aligners international No. 2, 2024
Cover
/ Editorial
/ Content
/ How to overcome obstacles in offering interdisciplinary dental care
/ Curaprox Aligner Foam: Optimising oral health during treatment
/ By combining aligners with temporary anchorage devices, clinicians can take this tool to the next level
/ Excellent performance and affordability: The just-launched K SCAN Pro intra-oral scanner
/ Instagram helps researchers evaluate patient satisfaction with clear aligner therapy
/ Multilayer materials enhance the efficacy of aligner treatment
/ ClearX teen smile transformation
/ SureSmile clear aligners—a proven system for predictably treating malocclusion
/ Strategies to enhance patient experience and interaction with aligner therapy
/ How far has 3D printing brought clear aligners?
/ Periodontal considerations in aligner treatment
/ Work–life balance—a lifestyle more than a goal
/ Industry news
/ Manufacturer news
/ International events
/ Submission guidelines
/ Imprint
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[1] =>
2/24
DE
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0 YEA
IA
& 2
R
OF
case report
ClearX teen smile transformation
Strategies to enhance the patient experience
and interaction with aligner therapy
E
D
EA
How to overcome obstacles in offering
interdisciplinary dental care
F
N
. • 30 Y
S
OEMUS
aligner orthodontics
trends & applications
practice management
INT
international magazine of
E
aligners
O
issn 1868-3207 • Vol. 3 • Issue 2/2024
M
[2] =>
Premier aligner.
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[3] =>
editorial
|
Dr Iro Eleftheriadi
Orthodontist, senior clinical specialist at Align Technology
The future of dentistry is digital
What is the next major trend that will bring us closer to the
future? Predictions concerning how cutting-edge technologies will improve healthcare seem to be in endless supply, and one area in which the practical value of digital is
expanding is in the field of orthodontics. The perception
of a typical dental practice is fast becoming a thing of the
past, thanks in no small part to the pace at which orthodontic innovations are advancing. Valued at US$3.9 billion
(€3.4 billion*) in 2021, the global digital dentistry market
is expected to reach US$5.8 billion by 2028, representing an impressive compound annual growth rate of 5.9%.
The number of dental appointments conducted online has
increased rapidly in recent years and continues to rise.
Patients today can share images of their oral cavity with
their dentists, allowing them to monitor treatments, identify potential problems and recommend treatment options
remotely, all through the use of a smartphone.
A human-centric model
As technology evolves, dentists today are tapping into
tried-and-tested innovations that support their profession,
providing them with the tools they need to deliver an enhanced patient experience. Align Technology, for example,
is taking digital dentistry to the next level with a myriad
of solutions to help make the orthodontist’s and patient’s
experience more seamless, efficient and modern. By implementing digital innovations, orthodontists can care for
more patients in a shorter time. For example, with the
Invisalign Virtual Appointment tool, dentists can monitor
the treatment progress of their patients and enhance patient communication by sharing their progress and answering their questions about their Invisalign treatment. The
tool allows dentists to schedule consults and follow-ups
and keep in touch with their patients. A further example
of the expanding adoption of digital is the intra-oral scanning of the patient at every consultation, giving the dentist
important data regarding the patient’s dentition to support
preventive care. Another growing trend in the uptake of
digital innovations is the use of clear aligners instead of
fixed orthodontic appliances. Align’s Invisalign is a globally renowned aligner system that is effective in rectifying
a broad range of problems, from purely cosmetic issues
to more complex conditions that could have a detrimental
impact on health, giving Invisalign-trained practitioners the
ability to deliver effective treatment to greater numbers of
patients in ever-shorter time frames.
Dentistry—but not as we know it
Considering the fast pace of the advancement of today’s
orthodontic technology and the trends in its uptake, how
is a dental visit likely to look 50 years from now? Here
are my predictions. When the patient arrives for a routine
dental appointment, his or her virtual profile will be available to the dentist and dental team and include smart
data analytics to help improve or maintain the patient’s
healthy smile. The appointment will be more time-efficient
from both the dentist’s and the patient’s perspective, saving them time in their busy agendas. No matter the stage
of treatment, an intra-oral scan will be taken, and the process will be efficient and comfortable. The patient will have
a more visual experience, being able to see the progress
of treatment in real time as well as 3D animated forecasts
of the expected results. The change that will take place
with more widespread adoption of digital dentistry will be
in the dynamics and quality of care, creating frictionless
access for patients. Technology is by no means here to
replace practitioners, but innovations in digital dentistry
will make it possible for the dental profession to evolve
and be able to offer more to a broad range of patients.
While we do not know for sure what the future holds, we
can be optimistic that it will be an exciting journey for both
dentists and their patients.
Dr Iro Eleftheriadi
Orthodontist, senior clinical specialist at Align Technology
Editorial note:
* Calculated on the OANDA platform for 31 December 2021.
aligners
2 2024
03
[4] =>
| content
editorial – Dr Iro Eleftheriadi
trends & applications
How to overcome obstacles in offering interdisciplinary dental care
– Dr Rooz Khosravi
interview
06
Curaprox Aligner Foam: Optimising oral health during treatment
14
By combining aligners with temporary anchorage devices, clinicians
can take this tool to the next level
16
Excellent performance and affordability: The just-launched
K SCAN Pro intra-oral scanner
18
Instagram helps researchers evaluate patient satisfaction
with clear aligner therapy
20
Multilayer materials enhance the efficacy of aligner treatment
22
– An interview with Dr Ana Bokuchava
page 06
03
– An interview with Dr Skander Ellouze
– An interview with Mariele Hölscher
– An interview with Dr Vincenzo Grassia
– An interview with Dr Tarek Elshazly
page 24
case report
ClearX teen smile transformation – Dr Miguel Teixeira
product report
SureSmile clear aligners—a proven system for predictability treating
malocclusion – Drs Ahad Sheikh & Carol Rugeles
practice management
page 34
Strategies to enhance patient experience
and interaction with aligner therapy – Dr Waddah Sabouni
news
How far has 3D printing brought clear aligners?
feature
DE
F
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IB
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OF
E
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& 2
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0 YEA
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international magazine of
N
aligners
OEMUS
M
aligner orthodontics
44
Operation Smile benefits from a significant legacy
ICD is the new home of the now Global Oral Health Leadership Institute
ADA releases first standard for clear aligner materials
manufacturer news
Revolutionising orthodontics: DynaFlex’s comprehensive suite of
advanced clear aligner solutions
International elite of the dental industry in dialogue at VOCO
meetings
International events
trends & applications
How to overcome obstacles in offering
interdisciplinary dental care
38
Work–life balance—a lifestyle more than a goal
industry news
2/24
34
40
– Jerko Bozikovic
issn 1868-3207 • Vol. 3 • Issue 2/2024
28
Periodontal considerations in aligner treatment
– Dr Irineu Gregnanin Pedron
Cover image: Solventum
www.solventum.com
24
case report
48
50
51
52
54
56
ClearX teen smile transformation
about the publisher
practice management
Strategies to enhance the patient experience
and interaction with aligner therapy
04
aligners
2 2024
submission guidelines
international imprint
57
58
[5] =>
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FOR ALIGNER ATTACHMENTS
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2 2024
05
[6] =>
| trends & applications
How to overcome obstacles
in offering interdisciplinary
dental care
Dr Rooz Khosravi, US
Interdisciplinary dental care
Delivery of dental care falls into two categories: single
provider care (uni-disciplinary) and collaborative care.
The structure of a practice—that is, solo practitioner,
private multi-practitioner or corporate dentistry model
(dental support organisation or orthodontic support organisation )—and a provider’s overall viewpoint on the
delivery of dental care influence adoption of one versus
the other approach. Multidisciplinary and interdisciplinary care are two forms of collaborative delivery of dental
care. In the multidisciplinary model, the patient will be
treated by multiple providers specialised or focused on
certain subdomains of dentistry. The overall treatment
plan and goals are not coordinated, and the delivery of
care is often in a tandem fashion; for example, the orthodontist optimises space for an implant and then passes
the patient to the periodontist to place the implant, and
the general dentist delivers the implant-supported restoration. The treatment outcome in multidisciplinary care
can be successful, especially if all providers think similarly and have an overlapping treatment philosophy.
Nonetheless, the likelihood of complications and substandard treatment outcomes is also high, primarily
owing to a lack of communication.
Collaborative dentistry ideally ought to be delivered in an
interdisciplinary model. Specifically, various providers
with an array of expertise collaboratively develop a treatment plan, involving the patient in this process. The delivery of the interdisciplinary treatment plan is sequenced
and timed with milestones defined for each provider.
The team collaborates through the delivery of care and
adjusts the plan as needed based on a common vision.
An example of such an interdisciplinary team is the
Northwest Network for Dental Excellence, a study club
developed by Dr Ralph O’Connor.
Various advantages of interdisciplinary collaborative
dentistry have been highlighted.1 These benefits can be
divided into patient-related improvement of care and
provider-focused professional development. Examples
of patient-related advantages are greater quality of care,
06
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2 2024
decreased potential error or duplication of services, enhanced cost-effectiveness and treatment efficiency, and
an overall elevated patient and caregiver experience. For
providers, delivering care as part of an interdisciplinary
team allows them to advance professionally. These collaborations have a compounding effect and create more
collaborations. Furthermore, having a group with whom
to discuss the daily ups and downs of practising dentistry is an indirect benefit of delivering dental care according to an interdisciplinary approach.
To develop an interdisciplinary team, one should identify
potential members that excel in the following five characteristics: collaborative mindset, commitment to learning, supportive personality, time management skills and
trustworthiness.2 Specifically, one should prioritise collective goals over individual achievements and understand that collaboration leads to better patient care outcomes. The interdisciplinary team members ought to
possess deep expertise in their respective fields, raising
the overall standard of care. An ideal member of an interdisciplinary team encourages and supports other
team members while maintaining focus on treatment
objectives and the overarching vision. High-level time
management skills to enable regular participation in
group discussions and meetings is essential, and an interdisciplinary team member ought to share opinions
openly and honestly, fostering a culture of transparency
and non-judgement. Individuals with inflated egos are
likely to weaken the team.
Obstacles to delivering interdisciplinary
dental care
Despite the significant advantages of delivering dental care through a collaborative interdisciplinary approach, most dental care is delivered according to
uni-disciplinary or multidisciplinary approaches. Anecdotally, when dental professionals are asked about their
reluctance to adopt an interdisciplinary approach to
dental care, their responses generally fall into two categories: the complexity of delivering interdisciplinary
care—essentially not knowing where to start—and the
[7] =>
trends & applications
|
Fig. 1: Four-step framework for achieving predictability and systematically developing and delivering interdisciplinary care.
time-consuming nature of communication within an interdisciplinary team.
To address these challenges, a systematic framework—
essentially an operating system for interdisciplinary
care—is necessary. The core advantages of this approach are the consistency and standardisation of best
practices, as well as the optimisation of treatment efficiency and resource utilisation.
A four-step framework for developing an
interdisciplinary treatment plan
To overcome complex issues, a set of guidelines is essential for tackling the problem consistently.3 These
guidelines help in formulating a clear plan and resolving
each issue by breaking it down into simpler, manageable components.
An interdisciplinary treatment planning framework offers
a comprehensive structure that encompasses various
methodologies, techniques and processes. Essentially,
it acts as an operating system guiding practitioners
through each step—from collecting information and analysing records to developing problem lists and treatment objectives (Fig. 1). Finally, it aids in formulating an
interdisciplinary plan and determining the sequence of
treatment. This framework simplifies the process and
helps practitioners develop muscle memory as they
practise delivering interdisciplinary dental care.
The first step of interdisciplinary treatment planning
begins with a clinical examination to collect both subjective and objective information. This includes acquiring
diagnostic records such as 3D dental models, radiographs, questionnaires, and intra-oral and extra-oral
photographs. Subjective information encompasses the
patient’s medical and dental history, as well as social
history (e.g. family structure and dynamics, distance to
commute for care and level of interest and engagement).
At this stage, it is also vital to assess the patient’s perceptions and expectations and conduct an objective assessment.
The clinical examination encompasses both extra-oral
and intra-oral assessments of the patient. These assessments should take into account all three planes of
space: anterior–posterior, transverse and vertical. During
the clinical examination, it is essential to document facial
and skeletal patterns, as well as collect smile arc
records. Additionally, a thorough periodontal evaluation,
an assessment of the patient’s restorative status (including aesthetic and functional occlusion) and a temporomandibular joint evaluation should be performed. The
periodontal examination should include an assessment
of gingival type, bone topography, oral hygiene, gingival
aesthetics (including display, colour, contour and papillary form), probing depths, recession and furcation
involvement–including horizontal bone loss. Restorative
assessments should cover all aspects of the occlusion:
contacts, guidance, mobility, functional mobility, tooth
position (including rotation and tipping) and any existing
restorative work or needs, such as caries. This comprehensive approach ensures a detailed and accurate evaluation of the patient’s overall oral health.
The second step involves evaluating the diagnostic
records and clinical examination information to develop
a comprehensive problem list. This evaluation should
involve analysis of all diagnostic records, such as 3D
scans and radiographs, video records (e.g. smile analysis), 2D photographs, questionnaires (e.g. nutrition or
aligners
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[8] =>
| trends & applications
2b
2a
2c
2e
2h
2d
2f
2i
2k
2l
2g
2j
2m
2n
2o
2p
2q
2r
2s
Figs. 2a–s: (a–g) Illustration of the use of digital treatment simulation to assess the feasibility of extracting the maxillary first premolars and ultimately restoring the maxillary anterior teeth with veneers. Extra-oral photographs and intra-oral scans of the initial
situation. (h–s). Digital treatment simulation in SureSmile (Dentsply Sirona) of treatment to be delivered through robotically bent
lingual fixed appliances.
08
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[9] =>
trends & applications
sleep evaluations) and reports (e.g. sleep reports and
physician’s letters). To ensure thoroughness and consistency, it is advisable to use a standardised template for
this step.4 This approach helps to avoid overlooking information and helps to maintain consistency over time,
facilitating a more accurate and reliable development of
the problem list.
The third step involves using the problem list to establish
treatment objectives that aim to completely or partially
address the identified issues. As part of this step, a
treatment simulation should be conducted to evaluate
the feasibility of the proposed treatment objectives. For
example, one might consider how much mandibular anterior intrusion is required to level the mandibular arch
completely and whether this level of intrusion is biologically achievable and predictable, or one might determine how much space is necessary to restore severely
worn maxillary anterior teeth. By carefully examining
these factors through treatment simulations, clinicians
can ensure that the treatment objectives are realistic
and achievable.
The fourth step entails formulating the treatment plan
and creating a treatment sequence with clear assignment of treatment objectives to be addressed by the respective members of the interdisciplinary team. When
developing a treatment plan, one ought to clearly define
the differences between normal and ideal conditions,
appreciate dental and skeletal compensations, and recognise the limitations of all procedures and techniques
in an interdisciplinary treatment plan.5 When finalising
the treatment plan, the financial aspect of care must be
considered. A practical and predictably successful interdisciplinary treatment plan can be developed around a
compromised treatment, for example leaving an adult
patient in posterior crossbite with a functional occlusion.
Following these four steps helps providers to develop a
clear and structured approach to interdisciplinary treatment, regardless of the complexity of care. For more detailed information on this process, please refer to Nelson
et al.4
Leveraging treatment simulation to deliver
a successful interdisciplinary treatment
Traditionally, treatment simulations—also known as
set-ups—are performed using physical dental models
mounted on articulators. This approach remains useful,
particularly for treatments that require accurate replication of occlusion and facial records using an articulator.
