Cover / Editorial / Content / Accelerated aligners with photobiomodulation / Treating teen athletes with ClearCorrect aligners and DentalMonitoring to minimise office visits / Clear aligner orthodontic treatment of a complex malocclusion / Printing clear aligners in-house—how accessible is it? / 3D printing in dentistry: Future-proof technology? / International Events / Submission guidelines / Imprint
Cover
1 - 1 viewEditorial
3 - 3 viewContent
4 - 4 viewAccelerated aligners with photobiomodulation
6 - 11 viewTreating teen athletes with ClearCorrect aligners and DentalMonitoring to minimise office visits
12 - 17 viewClear aligner orthodontic treatment of a complex malocclusion
18 - 22 viewPrinting clear aligners in-house—how accessible is it?
23 - 25 view3D printing in dentistry: Future-proof technology?
26 - 27 viewInternational Events
28 - 28 viewSubmission guidelines
29 - 29 viewImprint
30 - 30 viewArray
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[1] =>
issn 1868-3207 • Vol. 1 • Issue 1/2021
aligners
international magazine of
aligner orthodontics
w
e
i
v
e
pr
opinion
Accelerated aligners with photobiomodulation
case report
Clear aligner orthodontic treatment
of a complex malocclusion
trends & applications
Printing clear aligners in-house–how accessible is it?
1/21
[2] =>
What if you could experience the
next 100 years of dentistry today?
3D printing in dentistry is much more than just a new technology: it has the potential
to control costs, improve flexibility, and expand the scope of patient care. To deliver on
this potential, SprintRay products make it easy to bring digital dentistry and 3D printing
together in your practice.
WANT TO LEARN MORE?
Visit our website
en.sprintray.com
SprintRay Europe GmbH | Brunnenweg 11 | 64331 Weiterstadt | info.eu@sprintray.com | en.sprintray.com | +49 6150 978948-0
[3] =>
editorial
|
Dr Antonello Francesco Pavone
Private practice in Rome, dedicated to the management of
interdisciplinary and aesthetic treatment in prosthodontics
and implantology
In order to restore aesthetics, function and structure while
respecting biology, an interdisciplinary approach is necessary, especially in adult patients. Only the synergy between
various disciplines, such as restorative dentistry, prosthetics, periodontics and in particular orthodontics, can create
an adequate balance of therapeutic objectives in adult patients.
Drs Werner Schupp and Julia Aubrich correctly said in
their book: “since the anatomy of the teeth cannot be
changed orthodontically, then orthodontics cannot by
itself create perfect occlusal patterns in teeth with native
or acquired defects”.1 As a restorative dentist, one can also
add: since the position of the teeth cannot always be correctly modified with restorative treatment, such treatment
will not always be able to rehabilitate misaligned teeth by
obtaining an adequate compromise between aesthetics,
function, structure and biology. Thus, it is important to understand the limits of any discipline and the importance of
working together to achieve a perfect final result. The
major difference between orthodontists and restorative
dentists is that the latter think of teeth mainly in terms of
shape and size, while the former think in terms of position
and occlusion.
Orthodontic and prosthodontic issues are crowding,
rotated teeth, insufficient or excessive interdental spacing,
and inter-arch incoherence. When these problems exist in
adult patients, restorative or prosthetic treatment cannot
be performed such that a good balance between the four
fundamental parameters of aesthetics, function, structure
and biology can be respected and obtained. How can very
rotated and overlapping teeth be adequately restored?
Technically, the treatment would be very complex to carry
out, and in the long term, the crowded teeth could have
greater periodontal and functional problems after restoration. Inter-arch incoherence would inevitably have
greater risks of functional and mechanical problems.
The advantages and benefits of orthodontics for restorative and prosthetic dentistry are minimal biological impact
on tooth structure and involvement of fewer teeth, better
proportion and dimension of the definitive restorations,
adequate self-cleaning of the mouth, flow of food and
escape of food along the inlays of the correctly aligned
crowns, and an occlusion that avoids temporomandibular
disorder and improves the mechanical long-term result of
treatment.
As a restorative and prosthodontic dentist, I hope that
aligners facilitate access to orthodontic treatment for adult
patients who need to be treated and that my peers increasingly realise that proceeding without a holistic interdisciplinary approach both entails greater technical complications in carrying out the work and reduces the
possibility of achieving the ideal therapeutic goals. All
treatment for the adult patient today requires a complete
knowledge of the masticatory system, of alternative therapies, of adequate medical diagnostics and of interdisciplinary planning.
General, restorative and prosthetic dentists should always
first consider recreating arches aligned with a “U” and not
a “V” shape and with an adequate anterior overjet, in order
to allow aesthetic restorations in the anterior but with a satisfactory long-term prognosis. Lengthening the incisal
margins for aesthetic reasons in mouths with V-shaped
arches and with crowded mandibular anterior teeth means
great risks of mechanical failure in the short term. This is
why orthodontics truly is the key to restorative success
and aligners the best way to convince our adult patients
to undergo orthodontic treatment.
Many mouths today show localised wear due to misaligned teeth. Only orthodontics can allow these mouths,
through adequate realignment, to be able to receive structural restoration only where needed. Wear in crowded
dentition provokes asymmetrical and asynchronous loss
of tissue and consequently localised and sectorial compensatory eruption. Thus, orthodontic treatment before
restorative care is absolutely unavoidable. Restorative
treatment without prior orthodontics is not only complex
and somewhat unreasonable but also a diagnostic and
planning error.
1
Schupp W, Haubrich J. Aligner orthodontics: diagnostics, biomechanics, planning, and treatment. London:
Quintessence Publishing; 2016. 358 p.
aligners
1 2021
03
[4] =>
| content
editorial
Dr Antonello Francesco Pavone
03
opinion
Accelerated aligners with photobiomodulation
page 6
06
Dr Miguel Stanley
case report
Treating teen athletes with ClearCorrect aligners and
12
DentalMonitoring to minimise office visits
page 12
Dr Melissa Shotell
Clear aligner orthodontic treatment of a
18
complex malocclusion
Dr Gina Theodoridis
trends & applications
page 26
Printing clear aligners in-house–how accessible is it?
24
Jeremy Booth
industry
3D printing in dentistry: Future-proof technology?
26
Iveta Ramonaite
meetings
Cover image: Nomadneshot/Shutterstock.com
international magazine of
aligner orthodontics
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Accelerated aligners with photobiomodulation
case report
Clear aligner orthodontic treatment
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trends & applications
Printing clear aligners in-house–how accessible is it?
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1/21
issn 1868-3207 • Vol. 6 • Issue 1/2021
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Accelerated aligners
with photobiomodulation
Dr Miguel Stanley, Portugal
When I first heard about clear aligners in the early 2000s
(the US Food and Drug Administration approved the use
of clear aligners to straighten teeth in 1980), it must have
sounded like science fiction. The fact that it was created
in Silicon Valley by people who had nothing to do with the
dental industry, in seeking solutions that do not require
complicated appliances in the mouth, is really an incredible story.
In fact, some of the greatest leaps in medicine have come
from people outside of the medical industry. We live in an
era in which technology powered by incredible software
is completely redefining our industry. Having been in dentistry for 22 years, I have never felt so excited about the
future. The reason why so many companies continuously
develop new technologies and software is based on one
simple factor. Humans want faster, better, cheaper, not
just on the patient side but on the practitioner side as well.
