Routine cases are all but unknown in the orthodontic practice of William (Bill) E. Harrell, Jr, DMD. Except that most of the cases he treats are routine. Or at least they appear as if they will be routine, until during the initial examination he puts his patients under the lenses of his 3D imaging system.

"With 3D imaging, I find problems I was not expecting—and I find them just about every time I image a patient," says Harrell, who practices in Alexander City, Ala. "I've found broken necks, fractured cervical vertebrae, airway obstructions, and more. All of these can have bearing on my orthodontic treatment plan."

An example: one 11-year-old girl who Harrell evaluated not long ago presented with a single crooked upper lateral incisor. "A seemingly very simple, straightforward case that could have been treated any number of ways: Invisalign, a Hawley appliance, standard braces," he says. "But my imaging system revealed that the tooth had hardly any root. A traditional pan would not have picked up on this lack of root, owing to the angulation of the tooth. I suggested to the mother that this tooth not be moved because to do so would result in it falling out." The mother was unhappy with that suggestion and, as such, took her daughter to another orthodontist, who agreed to move the tooth. "He didn't have the technology I have, so he couldn't see what I saw," adds Harrell, who chanced to run into the mother 3 months later at the local Wal-Mart. "I asked her how her daughter was doing. She contritely told me the tooth fell out, just as I'd warned."

A Paradigm Shift

The primary imaging system Harrell relied on to obtain that otherwise-impossible view of the child's incisor root is a cone-beam computed tomography (CBCT) scanner. Harrell's office is the first in the state to have one installed.

"I'm an early adopter, no question about that," he allows. "I come across a piece of technology and can tell very quickly whether it has the potential to someday become standard-of-care. If I think that it does, I become very passionate about it. I'm not one to wait for the science to come along and validate the new technology before I'll look into it; I prefer to be the one out there making the science."

CBCT has been available in the United States for craniofacial imaging since 2001. Harrell acquired his system (an iCAT from Imaging Sciences International, Hatfield, Pa) not long after that. He says he was attracted to CBCT by its fairly small hardware footprint and relatively low radiation dosage, but more so by the remarkable views it generates of the craniofacial region. "The pictures are stunningly detailed and crisp. Everything shows up in them," he enthuses.

In conjunction with the CBCT scanner, Harrell also employs a 3D facial capture system made by Atlanta-based 3dMD for diagnosis of asymmetries, jaw displacements, and growth abnormalities. A special software package fuses the output of the two imaging modalities and allows Harrell to construct lifelike simulations that help him predict the effects of various treatment strategies. "What these technologies and capabilities do is allow me to more quickly and accurately diagnose, which then make it possible to arrive at the most appropriate treatment plan possible. And that sets the stage for better results, greater patient satisfaction."

Harrell chose his practice location in part to be closer to the natural beauty of Lake Martin.

Harrell postulates that these technologies, with their rapidly increasing prowess at rendering images of the maxillofacial region and associated internal structures, are prompting a paradigm shift in the way orthodontists map out their cases. "Diagnosis, treatment planning, and outcome evaluation are moving away from being about ‘treatment needs assessment' and moving toward being about patient-centric care," he suggests.

Keeping Kids Safe

Beyond diagnostics, Harrell uses his advanced imaging systems to help find children who have gone missing. Specifically, he provides 3D facial scans of children whose parents enroll them in a national safety program called Kid I.D.

"Kid I.D. is the most comprehensive, state-of-the-art child identification system available," Harrell says. "In an emergency, a child's information can be rushed electronically to law enforcement agencies and other authorities across the country—information that would include fingerprints, DNA coding, and, of course, pictures, which is the part that I'm contributing free of charge."

Harrell says he decided to volunteer his services to Kid I.D. after becoming alarmed by the statistics surrounding vanished children. "The one that really disturbed me and roused me to want to take action was the estimate that every 40 seconds another child becomes lost or is taken by predators," he shares.

To get a 3D facial scan of their child for inclusion in the national Kid I.D. database, all that parents need to do is show up at Harrell's office with their progeny in tow. "The kids don't even have to be patients of mine," Harrell clarifies. "My goal is for every child in Alabama to be identified in this manner, because I truly believe it can mean the difference between having a missing child found and returned safely home or losing that child forever."

Harrell says diagnosis is moving away from "treatment needs assessment" and toward "patient-centric" care.

Harrell is heading for that goal one child at a time. Or, in some cases, 300 children at a time, as happened last year when Harrell took his imaging equipment to a local elementary school and spent the day working the high-tech camera.

Thankfully, none of the children scanned into the Kid I.D. system by Harrell has gone missing. He hopes none ever does. But even without the program being put to the test, Harrell has reaped enormous public-relations benefits just by offering Kid I.D. "It's helped elevate our status in the community, and caused parents to look at us in a more appreciative way," says Harrell, who believes he is the first US doctor of any stripe to offer 3D facial scans as part of the program.

A Streak of Good Lake

Another first to which Harrell can lay claim: no one before him in his family has been an orthodontist.

Harrell's desire to become an orthodontist traces back to his experiences as a preteen wearer of braces living in his hometown of Columbus, Ga. Harrell's orthodontist, aware of the science-loving lad's interest in working with instruments, allowed him to spend time in the lab. There, Harrell was introduced to the art and science of bending wires. "That really fired up my interest in the profession," Harrell remembers.