However, digital technology has significantly enhanced
the process of simulating interdisciplinary treatments
(Fig. 2). Historically, the cost and time involved have
been major barriers to the widespread use of treatment
simulations.6 Software programs have alleviated these
|
issues by reducing or even eliminating costs. Some software, such as ClinCheck (Align Technology), is operated
by third-party technicians and often provided at no additional cost. Additionally, provider time is minimised, as
laboratory technicians create the simulations based on
the provider’s recommendations.
Beyond cost reduction and time-savings, the advantages of digital treatment simulation include the precise
identification of tooth movement and the ease of sharing
simulations with the treatment team and patients. A
recent study revealed that orthodontists found treatment simulations for patients with varying degrees of
treatment needs to be useful, even though they do not
routinely use them in their practices.6
Evaluating multiple digital treatment simulations can aid
in developing realistic treatment objectives. These simulations should be collaboratively planned after creating
the problem list and drafting the treatment objectives.
Examples of matters to cover in an interdisciplinary
treatment simulation include defining a healthy range of
tooth movement with orthodontic care, estimating the
response of periodontal tissue to planned tooth movements, determining the requirements of alveolar bone
morphology (width and height) for dental implant placement and marking the position of gingival margins in the
aesthetic zone.
Enhancing interdisciplinary care with 3D
printing
Dental 3D printing (additive manufacturing) has significantly improved over the last decade.7 As mentioned,
developing treatment simulations is a key strategy for
delivering successful interdisciplinary care. To further
enhance the benefits of treatment simulations, the interdisciplinary team can integrate 3D printing into the
process (Fig. 3).
Treatment simulations can be printed in various formats,
including dental models, temporary restorations and
surgical guides. These printed objects help solidify the
treatment plan and bring the interdisciplinary team’s
vision to life. The cost of these solutions has been decreasing owing to advancements in resin materials and
affordable design services. I believe that 3D printing
strengthens the third step of the interdisciplinary treatment planning framework.
Interdisciplinary team communication in the
digital era
Dentistry has undergone significant demographic and
psychosocial transformations over the past two
decades. What was once an industry predominantly occupied by white men has transitioned to a more diverse
aligners
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[10] =>
| trends & applications
3b
3c
3a
3d
3f
3e
3g
3i
3h
3j
Figs. 3a–j: (a–e) Demonstration of how 3D printing can enhance the delivery of interdisciplinary care. Design of 3D-printed temporary restorations for a patient with amelogenesis imperfecta. (f–j) Mock-up veneers for a patient who completed interdisciplinary
restorative and orthodontic treatment and was to receive veneers on all the maxillary anterior teeth.
field, in which an increasing number of female practitioners from various backgrounds practise. The needs
and norms of this new majority in dentistry are different.
In the past, communication among interdisciplinary team
members often took place within a boys’ club culture, involving breakfast or lunch meetings to review paper
charts, and sometimes included activities such as
smoking cigars or playing golf. These providers did not
face the modern complexities of managing a dental
practice, where practitioners must juggle multiple roles—
such as business-related practice tasks—alongside the
global shortage of dental auxiliary team members.
Today, many dental providers—often mothers—have
limited time for in-person meetings as they balance parenthood and work responsibilities. Additionally, generational expectations differ significantly, from baby
boomers to millennials, particularly in the US. Younger
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dental providers tend to emphasise a more pronounced
separation between work and personal life. Family or
non-work-related activities often take precedence over
lunch meetings or regular golf outings.
In addition to the changing attributes and expectations
of the new generation of dental providers, the postCOVID era has brought an abundance of tools for virtual
meetings. By integrating digital dentistry with online
communication tools, practitioners can manage short
and efficient meetings, facilitating collaborative interdisciplinary dental care (Fig. 4).
Google Meet, Zoom and WhatsApp are examples of
platforms that interdisciplinary dental teams can use for
communication. Because concerns about security on
these platforms may arise, it is essential for all providers
to implement measures to keep their communication on
these digital platforms secure. Dental companies are
[11] =>
trends & applications
|
4a
4b
Figs. 4a & b: (a) Contrasting traditional and modern communication approaches in interdisciplinary teams. Traditional approach:
communication mainly through in-person meetings, often incorporating social events, to review paper charts and physical treatment simulations. (b) Modern approach: communication primarily through digital technologies.
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[12] =>
| trends & applications
also contributing to this digital transformation by creating secure communities, such as Smilecloud.8
The integration of digital technology in dentistry enables
interdisciplinary team members to simulate treatment
plans, 3D-print diagnostic or therapeutic models and
appliances, and screen record their ideas for more
effective and efficient communication. For instance, I
primarily meet with my oral and maxillofacial surgeon
collaborator over Zoom to review surgical and orthodontic simulations for patients undergoing orthognathic
surgery. These meetings, which last for 30–45 minutes,
can easily be scheduled at any time of the week, effectively eliminating barriers to collaboration.
Interdisciplinary care principles
Based on my reading of Ray Dalio’s popular book titled
Principles, I believe an interdisciplinary team should
have an interdisciplinary principles book. Dalio suggests
developing a set of principles constructed through
self-reflection of positive and negative life experiences
to intentionally develop learning opportunities from mistakes and to establish clear decision-making processes
when facing challenges. An interdisciplinary principles
book—an evolving project over multiple years—includes
an agreement among the team members on patient
care and treatment philosophy (Box 1). Specifically, agreement
1 on patient care covers hospitality towards patients,
an optimised approach to the referral process, financial
processes for each member of the team and an effective
communication protocol. Agreement on the treatment
philosophy:
1. helps to align the interdisciplinary team’s approach to
patient care;
2. helps to align the interdisciplinary team’s approach to
the accuracy and completeness of patient records;
3. helps to align the interdisciplinary team’s approach to
challenges in delivering care; and
4. helps to align the interdisciplinary team’s approach to
periodic calibration on technique and knowledge.
Defining the goals and maintaining open communication
is an ongoing process that requires continuous refinement throughout the various stages of initiating and
completing interdisciplinary treatments.9
The compound effect in collaborative interdisciplinary dental care
Being part of an interdisciplinary team is a cornerstone
of professional growth. Knowledge gained through continuing education often has a short shelf life; much of
what one learns in a weekend course may be forgotten
within a month. However, the iterative process of evaluating, developing, delivering and refining interdisciplinary
treatment plans over time creates a compounding effect.
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Box 1: Collaborative interdisciplinary care principles. The
principles of interdisciplinary dental care define the core values and concepts that guide the refinement of collaborative
practices over time. These principles serve as guidelines for
decision-making in the development and delivery of comprehensive dental care, from managing single missing teeth to fullmouth occlusal rehabilitation. Notably, patients with systemic
conditions, such as diabetes or obstructive sleep apnoea, require interdisciplinary care involving both medical and dental
teams. The scope of these principles can extend beyond dental care alone.
Through collaboration, one can fill gaps in one’s knowledge with insights from other providers and gain firsthand experience of both successful and unsuccessful
treatment plans.
In the stressful life of being a dental practitioner and, for
some, a business owner, the sense of belonging to a
team provides crucial emotional and psychological
support. One can bring issues not related to interdisciplinary treatment to the group and seek help. Over time,
the culmination of collaborative dentistry enhances
problem-solving skills and improves efficiency and effectiveness in delivering patient-centred care.
As the founder and director of a local dental study club,
I frequently engage with young dentists who have
owned their practices for three to five years and have
reached a plateau. These dental providers often seek
further continuing education opportunities and a supportive network for growth and learning. Being part of
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trends & applications
an interdisciplinary team over time addresses many of
these gaps, transforming the potentially mundane practice of dentistry into a dynamic and fulfilling career.
Takeaway
Interdisciplinary collaborative delivery of dental care
offers an optimal choice for both patients and providers.
This approach, while complex, brings exceptional benefits and requires a structured and predictable framework.
Mastery of interdisciplinary dentistry involves a continuous cycle of data collection, planning and delivery.
To get started, familiarise yourself with the four-step
framework and its applications. Assemble a team with
the right characteristics for successful collaboration. Establish the guiding principles for your interdisciplinary
team and utilise digital tools to enhance communication
and streamline the treatment planning process. In
summary, follow these steps:
1. Study the framework.
2. Build your team.
3. Define your principles.
4. Leverage digital technology.
If starting from scratch, follow a phased approach in
three phases over 36 weeks to establish and refine your
interdisciplinary practice:
1. Infrastructure (weeks 1–12)
· Understand the fundamentals of interdisciplinary
care.
· Build your interdisciplinary team.
· Define your team’s principles and treatment philosophy.
2. Practice (weeks 13–24)
· Treat patients collaboratively with your interdisciplinary team.
· Apply the four-step framework in real-world scenarios.
3. Refinement (weeks 25–36)
· Identify issues and challenges in your system.
· Refine and optimise the framework based on practical experience.
Interdisciplinary collaborative dentistry is not only a
pathway to achieving exceptional patient outcomes but
also a fulfilling way to practise dentistry. It requires
passion, dedication and long-term commitment. Embrace this journey, and enjoy the transformative impact
it can have on your practice and patient care.
needs. I would also like to extend my gratitude to all the
students who have engaged in countless discussions in
helping to hone our interdisciplinary principles at the University of Washington School of Dentistry. Special thanks
go to Drs Vincent Kokich Sr, Dave Mathews, Douglas
Ramsay, John Moore, Ward Smalley, Chris Riolo and
Diane Doppel, who have established and evolved interdisciplinary care in the Department of Orthodontics at the
school over many decades.
about
Dr Rooz Khosravi is a clinical associate professor of orthodontics in the Department of Orthodontics at the University of Washington School of Dentistry
in Seattle in the US. He can be contacted at roozkh@uw.edu.
References
1
2
3
4
5
6
7
8
Acknowledgements
I am indebted to Drs Travis Nelson, Van Ramos,
Robert London, Sul Ki Hong, Greg J. Huang and Tarisai
Dandajena for their unwavering support and collaboration in treating patients with interdisciplinary dental
|
9
Spear FM. Forming an interdisciplinary team: a key
element in practicing with confidence and efficiency.
J Am Dent Assoc. 2005 Oct;136(10):1463–4. doi:
10.14219/jada.archive.2005.0062.
West JD, O’Connor RV, Cook DH. The interdisciplinary referral. Dent Today. 2002 Nov;21(11):98–105.
Pyzdek T. The lean healthcare handbook: a complete guide to creating healthcare workplaces. 2nd
ed. Cham: Springer; 2021. 252 p.
Nelson T, Khosravi R, Ramos V, Hong SK, Cook D.
Interdisciplinary dentistry for complex paediatric
dental cases. Int J Paediatr Dent. 2024 Apr 22. doi:
10.1111/ipd.13194.
Nguyen T, Sarver DM, Jackson TH. The decisionmaking process in orthodontics. In: Graber LW, Vig
KW, Huang GJ, Fleming PS, editors. Orthodontics:
current principles and techniques. 7th ed. St. Louis,
MO: Elsevier; 2023. p. 187–226.
Chiu A. Utility of automated digital setup for orthodontic treatment planning [thesis]. [Seattle, WA]: University of Washington; 2024.
Khosravi R. Additively manufactured dental appliances. In: Narayan RJ, editor. Additive manufacturing in
biomedical applications. Detroit, MI: ASM International; 2022. p. 466–71. (ASM handbook; vol. 23A).
Institut Straumann. Meet Smilecloud. Basel: Institut
Straumann; c2024 [cited 2024 Aug 23]. Available
from: https://www.straumann.com/en/dental-professionals/products-and-solutions/cares-digital-solutions/software/smilecloud.html.
Murphy MT. Collaborative interdisciplinary agreements:
a new paradigm in laboratory and specialist communication and patient care. J Am Dent Assoc. 2006 Aug;137(8):
1164–7. doi: 10.14219/jada.archive.2006.0358.
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[14] =>
| interview
Curaprox Aligner Foam: Optimising
oral health during treatment
Curaden
Clear aligners are gaining widespread popularity owing
to their convenience and effectiveness. However, maintaining good oral hygiene during aligner treatment is
crucial for achieving successful results. To address the
challenges posed by aligners, effective products for
aligner cleaning and to protect the teeth under the aligners are essential. Dr Ana Bokuchava, international marketing manager at Curaden, shares her insights on maintaining optimal oral health with Curaprox Aligner Foam.
Dr Ana Bokuchava. (Image: Curaden)
Dr Bokuchava, aligners are becoming more widespread. What should patients be aware of?
Aligners are a popular choice in modern orthodontics.
However, some shortcomings are often overlooked
and not well understood. Common concerns include
dry mouth, halitosis, oral dysbiosis, increased biofilm
accumulation, heightened risk of caries, tooth sensitivity and, white spot lesions. Patients need to be educated on proper oral hygiene techniques to prevent
these issues.
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How do aligners exacerbate these risks?
Aligners are recognised as foreign objects by the body.
The plastic aligner—or retainer for that matter—creates
an environment that reduces salivary flow. This reduction limits the natural cleansing, buffering and remineralising properties of saliva. When combined with poor
oral hygiene practices, this environment can lead
to rapid demineralisation, especially in areas more
susceptible to caries. It also leads to dry mouth, increased biofilm accumulation and a heightened risk
of caries. Reduced salivary flow heightens the risk of
acid-producing bacteria, which further hinders enamel
remineralisation.
How can products like Curaprox Aligner Foam
help patients address these risks?
Curaprox Aligner Foam is formulated with key ingredients like hydroxyapatite, hyaluronic acid, enzymes and
CCP—a combination of Citrox, cyclodextrin and polylysine. Hydroxyapatite promotes remineralisation, reduces
sensitivity, prevents plaque and smoothens the tooth
surface. Hyaluronic acid creates a protective barrier
and contributes to gingival health. Enzymes stimulate
saliva production, combat bacteria, fungi and viruses,
and break down biofilm, ensuring a cleaner oral environment. CCP helps fight germs, acts as a preservative and creates a protective oral environment. Additionally, its unique texture acts as a protective barrier
against anaerobic bacteria. This is particularly important in the reduced saliva environment created by aligners. The foam’s osmotic activity helps maintain moisture around the teeth, combating dry mouth and
promoting a healthier oral environment.
Can the foam be used in other contexts?
Absolutely! The foam is not only essential for aligner
wearers and those undergoing orthodontic treatment
but also ideal for daily care and after bleaching. It provides comprehensive care by fighting plaque, maintaining gingival health, freshening breath and offering
antibacterial properties to prevent caries. Children can
use it on prescription from a dentist. In fact, my entire
family uses the foam, including my 7-year-old daughter, and we’ve had great experiences with it and good
results.
[15] =>
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[16] =>
| interview
By combining aligners with
temporary anchorage devices,
clinicians can take this tool to
the next level
Nathalie Schüller, Dental Tribune International
An internationally recognised orthodontist, teacher, researcher and author, Dr Skander Ellouze is renowned as
a global authority on aligners, passive self-ligation,
lingual orthodontics and skeletal anchorage systems.
He enjoys working with patients as much as sharing his
knowledge and experience with his peers, and he takes
a holistic approach to patient care.
Dr Ellouze, what are the factors, if any, that influence
your choice between aligners and fixed appliances in
orthodontic treatment?
Biomechanics, treatment efficacy and efficiency remain
the most important factors for me in choosing between
these modalities. Aligners used alone still have limitations related to the mechanics of the system itself. By
combining aligners with temporary anchorage devices,
clinicians can take this tool to the next level. Our treatment goals are not negotiable and should never depend
on the appliance: tools follow; they don’t precede. To
surpass these limits while remaining minimally invasive
and improving the patient experience, orthodontists
need to be familiar with all the protocols available. Only
then can they advance their aligner treatments and
master all kinds of malocclusions and complex cases.
