Dental News - Dr. Eric Howard discusses benefits of SureSmile’s new diagnostic tools

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Dr. Eric Howard discusses benefits of SureSmile’s new diagnostic tools

Dr. Eric Howard (DTI/Photo provided by Dr. Eric Howard)
Ortho Tribune U.S. Edition

Ortho Tribune U.S. Edition

Mon. 14 May 2012


Since October 2011, Dr. Eric Howard has planned more than 50 cases using the latest release of SureSmile software, SureSmile 6.0. The software is the first tool that enables orthodontists to plan orthodontic care with information about root position within supporting bone. He answered a few questions for Ortho Tribune.

First, can you tell readers about SureSmile and how care is improved using its diagnostic tools and archwires?
SureSmile provides a fully customized approach to orthodontic care. It begins with 3-D imaging of teeth and, now, supporting bone. A dynamic model is created that allows you to virtually position teeth, design an occlusal scheme and evaluate the outcome based on your own standards or those defined by the ABO. Finally, a series of computer designed, robotically fabricated archwires are produced to help achieve the plan.

We’ve heard that the new SureSmile software is “groundbreaking.” What will most excite an orthodontist about the new release?
Among the most significant updates in SureSmile 6.0 is the ability to visualize and virtually treat teeth within supporting bone. Static 3-D images give us important information about the quality and quantity of bone, but the ability to plan tooth movement within the context of the bone support provides unparalleled diagnostic clarity. This ability to model the surface layer of bone and the position of the roots within the alveolus is going to change the way we think about orthodontics, both in planning care and when evaluating our treatment results. In previous versions of the software, I could see the patient’s crowns and roots, but now, with bone modeling, there is a more complete representation of each patient’s anatomy. This is an absolutely amazing advance that provides a new level of diagnostic power.

For what case types have you found SureSmile 6.0 to be most useful and why?
I learn something valuable from each case that I plan using SureSmile 6.0. Patients benefit from a 3-D visual prediction of each step in their care. This provides an ideal tool for communication with both patients and their families and with our referring dentists. There are several interdisciplinary planning and communication enhancements in 6.0. In one patient, where a Bolton discrepancy prevented space closure in the upper anterior, I used the virtual restorative features to estimate the size of the restorations and provide a visual prediction of the restorative treatment outcome. I conveyed this information to the patient’s dentist in an online meeting in order best visualize the dynamic 3-D images.

In another recent case, I sat chairside with an OMS colleague planning a complex two-jaw surgery. While we’ve always collaborated on these cases, much of the conversation involved crude manipulation of plaster models to estimate surgical outcomes. This time, we sat together in front of a computer monitor with a 3-D model manipulating jaw positions on the screen. We could rapidly test multiple virtual treatment strategies in 3-D. While surgical prediction is not a new feature, SureSmile 6.0 adds modeled bone, which clearly elevated our ability to plan and interact professionally and visualize clinical outcomes.

Can you give an example of how you might approach a case differently using SureSmile 6.0?
I’ll give you two examples. An exercise that opened my eyes to the value of an individualized approach to care was when I simulated treatment in a straight-forward orthodontic case that I thought could be treated well with straight wires and a stock prescription. When I virtually imposed the tooth movement by the fully-expressed bracket prescription, the lower anterior tooth roots violated the boundary of the labial cortical bone. For this patient with a Class I malocclusion, it appeared a popular stock prescription did not adequately position his lower teeth,

In one patient, we were planning to extract a patient’s lateral incisor and replace it with an implant. The patient brought a periapical radiograph to his consultation, which suggested absence of bone support for an upper lateral incisor. After 3-D imaging and bone modeling, it was apparent that labial bone support is present. In addition, simulating the bite with the virtual articulator in the SureSmile software allowed us to visualize trauma to the lateral incisor during function and devise a plan to protect this tooth early in treatment.

How does this technology impact the future of orthodontic treatment?
We are being challenged in the way we think, plan and deliver care. The ability to clearly visualize tooth position within supporting bone at the beginning of treatment is a huge advance in planning care. The future will provide important information about the appliances that we use and their impact on each patient as we compare pre- and post-treatment images.

Is there anything else you would like to add?
It is clear that our profession is at a crossroads. On one hand, we have colleagues practicing with one-size-fits-all approaches to orthodontics with stock bracket prescriptions and archforms. In contrast, there is a growing list of companies that provide a patient-specific appliance with the goal of individualized care. 3-D imaging and bone modeling are going to have a significant impact on our profession as research is conducted to validate some of our methods and discredit others. In the end, this will lead to better understanding of orthodontics and, most importantly, better care for each of our patients.

About the clinician

After attending the University of Pennsylvania, School of Dental Medicine, Dr. Eric Howard obtained his certificate in orthodontics and PhD from the University of Rochester, N.Y. He now practices orthodontics in Lancaster, Pa. He is a clinical associate at the University of Pennsylvania where he provides clinical instruction to the orthodontic residents. He began offering SureSmile in 2009 and is now a leading provider of this technology. Howard is an instructor for SureSmile, and he provides doctor training for new providers.

Note: This article was published in Ortho Tribune U.S. edition, Vol. 7 No. 1, Spring 2012.

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