodontists
alike.
Go to either www.YourOrtho
Postcards.com or www.Yourtown
-Direct.com to see a sample gallery
of what Yourtown Direct can do
for you and to take advantage of
their special offers now through
Dec. 31. OT

Ortho2 unveils a new look
for the next millennium
A

Orthobanc makes
list of the fastest
growing companies
O

rthoBanc, which has been
providing payment management services for orthodontists
since 2001, has been named to
Inc. magazine’s 2009 list of fastest
growing companies in the United
States.
The company, which began to
expand in 2003 to work with dentists, private schools and other
business types, ranked No. 64
on the financial services list and
1,480 on the overall list.
“Our success is directly attributable to our clients who have
entrusted to OrthoBanc the management of their payment plans,
and to the great staff here who
make it possible,” said Bill Holt,
president of OrthoBanc.

“We could never have grown
so quickly if not for the orthodontic consultants and many other
friends in the industry who have
promoted and supported us in
various ways.”
OrthoBanc has differentiated itself from payment drafting companies by developing a
payment management method
that includes all patient contact
regarding the payments. OrthoBanc has continued to enhance
its services by integrating with
leading technology companies in
the industry.
Other companies on Inc. magazine’s list include Microsoft, Timberland, Intuit, Jamba Juice, Oracle and UnderArmour. OT

nnounced Sept. 1, Ortho2
launched a new corporate brand
identity that is an expression of its
innovative orthodontic management, imaging and communication
solutions.
“We are excited to introduce
the new look and feel of Ortho2,”
says Dan Sargent, president and
co-founder. “Our challenge was
to create a modern brand identity
that represents our technologically
advanced software, yet maintains
continuity with our proven, established reputation as a leader in orthodontic practice management solutions.”
This comprehensive transformation coincided with the release of
the ViewPoint 7 software and will
include redevelopment of the corporate Web site, which will debut later
in 2009. ViewPoint 7 practice management software delivers improved
efficiency and convenience with
new advanced features designed
to increase office productivity and
cost-effectiveness.
By incorporating the latest technologies, the system is designed to
easily integrate and support both
local and remote networking needs,
ensure fast and secure access to
your data, improve Internet and

e-mail communication, and provide
advanced system tools. Features
such as wizards, graphical screens
and accelerator keys make ViewPoint easy to understand, navigate
and use.
“What remains unchanged is the
stellar, top-ranked customer service
and support for our clients; that is
integral to the Ortho2 mission,” Sargent said.
“Our team is continually exploring and working to bring exciting
new technologies and products to
improve orthodontic practice efficiency. This is the culture we have
at Ortho2 — a group of individuals
dedicated to our orthodontic partners and passionate about making
significant contributions to the orthodontic community.”

About Ortho2
Ortho2 is a leader in providing
comprehensive practice management, imaging and communication
solutions for orthodontists. Founded
in 1982, Ortho2 is the largest privately held orthodontic practice
management software provider in
the world, serving 1,500 orthodontists from countries around the
globe. For more information, visit
www.ortho2.com. OT

[24] =>

Industry

Ortho Tribune | August/September 2009

Collaborative software connects
dental professionals on a global scale
By Robin Goodman, Group Editor

t the end of June, Modulus
Media — a Toronto-based
technology development and
marketing company — announced
the release of www.DentalCollab.
com. Company founder Shane Powell sat down for an interview to
highlight what this unique service
has in store for the dental community.

DentalCollab.com is a prime example of “cloud computing,” but what
does cloud computing mean?
We use cloud computing services all the time, such as Twitter, Facebook, SalesForce.com and
LinkedIn. Dental Collab.com is a
software program that runs on the
Internet through your Web browser.
It doesn’t care whether you are
using a Mac or a PC, if you are a
technological wizard or a regular
computer user. All you need is an
Internet connection. It simultaneously scales to meet the demands
of each individual user, so you don’t
have to worry about costly software and hardware upgrades. It’s
all upgraded automatically, and for
free.
Can you trust this online “cloud”
with your information and, more
importantly, your patient’s information?
Just as you trust online banking with your finances, Facebook
with your personal information and
Gmail with your e-mail correspondence, Dental Collab.com has built
a security system that protects your
data. At rest or at play, your data is
being secured with 256-bit encryption — just like what the banks
use — 24/7 system monitoring and
redundant storage. Yes, it’s secure,
and yes, it can be trusted.
Why isn’t all of our day-to-day dental
software running in the “cloud?”
Most dental software was built
to run directly on your personal
computer. This includes everything
from your word processing to your
practice management software. You
can imagine that it’s not easy, or
AD