Pierre Fauchard, a Frenchman with an obvious passion
for straight teeth, is credited with inventing modern orthodontics in the eighteenth century. However, evidence
shows that the topic of tooth straightening goes back to
ancient Greece. There is also evidence of the Etruscans
using straightening and space maintaining devices. So,
evidently, for the longest time, people have given importance to their occlusion and smiles.
I remember going to the dentist when I was 10 years old
and having a removable palate expander fitted, which
cost my mother a fortune. I lost it in the first week and
thereafter had a guilty relationship with orthodontics to
such an extent that I never pursued studying it. I never
showed any real interest in developing my skills, but
always understood the importance of pretreatment orthodontics in complex cases and not just the classic
straightening of teeth in teenagers. I was very lucky to
have had some amazing mentors in the beginning of the
millennium who inspired me to always do the right thing
and take the long road when facing complex treatment
plans.
When I opened my first private practice in late 1999, I realised that this area, orthodontics, needed to be developed in my clinic, so I started working with a colleague in
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early January 2000, using the classic brackets with the
elastics and the regular monthly visits that became the
classic cash cow for both the clinician and the practice.
I did not really pay much attention to this, as I was so
focused on my implant and cosmetic dentistry practice.
This was how everybody else was doing it back then in
Portugal. This colleague was trained to extract first premolars in almost every single overcrowding case with
teenagers, a practice that I now find quite reductive,
because I do not think you should ever generalise, and
we now know many cases can be treated without extractions.
In 2001, I started working with a new orthodontist, trained
classically in Italy, and she has been running my orthodontic department ever since. Our focus has mostly been
on using the Damon system and Invisalign. We started
using these systems as early as 2005. We were one of
the first clinics in Europe to start working seriously with
these systems, and I am proud to say that our almost
18-year working relationship has been an incredible
success, there having been no tooth lost owing to aggressive movement and not one case of root resorption
so far. Meticulous planning is the key of success. Furthermore, the prediction of the length of the treatment proposed has almost always been correct. We found out
very early on that patients like to know when their treatment will be finished, and a well-trained professional,
with the right tools and good experience, can achieve
within a few months a time frame which is almost always
as planned. There are several reasons for this success.
The first is that, back in 2004, we invested in a digital
dental panoramic machine (orthopantomogram) with a
cephalometric arm in order to obtain lateral cephalometric radiographs for a complete analysis. This allowed us
to do proper treatment planning without having to outsource. Another reason was that I made my orthodontist,
even though she really enjoys general dentistry as well,
focus her practice exclusively on orthodontics. This was
not a common practice in Portugal back then. Orthodontics was generally performed by general practitioners.
The same was the case for implant dentistry and prosthodontics. The general thought was, why share the profits
when I can do it myself? I somehow implicitly understood
that having somebody focused only on this area would
[7] =>
opinion
Semiconductor emitting incoherent light
(typical LED)
|
Semiconductor emitting collimated light through
a lens (light rays as parallel as possible)
Figs. 1a & b: Differences between (a) a typical LED and (b) the ATP38. Vp = Positive voltage; Vn = Negative voltage; E = Energy.
Three-month treatment with twelve aligners
Fig. 2: Before (left) and after (right). The case was solved over three months with 12 clear aligners (Smilers) and photobiomodulation
therapy (with the ATP38), applied every week for six minutes every time aligners were changed.
lead to better results. Looking back, it was a smart decision. In the past decade, the practice has grown and we
have become a globally recognised centre for complex
cases. When it comes to orthodontics, we always try to
solve complex issues without surgery when possible. It
is amazing what you can do with a highly skilled orthodontist who works calmly and has an in-depth knowledge of biology and mechanics.
Notwithstanding, as the clinical director of a leading
dental centre, part of my job is to bring in new technologies and techniques that can improve the workflow at the
practice. I spend a great deal of time attending congresses around the globe, speaking to very clever people,
and over the years, I have learned how to filter the noise
from the facts. I thought it would be useful to share what
we have discovered over the past year and a half about
a relatively new system on the market that combines
clear aligners, obviously a software-driven technique,
with advanced photobiomodulation. This is in effect a
non-invasive method for an accelerated orthodontic
treatment.
What has happened in the last two decades around the
concept of clear aligners and the associated technology
has truly rocked the foundations of the dental world, and
without a doubt, the race for the best system has been
one that is only paralleled by the implant industry. If you
look at things from a larger perspective, very few companies have recently gained so much press in social and
traditional media as industry giants Invisalign and SmileDirectClub, two of the few companies that have promoted their products directly to the final consumer. I have
always been a big fan of anything that brings dentistry to
mainstream media. These companies have done a great
deal to inspire people to straighten their teeth and fix their
smiles.
Obviously, in the case of direct-to-consumer aligner companies, there is always a disclaimer that the patient must
have a clean bill of oral health before receiving orthodontic treatment. However, publicly traded companies
are usually highly focused on profits, like most large businesses should be, and perhaps the focus on acquiring
new clients is a little too financially driven, and in a clinical
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After four months of treatment
with Smilers and the ATP38
Figs. 3a & b: Upper jaws, before (left) and after (right). The case was solved over four months with 16 clear aligners (Smilers) and photobiomodulation therapy (with the ATP38), applied every week for six minutes every time aligners were changed.
setting, there are not enough medical and diagnostic
barriers between the problem and the solution. There is
absolutely nothing that can replace a quality check-up
done by an experienced dentist with the proper diagnostic tools.
We all know that this trend of direct consumerism for
orthodontic treatment has created substantial pushback from the dental community. I believe that the issues
raised are valid, and they give rise to a greater question:
can orthodontics be a direct-to-consumer product? I
have my thoughts on this, but I guess the simplistic
answer is no. The risk of poor orthodontics, planned by
technicians or artificial intelligence alone without any radiographs or CBCT scans, is in my opinion a health risk.
Poor treatment planning can lead to periodontal and
occlusal issues that can scar a person for life and lead to
massive health and financial issues as well. Therefore, orthodontics should never be taken lightly, no matter how
simple the case seems to be. Every single orthodontic
treatment should be planned by a well-trained orthodontist with in-depth knowledge of biology and mechanics,
backed up by CBCT scans and/or panoramic radiographs with a cephalometric study. Notwithstanding,
there is, in my opinion, a major role that software companies can play in improving the quality and speed of
these treatments.
Many patients around the world looking for clear aligner
options recognise very famous brands and of course are
quite impressed when they discover clinics in the area
that hold a certain member status, as providers of these
brands. This obviously creates the impression that they
are somehow better than the other providers of exactly
the same service, when in fact the only difference is the
volume of cases sold, which indicates nothing about the
quality of care but everything about their capacity to sell
treatments. It took me many years to understand that we
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should be more focused on acquiring a status based on
the final radiographs or CBCT scan and the final position
of the teeth and final occlusion. This would make more
sense. I would love to see companies award these different statuses based not on volume of sales but on successful cases treated without any biological interference.
