By Kristin Hübner, DTI

From 24 to 26 February, the or-thodontic community will come together at the Association of Orthodontists (Singapore) Congress (AOSC) at Marina Bay Sands in Singapore. Dental Tribune had the opportunity to speak with AOSC Chairperson Dr Mohan about high-lights of this year’s programme and why he thinks it is important for specialist congresses to both look at successfully treated cases and discuss and learn from cases that have failed.

Dental Tribune: One objective of the AOS is to provide a lively platform for dental professionals throughout the world and to foster closer ties between them. How im-portant is the congress in achieving this aim?

Dr Mohan: In orthodontics today, there are many new trends, clinical developments and tech-niques to advance excellence in orthodontic practices. AOS, through our biennial conferences, aims to bring together world- famous researchers, academics and clinicians to provide attend-ees with the most updated review of the evidence base and clinical areas related to the specialty of orthodontics.

This is the fourth biennial meeting. What has changed over the years?

In the last four editions, we have seen a tremendous growth in the number of attendees from around the world, not just limited to the Asia-Pacifi c region. We also have an increased number of international orthodontic com-panies exhibiting at AOSC, es-pecially in the fi eld of digital imaging.

What is the theme of this year’s event and why was it chosen?

The theme “Achieving success: Overcoming challenges in ortho-dontics” was chosen because, be-sides seeing successfully treated cases, we feel we can also learn from seeing cases that have failed. Seeing such cases allows us to re-view our approach and adjust the treatment plan as we go along. Our speakers have been asked to especially highlight cases with poor outcomes for discussion.

How many visitors do you expect to attend the meeting?

We are expecting 550 attend-ees from across the region and almost all of the workshops are already sold out. Based on our current registration numbers, we have noticed an increase in the number of visitors from neigh-bouring countries Malaysia, the

Philippines and Vietnam and else-where, making AOSC 2017 a truly regional event.

From your perspective, what have been the most important develop-ments in orthodontics in Singapore and the Asia-Pacifi c region in re-cent years?

The most important develop-ments in orthodontics in recent years are the advancements in digital imaging and 3-D printing. Besides being crucial for ortho-dontic diagnosis and treatment planning, digital imaging and 3-D printing are essential tools that allow us to closely monitor treatment progress and outcome. With advancements in imaging and 3-D printing, we are able to improve the level of diagnosis, vary the treatment options and achieve more predictable treat-ment outcomes.

What are the key topics of the scientifi c programme?

It is diffi cult to pick a key topic, as all of our presenters are leaders in their respective fi elds and will be speaking on their specialty topics. For example, Dr Richard McLaughlin, the creator of the

MBT system, will be giving an overview on clinical orthodontics. Prof. Ravindra Nanda will speak on managing complex multidisci-plinary patients, which is becom-ing more relevant these days as we see more and more adult patients. A range of topics, including reten-tion, anterior open bite and clear aligner treatment, will also be cov-ered, providing all participants with the opportunity to focus on their chosen key topic.

What will be happening on the pre- and post-congress days?

The days before and after the event have traditionally been reserved for limited-attendance workshops at AOSC. This edition is no different. We have fi ve half-day workshops, which will cover topics such as how anchorage concepts with mini-screws can be implemented, how to incorporate

evidence into the daily practice and the biomechanical background of Invisalign (Align Technology).

There will also be an industry exhi-bition alongside the congress. With the event being held just before the 2017 International Dental Show,

can visitors look forward to trying out some exciting new orthodontic products?

Yes, we are excited to have in-creased our number of exhibitors by 15 per cent for this edition, bring-ing the total to 30 exhibitors re-presenting 77 brands. Products on display will cover both well-estab-lished brands, such as Invisalign and CEREC (Dentsply Sirona), and new brands and services, such as Dental Monitoring and JoyAligner (Bliva). There will also be a number of live demonstrations of products and software during the exhibition that visitors can look forward to.

Aside from the exhibition and the lectures, what networking events have you planned this year?

