THE Issue 3

PROT OL

Soft Tissue Diagnosis and

Active Early Concepts Consumer 2.0
“SAP” Bracket Positioning

e d u c a t i o n | c o m m u n i t y | c o l l a b o r a t i o n
CONTRIBUTORS
Dr. Thomas Pitts D.D.S., M.Sc.D.
Ortho Country Orthodontics
Dr. Pitts is a world renowned lecturer and clinician. He is highly recognized for his continued
teaching of orthodontic finishing and clinical excellence. Dr. Pitts is an associate clinical professor
at the University of the Pacific and founder of the well-respected Pitts Progressive Study Club.

Dr. Pitts has been published in multiple journals and clinical publications. He has been actively
teaching the orthodontic community in a variety of settings both nationally and internationally
since 1986.

Dr. Duncan Brown B.Sc., D.D.S., D. Ortho

Smile Zone Orthodontics
Dr. Duncan Brown is a highly regarded international speaker and educator in passive ligation
bracket systems. Dr. Brown teaches regularly at the University of Alberta and University of Manitoba
and is also a Kodak/Carestream Dental speaker and consultant.

Dr. Brown has made large contributions to the orthodontic community from creating effective
hygiene programs for patients, to the G&H Pre-Torqued Archwire series and much more!

Dr. Nimet Guiga D.D.S., M.Sc.

Guiga Orthodontics
Dr. Nimet Guiga is a Portuguese-Canadian with a worldwide living and studying experience.

In addition to her authenticity, Dr.Guiga’s highly specialized training and clinical experience enables
her to diagnose and treat quickly and effectively even the most complex orthodontic situations.
She has patients from all around the world who especially come to Cascais to seek her for
orthodontic treatment.

Debbie Brown
Smile Zone Orthodontics Office Manager
Debbie Brown is trained as a Chartered Accountant, and has managed SmileZone Orthodontics for
over 25 years. Debbie will share the office experience with OrthoVend as a simple way to manage
inventory and save money.

Eric Ackerman
Ortho Classic Graphic Design Manager
Eric Ackerman has worked with Ortho Classic for more than 10 years developing and nurturing
their brand perception and awareness. He has helped invigorate their marketing campaigns and
has been key in the development of the Ortho Classic, OrthoAMP, Ortho University, and Ortho
Country brands within their target markets. He has developed many tangible elements that create
an emotional connection between the companies’ products and their target audience using a
variety of avenues for focused brand communication.
THE

PROT OL
TABLE OF CONTENTS

6 Active Early Concept

Learn About Flipping and Flocking Brackets

20 OrthoVend
How OrthoVend Changed our Practice

Soft Tissue Diagnosis &

22 SAP Bracket Positioning
Journey Towards Orthodontic Exellence

32 Consumer 2.0
Marketing to Today’s Consumer

© 2015 Ortho Classic. All rights reserved.

No portion can be reproduced without the expressed
written consent of Ortho Classic
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THE Issue 3

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4 2015 Issue 3 // www.orthoclassic.com

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 CONCEPTS

FLIPPING AND FLOCKING

“We cannot solve our problems with the same thought processes
we used when we created them”
-Albert Einstein

© O RTH O E VO LVE 201 5

6
 Introduction
  We live in a challenging time. Orthodontic clinical procedures and esthetic
preferences continue to evolve, so that the clinical approaches that we rely on today
are different than those that earlier generations of Orthodontists used frequently1.

  Esthetic declines that were quite common with treatment2 (including flat incisal plane
and excesive retraction of incisors) are no longer acceptable to the majority of patients.
Where “straight teeth” were once a primary goal, today’s parents/patients frequently
seek orthodontic treatment for esthetic improvement3, in addition to health benefits.
Contemporary research supports the human social benefits that accrue with improved
esthetics such as: more friendly, more intelligent, more interesting, more likely gain
better employment, more self confidence, more socially competent4.

  Fortunately, diagnostic appreciations have kept pace with these trends, with the
increasing appreciation of predominance of the upper incisor position in 3 planes
of space to esthetic outcomes5, while planning for age related esthetic changes. I
subscribe fully to this approach.

  Virtually every Orthodontist that practices today uses some variant of the “straight
wire appliance”, a concept that has dominated our profession since Larry Andrews’
breakthrough article led to its development in the 1970’s. Today I use the H4 bracket,
a precision “straight wire” appliance that incorporates a number of unique features at a
great price point. Over the years, I have developed a case management strategy that is
called “Active Early”, which leverages the features of the H4 appliance (Figure 1), while
overcoming many of the misconceptions imposed by rigid adherence to “straight wire
theory” for anterior torque and anxial inclination.

  Today I would like to further expound on the dual roles of case management strategy
and appliance selection to address some of the limitations in traditional application of
straight wire in a PSL setting in controlling anterior inclination.

Active Early Torsion Model

Tipping Torsion Inactive

Early Tipping Non-Adjustable Adjustable

Finishing
Mechanics Mechanics Mechanics
Figure 1: Pitts “Active Early” approach to case
management uses lighter forces, applied for
longer duration, earlier in the treatment cycle Tipping Torsion
to improve control of both axial inclination and
transverse arch development
Straight Wire Torsion Model
© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2 015 Issue 3 7

 .028 Slot Challenges of Torque Expression in
a “Straight Wire” Context:
  Orthodontics lost one of our great thinkers this year with the untimely passing of
Charles Burstone. Dr. Burstone clarified the distinction between axial inclination (the
buccal lingual inclination of the teeth), bracket slot (labio-lingual) angulation (incorrectly
termed torque), torsion (the forces resulting from a couple within the system), and
torque expression (the result of torsion). Clinicians, being primarily concerned with
torque expression, must be mindful of four things:
10 Weeks - .014
1. Contemporary fixed orthodontic treatment is usually completed in wire sizes that
are less than full dimension7 for the designed bracket slot. The consequence of this
incompletely filled bracket lumen is torsional play that decreases engagement of
the contact between the arch wire and the bracket8. While decreasing friction, a
potential benefit during early leveling, aligning, and sliding mechanics, torsional play
reduces control of axial inclination necessary for ideal esthetics. In clinical practice
then, incremental increases in arch wires size is NOT an effective means of
controlling axial inclination when the slot isn’t filled9.

10 Weeks - .018 2. Torque expression is a complex process dependent upon10: magnitude of torsion,
wire stiffness or resilience, bracket design, engagement angle, mode of ligation,
wire dimension corner radius, angulation of the bracket slot, deformation of the
bracket or wire under torsion, manufacturing tolerances in the bracket and the
wire, initial tooth inclination, bracket position, and the measurement technique
used to evaluate torsion. Fortunately, to the clinician, it matters solely when/
if torsion is developed within the slot during commonly used arch wire
progressions.

3. Today’s treatment targets for incisor position in 3 planes of space are based
on esthetics11,5, so that reliance on “treatment built” into the appliance through
10 Weeks - .014 x .025 anterior slot “torque” angulation to the occlusal plane is not a practical way to
ensure esthetically superior results. In the “Active Early” approach, individualized
Change to H4 bracket positions based on esthetics9 (SAP) is combined with other initial planning
considerations, to gain control of axial inclination earlier in the treatment cycle than
with .026 Slot has been possible before.