After high school, Harrell went to the University of Alabama at Tuscaloosa as a chemistry and math major (minoring in biology). He graduated in 1971. That same year, he started at the University of Alabama, Birmingham, School of Dentistry, finishing with a DMD in hand in 1975. Harrell then received his certification in orthodontics from the University of Pennsylvania, Philadelphia, in 1977.

For a time, Harrell planned to enter private practice in Columbus. But the closer he came to completing his training, the more he had second thoughts. "When I asked myself where I'd want to be in order to have not just a successful practice but a truly enjoyable life, the answer was Alexander City," Harrell says, explaining that he arrived at that choice because Alexander City is the largest town near Lake Martin, scene of many a Harrell family vacation. "My parents leased a cabin along the shore of the lake. Some of my happiest memories were of this place. So I decided this is where I'd like to open my office."

He did so initially by taking a small place in Alexander City. After 6 months, he moved to a medical building behind the town's hospital. He has been in that same location ever since.

Sleeper Sell

Harrell currently is Alexander City's only full-time orthodontist, with doors open from 7 am to 4 pm Monday through Wednesday, and from 7 am to 2 pm Thursday. His 1,800-square-foot, almost-paperless office is anchored by a four-chair open-bay operatory. A records room houses the CBCT system, the 3D facial-scan equipment, and conventional photographic cameras.

Limited space and a desire to avoid distractions that encourage young patients to dawdle in the waiting area keep him from transforming the office into an arcade-style fun zone, although the ambiance is decidedly lighthearted, owing to the joyful personalities of Harrell and his staff.

Harrell's professors at the University of Pennsylvania instilled in him an appreciation for light wire appliances, Roth technique, and early treatment. They also trained him to consider the patient's entire face—not just the teeth and the smile line—when assessing, diagnosing, and planning. Further, Harrell pays attention to identifying sleep disorders, which, he says, can have an adverse effect on the quality of orthodontic outcomes if left untreated. "In about 25% of cases, we're finding airway problems: polyps in the nose, maxillary sinus involvement, turbinate malformations, and narrowness in the arches," he says. "And in about 1/5 of those patients, it turns out they have early signs of TMJ degenerative changes—both children and adults. It's important to deal with these problems, because improper breathing can lead to changes in maxilla growth patterns."

Harrell does not himself attempt to treat airway problems. Instead, he refers cases to an otolaryngologist with ear-nose-throat surgery expertise.

Organization Man

Name an orthodontic professional organization, and chances are that Harrell belongs to it and has served it in a leadership capacity. For instance, he is currently the AAO's representative to the Standards Committee on Dental Informatics of the American Dental Association. He is a past president of the 9th District Dental Society of Alabama, the Alabama Association of Orthodontists, and the University of Pennsylvania's Orthodontic Alumni Association. He has served on the Alabama Dental Association's Board of Trustees and in its House of Delegates. He was a director of the Southern Association of Orthodontists, and held a seat on its technology committee. A diplomate of the American Board of Orthodontists, Harrell also is a member of the College of Diplomates of the American Board of Orthodontists and a member of the Midwest Angle Society.

Somehow, he carves out time to serve on the editorial review boards of the American Journal of Orthodontics & Dentofacial Orthopedics and the Journal of Oral Surgery, Oral Medicine, Oral Pathology & Oral Radiology. Additionally, he lectures all over the world on the topics of 3D imaging, TMJ disorders, and sleep apnea.

Last year, he was a featured speaker at the 1st International Congress on 3D Imaging held in New York; this coming January 16–21, he will be a presenter at the Midwest Angle Society's meeting in Bonita Springs, Fla, where he will share original research on 3D facial imaging conducted in conjunction with the University of Pennsylvania's Department of Orthodontics. On March 13–15, he will lecture on 3D cone-beam CT and 3D facial imaging applications in orthodontics to the Kodak Users' Group in Atlanta.

Harrell even belongs to the occasional group with little or no connection to orthodontics, such as the Alexander City Rotary Club (he is one of its past presidents), which just goes to show that he does indeed have a life outside of practice. He shares that life with his wife of nearly 35 years, Jay, who teaches preschool at their local First United Methodist Church. He and Jay have two adult children. The younger is William III, who works in construction and is a military police officer in the Alabama National Guard (with a tour of duty in Iraq under his belt). The older is daughter Tatum, who lives with her husband and newborn son in Calera, Ala.

Eye on the Ball

The baby, incidentally, is not yet 6 months old but is said to be interested in playing golf already (as evidenced by family photos in which he is gripping his grandfather's clubs). Harrell has pledged to teach the little one how to be a duffer when he comes of age (possibly at 18 months or so). A finer golf instructor the child could not request: In September, Harrell shot a five-under-par 67 at the challenging, 7,600-yard Willow Point championship golf course not far from his home. "The only bad part about that score was it lowered my handicap from 5 to 4," he says. Harrell makes it a habit to hit the links at least once per week. He says the hardest two holes at Willow Point are the 13th and 14th: the former a 175-yard, par-3 peninsula green and the latter a very long par-4 where the wind often blows briskly against the ball's direction of travel.

Harrell is close to the age when most people begin winding down their careers. However, retirement appears to be the furthest thing from his mind. At the moment, Harrell is thinking about growth. "I'm hoping to expand my referral area beyond the 30 to 40 miles out that we currently draw from," he says. The vehicle for that expansion will be Kid I.D. and the other cutting-edge, value-added services he offers that are based on his 3D imaging capabilities. Harrell says, "The advantages of 3D imaging are difficult to overstate."

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Rich Smith is a contributing writer for Orthodontic Products. For more information, contact .