aligners international No. 2, 2022
Cover
/ Editorial
/ Content
/ Stop asking aligners to do things they are not good at!
/ New concepts in aligner therapy with the orthocaps system
/ Addressing smile aesthetics with digital orthodontic planning and treatment: A case report
/ The informed, lifetime patient
/ If I could see through your eyes, I wonder what I would see?
/ Clinicians and researchers advancing aligner orthodontic treatment together
/ I hope that sustainable dentistry will soon reach critical mass and become the norm
/ Global clear aligner market: The stars are aligned
/ Industry report
/ Industry news
/ Meetings
/ Submission guidelines
/ International imprint
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[1] =>
issn 1868-3207 • Vol. 1 • Issue 2/2022
aligners
international magazine of
aligner orthodontics
opinion
Stop asking aligners to do things
they are not good at!
case report
The informed, lifetime patient
industry report
When do you waste unused aligners,
and how can you avoid it?
2/22
[2] =>
SprintRay Cloud Design
Fully-integrated dental appliance design
for SprintRay dental 3D printers.
The best design software is the one you don't have to learn how
to use. SprintRay Cloud Design was created to fuel the next 100
years of digital dentistry by removing the friction of dental CAD
design from your workflow.
Use Cloud Design to manage treatments and order designs,
then manufacture them with your SprintRay Pro for a truly
frictionless dental 3D printing workflow.
Reach out to us and fill out the contact form on our website
www.sprintray.com
[3] =>
editorial
|
Dr Luis Carrière
Specialist in orthodontics and dentofacial orthopaedics
Aligners, facial aesthetics and
quality orthodontic care
Orthodontics is all about facial and skeletal harmonious
relationships, adequate masticatory function, and perfect tooth alignment and occlusion. The orthodontist is
probably the top professional in facial aesthetics, as wellperformed orthodontics has the capacity to generate natural facial harmony and beauty, just by properly managing
the patient’s hard tissue orthodontically. It is important
to have in mind that the patient’s soft tissue is not selfsupported and needs adequate dental, dentoalveolar and
skeletal relationships to achieve the golden proportion of
the middle and lower thirds of the face as far as possible.
Aligners have certainly become a powerful orthodontic
treatment approach, a serious alternative to fixed appliances, or traditional orthodontics, so patients welcome
them as an appealing treatment option.
Orthodontic principles, the physiology of the masticatory
space and treatment objectives have not changed, but
because of new systems, new auxiliaries, new technologies and innovative treatment strategies, they have greatly evolved towards obtaining facial harmony, improving
temporomandibular function and improving the patient’s
airway.
Treatments with aligners drive us to use advanced digital
set-up treatment interfaces, but they are all related to the
teeth and only the teeth. Therefore, the knowledge and
skills of the practitioner are vital for implementing the principles of orthodontics and adapting digital treatments to
the individual needs of each patient. Understanding the
biomechanics of aligners properly is a key factor for treatment success, and knowing their advantages and disadvantages is essential for a clear treatment plan. Aligners
work well for controlling rotation, torque, levelling and
even expansion, but fail in controlling the sagittal dimension, or are not always efficient when dealing with certain
extrusive and vertical movements. If we clearly identify
those weak points, we can achieve good results using a
hybrid approach with external auxiliaries while boosting
aligner treatment efficiency. Hybridisation in orthodontics,
specifically when employing aligners, involves the use of
technology outside of the scope of aligners to expand the
treatment capabilities. An example would be the use of
the Carriere Motion appliance to solve Class II or III sagittal discrepancies at the beginning of the treatment. Once
the sagittal issue has been resolved, a shorter treatment
with aligners can be achieved. Another example of hybridisation would be the combination of temporary anchorage devices and aligners.
Efficient treatment planning with aligners is ideally done
with the 4D orthodontic perspective of the specialist, using his or her knowledge and vision to identify sagittal,
transversal, vertical, facial and skeletal problems in order
to predict which components and treatment strategies
are going to be necessary for the specific case in order to
achieve optimal results with minimal deviation. The objective is to diminish the necessity for refinements. If we leave
the treatment definition to the aligner technicians, the
company will provide us with a treatment proposal only
based on the original intra-oral scan and the treatment
will be a sequence of refinements, every one intended to
solve the errors generated in anterior aligner stages. The
final outcome could be an absolute orthodontic failure.
Keeping all this in mind will allow us to use aligners as a
true premium orthodontic treatment for the benefit of our
patients and our loved profession.
Dr Luis Carrière
aligners
2 2022
03
[4] =>
| content
editorial – Dr Luis Carrière
03
opinion
Stop asking aligners to do things they are not good at!
06
– Dr Bruce McFarlane
product analysis
New concepts in aligner therapy with the orthocaps system
12
– Dr Wajeeh Khan
case report
page 6
Addressing smile aesthetics with digital orthodontic
planning and treatment: A case report
18
– Drs Iro Eleftheriadi & Christodoulos Laspos
The informed, lifetime patient – Dr Tif Qureshi
26
feature
If I could see through your eyes, I wonder what I would see?
– Jerko Bozikovic
30
interview
page 26
Clinicians and researchers advancing aligner
orthodontic treatment together
34
I hope that sustainable dentistry will soon reach
critical mass and become the norm
36
market analysis
Global clear aligner marker: The stars are aligned
38
– John Fraser & Dr Kamran Zamanian
industry report
page 52
Ceramill Map DRS intra-oral scanner in the dental
practice: Jaw scans in just 1 minute–digital tooth
Impressions for more convenience and efficiency
41
– Amann Girrbach
When do you waste unused aligners, and how
can you avoid it? – Dr Victoria Martin
42
industry news
Cover image: Align Technology
www.itero.com
2/22
issn 1868-3207 • Vol. 1 • Issue 2/2022
aligners
international magazine of
aligner orthodontics
I-liner: Think differently – Sia Orthodontic Manufacturer
46
SprintRay Cloud services: You scan, We plan.
A frictionless design workflow – SprintRay
48
How Impress became the European leader in
invisible orthodontics in just three years – Impress
50
New Invisalign Outcome Simulater Pro helps patients
envision their future smile with in-face visualisation – Align Technology
52
meetings
opinion
Stop asking aligners to do things
they are not good at!
case report
The informed, lifetime patient
industry report
When do you waste unused aligners,
and how can you avoid it?
Aligner orthodontics: EAS summer meeting in Portugal
offered clinical and technical expertise
54
International events
56
about the publisher
04
aligners
2 2022
submission guidelines
international imprint
57
58
[5] =>
Xxxxxx
|
DIGITAL DENTISTRY –
VERSATILE AND
CONVENIENT.
The Ceramill DRS system for the dental practice and the laboratory!
CONNECTION KIT
PRACTICE
PRODUCTION KIT
PRACTICE
HIGH-SPEED ZIRCONIA KIT
PRACTICE
LABORATORY
FALL-SHARING
With its Ceramill DRS system, Amann Girrbach offers a future-oriented, convenient and versatile
solution for digital dentistry. As open and flexible as you want it to be.
It provides for convenient CAD/CAM workflows in your own practice as well as for interdisciplinary
collaboration with the laboratory, thus giving you more freedom for the essentials.
www.ceramill-drs.com/en
aligners
Amann Girrbach AG
Tel +43 5523 62333-105
www.amanngirrbach.com
2 2022
05
[6] =>
| opinion
Stop asking aligners to do things
they are not good at!
Dr Bruce McFarlane, Canada
Clear aligners have come a long way in the past 25 years
and have evolved to be incredibly pervasive and effective,
thanks to enormous consumer demand and innovation
from some of the best minds in orthodontics. There
remain, however, certain orthodontic movements that are
very difficult for clear aligners alone to achieve. Practitioners run into trouble, frustration, and roadblocks when
they ask aligners to perform movements they are not effective at achieving. These include:
• correcting severely rotated teeth, especially premolars;
• extruding teeth;
• large space closures;
• transverse corrections;
• Class II antero-posterior corrections; and
• Class III antero-posterior corrections.
Fig. 1: Severely rotated mandibular left second premolar.
The suggestion therefore is that orthodontic purveyors
simply recognise these limitations, humbly accept them
and stop trying to produce incredibly difficult manoeuvres with aligners alone. This means thinking about much
more effective and efficacious techniques along with
aligner treatment. It also means incorporating them right
from the start, instead of trying with aligners alone and
then back-pedalling when that approach fails.
The devices referenced here are mostly fixed and can be
utilised concomitantly with clear aligners in their first
round. Their outcomes are much more assured than
those which could be realised with aligners alone. This
results in the following advantages:
• better results are achieved;
• treatment takes less time;
• the important movement occurs early—when the
patient is most enthusiastic and compliant;
• fewer aligners are used overall;
• fewer aligners are wasted owing to failed attempts
with aligners alone;
• aligners are used to move teeth that are already
limbered up by the first-round fixed devices;
• the devices can be included in the fee if used proactively; and
• patient confidence and trust are optimised.
Let us look at some applications that incorporate this approach. The fixed add-ons are agnostic to any specific
06
aligners
2 2022
Fig. 2: Underway with rotational couples.
Fig. 3: After four months of de-rotation.
[7] =>
opinion
|
“The definition of insanity is doing the same
thing over and over again and expecting
a different result”—Albert Einstein
technique or philosophy. The examples given are simply
the favourites I use in most cases.
Severely rotated teeth
Aligners alone will fail because the plastic simply
cannot adequately deliver the appropriate rotational
couples—especially in cylindrical teeth. This is so despite
ingenious attachment combinations that will indeed
achieve some rotation, but not much. Instead use
bonded buttons and elastomerics strategically placed
into precision cut-outs of the first round of aligners and
activated to produce force couples that will indeed rotate
teeth (Figs. 1–3). The outcome is much more assured
rotations in a shorter amount of time and with less chance
of loss of aligner tracking.
Fig. 4: Maxillary right lateral incisor requiring extrusion.
Extrusions
Aligners alone will fail because of the push that clear
aligners produce, being very difficult to translate into the
pull required to extrude teeth. Again, this is so despite
brilliant attachments that incorporate inclined planes
in attempts to overcome this limitation. Instead use
fixed devices that will much more assuredly deliver extrusion. These can include buttons or elastics, intra- or
inter-arch, or even fixed appliances first, transitioning
to aligners alone once the extrusions have been produced (Figs. 4–9). The outcome is the delivery of true
extrusion in a timely and effective manner early on and
with less chance of aligner tracking loss.
Fig. 5: Intra-arch elastic–button technique.
Large space closures
Aligners alone will fail because bodily movement of
teeth is not a strength of clear aligners, and loss of
tracking or anchorage is very common. This is so, despite
some brilliant attempts to overcome this limitation
with attachments, velocity changes, sequencing, etc.
Instead use fixed appliances, which are much more
tried and true and effective for space closure. Various
auxiliaries can be utilised along with the fixed appliances
to direct the space closure and manage the anchorage.
This should all be performed with sectional aligners that
are effecting movement at the same time in the other
Fig. 6: Extrusion elastic in place.
quadrants of the mouth (Figs. 10–12). The outcome is
complete space closure in a much more assured manner,
without having to worry about loss of aligner tracking, frequent refinements, wasted aligners and wasted time.
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Fig. 7: Maxillary left canine requiring extrusion.
Fig. 11: The set-up with sectional brackets and a temporary
anchorage device.
Fig. 12: After six months of space closure.
Fig. 8: Inter-arch elastic–button technique.
08
Fig. 9: After three months of extrusion.
Fig. 13: Narrow maxilla.
Fig. 10: Maxillary left molar space requiring closure.
Fig. 14: Nitanium Palatal Expander2 (Henry Schein) with sectional
canine–canine aligners.
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opinion
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Fig. 15: After six months of expansion.
Transverse corrections
Aligners alone will fail with significant width corrections
because they simply cannot accurately produce the
bodily movement, bone remodelling and root torque
that is required to profoundly and fully provide transverse
corrections. Instead use a fixed expander. This most
often involves using clear aligners only in the mandible at
first while the expander of choice is widening the maxillary arch. In the time it takes the expander to be effective
(four to six months), the mandibular arch movements
have often been achieved with clear aligners. The case is
then finished with full maxillary and mandibular aligners
(Figs. 13–15). The outcome is much more assured width
change while the opposing arch is being aligned.
Fig. 16: Class II set-up for sequential distalisation.
Class II antero-posterior corrections
Aligners alone will fail because there are often significant skeletal components to Class II malocclusion, along
with dental compensations, frequently making Class II a
very difficult malocclusion to address with aligners alone
(Figs. 16 & 17). Instead use fixed Class II correctors. An
example is the Carriere Motion 3D Class II appliance
(Henry Schein), utilised off maxillary canines or premolars back to first or second molars. Again, other movements can be happening in other areas of the mouth
while the Class II correction is occurring, including maxillary canine–canine alignment, if desired (Figs. 18 & 19).
Fig. 17: After 12 months of unsuccessful distalisation.
The outcome is concomitant Class II correction while the
aligners are aligning elsewhere, toward the fastest, most
assured and synergistic antero-posterior correction possible.
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| opinion
a
b
Figs. 18a & b: Class II malocclusion requiring fixed appliance treatment. (a) Lateral view. (b) Occlusal view.
a
b
Figs. 19a & b: After six months of the Carriere Motion appliance and aligners. (a) Lateral view. (b) Occlusal view.
a
b
Figs. 20a & b: Class III malocclusion requiring fixed appliance treatment. (a) Frontal view. (b) Occlusal view.
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Fig. 21: Carriere Motion Class III appliance in place.
Fig. 22: After six months of the Carriere Motion appliance and aligners.
Class III antero-posterior corrections
Aligners alone will fail because there are often significant skeletal components to Class III malocclusion, along
with dental compensations, frequently making Class III a
very difficult malocclusion to address with aligners alone.
