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.