aligners international No. 1, 2024
Editorial: The future of aligner orthodontics by Dr Gina Theodoridis, President-elect of the European Aligner Society for 2025
/ Table of contents
/ Solving sagittal discrepancies in orthodontics is probably the most energy-demanding movement you can do with aligners: A case report by Dr Luis Carrière
/ Orthodontics and botulinum toxin: Integrated care of a patient with bruxism and occlusal alteration: A case report by Drs Tomás A. Salazar, Belen M. Perretta, Camila Reino & Kristen Kock
/ Skeletal and dental Class II, Division I malocclusion solved in 11 months with MTO system: Using Carriere Motion Appliance and clear aligners without extraction: A case report by Drs Carlos Colino, Laura Castillo, Isabel Drewling & Pedro Colino
/ How to safely speed up tooth movement and reduce the duration of orthodontic treatment by Dr Ana Paz
/ Artificial intelligence in dentistry by Dr Miguel Stanley
/ Ethical communication and brand building
/ The trajectory of technology in our field is promising: An interview with Dr Chris Laspos
/ “The primary aim of EAS remains to promote excellence in aligner treatment”: An interview with Dr Gina Theodoridis
/ Aligners are the present and future of orthodontics: An interview with Dr Iro Eleftheriadi
/ Motivating your team by Jerko Bozikovic
/ Research news: Clear aligners: Study examines anchorage loss during maxillary molar distalisation; Fraunhofer using smart materials to make clear aligner therapy cheaper, more sustainable
/ Business news: SmileDirectClub leaves patients in the lurch
/ Manufacturer news: Futurabond U—dual-polymerising universal adhesive; ClearX ushers in a new era of eco-friendly orthodontic care with revolutionary clear aligners; Form Auto enables an orthodontic practice to increase model production by 20-fold; DynaFlex–Revolutionising orthodontics with innovative solutions
/ Ongoing growth of the global clear aligner market by Dr Kamran Zamanian & Federica Cogoni, iData Research
/ Excellence in aligner orthodontics: Fifth EAS congress maintains trajectory of growth
/ Long-awaited Digital Dentistry Show to premiere in Berlin in June 2024
/ International events
/ Submission guidelines
/ Imprint
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[1] =>
1/24
DE
N TA L T R
IB
U
RS
0 YEA
IA
& 2
R
OF
case report
Orthodontics and botulinum toxin: Integrated care
of a patient with bruxism and occlusal alteration
How to safely speed up tooth movement and reduce
the duration of orthodontic treatment
E
D
EA
Solving sagittal discrepancies in orthodontics
is probably the most energy-demanding movement
you can do with aligners
F
N
. • 30 Y
S
OEMUS
aligner orthodontics
case report
technique
INT
international magazine of
E
aligners
O
issn 1868-3207 • Vol. 3 • Issue 1/2024
M
[2] =>
Model Production Made Easier
Automate Your Aligner Production with Formlabs Dental
Transform your 3D printers into automated fleets with our game-changing
hardware, software, and material streamlining solutions.
Labor savings
up to
Lower cost
per part by
Reduce packaging
waste by
Increase
productivity by
Increase resin
capacity by
Daily model
production up to
80%
3x
40%
5x
86%
330*
* Draft Resin V2 with 200 microns Fast Arch Printing settings using
one Form 3B+ printer and Form Auto.
North America Sales Inquiries
sales@formlabs.com
+1 (617) 702-8476
dental.formlabs.com
Europe Sales Inquiries
eu-sales@formlabs.com
+44 2039364378 (UK)
+49 3091734716 (EU)
dental.formlabs.com
[3] =>
editorial
|
Dr Gina Theodoridis
President-elect of the European Aligner Society for 2025
The future of aligner orthodontics
More than two decades ago, a new technique emerged,
one that no one ever thought would rock the stage of
orthodontics. Advancements in orthodontic tooth movement had always been about control. Throughout the
progression from removable to fixed appliances and from
Begg to edgewise appliances and the straight wire technique, there has been a consistent effort to develop a single appliance that incorporates multiple predefined mechanical properties. Clear aligners did not seem suitable
at first for all treatments, for two reasons: they were not
fixed on the teeth, so their performance could be affected by displacement, and the process used to produce
their prescribed characteristics was indirect and somewhat mysterious, contrasting greatly with the manual wire
bending that we were all familiar with.
Yet, here we are, more than 20 years later, witnessing
the reality of almost all orthodontic malocclusions being
successfully treated largely with aligners. The evolution
of aligner material and the tremendous advancement in
digitally designed mechanical implementation of forces
are the power duo that has brought success in aligner
treatment.
Nevertheless, there has always been some dispute in the
literature as to whether aligner treatment is really effective.
Multiple studies have sought to determine which aligner
movements are predictable and which tend to fail. Most
of these studies are largely influenced by two important
variables: patient cooperation on the one hand and treatment planning by the orthodontist on the other.
In past years, customisation with aligner planning software was generally limited, and planning was to a large
degree guided by an automated sequence and automatic
determination of attachment use. As dentists enhanced
their proficiency in aligner treatment, the degree of customisation through greater control of the software steadily
increased. We can now choose the type of attachment
and segregate, separate and sequence tooth movements, resulting in higher predictability and better clinical
outcomes with aligners.
Additionally, hybrid techniques, such as the combination
of fixed auxiliaries or mini-implants with aligners, made
aligner treatment possible even in complex cases. Never
in the history of orthodontics has there been such creativity in combining different methods, including bonded
auxiliaries, expanders and distalisers, all for the purpose
of providing an overall effective and aesthetic treatment.
Although the advancement of software is without a doubt
a very important reason for the evolution of aligner treatment, I believe it is the increasing proficiency in treatment
planning by dentists that has led us to the golden age
of aligners. Without a doubt, artificial intelligence too will
continue to evolve, being constantly trained on data and
metadata that are collectively accumulated in the system,
as well as research data from published studies. However, a successful treatment outcome often stems from
circumventing the software’s algorithm, deviating from
the established procedure and challenging the existing
rules—and this can lead to evolution of the technique.
As the fifth congress of the European Aligner Society, held
in Valencia in Spain, demonstrated, the limits of aligner
orthodontics are indeed continually being surpassed.
During this outstanding meeting, we enjoyed seeing the
excellent treatment outcomes produced either by aligners alone or by hybrid techniques. This should not cause
doubt about the use of aligners. The question need not
be whether one technique outweighs the other; it must
be how to better serve our patients by treating them with
the most suitable modalities for their malocclusion, giving
them an excellent orthodontic outcome and, very importantly, offering them a positive experience and the best
possible aesthetic treatment.
So, if you are ever wondering about our role in the future
of aligner orthodontics, the answer is simple: being creative. Sometimes creativity is the ultimate sophistication.
Dr Gina Theodoridis
President-elect of the European Aligner Society for 2025
aligners
1 2024
03
[4] =>
| content
editorial – Dr Gina Theodoridis
case report
03
Solving sagittal discrepancies in orthodontics is probably the most
energy-demanding movement you can do with aligners
06
Orthodontics and botulinum toxin: Integrated care of a patient with
bruxism and occlusal alteration
10
– Dr Luis Carrière
– Drs Tomás A. Salazar, Belen M. Perretta, Camilla Reino & Kristen Kock
page 06
Skeletal and dental Class II, Division I malocclusion solved in 11 months 16
with MTO system: Using Carriere Motion Appliance and clear aligners
without extraction
– Drs Carlos Colino, Laura Castillo, Isabel Drewling & Pedro Colino
technique
How to safely speed up tooth movement and reduce the duration
of orthodontic treatment – Dr Ana Paz
26
Artificial intelligence in dentistry – Dr Miguel Stanley
Ethical communication and brand building – Dr Anna Hajati
30
34
The trajectory of technology in our field is promising
38
The primary aim of EAS remains to promote excellence
in aligner treatment
40
Aligners are the present and future of orthodontics
42
opinion
interview
page 10
– An interview with Dr Chris Laspos
– An interview with Dr Gina Theodoridis
– An interview with Dr Iro Eleftheriadi
feature
Motivating your team – Jerko Bozikovic
44
Clear aligners: Study examines anchorage loss
during maxillary molar distalisation
Fraunhofer using smart materials to make clear aligner therapy
cheaper, more sustainable
48
SmileDirectClub leaves patients in the lurch
52
Futurabond U–dual-polymerising universal adhesive
ClearX ushers in a new era of eco-friendly orthodontic care with
revolutionary clear aligners
Form Auto enables an orthodontic practice to increase model
production by 20-fold
DynaFlex–Revolutionising orthodontics with innovative solutions
54
55
research
page 26
business news
manufacturer news
Cover image: ClearX
www.clearxaligners.com
Splash template courtesy of
© gfx_nazim – stock.adobe.com
1/24
N TA L T R
DE
F
IB
U
RS
E
R
E
D
EA
S
IA
& 2
. • 30 Y
0 YEA
INT
international magazine of
S M
N
aligners
OF
O
issn 1868-3207 • Vol. 3 • Issue 1/2024
OEMU
aligner orthodontics
industry report
Ongoing growth of the global clear aligner market
– Dr Kamran Zamanian & Federica Cogoni
50
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60
meetings
Excellence in aligner orthodontics: Fifth EAS congress
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maintains trajectory of growth
Long-awaited Digital Dentistry Show to premiere in Berlin in June 2024 66
International events
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case report
Solving sagittal discrepancies in orthodontics
is probably the most energy-demanding movement
you can do with aligners
case report
Orthodontics and botulinum toxin: Integrated care
of a patient with bruxism and occlusal alteration
about the publisher
technique
How to safely speed up tooth movement and reduce
the duration of orthodontic treatment
04
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submission guidelines
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[5] =>
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N
EW
Others imitated. We innovated.
While everyone else was busy copying our original
design, we were taking it to the next level.
Motion Pro Video
*Patent pending. Carriere Motion Pro Bite Corrector not available in all countries.
See your local distributor for more information
© 2024 Ortho Organizers, Inc. All rights reserved. Patent pending. M3338 03/24
aligners
1 2024
05
[6] =>
| case report
Solving sagittal discrepancies in
orthodontics is probably the most
energy-demanding movement you
can do with aligners
Dr Luis Carrière, Spain
Aligners are highly efficient in achieving several dental
movements, but they lose efficacy and predictability when
used for distalisation of the posterior teeth. Normally,
when we plan treatment using aligners only, we need to
address the sagittal dimension of malocclusion by
means of sequential distalisation. This sequential distalisation, or single-unit movement, aims to move the maxillary molars first, followed by the premolars and then the
canines, one after the other.1
Sequential distalisation with aligners has several limitations:
– It restricts orthodontic treatment to either maxillary
dental distalisation or mandibular dental distalisation in
isolation whether treating a Class II or a Class III malocclusion.
– It extends the total treatment time, as aligner distalisation requires many steps to achieve maxillary or mandibular distal correction.
– Biomechanically, aligners frequently deviate from the
planned movement during distalisation, leading to decreased treatment predictability.2
– It produces incisal protraction as a reaction to the distal movement in the posterior area of the maxilla.
The Carriere Motion Appliance offers a predictable hybrid
treatment approach to distalisation when using aligners.2–4 This appliance is designed to focus on solving the
1a
1b
1c
1d
Figs. 1a–d: Accurate driving of uprighting and distal rotation with the new Carriere Motion Pro.
06
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[7] =>
case report
2a
|
2b
Figs. 2a & b: Case of a Class I occlusion accomplished in two months with the Carriere Motion Pro.
sagittal dimension by moving groups of teeth, generating
a Class I occlusion before any comprehensive orthodontic treatment. In this manner, the molars, premolars and
canines are brought into a Class I relationship where the
maxillary and mandibular first molars exhibit adequate
distal rotation and adequate uprighting, depending on
whether the clinician is treating a Class II or Class III malocclusion.5–7 This Class I occlusion is usually accom-
plished during the first four months of treatment with the
Carriere Motion Appliance. This approach of achieving a
Class I occlusion with the Carriere Motion Appliance prior
to any further orthodontic treatment is described as the
Sagittal First approach in the Carriere system.
Today, patients request solutions for their malocclusion
that are both aesthetic and efficient. The new Carriere
3a
3b
3c
3d
3e
Figs. 3a–e: Case demonstrating the long-term stability of the Carriere Motion Appliance. Sixteen (16) years of follow-up of a Class II case.
aligners
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07
[8] =>
| case report
4a
4b
4d
4c
4e
4f
Figs. 4a–f: Various perspectives of the metal and clear Carriere Motion Pro.
Motion Pro is an appliance that uses design and biomimetics to substantially enhance the biomechanics of
the original Carriere Motion Appliance, boosting the
Sagittal First approach. Inspired by the shape and function of the temporomandibular joint, the new Carriere
Motion Pro incorporates a totally new condyle shape
hinge designed to produce ultra-low friction. This joint
facilitates accurate distal rotation, precise uprighting and
optimal molar torque simultaneously, achieving a Class I
occlusion efficiently (Fig. 1). The knowledge of the last
20 years of using the original Carriere Motion Appliance
has been employed in the redesign of the appliance to
achieve next-level movement (Fig. 2).
The concept is to establish an accurate Class I occlusion
with the ideal first molar position. Correct distal rotation
and adequate molar uprighting promote a passive Class I
occlusal scenario for the premolars and canines. If we do
not accomplish adequate uprighting or distal rotation of
the first molars, they will actively push the premolars and
canines mesially, promoting the loss of the Class I occlusion during aligner treatment.
The key to long-term occlusal stability is the position of
the maxillary first molars—83% of malocclusions have
excessively mesially rotated molars and excessively mesially inclined molars.8 Mesial rotation and mesial inclination are scenarios that promote a premolar and canine
shift to a Class II malocclusion. Rotating and uprighting
the maxillary first molars is of paramount importance for
generating long-term stability in both Class II and Class III
cases.
The Carriere Motion Appliance and Carriere Motion Pro
have been designed to drive those corrections and accomplish them with precision in order to establish a
passive occlusal environment. In light of these necessary
corrections, it is very important to understand that the
Carriere Motion Appliance comes in a left side version
and a right side version, and these can never be used on
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the opposite side. We cannot create a universal Carriere
Motion Appliance for both sides if we want to accomplish
a stable Class I occlusion, as the uprightness of the
molars is essential (Fig. 3).
The Carriere Motion Pro, available in metal and clear versions (Fig. 4), features a stronger, reinforced and anatomically adapted hook. The hook is designed for easy
attachment of elastics and offers biomechanically increased resistance to vertical pull stress. It effectively
redistributes the elastic force, optimising the direction
and distribution of the applied tension. Further new features include a vertical slot for drop-in hooks, which are
particularly useful for treatment approaches that require
minimal patient compliance.
Editorial note: Please scan this
QR code for the list of references.
about
Dr Luis Carrière, inventor of the
Carriere Motion Appliances, obtained
his dental degree from the Complutense
University of Madrid in Spain in 1991.
He then attended the University of
Barcelona in Spain and received his
MSc in orthodontics in 1994 and his doctorate in orthodontics in 2006. He was
the recipient of the Joseph E. Johnson Clinical Award from the
American Association of Orthodontists in 1995 and of a gold
award for the Carriere Distalizer MB in the 2009 Delta Awards
for Industrial Design, organised by the industrial design association of the Spanish association Fostering Arts and Design.
Dr Carrière is on the review board of the American Journal of
Orthodontics and Dentofacial Orthopedics and is a contributing
editor of the Journal of Clinical Orthodontics. He lectures internationally and is a visiting professor at several university orthodontic departments throughout the world. He maintains a
private practice in Barcelona.
[9] =>
case report
|
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2. SureSmile® treated cases - data on file 2023.
aligners
1 2024
09
[10] =>
| case report
Orthodontics and botulinum toxin:
Integrated care of a patient with
bruxism and occlusal alteration
Drs Tomás A. Salazar, Belen M. Perretta, Camila Reino & Kristen Kock, Chile
Introduction
Hypertrophy of the masseter muscle is defined as the
excessive growth of muscle mass in the transverse direction and is more common between the second and
fourth decades of life. Even though its aetiology is multifactorial, bruxism is the main cause. There are many
treatment alternatives, among which injection of botulinum toxin into the masseter muscle has been shown to
be a safe and effective option.1
Botulinum toxin is a powerful neurotoxin that, when injected into the muscle, generates interference with the
neurotransmitter mechanism, inhibiting the release of
acetylcholine at motor neuron axon terminals and
thereby producing selective paralysis, decreased contraction and consequent muscular atrophy.2, 3 It is this
last effect that is exploited for addressing hypertrophy of
the masseter, reducing its size and improving the patient’s aesthetics.