Instead use fixed Class III correctors off mandibular
canines or first premolars, extending back to mandibular
first molars or second molars, for a more assured, fast
and profound Class III correction as the maxillary arch is
aligning with clear aligners. An example of such a device
is the Carriere Motion 3D Class III appliance (Figs. 20–22).
The outcome is Class III correction that is much more
predictable than with clear aligners alone.
Of course, these ideas are measured approaches. Clear
aligners can indeed produce a certain degree of these
movements alone, but why struggle? Einstein was right:
trying to perform complex movements with clear aligners
alone, failing and then trying again is indeed insanity!
Instead utilise the horsepower of fixed devices early on
along with clear aligners for both success and your
sanity!
about
Dr Bruce McFarlane graduated in
dentistry from the University of Manitoba in Winnipeg in Canada in 1984
and certified as a specialist in orthodontics at the University of Western
Ontario in London in Canada in 1992.
He is a fellow of the Royal College of
Dentists of Canada and a diplomate of
the American Board of Orthodontics.
Furthermore, he is a fellow of the Pierre Fauchard Academy
and a Mensan. He has two practices in Ontario and teaches
orthodontics all over the world.
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New concepts in aligner therapy
with the orthocaps system
Dr Wajeeh Khan, Germany
Historical background
Aligner mechanics
Overlay appliances have been used in orthodontics for
more than 90 years. In the early days, such appliances
were shaped like positioners, that is formed as single
unit appliances with tooth cavities to receive both maxillary and mandibular teeth. For minor orthodontic tooth
movement, Remensnyder in 1923, described a rubber
gingival massaging appliance that he later patented
as an “orthodontic appliance”.1
The mechano-transduction (transmission of force) of orthodontic forces triggers a tissue response that results in
orthodontic tooth movement. Teeth and the surrounding
tissue do not differentiate between force generated by
aligners or any other type of appliances. The factors that
determine the quality and quantity of orthodontic tooth
movement depend greatly on the force system that is
used, including the amount of force, its duration and dynamics, and the underlying tissue response. It is therefore imperative that the design of the appliances, the material property of the thermoplastics, and the interface
between the tooth and the appliance are conducive to
creating a force system that ensures controlled, effective
and safe tooth movement.
In 1945, Kesling published a landmark article in the
American Journal of Orthodontics and Oral Surgery entitled “The philosophy of the tooth positioning appliance”.2
In this article Kesling described the setting of a set-up
model after teeth had been cut out from a plaster cast
and repositioned in wax on the model base. The “Positioner” was thus formed as a negative of the model
created by repositioning teeth in wax. Kesling, in a patent,
that was granted in 1945, stated that, if the extent of
tooth movement was beyond the scope of a single appliance, more than one appliance could be used in
sequence to move teeth. McNamara et al., Ponitz,
Nahoum, Sheridan et al., Rinchuse and Rinchuse, also
described the use of overlay appliances that took the
form of modern-day aligners to achieve orthodontic tooth
movement.3 –7
As the use of CAD/CAM became common in dentistry in
the 1990s, the concept of using digital 3D scanners and
rapid prototyping technology became apparent in the
manufacturing of aligners. François Duret, a French innovator and dentist, used CAD/CAM techniques to construct dental prosthetic and restorative units as early as
1983.8 In 1996, researchers like Alcañiz et al. and
Hemayed et al. separately described in detail the use of
CAD/CAM techniques to create computerised set-ups
and rapid prototyping models, for diagnostic and therapeutic purposes in orthodontics.9, 10
In 1998, Align Technology commercialised the production of aligners using such CAD/CAM techniques. Although the Invisalign system is the most widely used,
some companies, including Ortho Caps, offer alternative
aligner techniques, such as the orthocaps system.
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Aligner design
Aligners are removable appliances and are therefore inherently at a disadvantage when compared with fixed appliances. The aligner–tooth interface is mechanically less
efficient in transmitting orthodontic force to the surrounding tissue as compared with systems based on brackets
and wires. In order to overcome this disadvantage, it is
important that the appliance design incorporates features that enable the aligners to have a good grip on teeth
and allow the aligners to have maximum surface contact
with teeth.
Material properties of thermoplastics
A variety of thermoplastic materials are available that can
be used for manufacturing aligners. These materials not
only differ in their composition and thickness, but also
differ in properties such as elasticity, which is essential
for tooth movement. The choice of material essentially
depends on the type and amount of tooth movement, the
required force levels, and the condition and health of the
underlying tissue.
The aligner–tooth interface
As already mentioned, in order to transmit force effectively, it is important to create an interface (contact area)
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product analysis
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Fig. 1: Pressure points are counter-productive.
that allows the transmission of force without loss of magnitude, directional control, or both. This requires an exact
aligner fit, as well as an accurate reproduction of the tooth
surface and the interdental areas in models that are used
to manufacture aligners. Aligners manufactured on such
models have the required fit on the teeth to achieve a
good grip.
The orthocaps system
The orthocaps system is designed to address the core
problem that many aligner systems have, namely, the
lack of ability to transmit force to teeth without mechanical or directional loss, and the lack of adequate control
while delivering forces that move teeth accurately in all six
degrees of freedom (x-, y- and z-axis translation and x-,
y- and z-axis rotation) in 3D space.
For this reason, the system emphasises the use of elastic
materials in the fabrication of aligners. The orthocaps
system (TwinAligner) also uses two different types of
aligners for each treatment step throughout the treatment. This technique ensures the use of optimal forces
that can be generated by selecting different thicknesses
of elastic materials that are used for aligners that are worn
at night or during the day (DayCaps/NightCaps).
Aligner design
In the orthocaps system, an exact aligner fit is of paramount importance. Modifications to aligner design, like
pressure points, dents, divots or certain types of structures, such as power ridges, that are used in some other
systems to direct force to certain areas on clinical tooth
crowns are thought to be counter-productive. These
modifications result in spaces and voids (Fig. 1) that are
created between the teeth and aligners and therefore
reduce the grip of the aligners on teeth. The main design
feature for the orthocaps aligners is thus the ability to encapsulate the teeth completely. This allows the maximum
surface of the teeth to be in contact with the soft inner
aligner layer, which is more elastic than the outer rigid
aligner shell (layer). High-pressure thermoforming techniques also facilitate flow of the aligner material into the
interdental areas, thereby increasing the surface contact
area with the aligners.
Thermoplastic materials
Material elasticity is the foremost property that is needed
in achieving controlled tooth movements. Elastic deformation of aligner materials generates the force that is required to move teeth. Elastic materials can be deflected
or deformed to a greater extent without losing their shape
or form. This deformation is generated owing to the difference in the position of teeth between the set-up model
on which the aligners are fabricated and the actual position of the patient’s teeth. If the aligner material is elastic,
the aligner regains its original shape completely when it
is removed from the mouth. This means that the aligner
remains active and continues to exert a force until it
returns to its original form and thereby moves the teeth
effectively. In contrast, inelastic and rigid materials
undergo a plastic deformation even at lower deflection
levels (strain) and thus lose their form and therefore are
unable to move teeth. This is why inelastic materials for
aligners are not as effective as elastic materials.
In Figure 2, the material stress is plotted along the y-axis.
The amount of stress is the force (F) in newtons (N)
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Fig. 2: Difference in elasticity in two materials.
Fig. 3: Attachment types.
divided by area (A) in m2. The material strain or deformation is measured as a percentage of deflection from the
original state of rest. For linear deformation this is calculated as the increase in length (∂l) divided by the initial
length (L). The elasticity (modulus of elasticity, E) of a material is shown by the gradient of the curve, and is calculated by dividing stress by strain, as shown in the following equation: E = (F/A) / (∂l/L).
Bending, stretching, or deforming a material beyond its
elastic limit results in plastic deformation of the material.
It is important to remember that elasticity is a material
constant and does not depend upon the thickness or geometry of the material. The same degree (%) of deflection
or strain would result in permanent deformation of a given
material, regardless of its thickness or shape.
14
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Orthodontic movement is thus caused by the rebound
force that makes the elastic material regain its original
state or shape. This force is directly proportional to the
area, modulus of elasticity, and the deflection or strain
the material is undergoing, provided that the material is
not strained beyond its elastic limit as shown in Figure 2:
F = AE(∂l/L).
Attachments
Many types of attachments can be used to increase the
efficacy of tooth movement with orthocaps. The use of
soft and elastic materials also makes it easier to use attachment types that would otherwise be impossible to
use with rigid or hard materials. Some of the attachment
types are shown in Figure 3.
[15] =>
product analysis
a
Fig. 4: CAD model of the friction pads on
two teeth.
|
b
Figs. 5a & b: Friction pads bonded to several teeth.
Friction pads
Apart from normal attachments, a new type of attachment, a friction pad, was developed at the Ortho Caps
centre in Germany. This friction pad consists of a flat textured surface that is bonded to the tooth in order to increase the friction between the inner aligner surface and
the tooth. The advantage of using friction pads is that
these textured surfaces are only a fraction of a millimetre
thick, making them almost invisible under normal circumstances and therefore more acceptable to patients.
Figure 4 shows the CAD model of the friction pads on
two teeth.
The attachments or friction pads are bonded to the teeth
by indirect bonding techniques. Preformed attachments
or friction pads are sent to the clinician placed in the first
aligners ready for indirect bonding. Figure 5 shows the
friction pads bonded to several teeth. As can be seen in
the photographs, the friction pads are only visible on
close inspection. This aesthetic advantage of friction
pads over regular attachments makes this type of bonded
retention aid much more acceptable to patients seeking
an invisible treatment option.
Clinical cases: Before and after records
Case 1
This young adult female patient was treated for maxillary
and mandibular crowding and deep bite over 18 months
(Fig. 6). The orthocaps Pro system was used without any
auxiliaries.
Case 2
This young female teenager was treated for a Class II bite
and deep bite over 24 months (Fig. 7). The orthocaps Pro
system was used without any auxiliaries. Towards the
end of the treatment, a BiteMaintainer was used as an
active retainer.
Case 3
This 45-year-old female patient was treated over a total
of 28 months with a distalising apparatus based on
temporary anchorage devices, followed by orthocaps
aligners, to correct the overjet and a midline deviation
(Fig. 8).
Case 4
The treatment for this 12-year-old was started in the
mixed dentition with orthocaps Kids (Fig. 9). The last
phase of the treatment was completed with orthocaps
Pro. No auxiliaries were used in the entire treatment,
which took 30 months.
Case 5
This 33-year-old female patient was treated for posterior
crowding over 28 months (Fig. 10). The maxillary right
first molar was extracted and the space closed by moving
the second molar into the extraction space with orthocaps aligners. At the end of the treatment, Ortho Caps
provided a lingual auxiliary, consisting of four lingual
brackets and a pre-ligated nickel-titanium wire within an
indirect bonding tray to bond the appliance. Subsequent
aligners were designed to immobilise the two premolars,
while allowing the second molar to upright. This design
created the necessary anchorage in order to upright the
second molar effectively.
Conclusion
The mechanical limitations of aligners can be overcome,
and satisfactory orthodontic tooth movement, even in
complex cases, can be achieved to a certain extent provided the following conditions are met:
1. knowledge of the limitations of aligner mechanics;
2. use of auxiliaries (mini-screws, expansion appliances and partial fixed appliances) in conjunction
with aligner treatment;
3. use of elastic thermoplastic materials to avoid plastic
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| product analysis
Fig. 6: Case 1.
Fig. 7: Case 2.
Fig. 8: Case 3.
Fig. 9: Case 4.
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product analysis
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Fig. 10: Case 5.
deformation of aligners during treatment and to optimise force levels (light forces);
4. accurate reproduction of interdental areas in digital
scans to allow maximum aligner–tooth contact;
5. high-pressure thermoforming techniques to achieve
better aligner adaptation;
6. sound planning (regulation of the amount of movement per stage) in the treatment staging process;
7. use and placement of suitable attachments and friction pads to increase aligner grip;
8. clinician’s experience and ability to recognise problems during the treatment process;
9. division of treatment into phases and the evaluation
of treatment progress (superimpositions and deviation analyses) at regular intervals during treatment;
10. patient motivation and cooperation.
As the demand and need for aesthetic orthodontic treatment alternatives have grown, aligners have secured a
firm place in the orthodontic repertoire. However, the inherent disadvantages associated with the use of removable appliances such as aligners for orthodontic tooth
movement pose great challenges in improving their efficacy. The orthocaps system is an effort in that direction.
Editorial note: This article was originally published in
ortho–international magazine of orthodontics, vol. 3,
issue 2/2018. A list of references is available from the
publisher.
about
Dr Wajeeh Khan is a specialist in orthodontics and runs a private orthodontic practice in Hamm in Germany.
He is the Managing Director and Chief
Executive of Ortho Caps. Khan is a
member of the German Orthodontic
Society, French Orthodontic Society,
Deutsche Gesellschaft für Linguale
Orthodontie [German society for
lingual orthodontics] and American Association of Orthodontists. He is a Fellow of the World Federation of Orthodontists.
Khan regularly conducts lectures at symposia and universities
in Europe.
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| case report
Addressing smile aesthetics with
digital orthodontic planning and
treatment: A case report
Drs Iro Eleftheriadi & Christodoulos Laspos, Greece & Cyprus
Introduction
In an era where aesthetics and beauty dominate in advertisement, social media and many other aspects of our
everyday lives, patients are actively involved in the evaluation of the goals and outcomes of their orthodontic
treatment. Thus, optimal smile aesthetics is currently one
of the most important factors to take into consideration
when planning orthodontic treatment.1 There have been
various studies focusing on smile aesthetics.2–10 Among
elements like dynamic smile visualisation and relevant
treatment strategies,11 it has been suggested that the
effect of time is another important factor that should be
evaluated during treatment planning.12
When evaluating smile aesthetics, one should include the
following:
• alignment of the teeth;
• shade and shape of the teeth;
• proportions of the teeth;
• midlines;
• tooth exposure;
• smile arc (curvature of the maxillary incisal edges that
parallels the curvature of the lower lip);
• gingival display;
• arch form and buccal corridor (space between the
facial surfaces of the posterior teeth and the corners of
Fig. 1: Finishing the treatment with fixed orthodontic appliances.
