issnortho 1868-3207 Vol. 2 • Issue 2/2017 international magazine of orthodontics 22017
technique Tongue star 2 (TS2) – System for rapid open bite closure case report Use of diode laser in the treatment of gingival enlargement during orthodontic treatment industry report Sensorimotor training with RehaBite during orthodontic treatment 4th ORTHOCAPS® SYMPOSIUM 1 & 2 DECEMBER 2017 MUNICH, GERMANY
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Dear readers,
When I began working in the field of orthodontics (in the Middle Ages!), it was very differ- ent from what I encounter today in my daily practice. This is normal: with the progression of research on biology, biomechanics and biomaterials, as well as with the development of the technology, results have increasingly been improving, as have treatment times, aesthe tics and patient comfort.
There is another important aspect too that has completely changed our way of working: Prof. Carlo Fornaini orthodontics has finally come out of its isolation to perfectly interact with other fields of dentistry. In this sense, this issue of the ortho magazine fully interprets this new age by presenting, beyond papers, new and original orthodontic appliances and techniques that also make a contribution in different fields of dentistry applied to orthodontics, such as CAD/CAM technology, whitening and laser-assisted surgery.
I congratulate the editor for the choice of this new approach and wish you all a good read.
Yours faithfully,
Prof. Carlo Fornaini
Researcher, Université Nice Sophia Antipolis, France Researcher, University of Parma, Italy
ortho 2/2017 03 content
page 16 page 26 page 34
editorial industry report
03 Dear readers 32 Oral hygiene in orthodontics Prof. Carlo Fornaini 34 Structo’s high throughput dental 3-D printers help lay foundation for dental chain trends & applications to launch own brand of clear aligners Jonathan Lim 06 Virtual reality and orthodontics: A new patient experience 38 Sensorimotor training with RehaBite during Dr Yassine Harichane orthodontic treatment Dr Daniel Hellmann technique manufacturer news 10 Tongue star 2 (TS2) – System for rapid open bite closure 40 Coordinative training as a therapy Dr John Constantine Voudouris for temporomandibular joint dysfunction syndrome Dentrade International case report 42 Introducing AcceleDent Optima 16 Use of diode laser in the treatment of OrthoAccel gingival enlargement during orthodontic treatment: Case report 43 Ortho Rebels online shop: Prof. Carlo Fornaini, Drs Aldo Oppici, Great quality at low prices Luigi Cella & Elisabetta Merigo Ortho Rebels
20 Orthodontic management of maxillary lateral incisors agenesis meetings Dr Dan Andrei Iacob 44 European Aligner Society making strides: 26 Maxillary molar distalisation with aligners From Vienna to Venice and cyclic forces Dr Tommaso Castroflorio 46 EOS Congress made return to Switzerland
48 International Events
about the publisher
49 submission guidelines
Cover image courtesy of OrthoAccel Technologies Germany GmbH (acceledent.com) 50 imprint
04 ortho 2/2017 Essential Dental Media
Dental Tribune International The World’s Largest News and Educational Network in Dentistry
www.dental-tribune.com trends & applications virtual reality
Virtual reality and orthodontics: A new patient experience
Author: Dr Yassine Harichane, Canada
Imagine the following scenario: your patient ar- The applications in orthodontics are numerous rives, both relaxed and calm, at your practice. and at present we are exploiting only a tiny part Although the patient is visiting the practice for of its potential functions. The possibilities might the first time, he is familiar with it and knows its be endless. Hence, it might become possible for interior well. Without further introduction, the the patient to visit the dental office from his home, patient takes a seat in the dental chair, and the where he can visualise the front desk, admire the orthodontic procedure is performed quickly and treatment rooms or view the cleanliness of the comfortably with patient compliance. There are sterilisation room (Fig. 5). The aim is to offer a no complications or tension, and the treatment virtual visit of the practice to allow the patient to is easily achieved. Imagine such a soothing and choose a quality clinic, as well as familiarise him- comfortable environment in which to treat pa- self with the space before his first appointment. tients. Now imagine this very same scenario Once physically seated in the chair, the patient through the eyes of the patient. One can see that can wear the VR headset during the treatment it could actually be a comfortable experience. and visualise a restful environment of his choos- This is not some hypothetical futuristic utopia; ing. From here on, it is solely a matter of prefer- this is actually happening now, and the afore- ence, as the patient might enjoy the beach, a VR mentioned points are some of the many benefits video of Honolulu, or maybe even climbing a of virtual reality (VR). mountain. Any VR video is acceptable, as long as VR is a process that entails immersing the it achieves its purpose: calming the patient viewer in a 360° environment. By turning his head during a treatment session. Thus, everything left, right, up or down, the patient can visualise becomes less tense, and the patient is relaxed. a real or an artificial environment. The spectator This might also be convenient for the dentist, as could be immersed in the Caribbean Sea sur- he can then execute whatever treatment is neces- rounded by corals or in a Canadian forest (Fig. 1). sary as quickly and efficiently as possible. The operation is simple: the participant wears a Convincing the patient to undertake an or- lightweight and comfortable headset in which a thodontic treatment is one thing, convincing him smartphone is inserted (Fig. 2). Owing to the gy- to follow the relevant recommendations is an- roscopic sensors, the smartphone will project a other. Obtaining patient compliance is not easy, matching image corresponding to the move- especially in the case of younger patients. Fur- ments. If the patient raises his head, he will see thermore, dentists have an unfortunate notori- the sky or the ceiling, and if he lowers his head he ous association with pain and suffering, which will see his feet. This technique is made possible might induce anxiety in a patient. Again, VR can by a 360° shot using a dedicated camera (Fig. 3) be applied here to divert the attention of the most and simple editing software (Fig. 4). The result dynamic patients. Another aspect worthy of is simply astonishing as we find ourselves pro- mention regarding the benefits is the intellectual jected into a place that may vary from actual retention of instructions on hygiene procedures, tourist sites to virtual scenarios as in video games. for example, which might be dependent on sup-
06 ortho 2/2017 virtual reality trends & applications
Fig. 1 Canadian forest in VR.
Fig. 2 VR headset.
Fig. 3 Nikon KeyMission 360°.
Fig. 1
Fig. 2 Fig. 3
port. It is plausible to assume that verbal instruc- of professional education (Fig. 6). Many of us tions on hygiene may be forgotten once the pa- have not been able to attend a conference on the tient has left the clinic. Most orthodontic practices other side of the world for logistical reasons. In provide only leaflets, but few patients retain these the near future, it will be possible to attend an or follow their recommendations. A VR video orthodontic congress and listen to international featuring the practitioner or team members might speakers while sitting comfortably at home. Sim- have a much greater impact on follow-up care at ilarly, the demonstration of a new therapeutic home. The message could be pre-recorded and technique will be easier with a VR video rather viewed on demand by the patient. The aims of than plunging into a detailed explanation in an this format is that it can provide different intel- article without any illustration. The trainer can lectual integration between information, which record his or her procedures with a 360° camera is connected to a stream of visual and auditory to allow the student to learn through immersion stimuli. The clinician might wish to promote the the technical movements and ergonomics of the patient retaining the provided information in an technique being taught. easier way to achieve greater clinical success. It would be an understatement to claim that For example, youngsters might remember their VR provides an alternative to conventional styles favourite movie line by heart, as opposed to infor- of learning. Although it is far from perfect, it mation provided by their dentist. This is because allows a wider spread of knowledge and a totally it demands less of youngsters to remember words immersive pedagogy. VR is changing the way we that are connected with pictures. work, learn and treat our patients. We have seen For the health practitioner, VR may yield an over time an evolution of orthodontic care by im- unexpected, but welcome, advantage in terms proving patient comfort. We are not just dealing
ortho 2/2017 07 trends & applications virtual reality
Fig. 4 Nikon KeyMission Utility.
Fig. 5 Operatory room in VR.
Fig. 4
Fig. 6 Scan this QR code for a VR lecture. Fig. 5
with a set of teeth fixed into a bone mass appended time, since the transmission of knowledge is no to a skull, but with a person whose positive longer done with a Kodak Carousel slide projec- experience will inevitably lead to clinical success. tor, but with sophisticated presentation software, Similarly, orthodontic education has evolved over incorporating photographs and clinical videos. VR is paving the way to a higher degree of evolu- tion regarding how to understand our environ- ment, whether it is an environment of care or about work. As with tourism or cinema, VR offers many opportunities in the field of health. Orthodontics Dr Yassine Harichane is entering into a 360° revolution focused on the graduated from Paris Descartes patient experience. University in France and completed his MSc and PhD on dental pulp stem cells. He maintains a private practice in Acknowledgements Canada and can be contacted at The author reports no conflicting interests. He [email protected] would like to thank Dr Eren Cicek for the proof- reading and kind support.
08 ortho 2/2017 Hydrostatic Splint Appliances for instant TMD Treatment
The Aqualizer‘s fluid system creates perfect bite balance and stability through a minimally invasive approach to TMD treatment. It works by allowing the muscles themselves to automatically reposition the jaw to where it naturally works best. For TMD pain relief, restoring this balance is essential. Unlike other available dental splints, the Aqualizer self-adjusting oral splint is a TMD treatment which allows the body to unravel bite distortions and establish optimal systemic function and balance. The Aqualizer takes the uncertainty out of TMD diagnosis and treatment. While other dental splints and TMD treatment options can distort the jaw, causing TMD pain, the Aqualizer facilitates relief through ideal occlusion automatically and naturally. The Aqualizer is also a perfect supplement in other medical disciplines besides dentistry. Today this device is integrated into physical therapy, osteopathy, orthodontic treatment, orthopedics and many other medical disciplines.
