For Better Results, TRUST G&H

With a full portfolio of orthodontic products and 45 years’ experience, G&H Orthodontics® delivers predictable, reliable outcomes for your treatment plans.

hope, guiding innumerable individuals toward dental perfection.1,2,3,4

However, with the advent of digital technology and the rise of artificial intelligence models, we find ourselves on the cusp of a potential paradigm shift—an era that could signal the end of braces as we know them. To embrace the opportunities presented by technological advances, we must recognize that change is inevitable. Traditional braces have withstood the test of time, but the future holds the promise of alternative treatment modalities that leverage digital innovations and artificial intelligence, potentially revolutionizing orthodontics.4

What lies ahead on this transformative path to dental perfection can only be revealed over time. As we navigate the ever-evolving landscape of orthodontics, we remain captivated by the historical tapestry that has shaped this remarkable field. It is a testament to the ingenuity and dedication of ancient civilizations and modern pioneers that we continue to strive for dental perfection, improving not only the aesthetics but also the function and overall well-being of countless individuals.

Orthodontic Treatment: Embracing a Paradigm Shift

The 3D-Printed Clear Aligner Revolution in Orthodontics

The field of orthodontics is currently experiencing a paradigm shift with the convergence of 3D printing technology and orthodontic practices. This exciting development has propelled the field in a new and promising direction, offering a host of benefits over conventional orthodontic treatments. To fully comprehend the implications of this methodological breakthrough, it is imperative to explore the world of 3D-printed clear aligners and their potential impact on future clinical practices.5

The introduction of transparent, 3D-printed aligners has undeniably revolutionized the field of orthodontics. The concept of using transparent plastic trays for tooth alignment originated in the 1990s, when two graduates from Stanford University drew inspiration from a plastic retainer.

This led to the creation of the pioneering clear aligner system, Invisalign, in 1999. Since then, numerous other clear aligner systems have emerged, each with its own unique characteristics and advantages.6

The 3D printing process has played a pivotal role in the production of these transparent aligners. Through the use of digital scanners and advanced software, orthodontic clinicians can create precise 3D models of their patients’ teeth and design personalized treatment plans.

These digital models are then converted into physical aligners using 3D printers, streamlining the manufacturing process and ensuring a high level of accuracy.7

One of the primary advantages of 3D-printed transparent aligners is their aesthetic appeal. Unlike traditional braces, which consist of metal brackets and wires, clear aligners are made of transparent plastic material, rendering them nearly invisible when worn. This discreet nature appeals to adults and adolescents seeking orthodontic treatment without the noticeable appearance of traditional braces.8

In addition to their aesthetic benefits, transparent aligners offer increased comfort and convenience. The aligners are custom-made to fit snugly over the teeth, ensuring a comfortable experience for the wearer. With clean edges and a smooth surface, the likelihood of oral injuries or sores is significantly reduced.9

Oral hygiene is also greatly improved with transparent aligners. Since the aligners are removable, patients can easily maintain their regular oral hygiene routine by brushing and flossing without obstruction. This reduces the risk of plaque accumulation, tooth decay, and periodontal disease, promoting overall dental health during the course of treatment.10

Another notable advantage of 3D-printed transparent aligners is their ability to provide precise and predictable tooth movement. The digital design process allows orthodontic clinicians to visualize the expected outcome and plan each phase of treatment accordingly. The aligners are designed to exert controlled forces on specific teeth, gradually repositioning them into their ideal alignment. This level of precision enhances the efficacy of the treatment and improves the predictability of the final results.11,12,13

The advancements in 3D printing technology have also revolutionized the manufacturing processes associated with clear aligners in orthodontics. Clear aligners can now be produced through thermoforming on 3D-printed models or direct

3D printing, minimizing errors and defects that may occur during manufacturing. Additionally, 3D printing generates significantly less waste compared to subtractive and thermoforming processes, making it a more sustainable option.14,15,16

Various materials, such as epoxy resins, polylactic acid, polyamide (nylon), and glass-filled polyamide, are used in 3D printing for the fabrication of clear aligners. Durability, biocompatibility, and the desired level of transparency for the aligners are a few factors that affect the choice of material.17

Moreover, 3D printing offers increased productivity, accuracy, and environmental sustainability. By employing one or a combination of 3D printing techniques, it is now possible to directly manufacture clear aligners using 3D printing in a single step, eliminating the need for intermediate stages and reducing the overall production time. This streamlined method enhances the effectiveness of clear aligner production.17,18

The precision achievable with 3D printing is a significant advantage in orthodontics. The digital designs are accurately translated into physical aligners, ensuring a precise fit over the teeth.

This level of accuracy contributes to the efficacy of the treatment by facilitating predictable tooth movements and optimal outcomes.19

Personalization is another remarkable feature of 3D printing in orthodontics. Orthodontic clinicians can customize the design of clear aligners to meet the unique requirements and treatment objectives of each patient. The ability to create custom aligners for individual patients improves treatment outcomes and enhances patient satisfaction.17,18

From an environmental perspective, 3D printing offers substantial advantages. This additive manufacturing process minimizes waste by precisely depositing materials layer by layer, resulting in efficient utilization and reduced material waste. As a result, 3D printing contributes to a more sustainable method of orthodontic manufacturing.20

Remote Dental Monitoring Using Digital Technology

Digital technology has played a transformative role in the field of orthodontics, revolutionizing the way treatments are conducted. One significant impact of digital technology is the introduction of remote monitoring, which allows orthodontic clinicians to closely track the progress of their patients without the need for frequent in-office visits. This advancement holds great promise for patients using transparent aligners, offering them a more convenient and efficient treatment experience while benefiting both orthodontic clinicians and patients alike.21

Remote monitoring technology brings increased convenience and productivity to orthodontic treatment. Through this technology, orthodontic clinicians can remotely monitor the movement of teeth and make necessary adjustments to treatment plans. Patients no longer need to visit the orthodontic clinician’s office for frequent adjustments, saving them time and effort. Instead, orthodontic clinicians can assess progress and make informed decisions using digital scans, photographs, or even video consultations.22,23

Furthermore, remote monitoring technology enhances access to orthodontic specialist care. One of its primary benefits is the ability to connect orthodontic specialists with patients regardless of their geographical location. This means that local dentists can collaborate with experts in the field, bridging the gap between general dentistry and orthodontics. As a result, general dentists can provide orthodontic care that was previously limited to orthodontic specialists. This increased collaboration improves access to specialized care, particularly in regions where specialty orthodontists are scarce.24,25

The incorporation of remote monitoring technology also has the potential to increase the supply of orthodontic care and reduce costs. By allowing general dentists to administer orthodontic treatment under the supervision of remote specialists, the burden on specialist orthodontists is alleviated. This addresses the issue of limited availability and simplifies access to care. As the number of providers grows, competition may lead to lower treatment prices, making orthodontic care more affordable and accessible to a larger number of patients.