There is extensive literature on the parameters that must
be followed for the injection of botulinum toxin
to avoid risk areas and to reduce complications. In 2005,
Kim et al. delineated a safe zone for the injection of botulinum toxin, demarcated vertically by the anterior and
1a
1b
Figs. 1a–c: Initial extra-oral photographs.
10
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posterior boundaries of the masseter muscle and horizontally by a line drawn along the inferior border of the
mandible to the mandibular angle and a line drawn from
the base of the earlobe towards the corner of the mouth.4
In 2010, Kim et al. determined the subdivision of the
masseter muscle into six zones, according to which injection into Zones I, II and III would be associated with
adverse effects, such as injury to the parotid duct, and
injection into Zone VI would not be effective for masseteric hypertrophy, establishing Zones IV and V as safe for
botulinum toxin injection.5
Case report
A 35-year-old female patient presented with crowding,
muscle and joint pain, and headaches upon awakening.
Examination found a skeletal Class I with crowding and
bimaxillary protrusion. Facial examination showed a
convex profile with protruded lips and a square face
shape, intensified on smiling (Figs. 1–4). She reported
bruxism, and bilateral masseteric hypertrophy was observed, but there was no alteration of the temporomandibular joints.
The objectives of the treatment included correcting the
crowding, establishing a Class I occlusion, correcting the
1c
[11] =>
case report
2a
2b
2c
3b
3c
|
Figs. 2a–c: Initial intra-oral photographs.
3a
Figs. 3a–c: Initial occlusal photographs.
4a
4b
Figs. 4a & b: Initial cephalometric radiograph and dental panoramic tomogram.
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[12] =>
| case report
Fig. 5: Showing maximum anchorage planned for this case.
5
6a
6b
6c
6d
6e
6f
Figs. 6a–f: Intra-oral and occlusal photographs during treatment (after the 32nd aligner pair).
7a
7b
7c
7d
Figs. 7a–d: Final intra-oral photographs.
12
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[13] =>
case report
8a
|
8b
Figs. 8a & b: Final extra-oral photographs one month after botulinum toxin administration.
9a
9b
Figs. 9a & b: Final profile and smile.
10b
10a
Figs. 10a & b: Final cephalometric radiograph and dental panoramic tomogram.
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[14] =>
| case report
11a
11b
Figs. 11a & b: Profile comparison before and after.
12a
Figs. 12a & b: Smile comparison before and after.
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12b
[15] =>
case report
patient’s profile and reducing bruxism, along with its associated signs and symptoms. Orthodontic treatment
using aligners was planned, together with the administration of botulinum toxin for the bruxism signs and
symptoms and to improve the facial aesthetics.
Before the aligner treatment began, the maxillary and
mandibular second premolars were extracted to create
space. With orthodontic treatment, distalisation of the
anterior teeth was achieved by employing maximum
mandibular anchorage and moderate maxillary anchorage (Figs. 5–7). At the end of the treatment, a stable bilateral Class I occlusion had been achieved, as well as
normal inclination and retrusion of the anterior teeth,
consequently improving the profile (Figs. 8–10). Among
the post-treatment recommendations was a mouth
guard, which the patient was advised to wear every night
to protect the teeth from the excessive occlusal force
of bruxism.
Once the orthodontic treatment had been completed,
botulinum toxin was injected bilaterally into the masseter
muscle and an anterior portion of the temporalis muscle.
In the first session, three injections were performed in
the masseter muscle, administering 2.5 U in the most
superior point and 5.0 U in each of the two lower points,
a total of 12.5 U per masseter. Then, 10 U of botulinum
toxin was injected into the anterior portion of the temporalis muscle in this same session. After 14 days, a
second session was performed. Because the patient
presented with slightly greater hypertrophy on the right
side compared with the left side, 5.0 U of botulinum
toxin was injected into the right masseter and 2.5 U into
the left masseter.
At the end of the treatment, the patient showed a significant improvement in her profile thanks to the orthodontic
treatment (Fig. 11) and an improvement in her facial
shape thanks to the injection of botulinum toxin into the
elevator muscles (Fig. 12). She also had a decrease in
bruxism and its symptomatology thanks to the combination of both treatments.
Conclusion
This case report demonstrates that a comprehensive
and holistic approach to treatment is essential to
achieve the desired outcomes for the patient. Neither
of the two treatments alone could have resolved the
patient’s complaints at the first consultation, demonstrating the importance of listening carefully to the patient
during his or her first appointment to understand his or
her concerns and expectations and using all the treatment options available not limiting treatment to one
specialty.
|
about
Dr Tomás A. Salazar holds a DDS
from the Universidad de los Andes and
an MSc in orthodontics and dentofacial orthopaedics from the Universidad
Andrés Bello, both in Santiago in Chile
and a MSc in aligner orthodontics from
the University of Turin in Italy. He is an
adjunct assistant professor in the postgraduate programme in the department of orthodontics and
dentofacial orthopaedics at the Universidad Andrés Bello and
runs a private practice in Las Condes in Chile. Dr Salazar is also
an ambassador of the European Aligner Society in Chile.
Dr Belen M. Perretta holds a DDS
from the Universidad Finis Terrae in
Providencia in Chile. She is a prosthodontist and also has qualifications in
oral rehabilitation and facial aesthetics.
Dr Camila Reino holds a DDS and a master degree in orthodontics from the Universidad de los Andes in Santiago in
Chile.
Dr Kristen Kock holds a DDS from the Universidad San
Sebastián and a master degree in orthodontics from the Universidad de los Andes in Santiago in Chile.
References
1
2
3
4
5
Aragón Niño Í, Niño Aragón ML, Pampín Martínez MM,
del Castillo Pardo de Vera JL, Cebrián Carretero JL.
Tratamiento de la hipertrofia del músculo masetero con toxina botulínica. Consideraciones y manejo
[Treatment of masseter muscle hypertrophy with botulinum toxin. Considerations and management]. Med
Estética. 2022 Jun 15;71(2):45–50.
Kim NH, Chung JH, Park RH, Park JB. The use of
botulinum toxin type A in aesthetic mandibular contouring. Plast Reconstr Surg. 2005 Mar;115(3):919–30.
González Magaña F, Miranda LM, Malagón Hidalgo H,
González Amesquita V. Uso de toxina botulínica para
tratamiento de la hipertrofía del músculo masetero
[Use of botulinum toxin for treatment of hypertrophy of
the masseter muscle]. Cir Plast Ibero-Latinoam. 2012
Jul–Sep;38(3):297–302.
Fedorowicz Z, van Zuuren EJ, Schoones J. Botulinum
toxin for masseter hypertrophy. Cochrane Database
Syst Rev. 2013 Sep 9;2013(9):CD007510.
Kim DH, Hong HS, Won SY, Kim HJ, Hu KS, Choi JH,
Kim HJ. Intramuscular nerve distribution of the masseter muscle as a basis for botulinum toxin injection. J
Craniofac Surg. 2010 Mar;21(2):588–91.
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| case report
Skeletal and dental Class II,
Division I malocclusion solved in
11 months with MTO system:
Using Carriere Motion Appliance and
clear aligners without extraction
Drs Carlos Colino, Laura Castillo, Isabel Drewling & Pedro Colino, Spain
1
Fig. 1: Initial extra-oral photographs.
Introduction
Clear aligners are increasingly being used by orthodontists and requested by patients for its aesthetics, better
hygiene and comfort. Thanks to biomechanical advances
and materials, the effectiveness of treatments has improved.1, 2 In addition, very promising results have been
shown in Class II correction by distalisation of maxillary
molars together with Class II elastics and very good
control of the vertical dimension in cases of deep overbite
or open bite.3, 4 Sequential distalisation is a good means
of correcting Class II malocclusion and can be combined
with posterior interproximal reduction and elastics to
improve efficiency, but it involves an average of 12 aligners (three months if we change the aligners every week)
only to perform the 2–4 mm distalisation of a first and
second molar.5
Although sequential distalisation is highly predictable, it
constitutes a treatment that involves many stages, the
extent of which varies depending on the severity of the
16
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Class II malocclusion. Nowadays, patients desire not only
aesthetic results but also fast results, as they tend to lose
patience over the course of treatment, especially adolescents. For this reason, we have opted for a hybrid approach consisting of a first phase using the Carriere
Motion Appliance (Henry Schein Orthodontics) to correct
Class II malocclusion within a span of four to five months
and a second phase during which aligners are used once
a Class I occlusion has been established, thus reducing
the number of aligners considerably and allowing for
shorter treatment times. We have named this approach
the minimal time orthodontics (MTO) system, as it not
only reduces the frequency of appointments with the
patient, but also shortens the total treatment duration.
Diagnosis
A 15-year-old mild brachyfacial female patient in Stage 5
of cervical maturation presented with a skeletal and dentoalveolar Class II, Division I malocclusion due to maxillary protrusion. The patient’s main concern was the increased overjet and dental exposure when smiling—she
was being bullied. She had permanent dentition and
good oral hygiene. In the extra-oral analysis (Figs. 1 & 2),
we observed facial symmetry (Fig. 3), mandibular retrusion (Fig. 4) and a vertically balanced lower third (Fig. 5).
In the intra-oral analysis, we observed a bilateral Class II
molar and canine relationship, along with pronounced diastemas between the premolars and canines (Fig. 6).
There was a significantly increased overjet, which became
very evident during smiling, and a deep lower curve
of Spee (Fig. 7), and the mandibular midline deviated
0.5 mm to the left of the maxillary midline (Figs. 8–11). We
use the iTero intra-oral scanner (Align Technology).
[17] =>
case report
2
Fig. 2: Initial extra-oral analysis, showing
the maxillary midline aligned with the
facial midline.
3
|
4
Fig. 3: Initial transversal analysis, showing
facial symmetry.
Fig. 4: Arnett’s profile analysis, showing a
protruded maxilla.
5
Fig. 5: Initial vertical and sagittal analysis, showing a balanced lower third.
6a
6b
6d
6e
6c
Figs. 6a–e: Initial intra-oral photographs.
7a
7b
Figs. 7a & b: Curve of Spee analysis, showing the deep curve.
8a
8b
Figs. 8a & b: Initial midline analysis, showing the deviated mandibular midline.
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17
[18] =>
| case report
9a
9b
9c
Figs. 9a–c: Model analysis.
10a
10b
Figs. 10a & b: Model analysis, (a) maxilla and (b) mandible.
11b
11c
11a
Figs. 11a–e: Analysis of the (a) transversal, (b & c) sagittal and
(d & e) vertical models.
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11d
11e
[19] =>
case report
|
13
Fig. 13: 3D radiographic analysis.
12
Fig. 12: 2D radiographic analysis.
15a
14
15b
15d
15c
15e
Fig. 14: Initial Perrotti cephalometric analysis.
Figs. 15a–e: Suture analysis.
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19
[20] =>
| case report
16
17
Fig. 17: Airway analysis, axial.
Fig. 16: Airway analysis, coronal.
18a
18b
18c
Figs. 18a–c: Superposition of the initial and final mandibular arch in the first phase of treatment.
19
Fig. 19: Situation on the day of placement of the Carriere Motion Appliances.
20
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[21] =>
case report
The dental panoramic tomogram revealed that the
four third molars had not erupted (Fig. 12). We used
the 3D scan to complete the diagnosis (Fig. 13). The
Perrotti total face approach cephalometric analysis
was conducted with the Planmeca Romexis software,
and it found that the patient was slightly brachyfacial
and skeletally symmetrical and presented with a skeletal Class II malocclusion due to mandibular retrusion
(Fig. 14). She exhibited maturation Stage C of the midpalatine suture (Fig. 15),6 no transverse maxillary concerns
and a good airway volume of 19.3 cm3 (Figs. 16 & 17).
Treatment
Our treatment focused on solving the issues identified in
the three planes of space using the Sagittal First approach with Carriere Motion Appliances and clear aligners (Reveal, Henry Schein Orthodontics). We conducted
digital planning using the Reveal software to design the
mandibular aligners. These aligners are intended to
provide additional negative torque on the mandibular incisors, thereby counteracting the adverse effects of the
Carriere Motion Appliances due to elastic use (Fig. 18).
Additionally, these aligners served as a retention method
after the standard Carriere Motion Appliance protocol.
We do not schedule patient appointments for placement
of Carriere Motion Appliances until we have the mandibular aligners in our office.
In approximately 15 minutes, we completed the cementation of the Carriere Motion Appliances and provided patient
education regarding the 22-hour daily elastics protocol.
The protocol was 6 oz elastics during the first month and
then 8 oz elastics until Class I canine overcorrection had
been achieved. A mandibular aligner was to be worn to
prevent adverse effects whenever the patient was wearing
the elastics and was only to be removed for eating. We
placed mandibular tubes on teeth #36 and 46 and cemented transparent Carriere Motion Appliances from
canine to first molar bilaterally in the maxillary arch (Fig. 19).
Following the placement of the Carriere Motion Appliances, using our MTO system, both appointments and
chair time for the patient are minimised, as no further
review is conducted until the third month, when progress
is assessed (Fig. 20). If satisfactory progress is observed
during this visit, the patient is scheduled for the following
month. By the fourth month (Fig. 21), if a bilateral Class I
occlusion has been achieved at both the molar and canine
levels, we proceed to the second phase of treatment.
The next step involves performing a new intra-oral scan
with the Carriere Motion Appliances in place. However,
technicians are instructed to virtually remove these. It is
crucial to avoid physically removing the Carriere Motion
Appliances, as this could compromise the Class I occlusion achieved, leading to relapse. During this phase, the
|
patient continues to wear the Carriere Motion Appliances
and the last aligner. Elastics (6.5 oz, ¼ in.) are only worn
at night, serving as anchorage until the first aligners for
the second phase of treatment arrive (Fig. 22).
For the second phase of treatment (Figs. 23 & 24), we had
the technician design the aligner sequence to close the
remaining maxillary spaces through distalisation and retraction of the anterior teeth, applying lingual crown
torque to the maxillary incisors and incorporating Class II
elastics. To ensure the retention of the Class I occlusion,
we instructed the patient to wear Class II elastics (2.5 oz,
3 ⁄16 in.) nightly. This strategy aimed at closing the maxillary
anterior spaces by crown retraction and loss of torque,
facilitating relative extrusion to improve the maxillary
incisor exposure (Figs. 25–28).
Treatment outcome
The outcomes proved highly satisfactory for the patient,
meeting all the treatment objectives. Noteworthy skeletal
alterations were not evident, as the majority of changes
observed were primarily dentoalveolar in nature, and the
enhancement in the positioning of the maxillary incisors
did not affect the patient’s facial profile. From an anterior–
posterior perspective, the bilateral Class II malocclusion
had been successfully rectified, along with the correction
of the overjet (Figs. 29–32). The final transversal arch dimensions attained displayed parabolic and symmetrical
arches, demonstrating excellent alignment. The cephalometric measurements displayed minor variations, likely
attributable to the patient’s ongoing growth phase, given
her stage of cervical maturation (Fig. 33).
The patient presented with a Bolton discrepancy, having
excess of the mandibular arch due to the peg-shaped
maxillary lateral incisors. Because of the young age of the
patient and aesthetic requirements, we decided on
bonding veneers on teeth #12 and 22 in a future prosthetic phase instead of mandibular interproximal reduction.
Conclusion
The MTO system stands out as a highly effective and efficient approach for addressing severe Class II cases,
providing an alternative to extraction and significantly reducing treatment time, appointments and chair time. In
cases of Class II malocclusion that require numerous
aligners or aligner stages, the adoption of hybrid treatments such as the one we offer emerges as an advantageous strategy. Within a period of four to five months,
we can correct the Class II malocclusion using the
Carriere Motion Appliance—this represents the most
time-consuming part of the treatment—and then proceed
to the Class I phase using aligners to successfully conclude the case.
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21
[22] =>
| case report
20a
20b
20c
Figs. 20a–c: Situation in the third month of treatment.
21a
21b
21c
Figs. 21a–c: Situation in the fourth month of treatment.
22a
22b
22c
Figs. 22a–c: Situation in the fifth month of treatment.
22
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[23] =>
case report
23a
|
23b
Figs. 23a & b: Superposition before and after the second phase of treatment.
24a
24b
24c
Figs. 24a–c: Models for the second phase of treatment.
25b
25a
25c
Figs. 25a–c: Situation in the sixth month of treatment.
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23
[24] =>
| case report
26a
26b
26c
Figs. 26a–c: Situation in the ninth month of treatment.
27a
27b
27c
Figs. 27a–c: Situation in the tenth month of treatment.
28a
28b
28c
28d
28e
Figs. 28a–e: Situation in the 11th and final month of treatment.
29a
29b
29c
29d
29e
29f
Figs. 29a–f: Final extra-oral photographs.
24
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30a
30b
Figs. 30a & b: Before and after extra-oral photographs.
