Beyond patient care, Hessam Rahimi, DDS, DMSc, MBA, leverages his practice to test innovative orthodontic solutions, such as Brava by Brius.
By Alison Werner | Photography by Amir Fard
When Hessam Rahimi, DDS, DMSc, MBA, launched his first private practice, he envisioned it as more than just a clinic—it would be a center for research and development. He wanted to create a space where companies could bring their latest products and technologies for real-world testing, allowing him to critically evaluate whether their ambitious marketing claims held up in practice.
“[These companies] come from a good place, but the marketing is always a little bit ahead of the reality. Each [company] is geared to resolving a current issue we have, but it needs to be tested,” he says.
Over the past 60 years, orthodontics has undergone several paradigm shifts that have improved both patient treatment and the clinician experience, from the introduction of the straight wire appliance to the rise of aligners. As Rahimi evaluates new products and technologies, his primary focus is whether they will similarly enhance his experience as a provider and elevate the overall experience for his patients.
Starting out
Rahimi and his wife, Niloofar Khalesseh, DDS, MMSc, began their careers as general dentists in their native Iran before immigrating to the United States in 2006. Once in the US, he chose to specialize in orthodontics, completing his orthodontic training and earning a doctorate in oral biology from Harvard University School of Dental Medicine in 2011, while she pursued pediatric dentistry, completing her studies at Tufts University School of Dental Medicine. Following a friend’s recommendation, they settled in Dallas to begin their careers.
Rahimi initially worked as an associate in a corporate dental chain before partnering with his wife and friends, who had also emigrated from Iran, to open a multi-specialty practice. Eventually, he and his wife branched off to open their dual-specialty practice in 2014. Then, 2 years ago, he opened a solo orthodontic practice, Fusion Orthodontics, right next door.
Today, the practice has two locations and 25 employees. Rahimi takes a hands-on approach to patient care and focuses on a comprehensive treatment plan for each patient that often pulls in colleagues from other specialties.
Rahimi, a diplomate of the American Board of Orthodontics, has always envisioned running a cutting-edge practice. For him, this means using the latest technology to treat his patients while actively engaging in the research and development of new products. In his office, he not only has a CBCT but also a complete 3D printing lab. According to Rahimi, the lab has “become a significant portion of what we do in our day-to-day orthodontic activities.” The lab prints various appliances, including aligners, retainers, night guards, and mouthguards. “Instead of going to a third-party company, like Invisalign, for limited cases, I use the digital lab,” he says.
Proving ground
With Rahimi’s commitment to using his practice as a platform to test new products and technologies, he regularly invites orthodontic product manufacturers to send him samples to evaluate, assessing whether the product enhances his experience as a provider or benefits his patients’ treatment outcomes.
“Orthodontics is a field that has a lot of room for improvement in terms of efficiency, patient experience, provider experience, and staff experience. There are all these different fronts that we can make better; so I try to be involved as much as I can,” he says.
In 2018, Rahimi was introduced to a new orthodontic appliance concept designed to enhance treatment efficiency. During the Ormco Forum in Palm Desert, Calif, Rahimi met Mehdi Peikar, DDS, PhD, MS, who had just completed his doctorate in biomechanics at Johns Hopkins University. Before that, Peikar earned a master’s degree in quantum mechanics and condensed matter from the University of Illinois. At the time of their meeting, he was also pursuing an orthodontic residency at UCLA, retraining in orthodontics after emigrating from Iran, like Rahimi. As they discussed Peikar’s work, he explained his innovative “independent mover” technology, which allows for the independent and simultaneous movement of teeth to optimize patient outcomes, as described in a 2022 Orthodontic Products interview.
READ MORE: Brava, a Novel Orthodontic System Resolves a Functional Shift
Peikar’s goal was to design an appliance that would eliminate the compliance challenges that often reduce the effectiveness of aligner treatments. Additionally, he wanted it to be aesthetically pleasing, addressing concerns patients have about the appearance of traditional brackets and wires, which can discourage them from seeking treatment.
The Brava System was designed with different mechanics in mind. Unlike traditional edgewise systems that use sliding mechanics and one wire per arch, Brava uses independent tooth movers, which are programmed spring arms with shape memory that are designed to move a specific tooth to its final position as approved by the orthodontist.
Each spring arm extends from an anchorage base located near the tooth’s center of resistance and attaches to a lingually bonded bracket. Each arm is designed to move one tooth in a specific direction with a planned amount of force without negatively affecting adjacent teeth during treatment. Another benefit of the system is that teeth move in all six degrees of freedom, including torque and tip, from the moment Brava is first engaged in the brackets. According to Peikar, “This has resulted in significant reduction in treatment time and thousands of happy patients have been treated with this product.”