Moreover, remote monitoring technology overcomes geographical obstacles that may hinder orthodontic treatment, particularly for individuals living in remote areas far from major cities where orthodontic specialists are typically located. By eliminating the need for frequent in-person visits, patients can receive high-quality orthodontic care as long as they have access to a local dentist who can facilitate remote consultations and collaborate with specialists. This breakthrough ensures that patients in underserved regions have equal access to care compared to those in urban centers.25

The incorporation of digital technology and remote monitoring has truly revolutionized orthodontics, benefiting patients in numerous ways. Increased convenience, expanded access to care, and reduced costs are some of the key advantages. This transformation has led to a more patient-centered approach, empowering individuals from all locations to achieve optimal oral health and well-aligned smiles. 23,24,25

As technology continues to advance, we can expect further innovations and enhancements in orthodontic treatments. Digital technology will play an evolving role in orthodontics, providing orthodontic clinicians with effective tools to improve treatment outcomes and deliver personalized care. The future of orthodontics is promising, with increased accessibility, affordability, and patient satisfaction driven by the ongoing digital transformation in the field.25

Unlocking the Potential of Intraoral 3D Scanning in Orthodontics

In recent years, orthodontics has experienced a revolutionary leap forward with the introduction of 3D intraoral scanning technology. This innovative digital tool allows orthodontic clinicians to create precise and detailed 3D models of patients’ teeth and tissues, replacing traditional and uncomfortable dental impressions.26

At the core of this technology is a portable scanner that captures three-dimensional data about a patient’s dental structure. Orthodontic clinicians can now generate highly accurate 3D models of teeth, facilitating customized aligners and braces for optimal treatment outcomes.27

Align Technology Inc., the pioneering manufacturer of Invisalign aligners, has emerged as an industry leader in 3D-printed orthodontics. Their advanced iTero 3D scanning system sets the standard for 3D-printed and manufactured custom aligners. This revolutionary technology has not only transformed traditional orthodontic practices but has also inspired other companies to explore the potential of 3D printing in orthodontics.28,29

Beyond Align Technology Inc., several companies have embraced 3D-printed orthodontics, developing their own 3D-printed dental trays. These companies have made remarkable advancements in improving precision, effectiveness, and patient satisfaction. Several prominent companies in the field of 3D dental scanning include 3Shape, Carestream Dental, Dentsply Sirona, Planmeca, Medit, Straumann, KaVo Kerr, and Shining 3D. It should be noted that this is not an exhaustive list, as there may be additional companies offering 3D dental scanning technology.30

The advantages of 3D intraoral scanning extend beyond precision and convenience. Patients no longer endure the discomfort or messiness associated with traditional dental impressions.

Instead, they undergo a streamlined scanning procedure that collects accurate data about their dental structure, enhancing their comfort and understanding of the treatment process.27,28

Orthodontic clinicians and dental laboratories also benefit from simplified workflows. Eliminating production stages like impression materials and plaster models reduces costs, minimizes distortion and inaccuracy, and saves time. Additionally, the lack of transportation requirements contributes to a more environmentally responsible approach.20

The future of 3D intraoral scanning holds great promise as technology continues to advance. Ongoing research and development will lead to even more precise, faster, and user-friendly scanners, improving treatment outcomes. Artificial intelligence and machine learning algorithms will further enhance scan analysis, aiding orthodontic clinicians in detecting anomalies and predicting treatment progression.21,22

The integration of 3D intraoral scanning with 3D printing technologies opens up new avenues for innovation. Custom aligners, retainers, and other orthodontic appliances can be created, expanding treatment options and personalization.20

The potential applications of 3D intraoral scanning extend beyond orthodontics to restorative dentistry, implant planning, and prosthetic fabrication. Its precision and effectiveness make it an invaluable tool across all dental specialties, enhancing patient care holistically.20,31

Improving Treatment Planning with ThreeDimensional Cone-Beam X-Rays

The introduction of 3D cone-beam x-rays has brought about a significant revolution in digital imaging in the constantly evolving field of orthodontics. This revolutionary technology has not only surpassed the limitations of traditional 2D x-rays, but it has also provided orthodontic clinicians with a level of precision and accuracy in treatment planning that has never been seen before. By providing a precise and comprehensive visualization of a patient’s teeth, jaw, and adjacent structures, 3D cone-beam x-rays have become an indispensable instrument for orthodontic clinicians everywhere.32

One of the primary benefits of 3D cone-beam x-rays is their ability to reveal invaluable insight into the precise positioning of impacted teeth and their intricate relationship with adjacent roots. Unlike conventional x-rays, which often fail to capture the complexity of dental structures, 3D cone-beam x-rays provide a comprehensive and detailed image. This wealth of information enables orthodontic clinicians to develop highly individualized treatment strategies that maximize outcomes and guarantee the best possible results.33,34

To enhance the benefits of 3D cone-beam x-rays, multiple manufacturers have developed sophisticated cone-beam systems. The i-Cat Cone Beam 3D Dental Imaging System is one such example. With a single 360-degree scan, this cutting-edge technology captures a complete set of x-rays and generates comprehensive 3D images of the teeth. Orthodontic clinicians can examine the oral anatomy in greater detail and make more informed treatment decisions thanks to the level of detail the i-Cat system provides.34

Other industry leaders, such as Planmeca and Carestream Dental, have also made significant contributions to the field with their inventive conebeam systems. These systems provide orthodontic clinicians with intricate views of the oral anatomy, enabling them to obtain a comprehensive understanding of the patient’s dental structure. By incorporating these cutting-edge technologies into their practices, orthodontic clinicians can enhance the precision of their treatment planning and provide patients with more individualized care.34

