We're delighted to introduce Torque of the Town, our very first newsletter, written to open up conversations across the orthodontic community and, just as importantly, to learn from what you tell us in return.
Every issue begins with a crossword with order discounts for the winners, followed by a real case from our planning desk and how we went ahead with it, instances from the business world worth taking inspiration and ideas from, and finally a conversation with an orthodontist we admire. As an add on, we also have the invite for a national workshop to be held in Bangalore from the 4th to the 6th of September.
And this is a two-way street.
Your feedback decides what we publish next. Reply buttons sit on every page, so use them freely.
Inside this issue
✦The CrossBiteOrthodontic crossword, simple to solve and submit
✦Root Ca(u)seA case from our planning desk and the calls we made
✦MarginsThree business stories, and what each one means for your clinic
✦Wisdom TeethQ&A with an orthodontist we admire
✦The InvitationBiomechanics Unlocked, the national workshop on 4 to 6 September
Published by Synapse HealthTech, an Orthodontic partner you can count on.
Reach us at
Synapse HealthTech 2nd Floor, 71, 15th Cross Rd, Dollar Layout, 3rd Phase, J. P. Nagar, Bengaluru, Karnataka 560078
Let's begin the newsletter with a simple segment. Six clues from your own vocabulary.
Solve this crossword, submit the same and get 5% off on your next case with Synapse HealthTech!
Offer is valid till the next edition and cannot be carried forward, banked or combined across editions.
If the boxes will not accept typing, open this page in your browser. On iPhone, tap the share icon and choose Open in Safari.
Tap a cellto start solving
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2
3
4
5
6
Tap a highlighted cell again to switch between across and down
Across
1The midline gap Madonna made fashionable (8)
4Third order control that decides where the root sits (6)
5When the uppers bite inside the lowers (9)
6What every patient must wear after debond, ideally forever (8)
Down
2Resistance to unwanted movement; TADs make it absolute (9)
3Horizontal distance between upper and lower incisors (7)
0 of 42 letters filled
This Day, That Year in Science
18 August 1868Guntur, Madras Presidency
The French astronomer Pierre Janssen set up a spectroscope in a tobacco field in what is now Andhra Pradesh and waited for a total eclipse. In the six minutes of totality he found a bright yellow line in the Sun's atmosphere that matched no element known on Earth.
It was helium.
Still the only element in the periodic table to be discovered somewhere other than this planet. It would be another 27 years before anyone on Earth held any.
Torque of the Town · Issue 01Page 3 of 6
Root Ca(u)se
A case from our planning desk and the calls we made
41 Male · Chief complaint: Bite not properPlanned to be fabricated as Shape Memory Aligners
Some cases are difficult because a lot is wrong. This one is difficult because two things are wrong in opposite directions, and fixing either one alone makes the other worse.
The upper arch is constricted on the left. The lower arch is wide. Put those together and you get a posterior crossbite that no amount of upper expansion alone will comfortably close. Meanwhile the lower anteriors are severely crowded, 46 is missing, and 47 has tipped forward into the space that crowding needs.
What the scans showed
Upper occlusal. Arch constricted on the left. 25 rotated roughly 50°. Crowns on 12 and 11.Lower occlusal. Severe anterior crowding, wide arch form, 46 missing and 47 tipped mesially.
Left buccal. The crossbite itself, where the constricted upper meets the wide lower.
Anterior display. What the patient came in about.
The calls we made
Extract 38. Not for crowding, but to create the room that lets the third quadrant come in.
Constrict the third quadrant rather than asking the upper to do all the travelling.
Expand the upper left by 4–4.5 mm, and constrict the lower left by the same, so the crossbite closes from both sides.
Derotate 25 to recover arch length in the upper, and align the upper on the space expansion and derotation release.
Align the lower into the extraction space, which is the objective the treating doctor set out with.
Why shape memory
Expansion and constriction of 4–4.5 mm in opposing quadrants is precisely where a conventional tray struggles. Push the upper out and you tend to flare the crowns rather than move the roots. Squeeze the lower in and the tray simply flexes away from the tooth.
With BioSmart shape memory aligners the activation is built into the material rather than into the fit. Thickness is increased palatally in the upper left posterior to drive expansion, buccally in the third quadrant to drive constriction, and anteriorly as well, to add to the crossbite correction. The force then arrives from the side it is needed rather than from the tray gripping the whole arch.
Thickness on its own, though, would still only tip the crowns. So a counter moment is planned against each of these movements, and that is what converts tipping into bodily movement. Worth saying plainly: this is not something particular to shape memory aligners. A counter moment belongs in conventional treatment planning just as much. The material makes it easier to deliver, not necessary to invent.
