Customized Orthodontic Appliances: Theory, Design, Application

Edited by Nearchos C. Panayi, DDS, DOrtho, MOrtho • 2021, Quintessence Publishing • www.quintpub.com

Dr. Nearchos C. Panayi — a practicing orthodontist in Cyprus and a PhD candidate at Athens Medical School —  has assembled 21 other knowledgeable professionals to take readers through a multitude of digital transformations in orthodontics. Many of the changes from analog techniques to digital are still inchoate and not quite ready for universal adoption, while others are presently available and adaptable for clinical use.

In his introductory first chapter, Dr. Rafi Romano differentiates “Design It Yourself Orthodontics” from the common understanding of “Do It Yourself Orthodontics,” often found online or in shopping-center kiosks. Furthermore, he wisely reminds us that digital technology can only serve as an assistant, not the master, in orthodontic therapy.

This multi-author tome provides each chapter with a separate subject that could itself evolve into a book. Still, each chapter dedicates itself to the eventual development of a self-sufficient digital orthodontic clinic.

The first section regards 3D technology in orthodontics and covers such topics as CBCT in orthodontics and surface scanning, which offers information about the various types of scanners and manufacturers, and how those scanners perform. Additive Manufacturing (AM) contrasts these methods to conventional subtractive manufacturing such as drilling, cutting, and milling. These AM technologies have been used to print dental casts, indirect bonding trays, aligners, occlusal splints, brackets, etc. The final chapter of the first section describes the Orthodontic Office Digital Workflow, which converts the binary code of digitization into physical forms or what the author calls “undigitization.” The digital needs of this visionary new clinic will clearly need an abundance of expensive and cognitive-challenging equipment, which other sections cover in detail.

The second section deals with 3D Applications in Orthodontics, which is a primer on in-house custom appliance design that displays some astonishing appliances now printable with 3D printers, almost all of which require a specialized laboratory. A further chapter in this section focuses on custom appliance design using dedicated orthodontic software. It describes the various computer-aided design (CAD) software and follows through with examples best made in commercial labs. One such example is in-house customized orthodontic brackets: Ubracket software, which uses dedicated software ostensibly to produce complete customized brackets, has settled now for customizing the bracket bases to have the required 1st-, 2nd-, and 3rd-order movements built in via the amount of adhesive paste needed for each bracket, while using commercially available brackets. This technique, of course, relies on an indirect bonding technique.

The in-house customized lingual orthodontic appliances, which take up many pages of this volume, devotes an entire chapter to it. One useful suggestion is the use of a hybrid technique that uses brackets and wires to gain the space needed for complex tooth movements and then changes to an aligner to refine the treatment.

In-house clear aligners as described here should behave similarly to wires and brackets, but to this reviewer, that seems fantastically unrealistic. Still, the author gives some important reasons so many have endorsed this latter day-armamentarium: “Aligner treatment entails fewer visits, reduced chair time, and fewer emergencies, hence less contact with the patient.”

In-house digital indirect bonding covers the history and evolution of indirect bonding while displaying how digital solutions attempt to make this more accurate and predictable.

In-house orthognathic surgical splints reveals how digital solutions can improve the production of these guides. The in-house orthodontic archwire-bending robots section reviews only two recent ones: the LAMDA system, which offers only 1st-order bends, and the even more recent Verdopplerbot™ system, which bends wires in three planes of space much like the SureSmile^® 3D robot active for the past 23 years — nothing new here.

The final chapter on artificial intelligence and machine learning in orthodontics is the most speculative since so much depends upon a systemic collection of “big data,” which no organization or university system has to my knowledge yet started.

This Quintessence publication retains all of the important features we expect —  i.e., remarkable illustrations, thick, slick pages, exhaustive bibliographies, and careful attention to page design — in short, reader-friendly format. Clearly, the described digital transformation has by now violated some of the precepts of disruptive technology: It will neither be inexpensive nor much of it be easily learned and implemented, but this is direction we are going, and this book will be a helpful companion on the trip.

Review by Dr. Larry White.