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
  patients.


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.