If you look at it from a larger perspective, it is almost a
kind of marketing, as it creates the illusion for the consumer that one provider is better than another based on
the quality of care when that is not the case. I am sure
that these companies will say otherwise, and to be fair,
clear aligner companies provide a service that is founded
on the information given to them by the dentist. They do not
claim to do the diagnosis, and they thus rely entirely on
the accuracy and authenticity of the information provided. It really is up to each doctor to ensure that a comprehensive diagnosis and examination have been performed. If these companies were concerned with
compliance with the rules and ethics, then they might not
have a business, as we all know many dentists cut
corners on time and costs when they can. I have seen in
my career so many patients come into my clinic with
aligners or traditional orthodontic appliances with conditions such as caries and much worse, such as infections
in the bone, that were clearly there before orthodontic
treatment was started. In my opinion, the main reason is
that a lot of orthodontists do not receive payment for
general dentistry or prophylaxis, only for their orthodontic
work. This leads to a corruption of care. We must all be
aware of the fact that there are many clinics that cut
corners for a multitude of reasons. Another important
factor is the time it takes to do a proper diagnosis, and in
many cases, dentists do not get paid to pursue this in
depth. Critical thinking is not financially rewarded. This is
the main raison d’être of slowdentistry.com. Therefore, to
be able to outsource all of this analysis is awesome
for many, who simply send the basic information and
accept whatever is sent their way from the company’s
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opinion
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After eighth aligner and photobiomodulation
Figs. 4a & b: Upper jaws, before (left) and after (right). The case was solved over two months with eight clear aligners (Smilers) and
photobiomodulation therapy (with the ATP38), applied every week for six minutes every time aligners were changed.
technicians without even looking. The patient knows no
difference between these aligners and those fabricated
by a team that spent hours analysing and discussing the
case with peers after all appropriate diagnostic tools
were utilised. The box looks the same, the steps look the
same, and in many simple cases, the results might be
good. I doubt however that this will be the case with
complex cases or cases with underlying problems such
as thin biotype and bone loss, that can only be visualised
with a digital CBCT, combined with a good perio probing,
when only an intra-oral scan was sent in.
We live in a world where things are rapidly changing and
consumers are becoming more aware of their rights. This
is why I believe that systems that do treatment planning
using the largest amount of data possible, always using
radiographs or CBCT scans, and that are focused on understanding the situation at the end of care and not just
the beginning will be the most successful in the future.
Hopefully things will change soon in this regard and the
public will understand that, in orthodontics, it is the final
result, not the volume of sales, that should define success.
We are physicians of the mouth. If we do things properly
we can dramatically improve our patients’ lives. It is time
to slow down and remember what our job is all about. We
should not be in a rush to make money before taking care
of our patients.
Let us get back to understanding what has happened in
the industry over the past decade or so. In recent years,
I have slowly started to understand that there has to be
more to orthodontics than just fixing teeth. I, and many
leading dentists around the world, have for quite some
time been using aligners as a pretreatment requisite in
order to establish a minimally invasive treatment protocol.
One of the first to make this possible was the Digital Smile
Design (DSD) methodology, which was pioneered by
Dr Christian Coachman, a Brazilian dentist and dental
technician, and really took the dental world by storm. It
initially started with planning full-arch smiles and then
reverse-engineered the treatment steps, thanks to an
interdisciplinary software program, NemoStudio. This was
very well received around the world, by the dental industry and by patients, and has now become a household
brand. DSD is, in effect, an architect of smiles. It is no
longer necessary to explain what a new smile will look like
or to use complicated manual mock-ups; everything is
software-driven using 3D printing. That is why I believe
Invisalign made a move to collaborate with the DSD
brand, and they have been doing a good deal to promote
this concept of treatment plan acquisition. My team and
I were one of the first in the world to employ DSD planning
in treating a case in order to tell Invisalign what we wanted
based on the final anatomy of the veneers before we had
even started the treatment. We started to work on the
case in early 2018, and the results were incredible.1
(We have published a few articles on this matter.)
It is with great pleasure that I am seeing more dentists
using DSD and of course clear aligners as a pretreatment
for large, complex cases that will later involve prosthodontics with or without dental implants, regardless of
the fact that it adds to the cost and to the timing of each
procedure. For me, it is no longer acceptable to grind
healthy enamel simply to fix the tooth position so that you
can place your ceramic restorations fast. We owe it to our
patients to be as minimally invasive as possible. We all
know that a natural, healthy tooth is the best kind of
tooth and I argue with my patients that want “same day”
veneers and try to convince them for a slower approach
with aligners, bleaching, saving them enamel and cash
as well.
I must give credit to the biomimetic groups around the
world and to the Facebook page Style Italiano, for their
work, which really boosted the concepts of minimally
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Fig. 5: Photobiomodulation protocol: on the day the patient changes the aligner, photobiomodulation therapy (with the ATP38) is applied
for six minutes, using blue (470 nm), green (525 nm), amber (590 nm) and red (620 nm) light.
invasive adhesive dentistry and brought it front and
centre. So many more high-quality dentists are focusing
on minimally invasive therapies as a result of all of this information being made accessible by these groups and
the hard work of all of these great teachers.
The race to the top is on, and there are many interesting
companies that are working on better, faster and more
biological solutions. One of these is a French company
that really has done something extraordinary which
needs to be bought into the spotlight, and that is Biotech
Dental, whose CEO is Philippe Veran. The chief clinical
officer, Dr Olivia Veran, bought to our attention the Smilers
concept, which uses as a foundation the software NemoCast (NEMOTEC), which is the same software as DSD
employs. NEMOTEC, a Spanish company, was acquired
in 2019 by Mr Veran as the foundation for Smilers and is
the treatment planning software for Biotech implants.
This is something quite unique.
With my background in interdisciplinary treatment planning and being a fan of using clear aligners in combination with other treatments in complex oral rehabilitation
cases, I tested this system back in early 2018, and to our
great surprise, it was very impressive. Not only was it just
as good as the previous systems I had worked with; in
some cases, it was better. Why? The Smilers system is
run by NEMOTEC and can acquire the DICOM file of a
CBCT scan, as well as an intra-oral scan, and perform
true 3D planning based not only on the tooth-to-tooth relationship but also on the relationship of the roots to the
bone and surrounding ligaments. To the best of my
knowledge, no other system can do this. Moreover, if you
need to plan your implant case halfway through the treatment, the same planning centre can do that as well, so
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you can have your surgical guide to place implants while
you are still doing your orthodontic movements, saving
precious time so that everything is concluded at the end
of the orthodontic treatment. I visited Biotech’s headquarters in the south of France, nestled in a very beautiful
part of the world that also makes extraordinary wine. The
technology is impressive, and planning is done by orthodontists and not only technicians. Now Biotech has
launched Smilers Expert, a platform dedicated to the
orthodontist. Orthodontists can modify the treatment
plan and have control over the timeline.
I also realised that the cross-over of other technologies
in Biotech’s portfolio, such as the ATP38, a photobiomodulation low-level light therapy device capable of
non-invasive accelerated orthodontic movement, would
be a game-changer compared with other clear aligner
systems.
The increased demand for rapid orthodontic treatment,
especially by adult patients, has led to the development
of different methods to accelerate the rate of tooth
movement. Different approaches have been developed
according to their target. Some of these methods seek to
enhance the body’s natural pathways activated during
tooth movement, while others use agents that stimulate
an artificial pathway. All approaches attempt to increase
bone resorption as a key rate-controlling factor in orthodontic tooth movement. We can classify these approaches into invasive and minimally invasive techniques.
The most common one is corticotomy, which involves
exposing the alveolar bone by reflecting an extensive gingival tissue flap, followed by numerous deep cuts and
perforations into the cortical and trabecular bone
between the tooth roots, using a rotary high-speed drill.