4. The hardest torquing mechanics today for many orthodontists is lingual crown
torque with occlusal plane variable. Because of this variability, we like to relate the
anterior inclination to FH and not the occlusal plane, so that the labial surface of
the maxillary incisor is perpendicular to corrected FH.

.014 x .025

2 Weeks - .014 x .025 Final

Rotational control problems resolved and improved control of axial inclination with H4 bracket and 026 depth slot
- Courtesy Daniela Storino 2014

© O RTH O E VO LVE 201 5

8 2015 Issue 3 // www.orthoclassic.com

 “Active Early” Case Management Protocols
and the H4 Precision Bracket

  In “Active Early” protocols the appliance is activated as early as possible, using

the SAP12 bracket position to adjust vertical position of the incisors, inverting groups
of brackets where necessary. We have developed protocols to address torsion in
the appliance, selecting arch wire progressions that control axial inclination early in
treatment, arch forms that develop the posterior segments of the arches sooner,
ELSE (Early Light Short Elastics) to control forces and moments, and appropriate
disarticulation to encourage early “wanted” tooth movements9,, both A/PE vertical.

  Working with Ortho Classic® and their precision manufacturing, we have been able,
to introduce meaningful innovations that make an impact on the Orthodontists ability
to both control and predict how the PSL appliance will respond. Where commonly used
PSL brackets have manufacturing inconsistencies that become clinically significant13,
OC has manufacturing tolerances that are much tighter for more predictable
performance. Secondly, we have reduced the slot depth to .026, which results in two
benefits: improving rotational control, and reducing the engagement angle for torsional
control early in the treatment cycle, when using familiar wire progressions (Figure 2)
when the bracket is upright.

  My goal in clinical teaching has been to simplify complex concepts in contemporary

case management strategies that can provide significant advantages in the treatment of
most orthodontic cases. This distinction is very apparent in the “Active Early” approach
to appropriate torque selection.

“Active Early” Approach Removes the Need for “Variable

Torques”
  The concept of variable torque is not new. Andrews was the first to suggest “variable
torque” Rx’s to customize the appliance Rx to specific clinical situations (generally
extractions). The current approach of “high, normal, and low” torques14 is not practical
and overly complicated in my view.

  With the worldwide tendency to treat more cases without extractions, the control of
proclination of the upper anterior teeth has become a greater challenge. Correction of
pre-existing crowding and proclination, proclination associated with relief of crowding
during traditional round wire mechanics, or incisor proclination associated class III
(in the upper arch) elastics is particularly problematic. The challenge for many non-
extraction cases has been in getting enough lingual crown torsion without having to
resort to complex wire bending to attain esthetic results.

orthoevolve.com // © ORTHOEVOLVE 2015

Wire Torsion that Reaches the Target Sooner

Figure 2: Combining Pitts SAP bracket position and reduced engagement angle of the H4 bracket system (.026 depth slot) enable development of
torsion within the slot earlier in the treatment cycle when the bracket is upright using familiar wire progressions.

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2 015 Issue 3 9

 Present PSL “Low Torque” Brackets with More Lingual Crown Torque on the Lateral than
Central Rx’s do not Simplify Management Significantly
  While variable torques has been touted to improve this situation, popular brand brackets with more lingual crown torque on the
lateral than central Rx’s endorsed by some PSL bracket producers increase case management complexity for me15 in many ways:

• Once in treatment, it is difficult to determine if an individual bracket has the

potential to create clinically effective torsion because the slides all open in the
same direction. This is very confusing, especially when bracket torques decisions
Bracket Prescription are made on a tooth by tooth basis.

• Low torque brackets with more lingual crown torque on the lateral than central
Rx’s are not sufficiently low enough in the maxillary centrals to overcome both
mechanical inefficiency inherent in the appliance, and biological resistance to
movement associated with uprighting proclined teeth. At the clinical level, it is
difficult to know what “torque expression” can be reasonably expected. Wire
bending is almost immediate.

• When thse low torque variable torque brackets are employed, on individual teeth
for localized concerns, the bracket must be repositioned, or the wire adjusted in
order to finish well16.
Low Torque
• When upper incisors with “low torque” brackets with more lingual crown torque on
the lateral than central need to be activated further for esthetics, it is impossible to
do so with a uniformly spun wire due excessive lingual crown angulation placed in
the lateral bracket (figure 3), making either bracket replacement or complex wire
bending a necessity.

Simply put, for the most part, use of “variable torques” is confusing and very inefficient.

Torque Selection to Simplify Control of Axial Inclination -

“Flipping and Flocking”
Figure 3: Complication imposed by the use of   To avoid these complications, I have inverted standard torque anterior brackets for
“Low Torque” brackets where the Rx has greater
years to control axial inclination. Inverting the upper anterior brackets has the effect
lingual crown torque on the lateral incisor than
the central incisor when uprighting teeth with of building negative crown torsion into the appliance while using a flat wire (Figure 5).
uniformly spun wires. The H4 appliance Rx is perfect is this regard, predictable when upright, and appropriate
when flipped providing greater lingual crown torque to the central when uprighting of
the upper anteriors is required. The single H4 Rx, then provides torque combinations
suiting the majority of cases (figure 6) with a minimum of wire adjustments.

My teaching partner in crime, Duncan Brown, coined the terms “flipping and flocking”
as a memorable way of describing inverting groups of brackets to control changes
in axial inclination as a result of pre-existing conditions, relief of dental crowding, or
responses to mechanics. To our delight, many Orthodontists around the world now are
“flipping/flocking” regularly…….I can’t believe that is now in print.

Figure 5 - Effect of “flipping” an anterior bracket

is to place an effective degree of lingual crown
torsion in the appliance

“Flipping” places lingual crown

torsion in the appliance
upright flipped
© O RTH O E VO LVE 201 5

10 2015 Issue 3 // www.orthoclassic.com

Figure 6: Wide range of torques available in the
H4 bracket system attaining simply by inverting Torque U1 U2 U3 U4 U5
(“flipping”) brackets with an appropriate Rx
Normal +12 +8 +7 -11 -11
Low -12 -8 -7

Torque L1 L2 L3 L4 L5
High +6 +6
Normal -6 -6 +7 -12 -17
Low -7

Here are some highlights and benefits of using the technique:

• Choose bracket torques in groups, rather than on individual teeth. This greatly
simplifies bracket selection and case management when using adjustable wires,
and avoids having to replace brackets later in the treatment cycle, and simplifies
wire bending.

• Choosing to “flip” upper incisor brackets in cases with mild crowding and
proclination, “flock” upper cuspid brackets where significant crowding is present
in the upper arch, and “flip” lower incisor brackets when class III mechanics are
anticipated. It is immediately apparent, which upper anteriors brackets will have
active lingual crown torsion, as those brackets with slides opening to the gingival
are “active” when “flipped”. The Orthodontist knows immediately if active torsion is
present within the slot or not (Figure 7).