Why we expect it to track
Because no single movement is large. The crossbite is roughly 8–9 mm of correction, and we have split it in half — 4–4.5 mm from each arch. Halved movements sit comfortably inside what an aligner delivers per stage, which is what keeps the tray in contact with the tooth instead of unseating from it.
Because the space exists before it is needed. Extracting 38 first means the third quadrant constricts into room that is already there. Nothing in the sequence depends on space we are hoping to find later.
Because the force is directional. Thickness-modulated activation puts pressure on the specific surface that needs it, so the movement does not rely on the whole tray gripping and holding.
And because the two arches work against each other by design. The upper expands while the lower constricts, so each arch braces the correction of the other rather than fighting it. That is the argument for this plan: every difficult movement in it has been made an easy one.
The plan, in stages
16Upper stages
37Lower stages
The lower carries more than twice the staging as the lower arch has to accommodate the decrowding, the constriction and the extraction-space closure.
Watch the plan run
Click the video below to watch the movement from all views. Captured video from shape memory design software.
The staged simulation, from the current bite through to the planned finish.
Would you have planned it differently?
Thank you. Your note has reached the Synapse team.
Shared with consent. Age only; all identifying detail, including the patient's facial views, has been withheld.
Torque of the Town · Issue 01Page 4 of 6
Margins
Ideas from other businesses, translated for your clinic
Somewhere in your clinic is something so small that nobody has ever thought to question it. That is usually where the money is.
The business world has names for these things, and some genuinely surprising stories attached to them. Each of the three below is far smaller than you would expect, and each turned out to be worth far more than anyone guessed.
Unit economics
The olive that was worth $40,000
In 1987, American Airlines was under pressure to cut costs without upsetting passengers. Its chief, Robert Crandall, went line by line through the catering budget and stopped at the salad served in first class. It came with a few olives. Someone had counted, and most passengers were leaving one behind.
So he removed exactly one olive from every salad. Nobody complained. Nobody noticed. It saved the airline about $40,000 every year.
What it really meansBusinesses call this unit economics: the cost and the profit of one single unit of work. A cost so small you would never bother to look at it becomes a serious number once you multiply it by how often it happens. Volume turns pennies into salaries.
Find your olivePick one thing you use in every single case and work out its true annual cost. Start with the obvious one: the aligner stages you paid for inside a package and never used. An unlimited or bulk package feels cheaper per case, but you only save if you actually consume it. Count how many refinements, spare trays and retainers you bought last year against how many you fitted. Then keep going. Impression material discarded because the tray was over filled. A courier run that could have waited a day. Fifteen minutes of chair time that goes missing at every appointment. You are looking for something small, boring, and repeated a thousand times a year.
Leading indicator
The bowl of sweets that checked the rigging
Van Halen toured with nine trucks of equipment into venues built for three. If a stage was wrongly rigged, people could be badly hurt. Their contract ran to dozens of pages of technical requirements, and nobody read it properly.
So the band buried a strange clause in the middle: a bowl of M&Ms backstage, with all the brown ones removed. It was never about sweets. If the singer walked in and saw a brown one in the bowl, he knew instantly that the contract had not been read, and he ordered a full inspection of the entire stage. He said it almost always turned up a real technical error.
What it really meansBusinesses call this a leading indicator: one small signal that tells you about something much larger you cannot see. You cannot personally check everything. So you plant one small thing that is easy to see, and which is only ever correct if all the invisible things were done properly.
Plant your brown M&MChoose something tiny and visible that only happens if the whole protocol was followed. The patient photograph filed in the right folder. The scan uploaded before the patient leaves the chair. A recall date entered while the patient is still standing there. If that little thing is missing, stop and look properly, because it is rarely the only thing missing.
The bottleneck
The surgeon who is never allowed to wait
Aravind Eye Hospital in Madurai treats most of its patients free, funded by those who can pay. To make that work, it had to find far more surgery in the same working day, without asking anyone to rush.
So it changed the room. Every theatre has two operating tables instead of one. A surgeon finishes a patient, turns around, and begins the next patient who has already been prepared and anaesthetised by a separate team. The surgeon never waits for a room to be cleaned or a patient to be readied.
The result is not a small improvement. Their surgeons perform well over two thousand operations a year, against an Indian average nearer four hundred.
What it really meansEvery process has one step that sets the pace for all the others. Businesses call it the bottleneck, and the rule is simple: the bottleneck should never be the thing that is waiting, and it should never do work that something else could do. In a clinic the bottleneck is not the chair or the scanner. It is you.