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opinion
Although it has been proved an efficient technique in
cases of mild to moderate crowding, not all patients want
to have surgery. Piezo-incisions and micro-perforations
are alternative techniques; however, they are still considered invasive.
Minimally invasive techniques too have been developed
to accelerate orthodontic movements. A possibility could
be using chemical agents such as parathyroid hormone
or osteocalcin to increase the bone turnover and stimulate rapid tooth movement. Nevertheless, these methods
appear to be invasive and do not represent a solution to
patients who do not want to be subjected to injections,
apart from being an expense for the dental office. Physical stimulation methods such as high-frequency and
low-magnitude forces (vibration) are non-invasive techniques designed to be used at home with the aim of
increasing and prolonging osteoclastic activity in the
periodontal ligament. However, these methods require a
great deal of compliance from patients.
More recently, the application of heat, light and minute
electric currents and an electromagnetic field during orthodontic treatment have demonstrated an increase in
the rate of tooth movement. In this field of research, lowlevel light therapy or light-emitting diodes (LEDs) has
been demonstrated to be an effective minimally invasive
technique. The application of a specified set of wavelengths for an appropriate duration has been shown to be
a means of accelerating orthodontic movement. This
therapy is also known as photobiomodulation therapy. Its
objective is to activate cells at a mitochondrial level and
to make them produce more energy, adenosine triphosphate, which is essential for cell repair and regeneration.
There are several LED devices in the market; however,
the ATP38 (Swiss Bio Inov) has proved to be the most efficient owing to the semiconductor on the site of light
emission, which focuses and energises the light in a
similar way to a laser beam, rather than dispersing the
light as other LEDs do.
For the past year, we have exclusively been using this
French system, patient acceptance has been 100% and
my team absolutely loves it. We are managing to streamline the planning with complex cases, from the smile
design to the orthodontic planning and the implant planning. But what really makes this quite awesome is the
combination with the ATP38. To the best of my knowledge, there is nothing quite like it on the market today!
And that is not marketing; that is simply a fact.
We owe it to our patients to continuously up our game
and keep searching for things that can improve their lives,
faster, better and more affordably. We might sometimes
have to invest a little more money in the beginning in order
to save a great deal of time in the long run and to obtain
consistently better results, which is, without a doubt, the
|
best practice builder known to the dental industry.
Staying ahead of the game and staying relevant are critical to staying successful. You cannot do that without new
technologies and great companies that are willing to
work incredibly hard so that we can all have better, stress
free lives.
Acknowledgement
I am grateful to Dr Ana Paz for her contribution to this
article. Dr Paz is a full-time biological dentist and heads
the scientific research and development department at
the White Clinic in Lisbon in Portugal. She was an early
adopter of photobiomodulation therapy in combination
with clear aligners in a clinical setting.
Clinical note
The ATP38 device can be used in combination with any
clear aligner system, as well as traditional orthodontic appliances.
Editorial note: This article originally appeared in ortho–international magazine of orthodontics, Volume 5, issue
2/2020.
Reference:
1
Stanley M, Gomes Paz A, Miguel I, Coachman C.
Fully digital workflow, integrating dental scan, smile
design and CAD-CAM: case report. BMC Oral Health.
2018 Aug 7;18(1):134.
about
Dr Miguel Stanley is the clinical
director of the White Clinic, a hightechnology, advanced dental clinic
founded 20 years ago. He is a passionate advocate for high-quality dental
care, and his career has consequently
been focused on restoring smiles with
his interdisciplinary team, using stateof-the-art technology, software and
materials, according to a strong sense of ethics and in pursuit
of minimal invasiveness to better protect his patients. For this
reason, he created the No Half Smiles treatment philosophy
and Slow Dentistry, both aimed at improving the patient
experience and the overall quality of care. Based on his training
in implant dentistry, cosmetic dentistry and functional occlusion, Dr Stanley has developed an advanced biological comprehensive dentistry approach to his work that incorporates the full
scope of action of modern dentistry. Dr Stanley has given over
200 keynote lectures in more than 50 countries, and his lectures are critically acclaimed by dentists of all ages and specialties for the open dialogue an simple and engaging manner
in which complex cases are presented. He was nominated one
of the top 100 dentists in the world by his peers in 2020.
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| case report
Treating teen athletes with
ClearCorrect aligners and
DentalMonitoring to minimise
office visits
Dr Melissa Shotell, US
Introduction
In orthodontic practice, a challenge many clinicians encounter is the phenomenon of over-scheduled patients,
especially adolescents with substantial non-academic
activities. These scheduled school and extramural activities throughout the day make it exceedingly difficult to
attend regularly scheduled orthodontic appointments.
This dilemma leads to many parents seeking alternatives
to traditional orthodontic visits that allow their children to
be seen less frequently and complete treatment faster.
In addition, the recent world events associated with the
global pandemic have led to patients desiring to reduce
and/or limit office encounters.
Clear aligner therapy has become a growing aspect of orthodontic practice for a variety of reasons, including aesthetics, simplicity and enhanced orthodontic control for
select cases. In addition to the aforementioned advantages, development of artificial intelligence and remote monitoring technology, in combination with teledentistry, has
rapidly pushed clear aligner therapy into the modern age.
This case report highlights a clinical case in which clear
aligner therapy and remote monitoring were able to facilitate orthodontic treatment for a patient with scheduling
time constraints and limited ability to return for multiple
office visits.
Case report
A 14-year-old female patient presented for orthodontic
consultation with the chief complaint of pain in her mandibular incisors. The patient and her mother reported a
history of parafunction, of grinding and clenching, with
ongoing pain in the mandibular incisors. The patient and
her mother described that she was a serious athlete participating in competitive soccer and that she had concerns of injury to her teeth and lips if treated with tradition-
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al fixed appliances, owing to the high contact nature of
the sport. Both the patient’s mother and the patient herself expressed a strong preference for clear aligner treatment and were looking to minimise office visits, owing to
the demanding schedule of both school and soccer. They
were also interested in limiting the time in treatment with
limited goals to resolve crowding and decrease the pain
and pressure sensation on the anterior teeth.
Upon clinical examination, the patient’s occlusion was
classified as Angle Class II subdivision left, moderate
overbite of 60% and excess overjet of 4 mm (Fig. 1).
There was mild crowding noted in both the maxillary and
mandibular arches. The maxillary midline was centred
and coincident with the midline of the face, and the mandibular midline was 1 mm to the left. The occlusion was
stable, and there was no shift between centric relation
and centric occlusion. The maxillary lateral incisors were
small in size, creating a tooth size discrepancy with mandibular excess.
Radiographic examination with a CBCT reconstructed
panoramic radiograph and lateral cephalogram showed
a complete and healthy dentition for the patient’s age and
regular root morphology. It was noted that the mandibular
third molars had not developed (Figs. 2 & 3). The lateral
cephalogram showed a balanced skeletal Class I relationship, and the panoramic radiograph showed a fully
erupted adult dentition from second molar to second molar. The temporomandibular joints were well corticated on
the radiographic examination, with no signs of temporomandibular joint pathology.The patient was periodontally
healthy and demonstrated excellent oral hygiene for orthodontic treatment.
After discussing the findings of the clinical examination
with the patient and her mother, we reviewed their limited
goals for treatment and the desire to complete treatment
[13] =>
case report
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Initial (T1)
Figs. 1a–h: Pretreatment photographs showing the patient’s initial smile aesthetics and malocclusion.
