Interview with Dr Mohanarajah s/o S. Senathirajah: “We have seen a tremendous growth in the number of attendees” / Ortho News / 3Shape and Ormco expand collaboration / Creative adjuncts for clear aligners to improve predictability
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[1] =>
ORTHOTRIBUNE
The World’s Orthodontic Newspaper · Asia Pacific Edition
www.dental-tribune.asia
Published in Hong Kong
Vol. 15, No. 1+2
“We have seen a tremendous growth
in the number of attendees”
An interview with Dr Mohanarajah s/o S. Senathirajah,
Chairperson of the Association of Orthodontists (Singapore) Congress 2017
By Kristin Hübner, DTI
Philippines and Vietnam and elsewhere, making AOSC 2017 a truly
regional event.
From 24 to 26 February, the orthodontic community will come
together at the Association of
Orthodontists (Singapore) Congress
(AOSC) at Marina Bay Sands in
Singapore. Dental Tribune had the
opportunity to speak with AOSC
Chairperson Dr Mohan about highlights of this year’s programme and
why he thinks it is important for
specialist congresses to both look
at successfully treated cases and
discuss and learn from cases that
have failed.
Dental Tribune: One objective of
the AOS is to provide a lively
platform for dental professionals
throughout the world and to foster
closer ties between them. How important is the congress in achieving
this aim?
Dr Mohan: In orthodontics
today, there are many new trends,
clinical developments and techniques to advance excellence
in orthodontic practices. AOS,
through our biennial conferences,
aims to bring together worldfamous researchers, academics
and clinicians to provide attendees with the most updated review
of the evidence base and clinical
areas related to the specialty of
orthodontics.
This is the fourth biennial meeting.
What has changed over the years?
In the last four editions, we
have seen a tremendous growth
in the number of attendees from
around the world, not just limited
to the Asia-Pacific region. We also
have an increased number of
international orthodontic companies exhibiting at AOSC, especially in the field of digital
imaging.
What is the theme of this year’s
event and why was it chosen?
The theme “Achieving success:
Overcoming challenges in orthodontics” was chosen because, besides seeing successfully treated
cases, we feel we can also learn
from seeing cases that have failed.
Seeing such cases allows us to review our approach and adjust the
treatment plan as we go along.
Our speakers have been asked to
especially highlight cases with
poor outcomes for discussion.
How many visitors do you expect to
attend the meeting?
Dr Mohan, Vice President of the Association of Orthodontists (Singapore)
and chairperson of the 2017 congress
organising committee.
From your perspective, what have
been the most important developments in orthodontics in Singapore
and the Asia-Pacific region in recent years?
The most important developments in orthodontics in recent
years are the advancements in
digital imaging and 3-D printing.
Besides being crucial for orthodontic diagnosis and treatment
planning, digital imaging and
3-D printing are essential tools
that allow us to closely monitor
treatment progress and outcome.
With advancements in imaging
and 3-D printing, we are able to
improve the level of diagnosis,
vary the treatment options and
achieve more predictable treatment outcomes.
MBT system, will be giving an
overview on clinical orthodontics.
Prof. Ravindra Nanda will speak
on managing complex multidisciplinary patients, which is becoming more relevant these days as we
see more and more adult patients.
A range of topics, including retention, anterior open bite and clear
aligner treatment, will also be covered, providing all participants
with the opportunity to focus on
their chosen key topic.
What will be happening on the preand post-congress days?
The days before and after the
event have traditionally been
reserved for limited-attendance
workshops at AOSC. This edition
is no different. We have five halfday workshops, which will cover
topics such as how anchorage
concepts with mini-screws can be
implemented, how to incorporate
“We can also learn from seeing
cases that have failed.”
We are expecting 550 attendees from across the region and
almost all of the workshops are
already sold out. Based on our
current registration numbers, we
have noticed an increase in the
number of visitors from neighbouring countries Malaysia, the
What are the key topics of the
scientific programme?
It is difficult to pick a key topic,
as all of our presenters are leaders
in their respective fields and will
be speaking on their specialty
topics. For example, Dr Richard
McLaughlin, the creator of the
evidence into the daily practice and
the biomechanical background of
Invisalign (Align Technology).
