The Rise of Digital Orthodontics
By Anthony M. Puntillo D.D.S., M.S.D.
The Industrial Revolution of the mid seventeen hundreds to the mid eighteen
hundreds ushered in numerous social, economic, and cultural improvements to the
everyday lives of people of the day. Along with these improvements also came
disruptive forces. Businesses had to adapt to the new way of doing things to
stay competitive. The modern Technology Revolution is having similar beneficial
and unsettling influences on our lives. Technology is being employed to improve
the efficiency and effectiveness of virtually every aspect of our society. In
the field of healthcare, we have seen the mapping of the human genome, improved
medical imaging techniques, and robotic surgeries. Modern orthodontics has also
incorporated digital technology to improve the accuracy of orthodontic
diagnosis and treatment planning. As the quality of and methods for obtaining
digital data have improved, so has the orthodontic specialist’s ability to use
this data to improve the level of care he can provide his patients.
Two examples of recent technology that have changed the way orthodontists
provide care are intraoral scanning devices and three-dimensional Cone Beam
Computed Tomography or CBCT. There are several intraoral scanners currently
available. These machines typically use visible light and an intraoral
"wanding" procedure to create very accurate three-dimensional digital dental
models. It is possible to use these 3D models not only to diagnose, but also to
fabricate active clear plastic aligners and other treatment appliances.
Invisalign, Insignia Clearguide, and ClearCorrect are examples of aligners
systems created using digital models. SimpliClear is a digitally designed clear
biomer wire fabricated with adjustments bends already in place. Insignia uses
digital data obtained from an intraoral scan to create patient specific
brackets and custom bracket placement jigs.
Patients can benefit from
intraoral scanner technology by avoiding the impression procedure and by the
improved accuracy of the appliances provided by their doctor. Orthodontists
benefit by the elimination of costly impression materials and the improved
efficiency of digital models. One shortcoming of intraoral scanners however is
that the models they create are limited to supragingival tooth structures only.
Orthodontists are interested not only in the alignment of the crowns of the
teeth, but also how the entire dentition (including the roots) are positioned
relative to the supporting bone and facial structures. Using cone beam (CBCT)
technology, orthodontists now have the tool they need to evaluate the alignment
of the teeth in three dimensions. There are several CBCT machines and software
programs currently available that enable orthodontists to view the teeth and
supporting structures in all planes of space. This alone can improve
orthodontists’ ability to diagnose and treatment plan to the benefit of their
patients. There is now one system available (SureSmile) that incorporates the
bone data from a CBCT scan into its digital 3D models. This allows
orthodontists to make better treatment planning decisions regarding the roots
of the teeth by revealing the limits of the supporting structures. The software
can then follow the orthodontist’s “prescription” to robotically generate
custom archwires containing every necessary tip, torque, and angulation needed
to finish the treatment.
The rise of digital orthodontics has also spawned a resurgence in lingual
orthodontics. The ability to digitally create custom brackets and wires (i.e.
Harmony, Incognito, Suresmile QT, etc.) has made it easier for orthodontists to
manage the intricacies of lingual treatment. Consequently, an increasing number
of orthodontists are now offering lingual treatment options to their
Technology has drastically increased the pace of change in our society. As
orthodontists adapt and incorporate technology into their practices, their
ability to provide better treatment for patients will also increase at an
exponential rate. It is our challenge and obligation as orthodontic specialists
to identify and evaluate new technologies, and when appropriate incorporate
them into our patient care in a cost-effective manner.
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Merna Tajaddod Orthodontics
Proudly serving the city of Palo Alto and it's surrounding areas; Mountain View, Menlo Park, and Los Altos. Dr. Tajaddod has 11+ years of experience as an orthodontist here in the Bay Area's Mid-Peninsula and the East Coast.