Orthotown October 2016 - 43


Depending upon state laws, the clinical time required by the orthodontist
for indirect bonding is minimal. It's even possible to have multiple full-mouth
bonding procedures occurring at the same time.
In the 23 years that I've been using indirect bonding as my
preferred technique, I have rarely if ever had a case that did not
require some bracket repositioning during treatment. While
frustrating to say the least, there are new innovations that may turn
this disadvantage into a decided advantage for indirect bonding.

Virtual treatment planning
Current imaging, including CBCT and intraoral scanning, are
changing the indirect bonding from "static" to a virtual 3-D CAD
platform. Scanning technology that produces generic .STL files is
used to create printed models that are close to flawless.
As major orthodontic laboratories move their business models
toward a digital world, many now accept these .STL files and can
digitally print models to fabricate a variety of appliances. Indirect
bonding can be outsourced to some of these labs using a static
model and provide indirect bonding setups, much the way we've
been doing in-house for years. Orthodontists look at 3-D virtual
models and confirm the final placement of the brackets. Transfer
trays are fabricated and shipped to the office.
While this eliminates some of the errors associated with the
impressions, model preparation and tray fabrication, the key element
of examining the final tooth position after the teeth are aligned
with a straight wire is still missing.
More recently, proprietary software applications have been
introduced that allow visualization of tooth position after bracket
placement, simulating tooth movement achieved after placing a
straight wire (Figs. 1 and 2).
Elemetrix, Insignia, Orchestrate 3D and ArcadLab are just a
few proprietary systems that allow either brackets or teeth to be
repositioned digitally before visualizing the "final" results. Final
tooth position can be modified, which is then reversed back to the
initial bracket position in the CAD simulations. This provides a
more ideal setup from the start of treatment.

*

The simulations aren't completely realistic, primarily because
of the way torque is expressed in the final setup. Rotation,
leveling and arch-form simulation are much more reliable at
this stage of software development.
Over time, the software should improve so a dedicated staff member
can be trained to prepare digital setups to the point that the doctor
time required will be minimal. In addition, as 3-D printers continue
to drop in price, more orthodontists may choose to print indirect
bonding trays directly in their offices. This capability already exists
and the early adopters are working out the kinks for the rest of us.
The digital era of orthodontics is upon us and it may be time to
investigate these new technologies. It's worth taking a closer look. n

Share your thoughts online
Have you ventured into the world of indirect bonding, and
do you agree with our author? Sound off in the comments
of this article online: Head to orthotown.com/magazine.

Challenges and changes
*

*

There are some drawbacks to early adoption of this technology.
As with all new technology, there's a learning curve to
become efficient with the software. Most of what I've seen
isn't intuitive and doesn't provide a simplified workflow to
obtain the ideal setup. An average setup requires 10-30 minutes to finalize, which is all nonpatient time.
In addition, the patient's roots aren't visible-or the roots
shown are simulated ones that often don't match the
actual root position when compared to panoramic X-rays
or CBCTs.
orthotown.com \\ OCTOBER 2016

43


http://www.orthotown.com/magazine http://precisionplierservice.com http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown October 2016

Orthotown.com Highlights
Embrace Progress: What’s In Your Records?
New Products
Poll
Message Boards: HSD/Invisalign/Adult
Message Boards: Phase 1: Anterior Crossbite and Crowding
Interdisciplinary Ortho-Perio Treatment of Excessive Gingival Display
Creating a Strong Scheduling Architecture
Indirect Bonding: A Closer Look
Indirect Bonding: The Tech Effect
Welcome to Digital Orthodontics
Good Vibrations
Ad Index
Orthotown October 2016 - Cover1
Orthotown October 2016 - Cover2
Orthotown October 2016 - 1
Orthotown October 2016 - 2
Orthotown October 2016 - 3
Orthotown October 2016 - 4
Orthotown October 2016 - 5
Orthotown October 2016 - Orthotown.com Highlights
Orthotown October 2016 - 7
Orthotown October 2016 - Embrace Progress: What’s In Your Records?
Orthotown October 2016 - 9
Orthotown October 2016 - New Products
Orthotown October 2016 - 11
Orthotown October 2016 - Poll
Orthotown October 2016 - 13
Orthotown October 2016 - Message Boards: HSD/Invisalign/Adult
Orthotown October 2016 - 15
Orthotown October 2016 - 16
Orthotown October 2016 - 17
Orthotown October 2016 - Message Boards: Phase 1: Anterior Crossbite and Crowding
Orthotown October 2016 - 19
Orthotown October 2016 - 20
Orthotown October 2016 - 21
Orthotown October 2016 - 22
Orthotown October 2016 - 23
Orthotown October 2016 - 24
Orthotown October 2016 - 25
Orthotown October 2016 - 26
Orthotown October 2016 - 27
Orthotown October 2016 - Interdisciplinary Ortho-Perio Treatment of Excessive Gingival Display
Orthotown October 2016 - 29
Orthotown October 2016 - 30
Orthotown October 2016 - 31
Orthotown October 2016 - 32
Orthotown October 2016 - 33
Orthotown October 2016 - 34
Orthotown October 2016 - 35
Orthotown October 2016 - Creating a Strong Scheduling Architecture
Orthotown October 2016 - 37
Orthotown October 2016 - 38
Orthotown October 2016 - 39
Orthotown October 2016 - Indirect Bonding: A Closer Look
Orthotown October 2016 - 41
Orthotown October 2016 - 42
Orthotown October 2016 - 43
Orthotown October 2016 - Indirect Bonding: The Tech Effect
Orthotown October 2016 - 45
Orthotown October 2016 - 46
Orthotown October 2016 - 47
Orthotown October 2016 - 48
Orthotown October 2016 - 49
Orthotown October 2016 - Welcome to Digital Orthodontics
Orthotown October 2016 - 51
Orthotown October 2016 - 52
Orthotown October 2016 - 53
Orthotown October 2016 - Good Vibrations
Orthotown October 2016 - 55
Orthotown October 2016 - 56
Orthotown October 2016 - 57
Orthotown October 2016 - 58
Orthotown October 2016 - 59
Orthotown October 2016 - 60
Orthotown October 2016 - Cover4
Orthotown October 2016 - Ad Index
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