DentalCollab founder
Shane Powell

cheap, to “rewrite” software to run
in the “clouds,” also known as the
Internet.
The vast majority of dental professionals have been using their
practice management software for
years. Because of this, there are
massive numbers of users that are
ostensibly tied to their desktop computers.
What’s the ideal solution? It’s
simple. Continue using your desktop-based software and use DentalCollab.com to bridge your offline
practice with the online global dental community.
Significant examples of software trending to the clouds include
Microsoft Office Live bringing its
office products into the online cloud
and Google Docs — its online office
suite was the catalyst for Microsoft
to start bringing its office products
into the online clouds.
What about all the other programs
dentists are currently running on
their practice computers? Does all
this have to be replaced?
DentalCollab.com doesn’t replace

your desktop software; it will extend
your reach. Dentalcollab.com actually caters to the practices that
need a collaboration tool, an online
workspace, an information hub
that can be securely accessed and
easily shared online. Connect with
your team, specialists, referrals, any
other dental professionals or groups
of professionals from around the
globe.
Most dental offices are using legacy software that does a great job
of managing their day-to-day practice, but it ties them to their desktop computer. We all know it isn’t
practical to replace your practice
management software; therefore
DentalCollab.com acts as the intermediary, intuitively extending the
reach of your offline applications, or
“in the clouds” as we say.
How exactly does DentalCollab.
com’s cloud computing service help
dental professionals?
Now that dental professionals
know that they can still use their
existing software, they can relax.
DentalCollab.com is designed to
be super easy to use. Taking this
approach, we offer a much shorter
learning curve to effectively collaborate online. It’s quick and it’s
easy to get started and is exceptionally versatile.
There are tremendous benefits
for enhancing patient care through
extending one’s expertise through
a professional network of local
specialists, as well as dipping into
the vast global talent pool. Benefits
include: open up treatment mentoring with industry experts worldwide; better manage your referrals
by inviting labs, specialists, etc.;
request second opinions, something
insurance companies love; and provide patients with access to their
treatment plans, X-rays and followup information.
How can DentalCollab.com actually
save time and money?
Time savings is realized through
improved organization and better communication between team
members, suppliers, referrals and
even sales representatives, thus
saving you time and headaches.
Whether you are learning new procedures, training with new instrumentation or sharing your own particular expertise, DentalCollab.com
is perfectly suited for learning and
mentoring.
Enhanced patient health has tremendous short- and long-term benefits for your practice. No longer are
you limited to your local specialist.
With DentalCollab.com, you can
access world-class opinion leaders
to enable you to make the best decision possible.
A happy patient means more
referrals. Your insurance company

will love you. Managing your second
opinions through your Treatment
Workspace means that you automatically maintain a secure history
of all your collaborations. Think of
it as record-keeping insurance that
helps to protect you against patient
problems.
e-Consultations are becoming a
requirement as many patients have
less and less time. Common treatment planning and follow-ups can
be done over the Internet. Securely
invite patients to view their complete treatment plan past, present
and future.
How is charting handled?
We’re enabling you to connect
any of your existing software with
the online DentalCollab.com network. Quickly upload, organize and
share your charts, X-rays, photos
and all related files. Once you start
working with the system, you won’t
know how you did without this fabulous resource tool.
So would you walk us through a visit
to the site and what a dentist would
see once he begins using Dental
Collab.com?
Once inside, you’ll see right away
how easy it is to create a patient file,
create a new Treatment Workspace
and invite collaborators to join in.
1. Log in to your account.
2. Manage patients: As easy as filling out a form. Invite patients to
view their treatment information
anytime.
3. Create treatment workspaces:
Upload X-rays and supporting
files, create treatment plans, set
priorities and organize your tasks
between collaborators.
4. Invite collaborators: Invite office
staff, doctors, specialists, mentors, sales support staff from manufacturers and patients. Any of
these invitation-only “treatment
collaborators” can review/edit
treatment plans, provide a second opinion or simply provide a
follow-up e-Consultation.
5. How to manage collaborators: Revoke access at any time;
subscribe to daily, weekly and
monthly reports; and schedule
reminders.
DentalCollab has a solid developmental roadmap. Looking into
the future we see many opportunities for extending our functionality. However, it’s important that we
develop in the right places.
We welcome your feedback and
have set up a special offer. Enter
code “DTCLOUD” for one free
month’s access. You’ll see why we
believe that collaboration makes
the world a better place.
Please visit DentalCollab.com or
e-mail sales@dentalcollab.com for
more information. OT