18
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the lips when the patient is smiling);13 and
• facial balance.
For more than a century, orthodontists have based their
treatment planning on traditional principles of achieving
excellence in dental occlusion. Angle’s classification,
the most widely used and accepted occlusal classification system,14 and Andrews’ six keys to normal occlusion15 have guided the orthodontic way of thinking since
their introduction. These guidelines, treated as scientific
orthodontic laws, nowadays must be evaluated in conjunction with aesthetics as an equally important factor
in orthodontic decision-making. The aim of this case report is to demonstrate the importance of satisfying aesthetic demands of orthodontic patients while respecting
the well-established principles on which our profession
is based.
Case report
Diagnosis
The patient had undergone orthodontic treatment with
fixed orthodontic appliances at the age of 11.5. She initially presented with a Class I relationship on the left side,
a slight Class II tendency on the right side and moderate
crowding in both arches, which was corrected with fixed
orthodontic appliances at that stage (Figs. 1–11).
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case report
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Figs. 2–10: Facial and intra-oral photographs after treatment with fixed orthodontic appliances.
Figs. 11a–h: Pre-aligner treatment facial and intra-oral photographs.
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Figs. 12a–e: Pre-aligner treatment digital models.
Figs. 13a–h: Mid-treatment facial and intra-oral photographs.
Figs. 14a–e: Mid-treatment digital models.
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[21] =>
case report
Despite the achievement of an ideal occlusion and aligned
arches by following the basic orthodontic guidelines and
fulfilment of the treating dentist’s checklist, the patient
came back complaining. She and her mother were dissatisfied with the smile aesthetics, angulation and buccolingual inclination of the maxillary anterior teeth, and
reverse smile line.
The patient presented at the age of 14 as follows
(Figs. 12 & 13):
• Class I occlusion;
• midlines coinciding with that of the face;
• aligned arches with minor malpositions
(mainly concerning the maxillary anterior teeth);
• minor Bolton discrepancy (anterior discrepancy
of 0.51 mm mandibular excess; total discrepancy
of 0.46 mm); and
• straight facial profile with slightly short upper lip.
Treatment objectives and treatment plan
Based on the specific complaints of the patient, the
treatment plan had to be really detailed and address
them without affecting the Class I occlusion. Aimed at
this goal, the treatment objectives were the following:
• improvement of the alignment of the anterior teeth;
• correction of the smile arc and improvement of
gingival display; and
• maintenance of the Class I occlusion.
The treatment plan included:
• correction of the alignment, levelling and angulation
of the anterior teeth;
• reciprocal posterior intrusion and anterior
extrusion for correction of the reverse smile line; and
• no anteroposterior changes.
Treatment progress
This case was treated with the Invisalign system
(Align Technology). The initial approved treatment plan
included 27 aligners for the alignment and vertical
changes. The maxillary anterior teeth were planned to
be extruded to a correct smile arc following the lower
lip, whereas the posterior teeth would be intruded as
a reciprocal movement. All vertical changes planned
did not exceed 1 mm. Lingual root torque was applied
to the maxillary central incisors, and the canines were
brought to a more upright position.
Since the movements planned were specific, and
torque application requires time, some mid-treatment
corrections were necessary (Fig. 14). Some optimised
attachments replaced the horizontal conventional ones
on the maxillary anterior teeth: extrusion attachments on
the incisors and root angulation on the canines for
better control (Fig. 15). This additional aligner sequence
consisted of 15 aligners.
|
Treatment result
Final results were achieved with 42 aligners that were
changed weekly (10.5 months of treatment), leading to
a very aesthetic final outcome (Figs. 16–25), pleasing to
the patient and her parents. All details in the anterior aesthetic zone were addressed, and it is those corrections
that gave the patient the smile she desired: a smile line
following the lower lip with attractive anterior buccolingual
inclination and ideal gingival display according to her age.
Discussion
In an environment where emphasis on aesthetics is continuously increasing, the ideal occlusion remains a primary goal of orthodontic treatment, but nowadays an
aesthetic outcome is critical for patient satisfaction.16 –21
An aesthetically pleasing smile should include aspects
such as symmetry and proportion between the central
incisors, minimal gingival display, moderate to minimum
buccal corridors, ideal smile arc with the curvature of the
maxillary anterior incisal edges following the lower lip curvature, and adequate design of the gingival margins in the
aesthetic zone.22
There have been studies regarding how general dentists,
orthodontists and laypersons perceive smile aesthetics.23–35 In most situations, orthodontists have been found
to be more critical in their aesthetic evaluations, giving
lower scores than laypeople.22 For this reason, orthodontists worldwide are working hard to incorporate into their
clinical routine different tools to focus on improving smile
aesthetics.22, 26
Moreover, the contribution of digital technology has been
recognised as improving and simplifying diagnosis, treatment planning and execution in orthodontics.27 The tool
of digital set-up for diagnosing and treatment planning
has been found to be reliable for reproducing orthodontic treatment.28 ClinCheck software (Align Technology)
was effectively utilised in the presented case, in order to
plan the focused orthodontic treatment that was undertaken to address the aesthetic complaints of the patient.
Although there were no changes planned for the occlusion, which was already ideal, the patient was willing to
undertake a second orthodontic treatment to finalise her
anterior aesthetics.
The oblique dimension has been introduced as an important view in smile analysis,12 and it is used in this case
report to support the importance of paying attention to
the details (Figs. 26–28). Beauty is not a concept set in
stone but a dynamic notion that evolves over time.30 Clinical assessment and patient perception should be actively
correlated during orthodontic treatment planning.31 The
combination of these two factors led in the presented
case to excellent aesthetic results (Figs. 29–30).
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21
[22] =>
| case report
Figs. 15–23: Final facial and intra-oral photographs.
Figs. 24a–e: Final digital models.
22
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[23] =>
case report
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Figs. 25–27: Comparison of oblique views.
Figs. 28–30: Post-treatment views showing the excellent aesthetic result.
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[24] =>
| case report
Conclusion
In an era where beauty is presented in all aspects of
our patients’ lives, smile aesthetics should be taken into
detailed consideration when planning their orthodontic
treatment, and we should always strive for excellence in
every single smile we design.
about
Dr Iro Eleftheriadi received her DDS
in 2011 from the National and Kapodistrian University of Athens, where
she is currently a PhD candidate at the
dental school, and her master’s
degree in medical statistics in 2014
from the Athens University of Economics and Business, both in Greece. She
received her master’s degree in orthodontics and her specialty certification in 2017 from Tel Aviv
University in Israel. She is a doctoral candidate at the School
of Dentistry, University of Athens, Greece.
Dr Christodoulos Laspos received
his DDS in 1995 from the National and
Kapodistrian University of Athens in
Greece and his MDSc in 1999 from
the College of Dentistry University of
Tennessee Health Science Center in
Memphis in the US. He obtained his
doctorate in dental medicine in 2022
from the University of Bern in Switzerland. He specialised in treating individuals with craniofacial
malformations through a craniofacial fellowship in 2000 at
the University of Texas Southwestern Medical Center in Dallas
in the US and has been certified by the European Board of
Orthodontics. He is a scientific collaborator at the dental
school of the European University Cyprus in Nicosia.
References:
1
2
3
4
5
24
Isiksal E, Hazar S, Akyalçin S. Smile esthetics: perception and comparison of treated and untreated smiles.
Am J Orthod Dentofacial Orthop. 2006 Jan;129(1):8–
16. doi: 10.1016/j.ajodo.2005.07.004.
Zachrisson BU. Esthetic factors involved in anterior
tooth display and the smile: vertical dimension. J Clin
Orthod. 1998 Jul;32(7):432–5.
Philips E. The classification of smile patterns. J Can
Dent Assoc. 1999 May;65(5):252–4. Erratum in:
J Can Dent Assoc 1999 Jun;65(6):324.
Johnston CD, Burden DJ, Stevenson MR. The influence of dental to facial midline discrepancies on
dental attractiveness ratings. Eur J Orthod. 1999
Oct;21(5):517–22. doi:10.1093/ejo/21.5.517.
Benson KJ, Laskin DM. Upper lip asymmetry in
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adults during smiling. J Oral Maxillofac Surg. 2001
Apr;59(4):396–8. doi: 10.1053/joms.2001.21874.
6 Sarver DM. The importance of incisor positioning in
the esthetic smile: the smile arc. Am J Orthod Dentofacial Orthop. 2001 Aug;120(2):98–111. doi: 10.1067/
mod.2001.114301.
7 Thomas JL, Hayes C, Zawaideh S. The effect of
axial midline angulation on dental esthetics.
Angle Orthod. 2003 Aug;73(4):359–64. doi: 10.1043/
0003-3219(2003)073<0359:TEOAMA>2.0.CO;2.
8 Morley J, Eubank J. Macroesthetic elements of smile
design. J Am Dent Assoc. 2001 Jan;132(1):39–45.
doi: 10.14219/jada.archive.2001.0023.
9 Ward DH. Proportional smile design using the recurring esthetic dental (red) proportion. Dent Clin North
Am. 2001 Jan;45(1):143–54.
10 Ackerman JL, Ackerman MB, Brensinger CM, Landis
JR. A morphometric analysis of the posed smile.
Clin Orthod Res. 1998 Aug;1(1):2–11. doi: 10.1111/
ocr.1998.1.1.2.
11 Sarver DM, Ackerman MB. Dynamic smile visualization and quantification: part 1. Evolution of the concept and dynamic records for smile capture. Am J
Orthod Dentofacial Orthop. 2003 Jul;124(1):4–12.
doi: 10.1016/s0889-5406(03)00306-8.
12 Sarver DM, Ackerman MB. Dynamic smile visualization and quantification: part 2. Smile analysis
and treatment strategies. Am J Orthod Dentofacial
Orthop. 2003 Aug;124(2):116–27. doi: 10.1016/
s0889-5406(03)00307-x.
13 Frush JP, Fisher RD. The dynesthetic interpretation
of the dentogenic concept. J Prosthet Dent. 1958
Jul;8(4):558–81. doi: 10.1016/0022-3913(58)90043-x.
14 Du SQ, Rinchuse DJ, Zullo TG, Rinchuse DJ. Reliability of three methods of occlusion classification. Am J
Orthod Dentofacial Orthop. 1998 Apr;113(4):463–70.
doi: 10.1016/s0889-5406(98)80019-x.
15 Andrews LF. The six keys to normal occlusion. Am
J Orthod. 1972 Sep;62(3):296–309. doi: 10.1016/
s0002-9416(72)90268-0.
16 Johnston CD, Burden DJ, Stevenson MR. The influence of dental to facial midline discrepancies on
dental attractiveness ratings. Eur J Orthod. 1999
Oct;21(5):517–22. doi: 10.1093/ejo/21.5.517.
17 Rosenstiel SF, Rashid RG. Public preferences for
anterior tooth variations: a web-based study. J Esthet
Restor Dent. 2002;14(2):97–106. doi: 10.1111/
j.1708-8240.2002.tb00158.x.
18 Moore T, Southard KA, Casko JS, Qian F, Southard TE.
Buccal corridors and smile esthetics. Am J Orthod
Dentofacial Orthop. 2005 Feb;127(2):208–13; quiz
261. doi: 10.1016/j.ajodo.2003.11.027.
19 Parekh SM, Fields HW, Beck M, Rosenstiel S. Attractiveness of variations in the smile arc and buccal corridor space as judged by orthodontists and
laymen. Angle Orthod. 2006 Jul;76(4):557–63. doi:
10.1043/0003-3219(2006)076[0557:AOVITS]2.0.CO;2.
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20 Sarver DM, Ackerman JL. Orthodontics about face:
the re-emergence of the esthetic paradigm. Am J
Orthod Dentofacial Orthop. 2000 May;117(5):575–6.
doi: 10.1016/s0889-5406(00)70204-6.
21 Parrini S, Rossini G, Castroflorio T, Fortini A, Deregibus
A, Debernardi C. Laypeopleʼs perceptions of frontal
smile esthetics: a systematic review. Am J Orthod
Dentofacial Orthop. 2016 Nov;150(5):740–50. doi:
10.1016/j.ajodo.2016.06.022.
22 Correa BD, Vieira Bittencourt MA, Machado AW.
Influence of maxillary canine gingival margin asymmetries on the perception of smile esthetics among
orthodontists and laypersons. Am J Orthod Dentofacial Orthop. 2014 Jan;145(1):55–63. doi: 10.1016/j.
ajodo.2013.09.010.
23 Kokich VO Jr, Kiyak HA, Shapiro PA. Comparing the
perception of dentists and lay people to altered dental esthetics. J Esthet Dent. 1999;11(6):311–24. doi:
10.1111/j.1708-8240.1999.tb00414.x.
24 Kokich VO, Kokich VG, Kiyak HA. Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations. Am J
Orthod Dentofacial Orthop. 2006 Aug;130(2):141–51.
doi: 10.1016/j.ajodo.2006.04.017.
25 Pinho S, Ciriaco C, Faber J, Lenza MA. Impact of dental
asymmetries on the perception of smile esthetics. Am
|
J Orthod Dentofacial Orthop. 2007 Dec;132(6):748–
53. doi: 10.1016/j.ajodo.2006.01.039.
26 Machado AW, Moon W, Gandini LG Jr. Influence
of maxillary incisor edge asymmetries on the perception of smile esthetics among orthodontists
and laypersons. Am J Orthod Dentofacial Orthop.
2013 May;143(5):658–64. doi: 10.1016/j.ajodo.2013.
02.013.
27 Cunha TM, Barbosa ID, Palma KK. Orthodontic digital workflow: devices and clinical applications. Dental Press J Orthod. 2021 Dec 15;26(6):e21spe6. doi:
10.1590/2177-6709.26.6.e21spe6.
