Innovation, Digital Technologies Driving Change in Orthodontics

Intraoral scanners have revolutionized the way clinicians treat patients across dental disciplines. These convenient devices have continued to progress over the years, with much of the innovation fueled by clear aligner orthodontic treatment. Practitioners now have the ability to acquire a scan at each patient visit and use the associated software to perform a myriad of functions, including tooth movement simulation, caries detection, and visualization of intensity of occlusal contact. Also, the STL file can be used to create appliances, aligners, crowns, printed models, and more.

Further, scanners have revolutionized and streamlined the patient experience. Align Technology, for example, continues to expand the capabilities of its end-to-end digital platform, which all starts with a simple, painless, efficient scan. The software's simulation features can then be used to educate the patient, reveal progressive tooth movement, and show a desired treatment goal. This, along with the clear aligner prescription, can then be turned into a ClinCheck^® visualization, which is a stage-by-stage depiction of each changing aligner, paralleling the movement of the patient's teeth. Clinicians can now interpolate the final stage of the ClinCheck within the patient's smile, allowing the intraoral and extraoral effects of treatment to be visualized. Additionally, use of tooth movement tables allows for increased precision in treatment planning and execution. Such advancements-all of which stem from a digital scan-positively impact patient education, treatment acceptance, and, ultimately, treatment outcomes.

Another technological advance in orthodontics has been clinicians' ability to see patients virtually. New platforms continue to emerge and current ones keep improving. From new patient examinations, to monitoring during active treatment, to post-treatment retainer checks, this virtual aspect has changed the amount of time a patient needs to physically spend in the office. This allows orthodontic treatment to more seamlessly fit into busy patients' lives and provides the digital experience that people have come to expect from businesses and services across almost all industries. Further, such technologies can improve revenue per visit by decreasing the number of appointments needed, chairtime, and doctor time. The agility afforded by the ability to examine, start, and treat patients virtually became particularly evident during the COVID-19 pandemic.

As this digital revolution continues in dentistry, the hardware, such as scanners and cone-beam computed tomography (CBCT) units, will undoubtedly continue to improve, while software platforms will combine and extend their platforms across different specialties. This will facilitate the bridging of gaps among all disciplines of dentistry. Align Technology's acquisition of Exocad is one example. The ability to combine intraoral scans and CBCT scans and utilization of a single, centralized software that incorporates all disciplines in dentistry will significantly streamline treatment planning and patient care. For instance, orthodontic tooth movement can interface with the implant software so that, if needed, implants can be placed early in treatment for anchorage purposes. The restorative plan with a digital wax-up will then be used so that the patient can visualize the treatment and doctors can together plan interdisciplinary treatment from beginning to end.

The process of moving from analog to digital is occurring within the braces space as well, and the evolution has been impressive. Within a generation or two, orthodontics has gone from bands on every tooth with no prescription in the brackets to Andrews' straight-wire concept with prescriptions within the brackets. This has allowed for each type of tooth to have a standardized prescription that expresses the tooth movement in all three planes of space as the orthodontist proceeds through a sequence of arch wires. The bracket prescriptions are based on averages for each tooth type. This type of edgewise appliance is still commonly used today-an approach that remains analog as most orthodontists continue to individually place the brackets tooth by tooth intraorally. This leaves some variability in planning and outcome, as bracket placement precision is critical to achieving the overall result. If the brackets are not positioned ideally, they will eventually need to be repositioned or have detailing bends placed in the wire to achieve the desired outcome.

Some very exciting innovation is presently occurring in the bracket business, as companies such as LightForce Orthodontics are enabling the transformation of braces from analog to digital. Upon import of intraoral and CBCT scans into the company's proprietary software, tooth movements can be digitally planned and manipulated while the final occlusion is visualized. This gives orthodontists increased treatment planning capabilities for braces cases-similar to what is occurring in aligner cases-and allows for a completely digital experience within the office. The fact that the brackets are 3D-printed, specific to the patient, represents a transformative development in the future of braces treatments. These brackets are designed for each individual, specific tooth based on the tooth movement that was planned within the software. The brackets are then put in customized 3D-printed indirect bonding trays so that bracket placement outlined by the computer software transfers precise bracket placement into the mouth. The specificity and customization afforded by this technology has the potential to decrease the need for detailing, number of appointments, and time in treatment, and thus possibly eventually obsolesce standard bracket prescription.

The orthodontic profession continues to advance through technological innovation and unprecedented marketing exposure. More people than ever are experiencing the benefits of straight teeth and healthy smiles. With the proliferation of removable aligner therapy, many patients who previously refused conventional treatment with bonded brackets are now willing to proceed. These advancements in orthodontics along with the many more increasingly customizable options that are anticipated to come-much of which is being fueled by industry competition and consumer expectation for frictionless experiences across service categories-will continue to improve patient experience and the quality of care orthodontists provide to their patients. Orthodontic treatment will be able to accomplish things once never thought possible.

Dr. Ferris is a consultant for Align Technology, Inc.

Drew Ferris, DDS, MS
National and International Lecturer; Adjunct Faculty, Orthodontics, Loma Linda University School of Dentistry, Loma Linda, California; Director, Santa Barbara Dental Study Group; Private Practice in Orthodontics, Santa Barbara, California