In about half of my cases, aligners and fixed appliances
are equally effective. In those cases, the patient’s preference is king—and most patients today want aligners.
Have you encountered situations where aligners
demonstrate clear biomechanical superiority over
fixed appliances?
Definitely! I will give you three examples. Firstly, aligners
are superior in all situations where intrusion is needed,
whether anterior or posterior. I’ve also treated cases
with anterior or posterior extrusion, and the results have
been incredible. The limitations of aligners are being
overcome a little bit more every day. Secondly, at the
recent EAS congress, I had the pleasure of sharing
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cases presenting severe gingival recession and explained that, compared with fixed appliances, aligners
help me to minimise unwanted effects and prevent
further pushing the roots out of the bone during the
initial phases of the treatment. Thirdly, aligners can also
be more effective in achieving asymmetrical expansion.
Are there specific orthodontic challenges where
aligners consistently outperform fixed appliances?
I believe there are. I will give you just two examples. In
the case of anterior open bite cases, aligners offer advantages owing to their ability to apply targeted forces to
individual teeth. It is possible to use auxiliaries to address
underlying causes of the open bite and encourage
proper alignment. I am so happy to be able to avoid
using fixed appliances with the children I treat. Children
and especially teenagers may be apprehensive about
wearing fixed appliances, being concerned about their
appearance wearing these fixed appliances. Aligners
are more discreet, helping children feel less selfconscious. They are removable, making it easier to
maintain good oral hygiene and thus reducing the incidence of caries and periodontal disease. The ability to
remove them for eating and special occasions enhances
patients’ satisfaction and increases compliance. I would
even say that for these reasons compliance with children is better than with many adults.
Do factors like the length of treatment, patient compliance and treatment cost influence your choice
between aligners and fixed appliances?
Very often, yes. When both modalities will be equally effective, aligners allow shorter treatment time owing to
their ability to apply controlled forces and their flexibility
in tooth movement. However, if aligner treatment
exceeds a certain threshold, typically 12 to 15 months,
the orthodontist may recommend fixed appliances,
whether labial or lingual, for more precise control over
tooth movement.
[17] =>
interview
Compliance is crucial for the success of orthodontic
treatment. Aligners require consistent wearing for
optimal results, typically 20–22 hours a day. Some
patients find aligners more comfortable and thus easier
to comply with, whereas others struggle with wearing
them consistently. Fixed appliances require minimal
patient compliance.
In your paper during the EAS congress held earlier
this year in Valencia in Spain, you mentioned a
patient with sleep apnoea and expressed a preference for aligners over fixed appliances for addressing breathing issues. Dr Pinter during her presentation at the congress, discussed using maxillary
expansion to treat snoring. Have you noticed an increase in patient awareness or referrals from general
dental practitioners seeking assistance with breathing issues?
|
Absolutely. The patient you are referring to underwent
orthognathic surgery. Thus, the improvement was immediate and obvious.
In my courses, I generally recommend that clinicians
purchase a CBCT device or secure access to one, establish an airway protocol in their practices, and
educate other dental professionals and patients and
their parents in the case of paediatric patients on the
benefits of using aligners. Although the evidence is still
minimal, if we think about our clinical findings from
treating maxillary transverse deficiencies or retrognathic mandibles—there being a significant mandibular response in growing patients—or surgical mandibular advancement in adults, it’s clear that those
findings support a strong relation between these treatments and the improvement of patients’ breathing
problems.
Image: Dr Skander Ellouze.
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[18] =>
| interview
Excellent performance and
affordability: The just-launched
K SCAN Pro intra-oral scanner
K Line Europe
matic start and pause feature and a remote control function for an even more convenient scanning process.
K Line Europe is a prominent player in the dental and orthodontic industries and a well-known original equipment manufacturer of clear aligners. The company’s
portfolio includes advanced dental technology with the
K SCAN intra-oral scanner, the MEMOTAIN retainer and
the innovative ClearX 4D aligners. K Line has now released K SCAN Pro, representing a significant development in intra-oral scanning technology, and Mariele
Hölscher, the company’s digital product manager, discussed its cutting-edge features and benefits in a recent
interview.
Ms Hölscher, K Line’s K SCAN intra-oral scanner
has been on the market for some years already.
How does the new K SCAN Pro differ?
The new K SCAN Pro has many advanced features. Importantly, it allows cross-contamination to be considerably reduced, as the user does not have to touch the
PC. It is lighter in weight than the original K SCAN intraoral scanner and has an ergonomic and more compact
design, making it easier to hold the scanner for a longer
period without fatigue. Additionally, it has a 40% wider
field of view, making it possible to scan twice as fast.
Also, it allows for scanning of smaller mouths with
limited space using the accompanying paediatric scanning tips.
K SCAN Pro also has a tip status indicator that shows
when the scanning tip is ready for use. The anti-fog
module is now ready within 20 seconds, reducing
waiting time to start scanning. There are also an auto-
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How does K SCAN Pro’s open system design
enhance its compatibility with other dental software
and tools?
There are some intra-oral scanners on the market that
limit the ability to send the scan files to any lab, and with
them, you only have the option of sending files afterwards to a specific provider lab or manufacturer. For us,
it was important for K Connect, our own software, to
allow dentists to export data in commonly used formats,
such as STL, PLY or OBJ files, enabling the user to
employ the data flexibly based on his or her needs. We
can also offer users the option of connecting with labs to
submit their orders, including the scan data, directly
through the software. Previously, there was a lot of
manual work required—taking the scan, downloading
the files, uploading them and maybe sending them via
email or via the portal. Our software simplifies the user
experience and provides greater workflow efficiency
with just one or two clicks.
Could you tell us about the comfort level of K SCAN
Pro?
When it comes to comfort, the patient is far more comfortable because the dentist doesn’t have to take a
physical impression, which can be a traumatising experience for some patients! It is also much faster. A scan of
the entire mouth takes no longer than 3–5 minutes,
unlike physical impressions. The user can also pause at
any time if the patient needs a break—a brilliant capability! K SCAN Pro thus provides optimal comfort for patients and reduced chair time.
What are the benefits for clinicians?
The outcome is more precise and the use time-saving
and less costly. Dentists have to do fewer remakes—
also of benefit to patients. Also, with physical impressions, the dental office has a lot of physical waste, but
with K SCAN Pro, the dentist doesn’t produce any
waste, which is a meaningful benefit.
[19] =>
interview
|
K SCAN Pro also helps improve patient engagement. If
the dentist shows the patient a 3D model of his or her
mouth produced from the scan, it’s much easier for him
or her to understand compared with physical impressions. The dentist can show the details and explain
exactly what treatment is needed. With K SCAN Pro,
there are multiple benefits compared with physical impressions.
What advantages does K SCAN Pro offer in terms of
support?
K Line prides itself on support. We run strict quality
assurance on every scanner that we send out in order
to ensure reliable performance. In addition, we provide
training in which we explain how to use the product, and
the session is usually sufficient for dentists to get fully on
board and start using the scanner. Of course, our service
team is available should more assistance be required.
Providing language-specific services is important to us.
We have German-, Arabic-, Spanish-, French- and Englishspeaking customer care support on hand and work
within European time zones, allowing us to respond in a
timely manner. We are proud to be the service provider
for this quality intra-oral scanner.
How does K SCAN Pro maintain accuracy and reliability even with its open system architecture?
When it comes to the reliability of the scans, K SCAN Pro
never loses accuracy. All systems are integrated within
the scanner, so no manual calibration is needed. It
constantly monitors itself to make sure that it remains at
the same level of accuracy, so irrespective of whether it
has been used for one day or 500 days, it is always
correct.
It also doesn’t matter who is performing the scan; the
outcome will always be the same. Compared with physical impressions, which can vary widely based on who’s
taking the impression, dental practitioners can be reassured that the outcome is always accurate and reliable.
After using K SCAN Pro for just a few scans, practitioners will have mastered how to use it and will have
gained confidence in its use.
What feedback have you received from clinicians
regarding the time it takes to learn to use the
scanner, as well as its usability generally?
Clinicians love the simplicity and intuitive design of the
software because they feel like after a few uses they
already know what to do, which buttons to click, etc. to
get a great outcome. There are many systems out there
that have so many different functions that it can take a
long time to learn how to use them. The convenience
and time-saving ability of K SCAN Pro means clinicians
can really focus on what is important in their daily
routine.
Are there unique technological innovations that
contribute to K SCAN Pro’s high performance and
precision?
Rather than using unique innovations that haven’t been
seen before, K SCAN Pro is value-driven and provides
ultimate simplicity and ease of use. Clinicians are impressed with how great the scanner is for the price. It’s
important for us to be able to provide a great performance for an affordable price without compromising on
quality.
Do you have any final comments?
Our current and new customers show great satisfaction
with our scanner, and we’ve been thrilled with the great
feedback. The clean design and simple workflow
provide ultimate reassurance and convenience. The
whole scanner package, from the software to the
support, is fantastic and the K SCAN Pro really is a top
combination of performance and affordability.
K SCAN Pro webinar and information
To learn more about K SCAN Pro and explore its
features in detail, join one of the informative ondemand webinars providing in-depth insights into
how K SCAN Pro can enhance your dental practice.
Visit www.kline-europe.com/event-list to find a webinar.
K SCAN Pro will also be showcased at several upcoming industry events
K SCAN Pro is coming to Italy in October (SIDO International Congress), to the UK in October (Dentistry Show
London) and to Germany in November (Scientific Congress for Aligner Orthodontics).
aligners
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[20] =>
©️ sitthiphong/Shutterstock.com
| interview
Instagram helps researchers
evaluate patient satisfaction
with clear aligner therapy
Anisha Hall Hoppe, Dental Tribune International
Aligner orthodontics is one of the fastest-growing areas
of cosmetic dental treatment. To broadly assess patient
satisfaction with aligner therapy, a team of researchers
in Italy utilised the capabilities of social media to evaluate
how patients rated their experience with the treatment.
Dental Tribune International spoke with lead author
Dr Vincenzo Grassia of the University of Campania Luigi
Vanvitelli in Naples about the study’s unique approach
to data collection.
Dr Grassia, what inspired this study and the rather
novel idea of using social media to evaluate patient
satisfaction?
We were inspired by the growing influence of social
media in everyday life, including healthcare. Platforms
like Instagram provide a unique window into patients’
experiences and sentiments in real time. By analysing
these posts, we aimed to gain insights into patient per-
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spectives on clear aligner therapy that are often unfiltered and immediate, offering valuable feedback for both
clinicians and manufacturers.
The study found that 54.8% of the 1,503 social
media posts during aligner therapy were negative,
primarily owing to pain. What specific strategies do
you recommend for orthodontists to mitigate these
negative experiences during treatment?
Pain and discomfort are common issues with any orthodontic treatment. We recommend that orthodontists
provide thorough pretreatment counselling to set realistic expectations about potential discomfort. Additionally, offering tips for pain management, such as using
orthodontic wax or over-the-counter pain relievers, can
help. Regular follow-ups and open lines of communication can also ensure that any issues are promptly addressed.
[21] =>
interview
Given that some patients expressed dissatisfaction
with the aesthetic appearance of attachments, have
you identified any innovative solutions or modifications that could improve the visual appeal of aligner
therapy?
One promising area is the development of less noticeable attachments and aligners made from materials that
better match the natural colour of teeth. Advances in 3D
printing and materials science may soon allow for even
more discreet aligners. Patient education on the importance and benefits of attachments can also help mitigate dissatisfaction by emphasising their role in achieving the best possible treatment outcomes.
Although social media provides a wealth of qualitative data, it also has limitations such as selection
bias and recall bias. How do you think future studies
could address these limitations to ensure more accurate and representative findings?
Future studies could combine social media analysis with
traditional research methods, such as surveys and clinical
trials, to validate findings. Utilising multiple social media
platforms can also provide a broader perspective. Additionally, advanced data analysis techniques, including
machine learning, can help identify and correct biases,
making the results more robust and representative.
Is there anything else you would like our readers to
know about this or any other related research you
may be working on?
We are continually exploring how digital tools and platforms can enhance patient care in orthodontics. Our
future research will delve deeper into patient experiences and the efficacy of new technologies in orthodontic treatment. We believe that, by listening to and understanding patient feedback, we can improve treatment
outcomes and patient satisfaction.
The study, titled “Instagram and clear aligner therapy:
A content analysis of patient perspectives”, was published online on 20 May 2024 in Seminars in Orthodontics, ahead of inclusion in an issue.
©️ Jihan Nafiaa Zahr/Shutterstock.com
The research highlights high expectations among
patients before starting aligner therapy. How can
orthodontists better manage these expectations to
align with realistic outcomes and potentially reduce
negative sentiments during and after treatment?
Managing expectations is crucial. Orthodontists should
provide comprehensive consultations that cover both
the benefits and the limitations of aligner therapy.
Showing before-and-after photos of previous cases, explaining the potential challenges and discussing the duration of treatment and the commitment required can
help align patient expectations with reality. Ensuring that
patients understand the treatment process can significantly reduce dissatisfaction.
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aligners
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[22] =>
©️ TakSato/Shutterstock
| interview
Multilayer materials enhance the
efficacy of aligner treatment
Anisha Hall Hoppe, Dental Tribune International
According to a recent study, aligner force depends on
the type of material and the direction of movement, and
multilayer materials are superior to single-layer ones
owing to their lower initial force for enhanced patient
comfort and their ability to maintain consistent force application even after ageing. Dental Tribune International
spoke with lead author Dr Tarek Elshazly, who conducted wide-scale research on different aligner materials at the University Hospital Bonn in Germany, about
the implications of the research findings on orthodontic
treatment with aligners.
Dr Elshazly, could you tell our readers a bit about
your background and how you ended up in the very
specific research area of materials development for
dentistry?
I am a dentist with a strong interest in materials engineering. I earned my bachelor’s degree in dentistry from
Ain Shams University in Cairo in Egypt, where I also
completed a master’s degree in dental biomaterials.
After this, I moved to Germany to pursue a doctoral
degree (Dr. med. dent.) and a PhD in oral technology at
the University of Bonn. To identify a suitable and novel
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2 2024
research topic for my PhD, I reviewed the literature extensively and brainstormed ideas. I discovered that the
use of aligners was gaining significant global traction as
a promising alternative to traditional orthodontic treatments. However, there were still notable drawbacks and
limitations associated with the materials used and the
biomechanical behaviour of these appliances. This led
to my focusing my PhD research on this topic under the
supervision of Prof. Christoph Bourauel, a renowned
scientist in dental biomechanics. As part of my research,
we collaborated with various companies to test new and
innovative materials, employing different techniques and
specialised methodologies to study the forces generated by these aligners.
In your research you found that there was a significant reduction in force transmission after 48 hours
of thermal and mechanical ageing of aligner materials. Do these findings hold significance for the
schedule of wearing aligners?
We are constrained not only by the aligner material but
also by the periodontal ligament. Orthodontic tooth
movement occurs through a biomechanical process
[23] =>
interview
within the periodontal ligament and bone when an appropriate force is applied to the tooth. Therefore, the
ideal scenario is to use a material that can consistently
apply the optimal force over the desired time frame.
Based on our research, we suggest changing the aligner
every week or seeking a material capable of maintaining
the necessary force over a longer period. Otherwise, the
force is most effective only during the first few days of
use—typically two or three—after which the aligner
merely functions as a retainer.
