When an orthodontic practice purchases a scanner, we enter an opportunity to add new workflows and streamline clinical systems. Accordingly, an area we have focused on is reducing appointments in treatment and making the debonding process more efficient.
It is common for orthodontic practices to schedule debonds early in the day. We remove braces, take impressions, pour models, and fabricate retainers. Often, patients come in later in the day for a retainer delivery or on another day. To eliminate this additional appointment and remove the same-day retainer shuffle that rushes fabrication, we instituted a new workflow. In this process, we scan ahead of the debond, virtually remove brackets using CAD software, design any tooth movements necessary, 3D print models, and fabricate retainers.
Pre-debond appointment
When you find a patient is ready to complete treatment, create a checklist for finishing cases and prepare the patient for the appliance removal appointment. Remove wires and take a digital scan that captures the anatomy around the brackets well. This scan should have minimal objects around the natural tooth, so the virtual removal is easier to perform. We also confirm if we plan fixed retention for the patient. In other words, we decide if the patient requires any finishing movements or if tooth positions are acceptable for a final retention appliance.
CAD work
The next step in this workflow is loading the image captured. We export STL files from the scanner cloud storage and load them into the CAD software. Then, there are several options for software solutions to modify the impression and remove the brackets. We used to use a software called Meshmixer to remove brackets virtually. It is a free solution but takes time. However, a newer solution is available from EasyRx’s Automated Bracket Removal. This software will remove the brackets with an automated workflow that saves staff time. If tooth positions are acceptable for a final retention appliance, we then proceed with model printing and retainer fabrication. Lastly, we add block out to cases with fixed retention and fabricate the fixed retainers.
If the patient requires any finishing tooth movements, we can add detailing to finishing archwires and duplicate them on CAD software that allows tooth movement and staging. After virtual bracket removal, we follow tooth segmentation, tooth movement design, and staging. These finishing aligners allow for final tooth positioning.
Printing and fabrication
For offices that own 3D printers, we print models and fabricate retainers in the lab. We vacuum-form a flexible first retainer and a more rigid final retainer for patients. If we staged movements, we manufacture clear aligners to deliver additional movements in the finishing aligners. Whereas offices that don’t have a 3D printer can send the STL to a 3rd party lab to fabricate retainers or finishing aligners.
Debond appointment
Since we fabricate the retainers or finishing aligners before the debond appointment, patients are seated and sign a retention agreement form. We debond appliances, polish teeth, bond fixed retainers, and removable retainers are delivered. Then, we take final records and celebrate the “big day!” No additional appointments are necessary for delivery as we combined these through a digital workflow. Take a look at the total number of debonds you do per year, and consider the impact of removing that many extra appointments for delivery in your practice. Hopefully, this workflow will give you added efficiency.
