Case study – Dr. Ivan Goryalov

About Dr. Ivan Goryalov

Dr. Goryalov graduated in dental medicine at the Faculty of Dental Medicine – Medical University, Plovdiv in 2002. Between 2006 and 2013 he specialized in the clinic of Prof. Wick Alexander in Arlington, Texas, USA. In 2007 and 2008, he got trained in “Surgical-Orthodontic Approach in Dentofacial Deformities” at Chang Gung Memorial Hospital in Taipei, Taiwan.

Dr. Goryalov is the chairman of the Bulgarian Alexander Study Club. He received the highest jury award in the Dental Competition “ Smile of the Year” 2008, “ Smile of the Year” 2009, special jury award for complexity and excellent teamwork in ” Smile of the Year ” 2010 and award for complex esthetic restoration in “Smile of the Year” 2017

About USMIVKI courses

Dr. Goryalov began conducting CE orthodontic courses in Europe in 2008, and since then instructed hundreds of students in dozens of courses, focusing on the Alexander Discipline. His courses are both theory and practical, and include:

    • Bracket Positioning, Banding and Bonding – Direct and Indirect Technique, According to the Alexander Discipline
    • Diagnosis and Treatment Planning, According to the Alexander Discipline
    • Class 2 Deep Bite Mechanics in a Growing Patient, According to the Alexander Discipline
    • Typical Extraction Mechanics, According to the Alexander Discipline
    • Class 3 Open Bite Mechanics in a Growing Patient, According to the Alexander Discipline
    • Unusual Treatment with Mini-implants and skeletal anchorage system (SAS)

Following the success of his courses and the increasing demand, Dr. Goryalov is expanding his activities to new countries, and new office locations and courses.

The CephX Service

Dr. Goryalov teaches cephalometric tracing and analysis to his students, and for most of them it’s for the first time. “During an orthodontic course for general dentists I have to teach them a lot of theory in very short time, and streamline the transition to the practical part”, says Dr. Goryalov. “the CephX service makes it simple to get through the cephalometric analysis part – it’s an efficient educational tool”

CephX Artificial-Intelligence based algorithm performs automatic, immediate Cephalometric analysis, a template of dental and skeletal relationship of human skull, used by orthodontists and oral and maxillofacial surgeons as a treatment planning tool. CephX works from the cloud, providing service to over 1,000 users world-wide, also integrated into leading European dental-imaging manufacturers such as Sirona, Planmeca and NewTom.

“My students love the CephX service, since it gives them peace of mind with their cephalometric analysis – during the course and after. As an instructor, it’s important for me to ensure they are using the latest technologies, and CephX’s artificial-intelligence is a first of its kind” continues Dr. Goryalov. “It’s fast, accurate and simple to use, and as a web-based system it’s easy for me to help my students anywhere and anytime”.

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Case study – using CephX in imaging centers

Dental imaging centers, providing dentists with CBCT , panoramic, cephalometric and other imaging services, can leverage the CephX service to achieve better business outcome while keeping high accuracy standard across multiple centers.

About CT Dent

CT-Dent was established in London in 2007 by Mr. Kfir Atias, and has grown into a network running 6 branches across the UK, 7 franchised office in Europe, and is in the process of extensive growth throughout Asia, expecting to reach hundreds of offices by 2020.

CT-Dent provides the full spectrum of dental imaging services, allowing dentists to refer their patients to get all their needs taken care professionally in a 1-stop-shop, while freeing the dentist from the need to invest in expensive hardware and software and maintain highly trained personnel:

  • CBCT Scans
  • Digital Panoramic (OPG)
  • Digital Lateral Cephalometric (CEPH)
  • CEPH tracing Report
  • Radiology/Pathology Report
  • Digital Impression
  • Radiographic Template
  • Surgical Guide
  • Intra Oral Orthodontic Aligners Scan
  • Anatomical 3D Model

The CephX Service

The offices of CT-Dent provides a digital cephalometric radiograph of patients’ referred by their dentists. “Dentists sending their patients to us expect nothing but the highest accuracy tracing and professional analysis report. It is a challenge to train our personnel and maintain the professional level we’re expected to provide over time, and it is even more challenging to keep an equal level of accuracy across all offices”, says Kfir Atias. “Using the CephX service we know our cases are handled in a constant level of accuracy, and training is no longer a barrier for providing the service in new offices”.

