Aligners are the latest tech in orthodontics, says DR K V Sujan Kumar
All glory comes from daring to begin – Eugene Fitch Ware
The reach of technological innovations continues to grow, changing all industries as it evolves. Technology should help us reduce our work, create ease at diagnosis, treatment planning, optimize systems, reduce human error, help in improving treatment outcomes, and help both patients and clinicians at the same time. When compared to other fields like aeronautics, automotive, IT, even medicine, dentistry appears to be a tad late in adopting technology on a widespread basis, maybe CAD-CAM or AI.
If other industries have adopted the latest technologies, why are we behind? Where does our profession stand and where are we going? Our education system didn’t have a syllabus designed in that aspect as well as we are confined in what we call a ‘comfort zone’. New age graduates are adopting technology to think ‘out of the box’ and apply the same in dentistry and in our context Orthodontics. As Dr. Vaid mentions, Aligners can definitely be called ‘The Emperor’s New Clothes’. Now it is up to the Orthodontists to decide whether to embrace the technology, accept the paradigm shift, or be ‘the latecomers’ of the profession. Though not much meta-analysis exists on Aligners, considering the hierarchy of research methodology, many users and companies have published the successful outcomes of aligner therapy and we would be interested in the former. As Dr. Sandra Tai mentions ‘it is important to understand that clear aligner treatment is a technique, not a product’, who else but an Orthodontist will be a master in aligners. However rapid technology may advance, the science of CAD-CAM may improve, AI be bettered, without the inputs of ‘The US’, Orthodontists, with his sound knowledge in biomechanics, understanding of biological limitations, simulating tooth movements in our minds, can dictate software’s what is to be done.
Fixed appliances give us the flexibility of planning, execution, and also the power to correct treatment in all the three planes of space, similarly aligners too give us the flexibility. Most importantly aligners can show us the end result, simulating movements to anticipate, warns us what to expect and how to be prepared for challenges. The appliance is still a novice with only a handful of clinical experts, so it’s time to learn from their mistakes, read the available literature, apply standard orthodontic principles, and start aligner cases.
Cases treated with aligners shows us that teeth can be moved in all three planes of space, with some movements easier and some difficult. In contrast to fixed appliances, intrusion, distalisation are easier than extrusion, but ultimately planning will help us to position teeth in their ideal positions. Though some problems in finishing are expected, like an open bite in posteriors due to prolonged use of aligners, residual spaces or spaces opening up, these can be counteracted by measures such as cutting off the portion distal to canines allowing settling of occlusion, incorporating C chain effect to prevent the opening of spaces, etc. Hands-on experience while doing cases will allow the orthodontist in us to innovate. The biggest problem still is patient compliance, we have come a full circle. (removable-fixed- removable)
Biomechanically fixed appliances move teeth by PUSH and PULL, while aligners only PUSH. Additional elements like TAD’s, Fixed Functional, Expanders, etc are used in fixed appliances, while some of them can be used with aligners too. Though the debate of whether or not to use attachments still exists, experience tells us that attachments not only helps in applying forces but also aid in retention. Furthermore, the aligners themselves can be deformed to apply necessary forces by special pliers making almost all types of treatments possible.
Incorporating aligners into our practice will open the option for a plethora of patients who otherwise wouldn’t have opted for orthodontic treatment due to their own social or psychological reasons. Current options of aligners might be a bit expensive when compared to orthodontic treatment with traditional braces, but advances in technology, competition amongst companies, local manufacturers will aid in reductions of prices. We all know that the Taj Mahal wouldn’t have been as beautiful as it is if costs and budget were considered when it was built. Innovation, comfort, technology all comes with a price. It is us, who has to leverage and use it to our advantage. With a greater number of cases being treated, more knowledge with respect to biomechanics is available to learn, unlearn, and relearn. In spite of all the advances and advantages of aligners, the fixed appliance is still the gold standard and will continue to be so. How orthodontics will be seen in another 20 or 50 years, the future has to decide. With companies approaching patients directly with DIY products, who but an orthodontist is the best to use aligners as a modality of treatment. It’s time to join the wagon and whoever jumps in first is at an advantage. Always remember ‘there is never a patient for an appliance but always an appliance for a patient’, aligners also should find a place in the armamentarium of every orthodontist along with the range of fixed appliances as they strike a fine balance between patient convenience and quality of treatment results.
Prof. Dr. K V Sujan Kumar MDS MNR Dental College and Hospital Sangareddy, Telangana.
Sai Yashoda Dental Clinic & Braceline Orthodontics, Madinaguda & Gachibowli, Hyderabad