[25] =>
case report
31a
31b
31c
31d
31e
31f
|
Figs. 31a–f: (a–c) Initial models, and (d–f) final models.
33
Fig. 33: Initial and final sagittal CBCT scans.
32
Fig. 32: Final Perrotti analysis.
Editorial note: Please scan this
QR code for the list of references.
about
Dr Carlos Colino holds a master’s
degree in dentofacial orthopaedics and
clinical orthodontics from the Catholic
University of Murcia in Spain and is an
associate teacher at the same university. He won first prize for best clinical
case at the VIII Congreso Internacional
de Alineadores in 2023. He runs his own
practice in Malaga in Spain.
Dr Laura Castillo earned her master’s
degree in orthodontics from the University of Alcalá in Alcalá de Henares in
Spain. She is an associate professor in
the orthodontics and dentofacial orthopaedics master’s programme at the
Catholic University of Murcia in Spain.
She practises orthodontics exclusively
at Dental Colino clinic in Villanueva de la Serena in Spain and is
a member of the European Orthodontic Society.
Dr Isabel Drewling undertook her
dental degree in 2006 at the University
of Barcelona in Spain. She continued
her orthodontic and dentofacial orthopaedic training in 2013, and since then,
her practice has been limited to orthodontic treatment.
Dr Pedro Colino obtained his PhD
summa cum laude from the University
of Extremadura in Badajoz in Spain and
his MSD in orthodontic and dentofacial
orthopaedics with extraordinary award
from the University of Alcalá in Alcalá
de Henares in Spain. He is head of the
orthodontics and dentofacial orthopaedics master’s programme at the Catholic University of Murcia
and an associate professor at the Miguel de Cervantes European University in Valladolid, both in Spain. Dr Colino is
the author of three orthodontic textbooks and an active
member of the Spanish Society of Orthodontics and the
European Orthodontic Society. He maintains two private practices in Spain, one in Villanueva de la Serena and another one
in Malaga.
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[26] =>
| technique
How to safely speed up tooth
movement and reduce the duration
of orthodontic treatment
Dr Ana Paz, Portugal
The average length of an orthodontic treatment varies
between one and three years, depending on many
factors, such as degree of the problem, the biotype and
patient compliance. The big question is how can we
shorten the treatment time without affecting the biology
and the overall outcome of the case? Safely accelerating
therapy enhances the motivation of adult patients, as
time is a valuable commodity.
One of the methods used to speed up tooth movement
is photo-biomodulation therapy. Photo-biomodulation
has been described in the literature as a promising and
effective therapy for accelerating orthodontic movement
and improving its efficacy and comfort during orthodontic treatment, having an analgesic and bone remodelling
effect.1, 2
Also known as low-level light therapy, photo-biomodulation
therapy has been demonstrated to be a minimally invasive technique that appears to be effective. The application of light of a specified set of wavelengths over an appropriate period has been shown to be a means to
accelerate orthodontic movement. This technique has
the objective of activating cells at a mitochondrial level to
make them produce more energy, adenosine triphosphate, which is essential for cell repair and regeneration.
There are several LED devices on the market, however,
the ATP38 (Swiss Bio Inov) has proved to be the most
efficient, since it employs semiconductor technology to
focus the light emitted, creating an energy similar to that
of a laser beam, rather than dispersing the light like other
LED devices do.3
But how exactly can photo-biomodulation
be good for orthodontic movement?
Firstly, we need to understand how orthodontic forces
work and the biological process of tooth movement. The
application of orthodontic (mechanical) forces initiates
an inflammatory process in the periodontal complex and
a cellular chain reaction that results in tooth movement.
Orthodontic tooth movement is therefore the result of
26
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1a
1b
Figs. 1a & b: Clinical situation before treatment, occlusal view of
the (a) maxilla and (b) mandible.
remodelling changes in the bone adjacent to the periodontal ligament, arising from the effects of bone resorption by osteoclasts in areas of pressure and bone deposition in areas of root tension. When bone resorption
and deposition occur around different areas of the same
tooth, the result is tooth movement.
[27] =>
technique
1c
|
1d
Figs. 1c & d: Clinical situation after 20 weeks of orthodontic treatment with 20 aligner pairs in combination with photo-biomodulation,
occlusal view of the (c) maxilla and (d) mandible.
The periodontal ligament is rich in cells and blood vessels. It is made up of undifferentiated stem cells, which
have the potential to develop into osteoblasts, cementoblasts or fibroblasts. For bone remodelling, osteoblasts,
osteoclasts and fibroblasts communicate via the
RANKL–RANK–OPG signalling pathway, which involves
the interaction of receptor activator of nuclear factor
kappa B ligand (RANKL), receptor activator of nuclear
factor kappa B (RANK) and osteoprotegerin (OPG).
secrete OPG. This molecule binds to RANKL, preventing
it from attaching to its RANK transmembrane receptor and stopping osteoclastic activity. Osteoblasts therefore play a key role in bone remodelling, as they are
involved in activating osteoclastogenesis, inhibiting resorption and synthesising new bone matrix. Thus, in
areas of compression, RANKL levels are high, and
in areas of tension, TGF-β and OPG levels are much
higher.
The most abundant cell in the ligament is the fibroblast,
which is responsible for its structure by producing collagen. It also secretes RANKL and transforming growth
factor β (TGF-β) under mechanical stimulation. Stem
cells differentiate into osteoblasts under the influence
of the growth factor TGF-β. Osteoblasts (responsible
for bone formation) secrete RANKL, OPG, macrophage
colony-stimulating factor (M-CSF) and several other
molecules.
Photo-biomodulation therapy can play a key role in orthodontic movement, since it has the effect of increasing
cell proliferation, collagen synthesis and the release of
growth factors and other cytokines that stimulate the
activity of osteoblasts, osteoclasts and fibroblasts involved in bone remodelling.
Osteoclasts (responsible for bone resorption) differentiate into pre-osteoclasts from haematopoietic stem cells
present in the vascular system. These pre-osteoclasts
migrate to bone sites and fuse into osteoclasts in the
presence of RANKL and M-CSF.
When mechanical force is applied, an acute inflammatory response is triggered, inducing vasodilation and allowing leucocytes to penetrate from the capillaries into
the ligament matrix. Leucocytes produce cytokines,
which initiate the signalling pathway. The osteoclasts
remain active for as long as the adjacent cells are producing RANKL.
Under the influence of anabolic and hormonal (calcitonin, oestrogen), immunological (TGF, interleukin 17 and 4)
or inorganic (calcium) factors, osteoblasts produce and
For the past year, we have exclusively been using the
ATP38 photo-biomodulation device, and it has been
very well accepted in our daily workflow. We are managing to streamline planning for complex cases, from
smile design to orthodontic treatment planning and
implant placement (when necessary), but what really
makes this ecosystem remarkable is the regular combination with the ATP38. We have already had almost ten
years of success with this protocol and believe it should
be the benchmark in orthodontic therapy, whether with
fixed appliances or aligners (Figs. 1–3).
Establishing new protocols is always challenging, especially when including new technology in the workflow.
Nevertheless, it is helpful to regard this in light of the
metaphor of bamboo growth: it usually takes five years
to see growth, so initially it will be difficult to see the real
advantages, but as you obtain more cases and see the
benefits clinically and receive feedback from patients, it
will become clear that all the effort is worth it.
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[28] =>
| technique
2a
2b
2c
2d
Figs. 2a–d: Intra-oral scans before treatment, occlusal view of the (a) maxilla and (b) mandible. Intra-oral scans after 20 weeks of
orthodontic treatment with 20 aligner pairs in combination with photo-biomodulation, occlusal view of the (c) maxilla and (d) mandible.
References
1
Fig. 3: Photo-biomodulation session after weekly aligner change.
2
contact
Dr Ana Paz
R. Dr. António Loureiro Borges,
Ed. 5, 1° Andar
Miraflores
1495-131 Algés
Portugal
info@whiteclinic.pt
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3
Impellizzeri A, Horodynski M, Fusco R, Palaia G,
Polimeni A, Romeo U, Barbato E, Galluccio G.
Photobiomodulation Therapy on Orthodontic Movement: Analysis of Preliminary Studies with a New
Protocol. Int J Environ Res Public Health. 2020 May
19;17(10):3547. doi: 10.3390/ijerph17103547.
Yavagal CM, Matondkar SP, Yavagal PC. Efficacy of
Laser Photobiomodulation in Accelerating Orthodontic Tooth Movement in Children: A Systematic Review with Meta-analysis. Int J Clin Pediatr
Dent. 2021;14(Suppl 1):S94–S100. doi: 10.5005/
jp-journals-10005-1964. PMID: 35082474; PMCID:
PMC8754265.
Heidari M, Paknejad M, Jamali R, Nokhbatolfoghahaei H,
Fekrazad R, Moslemi N, Effect of laser photobiomodulation on wound healing and postoperative pain
following free gingival graft: A split-mouth triple-blind
randomized controlled clinical trial. J Photochem
Photobiol B. 2017 Jul:172:109–114.
[29] =>
technique
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[30] =>
©️ SomYuZu/Shutterstock.com
| opinion
Artificial intelligence in dentistry
Dr Miguel Stanley, Portugal
For those who have been paying attention to the latest
news in the technology space, you will most certainly
have noticed that OpenAI recently launched ChatGPT, a
new artificial intelligence (AI) chatbot. It is amazing to see
how this technology works and how quickly it can do incredibly complex tasks and have virtually all the information that is online at your disposal in a matter of seconds.
I had to test it multiple times and try to force it to make a
mistake on the information that I wanted, but this machine
learning technology is really powerful.
For example, I asked it to write me a song around a specific theme and asked for the chords I liked best, and in
less than 10 seconds, I had a song that I could easily play
on the guitar. I even asked it to write this article quoting
articles and giving examples of application of AI in medicine, and the result was quite complete, but naturally as
the applications of AI in dentistry are still few and of little
relevance, naturally there was little information it could
combine and use in an intelligent way. As such, the result
was somewhat interesting, but not what I was looking for.
That is not to say that in a year or two when the bot can
obtain more information online, and there are more cases
and documentation, the technology will not be able to be
even better.
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If ChatGPT is asked things for which a great deal of information is already available, the responses are simply
amazing, and the scary thing is that the bot is still learning. It learns with every question and with every answer.
It is going to revolutionise the way we search for information and the way we learn, and certainly many jobs are at
risk with this technology. As a rule, I am not a person who
is afraid of technologies, but if we look at the automobile
industry, which used to rely almost entirely on people, all
tasks are now mainly done using robots. The work of
cashiers at the supermarket can also already be 100%
automated. There are already platforms for lawyers and
legal articles written by AI programs and translated
almost instantly. It is all quite impressive.
Our dental business has three main components:
– diagnosis and treatment plan;
– execution of treatment; and
– daily management of the clinic.
Of course, I am simplifying here. We all know that it is far
more detailed and that there are many more factors at
play than these, but I think that these are the main areas
in the day-to-day running of a modern dental practice.
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opinion
Where might AI have an immediate impact on these specific areas?
Diagnosis and treatment plan
There are already several online platforms available to
help in diagnosis. Of course, they are not perfect, but
they are already able to very quickly through a panoramic
radiograph or CBCT scan segment all the teeth and identify problems such as caries, endodontics and missing
teeth. Some of these platforms also assist the dentist incredibly quickly in preparing a treatment plan beyond diagnosis. We are still in the early days of this technology,
but I believe that within a very short time the application
of AI in the diagnosis and treatment planning of our patients will be the norm, and for those who work for insurance or large dental groups, it will almost be a requirement.
The advantages implicit in this technology are that we
can often miss small details because we might be looking
at more complex problems in our patients’ mouths and
for example miss a small cavity between two teeth or
because we do not have the requisite amount of time
in our initial appointment to look at everything or are
focused on the primary reason the patient came to us
and might overlook broader aspects. This technology will
help mitigate error incredibly in this very important process when we are diagnosing a patient for the first
time or re-evaluating our case after a few years. We all
know that our eyes can sometimes deceive us. Here this
technology will play an incredibly powerful role in helping to analyse CBCT scans and radiographs, and I believe
that intra-oral scanners and laboratory scanners will
also be a part of this process, as well as the various software programs available for the dental laboratory.
AI will also play a predominant role in the preparation of
a treatment plan, as well as in the sequence of treatments
to be performed, making sure that the right methods are
in place. Depending on the technology used, the software will serve the clinic or the patient. Different groups
may create AI programs according to their various goals,
such the promotion of biomimetics or all-on-four or aesthetic treatment. This means that programs are going
to be trained to prompt a specific outcome by whoever
programmed them. AI software does only what it is programmed to do, so whoever creates these AI programs
can set whatever parameters they want.
Imagine an AI program available to the patient through
which the patient could influence the dentist’s treatment
plan and the materials used. The second the dentist
presents the treatment plan based on his or her diagnosis, the patient would be able to ask for that report and
enter it into the program on his or her smartphone and
instantly critically analyse whether the dentist’s goal is
|
financial only rather than the pursuit of optimal treatment.
This program might enable instant recommendations
from nearby clinics that can perform the same type of
treatment at a lower cost and with greater proficiency
because they have better means and materials to do so.
It appears that soon all this information will be available
to everyone, not just dentists.
That is why I have been warning for some time in my lectures and at international conferences that this is a very
good time to start investing in quality and to be as ethical
as possible in our professional conduct, because sooner
or later there will be technological entities controlling the
way we work. It is going to be very difficult to deceive your
patients, and we all know that there are many today who
practise dentistry that is not congruent with current
science and clinical evidence in order to save time or
money. It will certainly be very interesting to see the evolution of all these technologies in our industry.
Personally, I think that this is great! Since the beginning
of my career, I have been putting myself on the side of the
patient and not on the side of the industry. I practise
empathy every day when I have a patient in front of me. I
am sure that every patient in the world wants the same
thing: good treatment performed with the best materials,
painlessly and with care and that lasts a lifetime with high
aesthetics. Of course, this magic formula does not exist,
but surely the incredible tension that exists between patients and the industry will dissipate if we have a technological referee in our midst.
We all know that there are patients with unrealistic expectations who have a very complicated phenotype and
want complex mouth treatments that are unachievable.
An AI program will be able to immediately mediate in the
conversation by introducing an objective examination so
that the dentist can have more tools to demonstrate
the facts of the case based on science and to support a
challenging explanation to the patient and, by the same
token, so that the patient will have extra support to ensure
that he or she is not being misled and that the dentist is
not trying to sell something outside of the necessary
scope, in defence of the patient’s oral health and wallet.
I think that it will be an incredible help to many.
Of course, clinics that practise dentistry without regard
to quality and ethics should be very concerned about
these new technologies. I think that this mediation is
something that is missing in our industry. I have already
been working with companies and been helping some of
them, learning from them and trying to ensure that
decision-making and implementation are based only on
ethics, science and clinical evidence.
To summarise, I think that AI will provide an incredible
means to improve the effectiveness of diagnoses and
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[32] =>
| opinion
treatment plans, making the process much safer for
everyone involved, and to ensure that no step is forgotten in developing a treatment plan and that the sequencing of treatment steps is done according to the
principles of biology and mechanics, based on a deep
understanding of what is possible and tangible, in order
to achieve longevity and success for the dentist and of
course the patient.
Just like we have been doing with clear aligner treatment
for over 18 years, this whole process has to be validated
by a human, the dentist—who of course is sovereign at
the end of the day! If he or she changes the treatment
plan, however, the AI program will inform the patient of
this change immediately, giving the patient the opportunity to ask why. If things go wrong in the future, AI programs will certainly give patients the means to engage
with their dentists. This will have legal implications, and
I believe will make life more difficult for some but easier
for others.
Execution of treatment
I believe that this will be an area explored more by robotics than by AI. There are already robots that can place
dental implants remotely with incredible precision, and
naturally they will be controlled by AI in the future. For
now, we can be assured that, at least for the next few
years, the art of taking care of our patients’ mouths will
still be very manual, and here dentists play a leading role.
I believe that, if we are smart and use the time saved in
creating the treatment plans and diagnoses by AI, we
can use that time to invest more time in our patients.
Certainly, there will be clinics that will quickly fill those
hours with more patients, but as you know I am a strong
advocate of Slow Dentistry (slowdentistry.com), and I
believe this is how we will secure our future. The human
touch is going to be the major differentiator. I believe
that we have to focus on the human side of our art
because in the future the dentists who create the best
relationships with their patients will be more successful.
Patients will surely want to be sure that their dentist is
doing things right, and we all know that working in a hurry
is very difficult. There are more and more young dentists
in the business. Experience takes years to acquire, and
it is imperative to give young people adequate time to be
able to do their jobs well. I even believe that there will be
an AI program that will be able to measure what the
optimal time is for performing each task with quality and
that will inform the patient that the average optimal time
for a Class I restoration on a molar is 35 minutes, for
example, and that fitting a dental dam for treatment is
essential.