• physiotherapeutic TMD training tool • anatomically shaped design for comfortable use • coordinative training of muscles with biofeedback • ready to use • relieves pain of masticatory muscles • selfadjusting splint within 30 seconds • long lasting pain reduction • proven for more than 25 years • dissolution of pain-related relieving postures • activation of self-healing capacities • moves mandible into a physiologic position • clinically proven • different sizes • can substitute regular splints in some cases • different vertical dimension
Every restoration, extraction, prosthetic and orthodontic treatment changes the occlusion in static and dynamic. Small occlusal interferences of just a few microns, are disruptive for the propriorreceptors of the stomatological system. Patients are trying to compensate occlusal interference by adapting the mandible into a new habitual relieving position, with consequences for the attached tissue structures.
The first hydrostatic splint Aqualizer has been invented in the 1979 from Prof.Martin Lerman at the University of Illinois (TMJ Research Center). Since then Aqualizer has been used from countless patients as an instant drug free pain reliever. Latest clinical researches have proofed the therapeutic effect of hydrostatic self balanacing splints. Reestablishing of a pain free neuromuscular position of the mandible after orthodontic treatment is essential for a long lasting therapeutic success. Hydrostatic Splints are valuable tools especially during the process of orthodontic treatment Dentrade International e.K. Phone +49(0)221-9742834 Monheimer Str.13 • D-50737 Cologne Fax: +49(0)221-9742836 www.dentrade.com Internet: www.dentrade.de email: [email protected] technique open bite closure
Tongue star 2 (TS2) – System for rapid open bite closure
Author: Dr John Constantine Voudouris, Canada
Introduction of the system included tongue stars bonded at the same time as a Siamese twin, active self- The aim of this article is to discuss a new system ligating appliance that employed the third com- to treat severe skeletal open bite malocclusion ponent of new initial NiTi iArch wires for light using a new, miniaturised tongue star 2 (TS2) force control. These specialised archwires with device. In the first part, the author will focus on a higher vertical dimension than horizontal di- clinical evaluation of TS2, the second part is mension (for example .018” × .014”) acted closer devoted to tongue thrusting, open bite aetiology to the canter of resistance of the root for earlier and its treatment. moments of incisor torque, and were incorpo- rated with curve of Spee for the lower arches, and reverse compensating curve on the upper Clinical evaluation of TS2 arches to further facilitate incisor re-eruption. The fourth component of the system included a Methods vertical box elastic from the upper lateral incisors Clinical applications of the first generation of the to the lower canines (1/4”, 4.5 oz) that was addi- tongue star devices with nine rounded protru- tionally applied on the labial aspects for light in- sions, initially manufactured as one-piece, were cisor re-eruption in conjunction with the TS2s. evaluated over a two year period in the private orthodontic clinic of the author. Improvements Clinical results and conclusion were noted and implemented to develop a second TS2s were found to be highly effective in restrict- generation tongue star 2. ing anterior tongue positioning for rapid open bite The new TS2 was made in Italy by SIA Ortho- closure (ROC). No clinically significant root resorp- dontic Manufacturer as a four-piece unit includ- tion was noted that appeared to be related to the ing a body with six tie-wing undercuts for cross- light forces applied. Therefore tongue stars are bite elastics, brazed to the bonding pad for greater recommended for rapid open bite closure since flexibility, and 80-gauge mesh for higher bond they cause the tongue to be retracted during treat- strength against lingual shearing forces. ment to permit anterior dental re-eruption. For each orthodontic patient, 12 TS2s were bonded, including six tongue stars positioned on the palatal aspects of the gingival middle-third Multi-directional forces of the upper six anterior teeth from canine to of anterior tongue positioning canine, and six tongue stars were placed on the (tongue thrusting) lingual middle-third of the lower anteriors from canine to canine. The tongue affects the alignment of the dentition TS2s were the central device of a four com- because it has one of the strongest sets of muscles ponent system to treat severe anterior, and lat- in the human body capable of reflex.1 Malocclu- eral tongue positioning. The second component sions involving open bites are classified as two
10 ortho 2/2017 open bite closure technique
Fig. 1 types, anterior open bite located in the area of 4) Skeletal downward and backward growth of Fig. 1 the anterior canine-to-canine area, and lateral the mandible (dolichocephalic). Anatomy of the TS2: The seven characteristic features of open bites located at the premolars and molars. 5) Muscle hypoactivity (an extreme pathological the second generation tongue In open bite malocclusions, the tongue attempts example is observed in muscular dystrophy star 2 (TS2). to seal the oral cavity for effective swallowing patients). (suction-effect) in an unnatural, anterior posi- 6) Dental delay of incisor eruption and overerup- tion. In addition, the tongue thrusts both supe- tion of the molars. riorly and inferiorly. This results in progressive 7) Habits such as thumb-sucking, finger- sucking, opening of the bite preventing eruption of the blanket-sucking, over-retention of soothers upper and lower incisors. It is significant that both after the age of 6. the upper and lower incisors are not only intruded, but also proclined often by the unnatural ante- Several appliances have been developed to con- rior tongue position between the incisors. Sev- trol the anterior tongue positioning including the eral factors have been associated with open bites. traditional cemented tongue-cribs soldered to molar bands, and bondable tongue habit- breakers Aetiology of open bite includes: type brackets on the palatal of the upper incisors. 1) Primary anterior, superior and inferior tongue These were often bulky, uncomfortable and positioning in conjunction with lateral tongue cumber some for patients. thrusting. 2) Allergies, asthma, nasal obstruction from for What is TS2? example nasal septum deviation as a result of The first tongue star was developed in 2014 with chronically inflamed turbinates, chronically nine-reminder protrusions rounded at the tips to enlarged tonsils and adenoids, etc. prevent anterior tongue positioning. It was man- 3) Primary, habitual mouth breathing (or 2º), as- ufactured as a one-piece bracket and tested clin- sociated often with anterior, superior and in- ically for two years by the author in his private ferior tongue positioning. orthodontic clinic in Toronto, Canada. This first
ortho 2/2017 11 technique open bite closure
Figs. 2a & b Lateral open bites commonly associated with skeletal maxillary constriction frequently have an ENT aetiology, producing secondary mouth breathing and a chronic imbalance between a lower tongue position and buccinator muscle activity (facial muscles).
Figs. 3a & b The recommended positions of the tongues stars are mildly more gingival for the upper Fig. 2a Fig. 2b incisors (a).
Figs. 4a & b Tongue Stars 2 with anterior box elastic, and active self-ligating brackets shown, and found to be a highly effective and efficient system for rapid open bite closure (ROC) of severe skeletal anterior and lateral open bites.
Fig. 3a Fig. 3b
Fig. 4a Fig. 4b
generation tongue star was found to be effective hygiene. In addition, tie-wing like undercuts are in controlling the tongue for ROC. As a result, new designed into six of the nine protrusions to secure modifications were then implemented by the the placement of crossbite elastics. This is re- author to improve the first generation tongue quired commonly in lateral open bite treatment star (TS1). that is associated with severe skeletal maxillary constriction (Figs. 2a & b). The second generation TS2 was made in Italy, by SIA Orthodontic Manufacturer, as a four-piece Where should TS2 be placed? unit including: Clinically, TS2s are bonded on the middle-third 1) Bracket body with nine rounded protrusions regions of the upper and lower canine-to-canine and six new, tie-wing undercuts. regions (Figs. 3a & b). The TS2 position recom- 2) Braze (for flexibility) to a bonding pad. mended for the upper anteriors is just gingival to 3) Separate 80-guage mesh for greater shear the middle third to prepare for the corrected upper resistance and bond strength. incisors to approach contact with the lower inci- sors during rapid open bite closure. This provides The separate application of 80-gauge bonding a total of 12 TS2s on the day of first bonding of a mesh is used to improve bond strength during full Siamese twin, active self-ligating appliance shearing forces on the lingual. TS2s are minia- recommended with new .018” × .014” NiTi, iArch turised in size similar to bondable buttons to be wires (SIA Orthodontic Manufacturer). In addi- comfortable for patients and to facilitate oral tion, for each open bite treatment, TS2s are ap-
12 ortho 2/2017 open bite closure technique
Figs. 5a & b A 9-year-old patient demon- strating that the anterior tongue positioning is additionally directed inferiorly resulting in the proclination of the lower incisors, supporting the indication that TS2s need to be placed in both the upper and lower arches.
Figs. 5c & d The radiographs reveal that Fig. 5b anterior tongue positioning (c) is often associated with nasal obstruction related to enlarged and chronically inflamed turbinates (d), secondary mouth breathing, and molar Fig. 5a overeruption.
Figs. 5e & f Lip harmony and balance were shown after ROC using the four-component system of TS2s, anterior box elastics, active self-ligating brackets, and specialised archwires for torque control.
