Authors: Dr. Werner Schupp,Dr. Julia Steinmaier (née Funke)Dr. Julia Haubrich
Introduction: Aligner therapy as an established treatment method
Aligners have established themselves as a minimally invasive, comfortable and precise orthodontic treatment method. Originally used primarily for adults, aligner therapy is also becoming increasingly important for children and adolescents. Modern orthodontic software enables detailed planning and precise implementation of tooth movements, but in many cases additional therapy phases are necessary to achieve the desired end result.
The digital workflow in aligner therapy
Advances in 3D technology make it possible to carry out the entire treatment process - from planning to the production of aligners - directly in the practice. The workflow comprises several steps:
1. Intraoral scanHigh-precision digital recording of the dental situation using modern scanners (e.g. Trios 3).
2. Digital processing of the scan dataOptimization of the scan quality and segmentation of the teeth.
3. Virtual treatment planningCreation of a digital setup with defined movement targets.
4. 3D printing of the modelsPreparation of the sequential models for aligner fabrication.
5. Aligner fabricationDeep-drawing of the aligners from high-quality plastics and subsequent finishing.
6. Insertion of the aligners and patient careChecking the tooth movements and adjusting the treatment.
Planning with the OnyxCeph³™ software
The software enables precise definition of tooth movements and the planning of attachments for improved force transmission. The strategic staging of the movement steps is particularly important to ensure optimal predictability of the tooth movements. There are two main approaches:
- One aligner per movement stepSmaller movement steps with fixed material thickness.
- Several aligners with different material thicknesses per stepLarger movements with gradually increasing force.
3D printing and aligner production
Once the digital planning has been completed, the models are printed using either resin or filament printers. Resin printers offer maximum precision, while filament printers are a cost-effective alternative. The aligners are then thermoformed from high-quality materials and customized.
Patient case: Digital planning and implementation
A 36-year-old female patient with severely crowded arches and crowding was treated with a fully digital in-office aligner therapy. After an initial scan, the virtual planning was created and the tooth movements defined. The treatment comprised 14 models with customized attachments and a combination of aligner changes and elastics. After 28 weeks, a stable Class I dentition with a physiological overbite was achieved.
Advantages of in-office aligner therapy
- Fast availability of the alignersespecially for ongoing adjustments (e.g. erupting teeth in children).
- Full control by the orthodontistwithout outsourcing to external service providers.
- Greater efficiency through precise digital planningwhich minimizes errors.
- Patient friendlinessas conventional impressions are no longer required and the splints can be customized.
Conclusion
Digitalization has revolutionized orthodontics. The in-office workflow for aligner therapy offers a fast, efficient and highly precise way to treat malocclusions. By using state-of-the-art software, 3D printing and individualized planning, tooth movements can be controlled and optimized in a more targeted manner.
Source:
Schupp, W., Funke, J., & Haubrich, J. (2020). Der digitale Workflow in der In-Office-Alignertherapie [Digital workflow of in-office treatment with aligners]. Information from Orthodontics & Orthodontics, 52(4), 289-300. https://doi.org/10.1055/a-1241-9967