28 Barreto MS, Faber J, Vogel CJ, Araujo TM. Reliability of digital orthodontic setups. Angle Orthod. 2016
Mar;86(2):255–9. doi: 10.2319/120914-890.1. Epub
2015 Jun 4.
29 Lecocq G, Truong Tan Trung L. Smile esthetics: calculated beauty? Int Orthod. 2014 Jun;12(2):149–70.
English, French. doi: 10.1016/j.ortho.2014.03.015.
Epub 2014 May 14.
30 Rotundo R, Nieri M, Lamberti E, Covani U, PeñarrochaOltra D, Peñarrocha-Diago M. Factors influencing
the aesthetics of smile: an observational study on
clinical assessment and patient’s perception. J Clin
Periodontol. 2021 Nov;48(11):1449–57. doi: 10.1111/
jcpe.13531. Epub 2021 Aug 22.
AD
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| case report
The informed, lifetime patient
Dr Tif Qureshi, UK
What does it mean to care for a patient over a lifetime?
Are we, as dentists, treating a patient to make him or her
happy and then saying goodbye, or should we provide
that patient with a stable, functional outcome that we help
to maintain over many years? By applying orthodontic
and restorative principles to the treatment of mild and
moderate crowding cases, besides improving appearance, we are potentially carrying out interceptive functional treatment that can maintain a patient’s long-term
anterior guidance and a correct envelope of function.
I have found the align, bleach and bond approach provides the ability to reverse dental collapse and improve
anterior guidance, which if left untreated can lead to
future problems. Align, bleach and bond is much more
than aesthetic treatment. It is also functional and preventive and can change the way we approach all patients,
not only those requiring cosmetic treatment. Carrying out
Dahl build-ups is also important. When the Dahl technique is properly applied, it can be one of the most powerful tools in dentistry.
Fig. 1: 2004—discoloured maxillary central incisors.
Fig. 2: 2004—reduced anterior guidance.
Monitor, retain or treat?
I believe patients often agree to treatment even if they do
not really understand the functional advantages. Would it
be more helpful if patients who decided to have aesthetic
and cosmetic dentistry really understood the functional
and potential lifetime benefits of those treatments?
Developing a long-term relationship and communicating
with patients keeps them informed about what could
happen to their teeth over time. Understanding the occlusal and functional effects of continued tooth movement
enables the patient to make an informed decision about
intervention. I believe that it is crucial that we talk to patients, present the facts and avoid rushing into treatment
with veneers and crowns.
It is important to explain the slow, minor positional and
functional changes and educate the patient about what
is happening in his or her mouth. I record the amount of
dentine exposure and look very carefully at enamel chipping. I always explain that dentine is six to eight times
softer than enamel and that it will stain more heavily.
Taking regular photographs of the patient is also important, even if no treatment is provided. Each time a patient
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Fig. 3: 2004—wear on the mandibular teeth and crowding.
presents, we can look at the images together to see the
changes over time. I do not think dentists are taught or
conditioned to take photographs often enough. I will also
undertake a regular fremitus check, demonstrating the
pressure of fremitus and helping the patient understand
what it means to have a constricted envelope of function.
The key issue is that we explain that the change is gradual
and progressive. We observe, we do not panic. We offer
to monitor, retain or, of course, treat. Patients gain an appreciation that, over time, teeth keep moving, become
more crowded, collide and discolour.
[27] =>
case report
|
Figs. 4 & 5: 2004—lateral views of the initial clinical situation.
Fig. 6: 2004—after alignment of teeth #43–33 and direct edge
bonding.
The following case highlights the treatment of a patient
over 17 years. With simple orthodontics, direct edge
bonding applied according to the Dahl principle and a
little maintenance, the patient’s teeth were prevented
from becoming worse at a relatively low cost.
Case presentation
A 48-year-old female patient came to see me in 2004.
The patient initially presented because she was unhappy with her two discoloured maxillary central
incisors (Fig. 1). She also had chipping and wear of the
mandibular teeth and broken posterior bridgework. Her
“bite” also felt uncomfortable (Fig. 2).
On examination, she had reduced anterior guidance,
causing posterior interferences and heavy contacts
behind the maxillary central incisors. The patient was
keen to change the crown and veneer on the maxillary
central incisors. She also wanted to have the wear on her
mandibular teeth and the crowding treated (Fig. 3).
Treatment options
Options discussed with the patient were comprehensive
orthodontics versus a compromised plan. We also considered multiple maxillary and mandibular ceramic restorations versus alignment, bonding and replacing the two
central incisors (Figs. 4 & 5).
Owing to financial constraints and concern about the
amount of tooth preparation needed, the patient chose
simple anterior alignment with removable appliances.
Figs. 7 & 8: 2004—lateral views of the new ceramic crown and
veneer.
She opted for an Inman Aligner for alignment of
teeth #43–33. Interproximal reduction was carried out
progressively over eight weeks. Once her mandibular
teeth had been aligned, an indirect wire retainer was
bonded into place. This was followed with direct edge
bonding on the mandibular teeth according to the Dahl
principle,1 the primary contacts on the canines and light
contacts on the incisors (Fig. 6).
The occlusion was reviewed and readjusted about one
month later to ensure that any maximum intercuspation
and centric relation slide had been accounted for.
The anterior contacts were readjusted and balanced at
this point. The two maxillary central restorations were
replaced with a new ceramic crown and a veneer
(Figs. 7 & 8).
The patient’s occlusion settled over a two- to threemonth period. The result was not perfect, but we were
working within a limited budget. After about six years,
the bridges in the mandibular arch were replaced at the
patient’s own pace.
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[28] =>
| case report
Fig. 9: 2017—the mandibular teeth starting to wear.
Fig. 10: 2017—the maxillary central incisor restorations still in place
but the mandibular right central almost completely worn.
Figs. 11 & 12: 2017—palatal platforms placed on the maxillary canines using Venus Diamond (Kulzer).
Cost-effective and attainable treatment
Thirteen years later, the mandibular teeth were starting to
wear (Fig. 9). The maxillary central incisor restorations
were still in place, but the mandibular right central incisor
was almost completely worn (Fig. 10). The patient did not
want to replace all the mandibular composite at this
stage, as she was more concerned about improving the
appearance of the maxillary central incisors, one of which
had developed a hairline fracture.
Budget was still an issue, so for the time being we agreed
to redo the direct edge bonding according to the Dahl
principle. However, this time, palatal platforms were
placed on the maxillary canines. This was completed
using Venus Diamond nano-hybrid composite (Kulzer) in
Opaque Medium shade (Figs. 11 & 12). The palatal platforms were placed freehand, and a simple flat surface
was created that reproduces an anatomy similar to but
more basic than that of a natural cingulum. By placing a
flat platform, we could ensure correct axial loading.
The contacts were balanced and checked with articulating paper. These platforms provided enough room to
clean and rebuild the incisal edge of the mandibular right
central incisor without having to remove any of the other
original composite placed in 2004. To build up the man-
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2 2022
dibular tooth, a base shade of Venus Diamond in Opaque
Light was placed and B1 shades were applied over the
top.
I like the strength offered by Venus Diamond. I have been
using the material for more than 12 years, and it has
proved to be very fracture-resistant. The composite
offers easy handling, is predictable and adapts perfectly
to the colour of the teeth.
At this stage, if the patient’s teeth had not been treated in
2004, there would have been further heavy wear on the
dentine, probably 1 or 2 mm more tooth surface loss at
a minimum, and increased crowding. A constricted envelope of function potentially would have caused one of the
maxillary teeth to either break or push forward.
Strong, durable restorations
In 2021, the patient decided to have the two maxillary
central incisor restorations replaced with a lithium disilicate crown and veneer (Fig. 13). The maxillary palatal
platforms created with Venus Diamond in 2017 were still
functional, and the repaired mandibular central incisal
edge was still intact (Figs. 14 & 15). The original edge
bonding on the other mandibular teeth still remained in
place, 17 years later.
[29] =>
case report
Fig. 13: 2021—the two maxillary central incisor restorations
replaced with a lithium disilicate crown and veneer.
Fig. 14: 2021—the repaired mandibular central incisal edge still
intact.
Fig. 15: 2021—the maxillary palatal platforms created with
Venus Diamond still functional.
Fig. 16: 2021—the patient’s teeth 17 years later thanks to interceptive treatment with alignment and direct edge bonding
according to the Dahl principle to minimise the amount of
damage.
To enhance the mandibular canines and incisors, the
teeth were polished with the simple-to-use and predictable Venus Supra polishing kit (Kulzer). However, it is
likely that in the next two to three years they will all be
replaced with Venus Diamond composite.
Interceptive dentistry
This case effectively demonstrates that the concept of
“pausative” dentistry can be aesthetic, functional and affordable. If this patient’s teeth had been left untreated
from 2004, how would they have looked 17 years later?
The mandibular crowding would likely have worsened.2
The bite would probably have deepened, causing more
surface loss, as there were already signs of dentine exposure. The already reduced posterior guidance would
likely have worsened and more posterior teeth may have
failed.
The “pausative” approach with alignment and direct edge
bonding according to the Dahl principle can help to minimise the amount of damage in long-term cases (Fig. 16).
It can help prevent further tooth surface loss and tooth
positional changes and hold the occlusion in a much
better position over time.
For me, interceptive care should be a goal of dentistry.
Perhaps we should all be thinking more about intercepting and preventing obvious issues becoming predictable
problems later on. With this approach, the goal could
really be lifetime care.
|
about
Dr Tif Qureshi graduated from King’s
College London in the UK in 1992. He
is a partner at Dental Elegance in
Sidcup in the UK and has worked
in this private practice for nearly
30 years, and he is a clinical director
of the IAS Academy. He has a special
interest in simple orthodontics and
minimally invasive dentistry and pioneered the concept of progressive smile design using align,
bleach and bond. He is an experienced teacher of the Dahl
concept, which promotes minimally invasive, patient-centred
dentistry. Dr Qureshi is a past president of the British Academy
of Cosmetic Dentistry.
Editorial note: This article was first published in the
August 2022 issue of Clinical Dentistry, and an edited
version is provided here with permission from Kulzer.
References:
1
2
Dahl BL, Krogstad O. The effect of a partial bite raising
splint on the occlusal face height. An x-ray cephalometric study in human adults. Acta Odontal Scand.
1982;40(1):17–24.doi:10.3109/00016358209019805.
Little RM. Stability and relapse of mandibular anterior alignment: University of Washington studies.
Semin Orthod. 1999 Sep;5(3):191–204. doi: 10.1016/
s1073-8746(99)80010-3.
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[30] =>
| feature
Image: VLADGRIN/Shutterstock.
If I could see through your eyes,
I wonder what I would see?
Jerko Bozikovic, Belgium
Ever wondered why some things are very clear, very
natural, even very normal for you, yet someone else
thinks exactly the opposite, or you see or hear something
and of course expect that everyone else sees or hears
the same thing? Well, many of us live in an illusion, the illusion that how we perceive the world is reality. In fact, it
is never the reality, but it is definitely your reality. Let us
consider together how this can be, how this affects
our communication and our collaboration with our teams
and patients, and how we are influenced on a personal
level.
We all have a model of the world (MOW). An individual’s
beliefs, values, desires, expectations, experiences, culture,
education, age, family background, relational status,
sexual and gender identity, work experience, etc. help
create and define his or her MOW, acting as filters through
which he or she perceives, lives and acts. Filters are like
sunglasses: if it is sunny outside and you put on brown-
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coloured sunglasses, the world appears brownish; however, if you put on blue, yellow or pink ones, the world will
look blueish, yellowish or pinkish. The world is not brown,
blue, yellow or pink, but your perception of the world is.
Our filters colour our perception of reality.
We perceive reality through our five senses, our brain interprets what we perceive through our filters, including
our values, experiences and how we feel at that moment
(mentally, physically, emotionally), and we behave accordingly. Sometimes we do not understand where our
behaviour comes from or where the other person’s behaviour comes from. Now you understand that it is related
to your and/or his or her MOW.
Impact on communication
We may think that how we communicate is very clear;
however, we may notice sometimes that the other person
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feature
did not understand what we said the way we intended it.
I am sure that many of us remember the telephone game
we played as children: in a circle of children, the first
would whisper something in the ear of the second child,
who would whisper it to the next one and so on until the
sentence arrived at the last child. Very seldom was the
final sentence the same as the initial one. This shows the
many levels of interpretation but also of loss, during that
transmission.
An informative check to do in your clinic would be to give
clear instructions to a patient about a treatment plan and
care of his or her teeth, then ask your assistant at the front
desk to ask that patient what you said regarding the
treatment plan and dental care, and then compare
what you said with what the patient said. Do not be surprised that in too many cases it might be that what you
said was not heard the same way as you meant it, let
alone remembered to be able to repeat it to your assistant. That is because all our filters influence what we hear,
see and experience around us, linked to our MOW.
Therefore, being a good communicator is crucial, and
here are some tips:
|
• Repeat your messages.
• Do not speak too quickly. It is not what you say that
matters but what the other person hears, understands
and remembers.
• Keep your message short and simple. The more you
say, the more that can be lost; the more complicated,
the easier for the other person to zone out and stop
listening.
• Ask people to write down the instructions you give
them—make sure pen and paper are always available for patients and your team—encouraging them by
saying that writing down the exact instructions, what
the treatment will involve, etc. will help them recall this
better at home.
• We communicate through words but also through our
body language and our tone of voice, and that too
affects what the other person will hear, understand
and remember. Make sure that all three ways of
communicating (the way you use your body and
voice and the words you use) are aligned in giving
the same message—avoid looking at your screen
while conveying an important message, because
the other person will perceive it as less important,
since there was no eye contact.
NLP communication model – How we perceive the world
Image: Lightspring/Shutterstock.