Fig. 5c Fig. 5d
Fig. 5e Fig. 5f
ortho 2/2017 13 technique open bite closure
Fig. 6a Fig. 6b
Figs. 6a & b plied in conjunction with anterior box elastics to the centre of resistance for earlier incisor mo- The retraction reflex mechanism (1/4”, 4.5 oz, see Fig. 6b) from the labial aspects ments of torque and control required for open shown with TS2s (a). Application of the upper lateral incisors to the lower canines bite correction. The archwires incorporate curve of anterior box elastics and active SL (b). to facilitate a rapid open bite closure (Figs. 4a & b). of Spee for the lower arches and reverse com- This completes a system composed of four- pensating curve on the upper arches to further components for rapid open bite closure. facilitate incisor re-intrusion. TS2 incisor re- extrusion is further facilitated by the alignment Why apply TS2? of the anterior teeth, where a labial box elastic Normal swallowing takes place approximately can be placed that also restrains the tongue 600 times/day or more (including during chew- (please see Fig. 6b). No clinically significant root ing and speaking) the tongue is generally posi- resorption was found with the use of this light tioned in the palate. However, in anterior open force system that reduces the unnatural and bites the tongue fills the open bite space through multi-directional anterior, superior, inferior and anterior tongue positioning (previously referred lateral tongue forces. to as tongue thrusting). TS2s are applied for both Rapid Open Bite Closure and for Rapid Lateral How does TS2 work? Open Bite Closure (Figs. 4a & b). They are used The basic mechanism of action is that the TS2 in conjunction with active self-ligating appliances produces a negative conditioning reflex response due to the low resistance shown in vitro to permit for anterior tongue positioning.2 This is similar free and controlled movement of the upper and to a hot-stove effect (Fig. 6a). However, due to lower anteriors. Once the incisors begin to develop the rounded ends of the nine protrusions the a positive overbite relationship the tongue gen- tongue is not lacerated, nor is the operator’s glove erally begins to retract posteriorly into a more or skin. The feeling against the finger is one of natural tongue position assuming the aetiology coarse sandpaper as simply a reminder for the of the open bite has been additionally controlled tongue to stay retracted away from the open (for example, nasal obstruction). bite. This permits the TS2s to work effectively in conjunction with the anterior box elastics When should TS2 be placed? (5/16”, 4.5 oz) for rapid open bite closure (ROC) TS2s are recommended at all ages including for shown in Figure 6b. In lateral open bite patients both early interceptive treatment in children where the TS2s are placed at the premolars and (Figs. 5a–f) and in adults. The ideal recommended molars crossbite elastics are applied, that are time of placement is at the time of placement of generally heavy 1/4”, 4.5 oz, to further prevent active self-ligating brackets (that are regularly lateral tongue positioning while maxillary ex- positioned on the labial aspects). TS2s and active pansion is completed simultaneously. In addi- self-ligating brackets work ideally and syner- tion, it is important that the patient is instructed gistically with specialised iArch wires that have to exercise swallowing with the tongue in the a higher vertical dimension than horizontal roof of the mouth from the day of TS2 dimension (for example .018” × .014”) to be closer placement.
14 ortho 2/2017 open bite closure technique
Special procedures with TS2s and overcorrec- and lower archwires with its proven low resis- tion of open bites tance, in vitro. As anterior open bites are corrected it is import- ant to observe the gingival protrusions of the In conclusion: TS2s for the possible need of reduction with a 1) Metal TS2s are highly effective and efficient high-speed to prevent dental interferences. The chairside for ROC. objective is to overcorrect the open bite to be 2) Efficiency is gained by ready-made, bondable greater than 30% overbite for long-term reten- TS2s, that do not wear, are miniaturised for tion. The reason is that open bites are often asso- patient comfort and facilitate oral hygiene. ciated with patients growing with the mandible 3) TS2s are placed on all 12 anterior dental units in a downward and backward direction. It is addi- from the upper canine-to-canine, and lower tionally recommended that upper and lower canine- to-canine since the tongue was ob- brackets from canine-to-canine be bonded 1 mm served and found to be positioned anteriorly, toward the gingival than the customary average superiorly and inferiorly. height positions to facilitate open bite closure. This is particularly important at the upper lateral TS2s are applied in conjunction with anterior box incisors that are the smallest of the incisor teeth elastics (5/16”, 4.5oz) and ideally with new, low and affected most by the unnatural, anterior profile active self-ligating brackets with NiTi tongue positioning forces. clips for light, continuous forces for the peri- odontal membrane, completely frost-coated for Conclusions: Advantages of TS2 applications aesthetics, and with progressively lower forces A system of four components was developed from molars to incisors. Active self-ligating and tested to produce rapid open bite closure. brackets make use of reduced resistance found This included the use of new tongue stars, ante- in vitro and active seating of iArch wires for earlier rior box elastics with active self-ligating brack- moments of torque that are closer to the centre ets with new iArches to provide freedom of of resistance of the incisors to improve control movement of the system including the upper (future publication).
references about
1. Dr John Constantine Voudouris Ramford SP, Major MA. Occlusion. maintains teaching positions at the Philadelphia, US: W.B. Saunders Company; University of Toronto, as an associate in the discipline of Orthodontics, 1971; 42, 89–91. for 31 years, teaching mandibular advancement appliances, and at 2. New York University, as a visiting Cooper S. Muscle spindles in the scholar, in the Division of Biological Sciences for 18 years, teaching active intrinsic muscles of the human tongue. self-ligation. He is a full member of the J Physiol (London) Eastern Chapter of the Edward H. 1954;122:193. Angle Society of Orthodontists and the recipient of the prestigious American Association of Orthodontist’ Milo Hellman Research Award for condylar growth modifications and glenoid fossa remodelling with Herbst appliances, applying electromyo- graphic, cephalometric and histologi- cal investigations. Dr Voudouris maintains a private orthodontic specialty practice in Toronto, Canada.
ortho 2/2017 15 case report diode laser during orthodontic treatment
Use of diode laser in the treatment of gingival enlargement during orthodontic treatment: Case report
Authors: Prof. Carlo Fornaini, Drs Aldo Oppici, Luigi Cella & Elisabetta Merigo, Italy
Introduction volves increased production by fibroblasts of amorphous ground substance with a high level In recent decades, we have witnessed the sub- of glycosaminoglycans. Increases in mRNA ex- stantial development and expansion of the use pression of Type I collagen and up-regulation of of fixed orthodontic appliances. While their keratinocyte growth factor receptor could play application has many advantages, several prob- an important role in excessive proliferation of lems related to the health of the soft tissue may epithelial cells and increased development of sometimes appear during treatment. In fact, gingival enlargement, on the basis of some stud- the use of fixed orthodontic appliances may ies, in cases of poor oral hygiene status.7 How- provoke labial desquamation,1 erythema mul- ever, there is no clear definition on its aetiology, tiforme,2 gingivitis3 and gingival enlarge- although it is probably associated with the in- ment.4 flammatory response induced by the corrosion Gingival enlargement is a very common com- of orthodontic appliances, particularly those of plication during orthodontic treatment,5 but for- nickel,8 linked to an inflammatory response con- tunately, it seems to be transitory and generally sidered a Type IV hypersensitivity and manifested resolves after orthodontic therapy, even if some- as nickel-induced allergic contact stomatitis, times incompletely. Gingival overgrowth induced even if its aetiology has not yet clearly been by orthodontic treatment shows a specific fibrous defined.9 and thickened gingival appearance, different from The treatment of these conditions is surgical. fragile gingiva with marginal gingival redness Histological and histochemical studies have common in allergic or inflammatory gingival demonstrated that the removal of the gingival lesions.6 papilla can promote the formation of normal con- Several clinical studies suggest that ortho- nective tissue.10 Because the classic intervention dontic treatment may be associated with a de- performed by scalpel has some disadvantages, crease in periodontal health, causing a hypertro- mainly linked to the discomfort for the patient phic form of gingivitis. However, the actual (e.g. anaesthesia by injection and sutures), there pathogenesis of gingival enlargement is not yet has been great interest in the utilisation of laser completely understood, although probably in- technology.
16 ortho 2/2017 diode laser during orthodontic treatment case report
Fig. 1 Fig. 2
Fig. 3 Fig. 4
Fig. 5 Fig. 6
Fig. 1 Fig. 3 Fig. 5 Clinical view, showing gingival enlargement, Surgical laser-assisted treatment Healing five days after surgery. just before the debonding procedure. via laser gingivectomy. Fig. 6 Fig. 2 Fig. 4 One month follow-up. Application of a topical anaesthetic. Clinical view just after surgery.
ortho 2/2017 17 case report diode laser during orthodontic treatment
Case report Discussion
A 14-year-old female patient was referred to The first laser appliance was built by Maiman in our department by the orthodontics unit because, 1960, and some years later, it was successfully at the end of fixed orthodontic treatment, she employed in medicine and in oral surgery with had developed gingival enlargement in the upper several advantages. It may provide excellent arch (Fig. 1), probably related to the fast closure incision performance with sealing of small blood of the spaces associated with very poor oral and lymphatic vessels, resulting in haemostasis hygiene due to bleeding during toothbrushing. and reduced postoperative oedema. Further- Just after the removal of the appliance, a topi- more, target tissues are disinfected as a result of cal anaesthetic (EMLA, AstraZeneca) was applied local heating and production of an eschar layer, to the gingivae (Fig. 2) and a gingivectomy was which results in a decreased amount of scarring performed using a diode laser (XD-2, Fotona) owing to decreased post-operative tissue shrink- according to the technique of removal of the age, allowing one to avoid the use of sutures. inter dental papillae (Fig. 3). The parameters Diodes, the last generation of laser used in used were as follows: a wavelength of 808 nm, dentistry, have several advantages, such as re- 3 W in continuous wave, a 320 μm fibre in con- duced cost and size, and offer the operator the tact mode. The intervention had a duration of possibility to work both in continuous and chopped 375 seconds, and the patient did not feel any mode. Based on our experience, we can confirm pain (Fig. 4). After the intervention, the patient that this technology may represent a new approach did not take any kind of pain medication, and the to the resolution of gingival enlargement during healing process was completed in five days orthodontic treatment, with better comfort for (Fig. 5). the patient during and after surgery.