Our networking events are among the highlights of AOSC. This edition’s fully booked wel-come reception will be held at Aura, which sits on top of Singa-pore’s newest museum, the Na-tional Gallery. The location offers great views of Singapore’s skyline, while refl ecting Singapore’s his-tory, as the building in which the restaurant is housed is the former Supreme Court of Singapore.

The Gardens by the Bay Run will give participants another op-portunity to meet with their peers. I believe that the run is unique to our conference and exhibition. This edition’s two kilometres route will take participants along both the Marina Bay and the Gardens by the Bay before the conference begins on the second day.

Thank you very much for the inter-view.

ORTHO TRIBUNEThe World’s Orthodontic Newspaper · Asia Pacifi c Edition

“ We have seen a tremendous growth in the number of attendees”

An interview with Dr Mohanarajah s/o S. Senathirajah, Chairperson of the Association of Orthodontists (Singapore) Congress 2017

Published in Hong Kong www.dental-tribune.asia Vol. 15, No. 1+2

“We can also learn from seeing cases that have failed.”

Dr Mohan, Vice President of the Asso-ciation of Orthodontists (Singapore) and chairperson of the 2017 congress organising committee.

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© Koelnm

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18 Ortho Tribune Asia Pacifi c Edition | 1+2/2017ORTHO NEWS

Orthodontic supplies market: Report predicts highest growth rate in APBy DTI

PUNE, India: While North America and Europe are expected to have ac-counted for the largest share of the

regional segments in the global or-thodontic supplies market in 2016, the Asia-Pacifi c market is projected to register the highest growth rate over the next fi ve years, a new re-

port by market specialist Markets-andMarkets has found.

According to the research fi rm, the forces driving this de-

velopment are growing efforts to increase awareness of advanced orthodontic treatments in the re-gion and a very large patient pop-ulation with malocclusion and

jaw disorders. In addition, growth is being stimulated through in-creasing disposable income, cou-pled with a growing middle class and the stronger focus of global orthodontic and dental compa-nies on emerging Asia-Pacifi c countries.

Overall, the global orthodon-tic supplies market is expected to grow further at a compound an-nual growth rate of 8 per cent over the forecast period of 2016 to 2021 and is expected to reach US$4.71 billion by 2021.

Among the three major prod-uct categories, fi xed braces, re-movable braces and orthodontic adhesives, the fi xed braces seg-ment is expected to have gained the largest share in the global or-thodontic supplies market in 2016. According to the analysts, this is primarily attributed to the greater affordability (compared with re-movable braces) and increasing adoption of fi xed braces among adolescents.

According to the market review, the major competitors in the ortho-dontic supplies segment are 3M, Align Technology, Danaher Cor-poration, Henry Schein, Dentsply Sirona, American Orthodontics, Rocky Mountain Orthodontics, G&H Orthodontics, Dentaurum and TP Orthodontics.

The full report, titled Ortho-dontic Supplies Market by Remo-vable & Fixed Braces (Brackets (Self Ligating, Lingual, Metal, Ce-ramic, Aesthetic), Archwire (Nickel Titanium, Stainless Steel), Liga-ture (Elastomeric, Wire), Anchorage Appliances, Adhesives), Patient—Forecast to 2021, can be purchased from the MarketsandMarkets web-site.

[ Dates ]

[ Venue ][ Venue

[ Theme ]

[ U R L ]

The 65th Annual Meeting ofJapanese Association forDental Research

11/18 (Sat.) - 19 (Sun.) , 2017SHOWA UNIVERSITY, Tokyo, Japan Venue ]

Theme ]e ]e

SHOWA UNIVERSITY, Tokyo, JapanSHOWA UNIVERSITY, Tokyo, JapanForefront of Dental Science- Toward the Global Standard in Medical Science- Toward the Global Standard in Medical Science- Toward the Global Standard in Medical Science- Toward the Global Standard in Medical Science

http:/ / jadr65.umin.jp[ U RU RU R L ] http:/ / jadr65.umin.jphttp:/ / jadr65.umin.jp

[ Congress President ]

http:/ / jadr65.umin.jphttp:/ / jadr65.umin.jp

Congress President ] Ryutaro KamijoDepartment of Biochemistry, School of Dentistry, Showa University