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[32] =>
| feature
Impact on collaboration with your team and
colleagues
Of course, your team members and colleagues also have
their MOW, and so trying to understand how someone is
perceiving the world around him or her will help you to
make sure things are done the way you want them to be
done. A great way of understanding how people perceive
the world is through various personality models, such as
the Myers-Briggs Type Indicator, Herrmann Brain Dominance Instrument, DISC and Insights Discovery.
These models give some insight into how you and
others see the world. I have used several of these
models with entire teams in team building, but also when
there was conflict and frustration in teams, for example.
These models can help us understand why somebody
gives more attention to relationships, while others are
more scientific and factual. Some love and need structure
and security, while others just long for change and creativity.
Seeing and experiencing that we all have our own MOW
helps collaboration tremendously. I even know of several
companies who categorise their clients or patients based
on these different personality models and know exactly
how they need to communicate with them to motivate
them and to really connect with them. It is not about
putting people into boxes; it is about understanding why
someone acts or reacts in certain ways and what we can
do in our collaboration and communication to create a
more desirable outcome.
have seen in the past two years over vaccination. Even
wars are a clash of different MOWs. Who is right and
who is wrong? Honestly, nobody really is. So, a good
thing you can try to do for yourself is to look at the world
outside your box, outside your MOW, outside your ways
of looking at, thinking about and perceiving things in
and around you.
Maybe you think that you are not that influenceable, but
do you respond differently when a patient is friendly or
unfriendly to you? Might your behaviour be affected by
what you see? Might it be that because you have a belief
(conscious or unconscious) that, if someone is friendly
to you, you should be friendly back, but if someone is
unfriendly, that person should not see the friendliest
you? Of course, we do not know why someone is unfriendly, and what does unfriendly mean anyway? Is it
an interpretation through your filters of a certain situation or behaviour happening outside of you? Consider
whether receiving things from providers (material, trips,
money, opportunities, invitations, etc.) might influence
your MOW and thus your reaction, your preferences,
your neutrality? Or do you believe that you are not
affected by this? Just some food for thought…
A good tip I can give you is to from now onwards consider
that what you are experiencing or perceiving is your
reality, and to ask what it might be like for the other
person. Thinking this way will help you to learn more
about the other person’s MOW and to share yours. This
way we’ll get closer to each other, collaborate better and
understand each other better.
Of course, this also helps with personal and family relationships. You can avoid falling into the trap of thinking
that how you see the world is how everyone sees the
world. Rather you can try to understand why someone
has a certain reaction or certain understanding of what
you have said, in order to see how you could make yourself clearer by consciously applying the NAAA technique:
Never Assume, Always Ask.
Impact on yourself
Put two people across each other at a table and draw the
number six on a piece of paper. For one, it will look like
the number six, but the person opposite will see a nine.
Who is right? Both are; both just have a different perspective on reality. As mentioned before, reality how you
perceive it is always your reality, but never the reality.
We can take this much further in respect to our daily lives.
How often are relationships affected because both
people have a different way of looking at things? Insisting on being right can be a reason why friends and families do not communicate with each other. This is the
reason for ugly divorces and the division in society we
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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.
[33] =>
feature
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[34] =>
| interview
Dr Tommaso Castroflorio is the current president and director of education of the European Aligner Society.
(Image: Mauro Calvone)
Clinicians and researchers
advancing aligner orthodontic
treatment together
Nathalie Schüller, Dental Tribune International
Dr Tommaso Castroflorio is European Aligner Society
(EAS) 2022–2023 president and director of education.
He is a passionate and enthusiastic teacher, researcher
and orthodontist and shared that he “loves teaching and
new technologies” and therefore regularly writes scientific papers to contribute to education on orthodontics.
As graceful as always, he kindly answered some questions after the EAS summer meeting, which took place in
Oporto in Portugal on 1 and 2 July 2022.
Dr Castroflorio, was the second EAS summer meeting
a successful event?
I feel it was. We had a good representation of EAS
members, and the main players in the field involved in
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aligners, orthodontics and digital orthodontics were
present as well. Sometimes, we forget that EAS is
not only about custom aligner orthodontics but also
about every aspect of digital orthodontics. Today, orthodontics is benefiting from huge developments in terms
of 3D printing and new materials and techniques. I think
that this event was a good representation of what EAS
stands for.
During the plenary session, you announced the collaboration between Align Technology and EAS for
the European Board of Aligner Orthodontics (EBAO)
certification, the first of possibly many collaborations to come. Would you tell us more about it?
[35] =>
interview
EBAO’s mission is to certify and periodically re-evaluate
the expertise, skills and comprehensive knowledge of
orthodontists, with an emphasis on aligner and digital
orthodontics. It was created because of the importance
of orthodontists committing themselves to excellence in
aligner orthodontics. EBAO aims to be the global leader
in aligner orthodontic treatment board certification and to
set the standards of excellence for this discipline.
Align Technology was the first company interested in
EBAO, and our collaboration will enable Align to help
dentists working with its system to achieve the first
phase of the certification. It is to me a crucial step forward
on Align’s part because it seems that the focus is
centred not on number of aligners produced but rather,
on excellence in orthodontic treatment. This is great
news, and other companies will most likely follow suit.
Why do you feel that the EAS/EBAO Clinical Master
certification is important?
I think that EBAO will certify the excellence in skills
of an orthodontist working with aligners. It will also
provide certification of the orthodontist’s commitment
to obtaining the best results with aligners. That is the
reason why I strongly believe that the EBAO certification
is an important one. It is not only a title; it is an official
recognition of the commitment and the passion of an
orthodontist with respect to the craft, and will offer a
way in which aligner orthodontics can come closer, in
terms of recognition, to conventional orthodontics.
You are passionate about research and teaching.
Is being part of the EAS board of directors another
responsibility you are passionate about and why?
Indeed, as you know very well, I am passionate about
research and teaching. I think that education is part of
research and teaching, and that is another thing I am
passionate about. The EAS board agrees that education
in aligner orthodontics is a very important issue, and
we are thinking of creating a board of educators. This
is a vision for the future, since we feel that EAS should
lead in the field of aligner orthodontics and should work
with its members, in order to shape the future of orthodontics together.
|
The third EAS meeting in Malta was a welcome event
after three postponements due to the pandemic.
The fourth EAS meeting will take place in your
home town of Turin. What do you have planned for
attendees?
Together with the scientific chairman, Dr Francesco
Garino, we have titled the congress “The next level” in
aligner orthodontics—the next level because I have
asked my “super ortho” friends around the world to
be with us on stage, to explain why they are now using
aligners in their clinical practice, because some in
the past were against aligners. I think that these super
orthodontists can literally bring us to the next level. In the
past, they were at the top in terms of conventional orthodontics, so I am convinced that they can teach us how to
reach excellence, by sharing their skills with us.
It will, I believe, be a great congress. The venue—the
Lingotto auditorium—is wonderful. You may remember
that I always start my lectures by presenting my city.
It was the capital of Italy and is now the capital of
Piedmont. It is a royal city, a beautiful city, with a great
history and an important cultural centre.
How would you like to see EAS grow? Do you have
any new ideas you would like to pursue during your
presidency?
I would like to see more people become members of
EAS. There is a growing number of affiliated national
societies, which is very positive. I feel that it is better to
hold a bigger meeting, instead of too many. The key
opinion leaders are always the same. It is the reason why
the fourth congress will have other presenters on stage,
to bring to us fresh ideas, energy, technologies and innovations to take back to our offices.
As I mentioned, my area of focus is education and I
want to create a board of educators that will combine
clinicians providing clinical tips and tricks, and researchers to put together well-researched protocols, and allow
EAS to grow and be able to control and certify the
quality of educational programmes.
aligners
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35
[36] =>
| interview
I hope that sustainable dentistry
will soon reach critical mass and
become the norm
Iveta Ramonaite, Dental Tribune International
Dr Davinder Raju is the
lead dentist at Dove
Holistic Dental Centre
in Bognor Regis in the
UK and the founder
of Green Dentistry, an
online platform that
helps dental practices
become more environmentally conscious and
reduce their carbon
footprint. In this interview with Dental Tribune
Dr Davinder Raju
International, Dr Raju,
an ardent advocate of
sustainability, explains why he thinks apathy and the
fear of litigation are the greatest enemies of sustainable
dentistry and how dental professionals often have false
beliefs about sustainability. He also discusses why having
an environmentally aware team with a can-do attitude is
essential in order to promote sustainable practice and
describes why the dental industry should be transparent
about the environmental impact of its products.
Dr Raju, what does sustainability mean to you
personally, and how would you define sustainable
dentistry?
I’m continually amazed at the abundance of life that our
planet has to offer, and it is something that future generations should have the opportunity to enjoy. To me, sustainability is about being a good custodian of the environment and ensuring the well-being of future generations.
It’s about making decisions that reduce environmental
impact. I’m deeply concerned about the fact that underprivileged children will suffer disproportionately more in
light of the consequences of unchecked climate change.
As for sustainable dentistry, I would define it by combining Gro Harlem Brundtland’s famous definition of sustainability with minimally invasive dentistry. Sustainable
dentistry involves delivering optimal oral and dental
healthcare, with a focus on prevention, early diagnosis
and management, using minimally invasive operative
procedures and having the best long-term interests of
patients at heart, while at the same time mitigating
negative impacts on the planet so that we do not under-
36
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2 2022
mine prospects for future generations. Using a minimal
intervention approach to dentistry means that patients
are less likely to enter the restorative downward spiral,
thus reducing the need to provide resources such as
dental restorative materials.
You believe that great leaders should know not only
why they are running a practice but also how they are
running it. Could you elaborate on that?
We know that greenhouse gases emitted by human
activities cause climate change and that the effects of
climate change, some of which are already apparent,
pose a global health threat. Now, “to do no harm” is one
of the pillars of medical ethics, yet globally, the health
sector emits more carbon dioxide than Japan, which is
currently ranked as the fifth highest emitter of all countries. Given its mission to protect and promote health, the
health sector, including dentistry, has a responsibility to
reduce its own climate footprint. This can only be accomplished by examining how we are providing services.
Only by scrutinising how we operate can we consider the
possibility of delivering the same service, but by employing an approach that has a lower environmental impact.
Climate change will become an increasing concern for
consumers, and the dental profession must take action
to reduce the harm that healthcare is causing.
To follow up on the previous question, what motivated you to found Green Dentistry, and how do you
promote sustainable development in your business?
I first need to explain why I set up an eco-friendly dental
practice. The catalyst came about when I was studying
for my master’s degree in advanced minimum intervention dentistry. I was struck by the ecological plaque hypothesis. Inside a healthy mouth, there is a stable and
healthy community of cells—microbial homeostasis—
where a mutually beneficial equilibrium exists between
the microflora and the host. If this balance is upset,
disease ensues. Consequently, I started thinking about
the effects of my business on our host, namely the environment, and how I could mitigate that impact. When
I wanted to set up an eco-friendly dental practice, information about sustainable dentistry wasn’t readily available. Since there seemed to be a lack of practical advice,
I had to piece information together from other industries.
[37] =>
interview
Green Dentistry came about when I was approached by
other dentists who wanted to make their practices
greener but didn’t quite know where to start.
There has to be clear leadership and a desire to embrace
sustainability in order to promote sustainable dentistry,
and having an environmentally aware team with a can-do
attitude is essential. As a practice owner, I’m busy running
the practice, and I don’t have the time to manage day-today activities. Good ideas and strategies aren’t worth
anything if you can’t implement them, so I delegate the
role of maintaining the changes to a sustainability champion. However, we need the entire team to be on the
same page for both coherence and creativity. The team
needs to be willing to suggest ideas to the sustainability
champion and to ensure that they are discussed at practice meetings. Running a sustainable practice is about
creating a culture that consistently seeks new opportunities to improve efficiency and environmental performance. The right team is essential, and its members
need to unite and collectively participate. We’ve taken
many steps in the right direction, but we never assume
that we’ve done enough. I want the team to be forwardthinking and future-oriented, almost as if the team
members are carrying out mini eco-audits as they’re
walking through the practice, carrying out their regular
procedures while thinking to themselves: “Is there a
better way of doing this? Is there another product we
could be using?”
Sustainability is gaining increasing awareness in
dental practices worldwide. How would you explain
this trend?
Programmes like David Attenborough’s television series
The Blue Planet and professional magazines such as the
British Dental Journal have all helped raise awareness
of sustainability. Still, there is possibly a disconnect
between what we do at home and in our working environments. During the COVID-19 pandemic, many dental
professionals were alarmed by the large amounts of
extra personal protective equipment that they had to use.
This may have produced a cognitive tipping point and
made dental professionals realise how much the dental
sector negatively impacts the environment.
I believe that sustainable dentistry is currently being introduced to the dental curriculum at King’s College London
and hopefully at other dental teaching hospitals. I hope
that sustainable dentistry will soon reach critical mass
and become the norm.
Why is it crucial that the dental industry is transparent about its supply chains and environmental
policies?
The lion’s share of carbon dioxide emissions produced
by the provision of healthcare are generated upstream
and are attributable to the supply chain through the ex-
|
traction of raw materials and the production, transport
and distribution of goods and services. If the dental industry is transparent about the environmental impact of
its products, we, as end users of dental products and
materials, can make greener procurement choices. In addition, industry-wide environmental policies that promote
responsibility and accountability will help those working
in the dental profession to determine with which companies they wish to align themselves and do business.
What would you say is the greatest enemy of sustainable dentistry, and what are some of the barriers to
sustainability in dentistry?
The greatest enemy of sustainable dentistry is apathy. It
is the feeling that, since dentistry’s overall impact is relatively small compared with, for example, coal-fired power
stations, there’s no point in making the necessary
changes towards a more environmentally sustainable
future within the dental environment. However, we can’t
be passive bystanders. We can’t stand back and be
spectators knowing that conditions that humans have
created, and are continuing to create, are a threat to humanity and other life forms.
