Transcript The New Wave in Advanced Orthodontics

Numerous publications are being
written discussing our successes
• The May issue of OrthoTown compared all of the
options available for acceleration and “PROPEL
came out on top based on patient experience, cost,
predictability and speed.”
• It is important to note PROPEL is localized and
doctor controlled
• The Nov 2013 issue of AJO-DO quoted “Microosteoperforations are an effective, comfortable,
and safe procedure to accelerate tooth movement
during orthodontic treatment.”
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Here are just a few quotes from
PROPEL doctors
• “We are getting amazing results with PROPEL and bracjet and
Invisalign cases” Frank Andolino Manhattan, NY
• “Patients are excited about finishing faster." I am doing 7 day
Aligner change outs on many patients and no hiccups. I started
using PROPEL in June. I would love to rid refinements” Dr Adam
May Fitchburg, MA
• “Propel has not let me down. Fewer trays, less time in braces,
difficult movements. My patients love it!” Tom Shipley Peoria, AZ
• "I have seen my patient compliance increase with changing
Aligners weekly, so now I can bring the Invisalign experience to
more patients who did not want longer treatments: Payam Ataii
OrangeCounty, CA
The when, where and why with PROPEL
• Doctors are excited to use PROPEL to achieve
more efficient results and have more profitable
cases
• Doctors are using PROPEL:
o Proactively for more predictability/finish faster with less
refinements
o Reactively to get a tooth/teeth back on track
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Dr. Karen Guinn
Pasadena, CA
Premiere Preferred Provider
Teen Provider
http://www.youtube.com/watch?v=lH628n7VPog&feature=youtu.be
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The PROPEL Device
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Micro-Osteoperforations
with PROPEL
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Proactive or reactive
Doctor-controlled
Localized
No recovery time
Shorter treatment
More predictable
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3 Steps for
Micro-Osteoperforation
1. Evaluate Treatment area
• Locate roots, the mandibular nerve and maxillary sinuses.
• Micro-Osteoperforation depths are determined by bone and soft
tissue thickness.
• Micro-Osteoperforations should penetrate through the cortical plate
into cancellous bone.
2. Chlorhexidine rinse
Two times for one minute each
3. Anesthetize & PROPEL
Treatment area can be anesthetized using either a Topical or Local
Infiltrative anesthetic.
Profound topical anesthetic
10% prilocaine
10% lidocaine
4% tetracaine
With 2% epinephrine
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How to PROPEL
1. Remove from the sterile package and turn
the Adjustable Depth Dial to the preferred
setting 3mm, 5mm, or 7mm by holding the
driver body and rotating the dial clockwise
2. Hold the PROPEL Device against the gingiva
while keeping the tissue taut
3. Apply gentle pressure to engage the leading
edge while turning the device handle
clockwise. Check engagement by releasing
pressure
4. Continue to turn until the desired depth is
reached for penetration of the cortical plate
into cancellous bone
5. The LED Depth Stop indicator will illuminate
when desired depth is reached
6. Rotate the device counter-clockwise to
remove
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How deep do I go?
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How Deep to PROPEL
PROPEL has three depth settings: 3 mm, 5 mm and 7 mm. The correct depth should be
selected based on the thickness of the gingiva and alveolar bone in the treatment area. The
anterior is usually 3 mm or less and the posterior is generally 5 mm or 7 mm.
Recommended
perforation depth
Ref: Baumgartner et al.
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How Many
Micro-Osteoperforations
Where possible perform 1-3 micro-osteoperforations depending on proximity of
anatomical structures. Perforations can be made buccal or lingual in linear or triangular
patterns.
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Where to Perforate:
Buccal or Lingual
Micro-osteoperforations can be performed either buccally or lingually. Buccal access is
most often the simplest approach, depending on desired movement and patient’s
oral anatomy.
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Benefits to Patients
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Take the challenge out of challenging movements
Up to 50% faster treatment times with less refinements
Fewer office visits
Less time off work
Less compliance required shorter treatment
Shorter treatment means better hygiene
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Post-PROPEL
Micro-Osteoperforations 10 minutes post-treatment. There is no recovery time, and little
pain associated with treatment. Tylenol is recommended if patient feels any discomfort
after PROPEL.
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The micro-osteoperforation affects an
are of 7-10 mm in diameter, so you do
not have to be directly mesial, or distal
to the tooth/teeth we are trying to
address.
Repeat procedure every 10-12 weeks
until the completion of the desired
movement is expressed.
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DB Aligner beginning
Courtesy of Dr. Miraglia
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DB Final
Courtesy of Dr. Miraglia
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Close-up of MOP site
Courtesy of
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When to Recommend PROPEL?
• It is treatment planned at the beginning of the case at the doctor’s
discretion to ensure those difficult movements happen more
efficiently/predictably. This would help cases finish on time and eliminate
or minimize refinements.
• It is proactively treatment planned to ensure faster more efficient and
predictable results. For aligner patients, the patient wears aligners at 7
or 9 day intervals.
• Reactively, a quick resolution to resolving challenging movements that
may not be happening—this could take place at mid treatment or at the
end of the case.
• A “Premium Treatment” option for patients that want a shorter
treatment. Patients typically have 5 less office visits—saving the office
chair time and patient convenience.
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