TOKYO

TOKYO

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TOKYO [ Management Secretariat ][ Management Secretariat ]

[ Congress Secretariat ]

Japanese Association for Dental ResearchAcademic Square Co., LTD. 2-348-302, Ryogae-machi, Fushimi-ku, Kyoto 612-8082, JapanTEL: +81-75-468-8772 FAX: +81-75-468-8773 E-MAIL: jadr65@ac-square.co.jp

Department of Biochemistry, School of Dentistry, Showa University1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, JapanTEL: +81-3-3784-8163 FAX: +81-3-3784-5555

[ Dates ]

Dental Research

11/18 (

JADR 2017

AD

The fi xed braces segment is expected to have gained the largest share in the global orthodontic supplies market in 2016.

© Toey Toey/Shutterstock.com

19Ortho Tribune Asia Pacifi c Edition | 1+2/2017ORTHO NEWS

“ We need to update our knowledge on the various aligner systems available”

An interview with Dr Graham Gardner, President of the European Aligner Society

By Brendan Day, DTI

Since it was commercially intro-duced in 1999, aligner therapy has grown and developed substantially as an orthodontic treatment modal-ity. Dr Graham Gardner is the fi rst President of the European Aligner Society (EAS), an organisation dedi-cated to increasing education and research in aligner therapy. The in-augural EAS AlignerLab workshop will be held in Vienna in Austria on 18 February and aims to provide a hands-on learning experience for dental professionals interested in updating their knowledge of aligner treatment. Dental Tribune inter-viewed Gardner about the role of aligners in orthodontics and what the event organisers have in store.

Dental Tribune: What benefi ts do aligners offer over fi xed orthodon-tic appliances, and how have these developed since aligners were fi rst introduced?

Dr Gardner: In my opinion, the advantages of aligner therapy for the patient are:

1) They are more comfortable than fi xed appliances.

2) They are more aesthetic, and therefore less noticeable, com-pared with fi xed appliances. This is especially important for some-one seeking orthodontic treat-ment because he or she is al-ready concerned and self-con-scious about his or her teeth, as the last thing such a patient would then want is to draw at-tention to his or her teeth with fi xed appliances.

3) Improved maintenance of oral hygiene and no dietary restric-tions, as the aligners are re-moved for eating.

The advantages of aligner ther-apy for the orthodontist are:

1) Improved treatment planning capabilities owing to the 3-D treatment software. Virtual treatment planning allows one to evaluate different treatment options that, crucially, can be more clearly discussed with the patient owing to the virtual pres-entation process. In my opinion, this allows the patient to make a more informed decision on the treatment.

2) Broken brackets and emergen-cies are things of the past.

Additionally, a benefi t shared by both patient and clinician is that adjustment appointments are often quicker and certainly more comfortable for the patient com-pared with fi xed appliances.

What have the main impediments been to the adoption of aligners by dental professionals?

I think that, initially, aligners were basic and our knowledge on how to move teeth with plastic was limited. Hence, in the earlier years, only minor tooth movement could be predictably treated with align-ers, and this limited their use

and then restricted the number of practitioners prepared to use aligners. Combined with the fact that the practitioner now had to learn new software programmes and how to plan treatment on a computer—a vastly different skill to having the physical study model in one’s hands and brackets on teeth—one can see why the initial take-up was perhaps less than would have been expected.

The fi rst EAS AlignerLab is set to take place in Vienna in February. What prompted the EAS to hold this workshop, and what can partici-pants expect to gain from it?

We are excited about the fi rst AlignerLab. With the explosion in

the 3-D treatment planning and manufacturing processes now available, we at the EAS believe that not only do we need to update our knowledge on the various aligner systems available, we also need to understand the associated hardware, such as scanners, com-puters and 3-D printers, and soft-ware that is necessary to optimise the aligner system and improve treatment results. It is therefore our objective to bring these two areas together at one event with the AlignerLab.

This will allow attendees an opportunity to listen to world- famous clinicians on different systems, to compare these differ-ent aligner systems and to gain hands-on experience with the dif-ferent equipment associated with these systems.

