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What are the limitations of
NightShift?
NightShift is not designed as a
functional appliance, though functional
change often occurs when teeth are taken
out of cross bite, trapped mandibles
freed, palates expanded or bite planes
used. Class II & III cases can be
treated with the patient’s understanding
that any existing problems due to jaw
relationships will typically remain.
Many are most interested in the “social
six” anterior teeth and you can still
provide esthetic straightening. A waiver
is suggested for such cases
acknowledging certain deficiencies will
be left untreated.
The best cases are those in which the
teeth are only crowded and/or rotated,
with minimal spacing. Large diastemas
and large multiple spacing issues are
not well suited for NightShift. It is
predominantly a cosmetic treatment
appliance, though it has numerous
indications beyond that.
Do you offer a training course?
At present we have no hands-on
training course available. We do provide
a very helpful training CD ROM which
cover treatment protocol, case analysis,
case studies, indications and
contra-indications, adjustment
information and more. If you are
concerned with your ability to treat a
specific case, the lab will work with
you as closely as you desire via phone
and email and may be able to provide
some insightful suggestions.
Do you teach interproximal reduction?
We do not currently teach
interproximal reduction, but we have
included numerous slides on the training
cd that provide insight on the topic. You’ll find the NightShift appliance has bone remodeling
capabilities that diminish or eliminate
the need for stripping in many cases
which would otherwise require it to
achieve acceptable time and movement
outcomes with other appliances. There
are numerous options to learn IPR. We
have included links to a couple of
instructional resources found on the
web.
Interproximal Reduction (IPR) Tips
A guide to using interproximal reduction
to resolve crowding
Can NightShift be used in mixed
dentition?
Yes. It is regularly used in
mixed dentition for eruption guidance,
space maintenance, arch development,
cross bite correction and first phase
orthodontic treatment where parents
understand the possibility of additional
treatment after NightShift may be
necessary, yet they still desire
esthetic improvement, often for reasons
of self-esteem.
Can NightShift be used to treat
posterior teeth?
Yes it can, depending on the case.
It is most often used for buccal
movement or to tip, upright or rotate
mildly to moderately malposed teeth.
Posterior lingual movement can often
times be effected as well by laser
welding springs to the buccal. Mesial
and distal movement can also be achieved
in minimal amounts under a few
millimeters when space permits to insert
customized finger springs made from our
wire.
Is more than one appliance required?
NightShift is almost always a one
appliance treatment. It’s re-adjusted at
two to four week intervals. On rare
occasions a second appliance is
required. For example, if the required
tooth movement distance of one or more
teeth exceeds the reach of the active
range of an extended spring or if a
specific tooth is unable to be reached
by a spring in the initial appliance
because it is severely blocked out by
another tooth, a second appliance may be
necessary. If you’re uncertain, ask the
lab for an opinion.
How long should NightShift treatment
take?
This answer depends on several
factors which include the severity of
the case, the doctor’s acumen, his/her
familiarity with the appliance, the
patient’s age and the amount of time
they choose to wear their appliance each
day. The majority of part-time cases
being treated have been finishing in an
average of 6 – 9 months with monthly
adjustments. Bi-weekly adjustments are
also plausible if logistically
acceptable. If nighttime wear is chosen,
the appliance should be worn from early
evening until morning, removing the
appliance only to eat and brush.
What fees should I charge my
patients?
This depends primarily on two
factors; your demographics and the
severity of the case. We typically
suggest $1800 for one arch and $2800 for
both, though some have chosen to go as
low as $995 per arch to generate heavier
traffic. A nice profit is still
obtainable at this price and volume
leads to lots of other ancillary work,
especially since NightShift patients
have clearly identified themselves as
cosmetically oriented…but it’s
completely up to you.
What insurance codes do I use for
this treatment?
code 8030 and 8040 are for limited
orthodontic treatment in adolescents and
adults respectively. Comprehensive
adolescent and adult treatment codes are
8080 and 8090 respectively. Limited
usually pertains to one arch and
comprehensive to both. You should check
these codes for yourself. Dr. Thomas
Blair provides insights to numerous
orthodontic codes pertaining to
Invisalign treatment which are also
pertinent to NightShift. Check out the
following link for more info.
Tips on Filing Invisalign Insurance
Claims
Patients with orthodontic insurance are
an excellent niche for NightShift as the
typical insurance allotment averages
about $1500, which makes out-of-pocket
expenses minimal to manageable for many
who may not otherwise be able to afford
treatment even with coverage. It may
also be of interest to note that
successful NightShift claims have also
been filed under general dental codes
for preventative purposes, as crowded
teeth are bacteria traps and can lead to
periodontal disease or other hygienical
issues. It may be worth your while to
research this.
What is your lab turn-around time?
Usual turn-around time is 5-7
business days from the day we receive
the case, though less time in the lab is
not uncommon. Patient appliance
placement appointments should be
scheduled accordingly.
Where can I learn more?
Principles of Appliance Therapy is
an excellent resource to learn more
about treating various aspects of cases
not viable with NightShift alone. Should
that be of interest to you, it’s available
very inexpensively ($50) online at the
following link.Using Removable Orthodontic Appliances. | 