[25] =>

[26] =>

Industry

Ortho Tribune | August/September 2009

Nite-Guide: an interceptive
first-phase ortho procedure
for the 5- to 7-year-old
By Earl O. Bergersen, DDS, MSD

he Nite-Guide® technique1,2 is
a practical clinical solution to
first-phase early treatment and
has the potential to prevent future
relapse. The technique involves
various sized appliances that have
preformed sockets arranged in ideal
Class I occlusions. These sockets
serve as templates that gradually
guide erupting adult teeth into their
proper positions.
In this process they exert lateral
forces against adjacent teeth, which
significantly increases the arch,
after which adult periodontal fiber
formation takes place and stabilizes
this ideal occlusion. This procedure
mimics the natural eruption process
described by Moorrees3 for normal
dentitions.
At the same time, the adult incisors are prevented from supererupting into an unacceptable
overbite and creating mandibular
advancement when the overjet is
excessive. It has been shown that 93
percent of children are candidates
for this procedure, as determined
in a major study of 489 subjects at 5
years of age4.
There are specific signs in the
deciduous dentition that will lead to
malocclusions at a later age. These
signs serve as indications for the
Nite-Guide procedure and are as
follows:
• Closed incisal contacts or slight
crowding of the incisors of 1 to 2
mm5-9.
• Deciduous overbite of 1.25 mm or
more10,6,9.
• Deciduous overjet of 3 mm or
more7,3,9-12.
• TMJ sounds of clicking or crepitus that have an accompanying
overjet and overbite13-16.
• A gummy smile in excess of 2.3
mm with an accompanying overbite11.
Research2,11,17,18 has shown that

the Nite-Guide procedure can eliminate or greatly minimize all of the
above potential characteristics that
can result in later malocclusions.
In the event a second phase of fixed
orthodontics is needed, the treatment is usually of minor complexity.
Results from a study17 of 167
5-year-old patients using the NiteGuide technique from 5.1 to 8.4
years showed successful correction
of the overbite, overjet and crowding in the 69 percent of patients who
wore the appliance to completion.
No treatment fees were charged for
the procedure and patients wore
the appliances only while sleeping.
Mandibular length (CO-GN) in the
treatment group (N=115) increased
54 percent more when compared to
the control sample (N=104)18.
In another study11 of 45 NiteGuide patients, it was shown that
the treated sample experienced a
540 percent decrease in TMJ symptoms by 14 years of age when compared to the control group. Need for
further treatment after Nite-Guide
use17 in 117 patients when compared to a non-treated control group
of 104 individuals was 1 percent for
mandibular crowding (47 percent
for controls), 2 percent for maxillary
crowding (32 percent for controls);
0 percent for overjet (greater than
5 mm) (30 percent for controls); 1
percent for overbite (greater than 5
mm) (38 percent for controls); and
2 percent for overbite and open-bite
(74 percent for controls).
In conclusion, there was little
treatment needed at 8.4 years of
age when compared to the control
sample while there were no differences between the two groups initially. The results from these studies
indicate the Nite-Guide interceptive
technique can be a viable standalone or first-phase procedure.
The Nite-Guide method involves
appointments of five to 10 minutes every three months during the
corrective phase, lasting about two

Left, initial of patient 5.7
years of age with 5 mm
overbite, lingually-inclined
upper deciduous incisors
and a gummy smile.
Right, the final result
after 31 months of
passive nighttime wear.

