Latest / Orthodontic Products Podcast / How Dr Thomas Crary Uses 3D-Printed Clear Aligner Attachments to Improve Tracking
Transcript
- Alison Werner (00:06) Hello and welcome to the Orthodontic Products Podcast. I'm your host, Alison Werner In this episode, sponsored by Solventum we are examining a major technological shift in clear aligner therapy, the transition from conventional intraorally cured attachments to pre-formed 3D printed alternatives. The traditional attachment workflow has long been a primary source of clinical unpredictability for orthodontic teams, largely due to the manual flash removal process and its downstream impact on precise tooth tracking. Our guest today is Dr. Thomas Crary a board-certified orthodontist who practices at Milestone Orthodonics in Minnesota. Dr. Crary was one of the pilot testers for Solventum's Clarity Precision Grip Attachments, and he joins us to share his clinical insights on how integrating fully cured, pre-formed composite attachments can streamline daily practice operations, improve bond strength, and elevate the patient experience. Here's our conversation. Alison Werner (01:00) Doctor Crary, thank you so much for joining me. I really appreciate it. Tommy Crary (01:03) Good morning. Happy to be here. Thanks for having me. Alison Werner (01:06) Yeah. Okay, so let's kind of start with getting to know you a little bit. So as both the practicing orthodontist and a Solventum partner, can you share a little bit about your practice and how how does aligner treatment fit into your day-to-day workflow at this point? Tommy Crary (01:21) Absolutely. Yeah, a little bit about me. I was born and raised in Minnesota. I pursued engineering actually as an undergraduate degree, but like right at the end of it, I realized I want to be an orthodontist and pursued that, went to University of Iowa for dental school and residency as well for orthodontics, graduated in 2018 and joined a group practice that's now called Milestone Orthodonists back home in Minnesota. And have been there ever since. Love it. I've got three amazing partners, six locations in the northwest suburbs of the Twin Cities. We do quite a quite a bit of aligner treatment, maybe 20 to 25 percent of our cases are done with clear aligners, the other with fixed. We've been using the Clarity aligner system since it came out and been really happy with it. It's been fun to see it grow and develop and and keep implementing new features like these grip attachments. Alison Werner (01:56) Yeah. Tommy Crary (02:16) I've developed kind of a reputation of thinking outside the box and using auxiliary treatments like TADS and and hybrid treatments to get the job done as necessary. So I kind of get to apply my engineering degree a little bit with some problem solving day to day. So a little bit about me and then in terms of aligners in our practice, we Alison Werner (02:32) Yeah. Yeah. Tommy Crary (02:41) use them generally. I think I speak for all my partners and myself. It's not necessarily just adults or just adolescents. It's kind of just case selection based on what makes sense. Is the patient going to be compliant? Is this what they want? Is it a good case for aligners? And I again I I've kind of developed a reputation for pushing the envelope with them. I've got a cool portfolio of challenging cases and great finishes on otherwise, you know, that's Typically not a aligner case, but let's do it and and with the right cooperation and patient disposition, it's it's fun to get it done. So yeah, I I think it's it aligners are a wonderful tool for the right situations. Alison Werner (03:17) Yeah. Okay. All right. So you mentioned it there, but we're gonna focus in on the Clarity precision grip attachments in this conversation. So talk to me about when you first began working with them. What stood out to you compared with kind of the conventional attachment workflow you you were used to? Tommy Crary (03:34) Yeah, great question. maybe it's my engineering background, or maybe all of us orthodontists tend to be perfectionists and problem solvers. And I don't know, I go through my workday and I'm always looking at different things in clinic that like, hey, I feel like we could do this even better. It could be Alison Werner (03:43) Yeah. Tommy Crary (03:52) Protocols or materials, methods, systems we employ. Anyway, conventional attachments as we know them made my wish list on almost a daily basis. Just I wish they were better. And and anyway, when Solventum came out with these grip attachments, I was like, finally, that you know, they're finally here. This is what I've been dreaming of. I wish there was something better. We all know attachments are a necessary part of aligner treatment. But there's a lot of inherent issues with them and we'll we'll dive into that. but but I my first thought was just like finally they're here and I was thankful to be part of the development and pilot testing of the grip attachments and When we rolled them out, kind of what hit me most besides just these are exactly what I've been hoping for was they're actually pretty easy to implement for what they can do for the practice, workflow and and