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Library of Congress Cataloging-in-Publication Data

Names: Breuning, K. Hero, editor. | Kau, Chung How, editor.
Title: Digital planning and custom orthodontic treatment / edited by K. Hero Breuning, Chung H. Kau.
Description: Hoboken, NJ : John Wiley & Sons Inc., 2017. | Includes index.
Identifiers: LCCN 2016053363| ISBN 9781119087779 (pbk.) | ISBN 9781119087786 (Adobe PDF) | ISBN 9781119087793 (ePub)
Subjects: | MESH: Dental Impression Technique–instrumentation | Cone-Beam Computed Tomography–methods | Radiography, Dental, Digital–instrumentation
Classification: LCC RK521 | NLM WU 25 | DDC 617.6/43–dc23 LC record available at https://lccn.loc.gov/2016053363

CONTENTS

List of Contributors

Preface

Acknowledgments

1 Documentation of the Dentition

Introduction
Digital workflow using intraoral scanners
Accuracy of digital dental models
Conclusion
References

2 Documentation of the Face

Introduction
Imaging of the skull in 3D
Discussion
References

3 Dynamic Motion Capture of the Mandible

Introduction
JMT system
CBCT
Preparation of the jaw tracking system
Tracking system
Data fusion
Segmentation of the mandible
Recording of mandibular movement by SiCAT JMT⁺
Merge of CBCT and JMT data in SiCAT suite
Discussion
Conclusion
References

4 Analysis of Digital Dental Documentation

Introduction
References

5 Orthodontic Treatment Planning

Introduction
The setup
Example of digital planning for a custom buccal brace (Insignia) system
Showing the setup to the patient, the dentist, and the maxillofacial surgeon
References

6 Custom Appliance Design

Introduction
Custom design of orthodontic appliances
Custom design of aligners
Virtual bracket placement of standard brackets
Fully customized orthodontic appliance systems
Custom design of orthodontic retention appliances
Conclusion
References

7 Custom Appliance Fabrication and Transfer

Introduction
Aligner fabrication
Custom orthodontic brackets and tubes
Custom wire fabrication
Fabrication of orthodontic transfer appliances
Transfer of custom fixed appliances to the dentition
The bonding procedure
Rebonding brackets and tubes
References

8 Monitoring of Tooth Movement

Introduction
Workflow for the dental monitoring system
Procedure for taking pictures
Dental monitoring alerts
Discussion
Conclusion
References

9 Custom Retention after Orthodontic Treatment

Introduction
Removable retainers
CAD/CAM retention wires
Fabrication of the retainer wire
Advantages of these CAD/CAM retainers
References

10 The Invisalign System

Introduction
Predictable performance of aligners
References

11 Custom Lingual Appliances

Part 1: The History of Incognito
Part 2: eBrace and eLock Lingual Appliances
Further reading for Parts 1 and 2
Part 3: Harmony Appliance Systems
References

Appendix

Index

EULA

List of Illustrations

Chapter 1

Figure 1.1 A dental model scanner.
Figure 1.2 The segmented dentition on a CBCT radiograph.
Figure 1.3 An intraoral scanner.
Figure 1.4 Scan of the occlusion.
Figure 1.5 A digital dental model scanned with a color scanner.
Figure 1.6 A intraoral scan in color.
Figure 1.7 Superposition of two digital dental models.

Chapter 2

Figure 2.1 Superimposition of a facial scan, an intraoral scan, and a CBCT.
Figure 2.2 A 2D, 3D radiographic machine which can also make a facial scan.
Figure 2.3 Slices of a CBCT used for evaluation.
Figure 2.4 Segmentation of the airway in a CBCT.
Figure 2.5 Facial photographs in 3D.
Figure 2.6 A CBCT with simulated movement of the mandible.
Figure 2.7 Superimposition of an intraoral scan and a CBCT.

