Discussion in 'sirona, implant planning, ortho, other software' started by denticious, Mar 23, 2015.
This is haw you need to do the cuting.
Yan, why must the highest part of the gum be included? I find that gets in the way when thermoforming.
Expect another big player in this game very soon.. blue sky bio has an ortho ware coming out soon and if it follows their model of the planning software, this could be huge.
exocad as well! Countdown in.....10,9,8,7,6........
I do use Maestro software with a Shining 3 D Scanner and never had any issues
Im using maestro3d scanner with dental studio 4.
For sum reason I am an able to scan the upper model in accurate with 2 axis.
Im getting all time message that the model moved.
My scanner is calibrated.
And i started to think that model with base is to heavy for the scanner.
Maybe accurate 2a mode is fo small things.
And not for full model ?
In default 2a there is no problem.
It is only need to be lower then the highest point.
Does anyone here already used Orchestrate software for aligners? Is Maestro better?
I am the co-founder for ArcadLab Digital solutions.
We have developed and produced thousands of virtual setups using our Digital Indirect Bonding module. This year we have launched our Aligner Module. Our approach is a bit different, as we do not license the software. We provide the services of creating the setups and with that comes the option for the clinician to make adjustments as needed using our Arcad VSi software. We have two options. We can generate the setup and manufacture the aligners or we can generate the setup and allow a free export of STL files option for you manufacture the aligner in house.
Visit www.arcadlab.com for more info
www.arcadlab.com looks interesting.
What do you charge by case if you create the setups and send me the stl files to print the models in my clinic?
Hello Dr. Sitnov,
Please contact us directly to discuss pricing. We have several options to meet different markets.
My contact email is firstname.lastname@example.org
Tel. +1 201-315-8435
We can also setup a web demo at your time convenience.
I would like to discuss with you one problem that bothers me since the time I began my aligner practice: the anatomy of movement of frontal teeth in anterior-posterior direction using clear aligners. When watching the most part the virtual setups made for Invisalign or another big aligner manufacturers, I have a feeling that the teeth are being moved bodily in the A-P direction, the root shifts by the same amount as that of the crown. At the beginning of my practice, I did the same, with the result that I had to make few additional aligners to complete almost every case.
It is clear that the most part of the force coming from the aligner is transferred to the insicial edge area, which leads to uncontrolled tipping. Finding the correct center of rotation is the biggest problem. The more precisely we define, the more predictable will be the treatment.
In the study conducted by Carl T. Drake at al. in 2012, that's how they describe the location of rotation center:
"The center of rotation, on average, was located a distance of 41% of the root length apical to the faciolingual crestal bone"
The method of research was the imposition of CT scans before and after the study. The study involved 51 individuals.
In a new study published in the journal Korean J Orthod 2015 [45 (6): 275-281] 32 patients took part. The conclusion is:
"This study showed a relatively large amount of crown movement (~2.5 mm) but a relatively small amount of root movement (~0.4 mm). These results indicate that clear aligners cannot achieve bodily movement, explaining the poorer treatment quality and easier relapse than with fixed appliance therapy. The clear aligners mostly moved the teeth by tilting motion"
So this is 6,25:1 ratio of incisal edge to the apex.
There are many factors that affect this ratio: the length of the clinical crowns and roots, the plastic material which the aligner is made of, trimming line etc. From the moment when I started to set the center of rotation of incisors in the middle of the root length and stopped to move the teeth bodily, the predictability of my setups significantly increased. I do a CT to all my patients, so I know the exact length and the anatomy of the roots of teeth. I use Zendura plastic, which I cut off at 2-5 mm above the gingival zenith.
Invisalign invented Power Ridges for the possibility of developing torque and translation movements of the frontal teeth. But I have not found any researches confirming that it works the way it's designed to. Maestro Dental Studio also has the same option called "negative attachments", so that I will probably make some experiments on the patietns of mine.
Share your experience with me - whether you move teeth just with pure translational movements, or provide uncontrolled tipping? Where do you set the center of rotation?