There will also be an industry exhibition alongside the congress. With
the event being held just before
the 2017 International Dental Show,
can visitors look forward to trying
out some exciting new orthodontic
products?
Yes, we are excited to have increased our number of exhibitors
by 15 per cent for this edition, bringing the total to 30 exhibitors representing 77 brands. Products on
display will cover both well-established brands, such as Invisalign
and CEREC (Dentsply Sirona), and
new brands and services, such as
Dental Monitoring and JoyAligner
(Bliva). There will also be a number
of live demonstrations of products
and software during the exhibition
that visitors can look forward to.
Aside from the exhibition and the
lectures, what networking events
have you planned this year?
Our networking events are
among the highlights of AOSC.
This edition’s fully booked welcome reception will be held at
Aura, which sits on top of Singapore’s newest museum, the National Gallery. The location offers
great views of Singapore’s skyline,
while reflecting Singapore’s history, as the building in which the
restaurant is housed is the former
Supreme Court of Singapore.
The Gardens by the Bay Run
will give participants another opportunity to meet with their peers.
I believe that the run is unique
to our conference and exhibition.
This edition’s two kilometres route
will take participants along both
the Marina Bay and the Gardens
by the Bay before the conference
begins on the second day.
Thank you very much for the interview.
[2] =>
ORTHO NEWS
18
Ortho Tribune Asia Pacific Edition | 1+2/2017
Orthodontic supplies market:
Report predicts highest growth rate in AP
By DTI
regional segments in the global orthodontic supplies market in 2016,
the Asia-Pacific market is projected
to register the highest growth rate
over the next five years, a new re-
PUNE, India: While North America
and Europe are expected to have accounted for the largest share of the
port by market specialist MarketsandMarkets has found.
According to the research
firm, the forces driving this de-
velopment are growing efforts to
increase awareness of advanced
orthodontic treatments in the region and a very large patient population with malocclusion and
AD
The 65th Annual Meeting of
Japanese Association for
Dental Research
JADR 2017
[ Dates
Date ]
11 / 18 (Sat.) - 19 (Sun.) , 2017
[ Venue ]
SHOWA UNIVERSITY, Tokyo, Japan
[ Them
Theme ]
Forefront of Dental Science
- Toward the Global Standard in Medical Science
[U R L]
http://jadr65.umin.jp
[ Congress President ]
Ryutaro Kamijo
Department of Biochemistry, School of Dentistry, Showa University
The fixed braces segment is expected
to have gained the largest share in the
global orthodontic supplies market in
2016.
jaw disorders. In addition, growth
is being stimulated through increasing disposable income, coupled with a growing middle class
and the stronger focus of global
orthodontic and dental companies on emerging Asia-Pacific
countries.
Overall, the global orthodontic supplies market is expected to
grow further at a compound annual growth rate of 8 per cent over
the forecast period of 2016 to 2021
and is expected to reach US$4.71
billion by 2021.
Among the three major product categories, fixed braces, removable braces and orthodontic
adhesives, the fixed braces segment is expected to have gained
the largest share in the global orthodontic supplies market in 2016.
According to the analysts, this is
primarily attributed to the greater
affordability (compared with removable braces) and increasing
adoption of fixed braces among
adolescents.
According to the market review,
the major competitors in the orthodontic supplies segment are 3M,
Align Technology, Danaher Corporation, Henry Schein, Dentsply
Sirona, American Orthodontics,
Rocky Mountain Orthodontics,
G&H Orthodontics, Dentaurum
and TP Orthodontics.
[ Congress Secretariat ]
Department of Biochemistry, School of Dentistry, Showa University
1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
TEL: +81-3-3784-8163 FAX: +81-3-3784-5555
[ Management Secretariat ]
Japanese Association for Dental Research
Academic Square Co., LTD. 2-348-302, Ryogae-machi, Fushimi-ku, Kyoto 612-8082, Japan
TEL: +81-75-468-8772 FAX: +81-75-468-8773 E-MAIL: jadr65@ac-square.co.jp
The full report, titled Orthodontic Supplies Market by Removable & Fixed Braces (Brackets
(Self Ligating, Lingual, Metal, Ceramic, Aesthetic), Archwire (Nickel
Titanium, Stainless Steel), Ligature (Elastomeric, Wire), Anchorage
Appliances, Adhesives), Patient—
Forecast to 2021, can be purchased
from the MarketsandMarkets website.
