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Brace yourself. Orthodontics, jaw surgery go high tech.

A girl’s success story shows how 3-D printing and other technology are transforming dentistry for the iGeneration

Tori Copeland smiles after jaw surgery for her overbite
Tori Copeland's smile tells the story. The overbite that made her self-conscious and caused some eating problems is gone and her teeth are finally straight. Photo by Sarah Pack
Helen Adams | adamshel@musc.edu | August 20, 2018

Charleston County School of the Arts sophomore Tori Copeland used to be self-conscious about her extreme overbite. “It was hard. I could see it, and I knew other people could see it. I didn’t really get bullied or anything like that. But sometimes, people talked behind my back. I had people who told me about that. Kids are just mean."

Tori Copeland with braces
Pre-surgery
Her overbite was so pronounced that when she closed her mouth, she could fit her thumb between her upper and lower teeth. Mealtimes could be tough. “Mostly, it affected eating things like apples and hamburgers, things that were hard and big. And drinking out of straws and drinking in general was kind of hard.”
 
Not anymore. Tori got braces at MUSC Orthodontics in the James B. Edwards College of Dental Medicine and had surgery through the oral and maxillofacial program. As a member of the iGeneration, which includes people born in the mid-1990s and later, Tori has grown up with smartphones, tablets and laptops. But the technology in her orthodontist and surgeon’s offices still surprised her.
 
“They did a 3-D print of my teeth,” she remembers. “It was very interesting. They had this laser thing, kind of like a tube. It had a light and they shone it across my teeth at every angle they could.”
 
Pictures immediately popped up on a screen by her dental chair. “I was astounded. It looked just like my teeth. It was really cool to watch. I don’t understand how they could do all that.” 
 
Dentistry in the digital age has transformed the clinics in the College of Dental Medicine. Tim Tremont, chairman of the Department of Orthodontics at the Medical University of South Carolina, says patients like Tori are reaping the rewards. “It’s a tremendous improvement in terms of quality of care.”
 
When he started working as an orthodontist about 35 years ago, it was a different world. “There were no computers, period.”
 
Now, technology drives the field. “Gradually, we’ve seen the practice evolve into what we refer to as virtual patient care and virtual treatment. We think about what’s next in technology all the time,” he says.



Virtual planning lets doctors see how each step of the surgical process should go. These images show how Tori's facial structure would look after surgery on her teeth, chin, jaw and anterior nasal spine (the pointy bone at the base of her nose). VSP Orthognathics
When it comes to the sometimes literally shining star of the orthodontics world, braces, virtual care may begin with intraoral scanning. The orthodontist waves a high-tech wand over the patient’s teeth to create digital images, as Tori saw.
 
“When we scan the patients’ mouths, their dental arches are on a computer screen,” Tremont says. “We can move around the image three dimensionally and plan treatment.”
 
Once the orthodontist has the images, a 3-D printer may come into play. “We can print out the models in resin and make appliances,” Tremont says.
 
The printer is a small, squarish device that sits on a counter. It takes the images from the intraoral scans and turns them into a model of the patient’s teeth. It does that by creating the model layer by tiny layer, starting from the bottom. 
 
Having that 3-D model lets the orthodontists and surgeons see exactly what they’re dealing with. Kinon Lecholop, the craniofacial surgeon who corrected Tori’s overbite, says it makes such procedures more precise.
 
“Tori's entire surgery was virtually planned beforehand, and we were able to perform the surgery on a computer before taking the plan to the operating room to perform the actual procedure. It’s called virtual surgical planning, or VSP,” Lecholop says. 
 
“We are able to 3-D print different stents to planned positions to move both her lower jaw and entire midface. She had an unbelievable result.”
 
Tori agrees. She’s healed from the surgery, her braces are off and she now has a permanent retainer on her bottom teeth and one she uses at night for her upper teeth.
 
“I definitely feel more confident in my teeth, especially knowing my teeth are straight and I’ve had everything done. I’m all set the rest of my life unless I have a cavity or anything, so that’s a great feeling to have.”

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