INTRODUCING THE SECOND AUSTRALASIAN …...• ACAS2020 in Sydney, Australia (more than 450 tickets sold!) has an incredible line-up of world-leading orthodontists, elite cosmetic dentists

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DR CIGDEM KIPEL - P14

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CONTENTS DECEMBER 2019

P6 Getting clear aligner case startsDr Cigdem Kipel

P14The importance of a morning huddleDr Cigdem Kipel

P9 Open mic with Dr George & Theo Dr George Abdelmalek, Dr Theo Baisi

P16 Smile makeover with aligner therapyDr John Hagiliassis & George Abdelmalek

P21Kesling Award Win 1 of 2 major prizes of $1000

P25Product Review: Jakobi MirrorJakobi mist-free mirror

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WELCOMEWelcome to the second edition of Clear Idea, the official magazine of Australasian Clear Aligner Society’s (ACAS). Clear Idea magazine was created to build our sense of community and learning with feature articles, impartial (and strictly unpaid) product reviews, competitions as well as being your home of our society’s news and events.

A lot has happened over the last 6 months at ACAS headquarters, and I am excited to share this with you. First, a reminder of why ACAS was founded. ACAS has one simple goal; to create a community of progressive likeminded individuals through honest, engaging and impartial clear aligner education. Our mission statement: “ACAS was created to meet the changing demands in our dental industry. ACAS in an impartial, non-for-profit society that serves as a platform to provide unbiased information through education, innovation and a sense of community to the dental profession. ACAS believes that the fundamental principles of clear aligner therapy are universal and can be applied to any aligner system”

The society was formed in 2018 and we held our inaugural symposium in 2019 on the Gold Coast. The event sold out and was a clear message from the Australasian dental community that we are hungry and ready to learn, teach, unite and position Australasia as the leaders of the clear aligner space world-wide.

To this end, I am happy to share that:• ACAS now has 400 members, which positions us as one of the leading clear aligner societies in the world.

• ACAS is the official and exclusive Australian/NZ member of the Journal of Aligner Orthodontics (JAO). The JAO is the leading and most current peer reviewed academic journal on aligner orthodontics and is published quarterly. All ACAS members will receive exclusive access to this journal as part of their membership.

• ACAS has recently linked with The European Aligner Society (EAS) & Taiwan Association of Aligner Orthodontics (TAOO).

• Courses and group bulk discounts – ACAS members will have access to discounts from education providers and companies. • ACAS member badge and public member locator on our website now live

• ACAS2020 in Sydney, Australia (more than 450 tickets sold!) has an incredible line-up of world-leading orthodontists, elite cosmetic dentists and practice managers simultaneously covering five lectures rooms to deliver a weekend jam-packed with incredible learning. Our cocktail party on the Friday with special guest Naomi Simson (founder of Red Balloon) will be a good time to mingle and have some fun as well as be inspired to continue achieving better. There will also be a huge tradeshow with leading companies offering their best deals for our members.

I would like to thank all our world class speakers, many of whom have each completed over 2000 aligner cases, who bring an incredible wealth of knowledge, energy and expertise to ACAS and are paving the way for clear aligners in Australasia. I would also like to thank our non-clinical committee members who work tirelessly and expertly behind the scenes to ensure all events, publications and communications share the ACAS vision and ethos. Lastly, I would like to thank our sponsors who have supported the ACAS2020 event.Remember, your membership period expires in March 31st, 2020 – so be sure to renew to maintain access to all your benefits.Look forward to meeting you all at ACAS2020, be sure to come and say hi.Keep learning,

Kind regards,

Dr John Hagiliassis President

ACAS welcomes you to use our society’s membership badge as recognotion of your

constant pursuit in bettering the dental profession.


Getting clear aligner case startsDr Cigdem Kipel

Ok, you’ve done the course, but where are all the patients wanting to start? They’re everywhere. They’re your recall patients, your emergency patients, your periodontal patients, your staff, your mum, everyone.

GET YOUR MINDSET RIGHT

The number of patients that are motivated to start treatment is equal to YOUR confidence, motivation and enthusiasm for the treatment. It has far less to do with the patients and far more with OUR focus, interest and belief in the treatment. The patients have been there all along. So learn everything you can to boost your confidence. Anyone who dismisses these “mindset factors” is missing out bigtime.

PHOTOGRAPH AND SCAN

Take DSLR photos and digital scans of every potential case. In some practices, this might be every patient. Delegate this to your team and get them to practice doing a ‘work up’ efficiently. A well trained DA can do it in a few minutes, before you even sit down with the patient.

ASK QUESTIONS

Know how to approach a patient who is already interested in treatment. “I’m interested in aligners”. How do you reply? Many dentists stuff it up here - they think about everything they know about aligners and word-vomit it out an avalanche of confusing and irrelevant facts. Don’t teach your patients dentistry the way it was taught to you. It’s confusing and will end in “I’ll think about it”.

A better way: Ask a question back. Get them talking. Then sush. Listen, nod, acknowledge, agree.

“Tell me, what’s made you consider aligners?” “Can you show me exactly what it is that you’d want to change?”

“When do you notice it the most?

“How long has it bothered you for?”

“What’s prompted you to seek treatment now?”

Then re-iterate back to them to show you’ve understood. The more the patient talks = the greater your success in case acceptance.

WHAT ABOUT PT’S WHO DON’T SEEM INTERESTED?