Align Technologies, a leading provider of clear aligner systems, recognizes the critical role of cone-beam x-rays in treatment planning. They have integrated cone-beam x-ray technology into their treatment algorithms, resulting in enhanced precision and efficacy. By incorporating high-resolution 3D images into their planning process, Align Technologies can tailor their treatment strategies and aligner designs to the specific requirements of each individual patient. This integration ensures a personalized and accurate orthodontic approach, resulting in superior treatment outcomes.35

The combination of 3D cone-beam x-rays, the availability of multiple cone-beam manufacturers, and the incorporation of this technology into treatment planning algorithms by industry leaders all contribute to a comprehensive and well-rounded method of orthodontic care. This sophisticated technology, with its capacity to provide unparalleled insights and detailed views, has become an indispensable component of contemporary orthodontic practices.34 Furthermore, this technology is widely employed in the field of airway orthodontics to more precisely quantify the airway space. It has demonstrated the benefits of mandibular advancement in the treatment of airway space deficiency by accumulating more data. Studies have found that cone-beam computed tomography (CBCT) is a good way to measure how well mandibular advancement appliance (MAA) therapy works to open up the airway in people with obstructive sleep apnea (OSA).36

By utilizing the power of 3D cone-beam x-rays, orthodontic clinicians can provide exceptional care to their patients, optimize treatment outcomes, and ensure their dental and medical health over the long term. As this technology continues to develop, it has the potential to further revolutionize the field of orthodontics and influence the future of treatment planning, ultimately benefiting a large number of individuals seeking orthodontic care.36,37

Multiple providers offer this advanced technology, including Carestream Dental, Dentinger Sirona, Planmeca, Vatech, KaVo Kerr, Gendex, Owandy Radiology, and Morita. These companies are at the forefront of developing and manufacturing 3D dental cone-beam x-ray devices, expanding the accessibility of this technology to orthodontic practices worldwide.38

With the continuous advancement of 3D conebeam x-ray technology, orthodontic clinicians can expect further improvements in image quality, resolution, and diagnostic capabilities. Ongoing research and development efforts are focused on enhancing the efficiency and accuracy of treatment planning by incorporating artificial intelligence (AI) and machine learning algorithms. These intelligent systems have the potential to analyze vast amounts of data and assist orthodontic clinicians in identifying patterns, predicting treatment outcomes, and optimizing treatment plans for each individual patient.36,37,39

The ongoing integration of 3D cone-beam x-rays into treatment protocols and the cooperation between manufacturers, orthodontic clinicians, and researchers will influence the future of orthodontics. As this technology becomes more sophisticated and widely adopted, it will continue to transform orthodontic practices, enabling orthodontic clinicians to provide personalized, precise, and efficient treatment to their patients.40

Clear Aligners: A Revolutionary Option in Orthodontics

Due to the growing acceptance of the advantages of aligner-based treatments, the orthodontic industry is currently undergoing a significant transformation. Clear aligners have emerged as a revolutionary option in orthodontics, offering advantages such as improved patient comfort, reduced treatment duration, and enhanced aesthetics. Research has identified approximately 27 distinct clear aligner systems, highlighting their increasing popularity and acceptance.41

In particular, clear aligner therapy (CAT) has gained traction among adult patients seeking orthodontic treatment due to its cosmetic appeal and comfortable nature. It has been recognized as a viable alternative to traditional fixed appliances as it offers comparable effectiveness in treating malocclusion. However, clear aligners have demonstrated superiority in achieving segmented tooth movement. Improved outcomes in the clinical effectiveness of clear aligners can be largely attributed to the utilization of fabrication materials, along with advancements in material characteristics and fabrication protocols.42

Clear aligners differ from fixed appliances not only in their fabrication material but also in terms of orthodontic components and biomechanics. Previous research has often overlooked the unique properties of clear aligners, necessitating further investigation into their distinct characteristics.

A comprehensive analysis of existing literature provides compelling evidence of the growing prevalence of clear aligners in orthodontic practice. Embracing the future of orthodontics requires acknowledging the transformative potential of clear aligners in delivering exceptional treatment results while prioritizing patient satisfaction and well-being. No longer are clear aligners only for simple orthodontic treatment.43,44

It is evident that clear aligners offer a promising avenue for achieving orthodontic goals. As research and technological advancements continue, the field can further capitalize on the benefits of clear aligners and optimize treatment approaches. There is a lot of room for improvement in the field, however, and it cannot be seen as the final solution yet.45

The Byte-sized Brilliance of Computer Algorithms in Orthodontics

The field of orthodontics is undergoing a remarkable transformation through the integration of computer algorithms into treatment planning. This digital revolution allows orthodontic clinicians to create personalized treatment plans based on cuttingedge digital technologies, resulting in improved precision, efficiency, and patient satisfaction.46

Computer algorithms unlock the potential for individualized treatment by utilizing 3D intraoral scans and 3D cone beam x-rays to generate detailed models of patients’ teeth and jaws and subsequent treatment planning. This enables orthodontic clinicians to tailor treatment plans to address specific dental characteristics such as tooth alignment, mandible shape, mandibular position, and occlusion. These continuously improving algorithms and customizations ensure a patient-centric approach and maximize treatment outcomes.46,47

The incorporation of computer algorithms streamlines the treatment planning process, enhancing productivity in orthodontic practices. By analyzing comprehensive digital models of patients’ dental morphology, orthodontic clinicians gain a clearer understanding and evaluation of treatment options. This digital approach reduces reliance on physical models, accelerating decision-making and minimizing treatment delays.46,47

Align Technology, a leader in this technological revolution, combines digital treatment planning with mass customization and shape engineering based on biomechanical principles. Their innovative computer algorithms provide orthodontic clinicians with a suite of tools and resources to develop unparalleled treatment plans, resulting in superior patient experiences and outcomes.35