Some researchers argue that this is acceptable because
tooth movement primarily occurs within the first few
days and that the aligners are only needed to maintain
the new position to allow for bone resorption over the remainder of the period, usually ten days to two weeks. In
my opinion, it would be more effective to change the
aligner weekly. However, this approach would lead to increased material consumption, raising costs and negatively affecting the environment. The best solution would
be to develop a superior material that can sustain the
necessary force for a longer duration. Multilayer materials have been introduced relatively recently to address
some of the limitations of single-layer materials. While
they are not yet ideal, they do offer better force sustainability.
|
achieve optimal alignment. By ensuring precise control
of tooth movement from the outset, we can reduce the
number of aligners required and, consequently, the
amount of material wasted.
Another area of great interest to me is the development
of recyclable aligner materials. I recently encountered an
American company at a dental show that has innovatively introduced an eco-friendly, recyclable thermoformed aligner material. I haven’t found any research on
this material in the literature yet, so we are planning to
initiate studies on it soon.
Editorial note: The study, titled “Effect of thermomechanical ageing on force transmission by orthodontic aligners
made of different thermoformed materials: An experimental study”, was published on 18 June 2024 in Orthodontics and Craniofacial Research, ahead of inclusion in
an issue.
Could you explain a bit more about the specific benefits of using multilayer materials over single layer
materials, and should clinicians consider changing
their choice of materials?
The type of material used does not significantly alter the
overall process. Typically, aligners are quite rigid during
the first few days as they move the teeth. However, multilayer materials are more flexible, offering greater comfort, whereas, in our research, we showed that singlelayer materials provide better control over tooth movement. Based on these findings, we recommend using
a combination of two materials for each single step.
Treatment should start with a multilayer material for
one week, followed by a single-layer material for another week or just three days. This approach enhances
movement control and maintains the necessary force. I
believe that Angel Aligners is already implementing this
technique.
Are there any new topics of research in materials
development on the horizon that you are particularly
excited about?
What concerns me most right now is the high consumption of plastic in the aligner industry, which is why we are
actively seeking solutions. One potential solution is to
use 3D-printed shape memory materials to reduce material waste. This approach would also allow for better
control over the design, leading to improved tooth movement, increased treatment accuracy and fewer refinements and thus minimising the need for retreatment to
Dr Tarek Elshazly. (Image: Tarek Elshazly)
aligners
2 2024
23
[24] =>
| case report
ClearX teen smile transformation
Dr Miguel Teixeira, Portugal
This case presentation features a teenager’s journey to
corrected occlusion using ClearX (K Line Europe) invisible
aligners. The journey to a harmonious smile is often
complex and requires meticulous planning, especially in
cases that present with both aesthetic and functional
challenges. In the case of this 17-year-old female patient,
the clinical findings necessitated a carefully strategised
treatment plan using ClearX aligners to address her
specific orthodontic needs.
Clinical findings and treatment objectives
The patient’s initial assessment revealed a bilateral
quarter-unit Class II canine relationship, black corridors,
mild crowding and a slight mandibular midline shift
(Figs. 1–10). These findings were significant, as they not
only affected her smile aesthetically, but could potentially lead to functional issues in the future. The treatment objectives were clear: to correct the malocclusion;
realign the dental arches into a more natural, parabolic
shape; address the crowding; and correct the midline
shift to improve both dental function and facial aesthetics.
1
4
2
3
5
Figs. 1–5: Clinical photographs of the initial situation, showing the midline shift, mild to moderate crowding, a half-unit Class II canine
relationship and square arches.
24
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2 2024
[25] =>
case report
6
7
8
9
|
Treatment plan and execution
The treatment plan was devised to span over one year,
and treatment involved the following key phases:
1. Arch expansion:
To address the black corridors and create room for the
canines to move into their correct positions, arch expansion was carried out. This initial phase was crucial
in laying the groundwork for subsequent alignment.
2. Sequential distalisation:
Achieving a Class I canine relationship was essential
for a proper masticatory function and a stable bite.
Sequential distalisation was performed, utilising Class II
elastics to assist in this movement. Special hooks
were integrated into the aligners to facilitate the use of
elastics, as well as some movements required in the
planning. Medium-force elastics were used with aligner
hooks to avoid the bending and deforming of hooks
that occurs with heavy-force elastics.
3. Anterior segment rounding and alignment:
The arches having been expanded and the canines
moving into place, focus was then placed on the anterior segment. Rounding and alignment procedures were
executed to straighten the teeth and achieve a rounded
arch form, contributing to a more pleasing smile line
(Figs. 11–20).
4. Final refinement and occlusion settling:
The final phase of treatment involved detailed refinement to ensure each tooth was ideally positioned. Additionally, occlusion settling was performed to ensure
that the maxillary and mandibular teeth worked together harmoniously (Figs. 21–25).
10
Figs. 6–10: The corresponding digital STL files of the initial
condition.
Clinical outcomes
The use of ClearX aligners allowed for a discreet treatment process, which is often a significant consideration
for patients, especially teenagers. The aligners provided
the necessary force to achieve the desired movements
while being comfortable and minimally invasive.
The 4D component of ClearX which includes aligner activation throughout the treatment process, was key in
keeping the patient actively engaged. This approach
helped the patient feel more involved in her treatment,
rather than being a passive recipient of care.
By the end of the treatment period, the patient’s malocclusion had been corrected, and the midline shift
had been resolved. The final occlusion was functional,
stable and aesthetically pleasing, having a natural arch
form that complemented the patient’s facial features
(Figs. 26–28).
aligners
2 2024
25
[26] =>
| case report
11
14
12
15
13
Figs. 11–15: Clinical situation mid-treatment. Improved midline and improved alignment, but occlusion still unsettled.
16
17
19
18
20
Figs. 16–20: Corresponding stage in the treatment plan simulation, showing good case tracking in relation to the clinical situation.
26
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2 2024
[27] =>
case report
21
26
|
27
22
28
Figs. 26–28: Extra-oral clinical photographs showing the patient’s smile before, during and after treatment.
23
Patient satisfaction
The patient’s satisfaction with the treatment outcome
was evident in her confident smile. The ClearX aligners
delivered on their promise of an effective treatment with
minimal lifestyle disruption.
Conclusion
24
This case illustrates the versatility and effectiveness of
ClearX aligners in treating orthodontic cases. Through
the implementation of a well-planned treatment sequence and the use of innovative orthodontic tools, it
was possible to transform the patient’s dental profile,
enhancing her smile and boosting her confidence. This
case highlights the importance of individualised treatment planning and the capabilities of modern orthodontic solutions in achieving excellent clinical outcomes.
about
25
Figs. 21–25: Final clinical situation after finishing treatment.
Class I relationship with full intercuspation, anterior alignment,
coinciding midlines and rounded arches.
Dr Miguel Teixeira is a highly accomplished dental professional with a
strong background in orthodontics and
clinic management. He is currently the
senior clinical manager at K Line Europe
in Düsseldorf in Germany. He has been
sharing his knowledge and expertise
in orthodontics as a lecturer at various
European private institutes since January
2020 and is a prominent figure in the orthodontic community,
having extensive experience in entrepreneurship, teaching
and clinic management. Dr Teixeira founded Avin, Alinhadores
Invisíveis, a company that provided innovative invisible aligner
solutions.
aligners
2 2024
27
[28] =>
| product report
SureSmile clear aligners
—a proven system for predictably
treating malocclusion
Drs Ahad Sheikh & Carol Rugeles, US & Colombia
1
2
Figs. 1 & 2: Backed by Dentsply Sirona—a global leader in dental solutions with over 100 years of experience in oral healthcare—SureSmile clear aligners correct malocclusion in a deliberate, strategic and holistic fashion.
Malocclusion is a pervasive oral health issue associated
with numerous diseases and conditions that may affect
a patient’s overall health and quality of life. Oral health
issues associated with malocclusion are linked to
a range of systemic health problems. For example,
bacteria from the oral cavity have been identified in
Alzheimer’s lesions1 and in atherosclerotic plaques,2 and
periodontal disease is a well-documented risk factor
for cardiovascular disorder,3 stroke4 and impaired
glucose control.5 There is evidence that the systemic
spread of oral bacteria may induce chronic systemic inflammation. As patients with severe malocclusion often
have difficulty chewing their food, some researchers
have suggested a link between malocclusion and gastrointestinal disorders such as acid reflux and leaky gut
syndrome.6 Additional research is beginning to uncover
how under-developed jaws and malocclusion may contribute to upper airway resistance and obstructive sleep
apnea.7
Beyond the physical pain and discomfort associated
with misaligned teeth, the aesthetic impact of malocclusion can undermine patients’ self-esteem, confidence
and social lives. Multiple studies have found that malocclusion negatively affects the psychological well-being of
adults, many of whom experience anxiety, depression
28
aligners
2 2024
and interpersonal difficulties as a result of concerns over
their appearance.8
These findings underscore the importance of considering all aspects of a patient’s oral health—including his or
her behaviour, attitudes and other risk factors—when
assessing malocclusion and developing a treatment
plan. Guided by decades of orthodontic expertise, the
SureSmile system (Dentsply Sirona) offers the technical
support, clear aligner options and proprietary planning
methods to help clinicians address malocclusion with
customised and predictable treatment plans for their patients.
SureSmile clear aligners: A discreet treatment modality that addresses form and
function
Aligners play an important role in the treatment of malocclusion. In the hands of a dentist, aligners can do
more than improve aesthetics by aligning the “social six”
teeth patients associate with their smile. Aligners can effectively treat the entire mouth, correcting a broad array
of malocclusions and potentially alleviating associated
oral health issues to improve the patient’s health in a ho-
[29] =>
product report
listic fashion. Clear aligner therapy also addresses a
common patient concern about undergoing orthodontic
treatment by enabling predictable achievement of the
patient’s desired outcome without the use of unsightly
and uncomfortable brackets and archwires.
Backed by Dentsply Sirona—a global leader in dental
solutions with over 100 years of experience in oral
healthcare—SureSmile aligners correct malocclusion in
a deliberate, strategic and holistic fashion. Expert technicians in the SureSmile digital laboratory build customised set-ups and staging for aligners by applying more
than 20 years of experience in orthodontic treatment
planning to ensure dentists and their patients have an
excellent treatment experience.
1999
2008
2013
2020
2023
OraMetrix®
launched
globally
Multi·piece
surgical and
restorative
simulation
application
launched; CBCT
integrated with
SureSmile®
Software
SureSmile®U site
published; clouddelivered CAD
system released
SureSmile®
Software
enhancements
released
SureSmile®
Simulator
(powered
by DS Core)
introduced
to provide
chairside
3D smile
visualisation
to educate
patients about
their possible
new smile
and length of
treatment
1994
2004
2009
2018
2021
SureSmile®
CAD system for
othodontics
launched;
robotic wire
production
begun
Orthodontic
CAD/CAM system
integrated with
SureSmile®
Software;
3D scanner,
computer design
and multi-axis
robots launched;
SureSmile®
Software
commercial
launch
Workflow
automation
introduced;
lingual and labial
cases planned
with SureSmile®
Software
SureSmile®
System acquired
by Dentsply
Sirona; SureSmile®
Aligner FDA
510 (k) marketing
clearance
Dentsply
Sirona acquires
SureSmile® VProTM
vibration device
3
|
photographs are used to establish the global position of
the model, which is the natural position of the smile on
the patient’s face. Setting the correct global position of
the model using all records provided by the clinician
ensures that treatment planning begins how the patient
presents.
Treatment plan—the final treatment outcome
With an established link between the patient records
and the 3D models, SureSmile digital laboratory technicians can begin digitally aligning the teeth according to
the dentist’s prescription. Supported by proprietary
treatment planning software and visualisation tools,
SureSmile digital laboratory technicians can reliably plot
an efficient and predictable approach to correcting malocclusion while ensuring forces are applied judiciously
and refinements are minimised. This expertise is the
foundation of the partnership between clinicians and the
SureSmile digital laboratory, resulting in treatment plans
customised for each patient based on their specific
needs and goals.
SureSmile planning software suggests the most efficient
treatment plan. The final set-up, or the model of the
desired treatment outcome, is reviewed by the quality
control team before the individual patient’s treatment
plan is divided into stages.
Fig. 3: SureSmile boasts over two decades of pioneering digital
orthodontics. FDA = US Food and Drug Administration.
The SureSmile difference
Diagnosis
Effective and predictable SureSmile treatment plans
start with a high-quality digital impression. SureSmile is
an open platform that accepts digital impressions from
Primescan (Dentsply Sirona) and other commonly used
intra-oral scanners for seamless integration into existing
digital workflows.
Intra-oral scans, radiographs, smile photographs and
CBCT images are combined by experienced technicians
using advanced software tools to build complete 3D
models of the crowns, roots, gingivae and bone. In a
study published in the American Journal of Orthodontics
and Dentofacial Orthopedics, SureSmile software’s 3D
models provided the best combination of accuracy, reproducibility and time efficiency of measurement.9
After the quality of each 3D model has been verified by
SureSmile’s data integrity team, intra-oral and extra-oral
4
Fig. 4: Effective and predictable SureSmile treatment plans start
with a high-quality digital impression.
Staged models
Staging design involves several levels of quality assurance. As a tooth moves across any of the three planes
of motion (sagittal, coronal and transverse), a number of
factors can interfere with smooth, gradual and predictable movement. How teeth move across the three dimensions of space can greatly influence the success of
reaching the desired outcome. SureSmile incorporates
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2 2024
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[30] =>
| product report
the biomechanics of tooth movement, published research, experience from SureSmile’s founding orthodontists and a digital laboratory with exceptional attention to detail to give clinicians assurance regarding the
smiles being created. SureSmile digital laboratory technicians assess each plan to flag any movements that
could be achieved more easily or should be avoided.
This ensures that clinicians and their patients benefit
from SureSmile’s extensive orthodontic knowledge and
experience. Furthermore, SureSmile’s proprietary software incorporates powerful artificial intelligence to automate staging calculations.
Accommodation staging—enhancing patient compliance by easing into treatment
SureSmile digital laboratory experts are always at the
centre of the planning process, applying logic and a
concern for the patient’s well-being to every case. This
ensures that considerations such as patient comfort are
incorporated into the treatment plan. For example, in
many cases, SureSmile technicians recommend starting off with simple, comfortable movements to help encourage patients to stay compliant with treatment. This
accommodation staging delays some of the more uncomfortable tooth movements until later in the treatment
plan so that patients can become used to wearing their
aligners before more forceful movements are applied.
Variable tooth movement constraints
In the digital laboratory technicians use the SureSmile
software to calculate and customise the ideal amount
and speed of tooth movement the individual patient
needs for optimal outcomes. These movement rates, or
aligner constraints, are based on observations and proprietary calculations pioneered by SureSmile’s founding
orthodontists. These constraints balance a number of
factors to arrive at an individualised recommendation for
treatment staging, specifically:
– patient safety;
– average rates of biological tooth movement when
subject to optimum mechanical force;
– the amount of movement desired during each stage;
and
– which movements are combined into a single stage
and whether they work with or against each other.
Comparative case studies: The SureSmile
tooth movement system applied to an
incisor (Figs. 6 & 7)
The SureSmile digital laboratory assesses all the forces
to be applied to each tooth throughout a clinician’s proposed treatment plan. SureSmile then uses that information to recommend the most efficient and least disruptive set of movements needed at each stage of the
30
aligners
2 2024
5
Fig. 5: SureSmile digital laboratory experts are always at the
centre of the planning process, applying logic and a concern for
the patient’s well-being to every case.
plan for a successful, predictable outcome. Synergistic
movements require less force and often involve more
movement of the crown. Antagonistic movements
require greater force and are expressed over more aligners. When possible, SureSmile prefers to stage these
combinations of movements independently. Consider
this in following cases.