Chapter 3

Figure 3.1 Preparation of jaw moving tracking; (a) FusionBite reference tray with impression material; (b) adapt T-attachment with auto-polymerizing composite to study model.
Figure 3.2 Merging of CBCT and JMT data; (a) choose 3 radiopaque markers on the FusionBite tray; (b) other radiopaque markers were found and the tray was located.
Figure 3.3 Segmentation of the mandible.
Figure 3.4 Tracing images in selected planes by JMT during (a) opening; (b) right lateral movement; (c) left lateral movement; and (d) protrusion.
Figure 3.5 Patient-specific visualization of mandibular opening movement: (a) condyle pathway; (b) incisor pathway.
Figure 3.6 Patient-specific visualization of mandibular lateral movement: (a) lateral right; (b) lateral left.

Chapter 4

Figure 4.1 Measurements on a digital dental model.
Figure 4.2 Matching of a digital dental model and a cephalogram.
Figure 4.3 A CBCT and a digital dental model before superimposition.
Figure 4.4 A virtual articulator for digital dental models.
Figure 4.5 A machine for capturing facial scans, facial motion, and sound.

Chapter 5

Figure 5.1 Segmented crowns of a digital model.
Figure 5.2 Setup of the segmented crowns.
Figure 5.3 Traditional setup of plaster crowns and wax.
Figure 5.4 A setup can be used for multidisciplinary treatment planning.
Figure 5.5 Outline of the alveolar bone for setup fabrication.
Figure 5.6 Segmentation line for dental crowns.
Figure 5.7 Occlusion planning for a setup.
Figure 5.8 Original maxillary arch and a setup.
Figure 5.9 The use of an OPT and a setup.
Figure 5.10 Evaluation of the smile line on facial photographs.
Figure 5.11 Evaluation of the dentition and the digital documentation.

Chapter 6

Figure 6.1 Design for three-dimensional printed bands.
Figure 6.2 Design for a printed Herbst appliance.
Figure 6.3 Design for a printed splint.
Figure 6.4 Design for a printed positioner.
Figure 6.5 Virtually placed buccal brackets.
Figure 6.6 Complete indirect bonding trays.
Figure 6.7 Segmented indirect bonding trays.
Figure 6.8 Design for a custom lingual bracket.

Chapter 7

Figure 7.1 Printing of dental models.
Figure 7.2 Printed dental models.
Figure 7.3 “Horseshoe” printed model with bar for aligner fabrication.
Figure 7.4 Example of a printed aligner.
Figure 7.5 Custom lingual brackets with casted or printed bracket base.
Figure 7.6 A customized lingual bracket system with computer bend wires.
Figure 7.7 Segmented indirect bonding tray for the mandibular arch.
Figure 7.8 Indirect bonding procedure: a dry field system.
Figure 7.9 Alternative dry field system.
Figure 7.10 Digital planning of bracket position.
Figure 7.11 Rebonding jig for lingual brackets.

Chapter 8

Figure 8.1 Analysis of a progress dental scan using the “clipping” function.
Figure 8.2 “Smile line” correction during treatment.
Figure 8.3 Evaluation of the tooth position on a cone beam computer tomography radiograph.
Figure 8.4 Superimposition of cone beam computer tomography radiograph's after jaw surgery.
Figure 8.5 Superimposition of facials scans with a “color distance map.”
Figure 8.6 Cheek retraction device with markers.
Figure 8.7 The “smartphone” used to make a series of pictures of the dentition.

Chapter 9

Figure 9.1 A Hawley removable retainer.
Figure 9.2 A mandibular repositioning appliance.
Figure 9.3 Registration of the occlusion can be used to prevent failures.
Figure 9.4 A custom-made retainer made from nitinol.
Figure 9.5 An indirect bonding jig made on a physical model.
Figure 9.6 Optimal fit of the lingual retainer.