Computer algorithms offer orthodontic clinicians numerous advantages that transform their approach to patient care. The advanced visualization capabilities allow orthodontic clinicians to evaluate every aspect of dental structures, improving communication with patients and instilling confidence in the treatment process. Increased treatment planning productivity optimizes workflow management, enabling orthodontic clinicians to devote more time to patient care. The accuracy that algorithms offer improves treatment predictability, fosters trust, and makes informed decision-making easier. Furthermore, these algorithms play a crucial role in tracking treatment progress, ensuring efficiency, and allowing for timely interventions.48

With computer algorithms revolutionizing orthodontic treatment planning, it becomes crucial for orthodontic clinicians to embrace this technology. However, it is important to recognize that algorithms should be seen as a complement, not a replacement, for the expertise and human touch of orthodontic clinicians. Patient concerns, building rapport, and delivering personalized care are still vital aspects that go beyond the capabilities of technology alone. It is crucial for clinicians to be aware of the limitations of this new technology to avoid over-reliance on computer-based treatments without a comprehensive understanding of their current constraints.48

Overcoming Challenges and Embracing Digital Technology in Orthodontics

The incorporation of digital technology has revolutionized orthodontics, providing numerous advantages for improving patient care. However, along with these benefits come challenges that need to be addressed to fully realize the potential of digital technology.49

The implementation of digital technology in orthodontics involves various instruments, such as advanced scanners, 3D cone-beam x-ray machines, and computer algorithms. While these innovations can greatly enhance orthodontic procedures, their high costs may deter orthodontic clinicians from adopting them. The initial investment required to incorporate these technologies into a practice can be financially challenging, especially for those with limited resources.50

To address the financial barrier, orthodontic clinicians can explore options like leasing equipment or partnering with imaging centers that offer these technologies on a pay-per-use basis. Additionally, staying updated on funding opportunities and grants specific to digital technology adoption in orthodontics can provide financial support. By actively seeking alternative financing options, orthodontic clinicians can overcome the cost hurdle and leverage the benefits of digital technology.50

The adoption of digital technology in orthodontics comes with a steep learning curve for some orthodontic clinicians and their staff. Acquiring a comprehensive understanding of digital scanners, 3D cone beam x-ray devices, and complex computer algorithms and software platforms requires time, training, and resources. Without proper training, the potential benefits of these technologies may remain untapped, hindering progress and productivity.49,50

Orthodontic clinicians must invest in training programs that cover all aspects of digital technology implementation. Collaborating with equipment manufacturers, attending specialized workshops, or enrolling in online training courses can help orthodontic clinicians and their staff gain the necessary skills and knowledge. By prioritizing continuous education and providing ongoing training opportunities, orthodontic practices can bridge the knowledge gap and ensure seamless integration of digital technology into their workflows.51,52,53]

Ensuring patient acceptance and addressing their concerns is crucial for the successful implementation of digital technology in orthodontics. Some patients may have reservations about transitioning from conventional to digital orthodontic techniques. It is the responsibility of orthodontic clinicians to inform patients about the advantages of digital technology and alleviate any concerns they may have.54

Orthodontic professionals should take the time to explain how digital technology enhances the accuracy and effectiveness of the treatment process. By clearly communicating the benefits of these innovations, such as improved diagnostics, reduced treatment duration, and enhanced outcomes, patients can appreciate their value. Visual aids, such as before-and-after digital scan simulations, can also provide tangible representations of potential outcomes. Encouraging open dialogue and proactively addressing patient concerns will help build patient trust and foster acceptance of digital technology.54

Orthodontic clinicians must be cautious and aware that the general public’s knowledge and awareness of digital technology in the field may surpass their own. It is crucial for clinicians to recognize this reality and take proactive steps to upskill themselves. Failing to do so may result in a loss of credibility and the perception of ignorance in the eyes of their patients. In an era where information is easily accessible, patients may have done their own research and come prepared with questions about digital advancements in orthodontics. By staying up-todate and continuously expanding their knowledge, clinicians can maintain their position as trusted experts and engage in meaningful conversations with their patients. Embracing ongoing learning and professional development is essential to ensuring that clinicians remain at the forefront of technological advancements, reinforcing their expertise, and providing the best possible care to their patients.55

In the realm of orthodontics, the integration of digital technology has made it crucial to prioritize the protection of patient information and uphold data security. As orthodontic practices rely on electronic storage for digital scans, treatment plans, and patient records, it is essential to establish robust security measures to thwart unauthorized access and potential data breaches. Additionally, ensuring data reliability necessitates the implementation of adequate backup systems or cloud storage solutions.49

Orthodontic clinicians should prioritize the implementation of secure systems and comply with industry data protection standards. This includes utilizing encryption methods, regularly updating software and hardware, and restricting access to authorized personnel. Conducting periodic audits and risk assessments can help identify vulnerabilities and proactively address them. Demonstrating a commitment to data security will instill patient confidence and alleviate privacy-related concerns associated with digital technology usage.49

Digital technology in orthodontics not only transforms individual practices but also opens doors for interdisciplinary collaboration. Orthodontic clinicians now have the opportunity to collaborate with other dental specialists and contribute to comprehensive treatment plans. However, to fully harness the potential of interdisciplinary collaboration, effective communication and standardized protocols are essential.57

Orthodontic clinicians should actively seek opportunities to collaborate with other dental professionals, such as periodontists, oral surgeons, and prosthodontists, to provide patients with comprehensive care. Establishing clear channels of communication, securely sharing digital records, and aligning treatment objectives can enhance patient outcomes and foster synergistic collaboration. By adopting a team-oriented approach and leveraging digital technology as a unifying platform, orthodontic practices can dismantle barriers and deliver patientcentered, comprehensive care.57

Conclusion

“From Braces to Bytes: The Role of Technology in Modern Orthodontics” has explored the transformative impact of various digital technologies on the field of orthodontics, including 3D cone-beam x-rays, computer algorithms in treatment planning, and clear aligners. As professionals in the field, it is crucial to embrace modern technology and not be left behind due to outdated thinking or resistance to change. While traditional braces have withstood the test of time, the future holds the promise of alternative treatment modalities that leverage digital innovations and artificial intelligence, potentially revolutionizing orthodontics. By proactively addressing challenges related to cost, learning curves, and patient acceptance through innovative solutions, comprehensive training programs, and effective patient education, orthodontic practices can maximize the benefits of digital technology. In the era of digital advancements, orthodontic clinicians are presented with a remarkable opportunity to enhance the quality of care, enhance treatment outcomes, and propel the field of orthodontics towards new frontiers.