• Standard wire progressions with “flipped/flocked” brackets will produce effective

levels of lingual crown torsion with commonly used wire sequences. As you would
expect, uprighting of the upper anteriors requires space, gained through arch
development, slenderizing, or use of skeletal anchorage (TAD’s). The use of Pitts’
Broad arch forms are particularly helpful, in supporting arch development early in
treatment (Figure 8).

• When using “flipped/flocked” appliances, incremental increases in arch wire size

actually produces incremental increases in effective torsion. This is the way “straight
wire” appliances were designed to function.

• The inclusion of .020X.020 Thermal Activate Nickel Titanium and Beta Titanium
arch wires in the Pitts’ Broad arch forms allows active and effective lingual crown
torsion to be placed very early in the treatment cycle in either the second or third
arch wire (Figure 8). I am finding that many cases finish very nicely in .020X.020
wire dimensions, with .025 wire progressions being best suited for cases where
large degree of rotational control is required.

• When using “flipped” anterior brackets, we encourage the patient to be seen every
6-7 weeks when Beta Titanium arch wires are in place, to assess progress and
palpate the upper anterior alveolus.

• Once ideal axial inclination is attained, the appliance can be “deactivated” simply
by reducing the AW dimension or adjusting 3rd order wire bending in Beta T
arch wires. Of course it’s important to use alloy/wire profiles no larger than Beta
Titanium .019x.025 when using “flipped” appliances.

• We very rarely resort to stainless steel wires in the “Active Early” technique, although
it is available for those who wish it.

Figure 7: “flipped and flocked” upper appliance, Using these principles Orthodontists can achieve surprising benefits for our patients
“flipped” lower anteriors in a class III AOB with great efficiency (Figures 9 to 21).
patient

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2015 Issue 3 11

 Summary and Case Management Considerations
  In an earlier Pitts Protocol, we introduced the “Active Early” Case Management strategy12. By combining the SAP bracket position
to adjust vertical position of the incisors, selecting arch wire progressions that control axial inclination early in treatment, using arch
forms that develop the posterior segments of the arches sooner, and relying on ELSE and disarticulation to encourage “wanted”
tooth movements, great things are possible. The decision to “flip/flock” anterior brackets as a part of the “Active Early” approach, in
combination with the precision and dependable Rx of the H4 appliance makes a quantum leap for our non-extraction and class 3
treatments in the areas that Orthodontists have traditionally struggled with other PSL appliances.

  In the “Active Early” approach, lighter forces, applied earlier, for longer duration are accomplishing many things more efficiently for
the Orthodontist, and more gently for the patient than has ever been possible before. Our work in improving the lives of our patients,
and the ease with which Orthodontist can deliver esthetically superior results efficiently is just beginning. With Ortho Classic, we are
continuing to refine the appliance, as the “Active Early” protocols continue to evolve.

  Look for us to introduce more meaningful innovations in the coming months, and thanks for joining us on the journey. It’s going to
be a fun ride! Until next time………..

.014 x .025 .019 x .025 .020 x .020

Active Torsion with Wire Progression

Figure 8: “flipped” upper appliance demonstrating effective levels of torsion, increases with incremental AW progressions. Note that 020x020 AW
provides almost the same degree of torsion as 019x025

Figure 9: Pre-Treatment Extra-Oral Photographs © O RTHOE VO LVE 201 5

12 2015 Issue 3 // www.orthoclassic.com

Figure 10: Pre-Treatment Intra-Oral Photographs demonstrating class III, AOB, with proclined upper incisors

Figure 11: “Active Early” Stage I Mechanics: SAP bracket position, “flipped and flocked” upper H4 appliance, posterior disarticulation, ELSE (TTB short
class III elastics FT, anterior reverse rainbow PM)

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2 015 Issue 3 13

 PRACM - 7 Months, 4 Appointments

Very Nice Control Early in Treatment

Figure 12: PRACM appointment (7 months, 4 appointments): Smile Arc is developing and excellent control of axial inclination with tipping and early
torsion mechanics

Figure 13: PRACM appointment: good control of axial inclination, and improvement in occlusion with very simple mechanics

Flipped and Flocked Appliance

.020 x .020 TA
Figure 14: PRACM appointment: “Flipped and
Flocked” upper appliance delivers effective
lingual crown torsion to prevent increased
proclination of the upper incisor with class
III mechanics in the upper arch. Flipping the
lower anterior brackets prevents retroclination
of the lower anteriors with class III mechanics.

Flipped Appliance
© O RTH O E VO LVE 201 5

14 2015 Issue 3 // www.orthoclassic.com

 Debond - 16 months, 10 Appointments

Figure 15: Debond Records: very nice esthetic changes, improved smile arc, uprighting of upper
incisors, improved incisor display

Figure 16: Debond Records: very nice esthetic change

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2 015 Issue 3 15

 Debond - 16 months, 10 Appointments

Figure 17: Debond Records: uprighted upper incisor, lower incisor has not retroclined excessively with light class III mechanics

Figure 17: Debond Records: upper incisor inclination has improved, lower incisor inclination has not deteriorated
© O RTH O E VO LVE 201 5

16 2015 Issue 3 // www.orthoclassic.com

 Debond - 16 months, 10 Appointments

Figure 18: Debond Records: very nice occlusal change with very simple mechanics, great control of axial inclination

Figure 19: Debond Records: very nice arch development with Pitts Broad arch form

Figure 20: Debond Records: very nice control

of axial inclination, the CBCT demonstrates the
presence buccal plate
© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2 015 Issue 3 17

 Author’s Comments

Dr. Tom Pitts Dr. Duncan Brown

“Our goal in teaching continues to be to improve esthetic and functional outcomes, while sim-
plifying treatment mechanics and improving predictability, and efficiency. In Active Early case
management strategies, “flipping and flocking” the anterior brackets provides activation of torsion
within the appliance without bending wires. The H4 precision appliance is perfect in this regards.”

1
Janson, G. Frequency evaluation of different extraction protocols during 35 years: Progress in Orthodontics 2014, 15:51
2
Ackerman J, Ackerman MB, Brensinger CM, Landis JR. A morphometric analysis of the posed smile: Clin Orthod Res 1998;1:2-11.
3
Samsonyanova, L. A Systematic Review of Individual Motivational Factors in Orthodontic Treatment: Facial Attractiveness as the Main Motivational Factor
in Orthodontic Treatment: International Journal of Dentistry , Vol 2014
4
Jung, M. Evaluation of effects of orthodontic treatment on self esteem, AJODO, vol 138, 160-166, 2010
5
Sarver, D. The importance of incisor positioning in the esthetic smile: the smile arc, AJODO 2001: 120; 96 to 111
6
Andrews, L. The six keys of normal occlusion: AJO, 1972; 62: 269-309
7
Badawi, H - Torque Expression in Self Ligating Brackets. a systematic review: Am J Orthod Dentofacial Orthop 2008 May; 133(5): 721-728
8
Meling, T - On mechanical properties of square and rectangualr stainless steel wires tested in torsion: Am J Dentofacial Orthop 1977 March; 111(3);
310-320
9
Pitts, T - Active early Principles - Pitts Protocols Issue 2, 2015; 8 to 14
10
Archambault A - A comparision of torque expression between stainless steel, TMA, and CuNiti in metal self ligating brackets: Angle Orthod 2010 Sept
80(5); 884-889
11
Cao, L - Effect of incisor labial lingual inclination and anterior posterior position on smiling esthetics: Angle Orthod 2011; 81: 121-129
12
Pitts, T. Begin with the end in mind and finish with beauty: SIDO Published online: 29/05/2014,
39-46
13
Thorstenson G - Comparison of resistance to sliding between SL brackets with second order angulation in the dry and saliva states: Am J Orthod
Dentofacial Orthop 2002; 121:472-82
14
Lacarbonara, M - Variable Torque Prescription: State of the Art , Open Dentistry Journal; 2015 (9), 60-64
15
Pitts, T - OrthoClassic, a leading authority in orthodontics, OrthoTown November 2014
16
Johnson, E - Selecting custom torque prescriptions for the straight wire appliance, Am J Orthod Dentofacial Orthop 2013;143:161-167