Chapter 10

Figure 10.1 (a) In fixed appliance treatment the midline diastemas are most commonly closed with the aid of chain elastics. It may be presumed chain elastics pull too hard and too fast to create the red Christmas ball effect; (b) and (c) In contrast, aligner treatment with its programmed light force application allows remodeling of gingival tissues and prevents bunching.
Figure 10.2 (a and b) Effects of aligner treatment on periodontal health and enamel white spot lesions are superior to what is seen in patients wearing fixed appliances. Source: [3]. Reproduced with permission of JCO.
Figure 10.3 Incisal edge caries not seen until the introduction of aligner treatment, may be attributed to lack of brushing after consumption of sugar-laden beverages.
Figure 10.4 Pressure indicator paste discloses the aligner contact points.
Figure 10.5 (a and b) The corrugation in paper or plastic stiffens the material.
Figure 10.6 The ill-fitting aligner is more likely to create or compound a problem by applying pressure to unwanted areas of the teeth than do good.
Figure 10.7 (a–c) Segmental mechanics to move the lateral tooth requires full “cupping” of the tooth with no distractions. In ClinCheck only one tooth should be moved at a time until space is closed and all roots are parallel.
Figure 10.8 (a and b) In premolar extraction cases, as incisors are retracted the aligner length decreases. In turn, pressure is applied to the molars no different than a stretched rubber band; it pulls from both ends. In the absence of measures to prevent unwanted molar movements, these teeth tip uncontrollably.
Figure 10.9 (a–j) Second premolars are extracted. As the molars are moved mesially, they tip. Root uprighting with segmental fixed appliances is necessary. Once the roots at the extraction site are parallel or overcorrected, treatment is finished with aligners.
Figure 10.10 (a–h) In this four 1st premolar extraction case, long and prominent attachments are used to “prevent” tipping. Note the parallelism of the roots as the space is closed. The need for segmental fixed appliances to be parallel to the roots is removed.
Figure 10.11 The prominent attachments simultaneously aid in extrusion and torqueing of the posterior teeth.
Figure 10.12 (a–k) Radiological images suggest no excess vertical dimension. Thus, the open bite must be corrected by pure extrusion of upper incisors. Long prominent rectangular attachments enable the aligner to snap on and pull the teeth with the aid of vertical elastics.
Figure 10.13 (a–d) Extrusion of maxillary laterals can be unpredictable. Certainly, retention can be disappointing. Fixed retention helps. In this case the right lateral did not erupt. Application of vertical elastics clearly helped, but subsequently the retention check came with a disappointment. Patient did not agree to a fixed retainer.

Chapter 11

Figure 11.1 Design of occlusal rests for premolars and molars.
Figure 11.2 Design of the eBrace III brackets.
Figure 11.3 A horizontal and vertical position of the slot can be selected.
Figure 11.4 Design of self-ligating lingual eLock II brackets.
Figure 11.5 A second bracket will be placed for finishing treatment.
Figure 11.6 A combined mesh pad to improve the stability of the dentition.
Figure 11.7 The contact points of the molars normally will not be included.
Figure 11.8 (a–c) The design of the brackets will reduce tongue irritation.
Figure 11.9 Buccal tubes for molars can be ordered.
Figure 11.10 For the upper and lower incisors a self-ligation slot can be used.
Figure 11.11 The custom wires will usually have only horizontal corrections.
Figure 11.12 Rebonding jigs for the lingual custom brackets.
Figure 11.13 Design of custom bonding pads.
Figure 11.14 Occlusal bonding pads, for stability and bite raising.
Figure 11.15 Design of rebonding jigs.
Figure 11.16 Forsus spring in combination with Harmony.
Figure 11.17 Design for custom lingual wires.

List of Contributors

K. Hero Breuning DDS, PhD

K. Hero Breuning studied dentistry and orthodontics at the University of Utrecht, the Netherlands and started a private orthodontic office in Tiel, the Netherlands. He worked closely together with maxillofacial surgeons and finished his PhD study on intraoral mandibular distraction at the Free University in Amsterdam. He was an assistant professor of 3D imaging at the Radboud University in Nijmegen, department of Orthodontics and Craniofacial Biology. He has published over 60 journal articles, lectured at major orthodontic meetings, and presented courses on various topics in 16 countries. He is a reviewer for several orthodontic journals. Currently he is a lecturer, researcher, consultant, and trainer in orthodontic offices. He loves his wife, children, and grandchildren and likes art, playing golf, skiing, and sailing.

Shushu He BDS, DDS, PhD

Shushu He studied at the West China School of Stomatology, Sichuan University, China and followed the Postgraduate program in Orthodontics at the Sichuan University, China. She was awarded as an Outstanding dental student and PhD student of Sichuan University and she was a visiting scholar at the University of Alabama at Birmingham, Alabama, USA. Currently she is a lecturer, at the State Key Laboratory of Oral Disease, Department of Orthodontics, West China School of Stomatology, Sichuan University, China. Shushu published several articles in peer-reviewed journals.

