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Precision in orthodontics starts before the first bracket is bonded.
Insights from Dr. John Lippincott, Prairie View Orthodontics
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For Dr. John Lippincott of Prairie View Orthodontics, digital treatment planning has changed the relationship between the treatment plan, bracket prescription, mechanics, and the clinical result. In his KLOwen webinar, Precision Orthodontics: Custom Torque Control with KLOwen, Dr. Lippincott shared real clinical cases demonstrating how customized digital setups can help orthodontists optimize torque control, simplify mechanics, and more closely translate planned tooth positions into actual clinical outcomes.
After beginning with KLOwen in January 2025, Dr. Lippincott had approximately 750 KLOwen cases shipped by the time of the presentation. In the two offices where he practices, his team manages approximately 800–900 starts per year, giving him extensive experience applying customized treatment planning across a range of cases.
His central takeaway:
Plan the tooth where you want it to finish. Then build the mechanics to deliver that plan.
Why Torque Control Matters in Orthodontic Treatment
Traditional bracket systems inherently allow some play between the archwire and bracket slot. That difference can affect how completely the torque prescribed in the bracket is expressed clinically.
Dr. Lippincott highlighted the mechanical difference between a conventional .022-inch bracket slot and KLOwen’s system. He described the KLOwen bracket as having a .0195-inch slot height and .026-inch depth, paired with .019 x .019 finishing wires designed to more completely fill the slot.
In his presentation, he contrasted the 20–30 degrees of torque play he associates with generic self-ligating systems with approximately 2 degrees of torque play in the KLOwen system when using the final wire. KLOwen also uses a customized composite bracket base to translate the digital prescription to the individual tooth.
The clinical objective is straightforward: reduce the gap between the torque that is planned digitally and the torque that is expressed in the mouth.
From Digital Setup to Final Outcome: How Close Can the Two Get?
One of the most compelling examples from Dr. Lippincott’s presentation involved an adult Class II patient with anterior crowding and specific concerns around lower incisor root position.
The treatment objectives included maintaining maxillary incisor position, controlling the lower anterior teeth, aligning the arches, maintaining overall overbite and overjet, and achieving a Class I relationship with elastics. Dr. Lippincott initially estimated 14–18 months of treatment.
The case finished in approximately: 11 months | 7 total appointments | 0 repositioning appointments | 1 minor detailing appointment
Dr. Lippincott noted that the case potentially could have required as few as five visits under his standard protocol.
But treatment efficiency was only part of the story.
After treatment, KLOwen compared the patient's final iTero scan with the original virtual treatment objective, or VTO. According to the analysis presented in the webinar, the average greatest deviation between the planned setup and final scan was approximately 0.26 mm.
The data point to remember: 0.26 mm
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For this individual case, the final tooth positions closely tracked the digitally planned positions.
That matters because digital treatment planning becomes substantially more valuable when clinicians can translate the setup into the mouth with a high degree of precision.
Results shown reflect an individual clinical case and should not be interpreted as a guarantee of treatment time or outcome for other patients.
Four Lessons for More Precise Digital Orthodontic Treatment Planning
Dr. Lippincott shared several practical principles orthodontists can apply when reviewing KLOwen digital setups.
1. Use CBCT data when appropriate
Dr. Lippincott has moved toward incorporating CBCT into most of his digital treatment planning because it allows him to evaluate root position alongside crown position, tip, and torque. Here's a guide on mastering your digital setup with CBCT in 6 minutes or less from Dr. Jared Gianquinto.
2. "Plan in reality"
Rather than adding unnecessary overcorrection into the digital setup, position teeth where you want them to finish. Dr. Lippincott emphasized that customized mechanics allow him to plan toward the desired final tooth position instead of compensating for anticipated loss of control.
3. Create a consistent case-review checklist
KLOwen's digital workflow allows clinicians to customize the elements they evaluate on every case. Dr. Lippincott's review includes marginal ridges, tip, torque, alignment, symmetry, occlusion, bracket heights, bite, and smile arc considerations. He reported that a case review typically takes him approximately four to five minutes during clinic.
4. Teach the setup to reflect your clinical preferences
Treatment planning does not have to mean accepting someone else's ideal finish. Dr. Lippincott documents his general treatment preferences and case-review guidelines so the KLOwen team can incorporate those preferences into future setups.
Can Custom Torque Control Help Simplify Complex Orthodontic Mechanics?
Dr. Lippincott also presented an adolescent Class II open-bite case involving crowding, a vertical growth pattern, and differing posterior and canine inclinations.
His digital plan used a combination of expansion, torque control, extrusion with elastics, and posterior intrusion, with an initial estimated treatment time of 24 months.
At approximately 10–11 months, the open bite had closed while the patient was still progressing through the wire sequence. Dr. Lippincott described the case as an example of how improved control can make mechanics that initially appear complicated more manageable.
Again, the takeaway is not that every open-bite case will follow the same timeline. Rather, it demonstrates how digital treatment planning, bracket customization, torque control, and appropriate mechanics can work as one system instead of as separate treatment decisions.
Precision Starts With the Treatment Plan
Custom orthodontics is about more than custom-manufacturing a bracket.
The larger opportunity is connecting diagnosis → digital setup → customized prescription → bracket placement → mechanics → final tooth position.
For Dr. Lippincott, that connection has changed how he approaches treatment planning. As he explained during the webinar, the goal is for what is planned digitally to more closely become what is achieved clinically.
And that may be the most useful definition of precision orthodontics: greater control over the path from treatment plan to clinical result.
Frequently Asked Questions About Custom Torque Control
What is torque control in orthodontics?
Torque control refers to an orthodontist's ability to control the buccolingual inclination and root position of a tooth. Bracket prescription, bracket position, archwire dimensions, slot dimensions, and treatment mechanics can all influence how torque is expressed clinically.
How does KLOwen provide customized torque control?
KLOwen combines a digitally planned tooth position with a customized bracket prescription and composite bracket base. Dr. Lippincott also highlighted the relationship between KLOwen's bracket slot and finishing wire as an important part of torque expression and control.
What is a digital orthodontic setup?
A digital setup is a virtual representation of the intended tooth positions and treatment outcome. With KLOwen, clinicians can review and modify individual tooth position, tip, torque, alignment, symmetry, occlusion, and other treatment parameters before brackets are bonded.
How closely can a digital orthodontic setup match the final result?
Results vary by patient and case. In one case presented by Dr. Lippincott, comparison of the virtual treatment objective with the final intraoral scan showed an average greatest deviation of approximately 0.26 mm. This represents one clinical case rather than an expected result for every patient.
Does custom orthodontic treatment planning eliminate the need for detailing?
No. Orthodontists still diagnose, plan, monitor, and adjust treatment based on the individual patient. However, Dr. Lippincott's cases demonstrate how more precise upfront planning and customized mechanics may help reduce the amount of correction required later in treatment. In the adult Class II case presented, there were no repositioning appointments and one minor detailing appointment.
What should orthodontists evaluate in a digital setup?
Dr. Lippincott recommends a systematic review that can include marginal ridges, root tip, torque, torque gradation, alignment, symmetry, occlusion, bracket heights, bite, and smile arc. He also recommends incorporating CBCT information when appropriate to evaluate root position in three dimensions.
Watch the Full Webinar
See Dr. Lippincott walk through both cases, his setup review checklist, and the torque data in detail. Fill out the form to watch the on-demand recording and earn 1 CE credit.
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