years. Retention visits, following the
active stage until patient dismissal
at 12 years of age, are at six-month
intervals.
Usually two appliances are used,
both larger than the dentition, provided crowding is anticipated, to
guide the larger erupting adult
teeth into a perfect occlusion. The
first appliance (“C” series) is usually two half-sizes larger than the
measurement and is worn passively
for about five months while the
lower central incisors erupt.
The second and last appliance
used (“G” appliance) is usually three
half-sizes larger than the first and is
used until the patient is dismissed.
The “G” series is a closed version
of the “C” series and encourages
nasal breathing. The Nite-Guide
technique involves only nighttime
passive wear while the child sleeps.
A patient with a 5 mm deciduous
overbite and an excessive deciduous gummy smile is shown in
the figures above. The final result
shows significant correction during
nighttime-only wear for 15 months
and a retention period of 16 months.

9.
10.
11.
12.
13.

14.

Conclusion
The Nite-Guide procedure is a viable interceptive technique using
natural eruptive forces and normal
jaw growth to produce an ideal
adult occlusion. Crowding, rotations, excessive overbite, overjet,
TMD and gummy smiles can be
prevented, resulting in healthier
permanent dentitions.
For more information, visit www.
ortho-tain.com or call (800) 5416612. OT

References
1.

Bergersen, E.O.: Preventive eruption guidance in the 5 to 7 year old: The Nite-Guide
technique, J. Clin. Orthod. 29: 382–395,
1995.
Methenitou, S., Shein, B., Ramanathan, G.,

15.

16.

17.

18.

and Bergersen, E.O.: The prevention of
overbite and overjet development in the
3 to 8 year old by controlled nighttime
guidance of incisal eruption: A study of 43
individuals, J. Pedodont.,14:219–230, 1990.
Moorrees, C.F.A., The dentition of the
growing child, Harvard University Press,
Cambridge, Ma, 1959.
Keski-Nisula, K., Lehto, R., Lusa, V., Keski-Nisula, L. and Varrela, J., Occurrence
of malocclusion and need of orthodontic
treatment in early mixed dentition, Am. J.
Orthod. and Dentof. Orthod., 124: 631–638,
2003.
Sodermans, H.: Uber den Ablauf der Gebissentwicklung bei Kompressionsanomalien.
Deutsche Zahn., Mund. und Kieferheilk 6:
194–206, 422–439, 1939.
Baume, L.J., Physiological tooth migration
and its significance for the development of
occlusion, I. The biogenetic course of the
deciduous dentition, II.The biogenesis of
accessional dentition, III. The biogenesis of
the successional dentition, IV. The biogenesis of overbite. J. Dent. Res., 29: 123–132,
331–337, 338–348, 440–447, 1950.
Barrow, G.V. and White, J.R., Developmental changes of the maxillary and mandibular dental arches. Angle Orthod., 22: 41-46,
1952.
Neumann, D., Weitere Untersuchungen
uber die Gebissentwicklung an Hand von
Reihenuntersuchungen bei Kindern in 10
Lebensjahr, Deutsche Zahn. Mund-und
Kieferheilk, 22: 157–165, 1955.
Leighton, B.C., The early signs of malocclusion, Trans Europ. Orthod. Soc., 45th Cong:
353–368, 1969.
Silver, E.I., Forsyth orthodontic survey of
untreated cases. Am. J. Orthod. and Oral
Surg., 30: 635–659, 1944.
Bergersen, E.O., Unpublished data.
Foster, T.D. and Grundy, M.C., Occlusal
changes from primary to permanent dentition, Brit. J. Orthod., 13: 187–193, 1986.
Bernal, M. and Tsamtsouris, A., Signs and
symptoms of temporomandibular joint dysfunction in 3 to 5 year old children, J. of
Pedodont., 10: 127–140, 1986.
Grosfeld, O. and Czarnecka, B., Musculoarticular disorders of the stomatognathic
system in school children examined
according to clinical criteria, J. Oral Rehabil. 4: 193–200, 1977.
Egermark – Ericksson, I., Carlsson, G.E.,
and Ingervall, B., Prevalence of mandibular
dysfunction and orofacial parafunction in
7-11 and 15 year-old Swedish children,
Europ. J. Orthod., 3: 163–172, 1981.
Tallents, R.H., Catania, J., and Sommers, E,
Temporomandibular joint findings in pediatric populations and young adults: a critical review, Angle Orthod., 61: 7–15,1991.
Keski-Nisula, K., Hernesniemi, R., Heiskanen, M., Keski-Nisula, L., and Varrela,
J., Orthodontic intervention in the early
mixed dentition: A prospective, controlled
study on the effects of the Eruption Guidance Appliance. Am. J. Orthod., & Dentof.
Orthop., 133: 254–260, 2008.
Keski-Nisula, K., Keski-Nisula, L., Salo,
H., Voipio, K., and Varrela, J., Dentofacial changes after orthodontic intervention
with Eruption Guidance Appliance in the
early mixed dentition, Angle Orthod., 78:
324–331, 2008.