Editorial note: A list of references is available from the publisher.
about
Prof. Carlo Fornaini Dr Aldo Oppici is a lecturer at the MICORALIS is the Head of “Special Needs and Laboratory of the Côte d’Azur Maxillofacial Surgery Unit” of University in Nice, France, the “Guglielmo da Saliceto” hospital and a dentist at the “Special Needs in Piacenza, Italy. and Maxillofacial Surgery Unit” of the “Guglielmo da Saliceto” [email protected] hospital in Piacenza, Italy. He can be contacted at:
Dr Elisabetta Merigo Dr Luigi Cella is a lecturer at the MICORALIS is a maxillofacial surgeon at the Laboratory of the Côte d’Azur “Special Needs and Maxillofacial University in Nice, France, Surgery Unit” of the “Guglielmo and a dentist at the “Special Needs da Saliceto” hospital in Piacenza, and Maxillofacial Surgery Unit” of Italy. the “Guglielmo da Saliceto” hospital in Piacenza, Italy. [email protected]
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F +49 341 48474 173 SUBSCRIBE NOW! [email protected] case report lateral incisors agenesis treatment
Orthodontic management of maxillary lateral incisors agenesis
Author: Dr Dan Andrei Iacob, Romania
The purpose of this article is to show the differ- · The long axis of the central incisor and the ent modalities of treatment for upper lateral canines should be slightly mesial to incisors agenesis. In daily practice, orthodontists the gingival height of contour (Fig. 2). often meet cases of upper lateral incisors agen- · The long axis of the upper lateral incisor esis. The two common treatment options are: should be coincidental to the gingival height space closure, using canines to substitute the of contour (Fig. 2). missing lateral incisors, or space opening for · Dental proportions: the width of well- future restorations. proportioned teeth should be approximately 60 % to 75 % of their height (Fig. 3).
Introduction Functional occlusion objectives · 3–4 mm of overbite. · Theoretical considerations. · 0–2 mm of overjet. · The second most common agenesis, repre- · Anterior and canine guidance, which allows senting 20 % of the congenital missing teeth. for the immediate disclusion of molars · The second most common agenesis (Europe), and premolars when making lateral or after the mandibular second premolar. protrusive movements. · The most frequently missing tooth in the · Centric occlusion coinciding with centric American population. relation. · Unilateral agenesis is often associated with dysmorphia or microdontia of the corre- Treatment strategies for canine substitution sponding contralateral tooth. · Angulate and extrude the canine to mimic an upper lateral incisor relative to the Treatment alternatives gingival height of contour. · Space opening for future restorations. · Intrude the upper first premolar to mimic · Space closure–canine substitution of the an upper canine relative to the gingival lateral incisor. height of contour. · Apply lingual root torque to mimic the Treatment objectives emergence profile of the lateral incisor · Optimal dentogingival aesthetics. and improve the emergence profile of · Functional occlusion. the bulky gingival tissue of the substituted canine: use a lower second premolar Optimal dentogingival aesthetics objectives bracket on the upper canine. · Gingival height of contour of the upper · Adjust dental proportions as necessary: anterior teeth (Fig. 1): central incisors and mesiodistal reductions on the upper central canines are more superior than that of the incisors to balance adjustments on the lateral incisors. substituted canine.
20 ortho 2/2017 lateral incisors agenesis treatment case report
Fig. 1 Fig. 2 Fig. 3
Fig. 4 Fig. 5 Fig. 6 Fig. 7
Fig. 8 Fig. 9 Fig. 10
Fig.11 Fig. 12 Fig. 13
Fig. 14 Fig. 15 Fig. 16
Fig. 18 Fig. 19
Fig. 17 Fig. 20 Fig. 21
ortho 2/2017 21 case report lateral incisors agenesis treatment
When is canine substitution appropriate?
Occlusal considerations · Class II free of mandibular crowding: molars in full Class II and premolar brought forward Fig. 22 Fig. 23 to act as the canine, while remaining in a Class I relationship with the lower canine. · Class I with sufficient mandibular anterior crowding that would necessitate premolar extractions on the lower arch.
Profile Fig. 24 Fig. 25 ·Flat. · Slightly convex profile.
Canine size, shape and colour · The width at the cementoenamel junction: the wider the tooth, the more difficult it will be to mimic a lateral incisor. Fig. 26 Fig. 27 · Colour: canines are the teeth that are the most saturated with chroma. A canine that is smaller in shape and does not have an oversaturation of chroma would make an excellent candidate for canine substitution.
Smiling lip level
Fig. 28 Fig. 29 · Depending on how high the smile line is, it may show the canine eminence. · Large canines often have an obvious root prominence, and high lip levels may reveal that there is an unnatural eminence in the lateral sight.
Fig. 30 Fig. 31 Clinical case
A 13-year-old patient complaining about the aesthetic aspect of her smile was sent to my office by a general dentist with a diagnosis of the bilat- eral lateral incisors agenesis. The treatment started with an aesthetic anal- ysis of the patient’s face (Figs. 4–10), which was Fig. 32 as follows: · Square face. · Slight facial asymmetry, with menton deviated to the right. · Maxillomandibular biretrusion (Fig. 10). · Correct curl of the upper lip. · Left side of the face is more flat compared Fig. 33 Fig. 34 with the right side. · Right eye slightly higher. · Insufficient display of the upper anterior teeth with lips in repose.
Then occlusal analysis (Figs. 11–21) was performed: Fig. 35 Fig. 36 · Skeletal Class III (Fig. 17).
22 ortho 2/2017 lateral incisors agenesis treatment case report
Fig. 37 Fig. 38
Fig. 39 Fig. 40
· Dental Class I. canines with first premolars (Figs. 26–28). · Maxillary hypoplasia with lower arch dental · Finishing and occlusal settling (Figs. 29–31). compensations. · Verifying the implant site width (Fig. 32) · Insufficient overbite and overjet. and provisory implants and crowns place- · Upper spacing due to the laterals agenesis ment (Fig. 33). (Fig. 18). · Upper midline deviated to the right. Restorative phase · Initial CR mounting (Figs. 19–21). At the end of orthodontic treatment, gingival margins were well aligned, midlines were cen- Finally space analysis was carried out (Tables tred and canines and first premolars were posi- 1a & b). tioned to facilitate the restorative phase of treat- ment (Figs. 34–36). At this phase, a final CR Treatment plan mounting and wax-up was performed It was concluded that maxillary hypoplasia was (Figs. 37–39), as well as the anterior teeth res- an indication for space opening. Considering the torations (Fig. 40). young age of the patient, the skeletal pattern and Orthodontic treatment has improved both the high demands regarding aesthetics, it was dental and facial aesthetics (Figs. 41–47) and the decided to: functionality of the occlusion (Figs. 48–52). · Open spaces for two implants, but in the posterior area: 14 and 24. · Substitute the laterals with canines. Table 1a: Space analysis (Maxilla) · Temporary implants and crowns on teeth Needed to create space Maxilla Crowding -5 mm #14 and 24, until 18 years. for lateral incisors · Reshaping the canines and first premolars to match the shape of the lateral incisors AP incisors position 0 mm and canines: direct composites restorations Total -5 mm on teeth #13, 11, 21, and 23.