We are facing a climate crisis, ever-shrinking biodiversity
and acidification of the oceans. We can vote for policymakers who prioritise the environment and make a move
towards delivering sustainable dentistry now. Regulatory
change will come eventually, but we shouldn’t wait for the
government to take action. It’s immensely satisfying to do
the right thing.
The fear of litigation is also a barrier to embracing sustainability. In the UK, Health Technical Memorandum 01-05:
Decontamination in primary care dental practices has resulted in a significant increase in the use of single-use
plastics and increased costs for dental practices.
Although aware of the importance of infection prevention,
we seem to have tipped too far on the side of caution.
If used appropriately and recycled when possible, plastic
is a valuable material. However, single-use plastics are
now ubiquitous in the dental environment.
There is also a common perception that the changes
necessary to achieve a more sustainable approach are
expensive to implement. Yes, you can spend a great deal
of money on capital expenditure by purchasing solar
panels, ground source technology or heat pumps, but
this isn’t the only way to achieve a more sustainable
approach to delivering dentistry. For example, if a practice wants to help reduce carbon dioxide emissions, it
can simply switch to a renewable energy provider. As
demand grows, renewable energy will increasingly
be sourced for the grid, thus reducing the supply generated from fossil fuels. It’s picking the low-hanging fruit
that hopefully will spark a change in behaviour towards
sustainable practice.
aligners
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37
[38] =>
| market analysis
A number of factors are contributing to a decline in popularity of fixed appliance and wire treatment in favour of clear aligners,
according to market research company iData. (Image: Alexandr Grant/Shutterstock)
Global clear aligner market:
The stars are aligned
John Fraser & Dr Kamran Zamanian, Canada
The global clear aligner market continues to grow at a
rapid pace and looks set to overtake fixed appliances, as
the most popular orthodontic treatment. New research
from iData shows that the direct-to-consumer (D2C)
clear aligner category is gaining market share and that
the US no longer accounts for the majority of global clear
aligner case starts.
Clear aligners are simple custom-made orthodontic
devices that fit tightly over the teeth and offer aesthetic,
practical and cost-related advantages. The complexity
of cases that can be treated with clear aligner therapy
has increased over time and now ranges from simple anterior cases requiring mainly aesthetic movements, to
severe cases involving potential extractions or multiple
relapses. Owing to these and other factors, clear aligners
are quickly becoming the dominant and preferred malocclusion treatment.
38
aligners
2 2022
Many patients who previously would not have opted to
seek orthodontic treatment, are now undergoing clear
aligner therapy. This can be attributed to the visual benefits that clear aligners offer compared with fixed appliances, as well as to the ability of many manufacturers
to address the simpler aesthetically focused cases
cost-effectively. Improved materials and better scanning
technology are resulting in products becoming progressively more comfortable, and more adept at treating
malocclusion effectively and quickly.
Patients prefer clear aligners to fixed appliances and
wires, mostly because of the greater comfort offered, the
aesthetic appearance of the trays and the fact that they
can be removed before eating. In August 2020, Dentsply
Sirona, one of the largest names in orthodontics, announced that it was exiting the traditional orthodontics
business. This was an indication of the decline in pop-
[39] =>
market analysis
|
The global professional vs direct-to-consumer split. Professional cases (in blue) and D2C cases (in orange). (Image: iData)
ularity of fixed appliance and wire treatment in favour of
clear aligners. Both dentist-led clear aligner treatment
and treatment with fixed appliances incur a significant
cost to the patient; however, an increasing number of
less expensive alternatives now exist on the market.
Emergence of D2C clear aligner therapy
D2C treatment accounts for an evergrowing share of the
clear aligner market, and it has enabled companies to
target a demographic that was previously untapped in
orthodontics. Since the cost to the patient is considerably lower than the cost of dentist-led treatment, consumers who were previously priced out of the clear
aligner market now represent a substantial future revenue
source for clear aligner therapy providers, particularly in
lower income countries.
The SARS-CoV-2 pandemic had a considerable impact
on the D2C market. However, its growth was less severely affected than that of the dentist-led clear aligner
category, owing to the fact that patients received treatment remotely, and had no need to cancel in-person
check-ups. This led to further gains by the D2C segment
over dentist-led treatment. However, these gains appear
to have been largely temporary because, by 2021, the
market shares of the dentist-led and D2C segments had
reverted to their pre-pandemic split.
SmileDirectClub pioneered the D2C method of clear
aligner treatment in 2014. Through the company’s use of
SmileShops—pop-up locations where potential patients
can quickly undergo intra-oral scans—and a collabora-
tive network of dental office locations, SmileDirectClub
has treated over 1.5 million patients worldwide. Ease of
operation, affordable prices and the convenience of
having no mandatory in-office visits have resulted in
the D2C model becoming a key part of the clear
aligner market, especially in North America. In addition to
SmileDirectClub, Byte and Candid have made notable
inroads into the provision of D2C clear aligner therapy in
North America.
However, despite its rise in popularity in North America,
the D2C market has faced ongoing problems relating to
public perception and trust. Major market players offer
treatment options that address orthodontic issues less
adequately than dentist-led treatments do, and some
patients have reported1 that D2C treatment even worsened their malocclusion. D2C clear aligner therapy
accounts for a substantial share of the North American
market but is yet to become a market mainstay in the
rest of the world.
Clear aligners: around the world in 80 trays
The clear aligner market is swiftly changing2 from a UScentric market to one that is more globally balanced. In
2017, over 55% of all clear aligner cases were treated in
the US. This number dropped below 50% in 2021 and
is projected to fall to 40% by 2025.
The perceived importance of improving one’s appearance differs between countries, and in certain countries,
it has a high cultural significance. Many consumers who
previously would not have opted for treatment with fixed
aligners
2 2022
39
[40] =>
| market analysis
US vs rest of world case split. US total cases (in blue) and ROW total cases (in orange). (Image: iData)
appliances are now undergoing clear aligner therapy, and
many manufacturers can cost-effectively address the
simpler cases.
Moderate and complex professional cases require a
premium cost, thereby pricing out many potential patients, and many of the most complex cases are still being
treated with traditional braces. An estimated 75% of the
global population suffer from malocclusion, and this
means that a massive market opportunity remains unaddressed, particularly for those who are currently unable
to afford the more expensive dentist-led treatment.
However, an increasing number of D2C providers are
beginning to be able to tackle cases of more severe
crowding or spacing, overbite correction and other predictable and moderate movements.
The rest of the world is still in the early stages of adopting
the D2C treatment as a legitimate option. DrSmile from
Germany is an example of a company that is starting to
break through in the European market, and the North
American giant SmileDirectClub has made a global
impact since entering the international market in 2019.
The Asia-Pacific region has only a marginal D2C market,
as India’s Toothsi and Japan’s Oh my teeth are regional
players; however, multiple D2C providers can be found in
Australia. In South America, Brazil is home to a number
of notable D2C clear aligner companies.
Clear aligners: an industry on the rise
The global clear aligner market has already cemented
itself as a vital facet of the orthodontic industry, and it
40
aligners
2 2022
is projected to maintain much of its meteoric growth.
Dentist-led cases will soon overtake fixed appliances
as the preferred treatment option for malocclusion, and
the D2C market will continue to attract new patient
demographics. Globally, a rapid shift is taking place
whereby the treatment is gaining popularity around the
globe, and the US no longer accounts for the majority of
case starts.
Editorial note: For 16 years, iData Research has been a
strong advocate for data-driven decision-making within
the global medical device, dental and pharmaceutical industries. By providing custom research and consulting
solutions, iData empowers its clients to trust the source
of data and make important strategic decisions with confidence.
A list of references is available from the editor.
about
John Fraser is a senior research analyst at iData Research.
He develops and composes syndicated research projects regarding the medical device industry, publishing the Global
Clear Aligner Market research report.
Dr Kamran Zamanian is 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.
[41] =>
industry report
|
Ceramill Map DRS intra-oral
scanner in the dental practice:
Jaw scans in just 1 minute—
digital tooth impressions for more
convenience and efficiency
Every restorative or orthodontic treatment begins with
an impression. Dentists are increasingly resorting to
digital technologies. These offer patients more comfort
while making the day-to-day routines in the practice
easier. For example, the fully comprehensive Ceramill
Map DRS intra-oral scanner from Amann Girrbach
takes only 1 minute to scan a jaw. At the same time, the
end-to-end digital workflow simplifies collaboration between the practice and the laboratory.
With the Ceramill Map DRS intra-oral scanner, clinicians
can digitally record the dental situation of patients and
transmit the data to the laboratory in real time. This makes
conventional impression taking superfluous. With the oral
scanner, dentulous partial and full jaws (before and after
preparation), as well as bite situations and implant positions, can be scanned with the aid of scan bodies. Different heights of scanning tip are available for difficult-toaccess areas. Intelligent features in the corresponding
software, such as the automatic deletion of superfluous
data or the counting of autoclave cycles, offer clinicians
further convenience. In addition, the preparation line can
be defined and checked by the dentist in the scan and
then be re-prepared, if necessary.
As Amann Girrbach wishes to make it easy for dentists
to get started with digitisation, there are various kits available which can be expanded in stages:
• The basis consists of the Ceramill DRS Connection Kit,
which includes the intra-oral scanner, the corresponding software and the connection to the AG.Live digital
platform.
• The Ceramill DRS High-Speed Zirconia Kit allows zirconia to be sintered in the laboratory or dental practice
in just 20 minutes.
• Expansion with the Ceramill DRS Production Kit allows
simple restorations to be fabricated in the practice and
placed in the patient’s mouth in a single session.
“By digitising the data, smaller units can be fabricated
and also inserted on the same day, depending on the local distance to the laboratory. At the same time, users
benefit from our comprehensive training and service offers,” explains Elena Bleil, product manager for the global
clinical CAD/CAM business unit at Amann Girrbach.
contact
Amann Girrbach AG
Herrschaftswiesen 1
6842 Koblach
Austria
Phone: +43 5523 623 33-0
www.amanngirrbach.com
austria@amanngirrbach.com
aligners
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[42] =>
| industry report
When do you waste unused
aligners, and how can you
avoid it?
Dr Victoria Martin, Germany
Technology is no longer the sole competitor, companies
such as Ormco, Straumann and Dentsply Sirona having
also entered the clear aligner market.6
At the moment, the major aligner companies offer the same
system when it comes to the supply chain. They send you
as many aligners as you wish and send you more aligners
as soon as you request it, within a limited period. In the
case of Invisalign aligners, it is limited to five years. Apparently, this policy is fair to the patient and the dentist, since
dentists can guarantee a successful treatment regardless
of the number of aligners. For instance, in a complex case
where I plan 50% distalisation for my patient, I will receive
80 aligners at first, but if after 30 aligners, I see that the
aligners do not fit and the strategy is not working, I would
have to pause the treatment and order new aligners. It is
not easy to predict these undesired situations, but as there
are many factors involved, we encounter this problem frequently.
Dr Victoria Martin
Orthodontic treatment with clear aligners has been a
game-changer for our profession. If as an orthodontist you
use clear aligners, you probably have already experienced
all the advantages of clear aligners for you and your patient,
and probably some of its disadvantages, such as success
being determined by compliance, lack of control of certain
movements, unpredictability and numerous refinements.1–5
Since Align Technology developed this great product in
1998, the aligner market has continued to grow.6 Ten million patients were treated with Invisalign in 2021, and Align
42
aligners
2 2022
Maybe the misfit is due to the molars not distalising enough
or maybe the clinical crowns are too short, the bone is too
mineralised, there are micro-collisions between the teeth
or the patient has lost motivation and is not wearing the
aligners enough. No matter the reason, the strategy is not
working, and it does not make sense to continue just to
prove that it could. Therefore, I change the strategy and
set new goals with my patient. I order new aligners, and
I throw away 50 unused aligners. This means that I throw
away more aligners than the aligners I have already given
to my patient.
This policy of producing more aligners than necessary is
not only misaligned with today’s demands related to the
environmental crisis and climate change, but also has some
disadvantages regarding patient motivation and patient
trust. Does it really make sense to produce all the aligners at once? The patient would not even have seen those
50 custom-made aligners.
Has something similar happened to you as well? It probably
has, because it has happened to me on many occasions
[43] =>
industry report
during the nine years I have worked with clear aligners.
Everyone who treats complex cases with aligners throws
away unused aligners, but not all dentists pay much attention to this.
That was the case for me for my first two years of treating
malocclusions with clear aligners—until something happened: one of my patients told me how much she loved
her Invisalign aligners but how much waste they created.
I did not know what to answer because, before that conversation, I had never thought about it. I care about nature,
pollution and climate change, and I use a refillable bottle
and a reusable bag, but suddenly I realised the number of
unused aligners that we were wasting at work.
|
and, in doing so, save on production costs. It is not just the
plastic of the aligners that is saved, but also all the production scrap, since a printed model must be created for every
aligner. It is also about the transportation and the energy it
takes to destroy the aligners in the end. Wasting resources
is no longer something that can be overlooked in 2022.
Why would a company want to overproduce and create
waste? Is the latest price increase of Invisalign related to
overproduction?
According to the scientific literature and my own experience, there are several situations in which we waste aligners. This is my list of top ten situations:
1.
That was seven years ago. After that conversation, I started
using a strategy I named “divide and conquer”, according
to which I ask for the number of aligners that I need for the
first ten months or the number that I need to test how good
my strategy is or how compliant my patient is.
Aside from reducing the environmental impact of my daily
work as an orthodontist, this strategy has several benefits. Patients perceive clear aligners as high-technology
devices, and since they are custom-made and expensive,
throwing away unused aligners during treatment just because the teeth are not moving as planned is difficult to
accept. Ordering the aligners in two phases rather than all
at once allows you to adapt the treatment strategy easily
without having an awkward conversation with your patient
about why the treatment plan is not working and thus why
you need to throw away all those valuable aligners and
avoids you having to explain to your patient concepts like
biological limits and anchorage. You will also not have to
convince your patient to pause treatment and wait until the
new aligners arrive. Moreover, you will need less space in
the office to store your treatment boxes. Why would you
want to store aligners that your patient will need only in a
year or more? How large is your office storage space? This
strategy benefits your patient too, because the expectation
of receiving 45 aligners and then 25 more, for example, is
different from receiving 70 aligners at once. Of course, if
you care about pollution, this way of working is going to
have much more impact than using a reusable bag or reusable bottle.