Regarding the execution of treatment, I think that AI will
play a very relevant role in the selection of materials and
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technologies to use. Here it is easy to understand how.
When the AI program compiles the treatment plan, it will
be able to analyse all materials available quickly and determine the best material for each step in the treatment
to be executed, helping the dentist to select the materials
more carefully for his or her treatment. This will also help
laboratories avoid materials not congruent with the longterm success of the treatment being performed. Each
time, the dentist or dental technician does not accept the
recommendation provided the AI, the patient will be
warned.
Consider blockchain technology, a digital ledger in which
transactions made in a cryptocurrency are recorded
chronologically and publicly. This data is distributed
across a network of computers and cannot be changed
without verification and approval via time-stamp. This
means that the security of these assets does not rely on
a third party, heralding a significant decentralisation of
power over information.
All the information that we acquire from our patients, for
example via radiographs, intra-oral scans, CBCT scans
and photographs, belongs to the patient. I believe that
every time that information is shared with entities outside the clinic, the patient will be notified via an AI program. Imagine, for the groups that send crowns to be
manufactured in China or India or anywhere for that
matter, the patient will be notified that his or her file has
been sent abroad. Of course, this is no problem at all if
the dentist has informed his or her patient that he or she
will be doing this to lower costs, but it will be difficult to
explain this to the patient if he or she has been given a
guarantee that the crown will be manufactured in Portugal, for example. This demonstrates that ethical care will
be facilitated by default in the dental industry and in the
health business in general in the future, thanks to AI and
the associated technologies.
Daily management of the clinic
We all know the difficulties we have managing in complex
schedules. I believe that AI will play a major role in supporting the day-to-day management of our clinics. The
following are some areas where I believe that AI will very
quickly be of great use to us:
–
–
–
–
–
–
stock management;
calculation of dental professionals’ commissions;
invoicing;
legal documentation for patients;
patient conflict management; and
improving communication between departments.
Nowadays, all these tasks require endless hours of
human resources day in and day out throughout the
year, at great cost to clinic owners. Yet it is difficult to
[33] =>
|
©️ SomYuZu/Shutterstock.com
opinion
Xxxxxx
include redundancies in these tasks, and there are many
possibilities for error. All these errors come at a great
cost as well. Surely, it will be incredibly welcome for
practice owners, insurers and all those involved in
managing practices to have support that can enable
them to reduce error and increase efficiency.
Let us consider an example. Imagine a healthcare group
that has one dentist. This dentist works in three different
clinics and, at the end of the month, is remunerated
based on a calculation of the treatment activities performed. It is necessary for an accountant or an account
manager to confirm all the facts described and entered
into the system by the dentist. Now, the healthcare group
must confirm that the dentist has indeed performed
these tasks, but how can it know whether he or she has
done them well? How can it be sure that he or she has
not made a mistake? An AI program used by the clinic
management could very quickly go through the radiographs, the photographs, the clinic’s and dentist’s emails,
all communication between the parties involved, the
stock record for the materials removed from the stock for
the treatment, the chair time allocated for the treatment
and the laboratory workflow around the treatment and
calculate immediately whether in fact what the dentist
claims to have done was in fact done and done well. Naturally, the dentist will feel more secure because his or her
entire effort will be validated and confirmed by management, and his or her payment will be effected without
problems.
The problem arises if the dentist has not been correct in
his or her conduct, because the AI program will quickly
warn both parties of an error and help correct it to the
benefit of both parties. Surely no dentist will want to be
paid for work he or she did not do, and no organisation
will want to pay for work not done. Certainly in the future
there will be a discussion about whether organisations
should pay for poorly performed work, but that is another
discussion for another time.
I think that AI may make things more difficult for some but
also much easier for others. We are still a long way from
seeing all this happening, so do not become worried just
yet. It is important, however, to keep an eye on how things
are developing because it is not a matter of whether it will
happen but when.
contact
Dr Miguel Stanley
Rua Dr. António Loureiro Borges 5
1o Andar Arquiparque
Miraflores
1495-131 Algés
Portugal
Whiteclinic.pt
Miguelstanley.com
Missinglink.ai
info@whiteclinic.pt
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©️ aodaodaodaod/Shutterstock.com
| opinion
Ethical communication and
brand building
Dr Anna Hajati, Sweden
As communication and marketing through social media
become indispensable for cutting through the clutter of
media communication, the dental industry—especially in
the field of aesthetic dentistry—faces novel challenges in
upholding ethical integrity alongside brand development.
This challenge is particularly acute in orthodontics, a
specialty experiencing a marked increase in online and
social media marketing, which has in turn driven demand
for aligner-based treatments. In this article, I explore
strategies that allow dentists to build strong and enduring
brand identities through ethical and fact-based communication and evidence-based dental procedures.
Cosmetic dentistry and orthodontics in the
spotlight
The growing trend of aesthetic dentistry, in particular
products like aligners, has led to increased demand
through social media. While these platforms offer exceptional opportunities for marketing and patient education,
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they also bring challenges related to ethics and patient
welfare. Dentists face the difficulty of navigating this landscape while maintaining focus on the patient’s unique
medical needs and safety. It is important that dental professionals not only highlight the aesthetic aspects of
treatments, but also thoroughly evaluate the patient’s
needs and wishes holistically and inform them about
medical considerations and potential risks relevant to
their individual situation. Dentists should always, as the
very foundation, prioritise balanced and objective information delivery to patients in the light of the four principles of autonomy, beneficence, non-maleficence and
justice, described by Beauchamp and Childress.1 It is important to succeed in establishing a patient–dentist relationship which could lead to optimum clinical outcomes
while respecting the wishes of the patient and promoting
his or her best interests.
Furthermore, Smorthit and Cooper highlight the need for
dentists to combat misunderstandings and exaggerated
[35] =>
expectations that can arise
through social media,2 where
posts may be unrealistic and not
representative of the day-to-day
dentistry achieved by most practitioners. By engaging in authentic and ethical marketing, dentists
can contribute to a more informed and healthy view of aesthetic
dentistry.
Furthermore, it is important for
dentists to continue to update
their knowledge of and skills in
using new technologies to offer
the most effective and tailored
care possible. Continuing professional development is crucial
for maintaining a high standard
of patient-centred care.
|
©️ Natali_Mis/Shutterstock.com
opinion
Challenges with product-centred marketing
It is important that dentists balance the need to be informed about new treatment options with the responsible presentation of these products. If not handled correctly, product-centred marketing can lead to patients
choosing treatments that may not be the best option for
their specific situation.
©️ Drozd Irina/Shutterstock.com
An excessive focus on specific products, often seen in marketing campaigns for dental products, can lead to the overshadowing of dentists’ professional judgement and of individual patient assessments. This type of marketing risks
minimising the clinical and functional aspects of orthodontics, crucial for the patient’s long-term health and well-being.
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[36] =>
| opinion
Holden et al. emphasise that dentists should be careful
not to let commercial interests dictate treatment recommendations.3 Instead, they should strive to provide a complete and objective overview of all available treatment
options, including potential risks and benefits.
tal care. Transparency in communication includes being
open about any limitations or uncertainties that may exist
regarding certain treatments, and acknowledging risks
helps build a trusting relationship between dentists and
patients.7
It is crucial that products are not presented as universal
solutions but as part of a tailored treatment plan. This requires a careful assessment of each patient’s unique
medical needs and desires. By including the patient in all
treatment decisions, dentists can ensure that they
provide the highest standard of care.4
Transparency of care is not only an ethical obligation for
dentists, but also improves the patient’s experience and
treatment outcome, and this in turn can lead to patient
loyalty and boost the practice’s reputation.
Ethics and brand building
Future dentistry should include a shift towards patientcentred care, where each treatment decision is based on
the patient’s specific needs and desires, rather than
market trends and the hype around certain products, for
example. This focus prioritises the patient’s well-being
and individual goals, crucial for achieving optimal care
results.
Dentists should strive to build their brands by emphasising the importance of ethics, patient welfare and scientifically supported treatment methods. By integrating
these important values into all aspects of their practice,
including patient communication and marketing materials, dentists can strengthen their patients’ trust. This
support the creation of a brand synonymous with reliability and professionalism.
A strong ethical foundation in brand building also helps
differentiate a dental practice from practices who may
use less responsible marketing strategies. Patient-based
brand equity and the various ways that current pioneer
marketing entities can build and maintain a positive public
image of a dental practice.5
Additionally, emphasising scientifically supported treatment methods strengthens dentists’ reputation as experts in their field. Research has shown that evidencebased dentistry enhances outcomes for both practitioners and patients in terms of the provision of proven
and effective treatment, reduced harm to patients and
increased patient trust.6
Building a brand based on ethical principles and patient
welfare is not only the right thing to do, it is a smart
business strategy that benefits both patients and practices.
Education and transparency
It is crucial that dentists educate their patients about the
various treatment options, including the benefits, the
risks and realistic expectations. By providing comprehensive and easy-to-understand information, dentists
can help patients understand the complexities of orthodontic treatments and the underlying factors behind each
recommendation.
This educational process is a central part of promoting
transparent communication, which is essential for patients to make well-informed decisions about their den-
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Patient in focus
In a patient-centred care model, a thorough understanding of the patient’s unique medical situation and individual expectations is key to success. Listening to and
involving the patient in the decision-making process
by visualising a target set-up supports patient-centred
care.
The practitioner–patient relationship and use of technology are central to patient engagement and to improving
the patient experience.8 By centring the patient in all
dental procedures, dentists can ensure that they meet
patients’ expectations and contribute to a more positive
and effective care experience.
It is crucial that dentists stay updated on the latest
research and technology in their field in order to ensure
the best possible treatment outcomes for their patients
and to maintain a high standard of patient-centred
care. Undertaking continuing science-based education
and professional development activities is crucial for
keeping pace with the rapid changes in aesthetic dentistry.9
It is also important for dentists to continue to update their
knowledge of and skills in using new technologies to offer
the most effective and tailored care possible.
Conclusion
Owing to the commercialisation of our profession, dentists stand at a crossroads where we must find a balance
between building a brand and adhering to the ethical
principles fundamental to the profession. By prioritising
the patient’s best interests and advocating for evidencebased and tailored orthodontic care, dentists can build
successful, respected and sustainable brands.
[37] =>
opinion
about
Dr Anna Hajati his a prominent orthodontist, entrepreneur and pioneer in integrating innovation and science with a
human-centric approach in orthodontics, and her work emphasises ethical
communication, patient-focused care
and the transformative power of a smile.
She is the founder of OrtodontiAkademin, an orthodontic practice in Stockholm in Sweden, and has long been employing digitally supported treatment processes to improve treatment outcomes
and the patient experience. She obtained her DDS and PhD from
Karolinska Institutet in Stockholm and her certification in orthodontics from the centre for orthodontics and paediatric dentistry
in Linköping in Sweden. Dr Hajati is a member of the World
Federation of Orthodontists, European Orthodontic Society,
Swedish Association of Orthodontists, and Dental and Craniofacial Bionetwork for Image Analysis. She is a member of and
elected ambassador for the American Association of Orthodontists in Sweden.
References
Beauchamp T, Childress J. Principles of biomedical ethics: marking its fortieth anniversary. Am J Bioeth.
2019 Nov;19(11):9–12. doi: 10.1080/15265161.
2019.1665402. PMID: 31647760.
3
4
5
6
7
8
9
Smorthit K, Cooper J. Social media influence. BDJ
In Pract. 2020;33(6):5. doi: 10.1038/s41404-0200427-3.
Holden AC, Adam L, Thomson WM. Dentists’ perspectives on commercial practices in private dentistry. JDR Clin Trans Res. 2022 Jan;7(1):29–40. doi:
10.1177/2380084420975700.
Hayer N, Wassif HS. General dental practitioners’
perceptions of shared decision making: a qualitative study. Br Dent J. 2022 Feb;232(4):227–31. doi:
10.1038/s41415-022-3980-9.
Devetziadou M, Αntoniadou M. Branding in dentistry:
a historical and modern approach to a new trend.
GSC Adv Res Rev. 2020;3(3):51–68. doi: 10.30574/
gscarr.2020.3.3.0038.
Sellars S, Wassif HS. Is dentistry the orphaned field of
medicine? Ethical consideration for evidence-based
dentistry. Br Dent J. 2019 Feb 8;226(3):177–9. doi:
10.1038/sj.bdj.2019.145.
Hartshorne J. Trust and the dentist-patient relationship. Int Dent Afr Ed. 2022 Aug–Sep;12(4):26–37.
Chakaipa S, Prior SJ, Pearson S, van Dam PJ. Improving patient experience through meaningful engagement: the oral health patient’s journey. Oral. 2023
Dec;3(4):499–510. doi: 10.3390/oral3040041.
Lin E, Julien K, Kesterke M, Buschang PH. Differences in finished case quality between Invisalign and
traditional fixed appliances: a randomized controlled
trial. Angle Orthod. 2022 Mar 1;92(2):173–9. doi:
10.2319/032921-246.1.
©️ Jirsak/Shutterstock.com
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| interview
The trajectory of technology in our
field is promising
Nathalie Schüller, Dental Tribune International
Dr Chris Laspos (left) and Dr Claudia Pinter. (All images: EAS)
Dr Chris Laspos is an orthodontist who specialises in the
treatment of individuals with craniofacial malformation
and is an assistant professor in orthodontics at the
School of Dentistry of the European University Cyprus in
Nicosia. During the fifth European Aligner Society (EAS)
congress in March, he gave a lecture on tailored treatment strategies and demonstrated the impressive results
that can be achieved with the use of digital treatment
planning technologies driven by artificial intelligence (AI).
At the event, Dental Tribune International spoke with him
about the value of the congress and about AI in aligner
treatment.
Why is attending this congress important to you?
I find that this congress stands out as exceptionally professional when compared with many others. The calibre
of the board members, the enthusiastic participation of
emerging orthodontists who embrace our core values,
and the exceptional speakers and conference offerings
collectively contribute to its high quality.
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Aligners represent the future of orthodontics, and our
goal is to provide orthodontists with non-commercial
content that enhances their practice and career. Of
course, there is a commercial aspect to it, since each of
us by necessity must utilise a system to showcase our
orthodontic techniques, but we focus on clinical application and evidence-based practices.
The uniqueness of aligners is a key reason for their widespread adoption. Consider the increasing attendance at
events like the EAS congress, which welcomed over
1,300 participants this year. This reflects the quality and
relevance of aligner technology. The growing number of
attendees also underscores the increasing demand.
Mastery of the modality is essential for practice growth
and patient retention. It’s crucial to uncover the secrets
and learn valuable tips to stay competitive in the field.
Earlier, I talked to an orthodontist I know who is also
at the congress, and she said that, even though she
[39] =>
interview
uses aligners and sees their importance, she still
feels that fixed appliances have application and
value. What is your response to that?
Understanding the fundamentals of orthodontics is
crucial. It involves the manipulation of teeth and bone to
enhance the smile and alter facial structure, sometimes
through surgical means. Aligners serve as a powerful
tool, particularly valued for their aesthetic appeal and
versatility. They have numerous applications, simplify
tooth care compared with fixed appliances and have
been widely embraced by orthodontists and patients
worldwide.
Sometimes, when you have small teeth, the aligners’
plastic may not be able to engage well on the teeth, so
you might need to use some kind of auxiliary or fixed
appliance—these are what we call hybrid treatment
cases. Aligners work fine, but like most things, there are
limits, and you have to know them and what works. You
must keep on learning.
I liked what you said in your lecture about there
being no complex cases, only questions of good
planning. What strategies do you employ to optimise
your digital treatment planning process, particularly
in terms of integrating your own preferences and
streamlining the workflow?
Indeed, planning is paramount in our field; insufficient
preparation can lead to errors. As orthodontists, we
draw upon the bag of tricks at our disposal based on the
unique challenges presented in each situation we encounter. I engage in digital treatment planning on a daily
|
basis. Upon receiving the initial ClinCheck plan from
Align Technology, the AI algorithm is already acquainted
with my thought process. Consequently, certain details
may not be necessary to provide, as the AI has been
programmed to understand my approach and preferences. By inputting a substantial amount of fundamental
information, I have tailored the system to align with my
requirements, thereby streamlining the planning process
and saving valuable time.
What specific advancements in materials, techniques, or technologies do you believe will have the
most significant impact on improving treatment
planning and result visualisation in our field? And
how do you envision these advancements contributing to achieving superior outcomes for patients?
I wholeheartedly agree that the trajectory of technology
in our field, particularly in planning and result visualisation, is promising. With ongoing advancements in materials and techniques, we can anticipate continual improvement. The future holds even greater potential for
enhancing our capabilities and achieving superior outcomes.