References:

1 Wahl N. Orthodontics in 3 millennia. Chapter 1: Antiquity to the mid-19th century. Am J Orthod Dentofacial Orthop. 2005 Feb;127(2):255-9. doi: 10.1016/j.ajodo.2004.11.013. PMID: 15750547.

2 Naidu, Shyamala, and Anand Suresh. “EVOLUTION OF ORTHODONTIC

APPLIANCES-THEN AND NOW!!!.” International Journal of Dental and Health Sciences (2018): 319-329.

3 Phulari, B. S.: History of Orthodontics. 2013: publisher: JP Medical Ltd.

4 Corruccini RS, Pacciani E. “Orthodontistry” and dental occlusion in Etruscans. Angle Orthod. 1989;59(1):61-64.

5 Nour Eldin Tarraf, Darendeliler M. Ali, Present and the future of digital orthodontics,Seminars in Orthodontics,Volume 24, Issue 4,2018,Pages 376-385,

6 Bichu, Yashodhan & Alwafi, Abdulraheem & Liu, Xiaomo & Andrews, James & Ludwig, Björn & Bichu, Aditi & Zou, Bingshuang. (2022). Advances in orthodontic clear aligner materials. Bioactive Materials. 22. 10.1016/j.bioactmat.2022.10.006.

7 Ahmed Mohammed Alassiry,Clinical aspects of digital threedimensional intraoral scanning in orthodontics – A systematic review,The Saudi Dental Journal,2023,

8 Hong K, Kim WH, Eghan-Acquah E, Lee JH, Lee BK, Kim B. Efficient Design of a Clear Aligner Attachment to Induce Bodily Tooth Movement in Orthodontic Treatment Using Finite Element Analysis. Materials (Basel). 2021 Aug 30;14(17):4926. doi: 10.3390/ ma14174926. PMID: 34501017; PMCID: PMC8433704.

9 Macrì M, Murmura G, Varvara G, Traini T and Festa F (2022) Clinical Performances and Biological Features of Clear Aligners Materials in Orthodontics. Front. Mater. 9:819121. doi: 10.3389/ fmats.2022.819121

10 Madariaga ACP, Bucci R, Rongo R, Simeon V, D’Antò V, Valletta R. Impact of Fixed Orthodontic Appliance and Clear Aligners on the Periodontal Health: A Prospective Clinical Study. Dent J (Basel). 2020 Jan 2;8(1):4. doi: 10.3390/dj8010004. PMID: 31906577; PMCID: PMC7175220.

11 Muro MP, Caracciolo ACA, Patel MP, Feres MFN, Roscoe MG. Effectiveness and predictability of treatment with clear orthodontic aligners: A scoping review. Int Orthod. 2023 Apr 20;21(2):100755. doi: 10.1016/j.ortho.2023.100755. Epub ahead of print. PMID: 37086643.

12 Bilello G, Fazio M, Amato E, Crivello L, Galvano A, Currò G. Accuracy evaluation of orthodontic movements with aligners: a prospective observational study. Prog Orthod. 2022 Apr 11;23(1):12. doi: 10.1186/s40510-022-00406-7. PMID: 35399128; PMCID: PMC8995220.

13 Ren L, Liu L, Wu Z, Shan D, Pu L, Gao Y, Tang Z, Li X, Jian F, Wang Y, Long H, Lai W. The predictability of orthodontic tooth movements through clear aligner among first-premolar extraction patients: a multivariate analysis. Prog Orthod. 2022 Dec 30;23(1):52. doi: 10.1186/s40510-022-00447-y. PMID: 36581703; PMCID: PMC9800677.

14 Tartaglia GM, Mapelli A, Maspero C, Santaniello T, Serafin M, Farronato M, Caprioglio A. Direct 3D Printing of Clear Orthodontic Aligners: Current State and Future Possibilities. Materials (Basel). 2021 Apr 5;14(7):1799. doi: 10.3390/ma14071799.

PMID: 33916462; PMCID: PMC8038630.

15 Maspero C, Tartaglia GM. 3D Printing of Clear Orthodontic Aligners: Where We Are and Where We Are Going. Materials (Basel). 2020 Nov 18;13(22):5204. doi: 10.3390/ma13225204.

PMID: 33217905; PMCID: PMC7698787.

16 Lee, S.Y., Kim, H., Kim, HJ. et al. Thermo-mechanical properties of 3D printed photocurable shape memory resin for clear aligners. Sci Rep 12, 6246 (2022). https://doi.org/10.1038/s41598-022-09831-4

17 Tartaglia GM, Mapelli A, Maspero C, Santaniello T, Serafin M, Farronato M, Caprioglio A. Direct 3D Printing of Clear Orthodontic Aligners: Current State and Future Possibilities. Materials (Basel). 2021 Apr 5;14(7):1799. doi: 10.3390/ma14071799. PMID: 33916462; PMCID: PMC8038630.

18 Shivapuja P., Shah D., Shah N., Shah S. Direct 3D-Printed Orthodontic Aligners with Torque, Rotation, and Full Control

Anchors. No. 10,179,035. U.S. Patent. 2019 Jan 15

19 Jindal P., Juneja M., Siena F.L., Bajaj D., Breedon P. Mechanical and geometric properties of thermoformed and 3D printed clear dental aligners. Am. J. Orthod. Dentofacial. Orthop. 2019;156:694–701.

20 Prasad S., Kader N.A., Sujath G., Raj T. 3D printing in dentistry. J. 3D Print. Med. 2018;2:89–91.

21 Caruso S, Caruso S, Pellegrino M, Skafi R, Nota A, Tecco S. A Knowledge-Based Algorithm for Automatic Monitoring of Orthodontic Treatment: The Dental Monitoring System. Two Cases. Sensors (Basel). 2021 Mar 7;21(5):1856. doi: 10.3390/ s21051856. PMID: 33799930; PMCID: PMC7961518.

