Clinical Pearls Session. BOC 2021. October 6th 2021. Episode 140

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Hosted by
Farooq Ahmed

Clinical Pearls session

Join me for this years clinical pearls session at the British Orthodontic Conference.

Topics covered included; gold brackets, pontics and fixed appliances, new tools for space measurement in hypodontia, social media, ligation and video consultations.


Speakers: Preetpal Bhogal



All that glistens is gold Preetpal Bhogal

  • Plastic and composite brackets
    • Lack strength, deform, wear
  • Ceramic appliances
    • Main alternative to metal
    • Challenge: Bond strength which does not harm dentition
    • Enamel wear – Douglas 1989
    • Special instruments – Sishi pliers, 3m debonders, Damon debonders
    • Heat on debonding – increase temperature of pulp
      • Possible use of high speed to remove bracket
    • Preet experience with ceramic
      • Monocrytaline
      • Polycryrtaline
        • Conventional ligating – staining of modules
      • Self ligating
        • Challenging brackets
      • Aesthetic wires
        • Tried many – chip of wire
        • Performance inferior than un-coated
      • Gold brackets – what can it not do and undo – Sha
        • American Orthodontics Iconic brackets
          • Same as master series
          • Aesthetics – lighter / Champaign
          • Easy upsell from metal, cheaper than ceramic
          • Sliver modules and pearl work well – as stain blend in better with bracket
        • Advantages Vs ceramic
          • Cheaper
          • Less friction
          • Deeper tie wings
          • Vertical slots and power pins
          • Gentler to enamel, wear opposing arch
          • Easier debond and reposition
          • No special instruments / wire



A trick to make the pontic stick Ian Murphy

  • Traditional approach
    • Impression, stock tooth, lab bond bracket and ligated to archwire
    • Issues
      • Debond: Not supported at gingival aspect = occlusal loading = bouncing
        • Composite weak in compression
      • Pearl
        • Labial and lingual flange
        • Undercut made where bracket is planned
        • Placed intra-orally – supported by gingiva, then bracket placed in supported position


LISA: what can she do for you? Jayne Harrison

  • Measuring spaces for hypodontia case
  • Liverpool Implant Space Assessment
  • Precision milled space analysis
  • Lisa 2
    • Curved design to measure curvature
    • Use on study models
  • Inter-rater reliability 0.84 – very good
  • Before use and after
    • Use of LISA: Space achieved in hypodontia
      • Before use of LISA 43% achieve ideal space
      • After use of LISA 72% achieved ideal space
        • Odds ratio 3.4 on achieving ideal spaces – stat significant
      • Not commercially available yet



Harnessing Social Media to market, educate and set up an Orthodontic Practice

Mohammed Al -Muzian

  • 5 elements for setting social media for marketing
    • Target (what we wish to achieve), Select platform, manager, deliver (consistently)
    • Engage
      • Share simple results – morph tools Fantamorpth / MortphX
      • Try to be cool!
        • Engage in challenges
      • Sponsor local school teams / businesses
      • Supporting charities
    • Customer-oriented business developments
      • For example cleaning robot to entertain patients as well
    • Opportunity to share on social media
      • Red carpet, clip boards
    • In house lab
      • QR code per patients to see their own models being made
    • Friends – encourage friends to promote, they will be our manager
    • Tooth brushing – American style room with photo opportunity- can then share on social media
    • Instagram like counter in the window
    • Varied content – fish eye camera live streamed on youtube
  • Teaching and social media
    • Orthodontic Mastery Group
      • 10k members
      • 300 webinars ran for free
      • Kevin O’Brien’s social education recommendations
    • Squat surgery established September 2020


Use Floss to ligate Malaligned Teeth Safoora Keshtgar


Floss used to pull the archwire into the slot in palatal direction

  • Wax floss advised
  • Creates space to allow ligature tie


 In praise of the video-consultation Megan Hatfield


  • Advantages of video
    • Replace TCO consult
    • Reduce direct contact
    • Before consult



  • Patient enquiry
  • Booked into diary 30 minutes
  • Email invite with additional information request
  • Request for photos prior to appointment
    • BOS link of how to take photos
  • Video
    • Additional lighting
    • Checklist of items to discuss
    • Typodonts to hand
  • Child and parent together
  • Conduct same as clinic – check history, MH, form of clinical assessment
  • Remind just a guide, clinical exam required
  • Provisional plan possible, payment options, book exam for follow up

Pre and post video

  • Conversion rate
    • 21% Vs 35%


  • Low risk – free
  • Low commitment, easy to fit in to the day
  • Initial fact finding
  • Enable multiple consults


Practice advantages

  • Meet patients
  • Nurse not needed
  • Streamline records visit
  • Reduce wasted appointments



  • Inability to examine
  • Poor connection
  • Admin time




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