Brace yourself


dental-practice-designOrthodontist Dr Stephen Papas needed a practice with cutting-edge design and technology to treat adult patients. Susanna Nelson reports

The bulk of an orthodontic practice has usually consisted of children and teenagers having their teeth straightened early in life. Dr Stephen Papas’s Brisbane practice, Imagine Orthodontics, is a little different—his business is pitched firmly at the adult market, and his patients don’t sport the mess of wireworks and grimaces traditionally associated with the field.

“Only 10 per cent of my patients have metal braces on their upper teeth.” – Dr Stephen Papas, Imagine Orthodontics, Brisbane

Ninety per cent of the patients at Dr Papas’s city practice are adults, and this has had an obvious influence on the sleek, contemporary design of his surgery. “The general aesthetic of the practice aims at pleasing the adult demographic,” he says. “It has a modern, stylish feel with clean lines and a mix of visual textures throughout.”

The practice was designed and completed by Queensland architect Joe Adsett. Joe is a patient, and had a from-the-chair perspective that enabled him to create a built environment that would be relaxing and pleasing for both staff and patients. “It’s
a beautiful environment in which to work,” says Dr Papas.

Dr Papas has aimed to ensure the clinics have a fresh, uncluttered feel, with ceiling-mounted lights and the latest Planmeca chairs, renowned for their ergonomic design. “We opted for the Ultra upholstery option for the chairs, which prompts a lot of compliments from our patients with respect to comfort. The first patient we saw after we opened fell asleep in the chair!”

“The general aesthetic of the practice aims at pleasing the adult demographic. It has a modern, stylish feel with clean lines and  a mix of visual textures throughout,” says Dr Stephen Papas.
“The general aesthetic of the practice aims at pleasing the adult demographic. It has a modern, stylish feel with clean lines and
a mix of visual textures throughout,” says Dr Stephen Papas.

The emphasis on aesthetics doesn’t end with the practice itself. Dr Papas’s special focus is on visually unobtrusive and invisible orthodontics that move away from the metal braces that are the bane of many teenagers’ lives. “Only 10 per cent of my patients have metal braces on their upper teeth,” he says. He predominantly uses aesthetic appliances: ceramic braces with aesthetic wires, lingual braces and Invisalign technology, and he is currently one of only three practitioners in Queensland whose practice focuses on this type of invisible orthodontistry.

Dr Papas explains how he uses the Invisalign technology: “We use an iTero scanner. The scanner is an intra-oral scanning system based on a ‘parallel confocal’ scanning protocol, which creates a 15-microns-accurate three-dimensional model of the dental arches. The information is processed locally and uploaded to the practitioner’s Invisalign VIP database. “Parallel confocal imaging essentially filters out reflected light that is not at a particular focal length. The data processing of the scanner is impressive, projecting 100,000 parallel red-laser beams and processing a 13.5mm scan depth in a fraction of a second.”

Comfort, as well as aesthetic appeal, is enhanced by this process. Among other benefits for patients, the iTero scanner eliminates the need for the lengthy and uncomfortable polyvinyl siloxane (PVS) impressions normally required and provides a highly accurate three-dimensional model of a patient’s teeth—more accurate than PVS impressions—with the elimination of the chances of impression material defects. “Because confocal imaging rather than trifocal imaging is used, there is an equal capture of all intra-oral structures without the need for a coating of opaque powder,” Dr Papas says. “This allows me to delegate the Invisalign process to my staff with the confidence that a perfect 3D model will result.”

dental-practice-design3The occlusal record is also taken with the scanner so that a perfectly accurate, digital bite record can be obtained. This is more accurate than Invisalign’s software-interpreted bite record, which creates an occlusion based on wear-facets and intra-oral photographs. The scan can then be immediately uploaded to the Invisalign database for faster case development. “I’ve had a case arrive for ClinCheck review the following day,” Dr Papas says.

The treatment involves a series of clear, removable aligners that gradually straighten the patient’s teeth over the course of a six-month to two-year period, with the average course lasting around 12 months. “The Invisalign aligners fit more accurately, so it follows that tooth movements are more controlled. This leads to better results and faster treatments,” says Dr Papas.

As soon as the initial scan is taken, patients are able to view a three-dimensional, computer-generated simulation of how their teeth will look when the treatment is complete. “The Invisalign Outcome Simulator allows an on-site simulation of dental alignment prior to an Invisalign submission,” says Dr Papas.

dental-practice-design4Perhaps because adult orthodontics are still a bit of a niche market, the technology has been slow to catch on. “Currently we’re the only practice in Brisbane to use the iTero scanner for Invisalign submissions,” Dr Papas says. “There may have been a slow uptake on this generally because the scanner is a reasonably expensive piece of equipment—unless there is
a high volume of Invisalign patients in a practice it may not be a worthwhile investment.

“My decision to use an iTero scanner was fairly straightforward, considering that I see a high volume of Invisalign patients, and considering the benefits mentioned above.

“I think the big selling points for me were the assurance of a highly accurate representation of the arches and a highly accurate bite record. The cost of the scanner in a high-volume Invisalign practice is little more than the costs associated with PVS impression taking, so in this instance it’s definitely a good investment to gain significant advantages. Being able to confidently delegate what is otherwise a very technique-sensitive process is a big balancer in the cost-effectiveness equation.

“The current generation of scanner is on a mobile cart which houses a PC, a UPS and small compressor so it’s a larger piece of equipment than would be ideal. The handheld scanner is also fairly bulky in small hands, however because the image accumulates sequentially there is no data lost along the way.”

Dr Papas is passionate about his field, and is currently collaborating with the University of New South Wales to develop new orthodontic technologies. His practice forms part of the Invisible Orthodontist network of practices around the country—a group which aims to move the field away from the conventional ‘mouth full of metal’ model towards braces-free dental correction.

Depending on the procedures involved, a course of treatment can cost between $4000 and $9000.

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