22 Strunga M, Urban R, Surovková J, Thurzo A. Artificial Intelligence Systems Assisting in the Assessment of the Course and Retention of Orthodontic Treatment. Healthcare (Basel). 2023 Feb 25;11(5):683

23 Mohammad-Rahimi H, Nadimi M, Rohban MH, Shamsoddin E, Lee VY, Motamedian SR. Machine learning and orthodontics, current trends and the future opportunities: A scoping review. Am J Orthod Dentofacial Orthop. 2021 Aug;160(2):170-192.e4. doi: 10.1016/j.ajodo.2021.02.013. Epub 2021 Jun 5. PMID: 34103190.

24 Maspero C, Abate A, Cavagnetto D, El Morsi M, Fama A, Farronato M. Available Technologies, Applications and Benefits of Teleorthodontics. A Literature Review and Possible Applications during the COVID-19 Pandemic. Journal of Clinical Medicine. 2020; 9(6):1891. https://doi.org/10.3390/jcm9061891

25 Ismaeel Hansa, Steven J. Semaan, Nikhilesh R. Vaid, Donald J. Ferguson,Remote monitoring and “Tele-orthodontics”: Concept, scope and applications,Seminars in Orthodontics, Volume 24, Issue 4,2018,Pages 470-481,ISSN 1073-8746, https://doi.org/10.1053/j. sodo.2018.10.011.

26 Gan, N., Xiong, Y., & Jiao, T. (2016). Accuracy of Intraoral Digital Impressions for Whole Upper Jaws, Including Full Dentitions and Palatal Soft Tissues. PLoS ONE, 11.

27 Pattamavilai S, Ongthiemsak C. Accuracy of intraoral scanners in different complete arch scan patterns. J Prosthet Dent. 2022 Mar 4:S0022-3913(22)00046-4. doi: 10.1016/j.prosdent.2021.12.026. Epub ahead of print. PMID: 35256181.

28 Aly P, Mohsen C. Comparison of the Accuracy of ThreeDimensional Printed Casts, Digital, and Conventional Casts: An In Vitro Study. Eur J Dent. 2020 Mar;14(2):189-193. doi: 10.1055/s0040-1705243. Epub 2020 Apr 20. PMID: 32311750; PMCID: PMC7274830.

29 As of July 2020, iTero scans have been used in more than 5.5 million restorative case scans, including crown, bridge, and custom implant cases and more than 24.0 million iTero orthodontic case scans. Data on file at Align Technology, as of July 22nd, 2020. https://www.digitalplatform.me/references

30 Intraoral Scanner Reviews from IDS 2021 + IOS Market Update https://instituteofdigitaldentistry.com/news/intraoral-scannerreviews-from-ids-2021-ios-market-u pdate/

31 Schmalzl, J., Róth, I., Borbély, J. et al. The impact of software updates on accuracy of intraoral scanners. BMC Oral Health 23, 219 (2023).https://doi.org/10.1186/s12903-023-02926-y

32 García-Sanz V, Bellot-Arcís C, Hernández V, Serrano-Sánchez P, Guarinos J, Paredes-Gallardo V. Accuracy and Reliability of Cone-Beam Computed Tomography for Linear and Volumetric Mandibular Condyle Measurements. A Human Cadaver Study. Sci

Rep. 2017 Sep 20;7(1):11993. doi: 10.1038/s41598-017-12100-4. PMID: 28931867; PMCID: PMC5607232.

33 Anuraj Singh Kochhar, Gurkeerat Singh, Harshita Gupta. Applications of Cone Beam Computerized Tomography in Orthodontics: A Mini Review. On J Dent & Oral Health. 3(3): 2020. OJDOH.MS.ID.000565.

34 Venkatesh E, Elluru SV. Cone beam computed tomography: basics and applications in dentistry. J Istanb Univ Fac Dent. 2017 Dec 2;51(3 Suppl 1):S102-S121. doi: 10.17096/jiufd.00289. PMID: 29354314; PMCID: PMC5750833.

35 ALIGN TECHNOLOGY LAUNCHES NEW INVISALIGN SYSTEM INNOVATIONS FOR ORTHODONTIC AND RESTORATIVE DENTAL TREATMENT PLANNING WITH INTEGRATION OF CBCT INTO CLINCHECK TREATMENT PLANNING SOFTWARE Mar 18, 2022, https:// investor.aligntech.com/news-releases/news-release-details/aligntechnology-launches-ne w-invisalign-system-innovations

36 Alsufyani NA, Al-Saleh MA, Major PW. CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review. Sleep Breath. 2013 Sep;17(3):91123. doi: 10.1007/s11325-012-0799-7. Epub 2013 Jan 24. PMID: 23344828.

37 Kapila SD, Nervina JM. CBCT in orthodontics: assessment of treatment outcomes and indications for its use. Dentomaxillofac Radiol. 2015;44(1):20140282. doi: 10.1259/dmfr.20140282. PMID: 25358833; PMCID: PMC4277443.

38 Intraoral X-Ray Imaging Market Size, Status, Demand and Global Outlook- Danaher, Sirona Dental, Carestream, Gendex, Owandy Radiology, TPC Advanced Technology, Digital Doc, https://www. digitaljournal.com/pr/news/xherald/intraoral-x-ray-imagingmarket-size-status-dema nd-and-global-outlook-danaher-sironadental-carestream-gendex-owandy-radiology-tpc-advanc edtechnology-digital-doc

39 Hung K, Yeung AWK, Tanaka R, Bornstein MM. Current Applications, Opportunities, and Limitations of AI for 3D Imaging in Dental Research and Practice. Int J Environ Res Public Health. 2020 Jun 19;17(12):4424. doi: 10.3390/ijerph17124424. PMID: 32575560; PMCID: PMC7345758.

40 Petrescu SM, Tuculină MJ, Popa DL, Dută A, Sălan AI, Voinea Georgescu R, Diaconu OA, Turcu AA, Mocanu H, Nicola AG, Dascălu IT. Modeling and Simulating an Orthodontic System 41 Tamer İ, Öztaş E, Marşan G. Orthodontic Treatment with Clear Aligners and The Scientific Reality Behind Their Marketing: A Literature Review. Turk J Orthod. 2019 Dec 1;32(4):241-246. doi: 10.5152/ TurkJOrthod.2019.18083. PMID: 32110470; PMCID: PMC7018497.

