Australasian Dentist November-December 2018

Category 50 AustrAlAsiAn Dentist i nnovation defines and drives the digital orthodontic appliance suppliers of the 21st century. Clear aligners have revolutionised orthodontic treatments not just for the doctor but also for the treated patients. Clear aligners are rated as the most attractive orthodontic appliance and preferred choice for many patients 1, 2 when compared with fixed appliances. in the era of evidence-based dentistry, the scientific evidence on clear aligner treatments is still relatively limited when compared with fixed appliances. However, we have moderate level of evidence to indicate that clear aligners patients have better gingival and periodontal parameters during treatment, and recommended as first line of treatment for patients at risk of periodontal disease 3-5 . Patient motivation and compliance with oral hygiene instructions also tends to be higher with clear aligner appliances when compared with fixed appliances 5, 6 . there is currently moderate level of evidence to suggest that clear aligners are a viable alternative to conventional orthodontic therapy in the correction of mild to moderate malocclusions in non-growing patients that do not require extraction 7 . the evidence is also beginning to show practitioners the efficacy of clear aligner treatments for various tooth movements such as extrusion, intrusion, rotation and root torque 8-10 . However, improving the predictability of clear aligners clinically is still poorly understood. Most practitioners agree that besides establishing a correct orthodontic diagnosis and treatment plan, it’s the unseating of an aligner that needs troubleshooting on a regular basis and mother of all problems with clear aligners! troubleshoot aligner unseats early to increase treatment efficiency. so how do we ensure an efficient and effective clear aligner therapy for our patients? Here are my top 3 tips guaranteed to help you increase confidence, competence and case acceptance with clear aligner therapies: 1. Think soft tissue before anything else! this is one of the best orthodontic tip i can share. the late William r. Proffit proposed the “envelope of Discrepancy” for various tooth movements based on collective research and summarised it in his latest edition of Contemporary Orthodontics 11 . the boundaries of dental compensation for an underlying jaw discrepancy are established by pressures exerted on the teeth by the lips, cheeks, and tongue; limitations of the periodontal attachment; neuromuscular influences on mandibular position and the contours of the soft tissue facial mask 12 . 2. Know thy evidence! Average accuracy of planned tooth movement with clear aligner treatment are 10, 13, 14 : u Premolar rotation – 40% u Canine rotation – 35% u incisor extrusion – 70% u upper arch expansion – 72% u upper molar distalisation within 1.5 mm – 87% Knowledge of such evidence-based data in which the final tooth position is less consistent with the predicted position enables practitioners to build necessary compensations into the virtual treatment plan. Most of the above-mentioned studies on accuracy were in adults and may not apply to clear aligner treatments in children and teens. 3. Don’t be shy to use AI! using big data sets to build robust Artificial intelligence (Ai) is the basis of the new industrial revolution sweeping across 21st century healthcare. in the age of constant innovation and millenials as our majority of patients, smartphone app-based technologies such as Dental Monitoring ® (DM) provide us a clear solution for monitoring treatment progress during orthodontic treatments conveniently. DM is essentially a sophisticated form of teledentistry which was first used by the us army in the 1990s 15 . utilising Ai technology, smartphone-based apps such as DM, can help reduce inappropriate referrals 16 , unnecessary appointments and increase clear aligner compliance from 70% to 95% for prescribed aligner wear time (internal study at CCC smiles Orthodontist, sydney. n=200). the knowledge of Ai can be used at any stage of active orthodontic treatment, for growth monitoring, retainer checks and relapse management. interestingly, our internal study Clear Aligners: Improving Predictability from good to great! By Dr Vandana Katyal, Specialist Orthodontist, Australia. BDs (syd), MscMed (Clin. epi.), DClinDent (Ortho), MBA candidate, MrACDs, MOrth rCsed lInICal Figure 1. Monitoring clear aligner teen case with weekly DM protocol has many advantages as depicted here Vandana Katyal