DIGITAL DENTISTRY AND ITS IMPACT ON ORAL HEALTH-RELATED QUALITY OF LIFE.

Over the past 50 years, digitization has gradually taken root in dentistry, starting with computer tomography in the 1970s. The most disruptive events in digital dentistry were the introduction of digital workflow and computer-aided manufacturing, which made new procedures and materials available for dental use. While the conventional lab-based workflow requires light or chemical curing under inconsistent and suboptimal conditions, computer-aided manufacturing allows for industrial-grade material, ensuring consistently high material quality. In addition, many other innovative, less disruptive, but relevant approaches have been developed in digital dentistry. These will have or already impact prevention, diagnosis, and therapy, thus impacting patients' oral health and, consequently, their oral health-related quality of life. Both software and hardware approaches attempt to maintain, restore, or optimize a patient's perceived oral health. This article outlines innovations in dentistry and their potential impact on patients' oral health-related quality of life in prevention and therapy. Furthermore, possible future developments and their potential implications are characterized.

Orthodontic treatment and biological limits: a retrospective clinical trial.

BACKGROUND: The fundamental part of every successful orthodontic treatment is the detailed treatment planning including a precise determination of the virtual treatment objective (VTO) while considering the biological and anatomical limits. The aim of this study is to investigate and to compare the feasibility of the established reference values before and after orthodontic treatment and to determine the usefulness of this parameters as guidance for the sagittal anterior, sagittal posterior and transverse biological boundaries. MATERIALS AND METHODS: Thirty-two patients aged 9 to 18 years (12 male and 20 female) with all permanent teeth present were randomly selected for orthodontic treatment with fixed multibracket appliance regardless of the potential malocclusion. The parameters 6-PTV, 1-NB [mm] and the WALA ridge were set for the identification of the transverse, sagittal anterior and sagittal posterior tooth position. The measurements were carried out at the beginning (T0) and at the end (T1) of the orthodontic treatment. They were set in relation with their individual threshold values (G). After the results of the measurements were conducted using the software OnyxCeph3TM (version 3.2.185 (505), Image Instruments GmbH, Chemnitz, DE), they were statistically calculated in the software RStudio (2022.12.0 Build 353 © 2009-2022 Posit Software PBC). RESULTS: Among the 32 patients, the mean pre- and post-treatment changes measured through the three parameters in relation to the individual reference values were statistically significant (p < 0.01). The mean values for 6-PTV, 1-NB and the WALA ridge amounted 15.37 mm, 2.56 mm and 4.23 mm at the beginning of the treatment, while after the treatment the measured values amounted 20.31 mm, 2.4 mm and 5.55 mm. These measurements combined with the statistical analysis of the changes of WALA ridge (T0, T1) confirmed that the teeth have been successfully uprighted and aligned. Furthermore, the maxillary first molars have been moved slightly mesially, as proven by the changes in 6-PTV, without certainty as to whether bodily movement or mesial tipping took place. Additionally, the lower incisors have been protruded, slightly exceeding the individual threshold values. CONCLUSION: The parameters investigated provide a suitable assessment tool for recording the limits of the sagittal posterior, the sagittal anterior and the transverse dimension.

Effect of argon cold plasma composition on orthodontic bonding-new insights into input parameters and protocols.

PURPOSE: Cold atmospheric plasma can functionalize enamel without damaging the substrate morphology. It therefore has the potential to be a gentle alternative to conventional acid etching. To realize the full potential of cold atmospheric plasma in orthodontic bonding, the input parameters and protocols that are most beneficial to surface modification must first be identified. We aimed to clarify how the admixture of oxygen to cold atmospheric plasma and the rewetting of the enamel affect the conditioning properties for orthodontic bonding. METHODS: First, we illustrated the morphological effects of different plasma compositions on the enamel surface by means of scanning electron microscopy. Then, we measured the shear bond strength resulting from different conditioning techniques on bovine enamel specimens: conventional acid etching; no conditioning; pure argon plasma; argon plasma plus 0.5% oxygen admixture; argon plasma plus 0.5% oxygen and rewetting after plasma application. Brackets were bonded using light cured adhesive; all specimens were subjected to thermocycling. The shear bond strength of each specimen was measured in a universal testing machine and compared using Welch one-way analysis of variance (ANOVA) and Games-Howell post hoc test. RESULTS: Specimens conditioned with argon plasma plus 0.5% oxygen and rewetting showed a significantly higher shear bond strength than specimens conditioned with conventional acid etching. Conditioning with pure argon plasma and argon plasma plus 0.5% oxygen without rewetting yielded significantly lower shear bond strength. CONCLUSION: Admixing 0.5% oxygen and rewetting the enamel after plasma application are crucial steps that could help make cold atmospheric plasma a gentle conditioning technique in orthodontic bonding.