42 Li, M., Shen, S., Zhao, Z. et al. The application of a fully digital approach in the treatment of skeletal class III malocclusion: a preliminary study. BMC Oral Health 23, 237 (2023). https://doi. org/10.1186/s12903-023-02918-y

43 Alaa M H Alfawal and others, The impact of non-extraction orthodontic treatment on oral health-related quality of life: clear aligners versus fixed appliances—a randomized controlled trial, European Journal of Orthodontics, Volume 44, Issue 6, December 2022, Pages 595–602, https://doi.org/10.1093/ejo/cjac012

44 da Silva VM, Ayub PV, Massaro C, Janson G, Garib D. Comparison between clear aligners and 2 × 4 mechanics in the mixed dentition: a randomized clinical trial. Angle Orthod. 2023 Jan 1;93(1):310. doi: 10.2319/032322-237.1. PMID: 36066265; PMCID: PMC9797137.

45 Jaber ST, Hajeer MY, Sultan K. Treatment Effectiveness of Clear

Aligners in Correcting Complicated and Severe Malocclusion Cases Compared to Fixed Orthodontic Appliances: A Systematic Review. Cureus. 2023 Apr 29;15(4):e38311. doi: 10.7759/cureus.38311. PMID: 37128600; PMCID: PMC10148732.

46 Prasad J, Mallikarjunaiah DR, Shetty A, Gandedkar N, Chikkamuniswamy AB, Shivashankar PC. Machine Learning Predictive Model as Clinical Decision Support System in Orthodontic Treatment Planning. Dent J (Basel). 2022 Dec 20;11(1):1. doi: 10.3390/dj11010001. PMID: 36661538; PMCID: PMC9858447.

47 Kunz F, Stellzig-Eisenhauer A, Boldt J. Applications of Artificial Intelligence in Orthodontics—An Overview and Perspective Based on the Current State of the Art. Applied Sciences. 2023; 13(6):3850. https:// doi.org/10.3390/app13063850

48 M‘hamed Jihed, Ines Dallel, Samir Tobji, Adel Ben Amor. The Impact of Artificial Intelligence on Contemporary Orthodontic Treatment Planning - A Systematic Review and Meta-Analysis. Sch J Dent Sci, 2022 Jun 9(5): 70-87.

49 Alam MK, Abutayyem H, Kanwal B, A L Shayeb M. Future of Orthodontics-A Systematic Review and Meta-Analysis on the Emerging Trends in This Field. J Clin Med. 2023 Jan 9;12(2):532. doi: 10.3390/ jcm12020532. PMID: 36675459; PMCID: PMC9861462.

[50] Cunha TMAD, Barbosa IDS, Palma KK. Orthodontic digital workflow: devices and clinical applications. Dental Press J Orthod. 2021 Dec 15;26(6):e21spe6. doi:10.1590/2177-6709.26.6.e21spe6. PMID: 34932716; PMCID: PMC8690351.

51 Nazir M, Al-Ansari A, Alabdulaziz M, AlNasrallah Y, Alzain M. Reasons for and Barriers to Attending Continuing Education Activities and Priorities for Different Dental Specialties. Open Access Maced J Med Sci. 2018 Sep 22;6(9):1716-1721. doi: 10.3889/oamjms.2018.373. PMID: 30337997; PMCID: PMC6182532.

52 Friedman A, Phillips M. Continuing professional development:Developing a vision. Journal of education and work. 2004;17:361–76. https://doi. org/10.1080/1363908042000267432

53 Yeung AWK, Tanaka R, Jacobs R, Bornstein MM. Awareness and practice of 2D and 3D diagnostic imaging among dentists in Hong Kong. Br Dent J. 2020 May;228(9):701-709. doi: 10.1038/s41415-020-1451-8. PMID: 32385465.

54 Alauddin MS, Baharuddin AS, Mohd Ghazali MI. The Modern and Digital Transformation of Oral Health Care: A Mini Review. Healthcare (Basel). 2021 Jan 25;9(2):118. doi: 10.3390/healthcare9020118. PMID: 33503807; PMCID: PMC7912705.

55 Kosan E, Krois J, Wingenfeld K, Deuter CE, Gaudin R, Schwendicke F. Patients’ Perspectives on Artificial Intelligence in Dentistry: A Controlled Study. Journal of Clinical Medicine. 2022; 11(8):2143. https://doi. org/10.3390/jcm11082143

56 Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care. Clinical Data as the Basic Staple of Health Learning: Creating and Protecting a Public Good: Workshop Summary. Washington (DC): National Academies Press (US); 2010. PMID: 21595112.

57 Yellowitz, Janet. (2016). Building the ideal interdisciplinary team to address oral health. Generations. 40. 60-65.

How my book can be helpful….

It takes time to educate parents on the benefits of treating dental growth issues early and explaining what signs we look for. In writing this book in simple language I hope to bring an awareness to the larger parent community, which will in turn save my dental colleagues chairside time. This book would be a helpful resource for the waiting room, and for introducing the concept to younger colleagues joining your practice.

Growing Beautiful Teeth

Chapter 4: It’s Not Just about Teeth

Estie Bav is an active member and senior instructor of IAO. She graduated BDSc from the University of Western Australia, and practises in her own private family dental surgery in Melbourne Australia. In November 2018 she published her first book titled “Growing Beautiful Teeth,” primarily targeting parents, grandparents, teachers or any child health carer to look out for early signs of dental growth issues. It informs the unaware the importance and impact of teeth and jaw on other areas of health such as breathing, sleep, posture, and even behaviour.

Currently the dental profession tends to “supervise and wait” for growth issues to become complex and expensive to correct….”

“My concern is that most parents miss out on basic and important dento-facial growth information until too late.”

The book was designed to be a helpful resource for your patient to read, and for introducing the subject to younger dentists and allied health professionals who may not be familiar with the teeth-occlusion-airway-TMJsleep paradigm.

Her message is to get involved with a child’s dentofacial-airway development early.

Growing Beautiful Teeth is available from any major online booksellers, or at

• www.drestiebav.com

• www.growingbeautifulteeth.com

She can be reached at estie@drestiebav.com

The modern human is susceptible to having a compromised airway that worsens when the body is in a horizontal position during sleep. When we enter the deeper stages of sleep, our muscles become totally relaxed, almost paralysed, and the throat collapses somewhat. The tongue, which is also a muscle, can become a heavy blob that falls back to block the airway, especially when one is sleeping on the back with the jaw open.