[3] =>
Ortho Tribune Asia Pacific Edition | 1+2/2017
ORTHO NEWS
19
“We need to update our knowledge on
the various aligner systems available”
An interview with Dr Graham Gardner, President of the European Aligner Society
By Brendan Day, DTI
the 3-D treatment planning and
manufacturing processes now
available, we at the EAS believe
that not only do we need to update
our knowledge on the various
aligner systems available, we also
need to understand the associated
hardware, such as scanners, computers and 3-D printers, and software that is necessary to optimise
the aligner system and improve
treatment results. It is therefore
our objective to bring these two
areas together at one event with
the AlignerLab.
Since it was commercially introduced in 1999, aligner therapy has
grown and developed substantially
as an orthodontic treatment modality. Dr Graham Gardner is the first
President of the European Aligner
Society (EAS), an organisation dedicated to increasing education and
research in aligner therapy. The inaugural EAS AlignerLab workshop
will be held in Vienna in Austria on
18 February and aims to provide
a hands-on learning experience for
dental professionals interested in
updating their knowledge of aligner
treatment. Dental Tribune interviewed Gardner about the role of
aligners in orthodontics and what
the event organisers have in store.
Dental Tribune: What benefits do
aligners offer over fixed orthodontic appliances, and how have these
developed since aligners were first
introduced?
Dr Gardner: In my opinion, the
advantages of aligner therapy for
the patient are:
1) They are more comfortable than
fixed appliances.
2) They are more aesthetic, and
therefore less noticeable, compared with fixed appliances. This
is especially important for someone seeking orthodontic treatment because he or she is already concerned and self-conscious about his or her teeth, as
the last thing such a patient
would then want is to draw attention to his or her teeth with
fixed appliances.
This will allow attendees an
opportunity to listen to worldfamous clinicians on different
systems, to compare these different aligner systems and to gain
hands-on experience with the different equipment associated with
these systems.
Dr Graham Gardner at the first EAS congress last year.
3) Improved maintenance of oral
hygiene and no dietary restrictions, as the aligners are removed for eating.
The advantages of aligner therapy for the orthodontist are:
1) Improved treatment planning
capabilities owing to the 3-D
treatment software. Virtual
treatment planning allows one
to evaluate different treatment
options that, crucially, can be
more clearly discussed with the
patient owing to the virtual presentation process. In my opinion,
this allows the patient to make a
more informed decision on the
treatment.
2) Broken brackets and emergencies are things of the past.
Additionally, a benefit shared
by both patient and clinician is
that adjustment appointments are
often quicker and certainly more
comfortable for the patient compared with fixed appliances.
What have the main impediments
been to the adoption of aligners by
dental professionals?
I think that, initially, aligners
were basic and our knowledge on
how to move teeth with plastic was
limited. Hence, in the earlier years,
only minor tooth movement could
be predictably treated with aligners, and this limited their use
and then restricted the number
of practitioners prepared to use
aligners. Combined with the fact
that the practitioner now had to
learn new software programmes
and how to plan treatment on a
computer—a vastly different skill
to having the physical study model
in one’s hands and brackets on
teeth—one can see why the initial
take-up was perhaps less than
would have been expected.
The first EAS AlignerLab is set to
take place in Vienna in February.
What prompted the EAS to hold this
workshop, and what can participants expect to gain from it?
We are excited about the first
AlignerLab. With the explosion in
Organisers of ASOFRE 2017 invite
orthodontists to Brisbane
By DTI
BRISBANE, Australia: The Australian
Society of Orthodontists’ Foundation
for Research and Education (ASOFRE)
will play host to many of the specialty’s leading figures on 3 and 4 March
at its 2017 Foundation Meeting at
the Hilton hotel in Brisbane. The
organisers have warmly invited
dental practitioners to attend the
meeting, which has the theme of
“Aesthetics and evidence” this year.