© O RTH O E VO LVE 201 5

18 2015 Issue 3 // www.orthoclassic.com

 How It Changed Our Practice
“Do we REALLY need a “vending machine” in our office?”
I remember saying.

6 months prior to our adventure

with the “vending machine”, we had
transitioned the office from using an-
other popular self-ligating bracket, to
Ortho Classic’s H4 self-ligating bracket
system. We had so much success
with the H4, my husband Dr. Duncan
Brown (I only call him Doctor when
he makes me mad) decided to give
the OrthoVend “vending machine” a
shot. It made sense to try, due to the
fact that we could receive such amaz-
ing pricing on the H4 bracket, but
having managed the administration of
our office for the last 25 years, I was
still pretty skeptical! Our office had
been on the cutting edge of technol-
ogy before, and I had seen the hype
consistently fail to meet outcomes,
with us investing far too much money
on good ideas that just didn’t work in
practice.

www.smilezone.ca
Debbie Brown
Smile Zone Orthodontics
Office Manager

20
 Before the OrthoVend Simplified Inventory Management
System I had become used to a lot of things:

• Carrying tens of thousands of dollars of inventory (we used to make an

appointment to buy a hundred thousand dollars’ worth of brackets – REALLY!)
• Carrying inventory of several different brackets with different torque options (ever
notice you only run out of the ones you need)
• Buying in large quantities (to get better discounts), then having to store them (and
then find them when it was time to re-stock the clinic)
• “Re-balancing” the inventory a couple of times a year because we had not
calculated the number of brackets we would go through correctly (that was a
chance for our Rep. to sell even more brackets to “top-off” the ones we were using)
• Having to do an “inventory count” every year of loose brackets for year-end
purposes
• Hearing Duncan complain, “We are out” of some particular bracket a couple of
months after we had re-balanced the inventory
• Trying to get the supplier to re-stock brackets that we had not used (I loved
re-stocking charges, and REALLY loved it when the company wouldn’t re-stock
them because the manufacturing dates were too old, or the bracket pattern had
changed)
• Cut the “monthly check” for the even distribution of the years bracket order, every
month (I hated coming back from holidays knowing that the suppliers check was
And my personal favorite
due, even when we hadn’t bonded any patients)

• Making a HUGE donation to the

graduate program at the local
University of brackets that we had
already paid for and not used, when
Duncan decided to switch brackets
or a new bracket pattern was
introduced.

Notice I said “become used to”, and didn’t

say I liked it. Many of you are doing the
same thing we were doing, year after year,
an endless black hole.

Enter OrthoVend and the

light started to shine! Now
we:

• Top off the machine when Ortho

Classic sends us brackets

REALLY that’s about it, no more bullet points (Are you amazed? Because I was!). Ortho Classic owns the inventory in the machine,
and we only pay for what we use, with a credit card at the time of purchase. Brackets don’t get lost, and we always have enough in
the machine to meet our needs because Ortho Classic keeps the count, not the office.

I am REALLY GETTING USED TO no hassle, no inventory, and no questions about whether we can handle our patient demand or
not. It’s really that simple. Using Ortho Classic’s H4 bracket and OrthoVend simplified inventory system we have minimized costs,
controlled inventory, and there is no check to write for the monthly bracket order if we are not bonding patients!

So if you’ve ever wished you had an employee or piece of technology that costs you nothing, saves you money, makes doing your
job easier, and never forgets where something is...OrthoVend is it! I only wish it held everything we used in the office. (Editor’s note;
we’re working on it.)

www.orthoclassic.com // 2015 Issue 3 21

 Soft Tissue Diagnosis and
“SAP” Bracket Positioning
My Journey Towards “Orthodontic Excellence”
Part 1 of 2

Figure 1: Extra-Oral Photographs for esthetic assessment: profile rest, profile smile, 45 degree smile, animated smile

“In Contemporary Orthodontics we must strive for clinical goals

of excellence in both esthetics and occlusion.1”
-Dr. Tom Pitts
This is the first of two articles that
Dr. Guiga has been kind enough
to provide for publication in The
Protocol, and will concentrate
on the role of diagnosis, and SAP
bracket positioning in attaining
esthetically superior results.

INTRODUCTION

  I graduated as a dentist in 1992 from the University of Coimbra Medical School,

Portugal, and practiced for 6 years as a general dentist, specializing in Implantology
and Oral Surgery. In 2007, I decided to become an Orthodontist to be more involved
in smile esthetics. Professor Jacques Faure directed a wonderful Ortho Program at the
University Paul Sabatier in Toulouse, France. Professor Faure taught me the discipline
of clinical orthodontics, excellence in photography, models, and quality of x-rays
to fully document cases. Taking pictures every visit and managing case mechanics
with efficiency was of utmost importance to him, and I am forever grateful for his
mentorship.

  In my early years in practice, I strived achingly to achieve cephalometric results

dictated by the Tweed, Steiner, and Root analysis for all my patients. I studied the
lateral head x-ray and plaster models, did tracings on each patient, and planned
towards “evening out” the Steiner “box” (almost always with pre-molar extractions).
The questions that immediately came to mind were, almost always, “Which teeth are
you going to sacrifice in order to get your lower incisor in the proper position? What
mechanics do you need to get lower incisors right on the spot?” My belief structure
was that lower incisors properly placed and canines in Class I occlusion, would deliver
a patient that looked good and treatment results that would be stable. I believed that
failure to achieve these goals would banish me to rot in “Ortho-Hell” where visions of
crowded lower arches would haunt me constantly.

  There was just one problem...I disliked the way my patients looked after their
orthodontic treatment. Nasolabial angles were more obtuse, lip fullness was reduced,
and vermilion displays lessened. Posed smiles had reduced enamel display, flatter
smile arcs, less gingival display, and large buccal corridors. I was singlehandedly
aging my patients 10 years in just 2 years of treatment! Treating to cephalometric
profiles, consistently extracting bicuspid teeth “close to the problem”, and intruding
and retracting upper incisors to fit cephalometric ideal lower incisor positions was not
working for me or my patients.