Treatment step by step: Table 1b: Space analysis (Mandible) · Upper bracket placement (Fig. 22): level and Mandible Crowding -2 mm align the gingival margins, and correct the torque on the upper canines who will AP incisors position 0 mm substitute the lateral incisors. Curve of SPEE -1 mm · Implants space opening: substitute laterals Total -3 mm with canines (Figs. 23–25) and substitute
ortho 2/2017 23 case report lateral incisors agenesis treatment
Fig. 41 Fig. 42 Fig. 43 Fig. 44
Fig. 45 Fig. 46 Fig. 47
Fig. 48 Fig. 49
Fig. 50 Fig. 51 Fig. 52
about Conclusions Canine substitution can be an excellent treat- Dr Dan Andrei Iacob ment alternative for congenitally missing max- graduated from the Faculty of Dentistry of illary lateral incisors. Patient selection is critical the Grigore T. Popa University of Medicine and Pharmacy in Iași, Romania. He is a and depends on the type of malocclusion, pro- specialist in orthodontics and dentofacial file, canine shape and colour, and smile lip level. orthopaedics. Dr Iacob has participated in Pre-treatment evaluation of these selection numerous postgraduate training criteria is necessary to ensure treatment suc- programmes in Romania and abroad. He is a member of the Roth Williams Interna- cess and predictable aesthetics. tional Society of Orthodontists, The When planning to replace congenitally miss- Charles H. Tweed International Foundation ing lateral incisors, you should remember that for Orthodontic Research and Education, an interdisciplinary approach is necessary to and the Society of Esthetic Dentistry in Romania. provide the most predictable treatment outcome. TRIDENT DENTAL CLINIC The orthodontist should always consider Strada Louis Pasteur 1 the patient’s age, skeletal and facial pattern, 050533 Bucharest Romania dentoalveolar crowding, as well as performing dental and facial aesthetic analyses. [email protected]
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www.dental-tribune.com case report maxillary molar distalisation with aligners
Maxillary molar distalisation with aligners and cyclic forces
Author: Dr Tommaso Castroflorio, Italy
Introduction factor kappa B, and osteoprotegerin.2 Osteopon- tin is another protein that has been linked to bone In the last decade, clear aligner therapy (CAT) has resorption via promotion of osteoclast adhesion become a well-known treatment option in ortho- to the osseous matrix.3 dontics, mainly owing to patients’ preferences Research has demonstrated that the use of for aesthetic appliances. With respect to conven- cyclic forces increases the rate of bone remodel- tional fixed appliances, aesthetics is not the only ling compared with static forces.4 A force prop- advantage of CAT. Several papers have concluded agating through biological tissue, such as alveolar that aligners provide better comfort and, being bone and the periodontal ligament, is transduced metal-free, avoid irritation of the cheek and gin- as a tissue-borne and cell-borne mechanical stress gival tissue; facilitate better oral hygiene, allow- that in turn induces interstitial flow.5 Although ing the patient to remove the aligner while eating liquid flow is a current focus of the mechano- and to brush and floss the teeth after eating; and transduction pathways, its anabolic and catabolic results in less pain compared with conventional effects rely upon deformation of extracellular brackets. In clear aligner-based orthodontics, an matrix molecules, transmembrane channels, the intentional mismatch between the aligner and cytoskeleton and intranuclear structures.6 Cells the teeth is programmed based on the desired are known to respond more readily to rapid oscil- tooth position. Through this process, a force lation in force magnitude (i.e. to cyclic forces) than system is transmitted to the teeth. However, CAT to constant forces.7 However, randomised clinical has shown some limitations regarding the gen- trials testing the effect of a commercial device eration of complex force systems for achieving generating cyclic forces during orthodontic treat- extrusion, rotation, bodily tooth movements and ment produced contrasting results.8 Biases in root movement control. In order to overcome both the cited studies prevented the drawing of these limitations, auxiliaries such as power ridges a definite conclusion. In a real clinical setting, the and composite attachments were designed and same device has been reported to be reliable.9 engineered to improve CAT biomechanics, en- The tested device is AcceleDent (OrthoAccel Tech- abling the expression of more complex force sys- nologies). The device has a mouthpiece similar to tems. Even so, orthodontics is not only a matter a sport mouthpiece, which the patient bites on to of applied mechanics, since the biological response during use. The mouthpiece portion is connected of the patient plays a determining role. Aligners to an activator that stays outside the mouth. The are capable of producing the same biological re- activator houses the components that generate sponse as fixed appliances do.1 the cyclic forces (vibration). The activator includes Stimulation of the bone cells is mediated by a battery, motor, rotating weights and micropro- several factors, such as a member of the tumour cessor for storing usage data. The patient con- necrosis factor ligand and receptor superfamilies, nects the mouthpiece to the activator and uses including the receptor activator of nuclear factor the device once daily for 20 min. The applied force kappa B ligand, the receptor activator of nuclear from the device is 0.25 N (25 g). This low force is
26 ortho 2/2017 maxillary molar distalisation with aligners case report
Fig. 1a
Fig. 1b Fig. 1c
intended to be barely noticeable and not uncom- to manage because of her job as a make-up artist fortable. The device can be used with fixed appli- travelling across Europe. She presented with a ances and aligners. A human skull study has shown Class II, Division 1 relationship: mild crowding in that the vibration generated by the AcceleDent the lower arch and moderate crowding in the device can be well transmitted through the den- upper arch. The overjet was increased up to 10 mm. tition and skull.10 Therefore, the device is able to The profile analysis also revealed a protruded lip reduce treatment time by inducing a more rapid position (Figs. 1a–c). Considering the patient’s response of bone cells to orthodontic forces. aesthetic request and her refusal of surgical in- tervention or extraction, the treatment plan was designed to obtain a final molar and canine Class Case report I relationship through sequential distalisation of the maxillary teeth using Invisalign aligners (Align A 25-year-old female patient requested an aes- Technology), composite attachments on all of thetic orthodontic treatment that was not easy the distalising teeth and Class II elastics
ortho 2/2017 27 case report maxillary molar distalisation with aligners
Fig. 2
Fig. 3
(Figs. 2 & 3).11 The patient was instructed to wear the estimated treatment time was approximately the aligners and the Class II elastics for at least 30 months. However, because the patient had 21 h per day. Furthermore, she used the Accele- chosen to use AcceleDent, the case was finalised Dent device for 20 min per day for the duration in 18 months of treatment without any additional of the orthodontic treatment. Aligners were aligners with respect to the initial prescribed 63 changed every two weeks until the maxillary (Figs. 4a–c, 5a–c). second molars were fully distalised, then every The clinical results were excellent and re- ten days until the first molars were in their final vealed a final molar and canine Class I relation- position and then every seven days until the end ship with functional overbite and overjet, and the of treatment. profile of the lower third of the face was highly The ClinCheck (Align Technology) software improved. The superimposition of the cephalo- demonstrated the need for 63 aligners to obtain metric tracings revealed a maxillary molar dis- the desired results with the prescribed sequence talisation of about 6 mm without significant tip- of stages, attachments and Class II elastics. Thus, ping and excellent control of the buccolingual
28 ortho 2/2017 maxillary molar distalisation with aligners case report
Fig. 4a Fig. 4b Fig. 4c
Fig. 5a Fig. 5b Fig. 5c
Fig. 6
ortho 2/2017 29 case report maxillary molar distalisation with aligners
Fig. 7a Fig. 7b Fig. 7c
Fig. 8a Fig. 8b Fig. 8c
Fig.9
30 ortho 2/2017 maxillary molar distalisation with aligners case report
inclination of the incisors. The Class II elastics mittent forces are able to produce orthodontic were responsible for mandibular protraction of tooth movement with less cell damage with respect about 1.5 mm. Retention was provided by Vivera to light continuous forces.19 retainers (Align Technology) (Figs. 6, 7a–c, 8a–c). Cyclic forces applied by the AcceleDent device are oscillatory in nature and change in magnitude rapidly and repeatedly, affecting the cells with Discussion and conclusion each oscillation of force magnitude.20 The fre- quency of cyclic forces is never zero. Force fre- In several studies conducted on Class II intraoral quency is a concept of critical importance, but non-compliance appliances, dentoskeletal effects has rarely been considered in the field of ortho- revealed anchorage loss at the reactive part, distal dontics and dentofacial orthopaedics until recent tipping and extrusion of molars.12 Usually, the years. Cells are known to respond more readily anchorage loss occurred particularly in the incisal to rapid oscillation in force magnitude (i.e. to cyclic area owing to the reciprocal force reacting to the forces) than to constant forces.7 Therefore, Ac- distalising force. Previous studies have confirmed celeDent acts as a physical mediator of the bone that the use of Class II elastics during maxillary modelling and remodelling processes behind or- molar distalisation with aligners prevents the thodontic tooth movement, thus facilitating the uncontrolled proclination of the anterior teeth.13 action of the aligners. The result is excellent track- Furthermore, the sequential distalisation proto- ing of the aligners, because of the expression of col limits space opening between the distalising the biomechanics produced by the interaction teeth, which is more aesthetic, maintains maxi- between aligner, attachments and tooth surface mum aligner contact with the teeth and reduces (Fig. 9). The successful incorporation of Accele- the flexibility of the plastic material. That, in turn, Dent into an orthodontic treatment can signifi- minimises uncontrolled incisal tipping, which is cantly reduce treatment time, making it an at- expressed clinically as increased overbite with a tractive adjunct for patients. In the presented loss of palatal root torque. case, treatment duration was shortened by 45% Treatment duration is influenced by the mal- with an effective, user-friendly and safe occlusion complexity, the amount of tooth move- technique. ment required and the applied system of forces. The distalisation of maxillary molars is frequently required in Class II non-extraction patients. Re- solving Class II molar relationships by distalising maxillary molars may be indicated for patients with minor skeletal discrepancies.14 Simon et al. reported a high accuracy (88%) of the bodily movement of maxillary molars with CAT when a mean distalisation movement of 2.7 mm was prescribed.15 The authors reported the best accuracy when the movement was supported by the presence of an attachment on the tooth sur- face. Furthermore, they underlined the importance of staging in the treatment predictability. Ravera et al. investigated the dentoskeletal effect of max- illary molar distalisation with Invisalign aligners in adult patients and found that clinicians can con- sider the use of Invisalign aligners in treatment planning for adult patients requiring 2–3 mm of about maxillary molar distalisation.16 In order to obtain this amount of movement, maxillary third molars, if present, should be extracted to have sufficient Dr Tommaso Castroflorio room to move the second and first molars in Class II is an adjunct professor at the Department of Surgical malocclusions. It has been suggested that teeth Sciences of the CIR Dental School at the University of Turin in Italy. He can be contacted at: moved with aligners do not undergo the typical stages of orthodontic tooth movement described tommaso.castrofl[email protected] by Krishnan and Davidovitch,17 because of the in- termittent forces applied by the aligners. However, light continuous forces are perceived as intermit- tent by the periodontium18 and orthodontic inter-
ortho 2/2017 31 industry report hygiene in orthodontics
Oral hygiene in orthodontics
During orthodontic treatment, many patients How to use interdental brushes seek advice on how to clean their braces effec- in orthodontic care tively and gently. Since ordinary toothbrushes and interdental brushes are not suitable for or- Interdental brushes allow for effective prevention thodontic appliances, Swiss oral care provider of dental caries and periodontal disease and should Curaden, under its CURAPROX brand, is now of- ideally be used before, during and after orthodon- fering the new Ortho Kit. This specialised kit con- tic treatment. To maximise the potential for atrau- tains the CS ortho ultra soft toothbrush, the CS matic, effective and acceptable cleaning without 1009 single brush, the CPS 07, CPS 14 and CPS harm to the papillae, CURAPROX offers ultra-fine 18 interdental brushes, and ortho wax. The Ortho bristles, extra thin wire cores and a durable system Kit is a perfectly combined set of products and for all of its interdental brushing systems. Devel- gives dental professionals the best option for im- oped to suit the orthodontist’s needs, the CPS 07, proving orthodontic patients’ oral hygiene. CPS 14 and CPS 18 interdental brushes are espe- When used correctly, the right toothbrush cially capable of cleaning wires and brackets. With should dislodge and remove plaque through small an accessibility of 2 mm and an effectiveness of circular movements along the gingival margin. 8 mm, the CPS 18 allows for excellent cleaning of Demonstrating the right balance between com- the outer wires, whereas the CPS 14 is especially fort and effectiveness, the CS ortho ultra soft suitable for the inner wires. The CPS 07 allows for toothbrush is specifically designed to clean both complete cleaning of the gaps between the teeth. teeth and orthodontic appliances. With 5,460 CURAPROX has placed special focus on the filaments, the compact brush head allows for comfortable use of international brush holders for easy cleaning of the brackets’ outer surfaces and the specific needs of orthodontic patients. For ex- its shape helps patients brush at the right angle. ample, the UHS 451 holder has a smart click system Each filament has a diameter of 0.1 mm, allowing the production of a head with many fine, though durable, bristles. The groove in the middle of the brush head accommodates the brackets and wires to allow the brush to clean the teeth better. In addition, the octagonal handle facilitates brush- ing at an angle of 45°. The CS ortho ultra soft toothbrush cleans efficiently and thoroughly and has gained an outstanding reputation among orthodontic practices and patients. Patients wearing orthodontic appliances have to exercise particular care in their oral hygiene, since bacteria can accumulate more easily around the brackets and wire surfaces. A single-tufted toothbrush, the CS 1009 is particularly suited for use on wires and brackets. The brush adapts to the contours of the brackets, can easily be moved from the top to the bottom, and is gentle on the gingivae. The CS 1009 also adapts to the anat- omy of the gingival margin, making it an indis- pensable expert tool that every orthodontist should use.