The foundation is the primary
organisation for orthodontic research and education in Australia. It
aims to foster a collaborative and
sharing environment through its
biennial Foundation Meetings and
provides financial and educational
support to Australian universities,
Brisbane is set to host the Australian Society of Orthodontists’ Foundation for Research and Education’s 2017 Foundation Meeting.
We think it is a unique way to
update our knowledge on aligner
therapy, with a bonus opportunity
to forge links with our colleagues
across Europe.
Is the AlignerLab a one-off thing or
is it intended to become a regular
event?
We hope this will become a regular event because technological
developments and advances will
continue. Thus, an event at which
practitioners can both make direct
comparisons and trial new systems should become a popular and
regular occurrence.
Dental Tribune thanks Dr Gardner
for the interview.
students and researchers in the field
of orthodontics.
The event’s keynote speaker
will be Prof. Henry Fields, the Vig/
Williams Endowed Division Chair
of Orthodontics at the Ohio State
University’s College of Dentistry
in the US. Fields’s talk will cover
growth modification, smile aesthetics, and orthodontic surgical
treatments. In addition, a number
of Australian and international researchers will be conducting presentations throughout the two days
of the meeting. Those speaking include Dr Prashant Zaveri, Chairman
of the Asian Pacific Foundation for
Orthodontic Research and Education,
and recipient of the Medal of the
Order of Australia Dr John Fricker.
The Foundation Dinner on the
evening of 3 March is sure to be a
highlight, as it will take place in the
riverside restaurant of Brisbane’s
heritage-listed Customs House.
[4] =>
ORTHO BUSINESS
20
Ortho Tribune Asia Pacific Edition | 1+2/2017
3Shape and Ormco
expand collaboration
By DTI
COPENHAGEN, Denmark: Danish
dental manufacturer 3Shape has
announced that its indirect bondAD
ing solution, a function within the
company’s orthodontic software,
now integrates with the Damon
System bracket library by Ormco
Corporation. Consequently, users
are now able to digitally place the
Damon brackets based on a virtual model produced by 3Shape’s
TRIOS intra-oral scanner or conventional laboratory impressions.
Ormco’s Insignia Advanced Smile
Design already accepts TRIOS scans
for treatment. With the integration
of Ormco’s Damon System bracket
library, the companies are expanding
their collaboration.
“We are very excited to provide orthodontists and labs with
access to the Damon System
bracket libraries. The integration
gives professionals the advantage
of a fully digital workflow to reduce chair time and increase
treatment efficiency and patient
comfort,” said Allan Junge Hyldal,
Vice President of Orthodontics at
3Shape.
Owing to the simpler procedure, indirect bonding has proven
to have multiple benefits for the
patients compared with direct
bonding, including reduced treatment and chair time, as well as less
physical and mental stress.
The newly integrated Damon
System bracket library joins more
than 150 original bracket libraries
and orthodontic solution providers. “Ormco is pleased that doctors
now have access to our advanced
passive self-ligating metal and
aesthetic brackets, including the
improved Damon Clear2 bracket,”
commented Ormco President
Patrik Eriksson on the collaboration.
“With the increased demand
for aesthetic and effective treatment solutions, Damon Clear2
enables 3Shape customers to efficiently treat all of their patients
—including complex cases and
mixed dentition—to an exceptional result,” Eriksson said.
T/Shutterstock.com
[5] =>
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[6] =>
ORTHO TRENDS
22
Ortho Tribune Asia Pacific Edition | 1+2/2017
Creative adjuncts for clear aligners
to improve predictability
1
2a
2b
2c
3
4a
4b
5
Fig. 1: The Hu-Friedy Clear Collection consists of four instruments: the Tear Drop, Hole Punch, Vertical and Horizontal.—Figs. 2a–c: The Tear Drop is designed to cut a teardrop-shaped notch in the margin of clear
aligners to retain orthodontic elastics for various applications.—Fig. 3: Class II clear aligner treatment enhanced with Class II inter-maxillary elastics and Class I intra-maxillary elastics attached to mini-screw anchors
to produce the intended vectors of force.—Figs. 4a & b: The Hole Punch is used to cut a half-moon of plastic at the aligner margin to clear the way for bonded buttons or brackets in order to connect orthodontic elastics
or elastomeric chains.—Fig. 5: Seating elastics used to improve posterior intercuspation in finishing aligner treatment. The Hole Punch cleared plastic to permit bonding of buttons for the inter-maxillary box elastics.