Synergetic movement
In this case (Figs. 6 & 7), the clinician wished to apply
+8° of torque and +0.8 mm of buccal movement with intrusion to an incisor. Facial crown torque and buccal
movement are considered synergistic; they can be combined to improve the outcome. The rate of movement
can be safely increased, compared with a scenario
where facial crown torque and buccal movement are
applied to the tooth in separate stages without sacrificing predictability.
Antagonistic movement
In this case (Figs. 6 & 7), the clinician wished to apply
–8° of torque and +0.8 mm of buccal movement to an
incisor. Lingual crown torque and buccal movement are
considered antagonistic; the conflict between them
impedes the expression of either or both. The rate of
movement should be reduced compared with a scenario where lingual crown torque and buccal movement
are applied to the tooth in separate stages to ensure
both movements are fully expressed. To compensate for
the slower movement rate, SureSmile software will identify other stand-alone or synergistic movements that can
be safely accelerated so that the net result is a steady,
predictable treatment plan.
Attachments
To achieve the desired treatment outcome, some SureSmile treatment plans may include the use of attach-
[31] =>
product report
6
|
7
Figs. 6 & 7: SureSmile tooth movement system applied to an incisor. Blue represents the tooth position before movement is applied.
Green represents the tooth position after planned movements have been fully expressed.
ments. SureSmile’s treatment planning software automatically determines which attachment shape and
location are necessary to achieve the desired movement
for each tooth. Ellipsoid, rectangular and bevelled attachments can help aligners move the teeth whether rotation, angulation, extrusion or intrusion is the goal. In all
cases, the software suggests ways to optimise and minimise the number of attachments used to achieve predictable results in order to avoid refinements.
SureSmile trim lines: Various selections to
fit the diagnosis of the individual patient’s
needs
Trim lines give clinicians control over the amount of force
applied to the teeth, independent of attachments—
which is why SureSmile offers 20 different trim heights
and two trim lines (straight or scalloped).10 This wide
range of options allows clinicians to select the appropriate trim based on clinical performance and patient
factors.
SureSmile’s straight trim lines follow a consistent height
at or above the gingival zenith, starting at 0.0 mm and
increasing by increments of 0.1 mm up to 2.0 mm in
height. Straight trim lines have been shown to increase
aligner stiffness and retention and increase force to the
tooth at the gingival third. This supports better force distribution and control of tooth movement.10 Importantly,
evidence on file at Dentsply Sirona indicates that stronger force systems often reduce the dependency on attachments.10
Scalloped trim lines end at the junction between the
tooth crown and the gingival tissue so that the aligner
does not extend on to or above the gingival tissue. Scalloped trim lines may be considered a superior aesthetic
solution. Given the relative flexibility of scalloped trim line
aligners, forces applied to the teeth near the gingival
areas may be reduced.10 In such instances, SureSmile’s
software can strategically apply attachments to reinforce the shape and tooth-moving effects of the aligner.
There are a number of considerations when selecting a
trim line, specifically regarding clinical and patient
factors:
– treatment goals, such as the direction of tooth movement; the flexibility required for certain movements,
such as rotation or isolated extrusion; treatment time;
comfort during treatment; and aesthetics during treatment;
– amount of undercut due to misaligned teeth and/or
gingival recession;
– tooth morphology;
aligners
2 2024
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[32] =>
| product report
–
–
–
–
–
–
severe gingival recession;
spacing versus crowding;
tolerance of pain;
ability to remove or insert the aligners;
ease of removing and inserting the aligners; and
likelihood of compliance.
The following are examples of applications of trim lines
in light of such considerations:
– A 0 mm straight trim line is suitable for most cases,
balancing flexibility and stiffness.
– A 2 mm straight trim line is suitable for:
· deep bite correction, levelling the curve of Spee;
· bodily movement;
· arch expansion; and
· torque expression.
– A scalloped trim line is suitable for:
· severe crowding;
· isolated extrusion and rotation;
· gingival recession and large undercuts on tooth
anatomy; and
· when there is excessive spacing.
Conclusion: The SureSmile–clinician partnership for beautiful smiles and better lives
Rooted in a deep understanding of orthodontic principles and propelled by state-of-the-art technologies,
SureSmile empowers clinicians to treat the complexities
of malocclusion with precision and compassion. From
advanced software tools to seamless digital integration
and high-performance aligners, SureSmile is a trusted
partner for dentists seeking to improve their patients’
oral health and well-being. The SureSmile system acknowledges the systemic implications of malocclusion,
underscoring its impact on overall health and quality of
life. SureSmile’s commitment to patient well-being is
evident in considerations for comfort, compliance and
aesthetics—allowing for a nuanced approach based on
clinical and patient-specific factors.
SureSmile clear aligners, backed by the extensive experience of Dentsply Sirona, offer a discreet and predictable treatment modality by which to address both form
and function. The carefully designed digital workflow
ensures precision in diagnosis, treatment planning and
staged models, providing a customised approach tailored to individual patient needs.
The SureSmile difference lies in the meticulous attention to detail in treatment planning. By strategically addressing synergistic and antagonistic movements, the
SureSmile digital laboratory optimises tooth movement
for a steady and predictable treatment outcome. The incorporation of attachments and the availability of diverse
32
aligners
2 2024
trim lines further empower clinicians to exert precise
control over force application, enhancing treatment efficacy and extending treatment to conditions that could
not be treated with a one-size-fits-all approach.
SureSmile offers clinicians a sophisticated tool with
which to deliver tailored and predictable malocclusion
treatment. The system’s holistic approach, from diagnosis to treatment execution, has ultimately benefited the
oral health and overall well-being of over one million patients worldwide.
Editorial note: Please scan this QR code for the list of
references.
about
Dr Ahad Sheikh earned dual degrees
in biomedical sciences and psychology
from the University at Buffalo in New
York State in the US, along with a minor
in pharmacology and toxicology. He obtained a DMD from Temple University in
Philadelphia in the US. His career has
transitioned from hands-on clinical dentistry to a strategic corporate role. Beginning as a dedicated practitioner, he sharpened his clinical
acumen and patient care approach. These experiences reinforce
his role at Dentsply Sirona as the director of clinical affairs for
SureSmile, where he harnesses clinical expertise to advance
orthodontic technologies. He manages a global network of key
opinion leaders and collaborates with multidisciplinary teams,
upholding the highest standards of efficacy and safety in products. His efforts bridge clinical practice with corporate innovation, placing patient welfare at the forefront of technological
progress.
Dr Carol Rugeles, a skilled dentist
from Colombia, boasts 28 years of experience in the field. Over 21 of those
years, she has dedicated her career to
the success of SureSmile. Her educational background includes an MBA in
project management and operations,
which has equipped her with the necessary tools to adeptly navigate the complexities of the digital orthodontics business.
[33] =>
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|
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design not only facilitates predictable tooth movement, but it also offers
practitioners unparalleled versatility in their orthodontic procedures.
The innovative formula of Glacier® GX3 allows for seamless adaptation
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081224 © 2024 DynaFlex®, Lake St. Louis, MO 63367. All rights reserved.
aligners
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[34] =>
| practice management
Strategies to enhance patient
experience and interaction with
aligner therapy
Dr Waddah Sabouni, France
Introduction
The popularity of clear aligners has surged in recent
years, making them a preferred orthodontic solution for
many patients.1–3 However, the success of this treatment
relies heavily on the patient’s comprehension, adherence
and overall experience throughout the process. Implementing effective interaction strategies can empower
patients and encourage active participation in their care,
ultimately improving treatment outcomes. This paper
identifies key strategies to enhance patient interaction,
classifying them as digital and face-to-face and focusing
on various touchpoints along the treatment journey.
Digital strategies
Informative website
An elaborate and informative website dedicated to aligner treatment is pivotal in guiding patients through their
treatment journey. It can offer an in-depth understanding
of the treatment process, highlighting the stages from initial consultation to the final results. The website can also
delve into the advantages of aligner treatment, discussing how it differs from treatment with fixed appliances and
its impact on daily activities. Furthermore, the aftercare
instructions can be meticulously detailed, encompassing guidance on oral hygiene, dietary considerations and
follow-up appointments. Testimonials from actual patients
who have undergone aligner treatment can be prominently featured, providing a first-hand account of the
experience. The website can also showcase compelling
before-and-after images, allowing prospective patients to
visualise the potential outcomes. Moreover, integrating a
comprehensive FAQs section ensures that common concerns are effectively addressed, instilling confidence in
patients and equipping them with the necessary knowledge to make informed decisions about their treatment.
Online consultation tools
Through online consultation tools, potential patients can
conveniently upload their photographs and receive an
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2 2024
initial assessment from the healthcare professional. This
proactive approach facilitates a seamless transition from
enquiry to consultation and empowers patients with personalised information about what to expect. By offering
this initial guidance, patients can feel more confident and
at ease about the treatment process, ultimately paving
the way for a more positive and informed healthcare experience.4
Email and SMS communication
Consistent communication through emails or SMS reminders about appointments, aligner changes and care
tips can strengthen adherence and keep patients engaged. Allowing patients to select their preferred contact method can result in more effective communication
and better adherence. Sending personalised messages
based on treatment progress can make patients feel
appreciated and informed about their treatment status.
These communications can also remind patients to continue doing their part in achieving their dream smile.5
Educational videos and webinars
Creating educational videos and webinars can significantly enhance patients’ understanding of orthodontic
treatment, particularly treatment involving aligners. For
instance, topics such as “How to care for your aligners”
and “What to expect during treatment” and patient testimonials can be highly beneficial. Patients can better
[35] =>
practice management
grasp the necessary steps for successful treatment outcomes through the provision of detailed information on
aligner treatment and maintenance procedures. These
resources should be easily accessible online, enabling
patients to revisit the information as often as needed and
reinforcing their understanding of the treatment process.6
|
Social media
Mobile app
A mobile app designed specifically for aligner patients
has the potential to improve engagement and boost adherence to treatment plans significantly. By incorporating
progress tracking, personalised wear-time reminders, a
user-friendly interface for submitting questions and tailored advice based on the individual’s specific treatment
stage, patients can actively participate in their orthodontic journey. This level of personalisation and support
can contribute to better treatment outcomes and overall
patient satisfaction.7
Feedback surveys
Utilising digital tools such as surveys or feedback forms
can greatly benefit dental practices in evaluating patient
satisfaction and understanding the nuances of their experiences. These tools allow patients to provide detailed
feedback, including any concerns they may have, providing dentists with valuable insights into the potential causes of non-compliance. By addressing these concerns,
dentists can enhance the overall patient experience and
improve patient care. Regularly seeking feedback helps
to make necessary adjustments and demonstrates a
solid dedication to continuously improving patient care,
strengthening trust and fostering patient loyalty towards
the practice.8
In today’s digital age, the widespread use of social media has made it a potent tool for healthcare providers.
Providing comprehensive resources on social media platforms can benefit patients. Patients can use social media
to discover various healthcare services, gather information about treatment plans and options, gain insight into
success stories and witness real-life transformations.
Furthermore, it helps patients become familiar with the
dentist and the medical team personally, fostering a
sense of trust and ease. Additionally, social media can
be utilised to send out reminders and educational content, ensuring that patients stay informed and engaged
throughout their treatment journey.9
Face-to-face strategies
Welcoming office
Creating a welcoming and comfortable office environment is crucial, as it can have a significant impact on
patients’ initial impressions as well as their ongoing experiences. Thoughtful interior design with comfortable seating, warm lighting and soothing colours can help create
a positive and calming atmosphere. Furthermore, friendly
staff interactions, such as warm greetings and attentive
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[36] =>
| practice management
communication, can enhance the patient experience.
Finally, maintaining a clean and organised environment
promotes a sense of professionalism and contributes to
patients’ overall comfort and well-being, helping them
feel at ease during their visits.10
Personalised consultations
Orthodontists must provide personalised care catering to
each patient’s needs during in-office consultations. This
involves actively listening to patients, addressing their
questions and engaging in thoughtful discussions about
various treatment options. By customising conversations
based on each patient’s unique needs and concerns,
orthodontists can build a stronger and more trusting
dentist–patient relationship. This approach fosters a
sense of confidence and comfort for patients as they
progress through their orthodontic care journey.
Visualisation software
provide encouragement and motivation. Seeing real-life
examples of successful outcomes can help patients feel
more confident about pursuing treatment and taking
positive steps towards their well-being.
Hands-on demonstration of care
Showing patients what aligners and attachments look
like on a dental model can give them an idea of their
planned aligners and attachments. Providing handson demonstrations in the office for patients on properly wearing, cleaning and changing their aligners can
reassure them about what it will entail. This hands-on
experience can enhance their understanding of the
treatment requirements and improve adherence.
Monitoring progress
Consistent progress monitoring by the dentist and the
patient is an effective means of reinforcing compliance.
Patients can submit frequent progress photographs
and reflect on how their smile has changed from each
checkpoint, enabling them to see the small changes
and motivating them to continue adhering to the treatment to achieve their desired result.
Indicators on aligners
Progress indicators on aligners help patients remain accountable for their treatment. These colour-changing
indicators can provide patients with insight into
whether they have been compliant and encourage them
to keep up with their treatment. They can also educate
patients on the period for which they need to wear their
aligners, preventing them from having to guess whether
they have had their aligners on for long enough.
Visualisation and outcome simulation software can motivate patients to stay consistent with wearing their aligners. This software helps patients understand the changes
taking place week by week and visualise their results.
Even if patients do not see immediate changes in the
mirror, the simulator helps them know that progress is
happening, bringing them closer to their desired smile.11
Sharing success stories
Sharing success stories with prospective patients, especially those that showcase transformations of patients
with similar cases to theirs, can be a powerful way to
36
aligners
2 2024
Patient support groups
Organising in-person or virtual support groups or meetups for patients undergoing treatment can help create
a sense of community among patients. Providing a
platform for sharing experiences, tips and encouragement can significantly boost patients’ motivation and
compliance while expanding their social support network. This can also act as a non-judgemental space
for patients to share their unique situations and learn
from others who may have faced similar challenges.
Support groups can help patients overcome social
barriers associated with treatments and provide a
sense of connection with others who are going through
similar experiences.
Follow-up calls
After significant milestones or check-ins throughout treatment, follow-up calls from orthodontic staff can provide
an added layer of connection and means of open communication. Whether serving to check on the patient’s
experience or address any concerns, these calls show
that the practice genuinely cares about each patient’s
journey.
[37] =>
practice management
Celebrating milestones
Acknowledging treatment milestones, such as aligner
changes or progress, can foster a sense of achievement
and motivate patients. Whether through in-office celebrations, personalised notes or small rewards, recognising
progress affirms patient effort and strengthens engagement. Showing patients comparisons of when their journey started and how far they have come can be a great
way to empower patients and encourage them to continue their journey.
Involving friends and family
Involving others in patients’ orthodontic journeys can be a
great way to keep patients accountable. In particular, for
younger patients, involving parents in overseeing their children’s treatment can help ensure that their child is wearing
his or her aligners and staying on track with treatment.
Conclusion
Enhancing patient interaction and the patient experience
during aligner therapy involves effective communication
and engagement at various touchpoints. By deploying
digital and face-to-face strategies, orthodontic practices
can empower patients, ensuring that they are informed,
motivated and actively involved in their treatment. These
approaches improve patient satisfaction and outcomes
and foster lasting relationships between patients and
orthodontic providers, ultimately leading to a more successful practice.
about
Dr Waddah Sabouni is an orthodontist. He received his DDS in 2002, followed by a master’s degree in orthodontics in 2006 from Paris Descartes
University in France. He furthered his
education with a master’s degree in
lingual orthodontics in 2009 and
another in orthognathic surgery in
2011. He operates private practices in
the south of France and is an assistant professor at the University of Burgundy in France and the University of Reunion, and
he co-founded the European Master of Aligners programme.