32 ortho 2/2017 hygiene in orthodontics industry report
on which the CPS 07, CPS 14 and CPS 18 interden- Optimum orthodontics tal brushes can easily be mounted. Patients can right from the start also use various other holders. Another key element of the Ortho Kit, the Besides the new Ortho Kit, the new CURAPROX ortho wax helps patients become used to their Baby soother is a revolution in paediatric den- appliance and protects the oral mucosa from tistry. This soother promotes the proper devel- abrasion and injury by bracket edges. The trans- opment of the palate and jaws by preventing parent and tasteless wax can easily be placed on misaligned teeth, problems caused by mouth to the brackets once warmed and is available in breathing and skin irritation. Its flat tip ensures a convenient carrying case. Finally, the Ortho Kit sufficient space for the tongue, while the side contains a brochure with tips and advice on how wings guide the suction pressure in the optimal to clean teeth and appliances effectively. It pro- direction. vides specific oral hygiene instructions for each product, as well as information about proper nutrition.
More than just communication
In addition to offering innovative products, Curaden emphasises the need to motivate dental profes- sionals and patients. Motivation is crucial for effective orthodontic treatment because it en- courages patients to engage in positive behavioural change and helps to achieve an overall positive outcome. Through the iTOP (individually trained oral prophylaxis) educational system, dental pro- fessionals will learn to communicate more effec- tively with their patients, to listen to their ques- tions and concerns, and to establish long-lasting good oral hygiene for their patients. Owing to the combination of high-quality products and effec- tive communication, dental professionals can ensure that their patients act in accordance with their advice and practise good oral health habits.
ortho 2/2017 33 industry report dental 3-D printers
Structo’s high throughput dental 3-D printers help lay foundation for dental chain to launch own brand of clear aligners
FDC Dental Group is a network of 21 clinics in their own manufacturing process, giving them Singapore with a history spanning more than 15 an edge in the highly competitive orthodontics years. With a team of over 30 experienced clini- market.” By insourcing the manufacturing process, cians, FDC covers a wide range of treatments, FDC has managed to achieve cost savings of up including orthodontics and restorative dentistry to 50 per cent per patient, which will be shared and paediatric dentistry. With the recent rise in with the end user to make clear aligners more popularity of clear aligners as an alternative treat- accessible to a broader demographic. Beside the ment to conventional fixed orthodontic appli- cost, FDC managed to halve the manufacturing ances, FDC has seen a significant increase in turnaround time from one month to only two demand for these products and recognised the weeks upon receiving a case. Faster delivery of need to internalise its manufacturing process to aligners to the patient also contributes to AAA optimize quality, turnaround time and costs. Aligners‘ edge over its competitors. “Lately, a lot of patients have been requesting “Structo’s mission is to empower businesses clear aligners instead of traditional braces because like FDC to deliver superior products with the of the aesthetic appeal and ease of use,“ said help of digital dentistry and our application- Dr Nurul Aizat, CEO and group clinical director of specific solutions. We believe the speed of our FDC Dental Group. “Having previously relied on printers will allow us to spearhead the widespread an external aligner manufacturer for our cases, adoption of digital dentistry and we are glad we we saw the opportunity to start managing the are able to help Dr Aizat and the entire team at process ourselves in-house, to better control the FDC to realise the benefits of a full digital work- quality of the aligners and reduce manufacturing flow,“ added Huub. cost. We commissioned Structo to assist us with their dental 3-D printers and to set up the entire production line in our facility, “ Aizat added. Structo’s dental 3-D printers “The project with FDC was an exciting one making waves across the industry from our perspective because it allowed us to take a holistic look at the entire digital process With its unique application-based product de- from scanning to manufacturing, “ said Huub van velopment, Structo has brought two leading Esbroeck, one of Structo’s founders. “The Structo dental 3-D printers to the market. Developed OrthoForm’s high printing speed and throughput using its proprietary technology, called Mask enables businesses like FDC to take control of Stereolithography (MSLA), Structo’s printers are
34 ortho 2/2017 dental 3-D printers industry report
designed to be high throughput manufacturing “Structo’s unique MSLA technology is just machines. the type of innovation the industry needs.” The company’s biggest user, Glidewell Dental, David Leeson, Director of Engineering of runs three Structo OrthoForm printers round the clock in its production line enabling it to achieve Glidewell Dental. a throughput of 180 arches per printer per day –
“With the growing volume in (clear aligner) cases, we saw the opportunity to start managing the process ourselves in-house, to better control the quality of the aligners and reduce manu- facturing costs.” Dr Nurul Aizat, CEO & Group Clinical Director, FDC Dental Group. more than any other 3-D printer in the same price category. The 3-D printer purchased by FDC Dental Group is the OrthoForm, an orthodontic 3-D printer capable of printing up to 30 arches in 1.5 hours. To date, the OrthoForm has helped Structo expand its global reach with an installa- tion base in across four continents. “At Glidewell Dental, we run a high-volume facility with round- further integrate Structo’s MSLA technology print- the-clock production of various models and ers to expand the company’s production capa- appliances. When looking for a 3-D printer, I need bilities. By being the launch customer and adding something that not only prints accurately with two of the newly released DentaForm 3-D print- reproducible results throughout the print plat- ers, Glidewell Dental is now running five Structo form but is also able to deliver the speed and 3-D printers at its production facilities. “Operating throughput we require,” commented David Leeson, two of Structo’s new printers is not only sufficient Director of Engineering at Glidewell Dental. to replace a number of our existing printers, but After running three Structo OrthoForm print- also allows us to increase capacity overall,” added ers over the last year, Glidewell has decided to Leeson, who mentioned that the company foresee
ortho 2/2017 35 industry report dental 3-D printers
further expansion with BOILERPLATE more DentaForm printers in the second half of this Structo is a Singapore-based dental 3-D printing year. Glidewell’s California- solutions provider. It designs, develops and builds based dental laboratory 3-D printers tailored for dental applications using has been a DentaForm beta its unique proprietary MSLA technology. With user, providing valuable MSLA, Structo’s 3-D printers are able to achieve feedback to Structo before speeds much higher than that of conventional the printer was made avail- SLA printers, revolutionising the field of digital able to the mass market. dentistry with higher throughput and lower costs, The DentaForm 3-D printer without compromising on print quality. is designed to print die- fitting models for crowns and bridges fitting. ORTHOFORM “Having one of the leading dental labs in the world place its trust in our technology shows that With a large build platform and crisp printing res- our solution is addressing a very critical need in olution, the Structo OrthoForm 3-D printer is de- digital dentistry. David and his team have been signed for the rapid manufacturing of dental moulds providing us with a lot of feedback that has con- for use in secondary processes, such as vacuum tributed to new features and design elements of forming. The adoption of digital dentistry is no the DentaForm printer. We are really excited to longer a cause for concern with our unique pro- continue this partnership with Glidewell to help prietary MSLA technology which enables the them expand their capacity,” added Huub. Ortho Form to achieve record-breaking speeds Structo believes its high throughput printers (Up to 30 dental models in 90 minutes). The end which give laboratory managers greater flexibil- result is higher throughput and lower costs, all ity in how they manage their manufacturing pro- without compromising on print quality. cess, will help accelerate the adoption of digital Jonathan Lim dentistry. Technicians will no longer have to wait Marketing Manager 4–5 hours for a single print job to complete, an inherent challenge that used to be a roadblock Structo Pte Ltd. 114 Lavender Street that prevented most dental professionals from #07-53 CT Hub 2 deploying 3-D printing on a large scale. To fur- Singapore 338729 ther encourage the adoption of CAD/CAM in den- [email protected] tistry, Structo recently launched a blog on all www.structo3D.com things digital dentistry (blog.structo3d.com).