We think it is a unique way to update our knowledge on aligner therapy, with a bonus opportunity to forge links with our colleagues across Europe.

Is the AlignerLab a one-off thing or is it intended to become a regular event?

We hope this will become a reg-ular event because tech nological developments and advances will continue. Thus, an event at which practitioners can both make direct comparisons and trial new sys-tems should become a popular and regular occurrence.

Dental Tribune thanks Dr Gardner for the interview.

Dr Graham Gardner at the fi rst EAS congress last year.

© European Aligner Society

By DTI

BRISBANE, Australia: The Australian Society of Orthodontists’ Foundation for Research and Education (ASOFRE) will play host to many of the special-ty’s leading fi gures on 3 and 4 March at its 2017 Foundation Meeting at the Hilton hotel in Brisbane. The organisers have warmly invited dental practitioners to attend the meeting, which has the theme of “Aesthetics and evidence” this year.

The foundation is the primary organisation for orthodontic re-search and education in Australia. It aims to foster a collaborative and sharing environment through its biennial Foundation Meetings and provides fi nancial and educational support to Australian universities,

students and researchers in the fi eld of orthodontics.

The event’s keynote speaker will be Prof. Henry Fields, the Vig/Williams Endowed Division Chair of Orthodontics at the Ohio State University’s College of Dentistry in the US. Fields’s talk will cover growth modifi cation, smile aes-thetics, and orthodontic surgical treatments. In addition, a number of Australian and international re-searchers will be conducting pres-entations throughout the two days of the meeting. Those speaking in-clude Dr Prashant Zaveri, Chairman of the Asian Pacifi c Foundation for Orthodontic Research and Education, and recipient of the Medal of the Order of Australia Dr John Fricker.

The Foundation Dinner on the evening of 3 March is sure to be a highlight, as it will take place in the riverside restaurant of Brisbane’s heritage-listed Customs House.Brisbane is set to host the Australian Society of Orthodontists’ Foundation for Research and Education’s 2017 Foundation Meeting.

© M

aythee Voran/Shutterstock.com

Organisers of ASOFRE 2017 invite orthodontists to Brisbane

20 Ortho Tribune Asia Pacifi c Edition | 1+2/2017ORTHO BUSINESS

3Shape and Ormco expand collaborationBy DTI

COPENHAGEN, Denmark: Danish dental manufacturer 3Shape has announced that its indirect bond-

ing solution, a function within the company’s orthodontic software, now integrates with the Damon System bracket library by Ormco Corporation. Consequently, users

are now able to digitally place the Damon brackets based on a vir-tual model produced by 3Shape’s TRIOS intra-oral scanner or con-ventional laboratory impressions.

“We are very excited to pro-vide orthodontists and labs with access to the Damon System bracket libraries. The integration gives professionals the advantage of a fully digital workfl ow to re-duce chair time and increase treatment effi ciency and patient comfort,” said Allan Junge Hyldal, Vice President of Orthodontics at 3Shape.

Owing to the simpler proce-dure, indirect bonding has proven to have multiple benefi ts for the patients compared with direct bonding, including reduced treat-ment and chair time, as well as less physical and mental stress.

The newly integrated Damon System bracket library joins more than 150 original bracket libraries and orthodontic solution provid-ers. “Ormco is pleased that doctors now have access to our advanced passive self-ligating metal and aesthetic brackets, including the improved Damon Clear2 bracket,” commented Ormco President Patrik Eriksson on the collabo-ration.

“With the increased demand for aesthetic and effective treat-ment solutions, Damon Clear2 enables 3Shape customers to ef-fi ciently treat all of their patients—including complex cases and mixed dentition—to an excep-tional result,” Eriksson said.

ADOrmco’s Insignia Advanced Smile Design already accepts TRIOS scans for treatment. With the integration of Ormco’s Damon System bracket library, the companies are expanding their collaboration.