CephX Artificial-Intelligence based algorithm performs automatic, immediate Cephalometric analysis, a template of dental and skeletal relationship of human skull, used by orthodontists and oral and maxillofacial surgeons as a treatment planning tool. CephX works from the cloud, providing service to over 1,000 users world-wide, also integrated into leading European dental-imaging manufacturers such as Sirona, Planmeca and NewTom.

“Since CephX introduced their AI driven ceph tracing CT-Dent is able to send back the analysis to the clinician same day, saving time and increasing their efficiency”, continues Kfir Atias. “Knowing that the AI service is backed by CephX highly professional and experienced team gives us peace of mind with our ceph tracings. We look forward for their future AI products for automatic implant planning, radiology reports and liaison diagnosis.”

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Case study – using CephX in full time orthodontics office

Learn how Dr. Ballrik, a full time orthodontist with 2 offices, is using the CephX service to save almost 8 hours every month, while getting higher accuracy and peace of mind.

About Dr. Ballrick

Dr. John Ballrick runs 2 orthodontic offices in Fairview-park and Westlake, Ohio USA.  Dr. Ballrick followed in the footsteps of his father, Dr. James W. Ballrick who has practiced orthodontics since 1971. Dr. John Ballrick graduated Summa cum Laude from The Ohio State University College of Dentistry. He received his advanced specialty degree in orthodontics from Case Western Reserve University. His research on advanced 3D imaging is published in the American Journal of Orthodontics and Dentofacial Orthopedics. In addition to his degrees and published research in the American Journal of Orthodontics on advanced 3D imaging, Dr. Ballrick has earned numerous awards and achievements including:

  • Robert E. Lauer Award for outstanding performance in the dental anatomy program
  • The Orville E. Russel Award of Excellence
  • 2004 Basch Memorial Scholarship Award recipient
  • Phi Kappa Phi National Honor Inductee
  • The William S. Kramer Award of Excellence
  • The prestigious Alpha Omega Award for attaining the highest academic standing
  • Member of the Omicron Kappa Upsilon National Dental Honor Society
  • The American Academy of Implant Dentistry Certificate of Recognition for outstanding achievement, both academically and clinically, in implant dentistry
  • The American Association of Orthodontists Award for exceptional interest in the development of the oro-facial complex
  • The Sanford Neuger Award for clinical excellence in orthodontics
  • The B. Holly Broadbent Award for excellence in orthodontic research

The CephX Service

Dr. Ballrick has 10-15 Cephalometric x-rays a week that requires tracing and analysis. “Before using CephX, I had my staff trained to do it for me. But the accuracy wasn’t exactly there so I found myself editing points and reviewing everything. Eventually I went back doing it myself”, says Dr. Ballrick.

CephX Artificial-Intelligence based algorithm performs automatic, immediate Cephalometric analysis, a template of dental and skeletal relationship of human skull, used by orthodontists and oral and maxillofacial surgeons as a treatment planning tool. CephX works from the cloud, providing service to over 1,000 users world-wide, also integrated into leading European dental-imaging manufacturers such as Sirona, Planmeca and NewTom.

“Before using CephX I used to spend 5-10 minutes to generate an analysis for a single patient.  When I did the math, it added up to almost 8 hours every month on Cephalometric analysis. Time is my most valuable asset, and with CephX I can spend this time elsewhere, not in front of my computer”, continues Dr. Ballrick. “Having immediate Cephalometric analysis can very valuable when patients come in for a consultation. I’m always striving to use the latest technologies in any aspect, and AI is the future for dental imaging.”

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Are Clear Aligners Right for Your Patient?

When you’re an orthodontic provider, there comes a time in certain patient cases where you have to determine if particular individuals are or are not candidates for the type of treatment they’re asking for; particularly if it’s clear aligners.
Because removable aligners rely on different mechanisms of pressure and tooth movement to work properly, there are bound to be situations where a patient cannot pursue this avenue of treatment. It’s up to you as an educated provider to determine if this is the case…as well as how to break the bad news to your patient.

Your Experience as an Orthodontic Provider

From new orthodontic providers to more experienced specialists, there will always be cases where you feel uncertain or have a gut response about how you need to proceed with treatment. Strong willed patients that want a specific type of braces may make this decision process even more challenging to work through.