Fig. 2: Pretreatment panoramic radiograph.
Fig. 3: Pretreatment cephalometric radiograph.
quickly. Treatment options to correct the tooth size discrepancy with mandibular arch interproximal reduction or
bonding of the maxillary lateral incisors were presented.
Additional treatment options to correct the Class II malocclusion on the left side and reduce the excess overjet
were also presented. The patient and her mother both
wanted to avoid bonding of the maxillary lateral incisors
owing to long-term maintenance of the restorations, and
they both wanted to minimise interproximal reduction
(IPR). The patient was not concerned with addressing the
Class II occlusion on the left side and was primarily looking for an aesthetically pleasing smile.
With patient- and parent-limited goals for treatment in
consideration, a treatment plan with the following treatment goals was established:
1. Resolve crowding.
2. Resolve excess overbite.
3. Improve overjet.
4. Improve mandibular midline.
5. Improve smile aesthetics.
6. Reduce office visits utilising remote monitoring.
In addition to CBCT, other orthodontic records were
taken, including photographs and intra-oral digital
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Fig. 4: Initial treatment set-up with treatment details in ClearCorrect’s ClearPilot software.
Fig. 5: Initial treatment set-up with engagers and location of interproximal reduction.
impression scans. The records were submitted to
ClearCorrect to create a treatment set-up (Fig. 4). The
first set-up included 12 treatment steps and utilised engagers on the maxillary and mandibular anterior teeth,
to aid intrusive and rotational movements (Fig. 5). Interproximal reduction (0.9 mm in total) was planned on the
mandibular right to relieve crowding and to aid in shifting
the mandibular midline to the right and resolve crowding
of the mandibular incisors. The aligners were planned to
be worn for ten to 14 days per aligner.
Aligners were delivered to the patient with home care instructions, and the DentalMonitoring app was introduced
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for remote monitoring (Fig. 6). Patient treatment was
monitored using the DentalMonitoring app (Fig. 7), and
the patient was instructed to take her remote monitoring
scan every ten days to check the fit of each aligner. The
patient was instructed to move to the new aligner if the
current aligner was fitting correctly (Fig. 8). This reduced
the time of wear for each aligner from an arbitrary time
instruction to a custom timeline for the patient.
The patient completed the initial set of 12 aligners in four
and a half months and only two office visits in comparison with six months of treatment and four visits without
the DentalMonitoring app. The patient was seen in the
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case report
Fig. 6: Delivering ClearCorrect aligners.
|
Fig. 7: Introducing and demonstrating the DentalMonitoring app.
Fig. 8: DentalMonitoring remote monitoring of treatment progress.
office for evaluation of treatment progress at her third office visit. At this visit, it was determined that additional
improvement in tooth position could be achieved, including midline correction, additional correction of mandibular arch crowding, and improvement of canine guidance.
The engagers were removed, and progress records were
taken, including photographs (Fig. 9) and new intra-oral
digital impression scans. The progress records were sent
to ClearCorrect, and a treatment revision was requested. A total of four additional aligners with attachments on
the canines were planned, to aid extrusion for improved
canine guidance (Fig. 10). IPR of the mandibular central
incisor contact point was planned to resolve rotation of
the mandibular right central incisor and to improve the
mandibular midline.
It was agreed that the patient would discontinue use of
the DentalMonitoring app during the treatment revision
owing to her demanding schedule, but would stay very
consistent and compliant with her ClearCorrect aligners.
The patient completed her revision aligners in six weeks
and was not seen during the revision aligner sequence.
An office visit was scheduled at the completion of the revision aligner sequence, and at this visit, the engagers
were removed and the patient was placed into final retention with retainers made by ClearCorrect (Fig. 11).
Treatment results
Treatment was completed in a total of six months and a
total of 16 sets of aligners, and the patient came to the
office only five times from the initial consultation to final
retention. While her appointments to the office were minimised, her progress was tracked throughout treatment
on an individual basis using the DentalMonitoring app.
The final treatment results addressed the patient’s chief
complaint and fulfilled the goals and expectations of both
the patient and her mother. The crowding and excess
overbite were relieved, and the patient reported that the
discomfort in her mandibular anterior teeth was resolved.
The patient indicated that her aesthetics were greatly improved and that she was incredibly pleased with her overall treatment results and experiences of using both clear
aligners and remote monitoring technology.
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1 2021
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[16] =>
| case report
Progress (T2)
Figs. 9a–h: Progress photographs taken after the initial set of 12 aligners.
Fig. 10: Treatment revision set-up of four aligners with engagers and interproximal reduction.
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1 2021
[17] =>
case report
|
Final (T3)
Figs. 11a–h: Final photographs at the completion of treatment.
Conclusion
about
ClearCorrect aligners were able to deliver the treatment
results that the patient and her mother were expecting in
a limited amount of time. The use of ClearCorrect aligners allowed the patient to avoid injury to the teeth during
contact sports that can be caused when wearing traditional fixed appliances. The use of the clear aligners in
combination with attachments and IPR was able to resolve the crowding and provide excellent incisor intrusion
to reduce the excess overbite and relieve the traumatic
occlusion causing the patient’s initial discomfort. The use
of selective IPR was also able to correct the mandibular midline. There was an overall improvement in smile
aesthetics. The high level of patient compliance with the
aligners and the use of the DentalMonitoring app to customise the aligner wear schedule allowed the patient to
complete treatment more quickly than initially anticipated,
exceeding the expectations of both the patient and her
mother.
Dr Melissa Shotell is a boardcertified orthodontist and practises in
a multi-specialty practice in Sonora in
California in the US focusing on the
interplay of orthodontics and restorative treatment. She received all of
her dental training in the US. Dr
Shotell received her DMD at Nova
Southeastern University in Florida in
the US and a general practice residency certificate from the Ohio State University in Columbus
in Ohio in the US. After spending years in general practice
treating a broad range of patients, Dr Shotell completed a
certificate and master’s degree in orthodontics at Loma
Linda University in California. There, she focused her training
on cutting-edge 3D imaging technology for diagnosis and
treatment planning for interdisciplinary dentistry. Dr Shotell
considers education to be her passion and regularly consults
and lectures on dental technology, clear aligner therapy, orthodontics, in-office clear aligners, office efficiency and
workflow, and teamwork. She shares tips and tricks on orthodontics and clear aligners on social media as alignerbee.
Editorial note: This article originally appeared in ortho–
international magazine of orthodontics, Volume 6, issue
2/2021.
aligners
1 2021
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[18] =>
| case report
Clear aligner orthodontic treatment
of a complex malocclusion
Dr Gina Theodoridis, Greece
Introduction
Clear aligner orthodontic treatment has been gaining increasing popularity in the last decade. Orthodontic patients appreciate the benefits of a discreet orthodontic
appliance that can be removed for cleaning of teeth and
eating. During the coronavirus pandemic, the decreased
number of visits to the orthodontic office and decreased
chair time have also contributed to the advantages of the
technique.
In addition to the aesthetic benefits of clear aligner treatment, the orthodontic specialist enjoys some technical
advantages regarding the precision and predictability of
tooth movement. Aligner biomechanics applied through
the treatment software can produce orthodontic tooth
movement in directions not easily achieved with traditional appliances, such as posterior distalisation; this
results in effective correction of a Class II dental relationship to a substantial degree. Additionally, the aligner
plastic is effective in preventing unwanted incisal proclination not only during the distalisation phase, but
also throughout the treatment. As a result, aligners can
Figs. 1a–f: Initial intra-oral photographs.