[27] =>

Ortho Tribune | August/September 2009

Industry 27

Cadent celebrates 10 years of
OrthoCAD iCast digital models
C

adent, the leading provider of
3-D digital solutions for the
orthodontic and dental industries, is celebrating the 10th anniversary of the introduction of OrthoCAD iCast™ digital study models.
iCast broke new ground through
the electronic storage and retrieval
of cases, enabling practitioners to
visualize cases electronically without the need to create and store
plaster models.
The first case was submitted by
Dr. John Martin of Augusta, Ga. on
Aug. 16, 1999.
“The hassles associated with creating and storing plaster casts make
it very difficult to share treatment
goals and progress with patients,”
said Dr. Martin, who continues to
be an active OrthoCAD customer.
“Digital study models not only save
time and money, but also serve
as a vital tool in evaluating pretreatment and post-treatment cases.
iCast, which is standard of care
at my practices, has significantly
increased office efficiencies and
improved workflow.”

With more than 1.7 million cases
processed and 1,800-plus customers, OrthoCAD iCast is a world leader in orthodontic digital modeling,
said Timothy Mack, chief operating
officer of Cadent.
“Our commitment to continuously improve upon iCast’s functionality has led to a growing number
of new features and benefits,” he
said. “For example, recent upgrades
ensure extensive compatibility with
nearly all management and imaging software programs, state-of-theart diagnostics not found on other
digital study models, enhanced jaw
alignment tool with more options
to make occlusion adjustments and
a computerized discrepancy index
updated to new American Board of
Orthodontics specifications.”
OrthoCAD iCast enables orthodontists to assess case complexity
on pre-treatment digital models and
review clinical treatment results
instantly through multiple sites,
saving time. With iCast, a digital file
copy of all data and measurements
for future reference is created and

By making possible
the electronic storage and retrieval of
cases, Cadent’s iCast
enables practitioners
to visualize cases
electronically.

saved at Cadent’s service center for
a period of 14 years, ensuring data
is backed up.
As part of the certification process, the American Board of Orthodontists now accepts digital study
models submitted by orthodontists
in lieu of pre-treatment hard casts.
In addition, the OrthoCAD iQ™
system allows orthodontists to go
beyond study models to simulate

treatment strategies and select
and execute the most appropriate
treatment plan that includes more
optimal positioning of orthodontic brackets. OrthoCAD iQ services
reduce the treatment time and number of patient visits by an average of
25 percent, benefiting patients and
orthodontists alike.
For more information, please
visit www.cadentinc.com. OT
AD

[28] =>

Products

Ortho Tribune | August/September 2009

Leone Idea-L Light Lingual System
Idea-L lingual brackets were
designed to treat patients with light
relapses or those who desire to improve
their smiles with an invisible treatment.
The Idea-L series was designed both
to incorporate the Slide ligature pad
that allows for a low-friction, free-sliding
alignment of the anteriors and for twodimensional biomechanics to align and
level anterior teeth within a few weeks.
The small bracket size, along with

The Idea-L lingual system provides
a cost-savings alternative to transparent
aligners yet requires minimal cooperation from the patient.
the reduced thickness utilized with the
Slide ligature pad system, assures the
maximum patient comfort with minimal impact on the speech patterns.
For accurate positioning, either indirect

VALO

Orthocryl Black and White
Introducing VALO, a new LED curing light that cures rapidly and completely, even over brackets.
Featuring uni-body construction,
VALO’s tempered, aerospace aluminum
body is lightweight, exceptionally durable and accesses the posterior like no
other curing light on the market.
VALO offers three curing modes —
standard, high power and plasma emulation — to deliver the right power in the
right place.
Opal Orthodontics
(888) 863-5883

bonding or the special Idea-L bracket
height jigs are used. An added bonus
is the Slide pad itself adds additional
protection to the tongue because of its
bulbous design.