You need a way to bring it up from a place of clinical curiosity and non-judgmentally. For patients who have expressed NO interest in treatment but are good candidates, I simply ask whilst examining their teeth,

“did you have braces in the past?”

Answer is usually “Yes, but I didn’t wear my retainer and they’ve moved again”

or “No, but I wish I had”. Ok, so what’s your next question?

“When did you first start noticing that?”

“Is it something that bothers you?”

“Is it hard to floss there?”

“Have the teeth changed over time?”

Give them a mirror and ask, can you show me exactly what it is you wish you could change? All you need is a non-judgmental way to spark the conversation.

WHAT IF THEY SAY NO?

If they indicate it’s not for them, make sure they perceive that it’s totally, genuinely ok with you! Just let them know you’ve noted what you see today and can review over time.

NAIL YOUR SPIEL

Learn how to summarise the treatment in as few words as possible. You want your patient involved in the conversation before you blab on for too long. Ask them, “What do you know about the treatment? Do you know anyone who’s had the treatment?”. I have a 1 minute explanation that summarises the treatment, focusing on the outcome and re-connecting back to all their previous answers. What would the treatment meant to them?

TELL ME MORE

Now that your patient is keen to know more, make sure you have ready some before and after examples of cases similar to theirs handy (clinchecks, photos, models). Here, explain further the items needed for informed consent.

TIE IT TO OTHER TREATMENT

If your patient needs/wants other treatment (implants, veneers, vertical dimension recon-struction for wear cases, edge bonding) ask yourself, would pre-treatment orthodontics offer any advantage? Then offer it as an option as an adjunct to treatment for them to decide.

BONUS TIP

For an extra WOW - point out that YOU OR YOUR DA HAVE BEEN WEARING CLEAR ALIGNERS all long. “Wow, I couldn’t even see! So yes, get your team using clear aligners! It shows how much you believe in the treatment.

Above all - be ethical, be authentic.

Dr Cigdem Kipel is an accomplished dentist who heads a busy 7-surgery practice in Sydney. She is also CEO and co-founder of Principle practice management software and Level-Up practice systemisation software.

Infectiously passionate about personal and professional growth, she has a keen focus on developing high performance teams, efficient workflows and optimal practice systems that deliver outstanding patient experiences and business growth.

Follow more of Dr Cigdem on Instagram - @dr.cigdemkipel


Dr Cigdem KipelACAS Member & ACAS2020 keynote speaker

As a Principal Dentist and full-time General Dental Practitioner at North Sydney Dental Practice since 2009, Dr Kipel is dedicated to maintaining the highest level of clinical excellence throughout her patient care. Together with her passion for quality, outstanding skills in patient communication, her top academic achievements and commitment to ongoing education, she is able to deliver clinical treatment outcomes of exceptional quality for her patients.

One of Dr Kipel’s greatest passions is aesthetic dentistry and in particular, orthodontic teeth straightening with clear aligner technology or Invisalign. She has a keen eye for the artistic details that make up a beautiful smile and understands the individual aesthetic variations needed for each of her patients. As always, her top skills in communication are paramount in creating a shared vision with her patients to obtain the “dream smile” they imagined for themselves.She has gained extensive experience in straight-ening teeth with the Invisalign system and frequently attends coursework to expand her skill set and stay at the forefront of a continuously evolving technology. Hundreds of patients have thanked her for giving them their dream smile.

Dr Kipel has been awarded multiple academic prizes throughout both her university education in Queensland as well as in pursuit of further qualifications thereafter. Dr Kipel was;

Awarded the ADA prize for 1st place in graduating year (highest GPA) of her Bachelor’s Degree, BOralH(Dsc)

Awarded the Griffith University Award for Academic Excellence (for students attaining academic results within the top 5%) in consecutive years 2005, 2006, 2007, 2008 and 2009

Awarded the Australian Society of Orthodontics Prize for 1st in Orthodontics, 2009

Awarded the Australia and New Zealand Society of Paediatric Dentistry Prize for 1st in Paediatric Dentistry, 2009

Awarded the 2nd Place International Prize and Top Honours in Implant Dentistry for academic achievement in the gIDE Master Clinician Program, 2016

Awarded official commendations for all 6 (of 6) RACDS Primary Exam-ination subjects, 2012

Admitted as a Fellow of the Royal Australasian College of Dental Surgeons (FRACDS), 2015

Another major special interest of Dr Cigdem Kipel’s lies in using technol-ogy to optimise workflows in patient care. After analysing every step of a patients journey within a practice, Dr Kipel and her team have created cutting edge digital systems to streamline the ‘best practice’ methods of delivering superior patient outcomes. She is passionate about leveraging technology to unlock greater case acceptance, utilise more of the dental team in a patients treatment journey and to generate unique opportunities to WOW your patient at every step.

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Open Mic with Dr George & Dr TheoDr George Abdelmalek, Dr Theo Baisi

GA: It is an absolute honour and privilege to sit down and talk with you. On behalf of all ACAS members, please allow me to thank you for being so generous with your time and knowledge. The more I’ve got to know you, the more that I realised that not only are you an amazing, time-tested orthodontist, but you are also a very inter-esting individual.

Two lasting impressions of the first time I met you was that you are very witty and you absolutely love fishing. How did you get involved in fishing and why do you love it so much?