Do you have any fears about AI and the speed at
which technology is evolving?
I share the sentiment that many others have expressed
that AI won’t replace us in our field. Our expertise, our
cognitive abilities and the irreplaceable human touch will
continue to be indispensable. While AI can enhance our
capabilities, it cannot replicate the intuition, empathy and
creativity that define our profession.
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| interview
“The primary aim of EAS remains
to promote excellence in aligner
treatment”
Nathalie Schüller, Dental Tribune International
The European Aligner Society (EAS) was founded to
advance the field of aligner orthodontics and to that
end seeks to provide education on aligner therapy to
clinicians. At its fifth congress, which took place from
29 February to 2 March, Dental Tribune International
spoke with the event’s scientific chairperson, Dr Gina
Theodoridis, who is EAS president-elect for 2025 and
president of next year’s congress, which is to be held in
Rhodes in Greece. In this interview, she talks about the
factors that account for the quality of EAS, which she
regards as a society like no other, as well as about the
recent congress.
The EAS congress went from 300 attendees in
Vienna to 1,300 here in Valencia. What to you makes
EAS different and its congress such a special event?
Indeed, the Valencia congress has been an unprecedented success! EAS is unique in terms of the core
values on which it was founded. At that time, there were
only a few dentists who believed in the potential of clear
aligner treatment. As the use of aligners has become
more popular over the years, a growing number of dentists have joined EAS to expand their aligner knowledge.
The dentists who created EAS are educators themselves, and that is why the primary aim of EAS remains
to promote excellence in aligner treatment. This is something that was missing to a large extent from other orthodontic societies and scientific congresses. EAS was the
first society to envision this potential, and that is why it
has become a leader in aligner education.
You are the scientific chairperson of this congress.
What were your goals, what challenges have you
faced and what personal achievements came from
putting together this programme?
Being an orthodontist who has been using aligners for
24 years and an educator myself, I had an idea about
subjects that would be interesting to our delegates. We
wanted to create different themes in the agenda so that
people could join a whole session on a subject that
would appeal to them. This created structure, flow and
continuity in the lectures.
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My goal was to create a programme in which the presentations addressed the latest diagnostic modalities
in treatment, such as CBCT, made use of excellent
patient records and gave clarity regarding what treatment was performed and how. I wanted content that
was explained on the basis of the fundamental orthodontic principles that we were trained on. Furthermore, I
wanted to include the whole range of orthodontic treatments, addressing treatment of young kids, complex
treatments and surgery.
The challenge was determining how I would communicate this to the speakers without making them feel too
constrained, especially because almost all of them are
very experienced speakers. Surprisingly, upon my communication with them, everyone was very motivated to
create content that was tailored to our theme, and I am
deeply grateful that they have given us their best in
content and performance.
Another challenge was to create a plenary session that
would highlight the science behind aligner treatments
and not a specific product. That is why in the plenary
lectures we tried to keep commercial brands and logos
out of the presentations so that delegates could focus
on the methods and science.
I have to say that I am deeply satisfied that delegates
have enjoyed the benefits of the programme. It is so fulfilling to see a full auditorium from early morning and
people staying until the very end, as well as overbooked
workshops. The teams’ session on Thursday had
double the number of delegates than what we had
expected! We have received several messages to tell
us how the programme was so fulfilling to the attendees,
and this makes me very happy!
EAS President Dr Jose Gandia announced that you
would be the president for next year’s congress.
The European Board of Aligner Orthodontics (EBAO)
was launched last year, and this year, the legacy
fund was started, as well as online webinars.
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Image: EAS
Can you share what your vision is for the next congress, what delegates might expect, or is it too soon
to ask?
I regard my new role as president-elect of EAS for 2025
with enthusiasm, optimism and responsibility. EAS has
grown and has an ongoing obligation to give back to the
orthodontic community. We are looking forward to a
great sixth congress on the beautiful and sunny island of
Rhodes. No, indeed, the vision for the congress has
already been established, and most speakers have
already been booked and are very enthusiastic to participate!
How does the independence of EAS from any specific company influence the content and focus of
its events, particularly regarding the balance between scientific advancements and product promotion?
At this congress, the concept of the AlignerLab Innovation Village was reintroduced, and I believe it is here to
stay. This is a section within the congress where companies bring their best speakers to showcase the company
innovations. We found this to be a fair way of making it
clear to delegates which lectures are sponsored. The
company workshops were a great success as well.
During this congress, I have had the chance to collect
some feedback regarding what delegates wish to learn
more about. It seems like 3D printing, in-house aligners,
and hybrid and interdisciplinary treatment will be major
topics at the next congress.
At this event, EAS has prioritised sustainability, such
as the decision to forego printed programmes in
favour of a digital version. Does the board plan to do
more for the next congress, and how have delegates
received the congress app?
EAS’s commitment to sustainability is a core value. As
aligner users, we use a lot of plastic, so we are urging
companies to start thinking about sustainable production and appropriate disposal of aligners. I believe that
this will come into effect in the future, and I am glad to
share that EAS will be donating funds for research that
hopefully will address this issue, among others.
I believe that CBCT integration with aligners should be
included again because this is a tool that is of immense
diagnostic value, and we must use this with ethical responsibility as part of our orthodontic diagnosis. The
scientific chairman, Dr Chris Laspos, and I would also
like to include a section tailored to orthodontic staff and
practice management. Much of the practice’s operation
relies on delegation to staff, so we have an obligation to
educate our staff.
The same standards and quality as the Turin and Valencia congresses will be maintained. The third EBAO exam
will take place during the congress. For sure, the sixth
congress is not to be missed!
Congresses tend to create a lot of waste, and we will
continue to pursue sustainable development goals by reducing the paper and plastic used. We have received
very positive feedback on the congress app, and we will
continue to use it. EAS’s commitment to sustainability is
a core value, and we will continue to have this as a priority in the future, a future that is digital.
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| interview
Aligners are the present and future
of orthodontics
Nathalie Schüller, Dental Tribune International
Presenting at the fifth European Aligner Society (EAS)
congress, held in March, Dr Iro Eleftheriadi spoke
about the importance of establishing a streamlined
aligner workflow driven by digital technology and
teamwork in order to optimise practice efficiency and
foster its growth. She is senior clinical specialist at Align
Technology, responsible for Greece, Cyprus, Bulgaria
and Malta. In an interview with Dental Tribune International during the congress, Dr Eleftheriadi highlighted the
significance of collaborating with productive staff members and employing the advancements in aligner therapy to support patients’ satisfaction with their care.
Why is attending the EAS congress important to
you?
It is the top event in Europe in its field, and participants
come from all over the world. The best orthodontic clini-
cians and researchers come to this event to share their
ideas and learn about new technologies and ways to get
better treatment outcomes. Aligners are the future of orthodontics.
If you want to develop a specialty, you must embrace the
technology available and use it as a tool to get the
best results possible. We are the only specialty that is involved in aesthetics, but is not invasive. Creating smiles
and doing it in a non-invasive way—that is so, so inspiring!
Can you elaborate on the significance of task delegation and defining clear roles within the aligner
workflow, particularly in enhancing the practice efficiency and ensuring smooth treatment processes?
Things are changing. Orthodontics is no longer a oneperson show but rather a full time effort, and every person
Image: EAS
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interview
in the practice plays an important role. It is now much
more efficient and productive to have a strong team.
This teamwork helps us to make clearer to the patient
what he or she can expect regarding the possible outcomes of treatment. Teamwork makes for dream work.
Regarding the Align digital workflow, I can tell you that
the tools available for this modality are amazing. They
make it much easier for the practitioner to present the
issues at hand and what can be done to solve them.
The power of visualisation is critical. Our brains are very
sensitive to taking in visual information directly or indirectly.
These digital tools are very helpful in our everyday work.
If you embrace the Align digital workflow and what it can
give you, if you create a digital culture in your practice, it
will make the work of every member of your team easier.
The practitioner no longer has to take the photos or
scan—there are many tasks that they can nowadays
delegate. The digital workflow is a completely different
way of doing things. We need to embrace these positive
changes.
It seems to be not only a positive change for the
patient but for the whole dental team as well. New
responsibilities foster a feeling of inclusion and
being valued, don’t you think?
Indeed, it is a two-way process. Up until a few years
ago, the dental assistant’s job was to clean up after the
dentist was done and to put out clean instruments for
the next patient, every day, five days a week. Now, the
assistant interacts with the patient and plays a part in
the patient’s treatment journey. The clinician takes care
of the clinical aspects of the treatment, but the assistant can share with the patient the expected outcome
on the screen and has a closer connection to the
patient than previously, being in the position to gain his
or her trust.
How do digital tools contribute to different stages of
orthodontic treatment, and what specific advancements have you observed that have significantly affected clinical outcomes?
I will answer your question with reference to a clinical tool
and a marketing tool. The ClinCheck platform, a clinical
tool, has given us the ultimate means of treatment
planning. It gives control to the clinician, and this is very
important, especially for those who are resisting changing to a digital workflow for fear of being replaced at
some point. This is an unfounded fear; ClinCheck is a
tool in your hands. It gives you the control back, because
you are the doctor in charge, and you are the one who
makes the decisions. At the same time, this dental software supports you in achieving excellent treatment outcomes through continuous updates and new features.
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Regarding the marketing tool, Invisalign Outcome
Simulator Pro simulates the expected final treatment
result. It gives you the visualisation of the patient’s
smile in the context of his or her face at the end of treatment, and that is absolutely motivating for the patient
to go ahead with treatment, boosting acceptance of the
treatment plan.
In your opinion, what are the primary reasons that
clinicians should embrace these new working standards involving aligners and digital orthodontics,
and how do these contribute to staying at the forefront of orthodontic care?
The simple answer is that it makes their work easier.
Care needs and standards are very different nowadays,
especially regarding aesthetics. We cannot accept anything other than excellence. Patients have become much
more demanding in terms of their treatment expectations
and the technologies used and will even notice the
smaller details. The quicker the clinician adopts these
new technologies and ways of working, the quicker (and
easier) they will meet patients’ standards and expectations.
What about you personally? It is human nature to
hesitate in the face of novelty at first. So with new
tools and new applications constantly evolving, you
just jump in?
I am all about technology. I love technologies that are
easy to use and make my work easier. To me, it seems
obvious that one should take advantage of technology.
I have heard it argued that we need to safeguard the
specialty of orthodontics. In my eyes, the only way to
protect our specialty is to make sure that we are central
to it by embracing technology-driven changes and adapting to them.
Given the emphasis on the patient experience in
modern healthcare, how do aligners and digital orthodontics contribute to enhancing patient engagement and satisfaction throughout the treatment
journey, and what strategies can practices implement to maximise this aspect of care?
I wore fixed appliances for five years, and I still remember
the day the orthodontist took them off. I smiled at everyone, even if I did not know them. I still remember every
visit, the pain, the numbness. We must make sure that
we give our patients the best, and aligners have too
many pros not to take advantage of them. As clinicians,
our basic knowledge and orthodontic decisions remain
the same, but we can approach our end goal in more
patient-centred ways. My belief is that all treatment can
be done with aligners, and we will get to the point of all
cases being treated with aligners—it is part of the evolution of orthodontics. If one compares brackets 50 or
60 years ago with brackets today, one can understand
this evolution.
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©️ Plateresca/Shutterstock.com
| feature
Maslow’s hierarchy of needs.
Motivating your team
Jerko Bozikovic, Belgium
In training sessions, managers, dentists, leaders often
ask me how they can motivate their team and keep them
motivated. This is a million-dollar question, since so many
leaders struggle to keep their staff motivated, connected
and engaged. Over my more than 22 years of experience
as a trainer and coach and having held the role of manager of a team myself, I have gained a number of insights
in this regard and I share some of the most pertinent in
this article.
Teams are a combination of individuals
Everybody wants to be heard, to be seen and to be
respected, and these are key elements to consider in
relation to motivation. On one hand, people want to be
authentic and unique, and on the other hand, they want
to blend in with others, with a group. It is this constant
dynamic of finding a balance that we need to work with.
As a team, we want everybody to be aligned, but we
need to consider that everybody is an individual, so a
one-size-fits-all approach does not work, even though
sometimes it might feel that this is what society expects
from people. So how can you cherish the individuality in
your team?
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©️ Raywoo/Shutterstock.com
“Coming together is the beginning, keeping together
is progress, working together is success”—Henry Ford
Every team member has their own talents, qualities and
value, and as a manager, you want to start recognising
what these are and to start nurturing these qualities and
talents. You will find that some staff members are aware of
their own abilities and are waiting for opportunities to fully
express and use them, but some are not at all aware of
their own capabilities, and this is where you as a manager
can step into a coaching role to try to empower them
and create awareness of their talents in order to hopefully start giving them the confidence to be the best version
of themselves. If all team members are able do to this,
then TEAM (Together Everyone Achieves More)—a wordplay that I love, will come into place.
[45] =>
feature
Communication is key
In my 22 years of experience working with companies
and teams as a trainer and coach, I have often heard
from employees leaving the company that a lack of (clear)
communication is one of their top three reasons for doing
so.
Be clear in communicating your expectations and obtain
a commitment to these from your employees. Ensure
communication is a two-way process by involving your
team in making decisions about the future direction of
the dental practice.
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– listening to employees;
– giving employees the flexibility to choose their holiday
dates;
– giving employees nice work clothing;
– arranging team-building activities;
– celebrating birthdays and big holidays, such as with
the giving of Christmas gifts;
– communicating a clear vision of the direction the clinic
is evolving in;
– being open to feedback;
– empowering employees by giving them responsibilities
and autonomy; and
– offering employees training.
Establishing clear communication includes creating an
open feedback culture. How has that been rolled out
in your practice? Are there regular feedback moments
during the day/week/month with your staff? Does feedback include good points, compliments as well as points
of improvements? This feedback can be given in an informal way, in between patients, for example, or at the
start or end of the working day, as well as in a formal way
individually or in a group during meetings.
Regarding meetings, do you have a clearly set-out meeting structure? The other day I was working on team
communication with a practice in Belgium, and one of
the major takeaways for management was that they had
no structured meeting culture, so feedback was given
sometimes and sometimes not. Decisions were shared
sometimes and sometimes not. Half of the staff were
aware of certain information, decisions and changes, and
the other half not.
The staff thus decided to establish different meeting
structures with different time frames: meetings in smaller groups, depending on roles and responsibilities, on a
more regular basis, and then entire staff meetings on a
monthly basis. They decided not to book patients during
the timings of these meetings in order to be completely
focused. The encouraging thing about that team communication day was that it was the team members who
asked to set up more meetings, and the orthodontists
and management staff listened.
How you motivate your team matters
How do you motivate your team? This question is one I
love to ask during training and coaching sessions. I ask
people to write down all the things they do, or their clinic
does, to motivate their team. Actually, you might want to
do this exercise as well quickly. The answers we normally get—and maybe you will give similar ones—are things
like:
– offering good working hours;
– providing an adequate salary;
– respecting employees;
Herzberg’s motivation–hygiene theory with examples.
© Skyline Graphics/Shutterstock.com
Do you have any others?
Now let me introduce you to the motivation–hygiene theory. Frederick Herzberg et al. developed this theory and
published it in the book Motivation to Work. Influenced by
Maslow’s hierarchy of needs, Herzberg et al. concluded
that satisfaction and dissatisfaction could not be measured reliably on the same continuum and conducted a
series of studies in which they attempted to determine
what factors in work environments cause satisfaction or
dissatisfaction.
On the basis of their findings, they grouped these factors
into motivators and hygienic factors. Motivators are aspects that are intrinsic to the work itself, fulfilling needs
concerning achievement and recognition, for example,
and really motivate people, keep their focus and energy
high, create a good work atmosphere and increase job
satisfaction. Hygienic factors are basic needs that must
be met at work to enable people to do their jobs. These
are assumed to be obligatory and are extrinsic to the
work itself, such as salary and work environment. When
fulfilled, they can prevent dissatisfaction, but do not necessarily increase satisfaction.
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Consider the categorisation of some of the examples listed earlier regarding whether they are motivators or hygienic factors:
– Good working hours: Is this a motivator or a hygienic factor? Most people take good working hours for
granted, but poor working hours are a cause of demotivation.
– Adequate salary: Is this a motivator or a hygienic factor? Most people expect to have an adequate salary,
so poor remuneration may make them feel unappreciated and taken advantage of, leading to a lack of
motivation.
– Respect: Is this a motivator or a hygienic factor? For
most people, it is usual to be respected, but if they
are not treated with respect, then that is a cause of
demotivation.
– Celebrating birthdays and big holidays: Is this a motivator or a hygienic factor? For most people, it is a
motivator, a plus that goes beyond what is expected
at work.