treatment outcomes. It's actually that was probably the second thing that hit me was like this really isn't that bad. Like they're they're pretty easy to implement. In terms of changes, you know, some changes I've made to the practice, it's like, wow, that was really hard to roll out. It sounded simple on paper, and then you start implementing it's like, okay. Alison Werner (04:59) Yeah. Tommy Crary (05:01) You know, we could have thought this through more, but yeah, compared to conventional attachments, just making this switch hasn't hasn't been that bad. Alison Werner (05:09) So from your experience and practice, where do the conventional attachments tend to create the most variability for the team or the patient? Tommy Crary (05:20) Probably at the delivery appointment. what I've found in terms of things that disrupt our schedule and the flow of the day, I'd summarize it by saying anything that's unpredictable is prone to disrupting the day. And some appointments are more prone to surprises than others. Like for example, retainer checks. most of them, you know, patients wearing the retainers, they're happy with the result, everything's going great. Alison Werner (05:45) Mm-hmm. Tommy Crary (05:51) Keep up the good work, pat them on the back, see you next time. Call me if you need me. but you know, maybe one in however many, it's like there's something, something off, and there's conversations to be had. Anyway, at the aligner delivery appointment, that one with conventional attachments I found was less predictable. things come up. you are trying to fill the attachment wells, whether you're using flowable or full bodied composite, whether you're doing at the beginning of the day or chair. With the patient. It's arbitrary. Flash removal is definitely not an exact science, and there can be voids. there's all sorts of things that come up and you know, a lot of times we're finishing those appointments on time, but not always. sometimes things would would come up, there's a lot of flash removed. Sometimes even you know, a couple lower incisors get bonded together 'cause there's a enough flash overflow. It's like, okay, that you know, that's gonna really disrupt the flow of the appointment. so that's I think That's probably the biggest variable is that delivery appointment. And certainly there is variability with the conventional attachments throughout treatment. And we'll get into that more I'm sure. But but at that first appointment, that's where you really feel the benefit of the grip attachments. Alison Werner (07:12) Okay. You talked a little bit about it there, but a lot of clinicians will think that, you know, flash as the as a cleanup issue. Why is it actually more than that? Tommy Crary (07:22) Good point. I agree. I mean, cleanup issue, yes, but exactly. It's it's so much more than that. for one, it's not a precise activity. You it's it's as imprecise as filling the attachment wells. even if you're wearing loops, even if you've got exceptional hand skills, removing flash is somewhat arbitrary. You're trying to get all the flash off, of course. But are you gonna gouge the attachment and and disrupt its geometry? Are you gonna leave some flash behind? Maybe some of both. I mean, we're not human CNC machines. It's hard to expect to be able to mill it back down to what it's supposed to be on the screen. And so and then not to mention it, you know, anytime you involve the hand piece, it's more stuff to get out. It's noisy and aerosols are all disruptive to the clinic. Patients don't love the hand piece. So any way you can eliminate the use of a handpiece, it's definitely a win. So I think that's part of the flash. And the other thing is it's it is humbling to get it all off. You do a refinement scan and you'll look at it, and it's like, you know, you think you're good, and then you do a scan, and the scans don't lie. You'll see Alison Werner (08:33) Yeah. Tommy Crary (08:34) Remnant flash, even if Alison Werner (08:36) huh. Tommy Crary (08:36) it's just adhesive flash, that shows up and of course you go back and get it, but the point is it's just it's tough. It's tough to get all and you know that affects the fit of the aligners. How could it not? Alison Werner (08:39) Yeah. Yeah. Yeah, yeah, absolutely. So ha then okay, so talk to me then about having a preformed 3D printed attachment. How does that change the bonding appointment for you, the doctor, the team, and the patient? Tommy Crary (09:04) I think it helps each of those parties. from a doctor standpoint, I still go over and check the attachments once they're placed, but increasingly it starts to feel like a formality. Like I'm just going over just to say hi and and and because they just they turn out great. that they're predictably good. but I still check them. you know, from the patient standpoint, yeah, avoid the hand piece and There's nothing worse than you know, you're you're trying to deliver the best care you can and first impressions make a big difference. So if a patient's starting off in treatment and all of a sudden, you know, an attachment comes off or they've got to go in and repair one because it had a huge void, or there's a lot of