CDT Code Change Action Request Form

Requestor Information

Date Submitted:

October 28, 2015


Elliot Davis

Address (Line 1):

80 Fifth Avenue

Address (Line 2):



New York



Zip Code



(212) 645.9255


Does this request represent the official position of: a) a dental
organization or a recognized dental specialty; b) a third-party payer or
administrator; or c) the manufacturer/supplier of the product?

Yes  >


If Yes, Name:


No  >


Does the requestor or entity identified in item #1 or #2 receive any financial

Yes  >


If Yes, describe:


No  >









Code (Revisions & Deletions)


Full text of requested action (Additions
& Revisions)


Arch Reformulation Therapy (ART)


The utilization of sequential removable appliances (i.e.,
periodontal aligners) to improve the supporting structures of the dentition.

Rationale for this request (e.g., reasons why existing procedure code
is inadequate or no longer appropriate; description of technology inherent to
procedure; dental schools where taught).

Arch reformulation therapy (ART) is a dentally gentle non-surgical
methodology which uses sequential removable appliances (i.e., periodontal
aligners) to create new or enhance the existing osseous substructure that
supports the dentition and gingiva. ART can be used for a number of dental
maladies (e.g., periodontal disease, non-surgical elective orthognathic
therapy, TMD, chronic malocclusion).

Unlike comprehensive orthodontic therapy which this committee determined no longer merited classification as a long term dental remedy (February 2013)*, ART is designed to yield long term results. For additional information, please refer to the arch reformulation case studies (accompanying .pdf) as well as the additional videos
and tutorials at which will be posted in January 2016.

The dental public is desirous of and yearning for non-surgical and non-aggressive solutions to common dental problems. Arch reformulation offers clinicians and patients a prudent, predictable and cost effective option to significantly improve their oral health.

* For reference purposes: At its February 2013 meeting, the CDBP Code Maintenance Committee modified the CDT Descriptor for comprehensive orthodontic therapy. The CMC voted without a dissenting vote (20 yes, 1 abstention) to delete the most vital sentence in the descriptor, one included for many years: “Optimal care requires long-term consideration of patient’s needs and periodic re-evaluation.”

In contrast to when verbiage is considered during a discussion and debate but not included, the removal of an essential aspect of a descriptor validates the inverse definition. The revised descriptor, which went into effect in January 2014, for code D8090 is unambiguous. The inverse to the portion of the descriptor states: “Optimal care neither requires the long-term consideration of the patient’s needs nor any periodic re-evaluation by the clinician who rendered care once treatment’s been completed.”

For Additions – a) current CDT Code used to report the proposed
procedure; b) description of the procedure or clinical condition; and c) scenario
describing the patient, materials, technique, etc.

a) D8090, D4273, D4999

b, c) Arch reformulation therapy utilizes sequential
periodontal aligners which are specifically designed to reformulate the
osseous substructure. The enhancement to both the quality and quantity of the
gingival health, as well as the improvement of the occlusion, confirm the positive
results. Continued improvement after the conclusion of active therapy confirms
the occlusion and periodontal health are likely to maintain their long term, stable


Supporting documentation or literature: a) if protected by copyright,
written authorization to reprint and distribute must be provided; and b) all
material must be submitted in electronic format.

Material submitted?

Yes  >


Protected by

Yes  >


Permission to reprint?

Yes  >


No  >


No  >


No  >


Additional Comment/Explanation:

Permission to reprint is limited as follows: These are my photos of my patients. The use of my photos is restricted to the CDBP Code Maintenance Committee’s evaluation of this request and may not be used for any reason beyond the evaluation process. Please limit the use of these photos to citation purposes only.

The photos are presented to help one appreciate the distinction between the goals for and results obtained with ART when compared to those associated with comprehensive orthodontic treatment and gingival grafting procedures.



Patient #1:        10 years after the completion of traditional orthodontic care

3 years after the periodontal grafting surgery in the mandibular anterior region



#1:        5 years after the completion of ART with periodontal aligners

9 years after the periodontal grafting surgery

16 years after traditional orthodontic care


The periodontist who performed the grafting surgery in the mandibular anterior region recommended that she receive four additional surgical grafting procedures. After ART, that periodontist revised his recommendations. He believes that there has been sufficient improvement to her periodontal health, coupled with
the elimination of thermal sensitivity, that there is no longer a need for any additional
grafting surgeries.

Based on the continued improvement to her oral health, her general practitioner dentist(GP) has reduced the number of recommend prophylaxes per year from four to two.

For the past few years, the GP has performed all of the periodic exams and oral prophylaxes. The GP does not believe the patient requires the care of a periodontist at this time.


Patient #2: 4 years after the conclusion of orthodontic treatment with orthodontic aligners


#2:        4 years after the conclusion of ART with periodontal aligners.


The improvement to his occlusion has helped stabilize the dentition. That has helped to increase the stability of his dental composite restorations, which have lasted significantly longer than those placed previously. While his oral hygiene habits have not changed significantly, the improvement to his periodontal health has been steady and appreciated by the patient and his dental team.