Latest / Orthodontic Products Podcast / Balancing Aesthetics and Control: The Role of Ceramic Brackets Today
Transcript
- Alison Werner (00:06) Hello and welcome to the Orthodontic Products podcast. I'm your host, Alison Werner. Today we're looking at how ceramic brackets fit into the conversation around aesthetic treatment options. While aligners often dominate that discussion, fixed appliances remain a critical part of orthodontic care, creating space for ceramic brackets to serve patients who want a more discreet option without sacrificing clinical control. In this episode sponsored by Sylventum, we'll explore what patients are looking for, what orthodontists should consider when selecting a ceramic bracket system, and how this bracket category is performing in terms of efficiency, bonding, and day-to-day workflow with a focus on the Clarity Advanced Ceramic Bracket System. Joining me today is Dr. Lisa Davison, an orthodontist based in Palo, Ohio. With 15 years in practice, she shares her experience using ceramic brackets in a busy clinical setting, including how patients respond and how these systems integrate into to treatment. Here's our conversation. Alison Werner (01:13) Davison, thank you so much for joining me. I really appreciate it. Lisa Davison (01:16) Thanks for having me, Alison I'm happy to be here with you. Alison Werner (01:20) Yeah, okay. So before we get started, can you kind of just tell me about your office and how long you've been practicing? Lisa Davison (01:27) So I have been practicing for 15 years. I am in Powell, Ohio, which is a suburb of Columbus. And for my first few years of practice, I worked as an associate and then decided to open my own office and started from scratch. So really started ground up with just myself and one other team member. And since then we've grown to a two doctor and 15 team member practice, which is amazing. So we are big and busy practice and we really pride ourselves on making sure that our patients have an amazing and that we're efficient with what we're doing. Alison Werner (02:02) Great. So today we're looking at how ceramic brackets fit into the conversation around aesthetic treatment options. Aligners tend to dominate that discussion, but fixed appliances are still widely used. So how do you see ceramic brackets fitting into that landscape today? Lisa Davison (02:19) That's a great question. So we are in a practice where aesthetics are really important. It is definitely a big need in the population that I They want to make sure that something not only is going to meet their goals and objectives, but looks good while we're achieving that. And so even though we love aligners and we have about 20 % of our comprehensive cases currently in aligner treatment, I think that fixed appliances are great for a lot of our patients. When we talk about aligner treatment with our patients in their initial visit, my treatment coordinator and I really try to dig in deep to make sure that that patient is a qualified candidate for aligners. And what I tend to explain to people is that most orthononic problems can be treated with aligners, but not every patient is a great aligner candidate. And when we talk about utilizing something like aligners, we're dealing in humans. And it is human nature to be able to do something really well initially and maybe not see it out that entire time that we're asking of them, which might be 15 to 18 months. Alison Werner (03:28) Mm-hmm. Lisa Davison (03:29) So we have found that clear brackets are a great bridge between being able to provide something that's really aesthetic and meet the patient's goals and objectives and do it in a way that's going to be better for the patient where they can actually be successful in their treatment. Alison Werner (03:46) ⁓ OK. So how do ceramic brackets then help kind of bridge that gap between aesthetics and control? Lisa Davison (03:58) So for us, we're utilizing solventums Clarity Advanced, and they're a really beautiful, highly aesthetic bracket. And so it allows us to provide that nice aesthetic option for patients where they feel like when they're at a speaking distance from someone, they're really not that noticeable. We have the control over mechanics. So there are certain movements that I do prefer fixed mechanics for. But again, for that larger population of patients that wants a good outcome but knows they can't quite put in the effort to be to utilize aligners during that entire treatment time, ceramic brackets are a great option for them. Alison Werner (04:34) Okay. So from your point of view as the clinician, what are you looking for in a ceramic bracket system in terms of that placement efficiency and kind of just overall performance? Lisa Davison (04:45) So for us, a ceramic bracket, one has to be easy and efficient to place, meaning it doesn't take more time than a traditional fixed metal bracket. It has to be highly aesthetic. And highly aesthetic doesn't just mean from the day I put it on. That bracket has to look good all throughout treatment time. And I really feel like there's two factors when you talk about the aesthetics of ceramic brackets. You want something not only that the bracket itself looks beautiful, but in our case, we're utilizing the Clarity Advanced, it's a flash free product. That means when I put that bracket on, not only is it really quick and easy for me to place it, we don't have a lot of adhesive around the periphery and so you tend to have less staining, which is another part of that aesthetic component. So I find that these brackets look good not only the day they go on, but