By Dr S. Jay Bowman, US
The concept of clear aligners has
grown in leaps and bounds internationally since the introduction
of Invisalign (Align Technology)
in 1999. In the 1940s, Dr Harold
Kesling first proposed the original
theoretical basis for moving teeth
with a series of retainers, but it
took more than 50 years before
computer technology made the
idea workable.
Although some of the initial
excitement attending the idea
that all patients could be treated
without metal fixed orthodontic
appliances wore off quickly, early
adopters and innovators have
worked diligently to improve and
enhance clear aligner methods.
Limitations of clear aligner treatment simply required some time
and experience to discover, but
ultimately resulted in a series of
articles quantifying issues often
experienced clinically.1–16
endeavours, a series of articles were
published suggesting innovative
treatment options with various adjuncts to clear aligners,19–21 including Hu-Friedy’s Clear Collection
instruments (Fig. 1).22–24
As patients’ and practitioners’
desires for aesthetic alternatives
to fixed appliances continued to
coalesce in the past decade, there
have been a number of technological and biomechanical advancements that have led to an
ever-increasing number of treatment application possibilities for
aligners, including the expansion
to treating teenagers.17, 18 In those
As understanding of some of
the limitations of clear aligner
applications came to light, alterations to biomechanics, materials
and treatment planning were introduced. The primary aims were
to improve the predictability of
specific tooth movements and to
expand the scope of treatment
to a wider variety of presenting
malocclusions.
Clear Collection
A set of instruments were created specifically for clear aligners
in order to enhance, accent and
increase the spectrum of applicability and acceptability of this
form of aesthetic orthodontic treatment. The Clear Collection consists
of four instruments designed to
individualise aligners to address
specific treatment needs.23–24
The Tear Drop
The Tear Drop instrument is
used to add a notch or hook in the
gingival margin of aligner plastic
for the application of typical orthodontic elastics.19–21, 23 The design
of this cut-out is in the shape of
a teardrop with the intent that the
reservoir of the notch will keep an
6a
6b
7a
7b
8
9a
9b
10
elastic in place on the aligner (Figs.
2a–c). In this manner, the aligner
with elastics can be inserted into
the mouth, reducing the fumbling
and difficulty associated with attempting to put elastics into slits
or notches after the aligner tray is
already on the teeth. The Tear Drop
cuts can be made anywhere along
the aligner tray edges where elastics may be needed, such as intermaxillary Class II, Class III or delta,
or Class I intra-maxillary applications, even involving the use of
mini-screw anchors to support the
elastic forces (Fig. 3).19, 21, 23
The Hole Punch
The Hole Punch instrument is
used to create a half-moon cut-out
Figs. 6a & b: Areas of gingival impingement or irritation from clear aligners can be cleared using the Hole Punch to remove plastic.—Figs. 7a & b: The Vertical instrument produces a shallow indent in the plastic to
accent rotational couples on individual teeth.—Fig. 8: The indents from either the Vertical or the Horizontal pliers may be formed immediately adjacent to attachments to accent the contact point of plastic in the right
angle between composite and tooth, with the intention of increasing the effectiveness of the attachment.—Figs. 9a & b: Adding root torque to specific teeth is enhanced by creating indents with the Horizontal pliers.
The same tool may also be used to increase the retention of aligners or clear retainers.—Fig. 10: Aligner lag or loss of tracking is a common occurrence, especially for maxillary lateral incisors, the least predictable tooth
movement. The air gap is a symptom of ill-fitting aligners and may have a number of causes (e.g. poor compliance, insufficient space created for the tooth to follow and lack of surface area contact with plastic).