  I had to find a better way, and would like to share with you what I have learned in my
journey towards “excellence”, in the hope that it might help you towards a “safe haven”
in orthodontics, and support the passion that we share for our profession.

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2015 Issue 3 23

 DIAGNOSIS BASED ON SOFT TISSUE AND THE
IMPORTANCE OF UPPER INCISOR POSITION:

  “Begin with the end in mind2” is a phrase used by Dr. Tom Pitts1,3 to describe the
clinical habit of planning orthodontic treatment mechanics based on the desired
esthetic outcomes at all levels. The concept of finishing excellence starting before
the appliance is placed based both on soft tissue diagnosis and micro-esthetic
considerations is one I have found particularly useful.

  Cephalometric standards can only serve as a general guideline, to compliment

esthetic based considerations, as good facial harmony can exist within a wide range of
Lips Closed cephalometric values. Even well treated orthodontic cases that meet every criteria of
the ABO guidelines for successful treatment outcomes, may not produce an esthetic
smile5.

  Today’s patients want beautiful, faces, beautiful smiles, and beautiful teeth, so soft
tissue based diagnosis includes a complete smile analysis in terms of tooth shape
and proportions, gingival esthetic characteristics and esthetic tooth and gingival
relationships6,7. As esthetic considerations are paramount, an artistic sense needs to be
trained and cultivated, and rigid rules cannot be applied to the process.

SARVER’S MACRO, MINI, AND MICRO ESTHETIC

Lips Parted
CONSIDERATIONS AND “ANTI-AGING ” ORTHODONTICS

  Dr. Pitts supports David Sarver’s concept of macro, mini, and micro esthetic
considerations3, focusing on systematically evaluating the esthetic needs of each
particular patient with concentration on clinical examination of the patient both at rest
and during smile animation in all 3 dimensions of space.

  The 4th dimension - time - is also considered. Patients want to look great not only
after treatment but also 20, 30 and 40 years from now. The anticipation of the aging
effects brought upon the face and peri-oral tissues have to be taken into account in
our treatment planning, especially if one of the goals of treatment is to slow or reverse
the effects of aging on the face8. One discipline that Dr. Pitts suggests, that I have been
using for years, is the assembly of photographic diagnostic materials with the patient
Posed Smile standing in NHP (Figure 1, 2). Taking this series of photographs at critical milestones in
treatment allows me to focus on esthetic needs aside from the stresses of the clinical
schedule, and is a wonderful practice distinguisher for patients.

  Today, I will focus solely on some the mini-esthetic aspects of esthetics that we can
control orthodontically. Dr. Pitts has invited me to contribute another article on micro-
esthetic refinement of “the white and pink” tissues, so look for that in the next issue of
The Protocol.

Animated Smile
Figure 2: Series of EO frontal photographs
showing: lips closed, lips parted, posed smile,
animated smile
© O RTH O E VO LVE 201 5

24 2015 Issue 3 // www.orthoclassic.com

PITTS’ ACTIVE EARLY TREATMENT APPROACH AND THE
ROLE OF “SAP” BRACKET PLACEMENT
  If you have not been happy with the esthetic outcomes of your cases you are not
alone. Esthetic declines have been quite common with treatment9, but are no longer
acceptable to the majority of patients. Where “straight teeth” were once a primary
goal, today’s parents/patients frequently seek orthodontic treatment for esthetic
improvement10, in addition to health benefits.

  When I saw Dr. Pitts’ article where he discussed “smile arc protection/enhancement1”,
it was a milestone moment for me. Having read Sarver11, I understood the value of
a “consonant” smile arc (incisal edges of the upper teeth parallel to the lower lip in
posted smile), but was really at a loss on how to create it. In fact, my customary bracket
position commonly resulted in smile arcs that were worse after treatment than before
(Figure 3).

  Dr. Pitts’ diagram3 is a wonderful representation of the need to place brackets apical
to FA in the majority of cases (Figure 4). This has come to be called SAP (Smile Arc
Protection) approach to bracket placement.

  In SAP, the slot divergence created in the bonding progression from posterior to
anterior improves display of the upper anteriors and consonance with the curve of the
lower lip on smiling, without increasing the overbite. By enhancing the smile arc and
enamel display, esthetics is improved and harmony of the smile is created (Figure 5).

“Smile arc bracket positioning, is a case management strategy

that allows the orthodontist to protect or to create a more
curved smile arc and enhance upper incisor and gingival
display towards a more youthful and attractive smile, thus,
Figure 3: Flattening of the smile arch associated
improving esthetic and occlusal end results.” with bracket positions incisor to FA. The teeth
are straight, buccal corridors are filled, but the
smile arc is flat

Figure 4: SAP versus Traditional Bracket

Placement; for smile arc protection, the wire
plane should be parallel to the upper lip in
posed smile (yellow line), the incisor plane
parallel to the lower lip

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2015 Issue 3 25

 Figure 5 Above: SAP Bracket Position: Smile arc
has been enhanced by SAP bracket position
and good case management. The overbite has
not deepened beyond that desired to close the
AOB tendency

  The technique involved in SAP bracket placement has been published a few times
now1,3,12 so rather than repeat it, here are highlights I have found to be most useful:

• The vertical positions of the upper central, lateral, and cuspid are adjusted relative
to the upper posteriors depending on the steepness of the upper occlusal plane
• Lower posterior brackets are more gingival to avoid the occlusion
• Lower anterior brackets are more incisal to provide relative intrusion of the anterior
teeth and optimize overbite
• The contact points are aligned, and as the contacts points progress apically in the
upper arch towards the anterior, the slot plane follows the same progression

The degree of bracket progression is dependent on the desired position of the upper
incisor in an animated smile, so bracket position is individualized to optimize esthetics
(Figure 6).

Figure 6 Below: An Example of SAP bracket placement, designed to enhance the existing smile arc: note the bracket progression in the upper arch
from posterior to anterior. Due a tendency to openbite, and lower anterior brackets are placed more gingivally to close the AOB. Bracket placement
for H4 GO is the same as H4 steel

© O RTH O E VO LVE 201 5

26 2015 Issue 3 // www.orthoclassic.com

MY EXPERIENCE USING AN SAP BRACKET POSITION
  Having seen Dr. Pitts’ cases and desperately wishing to improve esthetic results for
my patients, I decided I had to learn more, and essentially became a “Tom Pitts stalker”,
travelling broadly in both Europe and North America to hear him. I attended some in-
office courses, but it was really the “Pitts Masters in Finishing” course that cemented the
concept for me. It is always harder to “unlearn” bad habits than it is to learn new good
habits. Along with my colleagues and good friends in the Master’s program, I learned
some new wonderful habits , the first was SAP bracket placement, and secondly was
the discipline to assess bracket position at PRACM13 and adjust it to respond to esthetic
progress in treatment. Where SAP bracket placement looked “odd” to me initially, it is
now one of my “orthodontic truths”, and I can’t imagine placing brackets any other way.