TB: Very simply my father took me fishing when I was four, and I have the patience to sit and wait, or hunt for the fish. I find it is the only place where work does not stay in my head. It soothes my soul. I do most forms of fishing, flyfishing in fresh and salt water, lure fishing as well as bait-fishing mostly for kingfish. I love being on Sydney Harbour.

GA: What other hobbies do you have?

TB: I love to cook, eat and whiskey!!

GA: Has your wit increased inversely pro-portional to the number of hairs you’ve got on your head?

TB: No but as I am now more mature (old-er!!), I feel freer to say what I think without worrying about the consequences.

GA: How did you meet your amazing wife, Railea?

TB: At a family dinner now over 33 years ago. She has put up with my craziness and fishing and strange ideas. She is amazing in so many ways and I could not have done what I have done in my professional life without her 110% support throughout. I am so blessed.

GA: One of the other things I remember about you is you always a next level think-er. You were a pretty early adapter of clear aligners. Do you remember how you got started in aligners? What made you take the leap?

TB: No choice! I remember when Invisalign came, I just signed up to accreditation and Professor Ali Darendeliler (Prof George) and I was in his office and we commented that we thought that this would likely change the way we do ortho in the future. HA!!! The future is here now!!

GA: What is the percentage of clear aligner / fixed braces ratio on your clinic? What was it 5 years ago? 10 Years ago?

TB: It has been growing steadily over the years until we hit the 100 plus per year and then we are now over 60% aligners, because we have incorporated teen and Invisalign first. It is just more comfortable for the patients and much less hassle for the parents.

GA: Most of us are control freaks - there’s no point denying it. As long as a patient maintained somewhat adequate oral hy-giene, orthodontists were comfortable with fixed braces as the patient couldn’t take it off which means we had control (plus or minus a few elastics). Clear aligners com-pletely turn that on its head. How did you learn to deal with this,

how did you learn to “let it go”? What has that meant to you, and your practice and how have you structured your clinic to weed out non-compilers?

TB: In short we haven’t let go, quite the opposite, we now do it on a weekly basis to the pixel!!!!! It is just that it is virtual using DM, (Dental Monitoring). We can even monitor if patients don’t wear their retainers, and they say they do, or at least that’s what they tell their parents. Hahaha.

Patients use the app to contact us about a lose tooth, an ulcer anything and get a response from us within 24hr with the need to come in.

We like to think that they need to come and see us, to interact with us and justify the fee. The reality is that that they drop the kids off with grandma and the race in after school and before soccer or ballet only to be seen for a couple of minutes in their minds to be told keep going, or just change the modules etc……and then drive home another 45 mins. I am treating patients from the Hunter Valley and Wagga Wagga.They actually love the interaction and the fact they only need to come in when necessary, while having the security of knowing they are being monitored. It is our egos that believe otherwise. GA: Are clear aligners just for adults? Are you using it for teens? Pre-teens?

TB: Our practice is the throes of a signifi-cant transformation. Simply put if aligners can be used to achieve the desired tooth movements, as well as fixed appliances, then I firmly believe treatment will be faster, more comfortable and much less of an intrusion into a family’s life. Parents can cook any type of food. Brushing is easier, and there are almost no emergency appointments. Teens are great compliers, and the phase 1s are even better and the aligners are certainly more comfortable than traditional appliances, and if they lose one they jump into the next aligner at no cost to the parent. What’s not to like???


Dr George Abdelmalek, Dr Theo Baisi

The younger generation dentists are so lucky in that were very adept to things like scanners. Is your practice currently equipped with scanners, and if you are, who is the person scanning in your practice? What has scanners done to your practice? We had the first itero scanners nearly 10 years ago. We ordered two in the first shipment to hit OZ. We now have 5 scanners, and while we are not fully digital because it is still easier and faster to take and impression and make a trutains on the spot, we use them for our Aligners, Invisalign and SureSmile and Angel, as well some expansion appliances.

GA: 10% of practices are currently using scanners, what do you think that number will be in 5 years time?

TB: 100% of practices who want to survive.

GA: Do it yourself aligners. Big talking point, I remember people 5-6 years ago talking about all the bad things about Cerecs, but the more I looked into it and played with it, it was perhaps the misuse (either treatment planning or how they use it) that got the poor results. These days, it is a very popular gadget to have and I’ve seen first-hand the quality and convenience. Is “do it yourself ” aligners, that is, in house printing and making aligners, a passing fad?

TB: No there are very good software programs around that can do this, it is just about the economics and scale. We use our SureSmile software platform to design our wires, as well as printing our models for us, cheaper landed in Australia than you can buy here, and we make our own aligners when we need to. Simple retreats, minor rotations, closing some stubborn molar band spaces etc. Printing your own models is a lot of work and effort, and I believe that we will be printing aligners in the nearer future, so why set up to print models and then have to make the aligners now???

GA: If you ever want to infuriate a den-tist, all you have to talk about is direct to consumer aligners. A recent evaluation of a DTC got valued at $3.2 Billion... that’s a scary stat. Is it worth fighting? How do we fight it? If you had a crystal ball how do you see this panning out?

TB: It is not a matter of fighting it. It is about looking at the opportunity. DTC has significantly increased the awareness of the need for orthodontic treatment, at an enormous marketing cost. I believe that one company alone is running about 1100 Facebook ads live at any one time in the USA. That is massive exposure, and of course we have all seen on our social media here in Australia.