LeoneAmerica, a division of American
Tooth Industries
Phone: (623) 925-2094 or (800) 242-9986
E-mail: leoneamerica@
americantooth.com
www.americantooth.com

The new Orthocryl® powder, in true black and white colors, opens up a new
realm of exciting and creative possibilities for today’s dental technician. Whether it
is a penguin or zebra, a set of dice or dominoes, a soccer ball or Magic 8 ball, many
black and white-colored objects offer exciting designs with great contrast.
Be inspired and let your imagination run wild. Offer your patients these new
choices for their appliances with Orthocryl Black and White. (Twelve new “Black
Edition” inlay designs are now also available.)
To date, more than 250 million appliances have been produced worldwide
with Orthocryl from Dentaurum. It is also very suitable for producing bite guard
splints.
Orthocryl is a cold polymerizate resin
system, consisting of two components:
the powder (polymer) and the liquid
(monomer). It has been subjected to
extensive scientific tests, and has been
proven to be a strong, efficient and biologically safe system. Orthocryl autopolymerizates are not toxic, cause no
irritation of the mucosa and possess no
mutagenic potential.
For more details, please view
the video on this product at www.
dentaurum.de/deu/15862.aspx or download a free brochure at www.dentaurum.
de/files/989-602-70.pdf.
DENTAURUM USA
10 Pheasant Run
Newtown, PA 18940
Tel: 800-523-3946
E-mail: sales@dentaurum-us.com
www.dentaurum.com

Tru-Pan for i-CAT
Imaging Sciences introduces Tru-Pan™, another breakthrough in cone-beam
technology for the award-winning i-CAT®. Tru-Pan is revolutionary software that
yields precise “true” panoramic views from 3-D scans.
Developed to meet the needs of dental professionals who require quick and
easy pan creation from existing 3-D scans, Tru-Pan delivers anatomically accurate
and precise panoramic images with optimal clarity and detail, plus time savings
over traditional arch detection methods found in today’s 3-D imaging programs.
Tru-Pan’s advanced reconstruction of unique anatomic landmarks automatically creates a custom, optimized focal trough specific to each patient. This focal
trough detection reveals a new level of detail that delivers consistently crisp and
clear views of root tips and crowns, including the incisor regions, and sinuses — all
within one panoramic image.
Tru-Pan’s panoramic images are created with just one click of the mouse. The
automatic custom focal arch detection works in conjunction with the patient’s 3-D
data to quickly and efficiently extrapolate “true” and precise panoramic views.
These consistent and optimal results save minutes of valuable clinical time over
manual and semi-automatic arch setting techniques.
Time savings extends to Tru-Pan’s easy integration. Available as an optional
feature in the i-CATVision™ software, the easy, one-click function triggers automatic reconstruction with no additional training for clinicians or team members.
Imaging Sciences
www.Tru-Pan3D.com
Video: www.tru-pan3d.com/trupanvideo.htm

[29] =>

[30] =>

Events

Ortho Tribune | August/September 2009

Those who see the ‘big picture’
gather for two days of 3-D education
By Fred Michmershuizen, Online Editor

re you using 3-D imaging yet?
Or are you stuck in the 2-D
X-ray world? If you haven’t
yet ventured into the new visual
frontier of cone-beam imaging, you
have no idea what you might be
missing. Just ask those who attended the third International Congress
on 3-D Dental Imaging, held in
Chicago from June 19 and 20. The
event was hosted by Imaging Sciences International and Gendex
Dental Systems.
Practitioners in a variety of
fields gathered for two full days
of intensive education and panel
discussions. The theme of the
meeting was “An Interdisciplinary
Approach to Treatment Planning,”
and an impressive roster of speakers shared their knowledge and
expertise in how they incorporate
3-D technology in general dentistry, implantology, orthodontics and
endodontics.
In addition, almost two dozen
companies were on hand to showcase their offerings, including new
products, software and ancillary
services.
“Cone-beam 3-D technology
has emerged as the superior treatment planning tool throughout the
industry,” said Bob Joyce, president of KaVo Group Imaging, in
remarks welcoming attendees to
the congress. “As practices around
the globe transition from 2-D to 3-D
imaging, we realized the need to
provide dental professionals with
the information and expertise to
successfully bring 3-D dentistry into
the everyday practice.”
Dr. Scott Ganz, who served as
moderator for the event, kicked
off the meeting with welcoming
remarks and an introduction. His
advice to attendees: If you have
cone-beam in your practice, scan
every patient regardless of what

