When I was first introduced to SureSmile, I thought the concept was interesting, but I didn’t see the point. 3D imaging, new treatment software, and robotic precision had a certain “wow” factor. But who really needed them? Were all these gizmos the brainchild of an entrepreneurial, yet ultimately ungifted wire bender? In my more than 19 years as an orthodontist, I’d seen over-hyped technologies turn out to be little more than fancy toys to brag about when marketing a practice. For an innovation to be truly transformative, it must show results. That’s just how SureSmile has won me over—not for mere cutting-edge gadgetry, but for its ability to improve almost every orthodontic outcome.
I first noticed SureSmile’s true potential when the Journal of Clinical Orthodontics published one of the first articles comparing SureSmile to traditional treatment. I was impressed with the improved ABO (American Board of Orthodontics) scores of the SureSmile treatments. Better end results like those provide more than enough justification to integrate new techniques and technologies. Yet SureSmile shows evidence of far more. It improves not only the final outcome, but results in fewer visits to the orthodontist and less overall treatment time. I was struck by the magnitude of that trio. I was determined to find out more. I contacted OraMetrix in Dallas and asked if I could pay them a visit. I’m from Missouri, the Show-Me State, so my intentions were not merely to learn more. I also wanted to become a patient. Two weeks into my SureSmile treatment, I knew the technique was the real deal. Never had I witnessed such accuracy in executing the smallest of details. I was experiencing it firsthand. Within months I had integrated it across all of my offices.
After 12 years using SureSmile, I see it as so much more than a wire-bending tool. The SureSmile platform provides a strong foundation for diagnosis, appliance selection, and execution of orthodontic treatment. Its multimedia suite combines photography, intraoral scan, and CBCT. It does so in a dynamic way, with each technology interacting and responding to one another. Setting the anterior aesthetic plane or testing the bounds of the alveolus while expanding the dental arch is commonplace and extends far beyond establishing an ideal occlusion. The ability to measure the displacements of each tooth not only purifies the treatment plan, but helps to pair the ideal treatment appliance. More than that, it provides the needed insight to balance and fine-tune the mechanics required to achieve the desired result. This approach opens the door to new treatment possibilities, such as choosing different therapeutic appliances for each arch. In that way, SureSmile perfects the concept of combo appliance therapy. Previously, lingual, labial, or aligner therapy was planned and executed through different companies. Now, all of the available appliances can be designed on the SureSmile platform to complement one another.
With the release of SureSmile Aligner this year, both the SureSmile and Elemetrix platforms now offer a full arch, full-service treatment option that was previously unavailable. With SureSmile Aligner, we orthodontists can offer patients the SureSmile speed and precision with the highest standard of in-treatment aesthetics.
The SureSmile Aligner system is powered by an advanced orthodontic digital treatment planning platform, giving us orthodontists complete control of treatment. Ceph registered to 3D model and a smile photo supports more biologically available outcomes that enable shorter, efficient treatment times. A Pano analysis ensures optimal root axis for the final digital setup while facial registration of digital treatment plan data ensures ideal smile design. Each aligner is custom designed to the orthodontist’s specific treatment plan while being anatomically designed to the patient’s facial photo.
The patented software platform is built to grow with clinicians like us, allowing us to embrace the more advanced features at our own pace. Plus, unlike other aligner systems, all SureSmile Aligner plans are digitally designed with ABO graded finish.1 Finally, SureSmile CAD models are clinically proven to be the most accurate.2
One of the other things I like about SureSmile Aligners compared to other aligner systems is that SureSmile Aligners are part of an overall software system that delivers multiple treatment options within one software platform. This allows me to select the option that best fits my practice. For example, within the Elemetrix platform, I have the ability to perform full aligner therapy or hybrid, as well as indirect bonding, depending on the case and desired amount of customization. I also have the choice of having the aligners fabricated in SureSmile’s digital technology center or exporting the staged models for fast 3D printing in my office or lab. The legacy SureSmile platform also offers practices like mine access to robotic wire bending and more advanced features which essentially deliver virtually infinite treatment options within one integrated software platform.
We orthodontists also have options when it comes to how much control we want before and during full-service aligner treatment. We can choose Complete for greater flexibility, full-arch treatment, and unlimited aligners (up to 3 years) or we can choose Select which is ideal for treatment plans under a year and offers a pay-per-aligner structure. No matter what options we choose, we won’t be going it alone. SureSmile offers users like us an outstanding community of fellow doctors, giving us support every step of the way.
I’ve seen SureSmile’s powerful combination of features works in scores of patients. SureSmile opens the door to treatment options that were previously either unavailable or impractical, given the constraints of a particular case. I’m thinking of a 26-year-old bride-to-be who came to my office for treatment. She wanted the perfect smile—with bite and teeth straightened—and she needed it in a year (figure 1).