Chung H. Kau BDS, MScD, MBA, PhD, MOrth, FAMS, FDSGlas, FFD (Ortho), FDSEdin, FAMS, FICD

Chung H. Kau is Chairman and Professor at the Department of Orthodontics, University of Alabama at Birmingham, Alabama, USA. He is a Diplomate of the American Board of Orthodontics and enjoys practicing clinical orthodontics. He has a keen interest in three-dimensional and translational research. At present he is Principal Investigator on a number of grants and has a research involvement in excess of $3.2 million dollars. He actively contributes and publishes in the orthodontic literature and has over 300 peer-reviewed publications, conference papers, and lectures. He was also made the King James IV Professor by the Royal College of Surgeons in Edinburgh in 2011.

Thomas W. rtendahl DDS

Thomas W. rtendahl is a member of the Swedish Orthodontic Society, European Society, American Lingual Orthodontic Society, and the World Society of Lingual Orthodontics. He finished his dental training in 1983 at the University of Gothenburg, Sweden. In 1987, he finished his PhD studies and started his orthodontic training, which he completed in 1991. Since 1997, he has lectured worldwide on topics such as Esthetic Orthodontic treatment. He was a clinical instructor at the University of Gothenburg for 10 years. Dr. rtendahl is co-author of the book Lingual and Esthetic Orthodontics (Quintessence Publishing, 2011) and is an adviser of several R & D departments. He is the head Orthodontist at the Smile Group, Mölndal, Sweden.

Philippe Salah PhD

Philippe Salah graduated from École Polytechnique, Palaiseau, France with a PhD in Biophysics, and made orthodontics his favored research subject early in his career. In 2007, he co-founded the Harmony system, the first fully customized self-ligating lingual solution. Acquired in 2011 by American Orthodontics, Harmony experienced remarkable international growth. In 2013, animated by a passion for optimization and deep learning algorithms, he founded Dental Monitoring with a team of doctors, researchers, and engineers. Dental Monitoring is the world's first web and mobile application designed for self-monitoring dental treatment. It provides doctors with a live vision of their patient's treatment evolution that includes a very accurate 3D positioning of the teeth and effective communication and encouragement tools.

Orhan Tuncay DMD

Philadelphia orthodontist Orhan Tuncay is an icon in the world of orthodontics. His academic career as an orthodontist is distinguished by his many contributions, innovations, and advances in the field of orthodontics. He has served as a department chairman for over 30 years and educated hundreds of orthodontists in the USA and abroad. His career started in the Department of Biochemistry at the University of Pennsylvania School of Dental Medicine. Subsequently, he received his orthodontic training at the same institution. He is known for his work on the biology of tooth movement, meta analyses, facial aesthetics, and 3D imaging and animation of the human face. He holds patents for his innovations in the field of 3D imaging. He has held innumerable official positions as an orthodontist in both scientific and professional organizations including: Chairman of the Council on Scientific Affairs of the American Association of Orthodontists, President of Greater Philadelphia Society of Orthodontists, and President of Craniofacial Biology Group of International & American Association for Dental Research. His textbook The Invisalign® System (Quintessence Publishing, 2006) is the first textbook in the world on Invisalign. Additionally, he is the founding editor of four international journals.

Neil Warshawsky DDS, MS

Neil Warshawsky is the founder and owner of Get It Straight Orthodontics, a leading orthodontic network in the Chicago area. A double board certified orthodontic specialist since 1992, he has over 23 years of experience with cleft palate and craniofacial cases. Currently, he is an Associate Professor of Surgery at the University of Illinois Craniofacial Center. In his private practice, he concentrates on esthetics and is one of largest volume users of Incognito^™ lingual braces in the USA. He teaches advanced mechanical courses for 3M Oral Healthcare in North America as well as hands-on courses for Dentsply Raintree Essix around the world on Essix appliance fabrication and design. When he is not at work, he is an assistant scoutmaster for his sons' boy scout troop, at home with his high-school sweetheart, fishing at the family cabin with one of their three kids, or just out for a run.