Airway blockage will compromise breathing: air intake is reduced and oxygen level in the blood drops. This is referred to as oxygen desaturation. The compromised intake of air during sleep is called sleep apnea. When the blockage is complete, the event is known as Obstructive Sleep Apnea (OSA). OSA happens not only in adults but children as well.

We also refer to this condition generally as Sleep Disordered Breathing (SDB) which explains a situation where breathing disorders take place during sleep. SDB and OSA disturb sleep and can affect the child in many serious ways such as growth, learning ability, mood, concentration, social behaviour and is linked to bruxism, and TMD and chronic pain in the older child.

So far, the reader has been alluded to the fact that there is more to it than just straight teeth. The upper and the lower jaws should be wide, and forward relative to the cranium, to give plenty of functional space for the tongue, facilitate nasal breathing, reduce the risk for compressing the TMJs, provide good airway and to enhance facial beauty.

Here are some more important factors in the equation: sleep and growth for the child.

Breathe Well to Sleep Well and to Grow Well

I want to draw the parent’s attention to the fact that for your child to grow beautiful teeth, jaw and face, your child needs to sleep well. And breathing well day and night is key to their sleeping well and growing well. Correct daytime breathing through the nose may ensure that this habit is also maintained during sleep.

I often ask parents to play the role of a detective and observe how their child sleeps. Is the child able to breathe easily through the nose? Some of the clues to SDB and poor sleep include open-mouth breathing, loud snoring, laboured breathing, tossing and turning, waking during the night, nightmares and bedwetting.1,2

Parents will be very surprised that studies have found that there is a connection between a child’s narrow palate and bedwetting during sleep.3

We adults know how a night of disrupted sleep or a lack of sleep can affect our state of being the following day. A child who does not sleep well is a miserable child, often with behavioural issues. In fact, more and more research studies and observations are noting the parallel symptoms of ADHD and sleep deprivation. Their learning ability and performance at school is also compromised.

Sleep is necessary. It is the time during the 24hour cycle that our body rejuvenates and recharges by flushing out chemical waste in the brain. In a growing child, during the deeper phase of sleep called REM (rapid eye movement) sleep, hormones are made and released which are essential for the child’s growth and development, including the formation of their brain and nervous system.

Poor quality sleep will affect the child’s growth. This has become a subject of increasing concern in the health and medical arena as it should.

Posture When Sleeping

During sleep, the body is lying horizontally and since the muscles of the body become totally relaxed in the deeper phases of sleep, the tongue may fall back and further constrict the oropharynx. This may be made worse in a child with enlarged adenoids and tonsils where the blockage can become quite serious.

Airway constriction reduces the intake of air to the body, especially to the high-oxygen- consuming brain. This stresses the brain and, due to a sympathetic nervous response to the stress, the child may not be able to go into the deeper REM sleep that is essential for growth.

The child may also have disturbed sleep as the brain directs subconscious actions to gain more oxygen. The child is subconsciously aroused, stirred, unable to enter the REM phase of sleep, wakes, or even wets the bed.

When a child sleeps well, he or she will grow better, perform better and potentially make for a happier child.

Any difficulty with breathing through the nose can be made worse during the night, and the child may be forced to hang the mouth open all night. Usually, parents will also observe that the child snores and has bad breath upon rising the next morning.

Whilst a mild degree of OSA is acceptable in adults, any amount of airway obstruction in a growing child has been considered unacceptable by pediatric sleep professionals.

In my practice, I routinely see worn down tooth enamel in children’s teeth, and the teeth may not even be decayed. Usually, these children also have a shortened or underdeveloped upper jaw and/ or they may have throats blocked by large tonsils. They tend to breathe through their mouth, not necessarily with their mouth hanging open, as sometimes this habit is not so obvious outwardly.

This predisposes to TMD which is more common in the child, usually an older child, than it is generally appreciated. Symptoms of TMD include TMJ pain which may also be interpreted as headaches, clicking jaw joints, limitation in jaw opening, jaw locks, and ear symptoms.

The traditional reason given for the cause of tooth clenching and grinding is mental stress or anger. Now, contemporary observations and interpretations of tooth clenching and grinding, or bruxing, explain that when the airway is compromised during sleep, oxygen desaturation or oxygen deprivation triggers a sympathetic fight-or-flight response. This is big stress for the brain.

The brain is very sensitive to any fall in oxygen level in the blood and, when detected, it will cause an arousal from sleep and trigger a mouth closure or a gasp in order to reduce the throat constriction and increase air intake in an attempt to restore the oxygen level.

Bruxing brings the lower jaw closed tight against the upper jaw, and a protrusion or forward repositioning of the tongue from the throat area to improve the airflow through the throat at the back of the mouth. It is the brain’s effort or attempt to remove the airway obstruction and restore oxygen level for the body.

However, the arousal or the stir from a deep sleep to restore breathing will disrupt the sleep. With chronic bruxing, the micro trauma on the TMJ’s can in time dislocate the jaw joints or the condyles from the disk that sits between the bony parts of the jaw joints as illustrated.

We all know how cranky we can be if we do not get a good night’s sleep. There is now an appreciation of how sleep disorders can contribute to negative social behaviour in children, behaviours that parallel those observed in ADHD.4,5,6

As mentioned earlier, bedwetting is a symptom of sleep disorder for children. A study as far back as the 1980s had found that treating the narrow upper jaw in children stopped their bedwetting. In adults, a common symptom of OSA is the need to get up and visit the toilet during the night. Similarly, airway compromise stimulates a child to urinate in their sleep.7

The subject of Tonsils and Adenoid that we touched on in chapter 3 is revisited here in relation to sleep disordered breathing. In children one common but not exclusive cause for OSA is enlarged tonsils and/or adenoids.

Enlarged tonsils and/or adenoidal tissues at the back of the child’s throat can physically block the airway causing breathing difficulty during sleep. For this reason, the dentist needs to work closely with an ENT surgeon. Sometimes, surgical intervention is needed to open the airway for improved breathing.