© YURALAITS ALBERT/Shutterstock.com

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education.ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

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22 Ortho Tribune Asia Pacifi c Edition | 1+2/2017ORTHO TRENDS

Creative adjuncts for clear aligners to improve predictability

By Dr S. Jay Bowman, US

The concept of clear aligners has grown in leaps and bounds inter-nationally since the introduction of Invisalign (Align Technology) in 1999. In the 1940s, Dr Harold Kesling fi rst proposed the original theoretical basis for moving teeth with a series of retainers, but it took more than 50 years before computer technology made the idea workable.

Although some of the initial excitement attending the idea that all patients could be treated without metal fi xed orthodontic appliances wore off quickly, early adopters and innovators have

worked diligently to improve and enhance clear aligner methods. Limitations of clear aligner treat-ment simply required some time and experience to discover, but ultimately resulted in a series of articles quantifying issues often experienced clinically.1–16

As patients’ and practitioners’ desires for aesthetic alternatives to fi xed appliances continued to coalesce in the past decade, there have been a number of techno-logical and biomechanical ad-vancements that have led to an ever- increasing number of treat-ment application possibilities for aligners, including the expansion to treating teenagers.17, 18 In those

endeavours, a series of articles were published suggesting innovative treatment options with various ad-juncts to clear aligners,19–21 includ-ing Hu-Friedy’s Clear Collection instruments (Fig. 1).22–24

Clear CollectionAs understanding of some of

the limitations of clear aligner applications came to light, altera-tions to biomechanics, materials and treatment planning were in-troduced. The primary aims were to improve the predictability of specifi c tooth movements and to expand the scope of treatment to a wider variety of presenting malocclusions.

A set of instruments were cre-ated specifi cally for clear aligners in order to enhance, accent and increase the spectrum of appli-cability and acceptability of this form of aesthetic orthodontic treat-ment. The Clear Collection consists of four instruments designed to individualise aligners to address specifi c treatment needs.23–24

The Tear DropThe Tear Drop instrument is

used to add a notch or hook in the gingival margin of aligner plastic for the application of typical or-thodontic elastics.19–21, 23 The design of this cut-out is in the shape of a teardrop with the intent that the reservoir of the notch will keep an

elastic in place on the aligner (Figs. 2a–c). In this manner, the aligner with elastics can be inserted into the mouth, reducing the fumbling and diffi culty associated with at-tempting to put elastics into slits or notches after the aligner tray is already on the teeth. The Tear Drop cuts can be made anywhere along the aligner tray edges where elas-tics may be needed, such as inter- maxillary Class II, Class III or delta, or Class I intra-maxillary applica-tions, even involving the use of mini-screw anchors to support the elastic forces (Fig. 3).19, 21, 23

The Hole PunchThe Hole Punch instrument is

used to create a half-moon cut-out

Figs. 6a & b: Areas of gingival impingement or irritation from clear aligners can be cleared using the Hole Punch to remove plastic.—Figs. 7a & b: The Vertical instrument produces a shallow indent in the plastic to accent rotational couples on individual teeth.—Fig. 8: The indents from either the Vertical or the Horizontal pliers may be formed immediately adjacent to attachments to accent the contact point of plastic in the right angle between composite and tooth, with the intention of increasing the effectiveness of the attachment.—Figs. 9a & b: Adding root torque to specifi c teeth is enhanced by creating indents with the Horizontal pliers. The same tool may also be used to increase the retention of aligners or clear retainers.—Fig. 10: Aligner lag or loss of tracking is a common occurrence, especially for maxillary lateral incisors, the least predictable tooth movement. The air gap is a symptom of ill-fi tting aligners and may have a number of causes (e.g. poor compliance, insuffi cient space created for the tooth to follow and lack of surface area contact with plastic).

Fig. 1: The Hu-Friedy Clear Collection consists of four instruments: the Tear Drop, Hole Punch, Vertical and Horizontal.—Figs. 2a–c: The Tear Drop is designed to cut a teardrop-shaped notch in the margin of clear aligners to retain orthodontic elastics for various applications.—Fig. 3: Class II clear aligner treatment enhanced with Class II inter-maxillary elastics and Class I intra-maxillary elastics attached to mini-screw anchors to produce the intended vectors of force.—Figs. 4a & b: The Hole Punch is used to cut a half-moon of plastic at the aligner margin to clear the way for bonded buttons or brackets in order to connect orthodontic elastics or elastomeric chains.—Fig. 5: Seating elastics used to improve posterior intercuspation in fi nishing aligner treatment. The Hole Punch cleared plastic to permit bonding of buttons for the inter-maxillary box elastics.

