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 Table of Contents  
SHORT COMMUNICATION
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 197-198

In-House aligners helping answer the distress call during the pandemic!


Department of Orthodontics, University of Puthisastra, Phnom Penh, Cambodia

Date of Submission28-Oct-2020
Date of Decision17-Dec-2020
Date of Acceptance18-Jan-2021
Date of Web Publication17-Apr-2021

Correspondence Address:
Adith Venugopal
Department of Orthodontics, University of Puthisastra, Phnom Penh.
Cambodia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_328_20

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  Abstract 

Fixed orthodontic treatment being a long‐term treatment has suffered during the pandemic. Clinics have undergone a prolonged and unforeseen lockdown, and patients are finding it extremely difficult to cope with their regular checkups and appointments. Advances in material sciences, simulation software, and 3D printing have enabled aligners to offer treatment solutions for complicated orthodontic problems. An orthodontist can use virtual simulations to plan out the entire treatment on a computerized three‐dimensional model, and then order aligners using these simulations. Patient compliance is one of the principal issues with clear aligner therapy and at a time when branded aligners are facing issues with regard to shipping, the entire process has become very expensive. For these reasons, it would be a good idea to consider using in‐house fabricated aligners. In‐house aligners can be easily fabricated using thermoformed plastic which is adapted to complex three-dimensional tooth surfaces that have a bearing on the deflection of the aligner on placement. They hold advantages over traditional commercially available aligners in terms of cost effectiveness and time required for fabrication and delivery.

Keywords: 3D printing, Aligners, COVID-19, In-house, Orthodontics


How to cite this article:
Marya A, Venugopal A. In-House aligners helping answer the distress call during the pandemic!. J Int Oral Health 2021;13:197-8

How to cite this URL:
Marya A, Venugopal A. In-House aligners helping answer the distress call during the pandemic!. J Int Oral Health [serial online] 2021 [cited 2021 Jun 19];13:197-8. Available from: https://www.jioh.org/text.asp?2021/13/2/197/313851

In the words of William A. Dembski, a prominent mathematician and theologist, “The very comprehensibility of the world, points to intelligence behind the world.” Science would be impossible if our intelligence did not evolve to the level of the intelligibility of the world. When we talk about Orthodontics, it is a specialty of dentistry carried out with the intention of improving the form, function, and esthetics of a patient. Fixed orthodontic treatment being a long-term treatment has suffered during the pandemic. Clinics have undergone a prolonged and unforeseen lockdown, and patients find it hard to cope with their regular checkups and appointments.[1] With no end to this pandemic in sight, is it time to put newer tools such as in-house clear aligner therapy (CAT) to better use?

While CAT was approved for orthodontic treatment by the FDA in the year 1998, there have been similar removable appliances being used since Dr Harold Kesling utilized tooth positioners.[2] Advances in material sciences, simulation software, and 3D printing have enabled aligners to offer treatment solutions for complicated orthodontic problems.[3] An orthodontist can use virtual simulation to plan out the entire treatment on a computerized three-dimensional model. Once predictable movements are planned out, these can be transferred to tooth-borne clear aligners which utilize digitally planned attachments to help the aligners carry out tooth movement.

CAT uses both attachments and pressure points both to bring about planned tooth movement.[4] Movements such as intrusion, expansion, and bucco-lingual inclination are more predictable, whereas anterior extrusion, molar uprighting, and correcting severe rotations can be unpredictable.[5] In comparison to fixed orthodontic treatment, CAT may prove advantageous in terms of treatment duration for simple orthodontic cases and very specific tooth movements but are found lacking in terms of gaining good occlusion, individual tooth torque, retention, and stability.[6]

Patient compliance is one of the principal issues with CAT and at a time when branded aligners are facing issues with regard to shipping, the entire process has become expensive and time-consuming. For these reasons, it would be a good idea to consider using in-house fabricated aligners.