all throughout treatment. The other things that we look at are strength and resilience. So we want to bracket that's not going to debond incredibly easily. So will withstand most of what patients are eating. But we also want to bracket that at the very end of treatment, we can easily take off. So there's a fine balance there, right? You want something that's strong, but not so strong that when you're taking it off, you're worried about chipping enamel or creating a poor patient experience because it's uncomfortable. The last thing that I would say is that I want something that's going to be efficient with my mechanics and easy for my clinical team. Alison Werner (06:03) Mm-hmm. Lisa Davison (06:15) work with. So we look for something that has a nice base and design to it where I can get my ligature ties on easily and get them off easily that we're not spending all this time fussing with them because we can't get the ties on properly because that distance between the base of the bracket and the wing is not appropriate. Alison Werner (06:24) Thank ⁓ I'm curious, you talked a bit there about your experience with it so far. What was the onboarding for you and your team, what was that experience like with taking on a new bracket system? Lisa Davison (06:47) I have been a 3M now Solventum user since the inception of my Alison Werner (06:53) Okay. Lisa Davison (06:54) Prior to that, when I was an associate and I worked in residency, I used a variety of bracket systems. So I was exposed to all sorts of different type of clear brackets. When I began using Solventum's products, ⁓ early on they came in and worked with my team to make sure they were up to date. We do have generally a yearly lunch and learn just so if my team has any questions about how a product works or even the bonding protocol, everybody's up to speed. Alison Werner (07:01) All Mm. Lisa Davison (07:24) on how things should be used properly. ⁓ In terms of the actual introduction of the appliance, I feel like it's pretty self-explanatory in how it works. I don't think it's really much different than a metal bracket in terms of untying or tying in. So I don't think there's really a whole lot of team training when it comes to utilizing that bracket. Alison Werner (07:46) Okay and then how do patients tend to respond to just ceramic brackets once they're in treatment? What kinds of feedback do you hear most often? Lisa Davison (07:56) That's a really good question. most patients find them comfortable. We haven't had any patients that have had any issues with them. And I can say that as a clinician and as a patient who's had Clarity brackets on, they're very smooth. They're designed with more of like a rounded edge to them. So you really don't have a lot of like catching or snagging of the tissue. They do have a nice profile. So ceramic brackets of years ago and even some of the current systems, some of those brackets Alison Werner (08:08) Mm. Lisa Davison (08:26) are a little bit bulkier to create that distance between the base and the tie wings. And I don't find that's the case with Clarity Advanced Brackets. It's a nice kind of more smooth or streamlined profile. So we really don't have a lot of patients that have issues with them. Patients love the appearance. They love that they're versatile. We use them a ton in our preteen and teen population. So one of the things that we talk about with the preteens and teens Alison Werner (08:32) Mm-hmm. Lisa Davison (08:56) that you can do clear ties if you want. So if you're going to a school dance or you're gonna have family pictures, it's really nice. You can use those clear ties and have it be very subtle. If you want to make it fun, we can still put those colors on and a lot of them really like to do the bright colors because that ceramic actually makes the color pop and look a little more vibrant. So in all honesty, most of our teen patients are still utilizing colors on them. They just like that they have that option. Alison Werner (09:26) Yeah, OK. ⁓ When you evaluate a ceramic bracket, what specific design features matter most to you? And how do those show up for you clinically? Lisa Davison (09:37) So again, when we're looking at design features, aesthetics is number one, because if a patient is asking for something aesthetic, it has to maintain its aesthetic components all throughout treatment. And then a bracket that's going to be efficient and actually be able to express the movements that we're looking for, ⁓ things like torque. And if we're doing an extraction case, being able to utilize sliding mechanics, those are things that sometimes in the past, I feel like ceramic brackets weren't excellent with, and we have not any issues with our mechanics or outcomes, ⁓ I find that my clear bracket patients treat out beautifully. So we want something that's going to work well, look good, and then like I mentioned before, we want something that's gonna be really easy to use chair side for my clinical team. I don't want a bracket that they're gonna fuss with getting that tie on and off of, especially the off part because you could break the bracket, you could slip and injure a patient. So it has to be a bracket that's designed and Alison Werner (10:25) Mm-hmm. Lisa Davison (10:37) in a certain way that it's gonna hold that ligature tie appropriately and be easy enough to grab it and remove it. Alison Werner (10:44) Yeah, okay. So from a clinical standpoint, how has the system actually performed for you in day-to-day use? So whether that's placement, handling, or just the overall workflow. Lisa Davison (10:57) It performs, I