Comparison between digital and conventional impression techniques in children on preference, time and comfort: A crossover randomized controlled trial.

OBJECTIVE: To compare the conventional alginate impression and the digital impression taken with an intraoral scanner of both dental arches in children, using a randomized crossover design. TRIAL DESIGN: This is a monocentric, controlled, superiority, randomized, crossover, open study. METHODS: Twenty-four orthodontic patients between 6 and 11 years of age underwent intraoral scanning (TRIOS 3; 3Shape) and alginate impression of both dental arches with an interval of 1 week between the two procedures. Participants were recruited from September 2021 to March 2022 and the study was completed in April 2022. Impression time for the two procedures was compared. Patients were asked which one of the two impression procedures they preferred. A questionnaire including Visual Analogue Scale (VAS) for comfort, pain, gag reflex and difficulty in breathing, was administered to the patients. RESULTS: Eighteen out of 24 patients preferred digital impression (75%, 95% confidence interval [CI]: 55% to 88%; P = .014). Scanning time was significantly shorter than alginate impression time (difference -118 seconds; 95% CI: -138 to -99; P < .001). Comfort was significantly higher for digital impression (difference 1.7; 95% CI: 0.5 to 2.8; P = .007). There was no difference in pain (difference -0.2; 95% CI: -1.5 to 1.0; P = .686) while gag reflex and breathing difficulties were smaller for digital impression (gag reflex difference -2.5; 95% CI: -4.0 to -0.9; P = .004 and breathing difficulties difference -1.5; 95% CI: -2.5 to -0.5; P = -.004). CONCLUSIONS: Digital impression is preferred by children aged 6-11 years and it is significantly faster in acquisition time than conventional alginate impression. REGISTRATION: The study was registered on ClinicalTrials.gov with registration number NCT04220957 on January 7th, 2020 (https://clinicaltrials.gov/ct2/show/NCT04220957).

Guia prático da fabricação de alinhadores inhouse ­ Parte 2: Planejamento e Estagiamento / Practical guide to inhouse aligner fabrication ­ Part 2: Planning and Staging

Resumo Movimentos ortodônticos realizados com alinhadores in-house possuem detalhes e particularidades que os diferem da mecânica ortodôntica convencional multi-bráquetes e que precisam ser respeitados pelo ortodontista na busca pela maior previsibilidade, eficácia e eficiência dos resultados. Detalhes quanto ao tipo de movimento programado para cada dente, controle de ancoragem, hierarquização das movimentações, peculiaridade da mecânica das variadas composições dos plásticos e tipos de attachments são apresentados nesta segunda parte do tutorial sobre a fabricação de alinhadores in-house (AU)

Abstract Orthodontic movements with in-house aligners entail specific details and nuances that distinguish them from traditional multi-bracket orthodontic techniques. The orthodontist must acknowledge these details to ensure greater predictability, efficacy, and efficiency in achieving desired outcomes. This second part of the in-house aligners manufacturing tutorial presents insights on tooth-specific movement requirements, anchorage control, movement hierarchy, unique aspects of plastic mechanics, and attachment types (AU)

Guia prático de fabricação de alinhadores in-house ­ Parte 1: Introdução ao sistema / Practical guide to in-house aligner fabrication ­ Part 1: Introduction to the system

Resumo O uso de alinhadores para o tratamento das más oclusões tem, cada vez mais, despertado o interesse dos ortodontistas. Desde a sua apresentação no mercado, há pouco mais de duas décadas, os alinhadores vêm conquistando um importante espaço, muito em função das mudanças direcionais no exercício da especialidade, geradas pela demanda por tratamentos com uma abordagem estética e de maior conforto. Na prática, essa transformação impactou a gestão dos consultórios dos ortodontistas, habituados com o total controle sobre o fluxo de montagem e fabricação dos aparelhos convencionais. A contratação de empresas para a fabricação industrial dos alinhadores foi o conceito proposto originalmente pela Align Technology, fabricante do Invisalign, pioneira nesse sistema comercial e líder no mercado. Entretanto, em função dos custos inerentes a esse serviço, bem como das limitações temporais impostas pela terceirização, foi criado um fluxo digital de fabricação in-house dos alinhadores, pelos próprios ortodontistas. Diante dessa realidade, o objetivo desta série de três artigos é trazer, aos ortodontistas iniciantes na técnica, considerações práticas para o início do emprego na fabricação própria de alinhadores. Adicionalmente, objetiva-se compartilhar, com os profissionais que já são usuários desse tipo de sistema, experiências relacionadas à fabricação e à gestão da técnica. (AU)

Abstract Clear aligner treatment has gained interest among orthodontists since its introduction in the market two decades ago. The high patients' demand for more aesthetic approaches, with greater comfort, is the primary aspect driving this direction change in the treatment of the malocclusions. However, this drift impacted the management of clinical practices because orthodontists lost absolute control over the flow of assembly and manufacture of conventional appliances. Third-party companies hired for the industrial manufacture of aligners was the concept initially proposed by Align Technology, manufacturer of Invisalign, a pioneer in the commercial system and market leader. Nevertheless, due to the inherent costs of this service and the time limitations imposed by outsourcing, the orthodontists created a digital flow for in-house manufacturing of aligners. This series of three articles brings practical considerations for using in-office aligners. Additionally, the goal is to share experiences related to the manufacture and management of the technique (AU)

Guia prático de fabricação de alinhadores in house ­ Parte 3: impressão de modelos, pós-processamento, termoplastificação, acabamento e gestão clínica / Practical guide for manufacturing aligners in house ­ Part 3: printing models, post-processing, thermoplasticization, improvement and clinical management

Resumo Após o planejamento virtual dos movimentos ortodônticos em plataformas apropriadas e a exportação dos diversos modelos digitais de subsetups, inicia-se a fase laboratorial de fabricação dos alinhadores in house, com a impressão 3D de modelos em resina fotossensível, seguida dos processos de lavagem e pós-cura. Assim, os modelos estarão prontos para serem estampados com variadas opções de laminados poliméricos termoplastificados, que serão recortados, receberão acabamento fino, higienizados e entregues aos pacientes. Na terceira parte do tutorial, serão apresentados esses conceitos práticos da fabricação de alinhadores in house. (AU)

Abstract Following the virtual planning of orthodontic movements using suitable platforms and the resulting exportation of multiple digital models of sub-setups, the laboratory phase begins to produce in house aligners. This phase involves the utilization of 3D printing technology to fabricate models using photosensitive resin, followed by additional steps of washing and post-curing. The models are then prepared for printing using a range of thermoplastic polymer laminate choices. After this, they are meticulously trimmed, refined, sterilized, and subsequently, disseminated to the intended recipients. The current part 3 of the tutorial will focus on the practical concepts involved in the in house production of aligners(AU)