1 2a 2b 2c

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6a 6b 7a 7b

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at the gingival margin of aligner plastic (Figs. 4a & b).19–21, 23 The in-tention is to relieve the plastic to permit the application of bonded buttons or brackets on specifi c teeth to support orthodontic elas-tics or chains. These cuts can be placed wherever needed along the aligners on either buccal or lingual surfaces. A common scenario would be punching holes in the buccal margin of plastic at the maxillary and mandibular fi rst molars and canines to bond buttons to sup-port seating or box elastics (Fig. 5)23 or cutting a half-moon on both the lingual surface of the maxillary fi rst molar and buccal surface of the mandibular fi rst molar to facil-itate the use of a through-the-bite cross-bite elastic.

In addition, the Hole Punch may be employed to simply clear plastic away from impinging gin-gival tissue anywhere along the aligners.23 The incisive papilla is a common location for this type of irritation that can be quickly resolved by clipping the plastic in that area for each tray in a series (Figs. 6a & b).

Individualising aligners with accent pliers

Two accent pliers round out the Clear Collection. These unique instruments were designed to enhance specifi c types of tooth movement by increasing plastic contact points in precise locations for individual teeth. The intent is to increase the predictability of tooth movements by creating shallow indents in the plastic to augment prescribed mechanical couples. Most importantly, these pliers are not heated. In addition, these indents may be produced to increase the retentiveness of align-ers or clear retainers in undercuts and at line angles.

The VerticalControlled rotations of teeth

are often diffi cult to achieve with aligners,20, 25–27 as the computer- generated prescribed movement may not be translated accurately to the tooth. The fi rst of the two ac-cent pliers is called the Vertical20, 24 and it is used to gently impress a vertical indent into the aligners in a specifi c location in the lingual and/or facial plastic for an individ-

ual tooth (Figs. 7a & b). Rotating maxillary lateral incisors and ca-nines are often sites of these types of problems.20, 25–27 As an example, the rotated lateral incisors in Class II Division 2 malocclusions are dif-fi cult to correct and typically require that overcorrection be designed into the aligners at the outset. If additional rotation is indicated, an indent can be placed in the plastic at the mesial line angle on the facial surface and the distal line angle on the lingual surface to create some extra force in the form of a rotational couple in a series of aligners.24 This may preclude the necessity of another round of refi nement appliances to achieve the intended goal. If a composite attachment is in place on a specifi c tooth, the Vertical can be used at the right-angle contact of the aligner and the composite to sharpen the contact point in that location for more effi cient transmission of force to the tooth (Fig. 8).

The HorizontalThe second accent instrument

is the Horizontal19–21, 24 and it is pri-marily used to produce an indent to affect a change in tooth root ro-tation or torque.18, 24, 28, 29 A horizon-tal impression into the plastic at the gingival margin of the aligners will emphasise the force applied to torque the roots of individual teeth (Fig. 9a). These horizontal indents can also be placed at the right-angle junction of a compos-ite attachment and the tooth to enhance the contact, thereby in-creasing the effectiveness of the intended tooth movement and re-ducing the risk of lag as the plastic may slip away. Another option is to place horizontal indents at the marginal undercuts of the crown of the teeth to increase the reten-tiveness of aligners or retainers (Fig. 9b).

Common applications: Beating aligner lag and bootstrap mechanics

Besides facilitating the typical addition of inter-maxillary elas-tics for a variety of anchorage supports for tooth movement or intention to alter dentoalveolar compensation (i.e. Class II, Class III,

resolving deep and open bites, ex-traction space closure, etc.19–24, 30–34), a common application for the Tear Drop and the Hole Punch is estab-lishing bootstrap mechanics.20, 23 For instance, a tooth or teeth may be lagging behind the prescribed movement, especially in terms of extrusion—the tooth may not be following along the projected path (Fig. 10). This may be due to in-adequate space created adjacent to each side of the tooth or lack of adequate contact on the tooth or attachment.