Try thisFor one day, note every minute you personally spend waiting. Waiting for a room to be reset, for records to be found, for a patient to be seated, for a plan to be opened on screen. Then ask which of those minutes needed a specialist at all. Anything that does not require your training is something someone or something else should be doing while you are already working on the next patient.
An olive. A sweet. A second table.
None of these came from a bigger budget or a busier day. They came from someone finally looking closely at something everyone had stopped seeing. Every clinic has its own version of each, sitting in plain sight.
Sources: Britannica and Forbes on the 1987 American Airlines olive; Snopes and David Lee Roth's autobiography on the Van Halen contract rider; Harvard Business School case material and published reporting on Aravind Eye Care System. Company names are used for illustration only, and no affiliation or endorsement is implied.
Torque of the Town · Issue 01Page 5 of 6
Wisdom Teeth
Q&A with an orthodontist we admire
Dr Sarojini Joseph
Senior orthodontic consultant, St John's Academy Founder member, New Faces Trust
In our very first edition, we're delighted to feature Dr Sarojini Joseph, senior orthodontic consultant with St John's Academy, founder member of the New Faces Trust, and for over two decades a mentor and guide to young orthodontists. She has worked in cleft and craniofacial orthodontics since 1989 and taught postgraduates for fourteen years. Today she devotes herself to training the next generation. In this edition she talks about learning, honesty, and the conversations nobody prepares you for.
When you did your PG, there was no internet, and books weren't freely available. How did you manage mam?
PG was only two years then, and there simply wasn't enough literature to read. I took to teaching largely to get access to the journals, and then found a training programme that actually paid me while it trained me. In the early nineties Dr Krishnaswamy, Dr Venkateswaran and Dr Ashwin at Ragas helped me enormously, and I learnt a great deal from the colleges I visited when I went for examinations. Dr Sadashiva Shetty at Bapuji Dental College then trained me extensively. Those straight wire courses in 1996 were my turning point. That led on to many other such training programmes, followed by the learnings from Charles Burstone in 2002, and it kept going on.
So to keep learning is the most important learning?
That is exactly it. That is my biggest learning. I have always tried to train with the best, attending landmark teaching programmes with orthodontic faculty from Connecticut, Yonsei and Chang Gung in Taiwan. Over 120 courses on, I still haven't stopped. During COVID I went back to the basics of physics and engineering from the book by Halliday and Resnick, and had the time to read about moment and couple and force systems, to understand how they interweave with what we do at the chair. In 2022 I did the European biomechanics course to tie the theory back to clinical practice. But not all of it comes from courses. A great deal of it also comes from conversations with the patient, understanding their pain points and trying to find the best remedy for them.
Talking about conversations, what is the most difficult aspect of conversing with a patient?
Telling someone we cannot treat them, like for example patients with body dysmorphia, or those who genuinely cannot maintain oral hygiene. There is no gentle way to say it, you have to have that difficult conversation. The other is mid-treatment honesty. If a plan needs changing, I say so. Sometimes patients might feel a particular treatment procedure is taking too long and would want a second opinion. In such cases, I never withhold records. Their right to information comes first.
A favourite quote
“Force is the tool of the orthodontist, just as the axe is the tool of the woodcutter.”
You spoke about learning from the right teachers. What do you make of social media then?
Please do not form your opinions from there. So much of what circulates isn't theoretically sound, but it spreads anyway. Go to the right courses. Learn from the real teachers.
And your one advice to a young orthodontist?
Do both the clinical and the functional examination thoroughly. A proper functional examination can change your diagnosis entirely. Spend time with the patient. You have the skillsets and the ability to change lives, so do not be in a rush, and enjoy what you do.
Dr Sarojini Joseph now devotes her time to training young orthodontists through courses and workshops. Her next workshop, titled Biomechanics Unlocked, falls on the weekend of Teachers' Day, chosen deliberately, as her tribute to the teachers who shaped her. The invite is on the next page.
Torque of the Town · Issue 01Page 6 of 6
The Invitation
Something worth clearing your calendar for
Biomechanics Unlocked · National workshop for predictable orthodontic treatment4 to 6 September 2026 · St John's Academy of Health Sciences
The workshop Dr Sarojini Joseph spoke about on the previous page, run as the Dr Kandavara Sadashiva Shetty Training of Trainers Programme. Three named lectures, delivered by faculty from Yonsei University in South Korea, the University of Siena and the University of Naples Federico II.
Scan either code on the invitation to view clinical cases, or to see the schedule and register.
What did you think of this edition?
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