– Being open to feedback: Is this a motivator or a hygienic
factor? For most people, it is normal for a workplace
to have an open feedback culture with clear communication, but a lack in this regard is a cause of demotivation.
– Giving responsibilities: Is this a motivator or a hygienic
factor? For most people, it is a motivator in that they
perceive this as demonstrating particular trust in them
and giving them opportunities to grow and learn.
As you can see—and I suggest you do this exercise with
your list of what you believe are motivators—what we all
thought were motivators are only partly motivators, and
often the majority are hygienic factors.
I remember a client who owned a wonderful restaurant
telling me in a training session that every year she invested in new work uniforms for her staff. She would select
the best materials and have the staff’s names embroidered on the uniforms. She spent quite a large amount
on doing this and was upset that the staff did not appear
to be grateful and more motivated when they received
their new uniforms. I asked her why she felt they should
be more motivated in their work because of these new
uniforms and who wanted to have these nice uniforms
in the first place. She wanted the staff to have these uniforms and thought it was important. For her staff, these
were just an outfit they needed to wear every day at work
but not something that made them feel appreciated or
offered them additional value in the workplace.
In another example, employees had to park their cars in
an unlit parking area, so when it was dark in the mornings or the evenings, they felt quite unsafe. This influenced their energy and motivation negatively. Therefore,
management decided to install large light fixtures to illuminate the parking area and thus create a feeling of
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©️ Luna2631/Shutterstock.com
| feature
safety for the employees. Management was then disappointed that the team’s motivation was not improved
by this.
Why was this so? When hygienic factors are not fulfilled,
this is always a source of demotivation. Because employees expect these factors to be in place, when a lack in
this regard is addressed, employees take it for granted. If
the baseline represents zero, then a lack in hygienic factors will reduce motivation to below zero. Solving this lack
will just bring motivation back to zero. If you want to go
above zero, you need to employ motivators, such as providing growth opportunities, celebrating achievements,
offering team-building activities, giving recognition and
creating unexpected moments.
Do you need to make some changes to how you approach motivating your team? I hope that you will now be
able to reflect on whether you are solving hygienic factor
issues or adding motivators. I wish you all the best in this
journey of moving towards true motivators, and both are
important but have a different approach and different outcome.
about
Jerko Bozikovic is a specialist in communication skills, emotional intelligence,
time and stress management, leadership, and change management. He is
fascinated by human behaviour and
finds working with people on personal
development to be a daily challenge and
blessing. He speaks seven languages
and has offered his training courses in
four languages since 2001. He embraces and embodies the
motto “Love the life you live; live the life you love”. He can be
contacted via LinkedIn.
[47] =>
British Dental Conference &
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©️ Alex Mit/Shutterstock.com
| research
Clear aligners: Study examines
anchorage loss during maxillary
molar distalisation
Dental Tribune International
Seeking to address a gap in the literature, researchers have analysed
premolar and canine anchorage loss occurring during maxillary molar
distalisation in patients receiving clear aligner therapy for Class II malocclusion. They found that the treatment was effective in obtaining
molar distalisation movement but observed an anchorage loss at the
level of the upper canines at the end of the first maxillary molar distalisation movement.
The researchers, from two universities in Rome and a university in
Tirana in Albania, said that only a few studies had analysed anchorage loss obtained during upper molar distalisation movement using
clear aligner therapy, particularly at the level of upper premolars
and canines. Their retrospective study1 included 49 patients who
had received clear aligner therapy at the University of Rome Tor
Vergata during a 12-month period beginning in January 2021. All
patients underwent the same non-extractive molar distalisation
protocol using Invisalign clear aligner trays with attachments and
Class II elastics as auxiliaries and showed either good (44) or moderate (5) compliance.
Comparing 3D digital casts that were taken prior to the treatment and
at the end of the first maxillary molar distalisation movement, the researchers observed a statistically significant distalisation of the maxillary first permanent molars (2.5 mm) and a slight, non-significant
anchorage loss of the first and second premolars. A statistically sig-
48
aligners
1 2024
nificant mesial movement of the upper canines (1.33 mm) was highlighted.
The researchers wrote: “Upper-molar distalisation achieved with clear
aligner therapy allows the correction of Class II relationship due to
maxillary dentoalveolar protrusion or moderate skeletal discrepancies. However, during the distal movement of the upper molars, side
effects on the anchorage teeth were present; in particular, a significant mesial movement of the upper canines was noticed.”
Discussing the results, the researchers pointed out that the significant
loss of anchorage was detected in patients who had shown poor compliance with the use of Class II elastics. “This indicates that the use
of Class 2 full-time elastics was able to generate an equal and opposite force to the reaction force in the anterior sector, supporting the
distalisation movement, strengthening the anterior anchorage, and
counteracting the unwanted side effects,” they said.
Reference
1
Loberto S, Paoloni V, Pavoni C, Cozza P, Lione R.
Anchorage loss evaluation during maxillary molars
distalization performed by clear aligners: A retrospective study on 3D digital casts. Applied Sciences.
2023;13(6):3646.
[49] =>
study
dental-tribune.com
dtstudyclub.com
|
E-newsletter
For 20 years,, Dental Tribune
International has been at the
forefront of dental media, education,
and events, shaping the global
landscape of dental knowledge
dissemination. With a presence
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network, connecting profesThe global voice in essential dental media
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Our integrated approach merges print,
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Together, Dental Tribune International and OEMUS MEDIA bring forth over
50 years of collective industry expertise, reflecting our commitment to
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innovation, quality, and service excellence.
Celebrating 20 years of
16
Interview
Prof. Phoebus
Madianos discloses
tendees can look
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News
The European
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More than 130
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An interview with
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[50] =>
©️ Fraunhofer Institute for Applied Polymer Research.
| research
Fraunhofer using smart materials
to make clear aligner therapy
cheaper, more sustainable
Dental Tribune International
Researchers at the Fraunhofer Institute for Applied
Polymer Research (IAP) and the University Hospital of
Düsseldorf have developed a new smart material for
clear aligner treatment.
The team has developed aligner trays that incorporate
shape memory polymers and can be used to complete a
number of steps in the treatment of malocclusion, thereby
enabling new treatment concepts and cutting costs.
Shape memory polymers are smart materials made from
plastics that can predictably and precisely change their
shape when prompted to do so by external stimuli such
as temperature, light, or electrical or magnetic fields.
The technology has already led to a number of developments in biomedical applications, and the researchers at
Fraunhofer IAP say that their use in clear aligner therapy
combines effective tooth movement with a greater efficiency in the use of resources.
“Aligners made of shape memory polymers allow to control the force acting on the teeth and thus make therapy more patient-friendly,” Dr Thorsten Pretsch, head of
the synthesis and polymer technology research division
at Fraunhofer IAP, commented in a press release. “Our
aligner allows several steps of tooth correction to be implemented at once”.
The institute explained that a thermoplastic polyurethane
that reacts to heat and water of body temperature was
synthesised for use in aligner treatment. “Depending
on how high the temperature is or how much water the
50
aligners
1 2024
material absorbs, the change in shape of the aligner
can be divided up into any number of individual steps,”
Fraunhofer IAP said. The advantages of the technology
include reducing the number of clear aligner trays used
during treatment, reducing material waste and lowering
treatment costs.
In a series of tests, the research team used aligner trays
made with the material to successfully move teeth and
was able to confirm gradual changes in the shape of the
aligner over a period of time using water and body temperature as stimuli. The results were published in a study.1
“In the future, the shape memory effect could be triggered
by saliva within the oral cavity,” Fraunhofer IAP pointed
out, adding that material thickness and the gradual heating of the aligner trays additionally controls the force applied to the teeth. “For orthodontic applications, these
special features harbour a number of unique advantages in aligner therapy—from smaller shape adjustments
through controlled heating to a reduction in the number
of treatment steps,” Dr Pretsch emphasised.
To date, the new smart material has been tested on model dental crowns, and further material development is
needed in order to prepare it for clinical application.
Reference
1
Schönfeld D, Koss S, Vohl N, Friess F, Drescher D,
Pretsch T. Dual Stimuli-Responsive Orthodontic
Aligners: An In Vitro Study. Materials. 2023;16(8);3094.
[51] =>
research
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[52] =>
©️ Krakenimages.com/Shutterstock.com
| business news
SmileDirectClub leaves patients
in the lurch
Jeremy Booth, Dental Tribune International
The self-proclaimed democratiser of orthodontic care,
SmileDirectClub (SDC) has abruptly shuttered its global
business after less than ten years of operations. The Tennessee clear aligner company announced in December
that it had failed to secure a financial lifeline in Chapter 11
bankruptcy proceedings and that it would consequently
liquidate and end all services with immediate effect. According to media reports, the closure came as a surprise
to thousands of SDC customers who were in various
stages of orthodontic care and who must now consult a
local dentist to continue their treatment.
Typically, a patchwork of reviews, endorsements and
promises of easy and cost-effective clear aligner therapy,
SDC’s website on 8 December was reduced to a landing
page featuring a short statement and a few brief FAQs.
52
aligners
1 2024
The company had “made the incredibly difficult decision”
to end its operations, the statement read, explaining that
customer care was no longer available. Recent orders
would not be fulfilled, the company’s Lifetime Smile Guarantee was now void and any questions about ongoing
treatment would need to be directed at local dentists, the
FAQs explained. For those seeking a refund, the company said that the ongoing bankruptcy process would determine the next steps.
SDC filed for Chapter 11 bankruptcy protection in the
US on 29 September, remaining in control of its business
operations while seeking capital reorganisation under the
oversight of the US Bankruptcy Court for the Southern
District of Texas. At the time of the filing, SDC owed creditors nearly US$900 million (€854 million) and had just
[53] =>
business news
US$5 million in cash, despite having been valued at close
to US$9 billion when the company went public in 2019.
Lawyers acting for the company told UK magazine Dentistry in October that the bankruptcy filing only affected its
US business and that its UK and “other international affiliated entities have not sought any bankruptcy protection”.
Too good to be true
Despite being laden with debt, SDC continued to ship
thousands of clear aligner cases to customers in Australia, Canada, Ireland, New Zealand, the US, and the UK
throughout 2023, and reports suggest that it continued
to advertise and sell treatment even into the final throes
of its global business. Public information shows that the
company shipped 106,419 unique clear aligner orders in
the first half of last year, and The Guardian highlighted the
plights of US consumers who responded to SDC promotions as late as November. Kat Fernandez of Texas told
the newspaper that she received an offer for SDC aligners
that was “too good to be true” and paid in full for the treatment on 3 November. “It infuriates me to know that they
were aggressively pursuing [customers] so close to when
they were going to pull out. I feel scammed and conned,”
Fernandez said.
was going to do. Then I looked it up and found out. That
kind of blows my mind,” Reynolds said.
In December, the UK’s Oral Health Foundation voiced its
concern about the ongoing orthodontic care of SDC patients. Dr Nigel Carter, OBE, chief executive of the foundation, said: “The closure of SmileDirectClub has created
an upsetting situation for many patients who were undergoing dental treatments. We are extremely worried about
what impact this will have on the oral health and mental
well-being of thousands of people currently undergoing
treatment.”
“It all leaves a very bitter taste,” Dr Carter said, adding:
“Patients have been left in the lurch and it will now no
doubt fall on orthodontists to rescue the situation for
those SmileDirectClub customers who remain unhappy
with their smile.”
Founded in 2014, SDC was on a strong upward trajectory in 2019 when it went public on the Nasdaq stock
exchange and installed 49 HP Multi Jet Fusion 3D printers at a new manufacturing facility. Running non-stop, the
printers enabled SDC to produce 20 million clear aligner
trays annually and made the company the largest user of
this 3D-printing technology in the US. Prior to the SARSCoV-2 pandemic—which hit the company particularly
hard, owing to its disproportionate financial impact on its
target market—SDC was a major employer in Tennessee and other US states and had a global headcount of
6,300 staff.
©️ Rawpixel.com/.com
Rebekka Reynolds of Oklahoma, who paid in full for her
treatment in October, told the newspaper that she received news about the closure via social media and not
from SDC. “I found out because a bunch of my TikTok
followers started tagging me in videos, asking me what I
|
aligners
1 2024
53
[54] =>
| manufacturer news
Self-etch. (Image: VOCO)
Futurabond U—dual-polymerising
universal adhesive
The dual-polymerising SingleDose Futurabond U from
VOCO is the market’s only true universal adhesive in a
disposable applicator. Besides the incredibly simple handling of the SingleDose format, Futurabond U provides
practitioners with an outstanding range of options for application, as much with regard to indications as to etching
technique and polymerisation mode. Self-etching, selective etching or total etching—Futurabond U allows practitioners to freely select how they wish to condition the
dental hard tissue, depending on the individual clinical
situation and their preferred way of working.
Applied in a single layer, this universal adhesive creates a
strong bond to enamel and dentine, thus ensuring a
durable, gap-free bond between the dental hard tissue
and the restorative material. At the same time, it offers
firm adhesion to various materials, such as metal, zirconium dioxide, aluminium oxide and silicate ceramics,
without any additional primer. An outstanding bond
strength is also guaranteed in cases of chemical polymerisation, thus making Futurabond U ideal for luting
posts within the root canal.
This universal adhesive is fully compatible with all lightpolymerising, dual-polymerising and self-polymerising
methacrylate-based composites and is suitable for
both direct and indirect restorations—and does not
need any additional activator for dual polymerisation.
Futurabond U can furthermore be used for desensitising hypersensitive tooth necks and after cavity preparation, and it is suitable as a protective varnish for glass
ionomer cement restorations.
54
aligners
1 2024
The patented SingleDose guarantees fast, simple working, as mixing errors are ruled out from the start, and the
product is very hygienic.
Futurabond U is available as a trial kit containing
20 SingleDose blister packs, a 2 ml Vococid syringe
plus cannulae and 20 Single Tim application brushes.
The bonding material also comes in SingleDose packs
of 50 and 200.
contact
VOCO
Anton-Flettner-Straße 1–3
27472 Cuxhaven
Germany
www.voco.dental
[55] =>
manufacturer news
|
ClearX ushers in a new era of
eco-friendly orthodontic care with
revolutionary clear aligners
ClearX is thrilled to announce the introduction of its innovative clear aligners, marking a significant advancement in orthodontic treatment that prioritises both
treatment efficiency and environmental sustainability.
Utilising cutting-edge technology initially inspired by
NASA’s laboratories, ClearX aligners are poised to redefine the standards of orthodontic care with their ecoconscious design and superior performance.
Innovative technology for a greener future
Crafted from high-temperature, shape memory polymers,
our aligners embrace the power of 4D shape-shifting
technology, a leap forward in orthodontic precision and
environmental responsibility. This technology, highlighted
in recent studies published in Frontiers in Materials and
on Dental Tribune International, not only enhances the
effectiveness of treatment but also significantly cuts
down on plastic waste, aligning with the values of ecoconscious patients and dental professionals.
A commitment to sustainability
Reducing carbon footprints with advanced
orthodontics
With over 1.2 million aligners produced daily worldwide,
the push towards sustainable alternatives is imperative.
ClearX’s initiative is a significant step in this direction,
potentially reducing plastic waste by up to 50%. Insights
into the environmental impact of aligner production
published by dental industry market research company
insightsZ underscore the importance of such innovations in decreasing the carbon footprint associated with
orthodontic treatments.
Join the sustainable orthodontics revolution
ClearX invites dental professionals to experience this
pioneering technology that not only promises an ideal
smile but also contributes to a healthier planet. For more
details and to become part of this eco-friendly movement, visit www.clearxaligners.com.
©️ ClearX
Dr Sherif Kandil, CEO of K Line Europe, the parent
company of ClearX, emphasised the dual focus of these
aligners: the achievement of dental perfection and advancement of sustainable practices within the industry.
“Our clear aligners are a testament to our dedication
to eco-friendly dental solutions,” Dr Kandil remarked.
“By incorporating heat-boosting, shape-shifting technology, ClearX ensures rapid and precise treatment with
fewer adjustments needed, thereby minimising aligner
waste.”
aligners
1 2024
55
[56] =>
| manufacturer news
Form Auto enables an orthodontic
practice to increase model
production by 20-fold
Alvetro Orthodontics, based in Sidney in Ohio in the US,
thrives on efficiency. Dr Lisa Alvetro and her tight-knit
staff of 22 rely on a digital workflow that Dr Alvetro pioneered more than a decade ago and which has evolved
continuously ever since. But how can Dr Alvetro’s practice effectively see 120 patients a day while maintaining
the highest standards of care?
The practice operates a fleet of 3D printers, including
Formlabs’ stereolithography (SLA) printers, to create
models for thermoformed aligners, direct-printed indirect bonding trays, and even direct-printed brackets.