I had worked under these kinds of deadlines long before I was familiar with SureSmile. Most all orthodontists have. You fashion a treatment plan that works and strive for perfection within the time allotted you. But SureSmile opens up new avenues, ones that—in the case of this bride-to-be—allowed me to deliver a treatment that was more effective, precise and less costly for the patient.
First, let me provide a synopsis of how the patient presented for treatment. She had a Class I molar and canine relationship with right maxillary canine slight class II tendency by 2mm (figure 2). The maxillary midline was 1mm to the right and mandibular midline was 1mm to the left. She exhibited an interior open bite with reverse smile. She had tapered maxillary posterior corridors with recession on the buccal of canines and 1st premolars (figures 3 and 4). Finally, she had anterior tongue thrust upon swallowing, with normal speech.
I begin all of my SureSmile treatment plans with a simulation establishing the anterior aesthetic plane. I next transitioned from the maxillary anteriors to the buccal corridor (figure 5). In this patient’s case, I wanted to increase the display (width) of the premolars, but I was limited by the lack of buccal bone to tipping the roots palatal and the crowns to the buccal, all the while striving for an improved bone to root relationship. Fortunately, this balance was achievable (figure 6). Further movement outside of the buccal confines would likely lead to additional recession. I have come to observe that many patients have roots on the outer limits of the alveolus and yet do not display any clinical signs of recession. I have also observed other patients with generous amounts of buccal bone and plenty of room for expansion. I enjoy knowing exactly the boundaries for every patient. When the information puts me at a crossroad, it is easy to discuss and demonstrate to the patient or collaborating dental clinician the potential scenarios.
With SureSmile, establishing the dental occlusion now comes easily. The software measures the desired movements for every tooth (figure 7). I can now begin to review the combinations of movements and identify the available therapeutic appliances. This is where SureSmile excels, and this is where it worked best for this patient. In more conventional treatment, this patient would be limited to a selected bracket prescription and the expertise of the orthodontist to properly position brackets and to customize wires for finishing. With SureSmile, I don’t have to settle for one of a few available prescriptions. Instead, I get a customized wire or aligner series planned for each and every tooth.
In the case of this bride-to-be, I combined lingual treatment for the maxillary dentition and SureSmile aligners for the mandibular dentition—a simultaneous combination that I would not have considered for her before I began using SureSmile (figures 8 and 9). SureSmile’s capability to robotically bend custom copper nickel titanium wires is invaluable when it comes to lingual treatment, where tolerances for error must be kept low. Human hands are less capable of rivaling this level of precision or, for that matter, even working with materials that can only be effectively crafted at temperatures of 1,000 degrees. With conventional treatment, you hope for the best, then adjust accordingly. With skill and effort, orthodontists can and do achieve beautiful results despite these challenges. But with SureSmile, the potential for success is far greater. The guesswork is gone, the precision is bankable. Treatment plans are then executed precisely as they were prescribed. There is a direct connection between diagnosis and therapy, but good cosmetic results are only part of this case study.
Quality orthodontics is about more than beauty and aesthetics (figures 10 and 11). It is about dental health. In the case of this patient, SureSmile’s 3D imaging technology kept the treatment focused on good dentistry, not merely a pretty smile. When treatment began, she exhibited a recession in the canine and pre-molar region. When treatment was complete, we reversed the consequences of dental recession and created for her a better foundation of periodontal health (figures 12, 13, and 14). This might not have been the case with generic wires and select prescription brackets. SureSmile isn’t merely about making treatment more efficient. It’s science and technology ultimately in service to a greater goal—improving oral health outcomes.
As this case and so many others like it that I’ve witnessed prove, SureSmile coordinates all treatment elements to provide the most precise and excellent orthodontic services possible. I once was skeptical that a new technology could do all that. Now I can say no other innovation has impacted my practice or added more value to my orthodontic brand. Integrating SureSmile has been the single best decision of my clinical career. OP
Brent Bankhead, DDS, MS, completed his undergraduate degree in biology at Brigham Young University. He graduated from the University of Iowa Dental School in 1996, completing his residency and orthodontic certification at Saint Louis University. He was awarded his masters from Saint Louis University in 1998. He has been in practice for 19 years in the greater St Louis area. He is part of a multi-doctor, eight location practice. He is an adjunct faculty member at Saint Louis University. Bankhead is a member of Orametrix’s advisory board and a lecture/mentor for the company.
Footnotes
- SureSmile automated quality scoring methods were designed and implemented in accordance with ABO Calibration Kit. ABO is not a registered trademark of Dentsply Sirona; no endorsement is implied.
- University of Minnesota study conducted in 2014. Grunheid T, Patel N, DeFelippe N, Wey A, Gaillard P, Larson B. Accuracy, reproducibility, and time efficiency of dental measurements using different technologies. Am J Orthod Dentofacial Orthop. 2014;145(2):157-164.