As Peikar started treating patients with his appliance, he sent Rahimi documentation of those cases, and Rahimi was impressed by the treatment efficiencies. “The biomechanics were different, but it just made a lot of sense,” says Rahimi.
At Rahimi’s suggestion, Brius Technologies chose Dallas as its headquarters with Rahimi offering to test the appliance at his nearby clinic and provide feedback. At the end of 2022, Rahimi was introduced to Lea Ellermeier, who had previously launched a successful lingual system in the US, and who was tasked to lead Brius Technologies forward as a global orthodontic technology company.
Brava experience
Currently, Rahimi, who was one of the first certified Brava providers and is one of the top providers globally, serves as a clinical advisor for Brius Technologies, frequently lecturing, though he has no financial interest in the company. As he continues to treat patients with the appliance, he has witnessed first-hand how Brava has evolved. According to Rahimi, the system’s foundation—the biomechanics—has remained the same, but the brackets have become smaller, rounder, and more polished to enhance the patient experience. When Rahimi first started using the appliance, bonding and engaging Brava could take over 90 minutes. Now, it only takes 20 to 30 minutes, and he feels confident using it to treat a wide range of cases (and ages, starting as young as 8).
Rahimi prefers to use Brava over braces or aligners for deep bite cases where the lower front teeth have over-erupted. Moving them back into the bone with braces can be time-consuming, and with aligners sometimes counter-intuitive. According to Rahimi, addressing deep bites is Brava’s “strength. It’s very efficient at fixing it in a few months.”
Rahimi also appreciates how Brava eliminates the need for different wire or aligner stages, or orthodontic auxiliaries like the Carriere Motion Distalizer, to progress through complex cases, such as those involving expansion, tooth rotation, and space closure.
“All stages happen at the same time [with Brava], giving us amazing efficiency. The clock for every single one of those movements starts on day one,” says Rahimi.
Most of his cases require only one appliance, but for extremely complex cases, the technician may recommend a second Brava appliance as part of the treatment plan. Rahimi also uses Brava as a dentoalveolar expander.
According to Rahimi, who received his MBA from the University of Texas at Dallas, patient management is key to success with Brava. During the consultation, he explains to patients that the first couple of weeks after bonding may be uncomfortable as the tongue adjusts to the lingual appliance. He compares this adjustment period to the experience patients have with other lingual bracket systems he has used.
When it comes to finishing, Rahimi opts for two to three aligners for the final 5% of the treatment—after Brava has completed 95% of the major work. Brius Technologies offers up to five aligners, if needed, to complete treatment. As Rahimi describes it, finishing aligners provide predictable tooth movement over short distances while Brava provides efficient tooth movement over long distances.
Rahimi, who has treated over 500 cases with Brava, has identified several additional benefits to the system since he first started working with it in 2019. First, he notes a lower rate of root resorption compared to traditional braces. The treatment planning software accepts CBCT imaging, allowing for consideration of the entire tooth root structure and bone volume during planning. Rahimi reports root resorption in about 2% of his Brava cases, compared to 6% with braces. He attributes this to the fact that Brava uses continuous light forces to move the teeth, treatment times are routinely short, and there is no round tripping with independent tooth movement biomechanics.
A second benefit of the Brava system relates to hygiene. Rahimi prefers Brava for patients who are inconsistent with brushing, noting that it eliminates the risk of white spot lesions on the visible part of the teeth. Additionally, patients can floss normally since there is no wire to interfere. He reports fewer issues with cavities among his Brava patients. He adds that, “Although non-compliant patients could experience gingival inflammation, it’s always temporary and quickly heals back to perfection, unlike scarred hard tissue left behind when the same patients are treated with labial appliances.”
Measuring success
The treatment efficiencies Brava creates are key to Rahimi’s embrace of the appliance. He believes treatment efficiency needs to be a key metric in determining treatment success in orthodontics.
“In our literature, we have all these amazing cases back in the day, by these amazing orthodontists, but one thing that was neglected all the time was how long it took that patient to get from point A to point B,” says Rahimi. As he sees it, if two systems provide identical outcomes, but one does it in 12 months and the other in 24 months, the efficiency of the former should mark it as the superior system.
As Rahimi continues to focus on treatment efficiency as a key metric in measuring product success, he has his eye on the role artificial intelligence and automation may play in the years ahead. In his opinion, AI and automation, as well as the continued growth of digital treatment planning, are going to play a key role in the field’s innovation.
“The future belongs to more automation, more AI, and more digital treatment planning. I think this is exciting,” he says.
For Rahimi, the goal isn’t just to keep up with technological advances, it’s to stay ahead; and to ensure both he and his patients have a positive orthodontic experience.
