Doctor

Orthodontics as a Design Profession

When I entered dental school, I was relatively skilled with my hands, which led me to experience waxing up a full bridge during a student practicum. Crafting all the upper arch teeth in wax and seeing them perfectly fit the patient was immensely satisfying. I also earned praise from my instructors. However, this experience left me somewhat disappointed, as I realized that nothing could truly surpass natural dentition.

While general dental treatment focuses on restoration, orthodontic treatment is about leveraging the existing dental materials (teeth) to design something new. This realization drove me to pursue a postgraduate degree in orthodontics.
Wax-up refers to the dental model used to diagnose the shape, position, and occlusion of future restorations.

Encounter with Dr. Raphael L. Greenfield: The Challenge of Non-Extraction Treatment

While studying the fundamentals of orthodontics in graduate school and spending many late nights in the lab, I had the transformative opportunity to attend the first lecture in Japan by Dr. Raphael L. Greenfield, a leading figure in American orthodontic treatment. It literally shocked me. The cases he presented, which seemed only treatable by premolar extraction, were instead beautifully managed without extractions. Having undergone premolar extraction myself, I was particularly struck by Dr. Greenfield's CAD techniques, which were unlike anything I had seen before. Had these techniques been introduced earlier in Japan, perhaps I could have been treated without extractions.

The following year, I wrote a letter to Dr. Greenfield and applied to visit his clinic in Florida. It was my first time in America. Despite my limited English, Dr. Greenfield graciously allowed me to observe his practice from morning till evening for three days. Convinced that I needed to master this technique, I established the Japan Non-Extraction Orthodontics Study Group the next year and assisted in Dr. Greenfield’s courses, repeatedly learning from them.

Endorsed by the Angle Society

Embracing non-extraction treatment has often led to criticism, especially from those deeply entrenched in traditional orthodontic paradigms because it was so different from the orthodontic approach of the time. Notable university professors and distinguished clinicians have explicitly criticized non-extraction methods as preposterous. Amid such opposition, opportunities like being invited to deliver a lecture at the American Association of Orthodontists (AAO), receiving the Best Table Clinic Award at AAO, and publishing the book "Non-Extraction Orthodontic Treatment: The Reality of Molar Oriented Orthodontics" co-authored with Dr. Kousei Kaku and Dr. Noriyuki Shinohara, gradually led to wider acceptance of our methods. This acknowledgment paved the way for my membership in the Angle Society, a prestigious group of orthodontic specialists that can only be joined through existing member recommendation. I am immensely grateful to Dr. Koyama, Dr. Asai, and Dr. Alexander for their recommendations and sponsorship.

The Angle Society, founded by students of Dr. EH Angle, known as the father of modern orthodontics, is an elite group that includes only about 20 Japanese members among globally renowned educators and clinicians. My experiences there have profoundly influenced my clinical practice.

Orthodontic Treatment Combined with Periodontal Regeneration

At the Angle Society, I learned about innovative methods of accelerated orthodontics combined with periodontal regeneration treatments, developed by the Wilcko brothers, orthodontists and periodontists. This technique, known as Wilckodontics or Periodontally Accelerated Osteogenic Orthodontics (PAOO), is revolutionary for safely treating patients with thinning periodontal tissues. After attending a seminar by the Wilcko brothers in Erie, a small city by Lake Erie, USA, I have collaborated with Dr. Tomo Urano, a specialist in periodontology, allowing us to achieve treatment outcomes previously thought impossible.

Applying TADs in Orthognathic Treatment

A groundbreaking moment for me was encountering Dr. DeClerk's Bollard Plate at the Angle Society, which he used for treating underbites in children during their growth phases. Traditionally, skeletal underbites in pre-pubescent children were left untreated until post-growth, when surgical orthodontics was applied. However, Dr. DeClerk demonstrated cases where using the Bollard Plate during the pubertal growth phase significantly improved outcomes compared to later surgical interventions. Inspired by his lecture, I visited Dr. DeClerk's office in Brussels the following year to receive direct training. Additionally, I learned firsthand from Dr. Moon about combining the Maxillary Skeletal Expander (MSE) with a facemask to approach skeletal issues. These techniques, known as orthognathic treatments, when combined with traditional orthodontics, allow us to set more ideal treatment goals.

Oral Power: Maximizing Functionality, Aesthetics, and Sustainability

As we challenged ourselves with various techniques, the Angle Society also gave us an opportunity to think deeply about what is truly good treatment. Members are required to present case reports annually. “Legends” doctor like Dr. Alexander and Dr. Borel present cases with stability over 10 or even 20 years post-treatment—a critical measure of orthodontic quality. Seeing such enduring results and engaging in discussions with these experts have been invaluable. From these experiences emerged the concept of "Oral Power"—a fundamental idea of customizing and maximizing the balance between functionality, aesthetics, and sustainability through orthodontic treatment. This concept has become a major goal in my approach to orthodontics.

The Challenge of Aligner Orthodontics

While I have pursued what is a good treatment, I can not ignore the demand from patients for aesthetic considerations during treatment. Over the past decade, I have been challenging to achieve the quality of Molar Oriented Orthodontics (MOO) with aligners. Using Invisalign, a leading product from Align Technology, I aimed to deliver good treatment outcomes with aligners in most cases. Since the mechanics of aligners and traditional braces are quite different, mastering treatment with wires does not necessarily guarantee success with aligners. To keep up with advanced treatments abroad, I attended conferences in Germany and the USA to gather the latest information. Soon after, I was welcomed as a faculty member by Align Technology, where I now provide advice on various products. Today, I treat most cases with aligners.

Establishing MAO Academy and Providing Guidance

Aligner orthodontics can be easily initiated with just an intraoral scanner. However, this accessibility has led to a proliferation of low-quality orthodontic treatments by practitioners who lack even the basic knowledge of orthodontics. Concerned about this situation, together with my colleague Dr. Kousei Kaku, we founded the Molar Oriented Aligner Orthodontics (MAO) Academy. Our goal is to teach and promote high-quality aligner treatments that reflect the principles of MOO. Due to Japan's pharmaceutical laws, aligner orthodontics here lags about two generations behind the rest of the world. It is part of my mission to spread effective and high-quality aligner treatment methods, incorporating the latest information.

Our Vision at E-Smile International Orthodontics

Orthodontic treatment requires a high level of specialization. It is not merely about aligning teeth. It involves assessing each individual's skeletal structure, gum health and the quality of their teeth to set a sustainable and accurate goal that accommodates growth and aging. Achieving these goals necessitates the use of safe and reliable specialized techniques.

At E-Smile, we aim to be a clinic where patients can confidently receive excellent treatment. We strive to create an environment where the treatment journey is enjoyable and educational, supported by a knowledgeable team. Although challenges lie ahead, we are committed to enhancing the oral power of our patients, brightening their futures without fear of change, and embracing the ongoing evolution of orthodontic care.