36 ortho 2/2017 World’s Fastest Orthodontic Model 3D Printer
Ƶŝůƚ&Žƌ >ĂƌŐĞƐƚƵŝůĚsŽůƵŵĞ ϯϬŵŽĚĞůƐŝŶ KƌƚŚŽĚŽŶƟĐƐ /Ŷ/ƚƐĂƚĞŐŽƌLJ ϭ͘ϱŚŽƵƌƐ
dĞů нϲϱϲϱϭϰϳϯϯϮ ŵĂŝů ƐĂůĞƐΛƐƚƌƵĐƚŽϯĚ͘ĐŽŵ tĞď ǁǁǁ͘ƐƚƌƵĐƚŽϯĚ͘ĐŽŵ industry report training with RehaBite
Sensorimotor training with RehaBite during orthodontic treatment Author: Dr Daniel Hellmann, Germany
In daily practice, temporomandibular disorders Coordinative sensorimotor training (TMD) are usually treated with splints, such as with RehaBite Michigan splints, or similar devices. However, orthodontists have the problem that occlusal Numerous studies have stated that home exer- splints cannot be used in patients who are grow- cises can have an equally therapeutic effect like ing, or in patients undergoing therapy. In this regular occlusal splints (Michigan splints or sim- context, sensorimotor training is an effective ilar).5–7 Sensorimotor training with the RehaBite therapy for pain relief. Relieving postures caused device improves the neuromuscular adaptation by TMD pain can be eliminated without any in- by controlling the movement and positioning of fluence on the occlusion of the patient. Addition- the mandible. Increased strain of sensory feed- ally, neuromuscular adaptation will be supported back systems and the stimulation of central ner- actively using the RehaBite sensorimotor train- vous integration processes are triggered by sensori- ing appliance during orthodontic treatment. motor training. The coordinative training leads to long-lasting changes of the intra- and intermuscular recruitment pattern. In conjunction with the train- Motor adaptation and ing effect, it is assumed that coordinative training rehabilitation also causes structural modifications in specific cortical regions.8, 9 In patients with muscle pain, Healthy motion sequences can transform to re- the coordinative training can cause a hypalgesic lieving posture patterns1 due to musculoskeletal effect, that is a significant reduction of sensitivity pain, changing the intra- and intermuscular re- to pain (exercise-induced hypalgesia).10 cruitment patterns. This can cause stiffening of muscles, in conjunction with a reduced range of movement patterns. The stiffening process is a Practice of coordinative training natural response that provides temporary relief with RehaBite by splinting the painful areas. Longer periods of pain can lead to lasting restriction of the physio- RehaBite is a training device for home treatment logical range of movement. In the long term, such and rehabilitation of muscle pain of the mastica- relieving postures can trigger unphysiological tory system. The elastic, fluid-filled bite pads stress of the tissue involved. Modern therapeutic work in accordance with the hydrostatic princi- concepts use active rehabilitation measures to ple. In other words, the mandible can auto-balance improve motion patterns. Such actions can help itself11 on the fluid-filled bite pads like a see-saw to relieve painful adaptations triggered by coacti- (Fig. 1). The automatic, built-in feedback of the vation patterns of the muscle structures device provides the patient the ability to control involved.2–4 the intensity of her training, and makes it possible
38 ortho 2/2017 training with RehaBite industry report
Fig. 1
Fig. 2
Fig. 3 Fig. 4
for the patient to accurately and faithfully repro- Fig. 1 duce training conditions (Figs. 2 & 3). Biofeedback The mandible can auto-balance in combination with active training can intensify on the hydrostatic device like on a see-saw. motor learning processes.12 Spontaneous modi- fications of the intra- and intermuscular patterns Fig. 2 of contractions of the muscles involved and phys- How the RehaBite works. iological activation are frequent effects. Biting on the elastic bite fork In the case of painful muscular jaw opening applies an impact of force to the restrictions, the training is supplemented by in- liquid in the closed hydrostatic tensive stretching exercises (Fig. 4). By using the system. This force is transmitted to a mobile piston connected to a post-isometric relaxation that is the result of the mechanical spring. The piston coordinative bite, the stretching effect is increased moves up and down in front of further still. The training exercises can either be the handle. The tip of the piston can be felt with the fingertip at performed under the instruction of the treating the front of the handle. The doctor or physician, or the patient may also use the about RehaBite allows five levels of RehaBite device for individual training, regardless intensity, which can be adjusted with the integrated force control of time or place, and can be further supplemented screw at the front of the handle. by exercises like gentle muscle massages. Dr Daniel Hellmann Coordinative training for relieving TMD symp- is senior physician of the Fig. 3 Department of Prosthodontics, toms is very effective, and in some cases, neces- Bite training with finger University Hospital Würzburg, feedback. sary for patients undergoing orthodontic treat- Germany. ment. Home exercises like gentle massage and training tools such as RehaBite have shown sig- Pleicherwall 2 Fig. 4 nificant results by improving muscle coordina- 97070 Würzburg Finger and thump grip for Germany stretching muscles to treat tion and resolving relieving postures. functional restricted mouth Editorial note: A list of references is available from the publisher. [email protected] opening.
ortho 2/2017 39 manufacturer news coordinative training with RehaBite Coordinative training as a therapy for temporoman- dibular joint dysfunction syndrome
Numerous studies in recent decades have proven that home exercises for treating temporoman- dibular joint dysfunction syndrome have the same therapeutic effect as that of occlusal splints. Recent scientific studies have shown that the masticatory muscles can be trained very effec- tively, particularly with coordinative exercises at a submaximal force level. The coordinative train- According to clinical research by the Oral Physi- ing causes long-lasting changes in the functional ology and Experimental Biomechanics group at patterns of the muscles. Owing to this training Heidelberg University and the Karlsruhe Institute effect, specific cortical regions of the brain are of Technology in Germany, inter- and intramus- modified. The muscular adaptations induced by cular adaptions are considered to have a success- the training are an essential effect of successful ful effect on muscle pain. Exercises with kinematic muscle pain treatment. feedback and electromyographic force-controlled RehaBite is the first training device that allows bite exercises and coordinative home exercises force-controlled intra-oral coordinative training with and without technical support have a signif- under reproducible training conditions. This is icant effect in reducing muscle pain. achieved with the aid of a hydrostatic system, RehaBite is an innovative training device for comparable to balancing on a see-saw. Other ther- home treatment and rehabilitation of muscle pain apeutic effects of RehaBite include post-isometric in the masticatory system. relaxation (i.e. therapeutically effective relaxation The elastic glycerine-filled Dentrade International of the muscles after previous tension) and haptic bite fork is made of non- Monheimer Str. 13 50737 Cologne control that works like biofeedback (perception toxic flexible plastic ma- Germany of the muscle function through the finger feed- terial. A major break- back provided by the RehaBite device). Compara- through is the haptic force T +49 221 974 2834 F +49 221 974 2836 ble forms of all these elements can also be found control based on the hy- [email protected] in contemporary physiotherapeutic concepts. drostatic principle. www.rehabite.net
40 ortho 2/2017 register for
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ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. manufacturer news AcceleDent
Introducing AcceleDent Optima Introducing the AcceleDent App
AcceleDent Optima is the only orthodontic device that directly connects patients and practices with monitoring and direct messaging, via the state- of-the-art AcceleDent App. The HIPAA-compliant app allows patients to track their usage and set reminder notifications. Orthodontic practice staff can view this real- time compliance data on each of their AcceleDent Optima patients via a web portal that is custom- ised for each AcceleDent provider. This access to compliance data allows for more proactive case Introducing AcceleDent Optima management, including informed scheduling, and an overall increase in practice efficiency. The com- AcceleDent Optima is the most advanced accel- pliance data also enables clinical teams to compli- erated orthodontic device with a comprehensive ment patients who are excelling with compliance suite of technology-driven features. The only vibra- and to encourage low-compliance patients. tory orthodontic device cleared by the US Food and Drug Administration, AcceleDent Optima is powered by patented and clinically proven Soft- Pulse Technology, a cyclic force that has been shown clinically and in research to increase the rate of bone remodelling in orthodontic treat- ment compared with static forces. With AcceleDent, orthodontists report that they are expanding the range of patients they are clinically confident in treating. Difficult or com- plex movements can become easier to achieve in the planned amount of time. In addition to help- ing orthodontists achieve predictable clinical outcomes, AcceleDent has been clinically proven to safely and effectively speed up tooth move- ment by as much as 50 per cent while reducing orthodontic discomfort.
New features Offering AcceleDent Optima at your practice Designed with enhanced patient convenience in mind, Optima is a smaller, lighter device that is AcceleDent Optima and the AcceleDent App are waterproof and able to connect with smartphones designed to help your patients achieve the healthy, and tablets through Bluetooth connectivity. The beautiful smile they want faster while increasing device’s small charging case enables patients to predictability in clinical outcomes. wirelessly charge the activator, which has a bat- Orthodontists interested in learning more about tery life of five to seven days. To achieve acceler- AcceleDent Optima can visit www.AcceleDent.eu ated treatment, it is important for patients to use to view the clinical evidence and case studies or the device daily for 20 minutes. contact OrthoAccel directly.
