In-office Customized Brackets: Aligning with the Future.

Digital technology introduced many innovations in the field of dentistry and orthodontics in the last years. The most important advancement was the ability to digitize the oral cavity using intraoral scanners. CAD software have been around for decades, but only in the last twenty years started showing up in the field of dentistry and orthodontics. 3D printers are not new in the field of manufacturing. Nevertheless, their inclusion in the orthodontist armamentarium was made possible only the last few years, while new printing materials have been also invented, allowing the manufacturing of many appliances previously made using traditional laboratory procedures. Orthodontic treatment is mainly based on the use of fixed appliances. The vast majority of orthodontists use commercial straight-wire brackets while customized brackets are preferred mostly for lingual orthodontic treatment. New CAD software called Ubrackets allows the in-office designing and printing of customized brackets using hybrid ceramic crown resin or zirconia slurry. Some scientific studies have been conducted to investigate the bracket printing outcome in terms of mechanical properties. More studies must be performed to allow the inclusion of in-office designing and printing of customized brackets in the orthodontic armamentarium.

Directly Printed Aligner: Aligning with the Future.

Orthodontics stands on a junction where traditional analog appliance manufacturing slowly but steadily changes to a digital one with the use of 3D technology. The main cause of this shift was the invention and use of computers. The use of computers, computer-aided design (CAD) software, computerized machines, and newly invented materials allowed this change to occur in a relatively short time in dentistry and orthodontics. The trigger for this transformation is the ability to digitally scan the oral cavity. CAD software and 3D printers already existed. It took a few years to include this technology in orthodontics and continuously apply it in the orthodontic office. Orthodontic treatment is mainly based on the use of fixed appliances, while in the last years, thermoformed aligners have been introduced as an alternative whenever a more invisible treatment modality is preferred. Clear aligner treatment is performed using thermoformed aligner. A new aligner resin has been recently invented to allow direct aligner printing. Directly printed aligner possess many advantages compared to thermoformed one. Research has been initiated to investigate all the aspects of the workflow and aligner printing outcome. More studies must be performed to look into the various aspects of directly printed aligners.

In-house three-dimensional designing and printing customized brackets.

Digital technology is one of the major advancements during the past years that changed many aspects of our daily life. Medicine and dentistry were positively affected from the very first years of this digital evolution. Orthodontics is not an exception to this global digitization. Intraoral scanners, computer-aided design software, three-dimensional printers, and new materials were invented and introduced in dentistry and orthodontics during the last 20 years. The ability to include a small digital laboratory in the orthodontic office helped the creation of the in-house manufacturing concept. Continuously, the ability to design appliances that fit exactly to the teeth of the patient allowed the digital customization of almost every orthodontic appliance. Lately, the development of computer-aided design software called Ubrackets enabled the orthodontist to design and print customized orthodontic brackets in the orthodontic office. The designing workflow follows a specific protocol, which makes designing fast and easy. Three-dimensional printing of brackets can be performed using hybrid ceramic resin or zirconia slurry. Although some controversial studies exist, customized brackets have not been extensively studied despite that. A new term, "biological customization" is proposed, which takes into consideration the different biology of each patient, as opposed to teeth roots, bone turnover, and characteristics. Complete treatment customization should necessarily include mechanical and biological customization.

Digital assessment of direct and virtual indirect bonding of orthodontic brackets: A clinical prospective cross-sectional comparative investigation.

OBJECTIVE: The objective of this report is to use in orthodontic patients the methods of virtual indirect bonding and direct bonding using eye vision or loupes in order to compare their accuracy in the three dimensions of space. MATERIAL AND METHODS: Brackets were directly placed by one clinician to 18 patients with a total number of 298 permanent teeth. Then loupes were used to improve bracket positioning. Intraoral scanning of the dental arches was performed before bonding, after direct bonding and after the use of loupes. Subsequently, an orthodontic software was used to virtually indirectly bond the brackets on the first intraoral scanning taken before bonding. A three-dimensional mesh processing software was used to superimpose the three scans and to perform measurements in the mesio-distal and occlusal-gingival dimensions as well as in the mesio-distal angulation. RESULTS: Virtual indirect bonding was more accurate in bracket positioning compared to direct bonding by eye vision or using loupes in all teeth and most of the teeth groups measured. Specific teeth and locations in the dental arch areas exhibited more bonding inaccuracies in the two direct bonding groups as compared to virtual indirect bonding. The use of loupes did not significantly increase the bonding accuracy compared to direct vision. CONCLUSION: Indirect virtual bonding facilitated accurate bracket positioning compared to direct vision or with loupes direct bonding in the dimensions and angulation measured.