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Weissheimer A, Pham J, Tong H, Akyalcin S. Esthetic outcomes in orthodontics through digital customization with a lingual appliance system. J ESTHET RESTOR DENT 2024; 36:1267-1280. [PMID: 38716890 DOI: 10.1111/jerd.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 08/11/2024]
Abstract
BACKGROUND Contemporary fixed orthodontic appliances are shifting from non-customized pre-adjusted appliances to custom-designed and printed appliances with novel digital setup systems. We are one step closer to precision dentistry and orthodontics using personalized mechanics and custom appliances. However, despite the evidential enhancement and other improvements to fixed appliances, tooth movement is still limited to five degrees of freedom. Opening or closing spaces still requires manually placing elastomeric chains or coil springs. AIM In this article, we aimed to demonstrate how advancements in CAD/CAM technology, reverse engineering, and digital customization are helping orthodontics constantly evolve, enabling treatment with enhanced esthetics and minimal compliance. The clinical system (InBrace®, Irvine, CA) described in this article uses a patient-specific, digitally designed multiloop NITI wire that delivers friction-free, light, and continuous forces and activates automatically whenever the malocclusion deviates from the digital setup. CONCLUSION Through digital customization, InBrace allows for automated tooth movement in all six degrees of freedom, including space opening or closure, via programmed non-sliding mechanics. CLINICAL SIGNIFICANCE Precision orthodontics and personalized treatment have been significant developments in orthodontics recently. This article focuses on how a technologically advanced lingual appliance system could achieve targeted cosmetic results methodically via automation and personalization.
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Affiliation(s)
- Andre Weissheimer
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, USA
| | - John Pham
- Senior Medical Scientist for InBrace, Irvine, USA
| | - Hongsheng Tong
- Postgraduate Orthodontics Program, University of Southern California, Los Angeles, USA
| | - Sercan Akyalcin
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, USA
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Gamil H, Marzouk E, Zaher A. Virtual bracket removal: a comparative assessment of different software packages. BMC Oral Health 2024; 24:770. [PMID: 38982396 PMCID: PMC11234721 DOI: 10.1186/s12903-024-04522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/23/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND High precision intra-oral scans, coupled with advanced software, enable virtual bracket removal (VBR) from digital models. VBR allows the delivery of retainers and clear aligners promptly following debonding, thus reducing the patients' appointments and minimizing the likelihood of tooth movement. The objective of this study was to compare the enamel surface before bonding and after VBR using three different Computer-aided design (CAD) software and to compare their accuracy. METHODS Maxillary scans of 20 participants starting orthodontic treatment were selected for inclusion in the study, who exhibited mild to moderate crowding and required bonding of brackets on the labial surface of permanent maxillary teeth (from the maxillary left first molar to the maxillary right first molar). Two intra-oral scans were conducted on the same day, before bonding and immediately after bonding using CEREC Omnicam (Sirona Dental Systems, Bensheim, Germany). The virtual removal of the brackets from the post-bonding models was performed using OrthoAnalyzer (3Shape, Copenhagen, Denmark), Meshmixer (Autodesk, San Rafael, Calif, USA), and EasyRx (LLC, Atlanta, GA, USA) software. The models that underwent VBR were superimposed on the pre-bonding models by Medit Link App (Medit, Seoul, South Korea) using surface-based registration. The changes in the enamel surface following VBR using the three software packages were quantified using the Medit Link App. RESULTS There was a significant difference among the 3Shape, Meshmixer, and EasyRx software in tooth surface change following VBR. Specifically, EasyRx exhibited lower levels of accuracy compared to the other two VBR software programs (p<.001, p<.001). A significant difference in enamel surface change was observed between tooth segments across all software groups, in both incisors and molars, with VBR of the molars exhibiting the lowest level of accuracy (3Shape p=.002, Meshmixer p<.001, EasyRx p<.001). Regarding the direction of tooth surface changes following VBR, it was observed that all three groups exhibited a significant increase in the percentage of inadequate bracket removal across all teeth segments. CONCLUSIONS 3Shape and Meshmixer manual VBR software were found to be more accurate than EasyRx automated software, however, the differences were minimal and clinically insignificant.