42 ortho 2/2017 Ortho Rebels manufacturer news Ortho Rebels online shop: Great quality at low prices
For a long time, Ortho Rebels has proven that orthodontic prod- ·Metal brackets ucts do not have to be expensive, but rather of good quality. Plus, · Aesthetic brackets that it is possible to order orthodontic products easily and round · Buccal tubes the clock on its site has made the Ortho Rebels online shop one ·Wires of the leading suppliers of orthodontic products today. · Adhesives ·Elastics One of the most distinctive elements of its business is that Ortho · Springs & ligatures Rebels has cut prices, but not quality. For this reason, more and · Pliers & instruments more cost- and quality-conscious orthodontists trust its products and conveniently make purchases online. Order conveniently online In addition to the reasonably priced, high-quality orthodontic Why the company calls itself a rebel products on sale, excellent service is what sets Ortho Rebels Ortho Rebels protests against the trend towards expensive ortho- apart. A high level of service is provided by excellent contact dontic products. It does not literally take to the streets to do this, persons who eagerly help customers with questions about but metaphorically mans the barricades by offering all the products products and orders. Customers can contact the shop telephon- in its online shop at extremely cost-effective prices. ically during office hours and, of course, the online shop is open 24 hours a day, every day. Visit www.ortho-rebels.de to start Shop a comprehensive range exploring the new era of online shopping. In the Ortho Rebels online shop, the dental professional can find a complete range of orthodontic products, including the following:
Atua Bracket ProMIM Bracket Cu-Alloy NiTi t .JOJ#SBDLFU t 4FMG-JHBUJOH#SBDLFU t $POTJTUTPGOJDLFM UJUBOJVNBOEDPQQFS t 1)TUBJOMFTTTUFFMNBUFSJBM t 1)TUBJOMFTTTUFFMNBUFSJBM t5IFQFSGFDUXJSFGPSPVS1SP.*. t .*.DPOTUSVDUJPO t 'JOFTUQPXEFSQBSUJDMFUPFOTVSF #SBDLFUT t 3IPNCVTTIBQF BTNPPUITVSGBDFBOEMPXGSJDUJPO t $POUJOVPVTMJHIUBOEHFOUMFGPSDFT t"DDVSBUFBOETNPPUITMPU t/POEFGPSNBCMFTMPU t 3FEVDFTUIFGSFRVFODZPGDIBOHJOH t4FU )PPLTPOPS t4FU )PPLTPO UIFXJSFT t3PUIBOE.#5 PS t3PUIBOE.#5 PS t 4NPPUITVSGBDFMPXFSGSJDUJPO t.PSFSFTJTUBOUUPEFGPSNBUJPO UIBOPUIFSOJDLFMUJUBOJVNXJSFT The Online-Shop!
Ovoid Arch We Nature Arch fi ght for low prices at high D-Form Quality. Price From 9,- € Price Set of 20 89,- € 12,50 € 10 Pieces Set of 20 www.ortho-rebels.deortho 2/2017 43 meetings European Aligner Society
European Aligner Society making strides: From Vienna to Venice
Two years ago, the European Aligner Society treatments, temporary anchorage devices and (EAS) started on its path as a scientific society digital smile design. Drs Luis Carrière, Benedict whose aims are to provide information and edu- Wilmes, Junji Sugawara, John Morton and Christian cation on aligner therapy, a treatment modality Coachman, among others, have already confirmed in which there has been an incremental growth their participation as lecturers. in interest over the last decade among both cli- The special Breakfast with the Expert will be nicians and patients. held on Sunday morning to give every participant The first congress in Vienna in Austria, under the opportunity to have a peer-to-peer discus- former President Dr Graham Gardner, was a great sion with the best-known experts in the field of success in terms of the scientific programme, aligner orthodontics. A post-congress course on visitor attendance and exhibitor presence. It rep- digital smile design to be held by Coachman will resented our time point zero from where we be the real novelty of this congress. The entire started working on a common project with pas- day on 19 February will be dedicated to this revo- sion and enthusiasm. lutionary approach to aligner orthodontics. One of the goals set by the EAS board for the EAS recognises that the orthodontic aligner second EAS congress is to continue to build on industry and allied companies are crucial in help- our success in Vienna by maintaining the quality ing to identify EAS as a reference and the provider of the lectures, compiling a scientific programme of gold standard meetings for aligner orthodon- with the highest standards in orthodontic treat- tics so that excellence, best practice and research ment and beginning to work on research awards. can be enjoyed and shared not only by EAS mem- The congress, to be hosted by our new pres- bers but also by all event attendees. The society ident, Dr Francesco Garino, will take place in the works closely with companies that operate in the breath-taking surrounds of Venice in Italy from field of aligner therapy, from manufacture to 16 to 19 February 2018. The event is planned to digital integration and efficiency in aligner treat- provide the most complete scientific and clinical ment. EAS is therefore in a strong position to education to orthodontists providing aligner bridge the gap between clinicians and the latest therapy not only in Europe but throughout the products being developed by these companies. world. Our commitment is to provide compre- This symbiotic relationship results in up-to-date hensive information on aligner therapy and to knowledge creating a better patient experience provide clinicians with the tools to offer the best and improved treatment outcomes. treatment choices available. With the enchanting city of Venezia, this con- With this aim, the scientific programme fea- gress will provide an outstanding combination of tures many of the specialty’s most distinguished educational, social and recreational opportunities. lecturers. The two-day programme consists of EAS looks forward to welcoming you to Venice! pre-congress courses and workshops in a variety of fields related to aligner orthodontics. In the ple- DTI is the official partner of the EAS nary session, keynote speakers from both the aca- demic and the clinical fields will be giving presen- Dr Francesco Garino, EAS President 2018/2019 Dr Graham Gardner, EAS President 2016/2017 tations on several aligner systems. Topics will cover Dr Tommaso Castroflorio, scientific chairperson biomechanics, auxiliaries, hybrid treatments, teen of the second EAS congress
44 ortho 2/2017 International Magazines ortho international magazine of orthodontics
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EOS Congress made return to Switzerland
develop ments in the field. This year’s extensive programme was organised by 2017 EOS President, Professor Christos Katsaros and his team at the University of Bern. It focused on the alveolar envelope as the limit to orthodontic tooth move- ment and the different treat- ment strategies to ex pand the anatomical limits. In a special session pre- sented by the European Journal of Ortho dontics, Prof. Martyn Cobourne and orthodontic con- sultant Dr Padhraig Fleming, both from the UK, as well as Forsyth Institute researcher Dr Alpdoğan Kantarci, from the US, debated accelerating tooth Photo: EOS movement and its rationale and effect with moderator and jour- Idyllically situated between the blue waters of nal editor Prof. David Rice. Furthermore, presen- Lake Geneva, the majestic snow-covered Alps tations in the greater programme covered the and the Lavaux Vineyard Terraces UNESCO World latest research on a variety of other important Heritage Site, Montreux is considered by many topics. Keynote speakers, all experts in their re- to be one of Switzerland’s hidden gems. Every spective fields, critically analysed these subjects, year, this medieval city, which over the course of followed by short presentations of new research its history has attracted artists and poets, draws data. visitors from around the world, most prominently The main programme was complemented for the annual Montreux Jazz Festival in July. by a number of special meetings being held by From 5 to 10 of June this year, more than 2,100 orthodontic societies for students and teachers, dental professionals from 75 countries, enjoyed among others. In addition to the programme, everything that Montreux has to offer, during the attendees were able to see and experience the 93rd Congress of the European Orthodontic Society latest innovations from some of the largest man- (EOS), which took place at the Montreux Music ufacturers of orthodontic products, including and Convention Centre (2m2c). Align Technology and DW Lingual Systems. All This year’s edition marked the return of the in all, over 60 sponsors had their latest offerings prestigious event to Switzerland since the last on display. In the evenings, participants were congress in the country was hosted in Geneva in able to enjoy the best Montreux has to offer, 1983. Over the course of the next five days, it with a lake cruise and gala dinner at the world- brought together professionals from all over the famous Chillon Castle as the highlight of this globe to discuss the latest scientific and clinical year’s social programme.
46 ortho 2/2017
meetings events International Events
48th SIDO International Congress 2017 19–21 October 2017 Rome, Italy The European Damon Forum → www.sido.it/en 7–9 September 2017 Monaco NESO Annual Meeting → www.ormo.de 9–12 November 2017 Boston, US Swiss Society for Aligner Orthodontics SSAO → www.neso.org 9 September 2017 Zurich, Germany Journées de l’Orthodontie → www.aligner-ortho.ch 10–13 November 2017 Paris, France British Orthodontic Conference → www.journees-orthodontie.org 14–16 September 2017 Manchester, UK 34th Annual Meeting of the German Association → www.bos.org.uk of Oral Surgeons (BDO) 17–18 November 2017 Canadian Association of Orthodontists Berlin, Germany Annual Scientific Session → www.oralchirurgie.org 14–16 September 2017 Toronto, Canada GNYDM → www.cao-aco.org 24–29 November 2017 New York, US 2017 European Carriere Symposium → www.gnydm.com 14–16 September 2017 Barcelona, Spain ADF Paris → www.carrieresymposium.com 28 November–2 December 2017 Paris, France 2017 Asian Carriere Symposium → www.adf.asso.fr/en 27–28 September 2017 Tokyo, Japan → www.carrieresymposium.com 2018 SEDA Congress 6–7 October 2017 2nd Congress European Aligner Society Madrid, Spain 16–18 February 2018 → www.seda.es Venice, Italy → www.eas-aligners.com DGKFO Bonn 11–14 October 2017 26th Australian Orthodontic Congress Bonn, Germany 9–12 March 2018 → www.dgkfo2016.de/jahrestagung-2017 Sydney, Australia → www.aso2018sydney.com.au PCSO 81st Annual Session 12–15 October 2017 American Association of Orthodontists – AAO Reno, US 4–8 May 2018 → www.pcsortho.org Washington D.C., US → www.aaoinfo.org 76th Annual Meeting of the Japanese Orthodontic Society 94th Congress of the European Orthodontic Society – EOS 18–20 October 2017 17–21 June 2018 Sapporo, Japan Edinburgh, Scotland → www.jpao.jp/foreign/en/ → www.eos2018.com
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ortho 2/2017 49 about the publisher imprint
ortho international magazine of orthodontics
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50 ortho 2/2017 The new Ortho Kit Everything you need. Wherever you are. --> Ortho Pocket Set --> CS Ortho ultra soft --> CS 1009 single --> Ortho Wax
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This document is for reference of dental professional only. © 2017 Align Technology (BV). All Rights Reserved. Invisalign,® ClinCheck® and SmartTrack,® among others, are trademarks and/or service marks of Align Technology, Inc. or one of its subsidiaries or affi liated companies and may be registered in the U.S. and/or other countries. 202660 Rev A