2. Numerous p ublications are being written discussing our successes The May issue of OrthoTown compared all of the options available for acceleration and “PROPEL came out on top based on patient experience, cost, predictability and speed.” It is important to note PROPEL is localized and doctor controlled The Nov 2013 issue of AJO-DO quoted “Micro- osteoperforations are an effective, comfortable, and safe procedure to accelerate tooth movement during orthodontic treatment.” THE NEW WAVE IN ADVANCED ORTHODONTICS2

3. Here are just a few quotes from PROPEL doctors “We are getting amazing results with PROPEL and bracjet and Invisalign cases” Frank Andolino Manhattan, NY “Patients are excited about finishing faster." I am doing 7 day Aligner change outs on many patients and no hiccups. I started using PROPEL in June. I would love to rid refinements” Dr Adam May Fitchburg, MA “Propel has not let me down. Fewer trays, less time in braces, difficult movements. My patients love it!” Tom Shipley Peoria, AZ "I have seen my patient compliance increase with changing Aligners weekly, so now I can bring the Invisalign experience to more patients who did not want longer treatments: Payam Ataii OrangeCounty, CA

4. The when, where and why with PROPEL Doctors are excited to use PROPEL to achieve more efficient results and have more profitable cases Doctors are using PROPEL: o Proactively for more predictability/finish faster with less refinements o Reactively to get a tooth/teeth back on track THE NEW WAVE IN ADVANCED ORTHODONTICS4

5. Dr. Karen Guinn Pasadena, CA Premiere Preferred Provider Teen Provider http://www.youtube.com/watch?v=lH628n7VPog&feature=youtu.be http://www.youtube.com/watch?v=lH628n7VPog&feature=youtu.be THE NEW WAVE IN ADVANCED ORTHODONTICS 5

6. 6 The PROPEL Device

7. THE NEW WAVE IN ADVANCED ORTHODONTICS 7 Micro-Osteoperforations with PROPEL Proactive or reactive Doctor-controlled Localized No recovery time Shorter treatment More predictable

8. THE NEW WAVE IN ADVANCED ORTHODONTICS 8 3 Steps for Micro-Osteoperforation 1. Evaluate Treatment area Locate roots, the mandibular nerve and maxillary sinuses. Micro-Osteoperforation depths are determined by bone and soft tissue thickness. Micro-Osteoperforations should penetrate through the cortical plate into cancellous bone. 2. Chlorhexidine rinse Two times for one minute each 3. Anesthetize & PROPEL Treatment area can be anesthetized using either a Topical or Local Infiltrative anesthetic. Profound topical anesthetic 10% prilocaine 10% lidocaine 4% tetracaine With 2% epinephrine

9. THE NEW WAVE IN ADVANCED ORTHODONTICS 9 1.Remove from the sterile package and turn the Adjustable Depth Dial to the preferred setting 3mm, 5mm, or 7mm by holding the driver body and rotating the dial clockwise 2.Hold the PROPEL Device against the gingiva while keeping the tissue taut 3.Apply gentle pressure to engage the leading edge while turning the device handle clockwise. Check engagement by releasing pressure 4. Continue to turn until the desired depth is reached for penetration of the cortical plate into cancellous bone 5.The LED Depth Stop indicator will illuminate when desired depth is reached 6.Rotate the device counter-clockwise to remove How to PROPEL

10. THE NEW WAVE IN ADVANCED ORTHODONTICS 10 How deep do I go?

11. THE NEW WAVE IN ADVANCED ORTHODONTICS 11 PROPEL has three depth settings: 3 mm, 5 mm and 7 mm. The correct depth should be selected based on the thickness of the gingiva and alveolar bone in the treatment area. The anterior is usually 3 mm or less and the posterior is generally 5 mm or 7 mm. Recommended perforation depth Ref: Baumgartner et al. How Deep to PROPEL

12. THE NEW WAVE IN ADVANCED ORTHODONTICS 12 How Many Micro-Osteoperforations Where possible perform 1-3 micro-osteoperforations depending on proximity of anatomical structures. Perforations can be made buccal or lingual in linear or triangular patterns.

13. THE NEW WAVE IN ADVANCED ORTHODONTICS 13 Micro-osteoperforations can be performed either buccally or lingually. Buccal access is most often the simplest approach, depending on desired movement and patient’s oral anatomy. Where to Perforate: Buccal or Lingual

14. THE NEW WAVE IN ADVANCED ORTHODONTICS 14 Benefits to Patients Take the challenge out of challenging movements Up to 50% faster treatment times with less refinements Fewer office visits Less time off work Less compliance required shorter treatment Shorter treatment means better hygiene

15. THE NEW WAVE IN ADVANCED ORTHODONTICS 15 Micro-Osteoperforations 10 minutes post-treatment. There is no recovery time, and little pain associated with treatment. Tylenol is recommended if patient feels any discomfort after PROPEL. Post-PROPEL

16. THE NEW WAVE IN ADVANCED ORTHODONTICS 16 The micro-osteoperforation affects an are of 7-10 mm in diameter, so you do not have to be directly mesial, or distal to the tooth/teeth we are trying to address. Repeat procedure every 10-12 weeks until the completion of the desired movement is expressed.

17. Courtesy of Dr. Miraglia DB Aligner beginning THE NEW WAVE IN ADVANCED ORTHODONTICS 17

18. Courtesy of Dr. Miraglia THE NEW WAVE IN ADVANCED ORTHODONTICS 18 DB Final

19. THE NEW WAVE IN ADVANCED ORTHODONTICS 19 Courtesy of Close-up of MOP site

20. THE NEW WAVE IN ADVANCED ORTHODONTICS 20 When to Recommend PROPEL? It is treatment planned at the beginning of the case at the doctor’s discretion to ensure those difficult movements happen more efficiently/predictably. This would help cases finish on time and eliminate or minimize refinements. It is proactively treatment planned to ensure faster more efficient and predictable results. For aligner patients, the patient wears aligners at 7 or 9 day intervals. Reactively, a quick resolution to resolving challenging movements that may not be happening—this could take place at mid treatment or at the end of the case. A “Premium Treatment” option for patients that want a shorter treatment. Patients typically have 5 less office visits—saving the office chair time and patient convenience.