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Affiliation(s)
- Heba Gamil
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champollion St, P. O. Box: 21521, Azarita, Alexandria, Egypt.
| | - Eiman Marzouk
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Abbas Zaher
- Department of Orthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Dock J, Copello F, Shirmohammadi I, Bosio JA. Three-dimensional assessment of virtual clear aligner attachment removal: A prospective clinical study. Am J Orthod Dentofacial Orthop 2024; 166:15-25. [PMID: 38597867 DOI: 10.1016/j.ajodo.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION In digital dentistry, virtual attachment removal (VAR) optimizes clear aligner therapy by enhancing efficiency for refinements and enabling prefabricated retainer production through the removal of attachments from a digital scan before the clinical removal of clear aligner attachments. This prospective clinical study aimed to evaluate the accuracy of VAR in the maxillary arch. METHODS A total of 110 teeth were analyzed from a sample of 54 maxillary scans from 25 subjects. Models with attachments were virtually debonded using Meshmixer (Autodesk, San Rafael, Calif) and superimposed over the control group in MeshLab. Vector Analysis Module (Canfield Scientific, Fairfield, NJ) was used to calculate and analyze 3-dimensional Euclidean distances on the buccal surfaces between the superimposed models. Statistical analysis was performed using SPSS (version 23.0, IBM, Armonk, NY). The Shapiro-Wilkes (α = 0.05) test determined a nonnormal distribution of results. The Kruskal-Wallis (α = 0.05) was used to determine differences between different tooth types and the number of attachments. RESULTS The VAR protocol showed no statistical differences in the root mean square between different tooth segments with an overall tendency for inadequate attachment removal. No difference between the groups was found regarding the number of attachments when used as a main factor. CONCLUSIONS The VAR technique is precise enough for the fabrication of retainers from printed dental models in a clinical setting and is not affected by the number of attachments on the tooth.
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Affiliation(s)
- Jeremy Dock
- Formerly, Division of Orthodontics, Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md; Currently, Private practice, Cincinnati, Ohio.
| | - Flavio Copello
- Division of Orthodontics, Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
| | - Iman Shirmohammadi
- Division of Orthodontics, Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
| | - Jose A Bosio
- Division of Orthodontics, Department of Orthodontics and Pediatric Dentistry, University of Maryland School of Dentistry, Baltimore, Md
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Li R, Zhu C, Chu F, Yu Q, Fan D, Ouyang N, Jin Y, Guo W, Xia L, Feng Q, Fang B. Deep learning for virtual orthodontic bracket removal: tool establishment and application. Clin Oral Investig 2024; 28:121. [PMID: 38280038 DOI: 10.1007/s00784-023-05440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/15/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVE We aimed to develop a tool for virtual orthodontic bracket removal based on deep learning algorithms for feature extraction from bonded teeth and to demonstrate its application in a bracket position assessment scenario. MATERIALS AND METHODS Our segmentation network for virtual bracket removal was trained using dataset A, containing 978 bonded teeth, 20 original teeth, and 20 brackets generated by scanners. The accuracy and segmentation time of the network were tested by dataset B, which included an additional 118 bonded teeth without knowing the original tooth morphology. This tool was then applied for bracket position assessment. The clinical crown center, bracket center, and orientations of separated teeth and brackets were extracted for analyzing the linear distribution and angular deviation of bonded brackets. RESULTS This tool performed virtual bracket removal in 2.9 ms per tooth with accuracies of 98.93% and 97.42% (P < 0.01) in datasets A and B, respectively. The tooth surface and bracket characteristics were extracted and used to evaluate the results of manually bonded brackets by 49 orthodontists. Personal preferences for bracket angulation and bracket distribution were displayed graphically and tabularly. CONCLUSIONS The tool's efficiency and precision are satisfactory, and it can be operated without original tooth data. It can be used to display the bonding deviation in the bracket position assessment scenario. CLINICAL SIGNIFICANCE With the aid of this tool, unnecessary bracket removal can be avoided when evaluating bracket positions and modifying treatment plans. It has the potential to produce retainers and orthodontic devices prior to tooth debonding.
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Affiliation(s)
- Ruomei Li
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China
| | - Cheng Zhu
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China
| | - Fengting Chu
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China
| | - Quan Yu
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China
| | - Di Fan
- School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ningjuan Ouyang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China
| | - Yu Jin
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China
| | - Weiming Guo
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China
| | - Lunguo Xia
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China.
| | - Qiping Feng
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China.
| | - Bing Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 500 Quxi Road, Shanghai, 200011, China.
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Ntovas P, Gogolas N, Gogolas G, Mougiou E, Papazoglou E. Tooth Splinting: Implementing a 3D-printed Guide with Pre-defined Composite Resin Reservoirs: A Digital Workflow. Oper Dent 2024; 49:5-10. [PMID: 38058017 DOI: 10.2341/23-069-t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 12/08/2023]
Abstract
The integration of digital technologies in dentistry has led to the development of various techniques to facilitate tooth splinting. In the present digital workflow, the advantages of the virtual treatment plan were combined with the versatility of the commercially available tooth splinting materials. An intraoral scanner was utilized to digitize both arches along with the patient's occlusion, eliminating the need for models from physical impressions. A template based on the virtual design of the splint was 3D-printed and served as a guide to individualize a twisted wire. The bent wire was transferred and bonded, using a 3D-printed template with pre-defined reservoirs for the composite resin. Digital technology has been implemented for tooth splinting, by fabricating a splint after its virtual design. However, the digital fabrication of the metal splints is available for limited splinting materials and the service is only provided by specific centers around the world.