While Dr Alvetro saves costs and improves efficiency by
keeping production in-house, her staff previously had to
spend significant time on manual tasks, such as removing build platforms from printers, removing prints from
the build platform and managing each individual printer’s job queue.
Everything changed when the practice brought on board
the Formlabs Automation Ecosystem, which includes
Form Auto, Resin Pumping System and Fleet Control.
Using the new automation solutions, Dr Alvetro’s practice can manufacture models and appliances more efficiently than ever before. With the Formlabs
Automation Ecosystem, a single printer can produce up
to 177 orthodontic models per day if using Draft Resin
on a Form 3B+ printer at 200 μm, all while minimising
staff interactions and costs.
Alvetro Orthodontics uses fewer printers now, often
relying on just two Form 3B+ printers for most of its
horseshoe models. Dr Alvetro said, “With Form Auto, the
number of prints is up 2,000%. We have probably about
eight [other printers] that we’ve not turned on since we
bought a Form Auto.” Form Auto is a hardware extension
for Form 3/3B/3+/3B+ printers that automatically removes finished parts from Build Platform 2 and starts
the next printing job without the need for operator interaction.
Automating these critical steps in the process means
that Alvetro Orthodontics’ printers run 24/7. In fact, the
practice’s printers have so far completed 275 consecutive prints without any human involvement other than
56
aligners
1 2024
Form Auto works with the Form 3B+ printer to automate
the printing process, enabling Alvetro Orthodontics to print
aligner models 24/7 while decreasing staff involvement.
(Image: Formlabs)
resin tank and cartridge changes. Form Auto has helped
decrease cost per part by reducing the amount of labour
needed to create each aligner sequence. Labour cost is
further decreased by tools like Fast Cure, Formlabs’
high-performance polymerisation unit, which significantly reduces the amount of time operators need to
spend waiting for parts to be ready.
Resin Pumping System is an accessory for Form 3/3B/
3+/3B+ printers that delivers 5 l of resin to the printer
without cartridge changeover, resulting in fewer workflow disruptions. With Resin Pumping System, a printer
can print for five times as long before needing the intervention of staff to change out the cartridge. A unique
resin card also tracks material usage and provides lowresin warnings. This improves operational efficiency,
streamlines the 3D-printing workflow and reduces waste
by 86%.
Alvetro Orthodontics paired its Form Auto with Fleet
Control, a suite of advanced features in Formlabs’
PreForm printing preparation software and Dashboard
printing management portal that facilitate the management of multiple 3D printers. Fleet Control simplifies
management and oversight of printers by identifying
which printer is most suitable for each print. It will automatically send the files to that printer, automatically generating a continuously moving queue across the entire
fleet. These features can be accessed from anywhere,
so operators can ensure the smooth running of the
[57] =>
manufacturer news
printer fleet remotely. These abilities allow Dr Alvetro’s
staff to focus their time on more complex tasks that drive
the business forwards.
Commenting on her staff’s work, she said: “Two-thirds
of their job has changed. They’re doing more digital
set-ups and different parts of the digital workflow.
Before, their main task was peeling prints off. The turnaround time for delivery of aligner cases has gone from
one or two weeks to 24–48 hours. This is because the
printing employee is freed up for fabrication, since Form
Auto is doing the printing.”
Form Auto extended the weekly active hours of production for the Form 3B+ printers to around 75–90 hours
with zero additional labour by enabling them to run
continuously at night and on weekends. This enabled a
true third shift so that production does not end when
the workday or workweek does. Dr Alvetro said that,
before Form Auto, “I’d be here on the weekend because
we had so much going on.” This is typical for those managing 3D printer fleets. After Form Auto, though, that all
changed, and Dr Alvetro said, “I have not been here on
a Saturday or Sunday since we bought Form Auto.
Nobody has.” Even when she was first exploring how
employing new technologies could help her practice,
Dr Alvetro recognised that a digital workflow went
beyond intra-oral scanners. “The thing we really dove
into was 3D printing,” she said. Early adoption of digital
dentistry technologies provided a valuable lesson.
“Once you’ve bought the scanner, you’ve already made
the major investment,” she explained, “and if you’re not
3D-printing in-house, you’re wasting it.”
A completely digital workflow enables Dr Alvetro to see
as many patients as possible and, more importantly, to
provide them with the highest quality of care. For
example, before Alvetro Orthodontics brought efficient
production in-house, patients often needed to wait three
or more days for an appliance after being scanned.
Now, they can be scanned in the morning and have their
appliance delivered in the afternoon. Entire aligner sequences can be produced on the same day thanks to a
digital workflow.
Automated 3D printing is a major part of that but not the
only part. Dr Alvetro accounts for the whole digital workflow when deciding which products to use and how to
use them. “One of the things that really helped efficiency
is the ability to scan in every chair,” she said. “When
people say, ‘Digital doesn’t help with my efficiency,’ the
problem is the way they’re using it. They can only scan
in one spot, or they just have one printer. You always
need redundancy in your system.”
As an example of how a digital workflow can improve the
in-office experience, Dr Alvetro recounted the story of a
|
patient who was moving to Chicago the day after her appointment at the practice. The patient’s teeth had shown
a little bit of movement since the last time she’d seen
Dr Alvetro, and she was worried that she’d have to come
all the way back from Chicago for the new aligners and
to check the fit. Thanks to digital scanning, Formlabs’
printers, Fast Cure and Form Auto, that scenario could
be avoided. Dr Alvetro said, “We were able to scan the
patient, do the set-up, export the file, print the models
and make the aligners. I said, ‘You don’t have to come
back from Chicago. Come back later today.’ ”
For Dr Alvetro, in-house digital orthodontics has become
a major driver of practice growth. She pointed out that
many of her peers who use intra-oral scanners still outsource the manufacturing of aligners, retainers and indirect bonding trays. In many cases, the laboratory bill for
one month is equal to the cost of a printer.
Often, when it comes to bringing production in-house,
“The biggest expense in any office is personnel time,
and it’s getting harder and harder to find people,”
Dr Alvetro lamented, but with Form Auto, less labour
time is needed to operate a printer fleet. “Your clinical
staff will love you because they won’t always be thinking,
‘I have to go get the printer’,” she said. “It’s going to free
up so much time.” Even practices that do not need to
print as often as Alvetro Orthodontics does could see
benefits from Form Auto, according to Dr Alvetro: “If
you’re trying to make your front desk staff or your clinical
staff jump in and 3D-print in between patients, you need
a Form Auto more than me, because I’ve got dedicated
digital staff. I think it’s for everyone who wants to print
and wants to maximise the efficiency of their printer.”
She pointed to reliability as a major reason Form Auto
has made such a difference in her practice, saying: “It’s
100%. I mean, it does not fail.”
Alvetro Orthodontics runs its two Form Autos around the
clock. “They are third-shift workers,” Dr Alvetro joked.
“They never call up sick. They’re in the basement
working. Our invisible employees work 75–90 hours per
week. Reliability, convenience and the ability to exponentially grow printing capacity overnight have catapulted Alvetro Orthodontics from a thriving practice to a
digital dentistry powerhouse. Form Auto, Fleet Control
and Resin Pumping System have enabled automation
for Alvetro Orthodontics, allowing Dr Alvetro and her
staff to spend less time working with printers. This
equates to seeing more patients every day while adhering to the highest standards of care.
Speaking about Alvetro Orthodontics, Dr Alvetro said:
“We do all the printing in-house. It’s a phenomenal way
to grow your practice.” For this purpose, she recommends the Form 3B+ printer: “If you invest in a printer,
you should invest in this.”
aligners
1 2024
57
[58] =>
| manufacturer news
DynaFlex–Revolutionising
orthodontics with innovative
solutions
In the fast-changing world of orthodontics, DynaFlex
has continuously been responding to the needs of the
specialist and introducing cutting-edge innovations that
improve the way orthodontists can reach the best clinical
outcome, DynaFlex can meaningfully improve the overall
patient experience. With a comprehensive suite of advanced technologies, including its Glacier aligner material, Precision Aligner Buttons, the five-axis LAC (laser
aligner cutter) SmileShare software, and the ability to
seamlessly combine brackets or appliances with aligners
for hybrid orthodontic treatment.
Glacier thermoforming material
Central to its innovative line-up is the Glacier aligner material, the heart of aligner treatment. Engineered to perform at the highest level for any type of case,
Glacier offers unparalleled transparency, durability and
flexibility. It provides firm, but flexible tooth movement
and exceptional adaptation to the patient’s dentition.
This ensures precise and comfortable treatment while
providing orthodontists with unmatched control.
Precision Aligner Buttons
DynaFlex’s commitment to delivering excellence extends beyond aligner material. Precision Aligner Buttons
can be used for all types of aligner cases and give orthodontists unprecedented confidence in using elastics with
aligners. Precision Aligner Buttons’ patented base is engineered to match the shape of the tooth at the
gingival margin and fits precisely in the aligner cut-out
window. In addition to the contoured shape, the base is
expanded to cover maximum surface area. This unique
design reduces unnecessary emergency visits and saves
valuable chair time thanks to improved retention.
Five-axis laser cutter
Being able to rapidly produce aligners, minimise postprocessing finishing and customise trim lines is essential in aligner manufacturing. With the advent of DMU’s
five-axis LAC, DynaFlex’s manufacturing has been a
game-changer in the aligner fabrication process. This
advanced technology enables precise and efficient
58
aligners
1 2024
cutting of aligners, ensuring accurate contours and a
perfect fit for each patient. The LAC’s ability to seamlessly translate digital designs into flawless aligners
streamlines the manufacturing workflow and saves valuable time for orthodontic practices.
SmileShare software
SmileShare treatment planning software stands as a
testament to DynaFlex’s dedication to enhancing the
practitioner–patient relationship. This software facilitates
efficient case management, allowing orthodontists to
seamlessly collaborate with patients, share treatment
progress and foster engagement throughout the orthodontic journey. With SmileShare, communication is streamlined between the clinician’s office and DynaFlex’s
treatment planners, maximising treatment outcomes.
Hybrid orthodontics
DynaFlex’s dedication to innovation extends to hybrid
orthodontic treatment: the company offers a dynamic
approach that combines the best of both worlds. With
the flexibility to initiate treatment using brackets or
appliances and seamlessly transition to aligners for
the finishing phase, orthodontists can optimise treatment plans based on individual patient needs, achieving exceptional results and unparalleled patient satisfaction.
Commitment to improving clinical outcomes
In the realm of transformative orthodontic advancements, DynaFlex continues to lead the way. The company
provides orthodontists with a full suite of solutions,
including Glacier aligner material, Precision Aligner
Buttons, customised options, user-friendly software and
the capacity for hybrid orthodontic treatment. With
DynaFlex as a trusted partner, orthodontists can embrace cutting-edge technology and achieve extraordinary results, while their patients embark on a transformative journey to a confident and beautiful smile.
To learn more about all of these offerings and how
DynaFlex can assist your practice, visit www.dynaflex.com.
[59] =>
OF DENTISTRY
DIGITAL
DENTISTRY
SHOW
Register at
www.dds.berlin
Digital
Dentistry
Show
In collaboration with
Digital
Dentistry
Society
aligners
1 2024
OF DENTISTRY
D I G I TA L D E N T I S T R Y S H O W • U N V E I L I N G T H E F U T U R E
28 & 29 JUNE 2024
|
D I G I TA L D E N T I S T R Y S H O W • U N V E I L I N G T H E F U T U R E
manufacturer news
59
[60] =>
| industry report
Ongoing growth of the global clear
aligner market
Dr Kamran Zamanian & Federica Cogoni, Canada
The global clear aligner market was valued at approximately US$5.2 billion (€4.8 billion) in 2022 and is expected to grow at a double-digit rate in the coming
years. This growth is being driven by the advantages
and popularity of aligners, the rise of alternative and less
expensive options offered by direct-to-consumer (D2C)
aligner companies, and the expansion of the market to
general dentists.
Invisible, practical, comfortable: The main
advantages of aligners
Advertising, teleworking, video meetings and social
media play important roles in the beauty economy,
driving the belief that the appearance of the face and
upper body determines beauty and acceptability to
others and encouraging the pursuit of straighter teeth
and an attractive smile. Aligners are a proposed solution
for treating varying degrees of reverse overjet, cross
bite, overbite, and open bite.
If their malocclusion permits the choice, patients prefer
aligners over fixed appliances because the solution
comes with multiple advantages. The obvious one is
that they are barely visible compared with fixed appliances. Aligners can be removed when eating or drinking, whereas with fixed appliances patients may have
limitations on the type of food that they can eat. Sticky
or hard food can be a problem. Their removability also
promotes hygiene maintenance and gingival health. Sig-
nificantly better gingival health has been observed in patients using aligners.1
Additionally, wearing aligners requires less care by
dental professionals. As the tooth movement is preplanned by the dental professional, dental appointments are simpler and assistance from an orthodontist
may not be required during each appointment. In comparison, an orthodontist may need to make appliance
adjustments, for example to the archwires, every three
to four weeks.
Aligners offer greater treatment comfort. Fixed appliances can irritate the oral tissue, whereas aligners only
cause some discomfort when new trays are worn owing
to the extra pressure applied. Patients treated with fixed
appliances report greater discomfort and consume
more analgesics than patients treated with aligners do.2
Fear of pain is one of the primary reasons that patients
fail to seek orthodontic care, and pain has a negative
effect on patient compliance.
The business model adaptation of D2C
Patients may be discouraged by the high cost of aligners. By cutting out in-person dental supervision and
monitoring, D2C companies offer treatment for considerably less than the cost of an in-office procedure. Proponents of D2C orthodontics argue that the low cost of
D2C aligners makes tooth alignment accessible to a
greater number of individuals. However,
D2C companies have been criticised for
their inability to adequately treat malocclusion. In 2018, the American Dental
Association passed a resolution against
D2C tooth alignment,3 and the American
Association of Orthodontists has publicly
cautioned against the practice via a consumer alert and has filed legal complaints with 36 dental boards against
SmileDirectClub, the leading D2C aligner
company.4
Fig. 1: Share of patients using traditional braces and clear aligners in 2019, 2022,
and 2023, according to iData Research. (Image: iData Research)
60
aligners
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In order to regain trust and improve their
reputation, D2C companies have chang-
[61] =>
industry report
|
Fig. 2: IData clear aligner research shows that the market share of D2C aligners is forecast to increase. (Image: iData Research)
ed their business model. Whereas the D2C business
model previously involved no visits to a dentist or an orthodontist, it is now common for D2C aligner patients to
consult either an orthodontist or a general dentist who is
employed by the company for an intra-oral scan. This
adaptation to the business model results in higher costs
for the patient. Customers will still receive their aligners
through the mail.
Expansion of the aligner market to general
dentists
Some orthodontists are sceptical about the efficacy of
aligners in treating malocclusion. In some cases, for
greater efficacy, patients need to switch from aligners to
fixed appliances during the course of treatment. For
example, one in six patients switched from aligners to
fixed appliances to finish treatment because the aligner
treatments could not adequately achieve certain tooth
movements or correct common malocclusions.5
Aligner companies are therefore expanding their products to general dentists for treatment of mild malocclusions or those requiring less complicated movement.
Align Technology continues to increase its presence
globally by making its Invisalign products available to
more customers in more countries. Among other growth
strategies, the company is seeking to enable general
dentists, who have access to a larger patient base than
orthodontists do, to easily identify potential cases they
can treat with the Invisalign system and monitor patient
progress while providing high-quality restorative, orthodontic and preventive oral care. Align is accomplishing
this strategy by providing training and clinical education
to general dentists and by offering digital tools such as
iTero scanners.
Conclusion
be driven by the popularity and practicality of aligners,
along with various efforts by companies to expand their
market share. Although D2C companies have been
criticised for addressing malocclusion inadequately,
they are adapting their business model to involve consultations with dental professionals. Considering the
sceptical stance taken by some orthodontists towards
aligners, treatment providers are planning to expand
their businesses to general dentists who have larger
patient bases than orthodontists do.
Editorial note: Please scan this QR code for the list of
references.
about
Dr Kamran Zamanian his CEO and
founding partner of iData Research. He
has spent over 20 years working in the
market research industry with a dedication to the study of dental implants,
dental bone grafting substitutes, prosthetics, as well as other dental devices
used in the health of patients all over the
globe.
Federica Cogoni is a research analyst
at iData Research. She develops and
composes syndicated research projects
about various fields within the medical
device industry.
