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SureSmile is a type of braces used by orthodontists to straighten teeth. With SureSmile the orthodontist combines 3-D imaging, treatment planning software and a robot to create the wires. The technique is reported in The World Journal of Orthodontics to decrease the time required to complete orthodontic treatment by 34% and increase the precision of the results.

How SureSmile Works
The orthodontists first take digital images of a patient's mouth and teeth using either a white light scanner or cone beam computed tomography (CBCT). The 3-D scanner transforms physical teeth into virtual teeth. The virtual model enables the orthodontist to visualize teeth not only from the front as with conventional orthodontics, but from all angles seeing roots, gums, things they never would have seen before without the imaging and software. Then as described on the Science Channel, with the software tools the orthodontist takes the teeth and individually aligns them into the proper position. Dr. Michael B. Stewart an orthodontist at Atlanta Orthodontic Specialists explained on Good Morning America that “[Orthodontists] have more control over how these teeth are moved than [they] ever had before."

Once the orthodontist has virtually designed the smile and bite, SureSmile software plans the most efficient and direct route for moving teeth into the proper place and sends this information to a robot that bends and shapes the wires specifically for that patient. The wire with all of the custom bends is then sent back to the orthodontist ready to place on the patient.

How SureSmile Differs from Traditional Braces

 * The treatment time is faster.  While a tooth will move at the same rate regardless of the method used, the SureSmile system moves a tooth to its target position in the most efficient path due to the software’s ability to calculate concurrent tooth movements and the robot’s ability to bend the wire to bend the wire precisely to generate the prescribed movement.
 * The patient only has 1-2 wire changes compared to many wire changes and/or adjustments with conventional braces. Unlike conventional treatment where the orthodontist manually bends a series of straight wires using pliers to move the teeth one-by-one into position, with SureSmile all the bends to move teeth are made in a niti (nickel titanium) shape-memory wire and when it is placed into the patient’s mouth-- their body temperature activates those permanent bends to move teeth directly into place. The end result has a more precise result.
 * SureSmile produces more precise results than traditional braces because of the software planning and the robot. Dr. Sammy Thabet of Germantown, MD explains on CNN Health Minute with Sanjay Gupta, MD,  The [treatment planning software] is accurate to 1/10th of a millimeter.  The robots are able to reproduce the accuracy with the wires and that is something I cannot do by hand.

Treatment Time and Cost
The range of treatment time for SureSmile varies from patient to patient. Generally however, finish times with SureSmile range from 6 months to 20 months. In the study also referenced above[1], it was shown that on average SureSmile treatment is completed 33% faster than conventional treatment. The cost of SureSmile varies from orthodontist to orthodontist. Some orthodontists include the cost of using SureSmile in their standard fees and some charge a separate fee. The price variance typically ranges fro 0-10%.

Lingual Braces
SureSmile has a lingual or behind teeth braces option called SureSmile QT. With lingual braces, brackets are adhered to the underside of the teeth on the to arch, bottom arch or both arches. Most patients choose lingual braces for aesthetic reasons, as they cannot be seen. Orthodontists that offer lingual braces will often suggest putting lingual braces on the upper teeth and clear ceramic braces on the bottom though patients can choose to have lingual braces on both arches. A news segment on WGN-TV Medical Watch recently featured SureSmile QT and explains that the same SureSmile robotic technology is used for the behind teeth braces.

SureSmile Advantages

 * Faster and more efficient treatment time.
 * Orthodontists say that they are able to achieve more precise results with the robotically bent wire.

SureSmile Disadvantages

 * Not all orthodontists offer SureSmile. Currently approximately 400 orthodontists in the United States, Germany, England, Japan, and Australia offer SureSmile.
 * The cost of SureSmile is often higher than traditional braces and varies from orthodontist to orthodontist.

SureSmile History
The SureSmile technology was developed and is owned by OraMetrix, a company founded in 1998 through the merger of two medical technology companies, one U.S. based and the other German. The company was launched globally in 1999 with the help of a $150,000 investment from STARTech Early Ventures LLC. Other key investors include Brentwood Venture Capital, CenterPoint Ventures, Rho Ventures and STAR Ventures. The SureSmile System received 510K marketing clearance from the FDA in November 2000. In 2003, OraMetrix relocated its U.S. corporate headquarters from Dallas to a larger, 25,000-square-foot facility in Richardson, Texas. Today, more than 100,000 patients have received or are in treatment with SureSmile at over 400 practices nationwide.

Further Reading and Studies on SureSmile
The editor of Techno Bytes, Dr. Robert Scholza, provides an in-depth interview with the Chief Clinical Officer of OraMetrix, Inc., Dr. Rohit Sachdeva.
 * “Interview with an innovator: SureSmile Chief Clinical Officer Rohit C. L. Sachdeva”, American Journal of Orthodontics and Dentofacial Orthopedics Robert P. Scholza and Rohit C. L. Sachdeva

According to the study, when compared with conventional finishing, SureSmile patients had significantly lower DI scores, less treatment time (,7 months), and better CRE scores for first-order alignment-rotation and interproximal space closure.
 * “Clinical outcomes for patients finished with the SureSmile method compared with conventional fixed orthodontic therapy”, Angle Orthodontist Timothy J. Alford; W. Eugene Roberts; James K. Hartsfield Jr; George J. Eckert; Ronald J. Snyder

Dr. Ed Lin gives an in-depth lingual case study using SureSmile QT.
 * “Class I with Deep Bite and Crowding Treated with Lingual, i-CAT & SureSmile”, Orthotown Dr. Ed Lin

The research shows that the SureSmile process results in a lower mean ABO OGS score and a reduced treatment time than conventional approaches with great potential to both decrease treatment time and improve quality.
 * “Efficiency and Effectiveness of SureSmile”, World Journal of Orthodontics Alana K. Saxe, DMD; Lenore J. Louie, MSc, DMD; James Mah, DDS, MSc, DMSc

This article describes the use of both ‘hard’ and ‘soft’ tools in managing the orthodontic care of a patient with SureSmile technology.
 * “Reframing Clinical Patient Management with SureSmile Technology”, Pacific Coast Society of Orthodontists Dr. Rohit Sachdeva and Dr. Mark P. Feinberg