Initially, Chewies Aligner Tray Seaters20, 23, 35 (another of our crea-tions from our private practice; DENTSPLY Raintree Essix) are rou-tinely used at each new aligner to assist in seating them on to the teeth (Fig. 11a), along with instruc-tions to massage the trays into place (use fi ngers to push the trays on to the teeth as though attempt-ing to stretch them over attach-ments and undercuts for the fi rst few days). Despite those efforts, an air gap between the incisal edge of the teeth and the plastic may develop (Fig. 11b). It may be that inadequate space has been created prior to extrusion and the inter-proximal contacts thus cannot pass by each other (consider the widening taper towards the ante-rior incisal edges) and aligner lag or lack of tracking is the result.

In these instances or in antici-pation thereof, a bootstrap set-up is prepared.20, 23 This consists of placing bonded buttons on the lingual surface of the offending tooth near the gingival margin by creating clearance for the button in the aligner plastic with the Hole Punch (Figs. 12a & b). On the facial surface of the same tooth there are two options: another button and a hole punch (Fig. 12c). The Tear Drop is used to create two elastic notches at the mesial and distal gingival embrasure spaces (Fig. 12d). A small-diameter orthodontic elas-tic is then applied to either the teardrop notches or the button on the facial surface of the tooth and stretched over the occlusal surface of the aligner to the lingual but-ton. In this scenario, the elastic is intended to more predictably ex-trude the tooth into the aligner to the prescribed position.

Future view on alignersAs demand by patients for

more comfortable, hygienic and aesthetic treatments increases, the clear aligner market will re-spond with more advances and al-ternatives. In addition, orthodon-tists will learn to better push the envelope of applications by adding adjuncts to improve the effective-ness and ultimately the predicta-bility of treatments with aligners. Much like fi xed appliances, the ability to individualise, accent and enhance clear aligner biomechan-ics reduces the known limitations of aligners and the associated clin-ical frustrations of the orthodon-tist. Managing alterations of series of aligner trays in real time (in-cluding the use of a Clear Collection prescription form;24 Fig. 13) pro-vides increased fl exibility in the endeavour towards increased pre-dictability of aligner orthodontic outcomes.

More details on the Clear Collection, treatment applications, downloadable publications (in-cluding the Clear Collection pre-scription form) and a series of instructional videos can be found on the Hu-Friedy website.

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Figs. 11a & b: Chewies Aligner Tray Seaters were developed as a kind of mini-tooth positioner for patients to clench in specifi c sites to encourage trays to seat and reduce the development of aligner lag.—Figs. 12a–d: Bootstrap mechanics are designed to extrude individual teeth into clear aligners with orthodontic elastics. (a & b) The Hole Punch is used to cut out a half-moon clearance for a bonded button on the lingual surface of a selected tooth. (c) The Tear Drop is used to place two elastic notches in the facial margin of the aligner at both the mesial and distal gingival embrasures. An elastic is then stretched from the dual notches, over the aligner, to the lingual button to generate an extrusive force. (d) A second option is to cut a second half-moon in the facial surface, bond a labial button and place the elastic from the labial to lingual surfaces over the aligner.—Fig. 13: A Clear Collection prescription form is completed for each patient to indicate the instruments that will be required to customise each aligner in a series, along with the specifi c sites where they will be employed on each tooth.

Dr S. Jay Bowman is a diplomate of the Ameri-can Board of Or tho dontics and a member of the Edward H. Angle Society

of Orthodontists. At the Association of Orthodontists (Singapore) Congress, he will be presenting a lecture titled “Creative adjuncts for clear aligners: Improving the predictability of aligner treatments”, among others. He main-tains a private specialty orthodontic practice in Portage in Michigan in the US. He can be contacted at info@kalamazooorthodontics.com.

11a 11b

12d12c12b12a 13

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