Dr. Scott Ganz welcomes attendees to the International Congress on 3-D
Dental Imaging.
kind of treatment they need. “Technology is our friend,” he said.
“Embrace technology.”
Ganz was joined by Dr. Jack
Krauser for the first session, “Lessons Learned: Incorporating ConeBeam CT and 3-D Implant Planning:
The Good, the Bad and the Ugly.”
They presented cases that had been
treated beautifully with 3-D imaging, and many others that did not
turn out so well when using traditional 2-D images.
Krauser, who said his cone-beam
machine is the single most important device he’s ever gotten for his
practice, pointed out that while the
data collected for a patient can be
useful for things such as guided
surgery, it is ultimately the dentist
— not the software — who must
interpret the data to determine the
best plan of action.
“Installing
the
cone-beam
machine is just the beginning,”
Krauser said. “It’s not the scan, it’s
the plan.”
Krauser said the technology can

be used by dentists to look back
at past cases that failed to find out
what went wrong and why. Such
insights are valuable, he said, in
preventing future mistakes.
Later in the day, orthodontist
Dr. Ed Lin presented “Taking 21st
Century Orthodontics into the 3-D
World.” He said while the software can be difficult to learn, the
improved results for patients makes
the investment of both time and
money worth it.
“With these tools we don’t have
to guess anymore,” Lin said. “It is
our responsibility to learn this.”
Also presenting on the first day
of the congress were Dr. James
Mah on “Lies, Damned Lies and
Cone Beam;” Dr. Michael A. Pikos
on “Interdisciplinary Esthetic Zone
Reconstruction: Synergy of Interactive CT/Hard and Soft Tissue Grafting;” and Dr. Walter Chitwood on
“Creating Better Communications
with Technology.”
Dr. W. Bruce Howerton Jr., who
offered “A Systematic Approach to

Interpreting DICOM Data Within
the Field of View,” was among the
presenters on the second day. Howerton took attendees on a “tour” of
the human facial anatomy, from
top to bottom and left to right. He
showed fellow dentists what to look
for in data sets. He even revealed
how to detect things such as sinus
infections and excessive earwax
buildup in patients, which is quite
common.
Later in the day, Art Curley, an
attorney, offered up some of the
legal ramifications involved in using
— or not using — 3-D imaging. Also
presenting on the second day of the
congress were Dr. Ralan Wong on
“3-De Endodontics: The Final Frontier;” and Dr. Steven A. Guttenberg
on “Cone Beam CT: Can You Afford
to Not Have One in Your Office?”
The meeting was made possible
by Imaging Sciences International
and Gendex Dental Systems, the
corporate hosts for the event. Also
supporting the meeting was gold
sponsor 3D Diagnostix.
Sponsoring companies were
360imaging, 3dMD, Anatomage,
BeamRiders Diagnostic Services,
BioHorizons, Dental USA, DEXIS,
Dolphin Imaging & Management
Solutions, Dimensions Imaging,
KaVo Dental, Materialase Dental,
Nobel Biocare, nSequence, Orascoptic, Ormco, Pelton & Crane, RLMS
Radiology Lab Management System,
SureSmile Digital Orthodontic System, Sybron Implant Solutions and
The Bottom Line Comprehensive
Course.
During breaks between presentations, meeting attendees were able
to visit all of the sponsoring companies in the exhibit area.
Plans are already under way for
the fourth International Congress
on 3-D Dental Imaging, to be held
June 25–26, 2010, in La Jolla, Calif.
For more information and to register, visit www.i-CAT3D.com. OT

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[cover] => Ortho Tribune U.S.

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Table of contents

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