Although clear alignment technology has expanded the situations that can be corrected, there remain several concerns that may contraindicate treatment. Some of the most common, include:

  • Inadequate crown height
  • Unerupted 2nd molars
  • Fixed dental prosthetics, such as bridges
  • The presence of dental implants
  • Chronic grinding/clenching habits
  • Crowding or gaps with spaces that need to be moved more than 6mm
  • More than 3-4mm of an overjet, overbite, or midline discrepancy
  • The presence of an open bite

While minor variations of these conditions can be treated with removable aligners, most of the time they will need to be addressed by an expert. If you have experience with easier or more moderate variations, then it may be an easier decision to make when it comes to initiating treatment. Otherwise, it’s suggested to get a second opinion or recommend another type of orthodontic therapy.

Getting a Second Opinion

What happens when you’re torn between starting treatment or saying “no”? Thanks to CephX’s innovative AlgoCeph technology, your patient’s cephalometric radiograph can be traced and analyzed with seconds and provide you with measurements and recommendations before the patient ever leaves the office.

This efficient, cloud based process allows you to quickly access cephalometric analysis, cephalometric superimposition, profile overlay and other features – all within seconds.

Reviewing the Treatment Plan

Patients tend to be more receptive to treatment recommendations when they’re educated about the pros and cons of other alternatives. It’s not just your job to tell them when clear aligners aren’t an option; it’s your duty to tell them why. Otherwise, they’re apt to “doctor hop” until they find an orthodontist that will say ok to the treatment, even if they know it’s not appropriate. When you educate, you show how much you care about the wellbeing of your patients. Not only does this earn the respect of your prospective patients, it adds quality and value to the services you offer in your practice.

The Patient’s Perspective

It’s hard to let something go, especially when you’ve had your heart set on it for a long time. For an adult to consider getting braces, sometimes it means they’re only willing to move forward with treatment if they can have a particular type of braces. Usually, that means clear aligners. It’s up to you to decide if their goals can be met, or another option is more appropriate.

The Ultimatum

There’s a lot of psychology that comes into play when you need to convince a patient that it’s better to have traditional braces or no treatment at all. Because you know the likely outcome, it’s up to you to explain to the patient that it isn’t worth pursuing a clear alignment tray system. The key is to point out the major factors involved in their decision to get treatment:

Money —Usually, a person will be paying more for clear aligners than they would with a conventional option. For the achievable results, is it going to be worth the investment…especially if you’re not able to reach them? Make it clear that even after paying for a full course of treatment, there may still be remaining alignment needs, disqualifying the effectiveness of this particular method or even doubling the total cost of their orthodontic therapy.

Time — All of those trips to the office, the maintenance at home, and cleaning your aligners…is it worth it? A traditional system would be able to move the teeth more efficiently, allowing your patients to complete treatment sooner and in fewer appointments. When it comes down to taking time off of work and paying for treatment, conventional braces may be more cost effective from every standpoint.

Aesthetics — What is your patient’s primary goal of treatment? Do they want a particular tooth moved? If you can’t make that happen with clear aligners, but could do it precisely with a strategically placed bracket, the trade-off should be worth it. Knowing what the end results will be — as opposed to guessing what they will be — should be enough to convince the patient of the best treatment.

Health — Correcting the alignment and occlusion of the teeth and jaws will be beneficial to long-term health and function. Explain the risk factors of allowing the condition to go uncorrected, vs. what complications could occur if alignment was attempted with a removable system.

Making Other Treatments Feel More Inviting
Because aesthetics is often the tilting point between traditional and clear braces, it’s vital to take advantage of discussing realistic options that can help. Ceramic brackets and low-profile arch wires should be kept on hand to show your patient — in person — what they look like. Once they’ve seen how cosmetically appealing they really are, your patients will be more open to the idea of traditional systems. Suddenly, the idea of “all or nothing” doesn’t seem quite so bad.

As an orthodontic provider, it’s your responsibility to only render services that will improve or maintain your patients’ oral health. When that means saying “no” to a particular treatment, you can know you’re doing the right thing.

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Is Single Arch Treatment Good for Your Patients?

As an orthodontic provider, you often have to weigh your patients’ personal requests with what you know is the most appropriate form of treatment. This is especially true in the situation that an individual asks for rapid “fast” braces, or single-arch orthodontics where appliances are only affixed to the upper teeth.

For Problem Specific Tooth Movement

Many orthodontic patients request single-arch treatment because they only want braces on their top front teeth. They feel this may be more comfortable, affordable, and faster.