How do we make use of this opportunity? We need to educate the patients, and make them understand the different levels of care, and then let them make clear choices. We now have to listen to what the patients want and not just say it is all or nothing. We need to think outside the box.

GA: What has plastic done to and for orthodontics?

TB: Before plastic orthodontics was limited by the physical skills of the practitioners. In essence doing good orthodontics required a lot of training and experience. I originally trained in the Begg appliance and I did full banded cases without brackets. Yes I was a child genius!!!.....or I am just old and crusty!!

I used to have calluses on my fingers from bending wires. Now I am stuck to a screen most of my time. I think it is amazing. When I think back that in 1983 I did a Pascal programming course on a 64k mainframe about the size of a small fridge, I am still amazed by the how fast things have changed in the last few years.

What this has done for orthodontics? - It now means treatment is now much more accessible to patients. They can now ask for full or part treatment, good, better or best.

They can choose to retain or not to retain. They have choice they never had before. They can get straight or straighter teeth and this could also be from an orthodon-tist, dentist or DTC.What has it done to orthodontics? – WOW!!! We don’t know yet. As ortho-dontists we are dinosaurs, very set in our ways and its takes time to change. This has happened in the last 5 years, and the reality is that most of us aren’t ready for it, or even want it to happen.It certainly has created some significant challenges with respect to the best for the patients in terms of outcomes, and I am sure the DTC model will continue to evolve, as it is moulded by different regula-tions and market pressures.My greatest concern is the future of the orthodontists in academic term. With the overall deregulation of dental duties across the board, and the fact that anyone can now deliver some form of orthodontic care, who is going to spend 12 years to specialise and carry on research in an aca-demic environment. We are already seeing the effects of this commercialisation.

What has it done to orthodontics? – WOW!!! We don’t know yet. As ortho-dontists we are dinosaurs, very set in our ways and its takes time to change. This has happened in the last 5 years, and the reality is that most of us aren’t ready for it, or even want it to happen.It certainly has created some significant challenges with respect to the best for the patients in terms of outcomes, and I am sure the DTC model will continue to evolve, as it is moulded by different regula-tions and market pressures.

My greatest concern is the future of the orthodontists in academic term. With the overall deregulation of dental duties across the board, and the fact that anyone can now deliver some form of orthodontic care, who is going to spend 12 years to specialise and carry on research in an academic envi-ronment. We are already seeing the effects of this commercialisation.


Dr George Abdelmalek, Dr Theo Baisi

GA: The most dangerous is to become complacent. But especially with the advent of things like scanners and dental monitor-ing, the clear aligner space is very scalable. Are you seeing more patients or less pa-tients or not noticed a change? Also, how did you, yourself maintain hunger and how do you motivate your team to be hungry?

TB: The threat of going broke keeps you hungry, with 30 staff I have an obligation to provide for them. I graduated in 1990 as an orthodontist in the recession we had to have. 11 % unemployment and 18 % inter-est rates. I bought into the practice and had 1 patient booked in in the CBD practice in Sydney on a specific Thursday. Now fortu-nately I have been around for thirty years, but I will never forget those times.

GA: Dr Gus and yourself started The Ortho Partners, an amazing service where you help other clinicians set up their third-par-ty aligner software. How has that been?

TB: Gus has been amazing; he is the one that has been treatment planning for a number of years already so knew how to put the website together to make if func-tion as well and as smoothly as it does. He is my twin brother!!!

The Ortho Partners has been growing steadily of the last 12 months with just organic growth and no marketing. This has allowed us to iron out any bugs and create our membership models etc. I have to say that initially people are worried about the expense, which is reasonable, but once they see what we can do to keep them out of trouble they get it.

In essence what we are seeing unfortunately is that many general practitioners are start-ing to do aligners because it looks easy and it is sold as being straight forward, however as we know this often isn’t always? the case. This is why aligner treatment is now the greatest source of complaints to the dental board against general practitioners.

I don’t think that this is fair. I do not believe that the general practitioners are doing the ortho other than to provide a good service to their patients, and make a living like the rest of us. They are allowed to do it after all.Our mentoring helps them see the pitfalls in their set-ups, gives them advice and allows them to learn our reasons behind our suggested modifications, etc. While we don’t teach orthodontics, by mentoring individual cases it ensures that the general practitioners have the confidence to learn and improve and help their patients.

I think that the ACAS meeting next year and our affiliation with AORTA will see things really grow next year, as well as the fact that there are many more aligner companies out there.In the end we know that the patients will have a better chance to have a great expe-rience and outcome if the practitioner uses our services.

GA: Does Railea ever get sick of you constantly being on your com-puter at home setting up software? TB: YES

GA: In two sentences, can you guess what you’ll be doing in 5 years time?

TB: Who knows?

I think our fixed appliances cases percent-age will drop further. I also think that we will see the establishment of virtual or-thodontic practices, where the ortho only visits to confirm treatment and the rest is done remotely.

GA: 5 quick questions: What is the first thing you notice about a person?

TB: Yes their teeth

GA: For what in your life do you feel most grateful?

TB: Railea being by my side for all this time. Laura for supporting Railea and I over the last 7 years as our Practice Manager, as well as our whole amazing team at work. If life is tough at work then life is mostly miser-able and I still pinch myself that I became an orthodontist. My very good friends. The fact that I have changed so many smiles and transformed some people’s lives over now two generations.