[7] =>
ORTHO TRENDS
Ortho Tribune Asia Pacific Edition | 1+2/2017
11a
12a
Figs. 11a & b: Chewies Aligner Tray Seaters were developed as a kind of mini-tooth
positioner for patients to clench in specific sites to encourage trays to seat and reduce
the development of aligner lag.—Figs. 12a–d: Bootstrap mechanics are designed to
extrude individual teeth into clear aligners with orthodontic elastics. (a & b) The Hole
Punch is used to cut out a half-moon clearance for a bonded button on the lingual
surface of a selected tooth. (c) The Tear Drop is used to place two elastic notches in
the facial margin of the aligner at both the mesial and distal gingival embrasures. An
elastic is then stretched from the dual notches, over the aligner, to the lingual button
to generate an extrusive force. (d) A second option is to cut a second half-moon in the
facial surface, bond a labial button and place the elastic from the labial to lingual
surfaces over the aligner.—Fig. 13: A Clear Collection prescription form is completed for
each patient to indicate the instruments that will be required to customise each aligner
in a series, along with the specific sites where they will be employed on each tooth.
11b
12b
at the gingival margin of aligner
plastic (Figs. 4a & b).19–21, 23 The intention is to relieve the plastic to
permit the application of bonded
buttons or brackets on specific
teeth to support orthodontic elastics or chains. These cuts can be
placed wherever needed along the
aligners on either buccal or lingual
surfaces. A common scenario would
be punching holes in the buccal
margin of plastic at the maxillary
and mandibular first molars and
canines to bond buttons to support seating or box elastics (Fig. 5)23
or cutting a half-moon on both the
lingual surface of the maxillary
first molar and buccal surface of
the mandibular first molar to facilitate the use of a through-the-bite
cross-bite elastic.
In addition, the Hole Punch
may be employed to simply clear
plastic away from impinging gingival tissue anywhere along the
aligners.23 The incisive papilla is
a common location for this type
of irritation that can be quickly
resolved by clipping the plastic in
that area for each tray in a series
(Figs. 6a & b).
Individualising aligners
with accent pliers
Two accent pliers round out
the Clear Collection. These unique
instruments were designed to
enhance specific types of tooth
movement by increasing plastic
contact points in precise locations
for individual teeth. The intent
is to increase the predictability
of tooth movements by creating
shallow indents in the plastic to
augment prescribed mechanical
couples. Most importantly, these
pliers are not heated. In addition,
these indents may be produced to
increase the retentiveness of aligners or clear retainers in undercuts
and at line angles.
The Vertical
Controlled rotations of teeth
are often difficult to achieve with
aligners,20, 25–27 as the computergenerated prescribed movement
may not be translated accurately
to the tooth. The first of the two accent pliers is called the Vertical20, 24
and it is used to gently impress a
vertical indent into the aligners in
a specific location in the lingual
and/or facial plastic for an individ-
12c
ual tooth (Figs. 7a & b). Rotating
maxillary lateral incisors and canines are often sites of these types
of problems.20, 25–27 As an example,
the rotated lateral incisors in Class
II Division 2 malocclusions are difficult to correct and typically
require that overcorrection be
designed into the aligners at the
outset. If additional rotation is
indicated, an indent can be placed
in the plastic at the mesial line
angle on the facial surface and the
distal line angle on the lingual
surface to create some extra force
in the form of a rotational couple
in a series of aligners.24 This may
preclude the necessity of another
round of refinement appliances
to achieve the intended goal. If a
composite attachment is in place
on a specific tooth, the Vertical can
be used at the right-angle contact
of the aligner and the composite
to sharpen the contact point in
that location for more efficient
transmission of force to the tooth
(Fig. 8).
The Horizontal
The second accent instrument
is the Horizontal19–21, 24 and it is primarily used to produce an indent
to affect a change in tooth root rotation or torque.18, 24, 28, 29 A horizontal impression into the plastic at
the gingival margin of the aligners
will emphasise the force applied
to torque the roots of individual
teeth (Fig. 9a). These horizontal
indents can also be placed at the
right-angle junction of a composite attachment and the tooth to
enhance the contact, thereby increasing the effectiveness of the
intended tooth movement and reducing the risk of lag as the plastic
may slip away. Another option is
to place horizontal indents at the
marginal undercuts of the crown
of the teeth to increase the retentiveness of aligners or retainers
(Fig. 9b).