  I’ll try to explain why these concepts have made such a difference in my practice and
use a case taken from my practice to illustrate the concepts:

IN THE VERTICAL DIMENSION Figure 7: This young lady had a beautiful smile
arc prior to treatment with traditional bracket
  As the vertical position of the upper incisor in NHP is a prime diagnostic criteria in placement positions
developing superior esthetics in orthodontics4,6,11,14, with full enamel display and 2 mm
of gingival display considered as most esthetic in a posed smile. In adolescents, more
display is desirable, especially in women, as aging changes in the lips decreases display.

  Based on my training, traditional bracket positions, and case management strategies

designed to reduce overbite by upper incisor intrusion were common (Figure 7,8). In
an SAP approach placing upper anterior brackets more gingivally than the bicuspids
improves enamel and gingival display by adjusting the vertical position of the upper
incisors and cuspids relative to the upper posteriors3,11 (Figure 9).

  As the smile arc develops from bicuspid to bicuspid, assessing patients based on NHP
(which has been shown to be stable in both the short and longer term), Orthodontists
can more accurately diagnose and treatment for esthetic outcomes15.
Figure 8: Traditional bracket placement with
  As smile arcs are highly dependent on the occlusal plane, assessment of patients slot level at or incisal to FA. This wire plane will
result in relative intrusion of the upper incisor
standing, engaged in natural conversation, and generating unposed smiles, allows
and flatten the smile arc
the Orthodontist to make patient specific decisions on bracket placement: larger
progressions where more display is required (flat occlusal planes), moderate
progressions to protect the existing smile arc (normal occlusal planes), or modest
progressions in cases with mildly excessive displays (steep occlusal planes) where
transverse arch development will flatten the upper incisor curvature1.

Figure 9: SAP bracket placement with slot level

gingival to FA. This wire plane will protect or
enhance the smile arc, with relative extrusion
of the incisors.

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2015 Issue 327

 IN THE SAGITTAL DIMENSION
  There is a worldwide tendency towards treating more cases non-extraction16, and
with that the need to control the axial inclination of the upper incisor becomes more
challenging3 as axial inclination of the upper incisor has a dramatic effect on smile arc.
As patients are more sensitive to changes in axial inclination than to changes in A/P
position17, anything that mitigates against incisor proclination frequently associated with
non extraction is a good thing.

  I have found SAP bracket positions to be more effective in controlling axial inclination
in both the tipping and torsional phases of treatment:

• Early in treatment, relative incisor extrusion creates a retroclining moment that

helps control proclination as crowding unravels, when supported by early light
short elastics (ELSE) and proper disarticulation buttons18
• In the torquing phase of treatment, SAP makes the effective bracket Rx slightly
Figure 10: PRACM appointment - teeth are more negative, which helps recover from non-extraction proclination later in
aligned, but the smile arc has been flattened treatment19
due to brackets position. An adjustment of
bracket position and case management is
  When combining SAP positioning with Dr. Pitts’ case management strategies in
required
keeping the upper incisor forwards in the face, protecting both the nasolabial angle and
fullness in the upper lip, wonderful esthetic changes are possible.

  I agree completely with Dr. Pitts when he says that, “SAP bracket placement is
most effective when combined with other “Active Early” principles of ELSE, and
disarticulation3”.

Figure 11: Recovery of smile arc after repositioning brackets to SAP and adjusting case management

© O RTHO E VO LVE 201 5

28 2015 Issue 3 // www.orthoclassic.com

 IN THE TRANSVERSE DIMENSION

  Broader arch width, especially in the molars is more attractive, with smaller buccal
corridors being preferred in both men and women4,6,20.

  The alignment and broadening of maxillary and mandibular dental arches to reduce
buccal corridors and producing “10” or “12 “ tooth smiles result, in a reduction of
curvature of the upper incisors with respect to the inferior lip curvature ( flattening of
the smile arc).

  One of the biggest impacts on transverse arch dimension in the molars, and arch
form in general, has been the adoption of “Pitts’ Broad” arch forms in both non-
adjustable, and adjustable wire profiles. This arch form improves the “flow” of mini-
esthetics, making attaining a “12 tooth” smile much easier.

  By using a moderate progression SAP bracket placement, the Orthodontist can

broaden the arches and still maintain a beautiful smile arc.

THE PRACM APPOINTMENT AS A CRITICAL PITTS’ CASE

MANAGEMENT MILESTONE
  Dr. Pitts adopted the term suggested by Dr. Jim Moorish of “PRACM” (Pan/Repo
Adjust Case Management) to apply to the clinical milestone where occlusal and esthetic
progress is assessed and case management adjusted if needs be (Figure 10,11). This
is a truly wonderful concept in esthetic driven treatment, and greatly improves the
prospects of attaining superior occlusal and esthetic results (Figure 12,13).

Figure 12: Beautiful occlusion and esthetics after SAP bracket position and adjusted case management

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2015 Issue 3 29

 Figure 13: Beautiful occlusion and esthetics
after SAP bracket position and adjusted case
management

SUMMARY
My journey towards excellence is just
beginning. As Dr. Pitts develops better
treatment protocols, and Ortho Classic
continues to refine their H4 appliance,
I hope to follow along closely. Given the
wonderful changes that I have seen in my
practice in only the first few years of using
SAP bracket placement, and an “Active
Early” case management approach, I am
really excited for the future. I left general
practice to make wonderful esthetic
changes for patients, and using the SAP
bracket position is vital part of that.

Dr. Pitts has asked me to describe how

micro-esthetic changes in the “white
and pink” tissues contribute to better
SAP BRACKET PLACEMENT IN AN “ANTI-AGING” bracket placement and to overall esthetic
PARADIGM outcomes, and I am delighted to do that.
See you in the next The Protocol!
  One of Dr. Pitts esthetic goals in treatment is to slow, or even reverse the effects
of facial aging on esthetics; an approach he describes as “anti-aging”. Facial aging is
frequently accompanied by:
• Lengthening of philtrum and commissure heights
• Reduced fleshiness in the upper lip, with reduced upper lip thickness
• Reduced incisor display at rest
• Reduced incisor and gingival display on smile.
  This esthetic treatment strategy involves increasing dental mass over skeletal volume
(usually without extractions), positioning anterior teeth prominently in the smile forward
in the face, and positioned vertically for full enamel display, in anticipation of aging. All
are strategies facilitated by SAP bracket placement. © O RTH O E VO LVE 201 5

30 2015 Issue 3 // www.orthoclassic.com

 AUTHOR’S COMMENTS

DR. NIMET GUIGA

My dream is to make every patient that walks through my door leave with a beautiful smile for life.
I care about the position of your teeth and your occlusion as an orthodontist but I also care about
the shape of your teeth, the color, the way the light reflects on your teeth when you smile, the
brighteness, the proportions, the way your smile looks from every angle, the way it looks when
you laugh, when you talk, when you are happy, when you are sad, when you are at work or school
or when you say “I love you”. I even think about how it will look when you age, when the position
of your lips change.