So divide and conquer instead of approving a ClinCheck
plan with over 90 aligners. You can ask for the first 30 aligners to test your strategy and patient compliance. If after the
first 30 aligners, you see that your treatment strategy is right
and everything is working as planned, then you ask for the
remaining aligners, without taking new records.
I have been doing this since 2015, and I have been giving this advice to everyone I can, always hoping that some
day Align Technology, Ormco and other aligner companies
will encourage dentists not to order all the aligners at once
large sequential movements like distalisation of more
than 3 mm;
2. extrusion of the canines or lateral incisors;
3. difficult rotations (mandibular premolars);
4. molar uprighting;
5. poor compliance;
6. excessive overcorrection;
7. dental eruptions in children;
8. small clinical crowns;
9. emergency dental treatments during the aligner
treatment; and
10. production defects.
How can you avoid unnecessary refinements and waste at
your office?
1.
2.
3.
4.
5.
6.
Ask your patient to keep all used aligners, in case he
or she has not worn them enough and can then go
some aligners back and wear them properly. Let your
patient change the aligners every seven days only if
he or she has proved that he or she has worn them
20 hours a day (if not, then every 10–14 days).
Be realistic with the movements you plan, use auxiliaries that do not require compliance to obtain predictable movements, do pretreatments and reduce
the treatment time with aligners. No one wants to
wear over 100 aligners.
Be careful with overcorrections. Some overcorrection is recommended, but do not think that the more
the overcorrection the better the outcome.
Prioritise your goals, divide long treatments and ask
for a reasonable number of aligners.
Do not start the case with erupting canines or premolars. It seems obvious, but sometimes dentists
are impatient to start.
Spend time analysing your old ClinCheck plans and
simulations to avoid repeating the same mistakes.
I have been trying to reduce aligner waste since 2015.
Since then, neither Align Technology nor its main competitors have implemented any measures to avoid wasting unused aligners. It is difficult to understand why the companies producing aligners are still not paying attention to this
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[44] =>
| industry report
issue. Ironically, all of them claim to care about sustainability; for example, Align Technology has even implemented
actions that encourage aligner recycling.7–9 Recycling is an
approach with very little impact and looks more like greenwashing, since the recycled materials cannot be used for
aligner production, preventing a circular system. In the best
case and with much effort, aligners and their production
scrap can only be downcycled. Therefore, recycling is not
an option for the aligner industry.
I do not want to criticise the aligner industry, since clear
aligners were a game-changer for me and I make my living using them. I just want the aligner industry to see this
issue as an opportunity to improve and to be an example
for other industries. I challenge the industry to take off its
rose-coloured glasses and put on green glasses. Let us
start the conversation and all be part of the solutions we
need in order to achieve the global goals and the transitions
that the Fridays for Future generation deserves.
References:
1
2
3
4
about
Dr Victoria Martin received her BSc in dentistry from the
Alfonso X el Sabio University in Villanueva de la Cañada
in Spain in 2012 and her MSc in orthodontics from the
University for Continuing Education Krems in Austria in 2018.
She has been working in Germany since 2012.
5
6
7
8
9
44
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Doomen RA, Aydin B, Kuitert R. Mogelijkheden en
beperkingen van orthodontische behandeling met
clear aligners. Een verkenning [Possibilities and limitations of treatment with clear aligners. An orientation].
Ned Tijdschr Tandheelkd. 2018 Oct;125(10):533–40.
Dutch. doi: 10.5177/ntvt.2018.10.18131.
Haouili N, Kravitz ND, Vaid NR, Ferguson DJ,
Makki L. Has Invisalign improved? A prospective
follow-up study on the efficacy of tooth movement with Invisalign. Am J Orthod Dentofacial
Orthop. 2020 Sep;158(3):420–25. doi: 10.1016/j.ajodo.2019.12.015. Epub 2020 Jun 30.
Blundell HL Dr, Weir T Dr, Kerr B Dr, Freer E Dr.
Predictability of overbite control with the Invisalign appliance. Am J Orthod Dentofacial
Orthop. 2021 Nov;160(5):725–31. doi: 10.1016/j.ajodo.2020.06.042. Epub 2021 Aug 7.
Thirumoorthy SN, Gopal S. Is remote monitoring a
reliable method to assess compliance in clear aligner orthodontic treatment? Evid Based Dent. 2021
Dec;22(4):156–7. doi: 10.1038/s41432-021-0231-x.
Epub 2021 Dec 16. Erratum in: Evid Based Dent.
2022 Mar;23(1):5.
Papadimitriou A, Mousoulea S, Gkantidis N, Kloukos D.
Clinical effectiveness of Invisalign® orthodontic treatment: a systematic review. Prog Orthod. 2018 Sep
28;19(1):37. doi: 10.1186/s40510-018-0235-z.
Align Technology. Who we are. 2022. [cited 2022
Aug 27]. Available from: https://www.aligntech.com/
about#who.
Envista. Environmental, social, and governance report. 2022. [cited 2022 Aug 27]. Available from:
https://envistaco.com/en/sustainability.
Institut Straumann. Sustainability. 2022. [cited 2022
Aug 27]. Available from: https://www.straumann.
com/group/en/home/about/sustainability.html.
Align Technology. Corporate social responsibility.
2022. [cited 2022 Aug 27]. Available from: https://
www.aligntech.com/about/corporate_social_responsibility.
[45] =>
industry
|
your patient exp erience with
the p ower of smile visualis ation
Introducing
Invisalign® Outcome Simulator Pro
A powerful tool for driving Invisalign treatment
acceptance, providing highly realistic in-face
visualisation of your patient’s potential future smile.
Available on iTero Element™ Plus Series scanners
and imaging systems.
Make the most of patient
chair time.
Enjoy realistic simulations.
Available on the scanner and the cloudbased MyiTero.com portal.
Designed to increase Invisalign
case acceptance.
Schedule a
demo today at
iTero.com
Align Technology Switzerland GmbH, Suurstoffi 22, 6343 Rotkreuz, Switzerland
©2022 Align Technology Switzerland GmbH. All Rights Reserved.
Invisalign®, iTero™, iTero Element™, the iTero logo, among others, are trademarks and/or service marks of Align Technology, Inc.
or one of its subsidiaries or affiliated companies and may be registered in the U.S. and/or other countries. 219442 Rev A
it starts with
aligners
2 2022
45
[46] =>
| industry news
I-liner: Think differently
I-liner’s range is completed with the following aligners
pliers:
Sia Orthodontic Manufacturer is proud to launch its innovative aligner system: i-liner is your choice for a complete
aesthetic treatment. It is uniquely clear, provides a precise
fit for predictable treatment and employs an easy-to-use
Web-based workflow. A specific manufacturing process
using outstanding, innovative Flexy material provides the
ultimate aesthetics and elasticity.
Round hole forming plier
Tear drop hole forming plier
Rectangular pin forming plier
Cylindric pin forming plier
I-liner aligners are individually handmade to round the
edges for increased comfort, and the superior material
used does not stain—some of the key benefits designed
to enhance patients’ confidence in their smiles.
Bite plane plier
contact
Sia Orthodontic Manufacturer
Zona industriale snc
81050 Rocca d’Evandro (CE)
Italy
Phone: +39 0823 908029
www.siaorthodontics.com
info@siaorthodontics.com
www.i-liner.it
info@i-liner.it
46
aligners
2 2022
[47] =>
meeting
Dental
newspapers
|
Specialty
magazines
CE
webinars
Online
dental news
WE CONNECT THE
DENTAL WORLD
Media | CME | Marketplace
www.dental-tribune.com
aligners
2 2022
47
[48] =>
| industry news
SprintRay Cloud services:
You scan, We plan.
A frictionless design workflow
Models for clear aligner fabrication
Per treatment plan: €140—turnaround in
three days!
Available from premolar to premolar for minor tooth
movement. Give patients the treatment they want at a
price they can afford. Upload patient data and let our
team of experts design ready-to-print aligner models that
you can fabricate in-office.
Provide your patient with the confidence of a great
smile—submit to SprintRay Cloud Design in minutes.
Step 1: Scan
Capture scans of the maxillary and mandibular
arches and of the occlusion. SprintRay Cloud
Design is compatible with any scanner of your
choice.
Step 2: Upload to SprintRay Cloud Design
1. Login or create an account at Dashboard.SprintRay.
com.
2. Create a profile for your patient.
3. Create a new treatment for your patient and select
“Models For Clear Aligner Fabrication” from the available options.
4. Select your treatment options, including midline movements, anterior–posterior relation, overjet, overbite
and tooth size discrepancy.
5. Provide an annotation for your aligner models.
6. Upload your scans, patient photographs (maxillary
occlusal, mandibular occlusal, left side, right side,
patient’s natural smile) and a recent radiograph.
7. Choose your material and print options.
8. Submit.
Step 3: Print
Print, wash and polymerise in under 35 minutes.
Thermoform each model and then remove the
aligner from the form following the instructions for
use of the aligner material.
48
aligners
2 2022
Step 4: Polish and deliver
Use a polishing wheel to remove any edges from the
aligner, wash it and deliver it to your patient.
Giving your patient a beautiful smile has never been
easier!
For more information, visit www.sprintray.com or contact
info.eu@sprintray.com.
[49] =>
industry report
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International Newsletter – 16 September 2021
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aligners
2 2022
49
[50] =>
| industry news
How Impress became the
European leader in invisible
orthodontics in just three years
Impress is the No. 1 European digital orthodontic brand.
Established in Barcelona in Spain in 2019, Impress has
revolutionised the invisible orthodontic segment with a
team of professionals specialised in making people smile
and the latest technology applied to the diagnosis, and
follow-up of all cases. Impress has managed to position
itself as the European leader in the orthodontic segment
with its award-winning invisible orthodontic treatment
and already has a presence in more than 130 European
cities across nine countries.
What makes Impress different?
How does it work?
Impress prides itself on its unique value proposition,
being the only invisible aligner provider to offer in-depth
medical check-ups and treatment monitoring led by inhouse orthodontists. Because direct-to-consumer
models continue to lose credibility, Impress employs a
hybrid model, having its own technology-enabled orthodontic clinics since the very beginning. This has led to
industry-leading sales conversion rates, an exceptional
customer experience and best-in-class clinical outcomes, all driven by a combination of technologies that
is becoming more difficult to replicate. The company
also has its own digital treatment planning and mass
aligner production facility, elevating the business to true
full-service status.
As Europe’s first full-service aligner specialist, Impress
provides 24/7 professional customer care via its app,
regular treatment oversight based on remote assessment and aligner attachments, all with a high rate of customer satisfaction.
Pretreatment
In the first phase, diagnosis and pre-orthodontic dental
treatment are carried out. In the first consultation, the
patient undergoes a complete oral examination, a radiograph, and a 3D scan, which allows the medical team to
diagnose the case and create a virtual simulation of the
entire treatment process. After just a few days, the patient
will receive a video simulation of what his or her future
smile will look like.
Treatment
Once the aligners have been created specifically to the
needs of the patient, they are sent directly to the patient’s
home, at which point the patient should notify Impress
and make an appointment to continue the treatment
process. Once the patient begins using his or her first set
of aligners, the majority of the progress will be monitored
online through the app, so he or she will not need to go
to the clinic as often, saving time and travel.
Post-treatment
After completing the treatment phase, the patient will
move on to the retainer stage. It is important for the
patient to know that teeth continue moving throughout
his or her life, so it is important that retainers are worn
properly.
50
aligners
2 2022
At Impress, all vital services are carried out by expert
teams in the company’s own clinics, which are now in
major cities throughout Europe (including in the UK,
Spain, France and Italy). While some competitors can
provide the same services, none do so from their
own clinics, leaving patients under the care of thirdparty dental services and therefore open to unnecessary
risk.
Technology is one of the main pillars of Impress. It has
strategic partnerships with 3D-printing technology
company Carbon and HP, taking advantage of the capabilities of the latter’s Multi Jet Fusion technology. The
digital orthodontic brand’s growing network of hybrid
clinics is supported by practice management software
and a best-in-class treatment monitoring app that make
use of artificial intelligence.
Impress takes the top spot
In just three years, Impress has become the No. 1 brand
and category leader in Europe. With more than 130 clinics
in nine countries, Impress has a global team of 1,000 employees, of which 500 are medical professionals specialised in orthodontics.
For more information, visit smile2impress.com or contact
yago.grela@smile2impress.com.
[51] =>
industry report
|
REGISTER FOR FREE
DT Study Club – e-learning community
THE GLOBAL DENTAL CE COMMUNITY
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Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist
dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse
individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.This continuing education
activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition
Program (ADA CERP) through joint efforts between Tribune Group and Dental Tribune Int. GmbH.
aligners
2 2022
51
[52] =>
| industry news
Dentist delivering an Invisalign treatment consultation with Align’s Invisalign Outcome Simulator Pro tool using an
iTero Element 5D Plus imaging system. (All images: Align Technology)
New Invisalign Outcome
Simulator Pro helps patients
envision their future smile
with in-face visualisation
Invisalign Outcome Simulator Pro is a powerful new tool
available on iTero Element Plus Series intra-oral scanners
and imaging systems. It enables dentists to show patients their potential new smile after Invisalign treatment,
using in-face visualisation and/or 3D dentition view, both
performed chairside in minutes.
