Ella Kaufman ’24: Noxon Orthodontics
When I was younger, I was told I would never need braces, and that my teeth were perfectly straight. However, seeing how perfectly straight my brother’s teeth were with his braces, I started to notice imperfections in mine: my bottom teeth were crowding in the front and two of my upper teeth were slightly crooked and turned. As I started my own orthodontic treatment, I became fascinated with the procedures that occurred on my teeth, as well as the patients around me.
This summer, I was fortunate enough to intern with Dr. Noxon and Dr. Bruno at Noxon Orthodontics in Wellesley, MA. Orthodontics is a specialty within the field of dentistry. Orthodontists correct mal-positioned teeth and improper bite patterns using braces, aligners, and specialty appliances, like palate expanders and separating bands.
On my first day at the practice, I was able to see an assistant take a 3D scan of a patient’s teeth on an iTero machine. Additionally, I was able to watch my own teeth get scanned by an in-training assistant. It was so satisfying and cool to see a 3D model of my own teeth and how my upper and lower teeth fit together. I was also a model for their picture records, where I was able to see my jawline and my bite pattern.
A few weeks later, I was able to see the process that the doctors go through to create a treatment plan using the scan, the photo records, and two X-rays. This was one of my favorite parts of my entire experience. The doctors were debating different treatment routes for a singular patient. They had to decide whether the patient’s issue was concerning only their teeth or was caused by their bone structure. For this specific patient, they had a severe overjet. Dr. Bruno and Dr. Noxon agreed that surgically repositioning his jaw would be the best treatment option; however, they didn’t feel like the risks, recovery, expense, and everything else that came with the surgery were justified. As the next best option, they were going back and forth over the idea of installing a specialty appliance called a MARA. This appliance fixes a severe overjut by training the lower jaw to bite closer to the top teeth. They debated the comfort of the patient, how quick the treatment would be, and what the result would look like. It was amazing to see how all these factors are inputted into the doctor's decision and ultimately determine the entire treatment plan for the patient.
My main job during my time was supporting the sterilization of equipment and cleaning after patients. I wiped the chairs and desks after every patient, putting instruments in the AutoClave sterilizer or the cold sterile bin, and carefully cleaning and resetting the iTero machine. I was also responsible for seating patients and setting out trays for the assistants. Each appointment had its own abbreviation and an instrument tray to match. For example, a patient who was getting their braces adjusted was scheduled for an “ADJUST” and needed an adjustment tray at their chair.
After each patient, when I cleaned down the chair of a patient, there would sometimes be a braces tray missing several of its braces. One of my favorite tasks was refilling the braces packets to make a full set. This task is very meticulous because it has to be done perfectly, or installing braces on the patient is more difficult than it should be.
During my time at Noxon Orthodontics, I was also exposed to many patients who were in the process of repositioning their teeth with Invisalign. Personally, I was more familiar with this treatment process, as I went through 52 weeks' worth of aligners about a year ago. I always wondered how the assistants perfectly matched the shape of the attachments on my teeth to the ones indented into the aligners. I watched many patients receive Invisalign, and I learned that the assistants fill an “attachment guide” aligner with composite dental resin. They then cure the attachments to completely dry teeth with a UV light. The attachments should be glued on the teeth until the doctor decides that they are ready to be taken off.
Through observing several Invisalign patients, I became very familiar with the term “IPR”, which stands for “interproximal reduction,” as I witnessed it used on several patients’ teeth. This is a procedure that removes a very minimal amount of enamel off of the sides of the teeth with a material described as a piece of “thick floss.” IPR allows the doctor to create a little bit of room for teeth to move in and straighten out.
Additionally, in the final days of my internship, I was able to see the animation of how a patient’s teeth were predicted to “track”, or reposition, with the aligners. I saw how the patient’s teeth moved after every aligner and could even stop on a specific aligner to see how the teeth were supposed to look after the teeth fully adjusted to it.
As I got more comfortable with the “orthodontic language”, I started to learn the names of the tools and appliances that the assistants or doctors would use. The orthodontic assistants started to ask me for materials they needed as they were in the middle of working on a patient and couldn’t get up. The most common tool I got asked for was a “distal end cutter.” This tool cuts the braces wire shorter so it doesn’t poke the patient.
Listening to the doctors give instructions to the assistants and watching the assistants work on patients allowed me to understand what each appliance was for. For example, there are two different types of wires: NiTi (nickel-titanium) and SS (stainless steel). NiTi wires have memory in them and are used to pull the teeth into the “perfect” arch. These wires are used with an elastic chain in order to keep the wire against the teeth and ensure that it is working. SS wires are more stiff and allow orthodontists to rotate teeth. These wires are used with single ties to help pronounce the bends made to the wire. There are also “add-ons” that can be added to the braces for different purposes. Coil, as an example, is added onto a wire and is used to hold open a space for a tooth that hasn’t grown in yet.
I had such supportive and patient people around me; each and every one of the team members was encouraging of my learning and allowed me to be comfortable to make mistakes and ask questions. While every day brought a new challenge, whether it was 15 different patients with a broken bracket, or a woman who refused to show her eyes in her photo records, I had to be ready for anything that could happen that day. Additionally, I was able to witness a real life situation where everyone has to pull their weight so that the group can collectively succeed. As I rooted myself deeper into the team, I learned to do my jobs correctly so that our day would run smoothly and efficiently.
I would like to thank Mr. Schlenker and the Noxon Orthodontics team for giving me this opportunity to immerse myself deeper into orthodontics and possibly see what this field may offer me in my professional future. I am incredibly grateful for this experience and all of the support and help I received during it.