1
Pitts, T - Begin with the end in mind, bracket placement and early elastics protocols for smile arc protection, Clin Impressions 2009: 17:1
2
Covey,S - The Seven Habits of Highly Successful People, Simon and Schuster, 1989
3
Pitts,T - Begin with the end in mind and finish with beauty, SIDO Published on line, 29/05/2014, 39-46
4
Brandao, RCB - Finishing procedures in orthodontics: dental dimensions and porportions (microesthetics), Dental Press J Ortho. 2013, Sept-October;
18(5);147-174
5
Schabel BJ - The Relationship between Post-Treatment Smile Esthetics and the ABO Grading System, Angle Ortho, 2008 78(4): 579-84
6
Sarver, DM - Dynamic smile visualization and quantification and it’s impact on orthodontic diagnosis, The Art of Smile, Chicago, Quintessence; 2005;
99-139
7
Sarver, DM - Principles of cosmetic dentistry: Part 1. Shape and porportionality of anterior teeth, Am J Orthod Dentofacial Orthop 2004; 126(6): 749-53
8
Term courtesy Tom Pitts
9
Ackerman J, Ackerman MB, Brensinger CM, Landis JR. A morphometric analysis of the posed smile: Clin Orthod Res 1998;1:2-11.
10
Samsonyanova, L. A Systematic Review of Individual Motivational Factors in Orthodontic Treatment: Facial Attractiveness as the Main Motivational Factor
in Orthodontic Treatment: International Journal of Dentistry , Vol 2014
11
Sarver DM. The importance of incisor positioning in the esthetic smile: the smile arc. Am J Orthod Dentofacial Orthop. 2001;120(2):98-111
12
Pitts,T - The secrets of excellent finishing. News and Trends in Orthodontics, April 2009
13
Term courtesy Jim Moorish - Pan/Repo/Adjust Cace Management
14
Camera CALP -Esthetica en Ortodonia: seis linhas hortzontais do sorriso. Dental Press Journal Orthod. 2010(15):118-131
15
White, L - The value of true horizontal in diagnosis and treatment planning - orthopracticeus.com, September 6, 2014
16
Janson, G. Frequency evaluation of different extraction protocols during 35 years: Progress in Orthodontics 2014, 15:51
17
Cao et al - Effect of incisor labiolingual inclination and anteroposterior position on smiling profile aesthetics, Angle Orthod 20;81; 121-129
18
Michael Major - personal communication
19
Pitts, T - Active Early Principles, Pitts Protocols 2015(2):8-14
20
Machado, AW - 10 Commandments of smile esthetics, Dental Press J Orthod, [online]. 2014, vol.19, n.4 [cited 2015-05-10], pp. 136-157

© O RTH O E VO LVE 201 5

www.orthoclassic.com // 2015 Issue 3 31

 CONSUMER
MARKETING TO TODAY'S CONSUMER

The Consumer 2.0 Connection

2.0
by Eric Ackerman Graphic Design Manager

  There has been a lot of discussion about Web 2.0, Marketing 2.0 and Net-
working 2.0, but the real key to your future marketing success will rely on
Consumer 2.0. The average consumer these days is no longer “average.” They
have unlimited access to information, opinions and education for just about any
product, service or business.

  Here’s a perfect example: I recently got my kids a puppy (Pembroke Welsh

Corgi) for Christmas. I personally haven’t had a dog since I was a small child,
and had no idea what type of vaccines he would require, what groomer I
should use (or even if he needed to be groomed), what type of food was best
for his breed, and many other questions. With a simple internet connection
and ten minutes, I was practically an expert on Pembroke Welsh Corgis. I
knew their dietary restrictions, their grooming needs (they only need their nails
clipped, and they shed a lot) and what set of shots he would need. I located
the best veterinarian in town based on customer reviews, found that Costco
had the puppy chow he required at the lowest price and located a natural
health pet supply store that had an owner who actually owned Pembroke
Welsh Corgis.

  As you can see, the information I needed came quickly and easily and be-
cause this information was all new to me, and I relied on the opinions of others
across the web to make my choices. This type of scenario is no different than
that of a potential patient who has decided they would like straighter teeth.
There is an abundance of information floating across the internet for them to
digest. They can search “straighten teeth” and view thousands of pages compar-
ing braces to aligners. They could go to YouTube and watch hundreds of per-
sonnel testimonials of actual patients. They could seek out friends and peers on
Facebook, Twitter, Instagram, Google+ and other social networking sites. Then
once they’ve made up their mind of what kind of appliance they want, they can
search for local orthodontists in their area. They will see Google results with
maps to offices, comparison pages with patient reviews, and actual websites to
the doctors in their area specializing in exactly what they are looking for.

  This is the point where your practice can really shine and your e-marketing
and social networking can dominate your local landscape to make their choice
an easy one. This is the point where your name and your practice’s name can
fill the entire first page of their search results. And with proper social marketing
this is the point where they realize that they’ve already heard about you and your

32 2015 Issue 3 // www.orthoclassic.com

 Consumers are tapping into their net-
works of friends, fans, and followers to
discover, discuss and purchase goods
and services in ever-more sophisticat-
ed ways. As the global economy strug-
gles to correct itself, and social-media
marketing becomes a strategic
imperative, orthodontic practices will
have exciting opportunities to expand
in new directions this year. The need
practice from their friends, acquaintances and peers. This is the Consumer 2.0 for trust, value and brand transparency,
connection. among other trends from last year, are
just as important today. But the current
  Let’s take a moment and back up and examine the roadmap to the Consumer
shift to geotargeting, mobile market-
2.0 connection. How can you get there? How do you create a positive web
ing and online reputation manage-
presence, and how do you bring in more patients? In its simplest terms, the solu-
ment require orthodontic specialists
tion is fairly straight forward; do what you’ve always done and focus on word of
modify their plans to surpass their
mouth. The internet and its social networks are simply amplified word of mouth
competitors.
consumers. Instead of little Johnny (or little Johnny’s mom) telling their personal
friends, family members, or neighbors about your practice, you now have them
telling the world, and what they say is up to you.

  Staying ahead of the message is the real key to successful consumer 2.0 mar-
keting. They can tell everyone how great you are, or, just as quickly, how much
they disliked you. Controlling the message is really the key component to taking
full advantage of Web 2.0 marketing.

  Orthodontics is an industry ready-made for social networking. Orthodontists

are specialists in their industry; providing services with an exceptional amount
of knowledge and precision that others simply can’t offer. Your job is to make
sure the average consumer knows the difference between visiting an ortho-
dontist and visiting a general dentist. This is also your opportunity to educate
them on why you’re the orthodontist they should be seeing.

www.orthoclassic.com // 2 015 Issue 3 33

 TEN MARKETING TRENDS
Orthodontists Should Incorporate Now to be Positioned for Success.

1
Build reliable brand advocates. The idea that you need tens of thousands of Twitter followers, blog
subscribers, LinkedIn connections and Facebook friends to build your practice via social media is
dead. Quality connections with those who are loyal to your
practice and brand are far more helpful to spreading your
message than large groups of connections who disappear
after the first interaction.

2
The key to Consumer 2.0 is their ability to create and distribute feedback and ratings of your busi-
ness and service. Consumers can easily read and post reviews of your business on sites such as
Yelp, Angie’s List and Yahoo Local to more industry specific sites like Dr. Oogle (www.doctoroo-
gle.com). It’s important to keep an eye on these types of website and manage your web presence.
Encourage your patients to post positive reviews and feedback. You can even setup a computer in
your office for them to use before they leave.