In-house aligners can be easily fabricated using thermoformed plastic which is adapted to complex three-dimensional tooth surfaces that have a bearing on the deflection of the aligner on placement. The number of in-office visits can be reduced by delivering more aligners upfront, and the patients can be evaluated with a remote monitoring system. In-house aligners can be fabricated using an intra-oral scanner and a generic aligner programming software for virtually trimming the models and simulation of movements. Once the aligner stages have been planned then each model file can be prepared for printing using a 3D printer. While the files can also be exported to a lab for printing, in-house production has been shown to be cost-effective over a prolonged period. Once the models are printed, a thermoforming machine is required in conjunction with a trimming handpiece.[7],[8] Materials form a vital part of the in-house production, and polyethylene terephthalate has been shown to have the lowest deformation under variable conditions.[9]

Clear aligners do have an advantage over fixed orthodontic therapy in terms of chair time and number of visits required for treatment completion. Whether these are superior in terms of carrying out planned tooth movements needs to be studied with further research.[9] In times of the Covid-19 pandemic, in-house production will enable orthodontists to deliver the entire set of aligners, thereby reducing patient visits to the office and following up on their progress via an online virtual or remote monitoring system.[10],[11] In conclusion, in-house aligners prove beneficial to the practitioner in terms of cost-effectiveness over a period compared with using third-party branded aligner manufacturers. It may also prove beneficial to the patient in terms of less waiting time and timely repair, since no shipping or unwanted correspondence between the clinic and the manufacturer is involved.

Acknowledgements

Not applicable.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interests.

Author contributions

Anand Marya—Conceptualization and preliminary draft; Adith Venugopal—Final draft and revision.

Ethical policy and institutional review board statement

Not applicable.

Patient declaration of consent

Not applicable.

Data availability statement

Not applicable.

 
  References Top

1.
Marya A Utilizing aligners to solve the COVID-19-affected orthodontic practice conundrum! J Adv Oral Res 2020;11:117-9.  Back to cited text no. 1
    
2.
Kesling HD The philosophy of tooth positioning appliance. Am J Orthod 1945;31:297-304.  Back to cited text no. 2
    
3.
Simon M, Keilig L, Schwarze J, Jung BA, Bourauel C Forces and moments generated by removable thermoplastic aligners: Incisor torque, premolar derotation, and molar distalization. Am J Orthod Dentofacial Orthop 2014;145:728-36.  Back to cited text no. 3
    
4.
Buschang PH, Shaw SG, Ross M, Crosby D, Campbell PM Comparative time efficiency of aligner therapy and conventional edgewise braces. Angle Orthod 2014;84:391-6.  Back to cited text no. 4
    
5.
Castroflorio T, Garino F, Lazzaro A, Debernardi C Upper incisor root control with invisalign appliances. J Clin Orthod 2013;47:346-51.  Back to cited text no. 5
    
6.
Ke Y, Zhu Y, Zhu M A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health 2019;19:24.  Back to cited text no. 6
    
7.
Kwon J-S, Lee Y-K, Lim B-S, Lim Y-K Force delivery properties of thermoplastic orthodontic materials. Am J Orthod Dentofacial Orthop 2008;133:228-34.  Back to cited text no. 7
    
8.
Hahn W, Fialka-Fricke J, Dathe H, Fricke-Zech S, Zapf A, Gruber R, et al. Initial forces generated by three types of thermoplastic appliances on an upper central incisor during tipping. Eur J Orthod 2009;31:625-31.  Back to cited text no. 8
    
9.
Ryokawa H, Miyazaki Y, Fujishima A, Takashi M, Koutaro M The mechanical properties of dental thermoplastic materials in a simulated intraoral environment. Orthod Waves 2006;65:64-72.  Back to cited text no. 9
    
10.
Khadijah AT. Precautions and recommendations for orthodontic settings during the COVID-19 outbreak: A review. Am J Orthod Dentofacial Orthop 2020;158:175-81.  Back to cited text no. 10
    
11.
Venugopal A, Bowman S, Ludwig B, Pangilinan P, Srirengalakshmi MP Orthodontics in the COVID-19 era: The way forward part 2 orthodontic treatment considerations. J Clin Orthod 2020;54:341-9.  Back to cited text no. 11
    




 

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