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Affiliation(s)
- P Ntovas
- *Panagiotis Ntovas, DDS, MSc, scientific associate, Department of Operative Dentistry, National and Kapodistrian, University of Athens, Greece
| | - N Gogolas
- Nikolaos Gogolas, DDS, private practice, Athens, Greece
| | - G Gogolas
- George Gogolas, DDS, private practice, Athens, Greece
| | - E Mougiou
- Eleni Mougiou, DDS, private practice, Athens, Greece
| | - E Papazoglou
- Efstatios Papazoglou, DDS, MSc, PhD, Department of Operative Dentistry, National and Kapodistrian, University of Athens, Greece
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Wang Y, Wang P, Ye S, Shi Y, He Y, Han X, Bai D, Xue C. Optimal settings for different tooth types in the virtual bracket removal technique. Angle Orthod 2024; 94:68-74. [PMID: 37839805 DOI: 10.2319/022323-124.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/01/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES To determine the optimal settings for reconstructing the buccal surfaces of different tooth types using the virtual bracket removal (VBR) technique. MATERIALS AND METHODS Ten postbonded digital dentitions (with their original prebonded dentitions) were enrolled. The VBR protocol was carried out under five settings from three commonly used computer-aided design (CAD) systems: OrthoAnalyzer (O); Meshmixer (M); and curvature (G2), tangent (G1), and flat (G0) from Geomagic Studio. The root mean squares (RMSs) between the reconstructed and prebonded dentitions were calculated for each tooth and compared with the clinically acceptable limit (CAL) of 0.10 mm. RESULTS The overall prevalences of RMSs below the CAL were 66.80%, 70.08%, 62.30%, 94.83%, and 56.15% under O, M, G2, G1, and G0, respectively. For the upper dentition, the mean RMSs were significantly lower than the CAL for all tooth types under G1 and upper incisors and canines under M and G2. For the lower dentition, the mean RMSs were significantly lower than the CAL for all tooth types under G1 and lower incisors and canines under M, G2, and G0 (all P < .05). Additionally, the mean RMSs of all teeth under G1 were significantly lower than those under the other settings (all P < .001). CONCLUSIONS The optimal settings varied among different tooth types. G1 performed best for most tooth types compared to the other four settings.
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Tsoukala E, Lyros I, Tsolakis AI, Maroulakos MP, Tsolakis IA. Direct 3D-Printed Orthodontic Retainers. A Systematic Review. CHILDREN 2023; 10:children10040676. [PMID: 37189925 DOI: 10.3390/children10040676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023]
Abstract
Three-dimensional (3D) printing technology has shed light on many fields in medicine and dentistry, including orthodontics. Direct 3D-printed prosthetics, implants or surgical devices are well-documented. The fabrication of orthodontic retainers using CAD technology and additive manufacturing is an emerging trend but the available data are scarce. The research approach of the present review included keywords in Medline, Scopus, Cochrane Library and Google Scholar up to December 2022. The searching process concluded with five studies eligible for our project. Three of them investigated directly 3D-printed clear retainers in vitro. The other two studies investigated directly 3D-printed fixed retainers. Among them, one study was in vitro and the second was a prospective clinical trial. Directly 3D-printed retainers can be evolved over time as a good alternative to all the conventional materials for retention. Devices that are 3D-printed are more time and cost efficient, offer more comfortable procedures for both practitioners and patients and the materials used in additive manufacturing can solve aesthetic problems, periodontal issues or problems with the interference of these materials with magnetic resonance imaging (MRI). More well-designed prospective clinical trials are necessary for more evaluable results.
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Affiliation(s)
- Efthimia Tsoukala
- Department of Orthodontics, National and Kapodistrian University of Athens, School of Dentistry, 11527 Athens, Greece
| | - Ioannis Lyros
- Department of Orthodontics, National and Kapodistrian University of Athens, School of Dentistry, 11527 Athens, Greece
| | - Apostolos I. Tsolakis
- Department of Orthodontics, National and Kapodistrian University of Athens, School of Dentistry, 11527 Athens, Greece
- Department of Orthodontics, School of Dentistry, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Michael P. Maroulakos
- Department of Orthodontics, National and Kapodistrian University of Athens, School of Dentistry, 11527 Athens, Greece
| | - Ioannis A. Tsolakis
- Department of Orthodontics, School of Dentistry, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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