Excel in one area rather than be all things to all people. This will be a year for orthodontic
specialists to focus on their unique niches, and position themselves as the definitive source
for orthodontic services related to the specific places in the markets where they operate.

3
Create quality content as a viable marketing tool. Social media marketing and content
marketing go hand-in-hand, and this is the year businesses will create useful content !
that adds value to the online conversation as well as people’s lives. The web is
a cluttered place; amazing content is essential to break through the noise!

4
Move more marketing dollars into social media. Statistics show that large and small companies are
shifting budget dollars into their social media and other digital marketing initiatives, and away from
print and radio advertising. Consumers spend more time online than ever, and to reach them and
stay competitive small businesses need to have a presence on the social web.

5
Track brand reputations on the social web in greater detail. Social media
has given consumers a large platform to voice their opinions, and small-
business owners are realizing the importance of actively monitoring their
reputation on the web. With dashboards and social media aggregators,
it’s easier than ever for small businesses to develop, nurture and track
their stature online.

34 2015 Issue 3 // www.orthoclassic.com

CONTENT + CONTEXT + CONNECTION + COMMUNITY = SOCIAL MEDIA MARKETING

6
Increase branded online experiences to meet diverse consumer
needs. Simply having a Twitter account or Facebook page isn’t
enough this year. Orthodontists must surround consumers with
branded online destinations such as a blog, LinkedIn profile, YouTube
channel, Instagram account, Pinterest account, Flickr profile and so
on. Consumers can then pick and choose how they want to interact with your brand. Of course,
quality trumps quantity, so extending a brand across the social web must be done strategically to
maximize opportunities without compromising content and communications.

7
Pursue mobile marketing. There is absolutely no doubt this is the year of mobile
marketing. While still in its infancy, it is the marketing imperative of the future.
With mobile advertising, branded mobile apps, and mobile marketing apps like
Foursquare, consumers will expect businesses to have a mobile presence in 2012.

8
Make geotargeting and localized marketing a top priority. Local discount websites like Groupon,
LivingSocial and Google Offers as well as local review sites like Yelp, Yahoo Local and Angie’s List
make it easy for consumers to find deals and reviews about businesses in their neighborhoods
and beyond. Creating targeted, local marketing campaigns using these
popular tools will become the norm this year.

9
Accept that silo marketing is ineffective. Offline, online and mobile marketing
initiatives create an opportunity to lead consumers from one message to an-
other by integrating those strategies. You can drive a significantly higher return
on investment by cross-promoting branded online destinations, discounts,
contests and events.

10
Engage in co-marketing to boost returns and lower marketing costs. The economy is still strug-
gling, which means small businesses can benefit from economies of scale by partnering with
complementary businesses to develop co-marketing programs in 2012. Promotional partnerships
not only lead to reduced costs, but also can lead to increased exposure and new audiences. Ortho
Classic’s OrthoAMP service offers a great co-marketing program.

This year, all businesses will be experimenting with a variety of online, local-
ized and mobile marketing initiatives. Remember, even if you’re not leverag-
ing marketing trends and opportunities, your competitors are.

www.orthoclassic.com // 2 015 Issue 3 35

 All of these new social media terms
can often sound like Klingon. Here is a
quick guide explaining the jargon:

Web 2.0

The second generation of the World

Wide Web, especially the movement
JARGON CONFUSION
away from static web pages to dynam-
ic and shareable content and social
networking
$%&@ #%*#$!
E-Marketing

Using digital technologies such as the

Internet, e-mail and mobile to market
your business.
Twitter

TIP: A social networking and micro-blog-

ging service which enables its users to
Make note of the URL for your listings and start promoting send and read other users’ messages
these sites and stimulating positive reviews from some of called “tweets.” The social media
your most loyal customers to get the ball rolling in your favor. network is based on 140-character
micro-blog posts.
(Some of the review sites appear to list businesses with more
reviews above others when people do local searches.) Instagram

An online mobile photo-sharing,

video-sharing and social networking
service that enables its users to take
pictures and videos, and share them
Facebook
on a variety of social networking
Social Media Currently the largest social network on platforms, such as Facebook, Twitter,
the internet, built on the concept of and Flickr
Media for social interaction. Social
friend-to-friend connections
media uses web-based technologies
to transform and broadcast me- Google+
dia monologues into social media
Google Plus is the fastest growing
dialogues.
social network. Similar to
Social Network Facebook but with TIP:
access to other
A social structure made up of individ-
Google services Start publishing your positive reviews in other forms of com-
uals (or organizations) called “nodes,”
such as Gmail, munication (maybe a T-shirt!). These testimonials can add to
which are tied (connected) by one or
Google search
more specific types of interdepen- your marketing message and act as subtle reminders to other
and YouTube
dency, such as friendship, kinship, happy customers that they might want to post reviews as well.
common interest, financial exchange,
dislike, personal relationships.

36 2015 Issue 3 // www.orthoclassic.com

 NEW PRODUCT
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bonding permanent teeth.

The Phase 1 Horizontal

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The Phase 1 Eyelet is a

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37
Rev. A 09/03/15 | NPI 0330-001
 LinkedIn Geotargeting

A professional social media application The delivery of ads spe-

TIP:
Make sure you are listed on the major social media
which allows you to connect with col- cific to the geographic
leagues, business prospects or people location of the search- sites and that your profile and business information

within your industry. er. Geo-targeting is up to date and as accurate as possible.

allows the advertiser to
Yelp, Yahoo Local, Angie’s
specify where ads will or
List
won’t be shown based on
Social networks and local search the searcher’s location; enabling
websites that provide users with a more localized and personalized
platform to review, rate and discuss results.
local businesses.
Blog
YouTube
A blog (a blend of the term web log)
A social video website with content is a type of website or part of a web-
from both amateurs and professionals. site. Blogs are usually maintained by
an individual with regular entries of
Groupon, LivingSocial, Goo-
commentary, descriptions of events,
gle Offers
or other material such as graphics or
Localized (Geo-targeting) “deal-of-the- video. Blogs allow users to reflect,
day” websites. share opinions, and discuss various
topics in the form of an online journal
while readers may comment on posts.

Micro-blogs

A blog on which one posts brief,

frequent updates on one’s activities.

TIP:
Add a few reviews of your favorite local businesses, particularly

those you may have strategic relationships with.

38 2015 Issue 3 // www.orthoclassic.com

Upcoming Events
CAO - Canadian Association Advance In-Office Hands-On AAO 2016
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Victoria, British Columbia November 20 - 21, 2015 April 30 - May 3, 2016
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Dr. Daniela Storino Lecture Master Course Part IV
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of Orthodontics December 6, 2015 September 15 - 17, 2016
Orlando, Florida
October 4, 2015 Dr. Tom Pitts Lecture
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of Orthodontics
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January 20, 2016
SIDO
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www.orthoclassic.com // 2 015 Issue 3 39

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