GA: If you could have lunch with one person, who would it be?

TB: My mother, who only lived to 55 years old

GA: Favourite country to travel?

TB: Anywhere with Railea

GA: Out of 10, how much are you looking forward to ACAS2020

TB: 11!

GA: Dr Theo, thank you for your time – and we look forward to speaking again soon!


Dr Baisi completed his Bachelor of Dental Surgery and Master of Dental Science (Orthodontics) from the University of Sydney in 1990. Since that time he has been in private practice as well as teaching undergraduates and postgraduate students at the University of Sydney. He continues to teach the postgraduate orthodontic students to this day.

In addition to teaching Dr Baisi is also an active member of the greater orthodontic community. Dr Baisi’s Invisalign® experience started soon after Invisalign® was introduced in Australia.

The Ortho Practice has now treated over 1500 aligner cases to date, involving complex extractions and surgery. Dr Baisi has presented at In-visalign® meetings and continues to expand the scope of treatment with Invisalign® in his practice.

Dr Theo BaisiACAS Member & ACAS2020 keynote speaker



The importance of a morning huddleDr Cigdem Kipel

Do this every day to grow to your pa-tient base and stay busy.

I’m not a morning person, but I never skip my morning huddle.

No, the huddle is not just about which teeth need fills or who the dingbat of the day is. It sets the INTENTION of the day and keeps you and your team accountable to the mini goals of each appointment.

Some might find this a bit full on but I follow this structure to maximise the success of each and every appointment. I’m sharing this, as it made a huge impact in my practice. Ultimately, the quality of my morning huddle is proportional to the success of my day, my future bookings and ultimately my success (or not) as a practitioner.

There are 3 parts: YESTERDAY, TODAY & TOMORROW

I have my DA and front office/treatment coordinator present. They prepare on their own, in advance, using the checklist below. They do this early in the morning before we meet so that our huddle is FAST and only relevant stuff discussed. Obviously start small - just take what you like.

YESTERDAY’S PATIENTS

- Is everyone re-booked correctly?

- Follow-up calls scheduled?

- Any referrals, Instagram/facebook likes, google reviews?

- Notes completed?

- Other tasks - labs jobs, referral letters, record requests, aligner prescriptions?

- New treatment plans selected/accept-ed vs not?

- Value of new treatment planned?

- Treatment plans/info/quotes provi-ded?

- NV item codes entered in plan as quoted

- Account correct

- Referrals, Instagram/facebook likes, google reviews

- Concerns/challenges/complaints/poor ‘vibe’?

- Were there any cancellations/ UTA/ FTAs, reasons and follow up?

- Low stock?

- Equipment issues?

TODAY’S PATIENTS

- What treatment is planned for today?

- Special equipment or materials needed

- Extras needed - consent forms, post-op kits, demo models, documents, medication, before and after photos, referral letters to be written, Dr certif-icates, etc

- What’s planned for NV?

- Further treatment opportunities?

- When is the next long treatment slot available?

- When are the next gaps for emergencies?

- Social notes/events

- Preferences: TV, movie, pillow, water, coffee, hot towel, noise cancelling headphones?

- New patient details - referred by? his-tory? specific concerns? opportunity to impress further? first impression goals?

- Breaks/lunches and DA cover planned

- Opportunities for before and after photos

- Opportunities to ask for referrals, FB check-ins, instagram follows, facebook likes, google reviews.

TOMORROW’S PATIENTS

- Everyone confirmed

- Lab work arrived

- Components ordered

- Treatment plans/quotes received

- Consent forms ready

Sometimes the challenge is getting the buy-in from your team members to commit to this structure. But when you get this buy-in, you see magic things happen to your book.



Smile makeover incorporating clear aligner therapyDr John Hagiliassis and Dr George Abdelmalek

“Remember, your goal in investing isn’t to earn average returns; you want to do better than average. Thus, your thinking has to be better than that of others — both more powerful and at a higher level. Since other investors may be smart, well-informed and highly computerized, you must find an edge they don’t have. You must think of something they haven’t thought of, see things they miss or bring insight they don’t possess. You have to react differently and behave differently. In short, being right may be a necessary condition for investment success, but it won’t be sufficient. You must be more right than others…which by definition means your thinking has to be differ-ent” - Howard Marks, second level thinking.

The funny thing about history defining moments is that most people who live through it, don’t realise its significance until after the fact. The people who do realise this invest a lot of time, effort and resources to ensure they not only survive the change, but flourish from it.

Everett Rogers published a second level thinking book in 1962 titled Diffusion of Innovations in which he attempts to explain how, why and at what rate new ideas, paradigms or technologies spread. He postulated that there are five categories of adopters – and they follow a bell curve, and this theory is highly cited in the technology industry. The categories are: innovators, early adopters, early majority, late majority and laggards. Relating this to the clear aligner industry that we see today, it is my view that we are currently nearing the end of the “Early Majority” and quickly transitioning to “Late Majori-ty”.

Direct to consumer marketing meant that the industries move towards clear aligner therapy was predominantly forced upon us via patient expectation and patient request. Rightly or wrongly, as social media began to take promi-nence, and image sharing became the new norm, so too has desire for cos-metic dentistry. It is my strong belief that our generation will be marked by the “selfie camera”. That is, the camera no longer only points away from us, it also points towards us. Interestingly, but not surprising, when we look at all phone manufacturers, the three things they have focused their R&D on: Camera, Speed and Storage. One of the most defining elements of our current world is that the camera points towards us, not away from us. Also, everything is geared towards speed and instantaneous. Upon re-flection, it is this directional change that is guiding societies view on many topics. An interesting discussion for another day is whether it’s the phone companies who guided society or has society guided the phone companies, but none the less, we are the generation that flipped the camera.