18
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1 2021
produce successful treatment outcomes without excessive incisal proclination in many cases of moderate to
severe crowding. This article provides a case review that
highlights the aforementioned benefits.
Case report
The patient was a 27-year-old female who presented with
the chief complaint of crowded teeth and an uneven bite.
She was a professional dancer and was deeply concerned about her looks during her public appearances
while she was undergoing treatment. Upon clinical examination, an Angle Class I relationship was observed on the
right side and a Class II molar and canine relationship on
the left side (Fig. 1). The left side posterior occlusion was
characterised by a cross bite in the molar, premolar and
canine area. A functional mandibular shift was not detected. The mandibular midline was deviated to the left
owing to a dental shift by 4 mm relative to the maxillary
midline; the latter was coincident with facial symmetry.
Additionally, the mandibular dentition was characterised
by a significant degree of crowding, measured at 11 mm,
and there was moderate crowding in the maxillary arch
[19] =>
case report
|
Fig. 2: Initial panoramic radiograph.
of 10 mm. The roots of teeth #31, 33 and 43 appeared
to be close to the buccal border of the cortical bone.
Both arches were constricted in the premolar–molar area.
Radiographic analysis revealed normal root structure and
morphology. A root remnant present in the area of extracted tooth #38 was discovered (Fig. 2). Cephalometric
analysis exposed a Class I skeletal pattern with slightly
increased proclination of maxillary and mandibular incisors (Fig. 3).
The treatment of choice for this patient was Invisalign
clear aligners (Align Technology). The orthodontic treatment plan was formed based on the following objectives:
• to eliminate the cross bite on the left side and establish
a Class I molar and canine relationship;
• to expand the arches and provide an anatomical form;
and
• to resolve the crowding and align the maxillary and
mandibular incisors with the minimum amount of interproximal reduction and without further increase of
incisal proclination.
The first ClinCheck plan consisted of 53 aligners for
planned posterior sequential distalisation of approximately 4 mm on the maxillary left side, expansion of
2 mm per quadrant and alignment in the anterior area, as
Fig. 3: Initial cephalometric radiograph.
well as selective interproximal reduction (IPR) of 0.25 mm
per tooth surface in the mandibular arch and between
0.10 mm and 0.15 mm in the maxillary right mandibular
arch (Fig. 4). Topical fluoride application was planned
in the areas of IPR after the procedure. Class II elastics
were used on the left side to assist with distalisation. The
aligner change interval was seven days and subsequently
five days, and an accelerating vibratory orthodontic
device was used in order to increase speed and predictability of the movement. Overcorrection aligners were
not used.
Figs. 4a–c: Initial ClinCheck simulated outcome.
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1 2021
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[20] =>
| case report
Figs. 4d & e: Initial ClinCheck simulated outcome.
The orthodontic movements programmed in the software were more than 95% successful after the first round
of aligners (Fig. 5). The arches had acquired an anatomical form, the cross bite and Class II relationship on the
left side had been corrected, the maxillary and mandibular crowding had been alleviated, and the midlines were
coincident. The progress clinical findings included a
posterior open bite, a result of passive posterior intrusion
due to the aligner material thickness and premature an-
Figs. 5a–e: Additional aligner ClinCheck plan (start).
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1 2021
terior contacts. Some finishing movements in the mandibular incisal area were also needed. A second batch of
aligners was planned in order to eliminate these
problems and finalise the position of the teeth. The
second ClinCheck plan consisted of 16 maxillary and
mandibular aligners for planned maxillary and mandibular posterior extrusion and mandibular incisal retraction in order to relieve the contacts and allow posterior
open bite closure. The patient continued the daily use of
[21] =>
case report
|
Figs. 6a–e: Final intra-oral photographs.
the vibratory appliance, and the aligner interval was set
at five and then three days. The final aligners were used
only for 12 hours per day in order to allow the final passive
posterior open bite closing.
Treatment results
After a period of 11 months and a total number of 66 maxillary and mandibular aligners, the case was finished and
all the treatment goals had been accomplished. A bilateral Class I relationship had been achieved, the arches
were symmetrical and the crowding had been resolved
(Fig. 6). According to the final panoramic radiograph
(Fig. 7), the roots were parallel and there was no evidence
of root resorption (although only periapical radiographs
would have been able to confirm this finding). The cephalometric analysis revealed that the maxillary and mandibular incisors had maintained their positions (initial
mandibular incisor to APog line: 14 mm; final mandibular
incisor to APog line: 13 mm; Fig. 8).
Conclusion
Clear aligners were efficient in satisfying our treatment
goals. During the distalisation phase, as the aligner encapsulates the incisors, it provides good control of the
position of the crowns and helps avoid unwanted proclination. Controlled movement of the mandibular incisors
in a lingual direction while alleviating the crowding with
the help of IPR helps prevent buccal displacement of the
Fig. 7: Final panoramic radiograph.
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1 2021
21
[22] =>
| case report
Figs. 8a & b: (a) Initial and (b) final cephalometric radiographs.
teeth and preserves the periodontal status. Unwanted
incisal proclination is a side effect that is very common
when uncontrolled tipping takes place at the levelling
phase when using fixed appliances with wires. Moderate
to severe crowding can often be resolved without extraction when treating with aligners. Efficient use of the
space created by IPR can help in this respect. Cross-bite
correction with aligners also takes place in a way that
avoids premature contacts during the transitional phase
of correction, owing to the occlusal coverage of the teeth
by the material. Finally, the aesthetics of an almost invisible orthodontic appliance was a factor that influenced
our patient’s psychology, adding to her motivation and
cooperation, and thereby helping us to reach a successful treatment result.
Editorial note: This article originally appeared in ortho–
international magazine of orthodontics, Vol. 6, issue,
1/2021.
22
aligners
1 2021
about
Dr Gina Theodoridis obtained her
degree in orthodontics from New York
University in the US, where she was
also a member of the teaching staff.
She has been employing clear aligners
in orthodontic treatment for more than
20 years and is an international lecturer
and an Invisalign Diamond Provider.
She is a member of the board of directors of the European Aligner Society
and of the Greek Orthodontic Aligner
Society. She has a private practice in
Athens in Greece.
[23] =>
i-arch
A New Approach
Welcome to the new age of biomechanics
in orthodontics. i-arch is a system of only
three rectangular archwires.
These archwires have been specially
designed and sized to allow an orthodontic
innovative approach characterized by
efficiency, simplicity, complementarity,
ef
and biological compatibility. With i-arch,
the day-to-day routine will be much easier,
faster, and cost-effective. Try it out!
www.i-arch.it
www.siaorthodontics.com
info@siaorthodontics.com
aligners
1 2021
23
[24] =>
| trends & applications
Printing clear
aligners
in-house—
how accessible
is it?
By Jeremy Booth, Dental Tribune International
A growing number of dental practices are choosing to manufacture their own clear aligners in-house using 3D-printing technology.
(Image: Ancapital/Shutterstock.com)
Bellevue Orthodontics says that its patients can walk out
of their rst appointment with a set of fully customised
clear aligners. Utilising an all-digital work ow, Bellevue
has joined the 3D-printing revolution that has seen private
dental practices begin producing clear aligners in-house.
The founders of the practice have also launched an educational community to help dentists and team members
incorporate 3D-printing technology into their workflow.
