Digital bonding and in-house aligners

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Join me for a summary of Oliver Liebl’s lecture looking at digital orthodontics, through both digital indirect bonding and in-house aligners. The workflow Oliver described was through Onyxceph in a step by step process, however the modules used are similar to other available software modules.

Oliver described the ‘digital orthodontist’ who uses

1. Digital bracket positioning with Indirect Bonding Trays IDB
2. Finishing with in-house aligners

Digital bracket positioning

Advantages

• Automatic placement of different heights, MBT, Andrews etc
• Virtual simulation = visualise effects of changes

Digital model, AI segments dentition, but requires some manual adjustment for the Gingival, occlusal and lingual aspects

1. Bracket selection

• Bracket library of commercially available brackets

2. Bracket positioning

• Select placement philosophy – automatically place brackets, MBT, Andrews, Alexander
• Customise
  • Change bracket position
  • Change prescription
• Visualise changes with automatic alignment on 3D pane
• Select archform

3. Indirect bonding trays
   • Transfers virtual position through a 3D printed tray to the patient
     1. Change geometry of tray, thickness, cutting guide
     2. Values of the tray Oliver shared for the brackets he commonly uses – Experience SLB by GC
   • Active STL file export to 3D resin printer
     1. Resin – fits to each bracket system and printer, trial and error

4. Print IDB tray
   • Horizontal position
   • Remove IBT trays
   • Wash – isopropanol
   • Light cure – 50 minutes in glyceryl
   • Placement of brackets in tray
   • Use separator / releasing agent such as oven spray
   • Place bracket into IDB tray
5. Clinical steps
   • Etch, bond, conventional bonding
   • Use of acetone to remove finger prints on bracket base
   • Butter in adhesive to the mesh base
   • Light cure

Finishing with aligners

Virtual debonding, however not great results, better to debond and re-scan to plan

Aligner 3D module set up Onyxceph

• Modify tooth position
• Settling process – like a Hawley
  1. Leave small occlusal gap for posterior settling

Aligner attachment 3D

• Select any available shape
• Can add SARA wings, act as class 2 correctors, developed by Aladin Sabbagh

Staging of aligner movement

1. Parameters programmed per aligner
   1. Chose values which are predictable, depends on clinician and size of aligner

Print working model

1. Horizontal model 25 minutes or vertical 60-70 minutes
2. Wash residual resin
3. UV light

Trimline choice

1. Straight Vs scalloped
2. Prefer straight. Cowley 2012
   1. Less attachments
   2. Greater force delivery

• Greater predictability

GET ORTHODONTIC SYMPOSIUM SEPT 8-9/2023, Aligners, bracket or both

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