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Will custom orthodontic appliances replace

traditional orthodontic appliances

Hero Breuning DDSPhD

Department of Orthodontics and Craniofacial Biology Radboud University Nijmegen The Netherlands

herobreuninggmailcom

Introduction

Damon (Ormco)

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Individual appliance

Archambault A et al Torque expression in stainless steel orthodontic brackets Angle Orthod 2010 (review article)

Wire selection

bull Breuning KH Early full size wires J Clin Orthod 2011

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Early full size wires

MichaelCAlpern

Neo Sentalloy (GAC)

Tritanium wire (American Orthodontics)

My first individual appliance Hero-System

In-Ovation (GAC) Time + Empower (AO) Victory (3M Unitek)

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Dual activation + bi-dimensional

bull Empower (American Orthodontics)

Breuning KH Am J Orth Dentfacial Orthop 2008

018

022

Dual activation

bull Ormco 3M Unitek

Damon Q

Prodigy

Gemini

Victory SL

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Individually selected torque values

bull Breuning KH Efficient orthodontics-J Clin Orthod 2011

Straight wire appliance

bull Andrews LF The six keys to normal occlusion1972

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Individual fixed appliance system

bull Bracket selection (activepassive) bull Slot selection (0018rsquo vs 0022rdquo) bull Torque selection bull Wire selection bull Indirect bonding

Need for custom appliances

bull Andrews LF The six keys to normal occlusion1972

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Bracket selection

Breuning KH Efficient orthodontics-J Clin Orthod 2011

Custom diagnosis and treatment

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Virtual treatment planning in 3D

bull Ludlow JB and Walker C Assessment of phantom dosimetry and image

quality of i-CAT FLX cone-beam computed tomography AJODO 2013

Virtual treatment presentation in 3D

bull Anatomage (In Vivo) Dolphin

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Fabrication of custom appliances

bull Digital dental models

Heat N Bite (Ormco)

Intra oral scanning

bull iTero scanner (Cadent)

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The dentition on CBCTrsquos

bull AnatoModels (InVivo dental)

Accuracy of digital dental models

bull I Tero scan CBCT Akyalcin S et al Diagnostic accuracy of impression-free digital models Am J Orthod Dentofacial Orthop 2013

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Gruumlnheid T et al Accuracy reproducibility and time efficiency of

dental measurements using different technologies AJODO 2014

Accuracy of digital dental models

bull SureSmile models were the most accurate and reproducible

bull emodels were significantly faster than those taken on the other models

Plaster

SureSmile

emodels

AnatoModels

Intra oral scanner + software

bull -Trios scanner (3Shape) Ortho Analyzer software

bull -Ortho Insight software and Facial Insight software

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Digital set up

bull Set up Insignia 3Shape

Custom appliances

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Claims of custom appliances

bull Shorter treatment bull Improved results

Individual System Insignia

Custom Damon Brackets

Custom buccal appliances

Insignia (Ormco)

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Pyamide of evicence for Insignia

bull Weber DJ 2nd et al Clinical effectiveness and efficiency of customized

vs conventional preadjusted bracket systems J Clinical Orthod 2013

Literature on efficiency of Insignia

bull

-Final PAR scores were not significantly different -The Insignia group had a lower average ABO score -Treatment time was significantly shorter -On average 7 fewer appointments needed

Weber DJ 2nd et al J Clinical Orthod 2013

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Selection of appliance

Suresmile

bull Shorter treatment bull Improved results bull Invisable

Pyramide of evidence for Suresmile

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Literature on Suresmile

bull Saxe AK Louie LJ Mah J Efficiency and effectiveness of SureSmile World J

Orthod 20101116-22

bull Alford TJ Roberts WE Hartsfield JK Jr Eckert GJ Snyder RJ Clinical

outcomes for patients finished with the SureSmiletrade method compared

with conventional fixed orthodontic therapy Angle Orthod 201181383-8

bull Sachdeva RC Aranha SL Egan ME Gross HT Sachdeva NS Currier GF

Kadioglu O Treatment time SureSmile vs conventional Orthodontics

(Chic) 20121372-85

bull Larson BE Vaubel CJ Gruumlnheid T Effectiveness of computer-assisted

orthodontic treatment technology to achieve predicted outcomes Angle

Orthod 201383557-62

Some of the articles are biased

Suresmile

bull Treatment time for the Suresmile patients was significantly shorter 31 (72 months) and the result increased with 11 to conventional fixed appliance treatmentrdquo

Alford TJ et al Angle Orthod 2011

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Custom wires for invisible appliances

bull Suresmile

LINGUAL APPLIANCES

Custom lingual bracket systems

IncognitoHarmony E braces etc

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Pyramide of evidence for Incognito

bull Grauer D Proffit WR Accuracy in tooth positioning with a fully customized

bull lingual orthodontic appliance Am J Orthod Dentofacial Orthop 2011

Literature on Incognito

They concluded ldquoThese fully customized lingual orthodontic appliances were accurate in achieving the goals planned at the initial setup except for the full amount of planned expansion and the inclination at the second molars ldquo

Grauer D and Proffit WR Am J Orthod Dentofacial Orthop 2011

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Aligners

bull Shorter treatment bull Improved results bull Invisable

Pyramide of evidence for Invisalign

bull Lagravere MO and Flores-Mir C The treatment effects of Invisalign

Orthodontic aligners A systematic review J Am Dent Assoc 2005

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Conclusions

Lagravegravere 2005 -Unable to draw strong conclusions Djeu 2005 -Deficient in its ability to correct large

anteroposterior discrepancies and occlusal contacts -Finished 4 months sooner Kravitz 2009 -To learn regarding the biomechanics Buschang 2013 -Less visits needed (4) -Shorter treatment duration (55 months)

-More expensive

bull Aligners on printed dental models

Custom aligners

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Attachments for aligners

Invisalign (Align) Orthocaps Ideal Smile (GAC)

Retention pads

Dimples

Scientific proof of efficiency and efficacy

Custom Aligners

Custom wires

Custom brackets and wires

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Follow up during treatment

bull I Tero scanner

Follow up during treatment

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Main advantage of custom appliances

bull More predictable treatment bull Improved communication with the patient bull More delegation possible bull Shorter treatment time Improved results

Main disadvantage of custom appliances

Digital planning is time consuming Custom appliances are more expensive

10 take home messages

bull Individual appliances bull Indirect bonding bull Early full size wires bull Reduced radiation for CBCTrsquos bull Intra oral scanners the orthodontist should have the STL files bull Setup in the orthodontic office bull The orthodontist corrects the initial set up bull Patient selects the appliance bull The orthodontist selects the company who will make the appliance bull Follow up appliances are needed (Finishing appliances)

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