We are also the generation that will guide adult orthodontics and be able to incorporate it into many more treat-ment plans to ensure comprehensive, conservative care. It was not long ago that the majority of adults would refuse to undergo orthodontic treatment due to not wanting the stigma and aesthet-ics of conventional braces. This meant that in some cases we tried using other methods to mask alignment issues such as ultra-thick veneers or aggres-sive tooth preparations. The advent of clear aligners as a sound alternative to braces has completely changed this,

and we are now seeing an increased acceptance, in fact even a “want”, in orthodontics for the adult population. With this, we can be again guided towards conservative, aesthetic and precise treatment planning. Interesting to note, adult orthodontics invariably include a restorative component to it whether it be due to uneven wear, chipping, physiological limitations or otherwise. This is the true power of our expertise, particularly if compared to the avalanche of direct to consumer of-ferings. Today, in smile makeover cases, your only limiting factors include your communication for case acceptance and of course your competence. Sec-ond level thinkers will realise that we are moving to a time where the future desire for adult cosmetic dentistry will only increase and ensure they are ready for this movement.

Below, please see a case of a young adult who presented to our clinic wanting to improve her smile. She was treated using AORTA’s smile design and clear aligner principles to achieve a wonderful outcome that brought our patient to tears.

PRESENTING COMPLAINT:A female patient in her early thirties presents for a consultation to improve her smile. She explains how she has lived the majority of her adulthood trying to hide her smile and that she is very self-conscious of it. She does not have any pain. Her friend has recently had veneers done, and she asks if ve-neers is something that we can do for her.


DIAGNOSTICS:Clinical examination shows patient presents multiple missing posterior teeth and also anterior tooth decay. She recently had her 16 and 17 removed at another practice due to decay. Her periodontal health is sound with no periodontal pocketing however she does have 2mm recession on tooth 41. She has chipped and worn anterior teeth and also has a tongue piercing.

FACIAL AESTHETICS- Extra oral- Horizontal thirds appear to be equal- Vertical fifths are uneven with the left maxilla region being wider- Nose deviates towards the right hand side- Smile line in line with the interpupil-lary line

PERI-ORAL- Right hand side lip cant- Maxillary central incisors midlines are symmetrical with the patient’s facial midline.- The nasolabial line angles wider on right side with narrow buccal corridors. DENTAL- Tooth 11 is in crossbite with tooth 42- Upper and lower central incisors have uneven wear/chipping- Uneven gingival heights anteriorly- Missing posterior teeth

TREATMENT OPTIONSDiscussion: Given the current anterior crossbite, it is the authors opinion that veneers (whether ceramic or compos-ite) to be unsuitable due to the risk of repetitive fracture. The use of third party orthodontic software tools and simulations to assist the patient convey what their concerns are and how we can help whether it is further tooth

movement, improving the shape, po-sition and colour of her teeth, golden proportions and smile. Additionally, the improvement of alignment and bite relationship will provide confidence that any future anterior restorative work will not be under concentrated force.

Given the software set up and the presenting complaint, the patient understood the importance of first undergoing orthodontic tooth move-ment. A discussion regarding gingival heights, ongoing maintained and the risk of tongue piercing was also had.

The treatment option offered to the patient are:I. Sequential aligner therapy to im-prove anterior crossbite and overall alignment (+/- orthodontist referral) II. Tooth whitening

III. Composite resin class IV resto-ration of teeth 11, 21, 31, 41 and strate-gic enameloplasty other anterior teeth post orthodontic treatmentIV. Composite veneers 13-23 and 31/41 post orthodontic treatmentV. Ceramic veneers post orthodontic treatmentVI. Gingivectomy to improve gingival heights if required post-orthodontic treatmentVII. Replacement of posterior teeth


PROGRESS



On embarking on a clear aligner treatment (CAT) plan that applies aesthetic teeth movements, the clini-cian needs to take into consideration: Patient consent and understanding all the treatment options, the importance of compliance, alternative treatment options and side effects of orthodontic and or restorative treatment such as recession, increase periodontal bone loss, relapse of whitening, maintenance of whitening and retention for life considerations, debonding and/or staining of bonding and risk of pulpal devitalisation.

PROGRESS

13 months CAT using strategic move-ment velocities, correct attachments and good patient compliance. Impor-tantly, the author spent time discussing with patient prior and during crossbite changes that she will go through a period where she will be biting on the tooth 11 edge-to-edge and to limit hard foods during this period. One of the advantages of clear aligner treat-ment with anterior crossbites is that the upper and lower plastic (approx. 0.75mm each aligner) disengages the teeth, allowing less interference during movement.