P.S. If anyone interested, I can make a big post about my new discoveries in the field of providing vertical movements of the teeth with clear aligners only, without using any auxillaries. Or maybe someone is interested in any another aspects of working with aligners. Since 2013 I've made 6000+ photos from start to finish of my aligner patients, so that I have many interesting things to show and to tell. Ask me here or via my email email@example.com
I am interested.
With the newer version of Planmeca's branded version of Maestro3d it is possible to import CBCT data to align software to long axis of teeth and see the actual length. This will be helpful to get the exact center of rotation for each individual tooth.
I put the center of rotation approximately 2mm apical of clinical crown. I only have four patients that I am working with. They are my first four cases. I will post results when I have finished the cases. We have been documenting the stages. 3 cases are just aligners and one we started with an arch spreader(thanks Terry). I am not ortho trained, but I am working with a GP that does ortho and I have an Orthodontist mentoring me as well. Mainly these aligner cases will be used to make minor corrections for C & B aesthetic cases prior to preparation.
Almine, have you experimented with over extruding a tooth to get the gingival architecture correct with the adjacent teeth and then intruding to get the position correct? Is this possible or will the bone keep following the established cemento enamel junction?
After updating to the new version of Dental Studio I also got this option, but I did not find out how to convert my DICOM data from Galileos CT to stl. I tried to do it with the Slicer but have failed. Will definetely try again later.
Usually the things you are saying are impossible due to many reasons. Bone production is a limited thing and ginival line does not follow the teeth shape if you move it beyond the limits. With this particular case, look at the initial photo of this patient. No way to make the same gingival shape for the central incisors without surgery.
Long before these publications, the research group led by Charles Burstone and Birte Melsen have done excellent studies regarding the Biomechanics of tooth movements. All those studies are the backbone of the whole rationale behind segmented arch technique and a must read for every aspiring orthodontist.
I absolutely agree that "biomechanically" speaking we can only have a "controlled tipping" movement with aligners. During virtual setups tipping is way more attainable than translation or torque (almost an unknown word for aligners). For this precise reason, I always set Maestro virtual setup planning for rotation center 3-4 mm apical to the cemento enamel junction (I don't know why but my software doesn't allow to displace it more apical then that) and reshape the length of the roots (just using common sense, since I do not possess scan data)
Power ridges is something I have been trying to emulate with the hot termoforming pliers like the ones seen in the picture below. It only takes a few seconds to create a ridge formed out of many consecutive pinches on the same line. Unfortunately I haven't found any remarkable improvements using such ridges.
It would be extremely interesting if you could share your cases in this forum. As far as my experience is concerned, the main problem I've had with the aligners patients is longterm stability, this is especially true when rotations are present in the beginning of treatment and because Italian patients have a natural tendency to be very undisciplined, even if their only duty is towear a nightime retainer after the active treatment phase is over. I must say that only 0,5% of my patients used to be treated with aligners until i started to do them by myself. The number now is rapidly growing.
Thank you so much, I will try to find those studies.
I will attempt to make the posting during the upcoming week. I bond fixed SS retainers to ALL of my patients and give them removable night-wear retention splints made of duran 1.0 as well. Treatment with clear algierns is always a compromise and very frequently we create a sagittal gap caused by ipr by the end of the treatment, so that I always tell to my patients that they need a life-long retention. My percentage of the adult orthodontic patients is like: 35% aligners / 15% WIN brackents / 5% STb brackets / 45% Alexander and Damon systems. I also use Maestro Dental Studio for the bracket positioning on a virtual setup and print individual bonding trays.
P.S. In which part of Italy is your office situated?
I used to bond retainers and make annual controls to all my patients too. Once I had a patient who accidentally modified the splinted retainer biting something. Thus the retainer became actively torquing the lower lateral incisor root and I had to bond brackets and make a new fixed therapy for free. From that moment on, I prefer to "transfer" the responsibility of results to the patient TELLING THEM EVEN BEFORE TREATMENT START they will have to wear the nightime aligner after the end of therapy.
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