The aligner market is forecast to grow at a double-digit
rate in the coming years, and that growth is expected to
aligners
1 2024
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[62] =>
| meetings
Image: EAS
Excellence in aligner orthodontics:
Fifth EAS congress maintains
trajectory of growth
Nathalie Schüller, Dental Tribune International
This year marks the tenth year since the founding of the
European Aligner Society (EAS) to provide information on
aligner therapy to clinicians. Its congress, aimed at disseminating advancements in aligner technology, has
continued to attract growing attendance, from 300 participants at the first EAS congress, held in 2016, to an
impressive 1,310 at the fifth congress, held last week at
the futuristic Valencia Conference Centre. This year,
dental professionals came to the event from 69 countries, even as far as Vietnam and New Zealand, proof of
the congress’s growing reputation for excellence, and
39 speakers accepted the invitation to present during
the comprehensive three-day programme.
The first day included a session for orthodontic teams.
The first speaker, management and productivity expert
Jerko Bozikovic, offered tools on how to be efficient and manage stress to avoid burn-out. Speaking next, on achieving practice efficiency with aligners, Dr Iro Eleftheriadi,
62
aligners
1 2024
senior clinical specialist at Align Technology, said that
aligners are the present and future of orthodontics, continuous advancements in the field bringing new incredible possibilities for treatment. The importance of digital
workflows in interdisciplinary orthodontic treatment
was highlighted by both Dr Andrea Bazzucchi, an Italian
dentist who teaches widely on the use of Invisalign, and
Dr Rooz Khosravi, a clinical associate professor at the
University of Washington in the US, who focused on the
role of 3D printing in supporting interdisciplinary collaboration, which is increasingly needed as more patients
are seeking orthodontic care.
Also held on the first day was a new congress feature,
the AlignerLab Innovation Village, which gave delegates
the opportunity to meet industry experts and attend
workshops and masterclasses on specific aspects of
treatment and become familiar with new products and
services being offered by companies operating in the
[63] =>
meetings
|
Jerko Bozikovic. (All images: EAS)
aligner space. These and others also participated in the
specialist exhibition, presenting their products and innovations. Some of the topics addressed were finding
efficient solutions to challenges clinicians face, using
shape memory aligners and taking an evidence-based
approach for increased efficiency and predictability.
On the second day of the congress, EAS President
Dr Jose Gandia and scientific chairperson of the fifth
EAS congress Dr Gina Theodoridis gave the opening
address. Dr Theodoridis told the audience that EAS is
committed to advancing the knowledge and practice of
aligner orthodontics towards greater quality of care
and successful treatment outcomes. The goal of the
plenary sessions, she told the audience, was to highlight
science rather than products.
Dr Gina Theodoridis.
Dr Tommaso Castroflorio.
That day’s plenary sessions dealt with the themes of
“The next level of aligner orthodontics” and “Growing
patients and early treatment”. In his lecture on aligner
orthodontics of the future, Dr Chris Laspos, an orthodontist specialist in craniofacial malformation, told the
audience that “there are no complex cases, only questions of good planning” and that it is important to focus
on the fundamentals of care and to spend time on planning cases in detail employing the digital technologies
available. Speaking on biomechanics in aligner treatment, Dr Tommaso Castroflorio, a founding member of
EAS, said that it is essential to be familiar with the aligner
material’s physical properties, for optimal planning and
successful treatment outcomes. Dr Ki Beom Kim, orthodontic programme director at Saint Louis University in
the US, talked about the integration of in-house aligner
printing using shape memory polymers, which enhance
aligners
1 2024
63
[64] =>
| meetings
precision and reduce errors. The day’s final speaker,
London orthodontist Dr David Raickovic, went over
planning for successfully treating growing patients who
have Class II malocclusion. He advised that, for efficiency
and precision, it is important to know the principles of
tooth movement and anchorage and to develop one’s
own methods to apply these principles. One of the tips
he gave was to consider that the planned movements
can only be efficient if the anchorage itself is efficient.
The themes of the plenary sessions on the final day were
“Auxiliaries and skeletal anchorage” and “Aligners, periodontics and surgery”. A recurring topic in the presentations was maxillary expansion to improve breathing. US
orthodontist Dr Ilya Lipkin discussed treating challenging cases using miniscrew-assisted rapid palatal expansion (MARPE) and aligners. MARPE can be used as an
adjunct in the treatment of obstructive sleep apnoea and
to improve breathing.
In his presentation, Tunisian orthodontist Dr Skander Ellouze
explored when optimal outcomes can be achieved with
aligners and when not. According to him, most published
studies show that fixed appliances are far more efficient
and accurate than aligners are, but what can be achieved
with aligners is “mind-blowing”. He demonstrated, for
example, that aligners are more suited for opening the
airway, using the case of a patient with sleep apnoea,
and that aligners show biomechanical superiority in
64
aligners
1 2024
treating excessive gingival display. He encouraged making a clear and honest assessment of which treatment
modality is suited for the particular case and that might
include a combination of both.
The congress was also an opportunity for recognition.
Established to promote clinical excellence, EAS’s European Board of Aligner Orthodontics (EBAO) this year
nominated three honorary members: Dr Juan Carlos
Rivero Lesmes, a founding member of EAS and one of
the first to lecture at university on aligner treatment;
Dr Nikhilesh Vaid, president of the World Federation of
Orthodontists; and Dr Leslie Joffe, CEO and executive
secretary of EAS. For the second year, the EBAO Clinical
Excellence Award was granted to 18 clinicians who passed the requisite examination. The certificate for best case
was given to Austrian orthodontist Dr Claudia Pinter,
who also spoke on treatment of transverse maxillary
deficiency at the congress. First prize for the poster
competition went to Drs Shizuka Funahashi, Kinji Amano
and Hisao Murakami from Japan.
It was advised that the sixth EAS congress will take place
in Rhodes in Greece on 22–24 May 2025. Dr Theodoridis
also announced EAS’s first online webinar, titled “CBCT
diagnosis of the alveolar processes for orthodontic treatment planning”. Oral and maxillofacial radiology consultant Dr Dania Tamimi will be presenting the webinar on
3 April, and it will be available for EAS members only.
[65] =>
3M™ Clarity™
meetings
Esthetic Orthodontic Solutions
|
3M Annual Excellere Summit
TM
to get greater
Clarity
TM
GRAND LAUNCH of Clarity Aligners
TM
2-DAY
IMMERSION
Lectures & workshops
on the latest innovations in orthodontics
Full 2-day event ticket
incl. Clarity White Night dinner
Early bird ticket (until July 1st)
Ticket for students and staff
660€
330€
330€
AUDITORIUM
DELLA TECNICA
Rome Italy
13-14 Sept 2024
Friday - Saturday
NETWORKING
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Historical Galleria del Cardinale
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SECURE
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go.3M.com/ClarityEvent
aligners
1 2024
65
[66] =>
| meetings
Long-awaited Digital Dentistry
Show to premiere in Berlin
in June 2024
Dental Tribune International
The 2024 Digital Dentistry Show will offer cutting-edge knowledge and skills that will help dental professionals better navigate technological advancements in the field. Located in Berlin’s Alt-Treptow inner-city district, the 6,500 m2 Arena Halle offers high-quality
professional infrastructure. (All images: © Markus Nass)
66
Now is an exciting time for dentistry. Technological innovations lie
at the heart of the profession and are significantly advancing personalised dental care. To provide a platform to celebrate digital innovations in the field and educate the dental team, DDS.Berlin has
collaborated with the Digital Dentistry Society, and they are bringing
a highly immersive experience to the capital of Germany— the Digital
Dentistry Show.
The Escobar is an extension of the Badeschiff that includes a
covered bar area.
Attendees will also have access to the Sonnendeck of the
Escobar, where they will be able to enjoy delicious food and
drinks.
aligners
1 2024
Scheduled for 28 and 29 June 2024 at the Arena Berlin, the event
promises to deliver engaging educational and social opportunities
[67] =>
meetings
|
with a special focus on digital products and the digital workflow in
dentistry.
Through live product presentations, workshops, discussion sessions
and an exhibition, the 2024 Digital Dentistry Show seeks to provide
attendees with first-hand knowledge of digital dental products and
services and to offer space for personalised advice and face-to-face
interactions with industry leaders. With the focus on robust research
evidence, the scientific programme will feature presentations by prominent opinion leaders, including Drs Henriette Lerner, Alessandro
Cucchi, Mirela Feraru, Howard Gluckman, Fabrizia Luongo and
Setareh Lavasani, and cover a wide range of topics, such as artificial
intelligence, the digital workflow in maxillofacial surgery and fullarch rehabilitation, and digital bone surgery. Attendees will have the
opportunity to earn valuable continuing education credits.
Besides a strong educational aspect, the 2024 Digital Dentistry Show
will serve as a social hub for dental experts, professional organisations, manufacturers and publishers who are looking to form or
expand their network of like-minded, future-oriented individuals.
To be hosted at one of Berlin’s industrial pearls, the unique event
location offers a rich history and a distinctive modern feel.
The adjacent Escobar and the Badeschiff spaces will enhance the
relaxed and jovial atmosphere, underlining the informal and engaging
nature of the show.
The 2024 Digital Dentistry Show is expected to attract over
2,000 eminent dental professionals from around the world. You are
invited to be one of them!
More information on registration and the scientific programme can
be found online at the event’s official website at dds.berlin.
The Badeschiff is a picturesque floating public swimming pool area overlooking the Spree river.
aligners
1 2024
67
[68] =>
| meetings
International events
American Association
of Orthodontists–AAO
German Society of Orthodontists–DGKFO
3–6 May 2024
Annual session
New Orleans, US
www2.aaoinfo.org/meetings/
25–28 September 2024
Annual conference
Freiburg, Germany
www.dgkfo-vorstand.de
Spanish Society
of Orthodontics–SEDO
Southern Association
of Orthodontists–SAO
Southwestern Society
of Orthodontists–SWO
68
26–28 September 2024
Combined annual session
Orlando, Florida, US
www.saortho.org
European Orthodontic Society–EOS
British Orthodontic Society–BOS
9–13 June 2024
Annual congress
Athens, Greece
www.eoseurope.org/annual-congress/
16–19 October 2024
British orthodontic conference
Birmingham, UK
www.bos.org.uk/boc2024/
Digital Dentistry Show–DDS
Italian Society of Orthodontics–SIDO
28–29 June 2024
Berlin, Germany
www.dds.berlin/en/
17–19 October 2024
International congress
Firenze, Italy
www.sido.it
Canadian Association
of Orthodontists–CAO
Swiss Orthodontic Society–SGK
19–21 September 2024
Annual conference
Kelowna, British Columbia, Canada
www.cao-aco.org/en/events
31 October–2 November 2024
Annual congress
Interlaken, Switzerland
www.swissortho.ch
aligners
1 2024
© 06photo/Shutterstock.com
5–8 June 2024
Annual congress
Gran Canaria, Spain
www.sedo.es
[69] =>
© 32 pixels/Shutterstock.com
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aligners
1 2024
69
[70] =>
| international imprint
aligners
international magazine of aligner orthodontics
Imprint
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— international magazine of
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Scan the QR code to register and read
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for typographical errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opinions expressed by authors are their own and may not
reflect those of Dental Tribune International GmbH.
70
aligners
1 2024
[71] =>
FLUORESCENT COMPOSITE
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AlignerFlow LC
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• Precise application with perfect flow
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Available from 1 May 2023
scan QR code
to learn more
VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Freecall 00 800 44 444 555 · www.voco.dental
[72] =>
| Xxxxxx
The
Partnership
that Elevates
ClearCorrect® is excited to
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Updates to our Empowering
Digital Workflow and Practice
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To become a partner
or learn more visit:
clearcorrect.com
72
aligners
1 2024
©2024 ClearCorrect | Approved for global use | Acc.1901_en_01
)
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[cover] => ![aligners international No. 1, 2024]()
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[title] => Editorial: The future of aligner orthodontics by Dr Gina Theodoridis, President-elect of the European Aligner Society for 2025
[page] => 3
)
[1] => Array
(
[title] => Table of contents
[page] => 4
)
[2] => Array
(
[title] => Solving sagittal discrepancies in orthodontics is probably the most energy-demanding movement you can do with aligners: A case report by Dr Luis Carrière
[page] => 6
)
[3] => Array
(
[title] => Orthodontics and botulinum toxin: Integrated care of a patient with bruxism and occlusal alteration: A case report by Drs Tomás A. Salazar, Belen M. Perretta, Camila Reino & Kristen Kock
[page] => 10
)
[4] => Array
(
[title] => Skeletal and dental Class II, Division I malocclusion solved in 11 months with MTO system: Using Carriere Motion Appliance and clear aligners without extraction: A case report by Drs Carlos Colino, Laura Castillo, Isabel Drewling & Pedro Colino
[page] => 16
)
[5] => Array
(
[title] => How to safely speed up tooth movement and reduce the duration of orthodontic treatment by Dr Ana Paz
[page] => 26
)
[6] => Array
(
[title] => Artificial intelligence in dentistry by Dr Miguel Stanley
[page] => 30
)
[7] => Array
(
[title] => Ethical communication and brand building
[page] => 34
)
[8] => Array
(
[title] => The trajectory of technology in our field is promising: An interview with Dr Chris Laspos
[page] => 38
)
[9] => Array
(
[title] => “The primary aim of EAS remains to promote excellence in aligner treatment”: An interview with Dr Gina Theodoridis
[page] => 40
)
[10] => Array
(
[title] => Aligners are the present and future of orthodontics: An interview with Dr Iro Eleftheriadi
[page] => 42
)
[11] => Array
(
[title] => Motivating your team by Jerko Bozikovic
[page] => 44
)
[12] => Array
(
[title] => Research news: Clear aligners: Study examines anchorage loss during maxillary molar distalisation; Fraunhofer using smart materials to make clear aligner therapy cheaper, more sustainable
[page] => 48
)
[13] => Array
(
[title] => Business news: SmileDirectClub leaves patients in the lurch
[page] => 52
)
[14] => Array
(
[title] => Manufacturer news: Futurabond U—dual-polymerising universal adhesive; ClearX ushers in a new era of eco-friendly orthodontic care with revolutionary clear aligners; Form Auto enables an orthodontic practice to increase model production by 20-fold; DynaFlex–Revolutionising orthodontics with innovative solutions
[page] => 54
)
[15] => Array
(
[title] => Ongoing growth of the global clear aligner market by Dr Kamran Zamanian & Federica Cogoni, iData Research
[page] => 60
)
[16] => Array
(
[title] => Excellence in aligner orthodontics: Fifth EAS congress maintains trajectory of growth
[page] => 62
)
[17] => Array
(
[title] => Long-awaited Digital Dentistry Show to premiere in Berlin in June 2024
[page] => 66
)
[18] => Array
(
[title] => International events
[page] => 68
)
[19] => Array
(
[title] => Submission guidelines
[page] => 69
)
[20] => Array
(
[title] => Imprint
[page] => 70
)
)
[toc_html] =>
[toc_titles] => Editorial: The future of aligner orthodontics by Dr Gina Theodoridis, President-elect of the European Aligner Society for 2025
/ Table of contents
/ Solving sagittal discrepancies in orthodontics is probably the most energy-demanding movement you can do with aligners: A case report by Dr Luis Carrière
/ Orthodontics and botulinum toxin: Integrated care of a patient with bruxism and occlusal alteration: A case report by Drs Tomás A. Salazar, Belen M. Perretta, Camila Reino & Kristen Kock
/ Skeletal and dental Class II, Division I malocclusion solved in 11 months with MTO system: Using Carriere Motion Appliance and clear aligners without extraction: A case report by Drs Carlos Colino, Laura Castillo, Isabel Drewling & Pedro Colino
/ How to safely speed up tooth movement and reduce the duration of orthodontic treatment by Dr Ana Paz
/ Artificial intelligence in dentistry by Dr Miguel Stanley
/ Ethical communication and brand building
/ The trajectory of technology in our field is promising: An interview with Dr Chris Laspos
/ “The primary aim of EAS remains to promote excellence in aligner treatment”: An interview with Dr Gina Theodoridis
/ Aligners are the present and future of orthodontics: An interview with Dr Iro Eleftheriadi
/ Motivating your team by Jerko Bozikovic
/ Research news: Clear aligners: Study examines anchorage loss during maxillary molar distalisation; Fraunhofer using smart materials to make clear aligner therapy cheaper, more sustainable
/ Business news: SmileDirectClub leaves patients in the lurch
/ Manufacturer news: Futurabond U—dual-polymerising universal adhesive; ClearX ushers in a new era of eco-friendly orthodontic care with revolutionary clear aligners; Form Auto enables an orthodontic practice to increase model production by 20-fold; DynaFlex–Revolutionising orthodontics with innovative solutions
/ Ongoing growth of the global clear aligner market by Dr Kamran Zamanian & Federica Cogoni, iData Research
/ Excellence in aligner orthodontics: Fifth EAS congress maintains trajectory of growth
/ Long-awaited Digital Dentistry Show to premiere in Berlin in June 2024
/ International events
/ Submission guidelines
/ Imprint
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