But what exactly is required and what advantages does
in-house production offer?
The clear aligner market leader Invisalign is facing increased competition from smaller, localised manufacturers. Dentists wishing to offer clear aligner treatment
have a number of options. Manufacturing and selling an
inhouse brand directly to patients is one option that a
growing number of practices are choosing.
A dental practice requires an intra-oral scanner, a suitable 3D printer and photopolymer dental resins for 3Dprinting applications, a thermoforming machine for adapting the aligner material to printed models, and a digital
workflow in order to bring it all together. Practice owners
need to invest in material resources, but they also need
to invest in education to help their team implement a
3D-printing workflow.
24
aligners
1 2021
3D printing offers workflow control
Dr Christopher Riolo founded Bellevue Orthodontics in
2019 after a decade of providing orthodontic treatment
to patients in the Seattle area from his downtown Riolo
Orthodontics clinic. In the clear aligner category, Bellevue offers its patients Invisalign but also its own in-house
product.
According to the practice, the bene ts offered by making
its own aligners in-house include a lower treatment cost
for patients owing to factors such as the ease of making
3D-printed retainers. A lifetime retainer policy is offered
to patients, for example, which lowers the overall cost
of treatment. The practice also points out that many
patients nowadays are conscious of the impact of
their treatment on the environment and that its inhouse aligners result in a lower environmental impact because shipping and handling are not required. It says that having a better understanding of
the materials used to make its own aligners means
that staff can offer patients greater peace of mind.
Clinic Manager Cali Kaltschmidt told Dental Tribune
International that the benefits of offering an in-house
brand also include an expedited start to treatment, the
[25] =>
trends & applications
possibility of same-day replacements and improved
compatibility with xed appliances for hybrid treatments.
“The ability to provide aligners on the same day or even
in the same week is huge. Our busy adult clientele love it,”
Kaltschmidt explained. She said that integrating 3D printing is inevitable once a practice has begun using intraoral scanners and that doing so has allowed Bellevue to
take control of its workflow.
“3D printing has allowed us to be in control of our own
work ow, and with that, the possibilities are endless.
We are able to provide aesthetic treatment options for
our patients and keep the cost down by not accruing
large laboratory fees from third-party companies. This
includes in-house clear aligners, lingual braces and hybrid treatment using a combination of both. 3D printing
has truly changed the way we practice,” Kaltschmidt
said.
“We’re so used to next-day delivery with Amazon and
other services, why should straightening teeth be any
different?” Riolo asked in a press note. “Orthodontists
have the technology and clinical expertise to expedite
care in ways that major corporations cannot deliver.
This is why we decided to adopt these technologies
early on.”
“The investment for orthodontists and dental professionals to get started (with a 3D printer) can be anywhere
from $500 to $20,000 or more,” Kaltschmidt said. “Technology is advancing so quickly, and the cost of 3D printers
will continue to come down. Our advice for those interested in getting started with 3D printing is to spend less on
the printer and invest more time into refining your digital
worflow. You will begin to notice the differences when you
go from analog to digital.”
“Orthodontists can de nitely brand their own aligners
and they absolutely should,” Kaltschmidt continued.
“The product you design and manufacture in your office as an orthodontist is a superior product in the end,
and you should package and brand your aligners to
reflect that. In-house aligners give the practitioner full control over workflow, time to delivery, trim line and choice of
aligner materials.”
Last year, Riolo and Kaltschmidt founded the Tooth
Movement 3D-printing educational community in order
to share their expertise on using 3D-printing technology
for orthodontic applications like clear aligner therapy.
Kaltschmidt said that demand from within the dental
community for the limited courses on offer has been
signi cant and that she and Riolo have worked mostly
with orthodontists, members of the treatment team and
recent graduates. “Many residents do not have any exposure to 3D printing while in their schooling,” she pointed
out.
|
Manufacturers are bullish on adoption of
3D printing in dentistry
Advancements in 3D-printing technology have seen the
quality of desktop models for dentistry climb while costs
have fallen.
According to Dr Baron Grutter, who owns a dental practice in Kansas City, being able to offer clear aligner treatment at a lower cost has improved case acceptance at
his practice for a product that is known for its high earning potential. Grutter was an early adopter of 3D-printing
technology in the dental practice and has manufactured
“Orthodontists have the
technology and clinical
expertise to expedite care in
ways that major corporations
cannot deliver”—
Dr Christopher Riolo,
Bellevue Orthodontics
his own clear aligners in-house for some time. He told
the manufacturer SprintRay in its Practice Insights series
last year that a return on the investment of a 3D-printing
workflow can be made by selling as few as three or four
cases.
Growing demand for this technology from dentists is
being met by companies manufacturing solutions that
are tailored to a number of dental applications, including
making clear aligners. Manufacturers predict that sales
will climb this year and that integrated digital workflows
will make the technology even more accessible.
Lee Kwang Min, vice president of the Korean 3D-printer manufacturer Carima, told the online trade journal 3D
Printing Industry in 2019 “[2020] will be a full-scale digital dentistry year. The emergence of a variety of 3D
scanning solutions with an affordable price range, which
has been an obstacle to the spread of digital dentistry, will
replace the milling machines in the market and, furthermore, (will accelerate) the rapid adoption of 3D printers.”
Min said that he expects that a collaborative approach
between individual manufacturers of 3D printers, software
and scanners will act to increase the accessibility and
adoption of the technology by dentists.
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[26] =>
| industry
3D printing in dentistry:
Future-proof technology?
By Iveta Ramonaite, Dental Tribune International
Most dental professionals are already using the technology of the future today. 3D printing can signi cantly
improve the work ow in any dental practice or laboratory
and can drastically reduce patient chair time. It offers exibility in product customisation and superior quality and
accuracy in 3D-printed dental models. Although it was
once unimaginable, dental professionals can now print
occlusal splints and other dental models in-house in only
a day. This not only helps to generate profit but also facilitates dental treatment.
1
Fig. 1: 3D printing allows dental professionals to stay up to date
with the newest technology and dental materials and is a valuable asset to both dental clinics and laboratories.
Fig. 2: SprintRay’s 3D-printed clear aligners.
(Images: © SprintRay)
Technological advancements in dentistry are like a
motor force that drives innovation and growth. This is true
for digital dentistry. Digital technology continues to
advance dentistry, and although not everyone has
embraced this technological evolution, most dental professionals would agree that going digital is the way
forward. For one thing, the bene ts of 3D printing in
dentistry are plentiful. It allows dental professionals to
stay up to date and is more costefficient compared
with analog methods. There are constant software
updates, frequent launches of new dental materials
and rapidly evolving applications in dentistry.
26
2
“More and more dental practices and laboratories invest
in a 3D printer because it is affordable and accessible. It is the type of tool that empowers dental professionals and makes them more con dent in tackling
their daily challenges,” Rudy Labor, sales and application specialist for orthodontics at SprintRay, a technology company that builds end-to-end 3D-printing
ecosystems for dental professionals, told Dental Tribune
International (DTI).
With 3D printing, there is always a place for continued
development. Every software release or update enhances
the hardware and offers new and exciting features.
There are constant innovations in 3D-printing materials
to provide users with a growing list of indications, and
3D printing can be easily integrated into the workflow of
any dental practice or laboratory.