flash, and I come over and check and there's still more flash to get off, it's okay, you know, we're everyone's doing their best and as long as we get it right. But still you want patients, especially the first impression to be. Alison Werner (09:57) Yeah. Tommy Crary (10:03) the best possible and if it feels like things are going wrong, understandably you're gonna start to question like, you know, what what's going on? They had to redo that attachment twice. There was a void under it. They had to peel it off and get a new one on. So I think from the patient standpoint, definitely a lot smoother. And then my assistants love it. When I was doing that beta testing, the the pilot study on these grip attachments, we I remember the I'll never forget the morning. It was fun. It's like, hey, we're trying something new. It's it's a really cool technology I've been part of. And I of course talked to the patient, said, Hey, here's what we're doing, are you okay with it? And everyone was on board. I trained my assistants in. It was a pretty quick training session, but there's some little nuances to know. And then at the the end they're saying like wow these are really cool I can see why you're excited about it. When are are these gonna be widespread use or are is this kind of one and done? And I like, no they're they're coming. It's exciting and they're like, Well I can't wait till we get to use this on everybody. So really in terms of me, the patient and my team, everyone wins. It's great. Alison Werner (10:56) Yeah. Yeah. Okay, so what have you noticed about aligner engagement and tracking when using these grip attachments? Tommy Crary (11:20) Right. I'm convinced they fit the trays a lot better. It like one of my mentors defines happiness as any time that reality exceeds the expectations. And it makes sense. You know, someone tells you your food's gonna be ready in a certain amount of time and it comes out early, you're happy. But if it's much later than that, you know, the expectations not met. in the aligner game, in a way, the way I look at it is. The expectation is that the attachment that's made in the mouth is exactly what is shown on the screen after all the aligners are fabricated off of what's shown on the screen as an attachment. So the expectation is that in the mouth it's going to be an identical replica, but it's there's so much opportunity for error up front and along the way with attrition and fractures of of attachments that it's like, how can you say these are accurate? So I'm convinced that my tracking is improved. And I know Solventum did a survey of orthodontists and the overwhelming majority found that yeah, like we're convinced that there's better tracking. Of course the fundamentals must be in place, good compliance and a good plan and all that, but I I am convinced it's helped a lot. And I won't be surprised if with further studies on the topic, if they come back and say, yeah, it's like, you know, proven proven that it really improves tracking, even for tough tooth movements like extruding a lateral incisor and some of the notoriously challenging things. So it's exciting. It's fun to see it work. It's not only easier to place them, but they work better too. So it's it's been fun to see. Alison Werner (13:05) Okay. Yeah, you mentioned it there, but I was gonna ask you, are there certain cases certain case types or movements or number of attachments that you've noticed a difference with? Tommy Crary (13:18) Good point. I I tend to use fewer and this is with conventional or grip attachments, but I use fewer attachments, but when I do implement them, I use bigger attachments. And I I pretty much use grip for as many attachments as I can. Like if I know I need it, I'll use grip if I can. there are some limitations due to the manufacturing. If you need a second attachment on a tooth, or if it's on the lingual surface, or if it's too close to the occlusal or gingival margins, then it's gotta be a conventional. But otherwise, my team and I all are in favor of use grip whenever you can. And like they're they're disappointed if if they see the the the blue on on the little iodonogram map of where the attachments are going, they see them in blue. That Alison Werner (14:05) Yeah. Tommy Crary (14:11) Blue is for the conventional and gre green is for the grip attachments. And they're like, Do you really do these need to be conventional? I'm like, Yeah, you know, unfortunately they do. Do your you know, yeah, you still got it. But yeah, so they're kinda they they love it. They're spoiled kind of with the grip attachments now. Alison Werner (14:18) Yeah. there you go. Well, okay, so durability is another area that matters throughout treatment. So what should clinicians know about how these attachments actually hold up over time? Tommy Crary (14:41) Yeah, that's another advantage. I think of it as like back to restorative dentistry, anything made intra-orally, direct restoration, you know, direct composite fillings, versus anything made in the lab, crowns, etc. Anything made in a controlled lab environment is gonna be of higher quality. Surface, porosity, material strength, etc. So you know, for the Solventum