His research contributions include over 40 peer-reviewed
journal articles, along with numerous conference papers and
book chapters. Dr Sabouni is an active member of several orthodontic societies, including the American Orthodontic Society
and World Federation of Orthodontists. He also serves as a
board member of the Société Française d’Orthodontie par
Aligneurs (French society of aligner orthodontics) and the European Aligner Society. As an international speaker for Align
|
Technology and an Invisalign Diamond Apex provider since
2013, Dr Sabouni is recognised as a member of the Invisalign
elite club and was honoured with the Align Technology International Research Award in 2015.
References
1
Adel SM, Hansa I, Vaid NR. Clear aligner therapy
in contemporary orthodontics: a scoping review of
scholarly literature. APOS Trends Orthod. 2024 Jan–
Mar;14(1):3–27. doi: 10.25259/apos_215_2022.
2 Bichu YM, Weir T, Zou B, Adel S, Vaid NR. Clear aligner
therapy concerns: addressing discrepancies between
digitally anticipated outcomes and clinical ground realities. Turk J Orthod. 2024 Jun 30;37(2):130–9. doi:
10.4274/TurkJOrthod.2024.2024.4.
3 Vaid NR. The emperor’s new clothes! APOS Trends Orthod. 2019 Jan–Mar;9(1):1–3. doi: 10.25259/apos-9-1-1.
4 Katyal V, Vaid N. Virtual-First: a virtual workflow for
new patient consultation, engagement and education
in orthodontics. Semin Orthod. 2023 Mar;29(1);109–
15. doi: 10.1053/j.sodo.2023.02.001.
5 Gupta G, Vaid NR. The world of orthodontic apps.
APOS Trends Orthod. 2017 Mar–Apr;7(2):73–9. doi:
10.4103/2321-1407.202608.
6 Vaid NR, Adel SM. Contemporary orthodontic workflows: a panacea for efficiency? Semin Orthod. 2023
Mar;29(1);1–3. doi: 10.1053/j.sodo.2023.02.002.
7 Vaid NR, Hansa I, Bichu Y. Smartphone applications
used in orthodontics: a scoping review of scholarly literature. J World Fed Orthod. 2020 Oct;9(3S):S67–73.
doi: 10.1016/j.ejwf.2020.08.007.
8 Adel SM, Alwafi AA, Pandian SM, Bichu YM,
Abuljadayel LW, Alansari RA, Vaid N. What are orthodontic residents perusing on social media? A
cross-sectional survey. Semin Orthod. 2023
Dec;29(4):382–9. doi: 10.1053/j.sodo.2023.11.009.
9 Grassia V, d’Apuzzo F, Alansari RA, Jamilian A,
Sayahpour B, Adel SM, Nucci L. Instagram and clear
aligner therapy: a content analysis of patient perspectives. Semin Orthod. 2024 May 20. doi: 10.1053/j.
sodo.2024.05.009. Epub ahead of print.
10 Meghna V, Nikhilesh V, Dhaval F, Meetali S. Integrating
“experience economy” into orthodontic practice management: a current perspective on internal marketing.
Semin Orthod. 2016 Dec;4(22):301–9. doi: 10.1053/j.
sodo.2016.08.011.
11 Sereewisai B, Chintavalakorn R, Santiwong P,
Nakornnoi T, Neoh SP, Sipiyaruk K. The accuracy of
virtual setup in simulating treatment outcomes in orthodontic practice: a systematic review. BDJ Open. 2023
Aug 28;9(1):41. doi: 10.1038/s41405-023-001673. Erratum in: BDJ Open. 2023 Sep 12;9(1):43. doi:
10.1038/s41405-023-00169-1.
aligners
2 2024
37
[38] =>
©️ Evgeniyqw/Shutterstock.com
| news
How far has 3D printing brought
clear aligners?
Anisha Hall Hoppe, Dental Tribune International
In the dynamic field of orthodontics, the advent of clear
aligners has marked a significant leap forward, marrying
aesthetics with functionality to offer patients an appealing alternative to fixed appliances. A new comprehensive review delves into the burgeoning realm of 3Dprinting technology and its use in the fabrication of aligners.
For dental professionals striving to stay abreast of cuttingedge research and developments, the peer-reviewed
synopsis provides an insightful overview, encapsulating
the evolution, methodologies and future prospects of
aligner technology.
In addition to covering the historical technological development leading to today’s aligners and the associated
CAD/CAM technology, the review offers a brief refresher
course on 3D-printing technology. Among the various
3D-printing methods, such as stereolithography, digital
light processing (DLP) and fused deposition modelling—
which offer unparalleled benefits in terms of customisation, speed and cost-effectiveness—DLP stands out for
its suitability in aligner production owing to its ability to
achieve high accuracy and optimal material properties
for dental applications.
However, the clinical efficacy of aligners is contingent
upon a myriad of factors, encompassing mechanical
properties, such as elasticity, force delivery and resilience, as well as the precision of fit and accuracy. The
review underscores the paramount importance of these
factors in achieving desired orthodontic outcomes,
highlighting the need for continuous material innovation
and process optimisation.
38
aligners
2 2024
Challenges in aligner therapy, including the management of complex tooth movements and the maintenance of material properties in the oral environment, are
addressed with a forward-looking perspective. The
review advocates for a multidisciplinary approach, leveraging advancements in materials science, digital dentistry and biomechanical understanding to surmount
these hurdles.
Aligner technology is poised to harness the potential of
emerging materials and 3D-printing techniques, promising further refinements in treatment efficiency, predictability and patient satisfaction. Innovations such as
smart materials capable of dynamic force application
and the integration of teledentistry for remote monitoring
are envisioned to redefine orthodontic treatment approaches.
For dental professionals, the review offers a concise yet
comprehensive understanding of current trends, challenges and future prospects, equipping them with the
knowledge to navigate the evolving landscape of orthodontic treatment. As the field continues to advance, embracing these innovations will be instrumental in delivering superior patient care and achieving optimal treatment outcomes.
The study, titled “Advancements in clear aligner fabrication: A comprehensive review of direct-3D printing technologies”, was published online on 29 January 2024 in Polymers.
Editorial note: This article was published in 3D printing—
international magazine of dental printing technology vol. 4,
issue 1/2024.
[39] =>
news
dental-tribune.com
dtstudyclub.com
|
E-newsletter
For 20 years,, Dental Tribune
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| feature
Periodontal considerations
in aligner treatment
Dr Irineu Gregnanin Pedron, Brazil
Introduction
Preconised by Kesling in 1946, treatment with clear
aligners was initially used to correct misaligned teeth.1
Currently, aligners dominate the orthodontic market,
promising superior advantages over orthodontic treatment with fixed appliances, particularly in terms of aesthetics.1–3 In addition, there has been significant recent
progress in the technological development of computeraided treatment planning and execution.2, 4, 5
Aligner treatment has also been driven by patient
demand.1 In Brazil, the pioneering brand (Invisalign, Align
Technology) pursued ostentatious marketing in the
major television media, leading to great interest among
the population. The demand for aligners also gained
momentum during the COVID-19 pandemic, during
which orthodontic clinical activities ceased owing to
lockdown recommendations from the World Health
Organization and various countries’ authorities. The
need to continue orthodontic treatment led to the use
of aligners, owing to the ability of treatment to progress
by the patient swapping the aligners. However, after the
pandemic period, the need for regular follow-up visits to
the orthodontist could be continued for adjustment of
the treatment to ensure the best possible result. Failure
to plan can result in problems such as delays in treatment, insufficient treatment, misaligned teeth and even
permanent damage to the teeth and gingivae.2
Adult patients often seek orthodontic treatment, and the
incidence of periodontal disease among this group
seeking orthodontic treatment is high. Orthodontic
treatment using fixed appliances is still the gold standard. It is known that all components of fixed orthodontic appliances (brackets, bands, archwires, etc.), regardless of the technique used, hinder the entire oral hygiene
process, favouring the increase of dental biofilm. A significant increase in the count of periodonto-pathogenic
microorganisms (Porphyromonas gingivalis, Prevotella
intermedia, Prevotella nigrescens, Tannerella forsythia
and Fusobacterium species), cariogenic microorganisms (Streptococcus mutans and lactobacilli) and
Candida albicans has been reported in patients undergoing fixed orthodontic treatment. The deposition and
40
aligners
2 2024
accumulation of dental biofilm, when not disorganised
by mechanical plaque control, by either the patient or
the dental professional, leads to the formation of dental
calculus, leading to the onset of gingival, periodontal
and peri-implant disease.2–7
However, orthodontic treatment for periodontic patients,
also favours good oral hygiene practices. Resolving
diastemas and crowding favours oral hygiene. Besides
orthodontic treatment favouring oral health, it addresses
patients’ general health.
Adult patients have high aesthetic expectations of orthodontic treatment. From this perspective, it is clear that
there must be synergy between the orthodontics and
periodontics specialties. Orthodontic management of
adult patients with periodontal problems must respect
the biology of the patient in terms of time, force and
orthodontic pressure. Orthodontic pressure induces an
inflammatory process in the periodontium—a predictable response to trauma—but essential in the tooth
movement process.4–6
Basically, periodontal disease depends on intrinsic and
extrinsic factors, such as host resistance, systemic
disease or pathological conditions, smoking, the periodontal phenotype (thickness of bone and gingival tissue),
and quantity and microbiological quality of the biofilm,
which can interfere with the periodontal disease
process. Thus, periodontal control before, during and
after orthodontic treatment is essential in order to contribute to periodontal health and better orthodontic
management, regardless of the therapy used, including
aligners.4, 5, 7
Because aligners can be removed for oral hygiene, patients may feel that oral hygiene is less of a concern and
under-estimate its importance. However, adequate oral
hygiene is required for satisfactory treatment with aligners. The use of conventional, tufted and interdental
brushes, as well as dental floss, prevents the accumulation of dental biofilm, and the initiation and progression
of caries and periodontal disease. These oral hygiene
procedures should be carried out after eating and
before the aligners are repositioned.3, 5–7
[41] =>
feature
a
b
|
c
Figs. 2a–c: Intra-oral photographs. (a) Right lateral view. (b)
Frontal view. (c) Left lateral view.
a
b
c
Figs. 1a–c: Orthodontic treatment planning based on extra-oral
photographs. (a) Frontal view. (b) Lateral view. (c) Patient smiling.
a
b
Figs. 3a & b: Occlusal views. (a) Maxillary view. (b) Mandibular view.
4
Fig. 4: Intra-oral scans.
5
Fig. 5: Panoramic radiograph.
The periodontal treatment of an adult patient undergoing treatment with aligners is illustrated in demonstration
of these points. Orthodontic planning considered the
extra-oral photographs (Fig. 1) and intra-oral photographs (Figs. 2 & 3). Intra-oral scanning (Fig. 4) and radiographic documentation using panoramic radiographs
and cephalometric radiographs (Figs. 5 & 6) were also
carried out. From a periodontal perspective, periapical
radiographs were recommended (Fig. 7), as this was an
adult patient who smoked and showed clinical signs of
advanced periodontal disease. Prior periodontal treatment was carried out (Fig. 8) to begin treatment with
aligners (Fig. 9).
The inflammatory process generated by orthodontic
forces on the periodontal ligament and alveolar bone
induces cells to release pro-inflammatory, angiogenic
and osteogenic substances, which act in the remodelling process of the periodontal ligament and alveolar
bone. A correlation between orthodontic movement and
periodontal disease has been reported, based on the
exacerbation of the inflammatory process due to the
6
Fig. 6: Cephalometric radiograph.
degradation of periodontal tissue, generated by increased concentrations of pro-inflammatory cytokines
(interleukin-1, -1β, -6 and -8; tumour necrosis factor-α;
prostaglandins E1 and E 2; nuclear factor-κΒ; receptor
activator of nuclear factor-κΒ ligand; vascular endothelial
growth factor; and alkaline phosphatase) released by
connective tissue cells and osteoclastic activity inducing
bone resorption.5, 6 Fixed orthodontic treatment has
been associated with gingival and periodontal lesions
(periodontal ligament and alveolar bone), clinically characterised by gingival recession, gingival hyperplasia and
loss of attachment.2, 4–14
aligners
2 2024
41
[42] =>
| feature
7
Fig. 7: Periapical radiographs.
a
b
Figs. 9a & b: (a) Treatment with aligners. (b) aligner set.
8
Fig. 8: After periodontal treatment.
Aligners have several benefits for the periodontium.
Reduced dental biofilm formation and improved gingival
and periodontal parameters compared with fixed orthodontic appliances have been reported in the literature.2–7, 15
Treatment with aligners has several further benefits
compared with treatment with orthodontic fixed appliances. The superiority of aligners over conventional
treatment has been reported in relation to the signs and
symptoms reported by patients via questionnaires
related to oral health-related quality of life. Factors such
as health, physical, psychological and social aspects
have been measured through physical pain, oral dysfunction, eating disorders, oral alterations (in the tongue,
lips or cheeks), anxiety, general activities, sleep or mood
alterations, and quality of life.1, 2, 6
42
aligners
2 2024
Aligners are more aesthetically pleasing and comfortable, which favours greater patient acceptance and improves self-esteem during treatment. Aligners have
been found to cause less pain compared with fixed appliances. The feeling of tension has been reported as
being lower in patients with aligners compared with patients with fixed orthodontic appliances. When the aligners were removed, masticatory comfort was greater in
these patients.1–3, 5, 7 Difficulty in phonation in the first
30 days in patients with aligners can occur and has
been found to be suppressed with use conditioning.1
Recent studies have shown statistically significantly
lower plaque indices and gingival bleeding and periodontal probing depth scores in patients with aligners
compared with patients with fixed orthodontic appli-
[43] =>
feature
ances.2–7 The lower incidence of dental biofilm formation
can be hypothesised to be due to the greater coverage
of the aligners over the dental structures. The margins of
the aligners should be checked by the dental professional to avoid trauma and gingival lesions.2, 5, 6 Favero et al.
concluded that aligners with a juxta-gingival flange
caused a higher incidence of gingival lesions and irritation, whereas aligners with a flange that extends into the
vestibule (between 3 and 4 mm) may have a protective
effect, less inflammation and less accumulation of dental
biofilm.2 Some studies have suggested that aligners may
be the first treatment option for patients with periodontal
disease, particularly in adults.5, 7
In summary, even with the use of aligners, it is imperative to establish supportive periodontal therapy in order
to clinically monitor patients with gingival, periodontal
and peri-implant disease and to achieve periodontal
health, favouring adequate and satisfactory orthodontic
treatment.
about
Dr Irineu Gregnanin Pedron is a
periodontist and implant dentist. He is
an independent researcher and runs a
dental clinic with radiography technology, ISO Radiologia Itaquera, in São
Paulo in Brazil.
References
1
2
3
4
Hashemi S, Hashemi SS, Tafti KT, Khademi SS,
Ariana N, Ghasemi S, Dashti M, Ghanati H, Mansourian M.
Clear aligner therapy versus conventional brackets:
oral impacts over time. Dent Res J (Isfahan). 2024
Jan 25;21:6.
Favero R, Libralato L, Balestro F, Volpato A, Favero L.
Edge level of aligners and periodontal health: a clinical perspective study in young patients. Dental
Press J Orthod. 2023 Apr 14;28(1):e2321124. doi:
10.1590/2177-6709.28.1.e2321124.oar.
Jiang Q, Li J, Mei L, Du J, Levrini L, Abbate GM, Li H.
Periodontal health during orthodontic treatment with
clear aligners and fixed appliances: a meta-analysis.
J Am Dent Assoc. 2018 Aug;149(8):712–20.e12. doi:
10.1016/j.adaj.2018.04.010.
