Scanners and Digital Treatment [Planning]

Excerpt from Improve Your Smile, Transform Your Life:  A Guide to Orthodontics for Adults by Dr. Leslie Pitner, founding ELOS member.  You can get a copy at Amazon or Barnes & Noble. Use the following link:

One of my patients’ favorite innovations is the digital intraoral scanner because it eliminates the need to take those yucky, gooey impressions that taste foul and make people gag. That technology was straight out of the Middle Ages; yes, it worked well enough for the most part, but there were so many things that could go wrong with an old-fashioned impression. It was a fairly technique-sensitive thing, and some practitioners were better at it than others. Some were more likely to make patients gag than others. If it wasn’t done right, it made an inaccurate mold. And if it didn’t come out right the first time, there was no fixing it. You’d have to just start all over again and hope for the best; a depressingly primitive process.

The first digital scanners took about an hour and a half to make a scan, but the technology has raced ahead and now you can get a scan in two to ten minutes, depending on the level of precision required. As the patient, you’re lying back as a wand is waved over your teeth; pretty painless, and certainly a quantum leap beyond biting into a tray of goop. If any part of the scan isn’t usable, it takes moments to go back and rescan a particular area. The level of accuracy and detail on these scans, once they’re stitched together, is remarkable.

We can do a lot with one of these models: we can use it in digital treatment planning, “virtually” moving teeth to optimize the treatment plan, as well as to print out customized retainers or other appliances. We can experiment with different placements, installing virtual brackets and wires to see what will work best in treatment. It allows us a level of precision that just wasn’t possible before.

Depending on the software we’re using, we can incorporate X-rays and photographs of the teeth, or integrate a three-dimensional CT scan with the real 3D teeth so that we can see the whole picture. We’re seeing more of these smaller CT X-ray machines in orthodontic and oral surgeons’ offices. They’re less precise than those found in hospitals, but they also deliver a far lower dose of radiation. I don’t usually find them necessary in normal treatment planning in my own practice, but occasionally when surgery is required, they’re very helpful.


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If for instance, a tooth hasn’t come in properly and we’re wondering exactly where it is, a regular X-ray distorts our view into 2D and makes it difficult to be precise; when we have a CT scan, we can see exactly in three dimensions where the tooth is. While this level of detail isn’t required for most cases, it does help us to arrive at best-case treatment options for more complex cases.

Many companies are using virtual models to create precisely fitted braces, either with customized brackets and stock wires or by using stock brackets but customizing the wires. There are hybrid versions too; some lingual orthodontic systems now offer custom wires and custom brackets. All of these are designed to help create a greater level of precision.

Orthodontists without these tools can, if they’re good and detail-oriented, get you to a similar outcome, depending on the complexity of your case. But they’re not going to get there as directly; it’s going to require more trial and error and tweaking along the way. It’s a little bit like sailing: If someone is trying to travel in a specific direction, he might have to tack to the right to catch the wind, then tack left; back and forth and back and forth. Eventually, he’s going to get where he’s going, but not via a straight line. By contrast, digital treatment planning is like getting in a motor boat and going in a straight line.

It’s all proactive and preplanned. Biology is not always so predictable, and inevitably there are times that things don’t go exactly as we’d planned. But more often than not they do because we have the end in sight before we begin

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And progress continues: German engineers have actually built a robot that creates customized wires based on virtual models so that they fit a patient’s teeth perfectly and accomplish what that patient needs to be done. Not only that, but the robots can bend wires that humans can’t bend by shaping them under extreme heat during the manufacturing process. That lets us apply a light, continuous force with a customized fit that would have been nearly impossible to get before such technology existed.


To contact Dr. Leslie Pitner, a founding ELOS member, click here or roam our website for full information on all lingual brace technologies.


Scanners and Digital Treatment [Planning]

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