FINISHING

Once alignment finished then options are assessed to augment and finish and whitening the dentitionPhillips Zoom in chair tooth whiten-ing and I. Composite resin class IV restoration of teeth 11, 21, 31, 41 and strategic enameloplasty other anterior teeth OR II. Composite veneers 13-23 and 31/41 OR III. Ceramic veneers And medium term: IV. Replacement of posterior teeth

RETENTIONFirst three months full time zendura retainers that can be used as whitening tray

SUMMARYThis case would be incredibly chal-lenging and unpredictable without incorporating orthodontic treatment. The patient was open to clear aligner treatment but had commented that should would not have been interested in fixed braces. We were able to design a stable, functional and aesthetic smile incorporating a mix of orthodontics, restorative, whitening and routine hygiene that, on completion, brought our patient to tears.

Total treatment time was 16 months using a combination of:- Sequential Aligner Therapy- External tooth whitening- Enameloplasty- Ceramic veneers- Composite bonding

The case has been reviewed and stable for 1 year.

FINISHING UP

THE PATIENT OPTED FOR WHITENING AND CERAMIC VENEERS 13-23 AND COMPOSITE BONDING 31/41.


Dr

George graduated from La Trobe Dentistry in Bendigo, and has worked in both private and public practice and has a keen interest in clear aligner therapy and aesthetic dentistry. He has completed post graduate exam-inations with the Royal Australasian College of Dental Surgeons and is passionate about teaching. He is currently in private practice, a clinical demonstrator at La Trobe University, a member of the AORTA training team and vice president of ACAS.

Dr George AbdelmalekACAS Member & Vice-President

THE PATIENT OPTED FOR WHITENING AND CERAMIC VENEERS 13-23 AND COMPOSITE BONDING 31/41.



Harold Dean Kesling (April 8, 1901 – 1979) was an American Orthodontist who is known for developing the tooth positioning appliance called “Positioner”. This appliance is used in Orthodontics at the end of treatment to allow teeth to settle in occlusion.

In 1945, H.D. Kesling stated that “Major tooth movements could be accomplished with a series of Positioners by changing the teeth on the setup slightly as treatment progresses.” The history of clear aligner therapy began when H.D. Kesling pioneered the concept of straightening teeth without braces with the invention of the “Positioner.”

H.D. Kesling founded orthodontic company TP Orthodontics, Inc. in 1959.

Harold Kesling is long regarded as the forefather of clear aligner therapy. Austral-asian Clear Aligner Society is excited to develop an award which pays respect to his amazing and innovative contribution and legacy to orthodontics!

Eligibility: The Kesling Award is open to all ACAS members (excluding speakers) who will be present at ACAS2020.

Criteria: one award will be given to the entrant with the most orthodontically sound treatment result as graded by our speakers including complete records, difficulty and finished result. The second award will be selected via the most popular result as voted by fellow ACAS members.

When will it be drawn: ACAS2020 cocktail party (Friday, 21st February). HOW TO ENTER: Entry is simple, send in complete records of your case including full set of orthodontic photos and OPG and Lateral Ceph. Send to [email protected] before 11.59pm December 31st, 2019. Each person can enter a maximum of three (3) cases. Please ensure you have consent from your patient to use their images.

Prize: 2 major prizes: 1 x $1000 Cash prize (Society vote) 1 x $1000 Red Balloon Voucher (Peer Vote)

Introducing the Kesling Award

Dr Harold Dean Kesling

About the award & How to enter

To be drawn at ACAS2020 - Vote via the Official ACAS App!

2 PRIZES TO WIN

EMAIL: [email protected]


Product review: Dental MonitoringReview by Bridgette Davey (Oral Health Therapist)

Welcome to the product review section. In this section we will aim to review products relating to clear aligner treatment in the hope that as a collective we can continue to learn about suitable products that will improve our overall treatment. If you have any products that you want us to review, please feel free to email us suggestions. If you want to contribute a review of your own and any aligner related product, also feel free to contact us via email – [email protected].

23WWW.ACASOCIETY.COM | [email protected]: [email protected]

Product review: Dental MonitoringReview by Bridgette Davey (Oral Health Therapist)

Dental monitoring has been one of the biggest advancement in clear aligner treatment over the last decade with dental practitioners being able to remotely monitor clear aligner treatment. This enables practitioners to oversee more patients with increased accuracy and with less clinical chair time, essentially re-modelling the traditional practice workflow.

How it works: The Dental Monitoring app assists patients in taking a series of photos at set intervals determined by the overseeing dental practitioner. The photos are taken by the patient in the comfort of their own home, not in a clin-ical setting. Patients use their own smartphone and download a free app via the app store. The photos that are captured by the patient are then uploaded and assessed by Artificial Intelligence technology. The assessment recognises and assesses a number of areas such as fit of the aligner, appliance care, gingival recession, gingival inflammation, evidence of calculus and missing attachments just to name a few. Once the scans are assessed the patient is then told if they proceed forward to the next aligner or to hold for an additional number of days before reassessing with another scan.

Dental Monitoring began with just the smartphone scans using only cheek retractors; however images were compromised with bad lighting and inaccurate angulation. The intro-duction of the scan box as part of the process has improved the quality of photos and stan-dardizes the scanning process. The in-app chat feature has been great in that it allows two-way text communication with patients which also remains documented for medicolegal reasons.

We have welcomed Dental Monitoring tech-nology into our practice and are now rolling this technology out for almost all new case starts. Dental Monitoring so far has been well received by the vast majority of patients with the introduction of appointment by demand philosophy. The ability to assess each aligner fit reduces the likelihood of needing additional aligners. We have found that compliance with clear aligners has improved with patients that use dental monitoring and makes the patients more accountable for their own treatment. The ability to send messages through the app helps with documentation of treatment and patients feel a greater degree of care with their treatment.