Invisalign Outcome Simulator Pro supports a more
streamlined workflow and consultation. Advanced algo-
52
aligners
2 2022
rithms generate realistic simulations of Invisalign treatment outcomes to help drive patient education and treatment acceptance. Patient photos are easily captured
on a mobile device using the Invisalign Practice App,
and the scan is performed with the iTero Element Plus
Series intra-oral scanner. Upon the scan submission,
Invisalign Outcome Simulator Pro runs in the background. This enables dentists to continue the consultation using other iTero tools in their chairside discussions
[53] =>
industry news
“I think Invisalign Outcome Simulator Pro can take treatment acceptance to completely new levels. We’ve had
multiple patients attending for routine hygiene appointments, who, after seeing their in-face visualisation, have
decided to proceed with Invisalign treatment,” said
Dr Jonathan Fitzpatrick, an aesthetic and restorative
dentist from Glasgow in Scotland, who participated in the
limited market release of the tool. He added: “We’ve
also had multiple cases where patients were not aware
that Invisalign treatment was even an option for them,
thinking they would need years of fixed braces and
extractions. Being able to illustrate how the Invisalign
clear aligner treatment could transform their appearance
has completely changed the way we interact with patients.”
has been particularly effective for anterior spacing cases
and cases where there are significant changes to the anterior alignment, as the tool really shows the contrast of
before and after. “I had a very interesting case with a
patient who had a 3 mm midline diastema,” explained
Dr Harrington-Taylor. “She attended with a very positive
intention that she wished to fully close the diastema. We
ran a facially driven simulation using Invisalign Outcome
Simulator Pro with the plan to fully close the midline
diastema. But the patient felt that, when the diastema
was fully closed, she no longer recognised herself and
asked to modify the plan, leaving a 1–2 mm diastema
at the end of treatment. Without this tool, the standard
simulation would have shown her the diastema closed
which was what she initially had hoped for but using the
in-face visualisation feature enabled a more realistic and
personalised simulated view that allowed us to modify
our treatment goals to achieve the patient’s true desired
outcome. This was very helpful from a consent point of
view as well.”
For Dr Chloe Harrington-Taylor, a dentist with a special
interest in orthodontics and prosthodontics from
Abergavenny in the UK, Invisalign Outcome Simulator Pro
For information about the iTero Element Plus Series
scanners and imaging systems with Invisalign Outcome
Simulator Pro, please visit www.itero.com.
with their patients while the Invisalign treatment simulation is generated. Patients can then visualise what they
would look like after Invisalign treatment, rather than
wondering how straight teeth could change their smile.
|
The Invisalign Practice App with guided photo capture for consistency.
Dr Chloe Harrington-Taylor,
general practitioner and
Invisalign provider.
Dr Jonathan Fitzpatrick taking
treatment acceptance to new
levels.
aligners
2 2022
53
[54] =>
| meetings
Image: Shutterstock_1718628814
Aligner orthodontics:
EAS summer meeting in Portugal
offered clinical and technical
expertise
Nathalie Schüller, Dental Tribune International
The second European Aligner Society (EAS) summer
meeting, held at the Hilton Porto Gaia hotel on 1 and
2 July, was attended by 276 dental professionals and
11 exhibitors. Held under the theme “ALIGNERS AND 3D
PLANNING: FROM VIRTUAL TO REAL”, the event provided a day of lectures and a day of workshops and indepth courses hosted by leading aligner and treatment
planning companies.
The congress opening address was given by EAS 2022–
2023 President Dr Tommaso Castroflorio and EAS Scientific Chairman Dr Francesco Garino. Dr Castroflorio
emphasised the importance of science and technology
and EAS’s goal of benefiting its 600 members by inviting
54
aligners
2 2022
“real innovators to share their knowledge to improve everybody’s work”. He further stated that EAS “always
strives for excellence and has a need to show that excellence is possible with aligner orthodontics”.
With the stage set, Dr Victoria Martin gave the first presentation, describing her virtual planning routine and mistakes to avoid. She advised attendees to consider
attachments on the anterior teeth because without
them some movements are impossible and to order
fewer aligners and adjust the number ordered as the
treatment progresses. Ordering all the aligners at the
beginning of the treatment creates waste, takes up
office space and pushes up the treatment cost. She
[55] =>
meetings
emphasised the importance of respecting the biological
limits and of taking good photographs to develop a
treatment plan that respects them, the software not
being able to do it for the practitioner.
Dr Bruno Filipe Almeida Gomes talked about movement
predictability in the analysis of the treatment plan. He
highlighted that predictability supports good results and
that in this regard aligners offer something conventional
treatments do not: control. The biological limits are the
basis of a treatment plan, and for a good treatment plan,
the amount of movement to be done as well as the type
and the sequence of movements need to be well defined,
he advised.
In his presentation on Invisalign with mandibular advancement in Class II malocclusions, Dr Pedro Costa
Monteiro made it clear that dentists should fully exploit
technology. Furthermore, he emphasised that the airway
is crucial in early orthodontic treatment: a patient who
does not breathe normally will face many problems.
To conclude the morning session, Dr Castroflorio spoke
about the European Board of Aligner Orthodontics’
(EBAO’s) certification of excellence in aligner orthodontics, introduced during the third biennial EAS congress,
and the accreditation process. He also announced EAS’s
partnership with Align Technology, aimed at elevating education standards in orthodontic aligner therapy. Align
will be advocating its educational programmes as preparation for the EBAO Clinical Master, and EAS recognises
them as being compliant with the EBAO clinical guidelines and objectives.
In the afternoon, Dr Bruce McFarlane went over the advantages of using Henry Schein SLX/Reveal clear aligners. He explained that the design and material and fabrication method used make it possible to have fewer
attachments, aligners that are less visible and reduced
staining.
Matthias Peper, founder and managing director of TP
SOLUTION, explored whether there is a science behind
digital treatment plans in complex aligner orthodontics. A
master dental technician, he pointed out the importance
of the dental practitioner giving as much information as
possible to the dental technician to achieve a successful
digital treatment.
Dr Vincenzo d’Antò discussed aligner treatment of patients with dentoalveolar asymmetries. According to him,
the only way to plan predictable movements is to move
the crown, not the root. The clinical tips he gave were to
|
evaluate elastic biomechanics, to be careful with jumps
and ask why the dentist would want to plan the jump and
to consider extractions as an option.
A highlight of EAS meetings is learning about new technology and how to apply techniques, and attendees thus
look forward to the workshops and in-depth courses.
Intensiv SA, SprintRay, ORTHOiN3D, Clear TPS and
DentalMonitoring offered five 45-minute workshops in
five sessions, making it possible for delegates to attend
each of them.
Dr Paolo Manzo presented the DentalMonitoring workshop, during which he explained how using the company’s software can improve the dentist’s practice and
relationship with patients. The smart algorithm supports
the dentist in detecting problems and checking treatment
progress based on intra-oral images taken and submitted by the patient, reducing the need for office visits.
The patient can contact the dentist directly via the app,
and the dentist can chat with the patient too but can
decide when, where and how.
Align Technology hosted a practical discussion on
complex cases in teens by Dr Ramón Mompell and a
session in which Zelko Relic, executive vice president
and chief technology officer at Align, explored reimagining digital orthodontics and Dr Costa Monteiro described his experiences of treating growing patients with the
Invisalign system, demonstrated with examples of some
of the challenging cases he has treated. Tracy Posner
who attended the session commented: “His kick-off
point was the use of the newly enhanced aligners for
young patients which enable mandibular advancement,
and he went on to share in depth his tips and tricks
for getting the most from the Invisalign innovations.
This proved to be fertile ground for a slew of questions
from engaged delegates keen to pick the brains of such
an experienced Invisalign master.” In Henry Schein’s
course, Dr McFarlane, with great enthusiasm, presented
on aligner treatment efficiencies and Class II and III
correction with SLX/Reveal aligners.
The Italian city of Turin, the home of Drs Castroflorio and
Garino, will host the fourth biennial EAS congress from
11 to 13 May 2023. The theme of the congress will be
“The next level”. In aligner orthodontics, the technology
is progressing so fast that it would not be an overstatement to say that the event will have much new to
report.
Information on the EBAO Clinical Master process can be
found on the EAS website: https://ebao.eas-aligners.com.
aligners
2 2022
55
[56] =>
| meetings
International events
Italian Society
of Orthodontics – SIDO
Swiss Orthodontic Society
13–16 October 2022
53rd International Congress
Florence, Italy
www.sido.it
17–19 November 2022
Annual Congress
Interlaken, Switzerland
www.swissortho.ch
Pacific Coast Society
of Orthodontists – PCSO
27–30 October 2022
Western Orthodontic Conference – WOCON
Combined meeting PCSO & RMSO
San Diego, US
www.pcsortho.org
Asian Pacific Orthodontic
Society – APOS
28–30 October 2022
13th Conference and 55th Annual
Scientific Congress of the Korean
Association of Orthodontists
Seoul, Korea
www.asianpacificortho.org
International Dental Show – IDS
14–18 March 2023
Cologne, Germany
www.english.ids-cologne.de
American Association
of Orthodontists – AAO
21–24 April 2023
Annual Session 2023
Chicago, US
www2.aaoinfo.org/meetings
Southern Association
of Orthodontists – SAO
4th EAS Congress – EAS
Fédération Française
D’Orthodontie – FFO
11–13 November 2022
24es Journées de l’Orthodontie
Paris, France
www.journees-orthodontie.org
56
aligners
2 2022
11–13 May 2023
Turin, Italy
www.eas-aligners.com
EOS Annual Congress 2023 – EOS
11–15 June 2023
Oslo, Norway
www.eoseurope.org/annual-congress
© 06photo/Shutterstock.com
3–5 November 2022
Annual Meeting
Austin, US
www.saortho.org
[57] =>
© 32 pixels/Shutterstock.com
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Xxxxxx
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How to send us your work
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Please do not submit multiple files for
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Questions?
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aligners
2 2022
57
[58] =>
| international imprint
aligners
international magazine of aligner orthodontics
Imprint
Publisher and Chief Executive Officer
Torsten R. Oemus
Chief Financial Officer
Dan Wunderlich
Chief Content Officer
Claudia Duschek
Managing Editor
Nathalie Schüller
n.schueller@dental-tribune.com
Contributing Editor
Iveta Ramonaite
International Office
Dental Tribune International GmbH
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Germany
Phone: +49 341 4847 4302
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General requests: info@dental-tribune.com
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www.dental-tribune.com
Scientific Advisor
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Project Manager
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Copy Editors
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Executive Producer
Gernot Meyer
Sign up for the free newsletter by scanning the QR code and receive the
latest news on aligners, as well as the digital version of the magazine.
For print copies and subscription, please contact
info@dental-tribune.com.
Advertising Disposition
Marius Mezger
Copyright Regulations
All rights reserved. © 2022 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International
GmbH is expressly prohibited.
Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or
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.
58
aligners
2 2022
[59] =>
ADVANCED CLEAR ALIGNER
SYSTEM FOR ORTHODONTISTS
MORE CONTROL AND FLEXIBILITY
FOR PREDICTABLE TREATMENT PLANNING
With clinical experience from trusted doctors around the world,
SPARK has created an advanced clear aligner system that is
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From Ormco, where your practice is our priority.
To find out more, go to: ormcoeurope.com
Approver Software featuring CBCT integration for more predictability.
19% better contact with the tooth for precise tooth movement.
TruGEN™ material with higher sustained force retention.*
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refinements by 20%.”
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More clear, more comfortable, stains less.*
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*Data on file.
[60] =>
| Xxxxxx
The TwinAligner® System
# Leading-edge technology
# Patient-friendly
# Accurate, visible results
Orthocaps®, the Aligner System
which provides free consultancy
services to all its users.
A customized treatment plan that incorporates
HAT (Hybrid Aligner Treatment) Auxiliairies for complex treatments.
orthocaps® PRO
orthocaps® KIDS
orthocaps® NOCTIS
orthocaps® TEN
Quality - Made in Germany -
orthocaps® TEN+TEN
The Orthocaps® aligners are manufactured at our facility in Germany.
This guarantees the highest quality standards, short delivery times and faster service.
60
aligners
2 2022
Ortho Caps GmbH | An der Bewer 8 | 59069 Hamm
Fon: +49 (0) 2385 92190 | Fax: +49 (0) 2385 9219080
info@orthocaps.com | www.orthocaps.com
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[title] => Stop asking aligners to do things they are not good at!
[page] => 6
)
[4] => Array
(
[title] => New concepts in aligner therapy with the orthocaps system
[page] => 12
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[5] => Array
(
[title] => Addressing smile aesthetics with digital orthodontic planning and treatment: A case report
[page] => 18
)
[6] => Array
(
[title] => The informed, lifetime patient
[page] => 26
)
[7] => Array
(
[title] => If I could see through your eyes, I wonder what I would see?
[page] => 30
)
[8] => Array
(
[title] => Clinicians and researchers advancing aligner orthodontic treatment together
[page] => 34
)
[9] => Array
(
[title] => I hope that sustainable dentistry will soon reach critical mass and become the norm
[page] => 35
)
[10] => Array
(
[title] => Global clear aligner market: The stars are aligned
[page] => 38
)
[11] => Array
(
[title] => Industry report
[page] => 41
)
[12] => Array
(
[title] => Industry news
[page] => 46
)
[13] => Array
(
[title] => Meetings
[page] => 54
)
[14] => Array
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[title] => Submission guidelines
[page] => 57
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[15] => Array
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[title] => International imprint
[page] => 58
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[toc_html] =>
[toc_titles] => Cover
/ Editorial
/ Content
/ Stop asking aligners to do things they are not good at!
/ New concepts in aligner therapy with the orthocaps system
/ Addressing smile aesthetics with digital orthodontic planning and treatment: A case report
/ The informed, lifetime patient
/ If I could see through your eyes, I wonder what I would see?
/ Clinicians and researchers advancing aligner orthodontic treatment together
/ I hope that sustainable dentistry will soon reach critical mass and become the norm
/ Global clear aligner market: The stars are aligned
/ Industry report
/ Industry news
/ Meetings
/ Submission guidelines
/ International imprint
[cached] => true
)