In discussing how 3D printing is the future of dentistry,
Labor highlighted the significant role of those working
behind the scene to make 3D printing a leading-edge
technology. He stated: “What makes 3D printing the
technology of the future is the commitment of the pro-
[27] =>
industry
|
3
Fig. 3: 3D-printed temporary bridge made of VarseoSmile Temp. (Image: © BEGO)
fessionals who work tirelessly to improve and elaborate
the existing printing techniques and to explore and exploit
new possibilities. As far as SprintRay is concerned, 3D
printing will be future-proof.”
3D-printing applications in dentistry
Some of the 3D-printing technologies that are currently
available and used in the dental industry include digital
light processing, selective laser melting, stereolithography
and fused deposition modeling. All areas of dentistry are
covered by 3D printing, including printed study models,
surgical guides, metal frameworks, dental prostheses,
temporary crowns and bridges, permanent restorations,
occlusal splints, aligners, and removable dentures.
Prof. Markus Blatz, who is chair of the Department of Preventive and Restorative Sciences and assistant dean for
digital innovation and professional development at the
University of Pennsylvania School of Dental Medicine in
Philadelphia, US, previously told DTI that he believes
3D printing to be the future of restoration fabrication in
dental laboratory technology and that it is likely to be
used for all types of materials and restorations.
In a previous interview with DTI (CAD/CAM 1/2021),
prosthodontist Dr Ryan C. Lewis noted: “3D printing has
changed the way that we produce surgical guides.
3D printers have become so accurate and inexpensive
that any dentist can now afford to have them in his or her
of ce and print surgical guides as well as casts for diagnostic purposes or aligners at a relatively low cost.” He
added that going back to traditional dentistry would
have a significant impact on costs, ef ciency, quality of
work, and ability to communicate with surgeons and
dental technicians.
The advantages of 3D printing over CAD/
CAM technology
3D printing, or additive manufacturing, consists of adding
material. In contrast, milling is a method that involves subtracting material. Labor told DTI that additive manufacturing is more cost-effective than subtractive computeraided manufacturing and explained that it produces less
waste. Additionally, 3D printing is highly accurate, faster
for many indications and offers increased production
ef ciency since the user can produce printable solutions
in volume.
Finally, Labor stated that additive manufacturing
boasts consistency, which is crucial for successful
product fabrication. He explained: “3D-printing technology has proved to be more accurate and more consistent in replicating consistency when mass-producing.
When using the analog way of fabricating dental apparatus, you can never replicate a process with exactitude, and we all know how important consistency is in
production.”
Investing in new technology is a way of reaching and
establishing high standards of patient care. As Patrick
Thurm, the managing director and general manager
for Europe at SprintRay noted, dentists and laboratories are currently seeking ef cient solutions for their practices and their patients post-pandemic, and a 3D printer,
such as the one from SprintRay, could be a great asset
to dental practices, laboratories and patients.
aligners
1 2021
27
[28] =>
| meetings
International Events
Societa Italiana di Ortodonzia
18–19 March 2022
International Spring Meeting
Genova, Italy
www.sido.it/eng
-----------------------------------------------------------------------
European Aligner Society
May 2022
EAS 2nd Spring Meeting
Oporto, Portugal
www.eas-aligners.com
-----------------------------------------------------------------------
American Association of Orthodontists – AAO
21–24 May 2022
Annual Session 2022
Miami Beach, USA
https://www2.aaoinfo.org/meetings/
-----------------------------------------------------------------------
EOS Annual Congress 2022
31 May–3 June 2022
Limassol, Cyprus
www.eoseurope.org/annual-congress/
-----------------------------------------------------------------------
Spanish Society of Orthodontics
22–25 June 2022
SEDO 68th Annual Congress
Madrid, Spain
www.sedo.es
-----------------------------------------------------------------------
Canadian Association of Orthodontists
15–17 September 2022
Annual Conference
Delta Bessborough & TCU Place, Saskatoon, Canada
www.cao-aco.org/orthodontics/events/upcoming-events/
-----------------------------------------------------------------------
German Orthodontic Society
21–24 September 2022
Jahrestagung der DGKFO
Estrel Berlin, Germany
www.dgkfo.de
-----------------------------------------------------------------------
Società Italiana di Ortodonzia
13–15 October 2022
53rd International Congress
Florence, Italy
www.sido.it/eng
-----------------------------------------------------------------------
Asian Pacific Orthodontic Society
27–30 October 2022
13th Congress and 55th Annual Meeting of KAO
Seoul, Korea
www.asianpacificortho.org/events/
28
aligners
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[29] =>
© 32 pixels/Shutterstock.com
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Xxxxxx
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aligners
1 2021
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[30] =>
[31] =>
[32] =>
| Xxxxxx
$
Attractive and accessible
With a strong price/performance ratio and smart training
options, ClearCorrect makes aligners accessible to more
dentists and patients.
Clear.
Simple.
Friendly.
Founded by dentists
Dentist-friendly by nature, ClearCorrect has been
listening to dentists and collaborating with them to
create solutions they love since 2006.
Quality: born in the USA
Engineered in the USA with care and pride at our Center
of Excellence in Texas, ClearCorrect aligners are made
from material optimized for stress retention and clarity
while resisting stains and cracks.
visit us at clearcorrect.com
Top-notch support
32
Dealing with us is easy-going and uncomplicated. We
offer real, human service from fully committed and
highly-trained support specialists who go the extra mile
to help dentists succeed.
aligners
1 2021
A Straumann Group Brand
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[1] => Array
(
[title] => Editorial
[page] => 3
)
[2] => Array
(
[title] => Content
[page] => 4
)
[3] => Array
(
[title] => Accelerated aligners with photobiomodulation
[page] => 6
)
[4] => Array
(
[title] => Treating teen athletes with ClearCorrect aligners and DentalMonitoring to minimise office visits
[page] => 12
)
[5] => Array
(
[title] => Clear aligner orthodontic treatment of a complex malocclusion
[page] => 18
)
[6] => Array
(
[title] => Printing clear aligners in-house—how accessible is it?
[page] => 23
)
[7] => Array
(
[title] => 3D printing in dentistry: Future-proof technology?
[page] => 26
)
[8] => Array
(
[title] => International Events
[page] => 28
)
[9] => Array
(
[title] => Submission guidelines
[page] => 29
)
[10] => Array
(
[title] => Imprint
[page] => 30
)
)
[toc_html] =>
Table of contents
-
Cover
1 - 1
view
-
Editorial
3 - 3
view
-
Content
4 - 4
view
-
Accelerated aligners with photobiomodulation
6 - 11
view
-
Treating teen athletes with ClearCorrect aligners and DentalMonitoring to minimise office visits
12 - 17
view
-
Clear aligner orthodontic treatment of a complex malocclusion
18 - 22
view
-
Printing clear aligners in-house—how accessible is it?
23 - 25
view
-
3D printing in dentistry: Future-proof technology?
26 - 27
view
-
International Events
28 - 28
view
-
Submission guidelines
29 - 29
view
-
Imprint
30 - 30
view
[toc_titles] => Cover
/ Editorial
/ Content
/ Accelerated aligners with photobiomodulation
/ Treating teen athletes with ClearCorrect aligners and DentalMonitoring to minimise office visits
/ Clear aligner orthodontic treatment of a complex malocclusion
/ Printing clear aligners in-house—how accessible is it?
/ 3D printing in dentistry: Future-proof technology?
/ International Events
/ Submission guidelines
/ Imprint
[cached] => true
)