Overall, it is the authors opinion that DM is well worth the time and financial investment, both from a clinical efficiency, patient satisfaction and overall treatment accuracy.

Please note: the society and the author of this review are not sponsored or financially rewarded for this review. The review expresses the opinion of the author alone. Readers are encouraged to do their own research prior to making any decisions about product purchases.

An example of GOOD compliance

An example of BAD compliance

Example notification of attachment missing


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Product review: Jakobi Mist-Free MirrorReview by Dr George Abdelmalek (Dentist)

Welcome to the product review section. In this section we will aim to review products relating to clear aligner treatment in the hope that as a collective we can continue to learn about suitable products that will improve our overall treatment. If you have any products that you want us to review, please feel free to email us suggestions. If you want to contribute a review of your own and any aligner related product, also feel free to contact us via email – [email protected].


Clinical photography has long been a staple of clinical practice, particularly orthodontics and fixed prosthodontics. As time goes, photog-raphy has become more prevalent, useful and diagnostic. As technology advanced, so too did the quality, speed and ease of our photos. The vast majority of the advancements, however, have been related to camera, lighting or filters. However, excellent clinic photography (and particularly intraoral) is not dependent on one element but instead a combination of multiple factors – camera, lighting, good retraction and high quality mirrors.

Reasons for good dental photography:

Record keeping – Good pre and postoperative photos give the best visual record of any treat-ment done.

Case reflection – Taking before and after pho-tographs and analysing them will improve thestandard and predictability of your dentistry.

Laboratory/third party orthodontic commu-nication – Sending orthodontic series photos to your third party orthodontic lab is often a compulsory aspect of your prescription.

Marketing – This is becoming more and more relevant with social media and websites.

Patient education – Showing patients pictures of their teeth if a great way to visually improve case acceptance and treatment motivation by increasing emotional connection.

Medico legal purposes – This is especially the case when doing any aesthetic or cosmetic dentistry.

The scope of this review will focus on mirrors, particularly focused on a general dentist or orthodontic practice. Those who take enough photos know that the main challenges we have with mirrors is:

1. Fogging / water droplets on mirror surfaces obscuring view

2. Scratches on the surface of the mirror

3. Staff incidentally breaking the mirror With that in mind, I wanted to review the Jakobi Dental “Mist Free Mirror”. This mirror is

marketed as a mist-free solution and comes in a simple yet comprehensive kit including mirror holder (demister unit), battery and charger (USB), mirror tray and 4 included stainless steel mirrors (2 Occlusal, 2 Buccal). The mirrors are stabilised using a screw at the back of the Demister unit and can be changed over by loos-ening the screw and putting a different mirror in. The unit has three simple buttons – On, Plus and Minus and 5 yellow LED dots (which indicates strength of fan). The unit also has two LED lights directed to the mirror to improve visibility.

Quality of the photos: The device does exactly as it says it would, and that is, when the mirror is placed in the patient’s mouth – the initial fog is dispersed quickly and efficiently within seconds. The mirrors are clear and light-weight, but do seem to get fingerprints easily. A good benefit of stainless steel mirrors means they are a lot harder to break compared to glass, which if this was an issue in your practice – is a welcome benefit. We did find that the surface of the mirror did scratch easier, so be careful with this.

Battery life: we have only been using it for a short amount of time, but find the battery life very good – and also has an LED light indicator as to the level of charge. Additionally, the bat-tery pack can be changed and bought separately if and when the battery no longer keeps charge well.

Mirror shapes: The four included mirrors cover most types and needs. The occlusal mirrors (one smaller and one larger) fit well for the majority of patients we used it on. Our practice has moved to, and get excellent results with, “V” shaped side cheek retractors, which means we find the buccal mirrors relatively redundant.

Unit: The unit is quite well designed, and a particularly clever aspect is the long handle allows someone to hold it without getting their fingers in the photo. Similarly, simply having the handle means the patient can very comfortably hold it and hence the need for a second assistant or patient coaching is reduced. The buttons are high up on the unit and quite firm to press. This makes adjusting speed of fan while in the patients mouth harder. The mirror stabilising screw can be better designed.

Price: The unit is sold through Osseo dental and RRP is $1495 + GST

All things considering, the Jakobi “mist free” mirror is a welcome addition to the practice. It is convenient and does exactly as it says it does - and that is fog-free, high quality images with an easy to hold handle. Although the unit is definitely an improvement on traditional mir-rors, it doesn’t quite make us want to actively change over all of our mirrors in the practice. However, it will be seriously considered as the older mirrors need to be replaced. With that noted, it is the authors opinion that we will soon see intra-oral scanners will stitch HQ images to-gether to replace ‘photography’ – both in terms of quality and usefulness.

Please note: the society and author of this review are not sponsored or financially reward-ed for this review. The author was send a Jakobi Mirror Demister Professional Pack to trial. The review expresses the indepedent opinion of the author. Readers are encouraged to do their own research and consider their own needs prior to purchasing any products

Product review: Jakobi Mist-Free MirrorReview by Dr George Abdelmalek (Dentist)

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INTRODUCING THE SECOND AUSTRALASIAN …...• ACAS2020 in Sydney, Australia (more than 450 tickets sold!) has an incredible line-up of world-leading orthodontists, elite cosmetic dentists