Australasian Dentist November-December 2018

Category AustrAlAsiAn Dentist 51 at CCC smiles in sydney showed an increased compliance with clear aligner wear even though our patients spent 2-5 minutes extra each week using the DM app compared to patients that were not using DM. We found that using DM can help reduce case revisions and attain more predictable outcomes even for complex movements with clear aligners. How can a smart-phone based app deliver such value? the answer lies in understanding the Hawthorne effect 17 . it is well known that the Hawthorne effect is a type of reactivity in which individuals modify an aspect of their behaviour in response to their awareness of being observed. so regular observations means patients are more likely to comply. Another mechanism by which DM is invaluable for clear aligner treatments is by personalising the customised orthodontic treatment plan for individual patients. speed of tooth movement is a function of underlying osteoclastic activity and mediated via numerous cytokines. since this is highly variable across individuals, DM and its developed Ai can help modulate and provide the appropriate aligner change schedule for the patient based on their compliance, underlying osteoclastic activity and stage of treatment. the good news is that the Ai-based DM app can be fully automated or semi-automated as per practitioner preferences. so you can drive it or discard it as you wish. lastly, DM acts as an active reminder system for practitioners and patients, increasing compliance with appliance wear and oral hygiene instructions. it is known active reminders have a positive effect on oral hygiene and adherence to appointments in orthodontic patients, in the short- and long-term 18 . Clear aligner treatments are no longer considered an alternative to traditional fixed appliances. in fact it is my 1st choice of treatment for many patients, from childhood to adulthood. strong evidence is lacking to fully understand its benefits for the patients that include freedom of diet, reduced chances of white spot lesions and increased motivation during treatment. similarly, practitioner benefits such as increased communication with patients, less disputes and reduction of unnecessary chairside time also need to researched in the future. Good luck and i hope the readers enjoy moving teeth predictably and efficiently using clear aligners! u lInICal Dr Katyal is an avid lecturer at national and international orthodontics conferences. Her clinical practice Clean Clear and Correct Smiles is based in Mosman and Sydney CBD. She is also the head lecturer for Best Orthodontic Seminars and Sessions. With a special interest in paediatric sleep-disordered breathing, snoring and oral appliances, clear aligners, tele-dentistry and recent technologies her research has been published in orthodontic journals worldwide, and featured in mainstream media including Channel 9 news, ABC radio, 4BC radio, The Daily Telegraph , The Sun Herald and Bite dental magazine. The recipient of prestigious orthodontic clinical and research awards, she has also been awarded the prestigious Sam Bulkley travelling scholarship twice by the ASOFRE, an honour shared with only the most distinguished Australian leaders in orthodontics. References 1. rosvall, M.D., et al., Attractiveness, acceptability, and value of orthodontic appliances. Am J Orthod Dentofacial Orthop, 2009. 135(3): p. 276.e1-12; discussion 276-7. 2. Ziuchkovski, J.P., et al., Assessment of perceived orthodontic appliance attractiveness. Am J Orthod Dentofacial Orthop, 2008. 133(4 suppl): p. s68-78. 3. lu, H., et al., Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed appliances and invisalign system: A meta-analysis. Medicine (Baltimore), 2018. 97(13): p. e0248. 4. levrini, l., et al., Periodontal health status in patients treated with the invisalign((r)) system and fixed orthodontic appliances: A 3 months clinical and microbiological evaluation. eur J Dent, 2015. 9(3): p. 404-10. 5. Azaripour, A., et al., Braces versus invisalign(r): gingival parameters and patients’ satisfaction during treatment: a cross-sectional study. BMC Oral Health, 2015. 15: p. 69. 6. Abbate, G.M., et al., Periodontal health in teenagers treated with removable aligners and fixed orthodontic appliances. J Orofac Orthop, 2015. 76(3): p. 240-50. 7. Papadimitriou, A., et al., Clinical effectiveness of invisalign(r) orthodontic treatment: a systematic review. Prog Orthod, 2018. 19(1): p. 37. 8. Bowman, s.J., improving the predictability of clear aligners. seminars in Orthodontics, 2017. 23(1): p. 65-75. 9. Grunheid, t., C. loh, and B.e. larson, How accurate is invisalign in nonextraction cases? Are predicted tooth positions achieved? Angle Orthod, 2017. 87(6): p. 809-815. 10. rossini, G., et al., efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod, 2015. 85(5): p. 881-9. 11. Proffit, W.r., H.W. Fields, and D.M. sarver, Contemporary orthodontics. 5th ed. 2014: elsevier Health sciences. 12. Ackerman, J.l. and W.r. Proffit, soft tissue limitations in orthodontics: treatment planning guidelines. Angle Orthod, 1997. 67(5): p. 327-36. 13. Kravitz, n.D., et al., influence of attachments and interproximal reduction on the accuracy of canine rotation with invisalign. A prospective clinical study. Angle Orthodontist, 2008. 78(4): p. 682-7. 14. Houle, J.-P., et al., the predictability of transverse changes with invisalign. the Angle Orthodontist, 2017. 87(1): p. 19-24. 15. Kravitz, n.D., et al., teledentistry, Do-it- Yourself Orthodontics, and remote treatment Monitoring. J Clin Orthod, 2016. 50(12): p. 718-726. 16. Mandall, n.A., et al., teledentistry for screening new patient orthodontic referrals. Part 1: A randomised controlled trial. Br Dent J, 2005. 199(10): p. 659-62, discussion 653. 17. sedgwick, P. and n. Greenwood, understanding the Hawthorne effect. Bmj, 2015. 351: p. h4672. 18. Mohammed, H., et al., reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis. eur J Orthod, 2018. Above: Advantages of using artificial intelligence (AI) with aligners Left: A patient taking their Dental Monitoring(R) scan via their smartphone with aligners on to assess tracking issues weekly. Time taken is 2-5 minutes per week.

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