Luchian I, Surlari Z, Goriuc A, Ioanid N, Zetu I,
Butnaru O, Scutariu MM, Tatarciuc M, Budala DG.
The influence of orthodontic treatment on periodon-
|
tal health between challenge and synergy: a narrative
review. Dent J (Basel). 2024 Apr 17;12(4):112. doi:
10.3390/dj12040112.
5 Di Spirito F, D’Ambrosio F, Cannatà D, D’Antò V,
Giordano F, Martina S. Impact of clear aligners versus
fixed appliances on periodontal status of patients undergoing orthodontic treatment: a systematic review
of systematic reviews. Healthcare (Basel). 2023 May 6;
11(9):1340. doi: 10.3390/healthcare11091340.
6 Partouche AJ, Castro F, Baptista AS, Costa LG,
Fernandes JC, Fernandes GV. Effects of multibracket orthodontic treatment versus clear aligners
on periodontal health: an integrative review. Dent J
(Basel). 2022 Sep 21;10(10):177. doi: 10.3390/
dj10100177.
7 Crego-Ruiz M, Jorba-García A. Assessment of the
periodontal health status and gingival recession during
orthodontic treatment with clear aligners and fixed appliances: a systematic review and meta-analysis. Med
Oral Patol Oral Cir Bucal. 2023 Jul 1;28(4):e330–40.
doi: 10.4317/medoral.25760.
8 Pedron IG. Surgical crown lengthening and botulinum
toxin and in the management of the orthodontic patient with gummy smile. Ortho. 2018;3(1):10–12.
9 Di Francesco ER, Zavalloni EV, Risemberg RI,
Shitsuka C, Pedron IG. Visagism, attractiveness and
harmonization complementing orthodontics: case
report. SVOA Dent 2022;3(2):63–7.
10 Dos Santos MA, dos Santos AF, Pedron TG,
Shitsuka C, Pedron IG. Periodontal reinsertion after
orthodontic intrusion in a patient presenting aggressive periodontitis: an 18-years follow-up case. Sci Arch
Dent Sci. 2020 Aug;3(8):27–32.
11 Pedron IG, Galletta V, Azevedo LH, do Lago Pimentel
Maia M, Shitsuka C. Comparative evaluation among
three therapeutic modalities in the removal of gingival hyperplasia in orthodontic patient: case report.
Sci Arch Dent Sci. 2019 Nov;2(11):37–42.
12 Pedron IG, Utumi ER, Calábria Tancredi AR, Guillin
Perez FE, Marcucci G. Non-neoplastic proliferative
gingival processes in a patient undergoing orthodontic treatment. Dent Press J Orthod. 2010 Nov–
Dec;15(6):80–7.
13 Pedron IG, Horliana AC, Horliana RF, Aburad A,
Tortamano IP. Hiperplasia gengival em pacientes sob
tratamento ortodôntico—indicações terapêuticas
[Gingival hyperplasia in patients undergoing orthodontic treatment—therapeutic indications]. Rev Ortodontia SPO. 2008 Jan–Mar;41(1):33–7.
14 Pedron IG, Mangano A. Gummy smile correction
using botulinum toxin with respective gingival surgery.
J Dent (Shiraz). 2018 Sep;19(3):248–52.
15 ElNaghy R, Al-Qawasmi R, Hasanin M. Does orthodontic treatment using clear aligners and fixed appliances affect periodontal status differently? Evid
Based Dent. 2023 Jun;24(2):73–4. doi: 10.1038/
s41432-023-00890-8.
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[44] =>
© Creative Cat Studio/Shutterstock
| feature
Work–life balance—a lifestyle
more than a goal
Jerko Bozikovic, Belgium
Why is it that so many people struggle to find balance in
their life and work? Why is it that it feels like time flies and
we cannot get half of the things we intended to done?
Why is it that we sometimes feel like we're constantly
playing catch-up while life goes on around us? I can
think of many more “Why is it” questions. Do these resonate with you—or with your team? Why is it that we can
or cannot reach a state of work–life balance?
Maybe it is because the terminology is wrong. “Work–life
balance” implies that work is not part of life. It might be
more accurate to look at what we do, how we feel and
how we invest our time, energy and focus in work and in
life. And is there a large difference? And why? Or why
not?
Work is love in action
Many years ago, I heard the saying “Work is love in
action”. This changed my whole perspective on work.
Before that, it felt more that work was something I had to
do to get what I needed (money) to do the things I really
liked in my free time. In truth, though, I never saw work
as a burden; it was always about connecting with
people, enjoying my time, using my talents and competences. So, in reality, it had always been about love, only
I never saw it that way.
So how do you see your work? I have met many orthodontists in the past 11 years since I started collaborating
with Align Technology, and common points among them
44
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have been their passion for their work, their dedication to
their patients, their commitment to their teams and their
aim to strive for excellence. Would we not call that love
too in a sense? And if this is love too, how should we
then create balance? Is it that we give too much of it, that
we do not know when to stop giving to others and start
giving to ourselves? Do we have balance in that? And do
we have balance in the love, the energy, the time we give
to our teams and patients compared with what we give
to our families and friends? Interesting food for thought.
Signs of a disbalanced work and life
Many of the challenges in these current times can be
physical, mental, emotional and spiritual. The body
always tells us when something inside of us is off, but so
do our heart, our thoughts and our sense of something
greater in life. Experiencing chronic disturbances like
little sleep, poor eating habits, addictions, challenging
relationships with a great deal of emotional struggle,
negative thought patterns or recurrent questions like
“Why am I doing this?” “Who is this all for?” “What about
me?” are very good indicators of the need to take some
time off and reflect. Gain some distance from your life to
observe, feel and analyse.
I take this approach quite regularly, several times a year,
to see where I am at, what I am doing, what I need and
how I feel. This summer, I spent five days in the woods in
Belgium with 475 men, including a subgroup of 50 entrepreneurs and leaders. We had over 100 workshops to
[45] =>
feature
choose from to work on ourselves over these five days.
The camaraderie, the dedication to learning, growing,
healing, letting go, forgiving, re-examining one’s life, accompanied by laughter, tears, insights, support of one
another, was very inspiring. We all went home with a
deeper sense of who we are and what we want in life.
This sort of activity provides food for one’s mind, heart,
body and soul.
Solutions—what can we do?
Do you create these moments for reflection in your life,
whether it is sitting still for 15 minutes a day or spending
a few days in nature? What else do you do to seek
balance, insights, growth?
Here are a few concrete questions to explore that will
help you create a more balanced work life:
• Consider your leadership style:
· Do you find it easy to delegate?
· Do you find it easy to trust others?
· Do you take enough time to train new people?
· Do you take enough time to have meetings (one to
one and in a group) to check in with your teams,
not only on work-related topics but also on personal
matters?
· Are you a good listener?
· Do you communicate clearly?
• Consider your framework for me time, family time and
friend time:
· Do you bring work back home?
· Do your friends and family know what they can expect from you in terms of time and focus, or do you
keep changing this to prioritise work?
· Can you turn off your work mindset and be fully present with yourself and your loved ones?
If you feel that you have some growth potential in any of
these areas, you can start changing them today—not
everything all at once but in micro-steps. Rather than
putting too much on your plate, start by setting goals
that are achievable and do not take too much time and
energy.
For demonstration, consider these examples of microsteps in areas needing change:
• Do you want to have a healthier morning routine? Do
not immediately reach for your smartphone on waking
up and spend 15 minutes scrolling. Instead, sit up in
bed, take ten deep breaths and visualise how you
would like your day go.
© inspiring.team/Shutterstock
• Consider your work framework:
· What is expected of you and of others regarding
roles, responsibilities and tasks?
· Is the structure of who does what clear?
· Can you let go and delegate?
· Do you and your team have the necessary skills in
communication, time management, stress management, clinical knowledge and other relevant areas to
deal with everyday situations and challenges?
· What is your desired time frame for your availability
to your patients, your team, your family, your friends
and yourself?
· How reachable do you want to be outside of working hours by your teams and patients (smartphone,
emails, messages)? And has this been clearly communicated to them?
|
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[46] =>
© inspiring.team/Shutterstock
| feature
• Do you want to have a healthier breakfast routine? Do
not wake up and immediately get your coffee. Get up,
drink a glass of water or even a glass of warm water
with some olive oil and a squeeze of lemon—it will activate your liver and other organs to start working and
detoxing—and then drink your coffee 20 minutes later.
• Do you not want to bring work back home? Instead
of allowing yourself to work for an extra 2 hours from
home after work every day, reduce this by 15 minutes
per day, giving you this amount of free time. Continue
to reduce it week after week by 15 minutes until you
reach an amount of time for working from home that is
acceptable to you, maybe 30–45 minutes rather than
the 2 hours it used to be.
Be creative! You know what you can do—and make it
feasible. If something is feasible, it is much less likely that
you will fail.
Include your team
Your team might feel overwhelmed from time to time or
that there is a lack of structure or an imbalance. In
August, I was in New Zealand to speak at the ANZ Align
Orthodontist Forum. Another speaker at the event
shared the following very significant statement: “Everybody’s time is as important.” By that, he meant that everybody wanted to be able to go home on time, have a
family life, do hobbies and sports, and have me time, including himself. With that in mind, he had organised a
meeting with his team explaining this viewpoint and
asked a very vulnerable question: “My private time is as
valuable as yours, and I have noticed that it is not in
balance. How can you help me so that we can all end
our working day together?”
Asking this of his team made them aware of his inner
challenges in this regard, and they all started looking for
46
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2 2024
solutions. Some took on more responsibilities, some
became more proactive and some came up with creative ideas, and within a few weeks, they all ended work
at the same time, and his working day truly came to an
end the moment he left the clinic. I found this very inspiring.
So, what will you do to make sure that the following
questions do not keep burdening you?
– Why is it that so many people struggle to find balance
in their life and work?
– Why is it that it feels like time flies and we cannot get
half of the things we intended to done?
– Why is it that we sometimes feel like we are constantly
playing catch-up while life goes on around us?
I am convinced that we have so many answers inside of
us; we just need to stand still from time to time to reflect
on, observe, think about and feel what we want to do and
where we want to go. I wish you a wonderful journey in
discovering and balancing your work and life!
about
Jerko Bozikovic is a specialist in
communication skills, emotional intelligence, time and stress management,
leadership, and change management.
He is fascinated by human behaviour
and finds working with people on personal development to be a daily challenge and blessing. He speaks seven
languages and has offered his training
courses in four languages since 2001. He embraces and embodies the motto “Love the life you live; live the life you love.” He
can be contacted via LinkedIn.
[47] =>
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26 & 27 JUNE 2026
ARENA BERLIN
W W W. D D S . B E R L I N
S H A P I N G TO M O R R O W:
REVOLUTIONISING
D I G I TA L D E N T I S T R Y
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[48] =>
| industry news
Operation Smile benefits
from a significant legacy
It has been announced that Operation Smile is the beneficiary of a significant legacy fund donation from the
European Aligner Society (EAS). An amount of £80,000
(€95,182.40)* will be paid over three years to help the
charity develop and support cleft lip and palate treatment programmes which will have a lasting impact in
developing countries.
Operation Smile carries out hundreds of surgical programmes all over the world with the long-term vision of
improving the local healthcare system in the areas in
which it operates. In addition to mobilising highly accredited medical volunteers, Operation Smile trains local
medical professionals and partners with hospitals, governments and ministries of health in order to support
safe and effective surgery for everyone in need. The
charity ensures that its ongoing programmes are run by
local medical teams to the extent that over 85% of all its
programmes globally are now managed by local
teams—a testament to the significance of the work it
carries out with local healthcare professionals.
EAS has a burgeoning membership of orthodontists
and general dentists with a special interest in clear
aligner orthodontics. Its most recent congress, held in
Valencia in Spain, was attended by over 1,300 dental
professionals from 60 countries and supported by many
of the major aligner manufacturers.
Dr Les Joffe, CEO of EAS, commented: “The EAS board
considered what it could do with surpluses generated
by sponsorship and delegate fees from a series of highly
successful congresses and meetings. EAS is a notfor-profit organisation, so we created a legacy fund into
which surpluses could be directed.”
The EAS Legacy Fund focuses on three aspects:
1. donating funds to worthy causes in the oral health
field;
2. applying funds to research projects in the area of
aligner orthodontics; and
3. launching summer schools on aligner education for
young aspiring orthodontists.
“EAS chose to collaborate with Operation Smile, an internationally renowned charity, as we were particularly
interested in its work on patients with cleft conditions in
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developing countries. Operation Smile works with
clinicians to initiate the diagnosis, repair and support
for patients with a cleft at the start of life. The expertise
that Operation Smile brings to each country is handed
on to the local clinicians so that ongoing care and
support can be carried on locally, and the hands-on
training and support for a range of oral health projects
globally meant that our legacy fund could in turn fund a
significant legacy in less-developed countries,” Dr Joffe
continued.
He concluded: “The outcomes of Operation Smile’s
work is both wonderful and heartwarming. You only
have to look at the organisation’s website to understand
why EAS, with its sponsors’ and delegates’ support,
wants to support what Operation Smile is achieving—it
is so worthwhile!”
Dr Phil McDonald, Operation Smile UK’s medical director, a trustee on the board and one of the charity’s
medical volunteers, responded to news of the donation:
“We are extremely grateful to EAS for their generous
commitment to our life-changing work. In the countries
where we work, we estimate that five million people with
cleft conditions need our help. Most of them lack access
to safe surgery and cleft care.”
“Our ongoing commitment to providing safe surgery
and comprehensive care, including dental and orthodontic care, is made possible by visionary partners like
EAS. Their support enables us not only to offer vital
support and make a profound impact on those born
with cleft conditions and their communities, but also to
provide training and education to local medical professionals. This empowers them to provide safe surgeries
to their own communities in the future,” Dr McDonald
explained.
For more information about the work of Operation Smile,
please visit www.operationsmile.org.
Editorial note:
* Calculated on the OANDA platform on 25 July 2024.
[49] =>
industry news
|
YOUR
GUIDING STAR
Remineralises and
protects your teeth
during treatment.
PROTECTS
YOUR SMILE
LIKE A GUARDIAN ANGEL
aligners
2 2024
49
[50] =>
| industry news
ICD is the new home of the now
Global Oral Health Leadership
Institute
The International College of Dentists (ICD) is proud to announce the transition of the Senior Dental Leadership
Program, previously managed by the Global Child Dental
Fund (GCDF), a UK-based charity. Rebranded as the ICD
Global Oral Health Leadership (GOHL) Institute, this initiative will further the development of emerging healthcare trailblazers globally. The institute’s one-year programme seeks to instil strategic leadership skills to
support the implementation of solutions for improving
oral health and systemic wellness worldwide.
“The ICD began its second centennial a few years
ago and had been making efforts, such as achieving
consultative status with the United Nations Economic
and Social Council and collaborating with World Health
Organization initiatives, to increase the college’s global
footprint. Now, the ICD has reached an even higher level
towards improving global oral health through the procurement of this rebranded [GOHL] Institute,” said ICD
International Council President Prof. Argirios Pissiotis.
Established in 2007, the Senior Dental Leadership
Program has graduated more than 200 emerging healthcare leaders from 43 countries. Recognising the need for
a long-term home for the programme’s future iterations,
Henry Schein collaborated with two of its academic partners, Harvard School of Dental Medicine in the US and
King’s College London in the UK, to engage the ICD. The
ICD’s vast global network of 12,000 dental leaders
makes it an ideal home for the programme’s next chapter.
“It has been a privilege to have led the Senior Dental
Leadership Program over the past 14 years. Good leadership brings about change, and [the programme] has
reinforced its importance in improving child oral health.