Common applications:
Beating aligner lag and
bootstrap mechanics
Besides facilitating the typical
addition of inter-maxillary elastics for a variety of anchorage
supports for tooth movement or
intention to alter dentoalveolar
compensation (i.e. Class II, Class III,
23
12d
resolving deep and open bites, extraction space closure, etc.19–24, 30–34),
a common application for the Tear
Drop and the Hole Punch is establishing bootstrap mechanics.20, 23
For instance, a tooth or teeth may
be lagging behind the prescribed
movement, especially in terms of
extrusion—the tooth may not be
following along the projected path
(Fig. 10). This may be due to inadequate space created adjacent
to each side of the tooth or lack of
adequate contact on the tooth or
attachment.
Initially, Chewies Aligner Tray
Seaters20, 23, 35 (another of our creations from our private practice;
DENTSPLY Raintree Essix) are routinely used at each new aligner to
assist in seating them on to the
teeth (Fig. 11a), along with instructions to massage the trays into
place (use fingers to push the trays
on to the teeth as though attempting to stretch them over attachments and undercuts for the first
few days). Despite those efforts, an
air gap between the incisal edge
of the teeth and the plastic may
develop (Fig. 11b). It may be that
inadequate space has been created
prior to extrusion and the interproximal contacts thus cannot
pass by each other (consider the
widening taper towards the anterior incisal edges) and aligner lag
or lack of tracking is the result.
In these instances or in anticipation thereof, a bootstrap set-up
is prepared.20, 23 This consists of
placing bonded buttons on the
lingual surface of the offending
tooth near the gingival margin by
creating clearance for the button
in the aligner plastic with the Hole
Punch (Figs. 12a & b). On the facial
surface of the same tooth there are
two options: another button and
a hole punch (Fig. 12c). The Tear
Drop is used to create two elastic
notches at the mesial and distal
gingival embrasure spaces (Fig. 12d).
A small-diameter orthodontic elastic is then applied to either the
teardrop notches or the button on
the facial surface of the tooth and
stretched over the occlusal surface
of the aligner to the lingual button. In this scenario, the elastic is
intended to more predictably extrude the tooth into the aligner to
the prescribed position.
13
Future view on aligners
As demand by patients for
more comfortable, hygienic and
aesthetic treatments increases,
the clear aligner market will respond with more advances and alternatives. In addition, orthodontists will learn to better push the
envelope of applications by adding
adjuncts to improve the effectiveness and ultimately the predictability of treatments with aligners.
Much like fixed appliances, the
ability to individualise, accent and
enhance clear aligner biomechanics reduces the known limitations
of aligners and the associated clinical frustrations of the orthodontist. Managing alterations of series
of aligner trays in real time (including the use of a Clear Collection
prescription form;24 Fig. 13) provides increased flexibility in the
endeavour towards increased predictability of aligner orthodontic
outcomes.
More details on the Clear
Collection, treatment applications,
downloadable publications (including the Clear Collection prescription form) and a series of
instructional videos can be found
on the Hu-Friedy website.
Dr S. Jay Bowman
is a diplomate
of the American Board of
O r tho do ntics
and a member
of the Edward
H. Angle Society
of Orthodontists. At the Association of
Orthodontists (Singapore) Congress,
he will be presenting a lecture titled
“Creative adjuncts for clear aligners:
Improving the predictability of aligner
treatments”, among others. He maintains a private specialty orthodontic
practice in Portage in Michigan in
the US. He can be contacted at info@
kalamazooorthodontics.com.
AD
22
nd
International Expo
Guangzhou
Top Dental inShow
China 行业盛事博览牙科
March 2 -5 ,2017
nd
th
www.dentalsouthchina.com
Area C of China Import and Export Fair Complex
Organizer: Guangdong Int’l Science & Technology Exhibition Company
Exhibitor Service
Tel: 0086-20-83549150
Email: dental@ste.cn
Visitor Service
Tel: 0086-20-83561589
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Fax: 0086-20-83549078
[8] =>
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