In instances where minor tooth movement is all that is necessary, this alternative may be appropriate. For example, a mild diastema between the central incisors can be closed, which also reduces slight overbites. Assuming that the patient will be content with the aesthetic results (and the provider with the occlusal relationships,) this type of alternative treatment may be a viable option.

Mild crowding, tooth overlap, or orthodontic relapse may also be adequately treated with single arch ortho on a case-by-case basis.

Mixed Dentitions

Younger patients who are undergoing “phase 1” or interceptive treatments are some of the most common individuals to need single arch treatment. This is usually due to the physical maturation of the oral anatomy, tooth development, or eruptive stages. In such instances, single arch therapies can make it more effective to lay the groundwork for more complex comprehensive phase 2 treatments later on.

Determining “if single arch treatment is right” or not may be a simple decision, solely due to the patient’s oral anatomy.

When Single-Arch Braces Should be Ruled Out

There is only so much that can be done with overall tooth alignment if the upper and lower teeth do not occlude properly. Single-arch treatment could result in an open bite, cross bite, or fail to correct an overbite if the patient refuses to have braces placed on the opposite arch. Over time, this might contribute to occlusal wear, fractured dental work, or TMJD.

It’s easy for a dental expert to understand this, but a patient may not. A good analogy is comparing single arch treatment to screwing the lid onto a jar, by only holding the lid. The final fit wouldn’t be what it could have if you had a “grip” on both the jar and lid, as it would if you had braces on both the upper and lower arches at the same time.

Discuss the Patient’s Concern for Getting “Only Single Arch” Treatment

Many patients assume that asking their orthodontist to “only put braces on their top teeth” will result in a 50% reduction in the overall cost of their orthodontic therapy. As a dental professional, you know otherwise.

If a patient is hesitant to accept a comprehensive orthodontic treatment plan, find out if they have any questions or need to understand aspects of the plan better. Offer financing information up front, as some individuals may be too embarrassed to ask, and thus appear to be close minded about starting treatment.

Should the conversation turn the direction of “getting braces on one arch will be much cheaper,” redirect the discussion to conclude that there is not a significant price difference between comprehensive (upper/lower arch) and single-arch therapy, and why. This information should be presented in any situation that a patient requests single arch treatment.

“Superelastic” Archwires and Clear Aligners

Modern orthodontic brands are beginning to target this market with specially designed systems that use force optimized biomechanics for a single-arch-only treatment. If attachments, rubber bands, TADs, or other extensions aren’t primarily mandatory for the given situation, a clear aligner or superplastic archwire system may do the job.

Additional Analysis to Make the Final Call

With digital cephalometric analysis performed by radiographic experts like the team at CephX, AlgoCeph technology makes it possible to plan the most accurate and efficient orthodontic case for your patient. In instances such as single arch treatment where you may want a second opinion, the AlgoCeph reading can be performed in an efficient timeframe without referring your patient elsewhere or lowering your productivity.

Determining Your Options

One of the foundations of treatment planning and case presentation is presenting your patient with all viable options to treat their concerns, and weigh the advantages of each. For orthodontic providers who tend to have a bias against single arch ortho cases, it can be difficult to encourage the patient to accept a care plan when this option is overlooked.

Knowing that the patient will decline any therapies aside from one-arch braces should be weighed against whether or not the therapy would be doing harm over good. Sure, it may not be the most preferred method of treatment — especially if you were planning the course of therapy for yourself or your own child — but if that is all the patient is willing to consider, this must be kept in mind.

Is it Time to Think Outside of the Box?

In dentistry, technology and treatments can change significantly from one decade to the next. What we’re taught in school may be completely obsolete once a few years have passed and new studies back findings in more recent clinical research studies. When it comes to single arch treatment, it’s vital to go into the planning process with an open mind. Given the case-by-case nature of patients in general, there will be exceptions that are worth your consideration.

If you’re new to single-arch therapies, aim to work with fellow specialists who can help you treatment plan the case during the initial diagnosis and assessment phases; that way you can ensure a positive outcome from the beginning of therapy.

Orthodontic Specialists Consider all of the Options

At CephX, our x-ray analysis experts can efficiently measure and assess the digital images of your patient’s radiographs, so that you have all of the information on hand during your case presentation. This saves you valuable time without risking the quality of care your office provides. The cephalometric analysis is available on demand, and all records are securely backed up at the highest level of privacy. Visit today to learn more about on-demand orthodontic cephalometric analysis for providers on a worldwide scale.

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