As the new president-elect of the World Federation of
Public Health Associations, my first task will be establishing a global public health leadership programme so
that our public health colleagues can benefit from effective leadership networks,” said Prof. Raman Bedi, former
GCDF chairman and the founder of the Senior Dental
Leadership Program. David Kochman, chief corporate
affairs officer at Henry Schein, stated: “We are grateful to the
[GCDF] and Prof. Raman Bedi for their longstanding
steward-ship of the Senior Dental Leadership Program,
building it into a flagship opportunity for burgeoning
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dental professionals to collaborate and learn. By harnessing the knowledge and experience gained from
the GCDF’s work and decades-long partnership
with the [ICD] and its most prestigious community of
fellows, we are enthusiastic about the opportunities to
continue meaningfully advancing oral health training,
best-practice sharing and relationship development
through the [GOHL Institute].”
Through fostering dialogue, debate and shared learning, the GOHL Institute will further advance its aim to
empower next-generation leaders in achieving impactful
and sustainable improvements to oral health, strengthening prevention and wellness models of care and
ultimately enhancing populations’ overall health. The
GOHL Institute’s new home under the ICD umbrella
will enable the continued growth of its mission to
empower oral health leaders worldwide. Through Henry
Schein’s enduring partnership and the strategic oversight of the GOHL programme directors, Drs Sara Hurley
and Tom Kennie, the GOHL Institute is positioned to
spearhead systemic change at regional, national and
global levels.
Under the ICD’s management, the GOHL Institute will
maintain its rigorous process of selecting an annual
cohort of international participants for the full-year programme, which includes an immersive five-day residential component complemented by virtual seminars, reflection, project planning discussions, alumni events and
mentorship, and regional networking opportunities. The
ICD plans to leverage the high-calibre ideas, resources
and connections that result from this initiative to solve
global oral health challenges, especially in communities
with the greatest need for oral healthcare.
The ICD invites all Senior Dental Leadership Program
alumni to join the alumni network it is building to enhance
the overall GOHL Institute, offer mentorship and
strengthen oral health initiatives and resources globally.
Scan the QR code to join the
GOHL Institute Alumni Network:
[51] =>
industry news
|
ADA releases first standard for
clear aligner materials
© Ancapital/Shutterstock
Dental Tribune International
Aligner therapy has revolutionised the treatment of malocclusion; however, regulators have been unable to
keep pace with the rapid market expansion. US dental
associations played a pivotal role in reigning in direct-toconsumer providers to improve patient safety, and efforts
are well under way to regulate the materials used in the
aligner manufacturing process. Last month, the American Dental Association (ADA) released a draft version of
the first national standard on aligner materials. The public
has until 10 October to provide feedback on the standard, which aims to provide a framework for characterisation of the mechanical, physical and thermal properties
of aligner materials.
The proposed standard mandates specific mechanical
testing to enable comparison of the strength and flexibility of aligners made by different manufacturers. It outlines
the necessary requirements and test methods for both
thermoforming and additive manufacturing materials
used in the production of aligners and stipulates requirements for the packaging and labelling of aligners.
Dr Hera Kim-Berman, leader of the project behind the
draft standard, commented in an ADA press release:
“Clear aligner therapy is widely used in orthodontic treatment. However, there is no dental standard that specifically addresses the characteristics of the materials used
to produce orthodontic sequential aligners, neither for
thermoformed nor additively manufactured aligner materials.” She added: “This makes it difficult for practitioners,
patients and regulators to compare them.”
The ADA is accredited by the American National Standards Institute to develop standards for dental applications and has been doing so since 1928. According to the
ADA, “these standards establish requirements for safe
and effective dental products and technologies through
a consensus-based process”. The ADA Standards Program working groups consist of volunteers who contribute their expertise to the development of standards
and represent clinicians, health bodies, academic institutions and the dental industry. “Developing precise test
methods and criteria for key dental materials is essential
for researchers, industry professionals and clinicians
to better understand and identify their optimal characteristics, ultimately improving patient care,” commented
Dr Spiro Megremis, chair of the ADA Standards Program
Working Group 1.7 on Orthodontic Products, which
helped develop the standard.
The proposed standard—American National Standards
Institute/ADA Standard No. 188—can be accessed at
www.ada.org. Visit the site for more information on the
standards programme.
aligners
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[52] =>
| manufacturer news
Revolutionising orthodontics:
DynaFlex’s comprehensive suite
of advanced clear aligner solutions
In the fast-changing world of orthodontics, DynaFlex
has stood out as an industry leader in developing solutions for all modalities of clear aligner therapy. By continuously responding to the needs of the specialist and introducing cutting-edge innovations that improve the way
orthodontists can reach the best clinical outcome,
DynaFlex can meaningfully enhance the overall patient
experience. With a comprehensive suite of advanced
technologies, including its Glacier aligner material,
Precision Aligner Buttons, the five-axis Laser Aligner
Cutter (LAC) and SmileShare software, and the ability
to seamlessly combine brackets or appliances with
aligners for hybrid orthodontic treatment, DynaFlex empowers orthodontists to achieve remarkable results
while providing an exceptional patient journey.
perior clarity with durable, film-protected material. Specifically made for aligners, Glacier GX3 combines
durable outer layers with an elastomeric inner core for
flexibility and predictable results at a cost-effective price
compared with leading competitors. The latest addition,
Glacier LTR excels in long-term retention, having remarkable durability, crack resistance and clarity, and is
designed to last for up to three years of continuous use.
Embrace the innovation and reliability of Glacier by
DynaFlex to elevate your practice and enhance patient
satisfaction.
Precision Aligner Buttons
Glacier thermoforming materials
DynaFlex has developed and engineered a full line of
Glacier materials specifically for aligners and retainers
and designed these for diverse orthodontic needs, offering exceptional quality and performance. The original
Glacier is an affordable, high-quality material for aligners
and retainers, ensuring precise tooth movement and su-
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DynaFlex’s commitment to delivering excellence extends beyond aligner material. Precision Aligner Buttons
can be used for all types of aligner cases and give orthodontists unprecedented confidence in using elastics
with aligners. The patented base of Precision Aligner
Buttons has been engineered to match the shape of the
tooth at the gingival margin and to fit precisely in the
aligner cut-out window. In addition to the contoured
shape, the base is expanded to cover maximum surface
area. This unique design reduces unnecessary emergency visits and saves valuable chair time thanks to improved retention.
[53] =>
manufacturer news
Five-axis laser cutter
Hybrid orthodontics
Being able to rapidly produce aligners, minimise
post-processing finishing and customise trimlines is essential in aligner manufacturing. With the advent of
DMU’s five-axis LAC, DynaFlex’s manufacturing has
been a game-changer in the aligner fabrication process.
This advanced technology enables precise and efficient
cutting of aligners, ensuring accurate contours and a
perfect fit for each patient. The LAC’s ability to seamlessly translate digital designs into flawless aligners
streamlines the manufacturing workflow and saves valuable time for orthodontic practices.
DynaFlex’s dedication to innovation extends to hybrid
orthodontic treatment: the company offers a dynamic
approach that combines the best of both worlds. With
the flexibility to initiate treatment using brackets or
appliances and seamlessly transition to aligners for the
finishing phase, orthodontists can optimise treatment
plans based on individual patient needs, achieving
exceptional results and unparalleled patient satisfaction.
|
Commitment to improving clinical outcomes
SmileShare software
SmileShare treatment planning software stands as
a testament to DynaFlex’s dedication to enhancing the
practitioner–patient relationship. This software facilitates efficient case management, allowing orthodontists to seamlessly collaborate with patients, share treatment progress and foster engagement throughout the
orthodontic journey. With SmileShare, communication is
streamlined between the clinician’s office and DynaFlex’s
treatment planners, maximising treatment outcomes.
In an era of transformative advancements, DynaFlex continues to shape the future of orthodontics. By providing
orthodontists with a full suite of solutions—Glacier materials, Precision Aligner Buttons, an unbeatable custom
cut, easy-to-use software and the ability to perform
hybrid orthodontic treatment—DynaFlex empowers
practitioners to deliver superior care and elevate the
orthodontic experience for patients. With DynaFlex as
a trusted partner, orthodontists can embrace cuttingedge technology and achieve extraordinary, predictable
results.
To learn more about all of these offerings and how
DynaFlex can assist your practice, visit www.dynaflex.com.
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[54] =>
| manufacturer news
The VOCO International Fellowship Symposium was attended by 60 renowned dentists from 28 countries. (All images: VOCO/Kevin
Lammers)
International elite of the dental
industry in dialogue at VOCO
From developing new materials, devices and techniques
to meeting the increasing demands of our patients, the
world of dentistry is constantly adapting and evolving.
Around 60 renowned dentists from all over the world
came together at the sixth VOCO International Fellowship
Symposium to discuss the wide variety of possibilities
and opportunities. The event had the highest participation to date and was attended by a delegation from the
US for the first time, alongside dental professionals from
Europe, Asia, and Latin and South America, who accepted the invitation to Cuxhaven to find out more about
the latest trends and exchange ideas with their peers.
“We are very proud and thankful to be able to welcome
so many renowned experts,” said event organiser
Dr Matthias Mehring, who is knowledge manager at
VOCO. “Bringing together so many top dentists from all
over the world is not to be taken for granted and offers
enormous advantages for both research and practice.”
The three-day event revolved around 25 specialist presentations given by the fellows, offering a varied mix of
scientific talks and clinical case reports. These included
an in-depth examination of the different possibilities
available in the scope of direct restorations, as well as
the comprehensive explanation and discussion of stateof-the-art techniques such as injection moulding and
the stamp technique.
54
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2 2024
All the presentations were met with vigorous applause.
Dr Ronni Brown, a dentist, researcher and author from California
in the US, gave an impressive keynote speech on the treatment
of patients with methamphetamine dependence.
Happy hosts (from left): Dr Axel Bernecker, VOCO’s head of
marketing; Olaf Sauerbier, VOCO’s managing director; and
Dr Matthias Mehring, event organiser.
[55] =>
manufacturer news
|
EAS6 2025
S I X T H
C O N G R E S S
THE FUTURE OF
aligners orthodontics
Registration will open on
October 21st 2024
www.eas-aligners.com
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[56] =>
| meetings
International events
British Orthodontic Society–BOS
Italian Society of Aligners–Sialign
16–18 October 2024
British orthodontic conference
Birmingham, UK
www.bos.org.uk
15–16 November 2024
11th National congress
Bologna, Italy
www.sialign.it
Italian Society of Orthodontics–SIDO
German Society
for Aligner Orthodontics–DGAO
Swiss Orthodontic Society–SGK
Association dentaire française–ADF
31 October–2 November 2024
Annual congress
Interlaken, Switzerland
www.swissortho.ch
26–30 November 2024
Annual meeting
Paris, France
www.adfcongres.com
Fédération française
d’orthodontie–FFO
International Dental Show–IDS
8–10 November 2024
26es Journées de l’orthodontie
Paris, France
www.orthodontie-ffo.org/
56
22–23 November 2024
8th Scientific congress for aligner orthodontics
Cologne, Germany
www.dgao.com
25–29 March 2025
Cologne, Germany
www.english.ids-cologne.de/
Pacific Coast Society
of Orthodontists–PCSO
American Association
of Orthodontists–AAO
14–17 November 2024
Western Orthodontic Conference–WOCON
Annual session
Palm Springs, US
www.pcsortho.org/
25–27 April 2025
Annual session
Philadelphia, US
www2.aaoinfo.org/meetings/
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2 2024
© 06photo/Shutterstock.com
17–19 October 2024
55th International congress
Florence, Italy
www.sido.it
[57] =>
© 32 pixels/Shutterstock.com
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How to send us your work
Please note that all the textual components of your submission must be combined into one MS Word document.
Please do not submit multiple files for
each of these items:
· the complete article;
· all the image (tables, charts, photographs, etc.) captions;
· the complete list of sources consulted
and
· the author or contact information
(biographical sketch, mailing address,
e-mail address, etc.)
In addition, images must not be
embedded into the MS Word document.
All images must be submitted separately,
and details about such submission follow
below under image requirements.
Text length
Article lengths can vary greatly—from
1,500 to 5,500 words—depending on
the subject matter. Our approach is that if
you need more or fewer words to do the
topic justice, then please make the article
as long or as short as necessary.
We can run an unusually long article in
multiple parts, but this usually entails a
topic for which each part can stand alone
because it contains so much information.
In short, we do not want to limit you in
terms of article length, so please use the
word count above as a general guideline
and if you have specific questions, please
do not hesitate to contact us.
Please use single spacing and make sure
that the text is left justified. Please do not
centre text on the page. Do not indent
paragraphs, rather place a blank line between paragraphs. Please do not add
tab stops.
Should you require a special layout,
please let the word processing programme you are using help you do this
formatting automatically. Similarly, should
you need to make a list, or add footnotes
or endnotes, please let the word processing programme do it for you automatically.
There are menus in every programme that
will enable you to do so. The fact is that
no matter how carefully done, errors can
creep in when you try to number footnotes
yourself.
Any formatting contrary to stated above
will require us to remove such formatting before layout, which is very timeconsuming. Please consider this when
formatting your document.
Larger image files are always better,
and those approximately the size of
1 MB are best. Thus, do not size large
image files down to meet our requirements but send us the largest files available. (The larger the starting image is
in terms of bytes, the more leeway the
designer has for resizing the image in
order to fill up more space should there
be room available.)
Also, please remember that images
must not be embedded into the body of
the article submitted. Images must be
submitted separately to the textual submission.
You may submit images via e-mail, via
www.wetransfer.com or Dropbox directly
to us.
Please also send us a head shot of
yourself that is in accordance with the
requirements stated above so that it can
be printed with your article.
Image requirements
Abstracts
Please number images consecutively
throughout the article by using a new
number for each image. If it is imperative
that certain images are grouped together,
then use lowercase letters to designate
these in a group (for example, 2a, 2b, 2c).
An abstract of your article is not required.
Text formatting
Please place image references in your
article wherever they are appropriate,
whether in the middle or at the end of a
sentence. If you do not directly refer to the
image, place the reference at the end of
the sentence to which it relates enclosed
within brackets and before the period.
We also ask that you forego any special
formatting beyond the use of italics and
boldface. If you would like to emphasise certain words within the text, please
only use italics (do not use underlining or
a larger font size). Boldface is reserved
for article headers. Please do not use
underlining.
In addition, please note:
· We require images in TIF or JPEG format.
· These images must be no smaller than
6 × 6 cm in size at 300 DPI.
· These image files must be no smaller
than 80 KB in size (or they will print
the size of a postage stamp!).
Author or contact information
The author’s contact information and
a head shot of the author are included
at the end of every article. Please note
the exact information you would like
to appear in this section and format it
according to the requirements stated
above. A short biographical sketch may
precede the contact information if you
provide us with the necessary information (60 words or less).
Questions?
Please contact Nathalie Schüller at
n.schueller@dental-tribune.com.
aligners
2 2024
57
[58] =>
| international imprint
aligners
international magazine of aligner orthodontics
Imprint
www.dental-tribune.com
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0 YEA
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OF
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& 2
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2/24
issn 1868-3207 • Vol. 3 • Issue 2/2024
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Scientific Advisor
Dr Carlo Fornaini
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Editors
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Scan the QR code to register and read
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trends & applications
How to overcome obstacles in offering
interdisciplinary dental care
case report
ClearX teen smile transformation
practice management
Strategies to enhance the patient experience
and interaction with aligner therapy
Copyright Regulations
All rights reserved. © 2024 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 2024
[59] =>
N
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© 2024 Ortho Organizers, Inc. All rights reserved. Patent pending. M3557 08/24
[60] =>
| Xxxxxx
60
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2 2024
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