grip attachments that are it's cool, it's a 3D printed proprietary, fully cured composite. And it it's just it's it's a lot more durable, stain resistant, because it's it's not gonna have the surface porosity that something made on the fly intraorally is gonna have. So they've shown it it resists staining dramatically more than any of the composites compared against and durability, they don't, they're not as prone to attrition and fractures as conventional attachments. So it it's cool. It's I I don't know how they do it. I think it's I think it's proprietary. Technique, but 3D printed composite, and another advantage of it being fully cured and ready to go is When you're gluing them to the teeth, conventional attachments, you don't really want to push the curing light on the attachment too hard. I mean you want to adapt the aligner template to the teeth, but if you push on the attachment too hard before it's cured, you'll distort it. The plastic's somewhat soft. But with the grip attachments fully cured, we we actually recommend pushing the attachment against the tooth fairly, you know, with fairly firm pressure. Use the curing light tip. And push it on there before starting the light up. And that way you're you're really limiting the bond interface between the the intaglio of the attachment and the enamel surface. And the thinner the bond interface, the better the bond strength. And and you can do that with grip attachments because they're fully cured. So that's why it's just it's such a perfect solution that they're just out of the box, custom made for each patient, fully cured, and a more durable material that's gonna resist damage throughout treatment, which is great. You can trust it Alison Werner (16:59) Okay. All right. So what advice would you give to a doctor who is interested but wants to make sure that implementation goes smoothly? Tommy Crary (17:11) Great, good point. It yeah, anything new, yeah, you you need to I'd say my best advice is it sounds kind of silly, but you know, read the instructions. they're it it's not the most challenging thing to implement. In fact I you know, I thought it was pretty straightforward, but there's a couple of nuances that make sense once you understand it, but for example, there's in the welcome kit when you order your first grip attachment, they send you all the materials you need to bond it. And there's a primer in there that you may or may not already have stocked. So definitely use that. And you know, we all want to keep inventory low on how many products you stock, but there's been a ton of quality research done on what's the best way to make these work. And so follow the directions, don't shortcut it. It's really it's I'd actually say easier than the conventional attachments to place So follow the directions. Consider getting your rep involved if if you want to. I'd encourage it. They may even want to be there for the first bonding and and kind of shoulder surf and watch the process and make sure it goes off smoothly and may have some helpful t tips for you. So that's how I'd go about it. I I was involved with Alison Werner (18:21) Yeah. Yeah. Tommy Crary (18:25) the development so I was really familiar with each step and why it mattered. But if this is new to you, just yeah, read the directions, talk to your rep and it should go off really smoothly. Alison Werner (18:28) Yeah. And it sounds like when you were kind of doing that beta testing with your team that the you know, it was a conv you know, you showed your team how to do it and it was a fairly easy transition for them. Tommy Crary (18:48) Totally. Totally. Yeah, they I I I actually I think it like the date kind of crept up on me and I I feel like I under prepared them. I was just like, hey, we're doing something new today. Here's the scoop, here's the steps. I'll kind of keep an eye on it. But I got a consult to hop into and let's see how it goes. Let me know if you got any questions. It was a pretty basic crash course and Everything stayed on and everything was great and they're like, Yeah, we love it. It was great. And the patient gave me thumbs up. They're Yeah, cool product. I don't know any different, but it this seemed to go pretty smooth. I was like, Great. So it was fun. That's right. Yeah, exactly. Alison Werner (19:30) All right. So if you had to summarize the value of the Clarity precision grip attachments in one sentence, what would you want clinicians to remember? Tommy Crary (19:42) I would say in the spectrum of new technologies and things that you can implement for what grip attachments can do for your workflow and predictability of the delivery appointment and tracking and stain resistance, etc., for for how powerful of a change it can make to your process, it's actually quite easy to add into your protocol. Compared to, you know, many other new things out there, there's there's so many great things you can consider implementing, but this is an easy one to do it with. Alison Werner (20:19) Yeah. Well, Doctor Crary, it's been great talking to you. I really appreciate you sharing your experience. Tommy Crary (20:26) Yeah, it's been a privilege being here. Thanks for having me.