mean, pretty much identical to our traditional fixed mechanics with metal brackets. So placement, because it's flash free and that's what we utilize for both our metal and clear system, it takes me less than five minutes to place them chair side. They're very easy to put on with the Clarity Advanced. There's these nice little guidelines when you're putting them on so you can get the bracket positioned perfectly. And then as soon as the patient goes to rinse, they come right off. Alison Werner (11:23) Mm-hmm. Lisa Davison (11:27) So ease of place is ideal in terms of the workflow. Again, same workflow as our traditional fixed mechanics. We don't do anything differently in terms of wire selection or wire size. So it's really applying those same philosophies and treatment mechanics that you are using with metal brackets to clear brackets. Alison Werner (11:49) Okay. And then how do you evaluate the bonding with a system like this and what has that experience been for you and your team? Lisa Davison (11:58) So we look at our different emergency type of appointments. And we really break that down into those specific emergencies. So brackets that come off, we're looking at when they came off. Did they come off shortly after they were bonded? Is this something that's been in the patient's mouth for a year and came off? And then we look at metal versus ceramic. And I would tell you in all honesty, we have more metal brackets that debond than ceramic. initial bonding with ceramic brackets can sometimes be better for multiple reasons. One of them being when you're working with a chair side assistant, everybody's a little bit different. And when you're curing with the ultraviolet light, it transmits through that ceramic a lot more effectively versus a metal bracket that if you're not angling the light properly in every position around the base of the brace, you may not get as good of a cure. So I rarely see a ceramic bracket immediately after placement and immediately for us is really in that first few weeks. When a ceramic bracket does fail it tends to be like a gross failure meaning that it snaps in half or breaks. Even that is pretty rare and when it does happen it's usually under a higher tensile force so the patient bit into something harder like a Jolly Rancher or an almond and those are the same cases that if you had a metal bracket that bracket would fail under that Alison Werner (13:01) Yeah. on. Lisa Davison (13:25) force as well. Alison Werner (13:26) Yeah. For orthodontists who haven't taken a recent look at ceramic brackets and where they are today, what would you tell them to look at or to consider? Lisa Davison (13:41) So I think that, again, ceramic brackets have come a long way in the past 10 to 20 years. The Clarity Advanced Bracket is designed so beautifully, again, in terms of its efficiency, in its chair-side compatibility for your assistants, and its aesthetics. So I think it's really important to look at something ⁓ and reach out to other orthodontists or get on a Facebook group or social media where you can ask your colleagues, what do you tend to see with the ceramic system? that you're using because I've worked with brackets in the past again as an associate and in residency that did break or fail very easily. They were much more brittle. I also worked with a system that even though it looked great and held up great was terrible at debond Taking those off of patients was not a great experience. It was uncomfortable. They tended to fracture and leave little pieces behind which makes debond take longer from the clinician side as well. Alison Werner (14:21) Mm-hmm. Mm-hmm. Lisa Davison (14:41) So I really think, again, talking to colleagues and getting a good idea of what the general experience is and helping to select that bracket and looking for something very aesthetic, very efficient, doesn't break easily, but comes off nicely at debond Alison Werner (14:59) Yeah, okay. So as you look ahead, how do you see ceramic brackets evolving both in terms of the patient expectations and what you need clinically from these systems? Lisa Davison (15:12) I think clinically they perform well. So I don't know that you're going to see a lot of changes in the clinical performance. Again, with using the flash free for us, I think that's a clinical advantage. It's so easy at the time of placement. I don't necessarily see a lot of changes in that. ⁓ The only thing that I could see over time is maybe even making them a little bit smaller if they're able to be continued to milled at. be milled at a very high strength. It's possible you could make them smaller. But even the brackets that we have now, they're definitely not bulky. They're not obtrusive. I think utilizing them as a nice bridge between those patients who want aligners and aren't a great candidate and having like a traditional fixed metal appliance is great. We are seeing so many adult patients in our practice and I think most practices will continue to see that over time. There's plenty of patients who had orthodontic treatment in their adolescence that didn't wear retainers or have had some level of relapse. And I think as a society, we're just so much more in tune with aesthetics and wanting things to look good. And I think it's also so much more accepted to be an adult that's in orthodontic treatment. It's a great option for practices to be able to offer their adult patients and even their adolescent patients. Alison Werner (16:36) Yeah. Well, Dr. Davison, thank you so much for joining me. I really appreciate it. Lisa Davison (16:40) Thank you, Alison. I appreciate you.