Fused filament fabrication (FFF): influence of layer height on forces and moments delivered by aligners-an in vitro study.

OBJECTIVES: To investigate the effect of layer height of FFF-printed models on aligner force transmission to a second maxillary premolar during buccal torquing, distalization, extrusion, and rotation using differing foil thicknesses. MATERIALS AND METHODS: Utilizing OnyxCeph3™ Lab (Image Instruments GmbH, Chemnitz, Germany, Release Version 3.2.185), the following movements were programmed for the second premolar: buccal torque (0.1-0.5 mm), distalization (0.1-0.4 mm), extrusion (0.1-0.4 mm), rotation (0.1-0.5 mm), and staging 0.1 mm. Via FFF, 91 maxillary models were printed for each staging at different layer heights (100 µm, 150 µm, 200 µm, 250 µm, 300 µm). Hence, 182 aligners, made of polyethylene terephthalate glycol (PET-G) with two thicknesses (0.5 mm and 0.75 mm), were prepared. The test setup comprised an acrylic maxillary model with the second premolar separated and mounted on a sensor, measuring initial forces and moments exerted by the aligners. A generalized linear model for the gamma distribution was applied, evaluating the significance of the factors layer height, type of movement, aligner thickness, and staging on aligner force transmission. RESULTS: Foil thickness and staging were found to have a significant influence on forces delivered by aligners, whereas no significance was determined for layer height and type of movement. Nevertheless, at a layer height of 150 µm, the most appropriate force transmission was observed. CONCLUSIONS: Printing aligner models at particularly low layer heights leads to uneconomically high print time without perceptible better force delivery properties, whereas higher layer heights provoke higher unpredictability of forces due to scattering. A z-resolution of 150 µm appears ideal for in-office aligner production combining advantages of economic print time and optimal force transmission.

Design, numerical simulation, and in vitro examination of a CAD/CAM-fabricated active orthodontic treatment element.

AIM: Orthodontic treatments with custom-made active elements may lead to more efficient treatment with fewer side effects. The objective of the present in vitro study was to determine whether individually constructed, mathematically simulated, and 3D-printed power chains could generate adequate forces for orthodontic tooth movement. MATERIALS AND METHODS: An individual measurement device was developed using a high-precision load cell, amplifier, and microcontroller for signal processing. Elastic chains were designed and subsequently printed from two different thermoplastic polyurethane (TPU) filaments and a thermoplastic elastomer (TPE) filament. With the CAD data, a finite element analysis (FEA) was performed to calculate the reactive forces to be expected at different activation levels. The measured force development of the test objects was compared with the results from the FEA. RESULTS: The results showed a high precision of the measurement device, with an intraclass correlation coefficient (ICC) of 0.999 and a Dahlberg error of 0.05 N. The measured forces ranged from 196 to 681 g. There was a significant correlation between the measured and calculated forces (R 0.91 to 0.98). DISCUSSION: In the present study, the fully digital workflow of producing an individualized active orthodontic treatment element, which developed almost exactly the force values calculated in the FEA, was shown. Future clinical use seems promising, in combination with fully individualized and digitally planned treatment approaches. This offers the possibility to integrate these insights from exemplary applications into patient-specific digital planning in orthodontics. The combination of CBCT root reconstruction, intraoral scans with customized brackets, and wires is the perfect starting point to add mechanical and numerical simulations. This would be the next step from shape-driven planning to force-driven planning. The goal is to reduce treatment time and negative side effects, eg, root resorption. CONCLUSION: The present in vitro study is the first to show the possible individualized construction and 3D printing of elastic chains exhibiting reproducible, predefined forces.

Cephalometric analyses for cleft patients: a statistical approach to compare the variables of Delaire's craniofacial analysis to Bergen analysis.

OBJECTIVES: Cephalometric analyses using lateral craniofacial radiographs are common diagnostic procedures for evaluating skeletal patterns. However, in patients with pronounced abnormalities like cleft lip and palate, standard cephalometric analyses and landmarks may not be suitable. This study aims to clarify whether the inclusion of landmarks less compromised by the cleft defect or located outside the cleft area results in a different cephalometric assessment of the viscerocranium. Delaire's whole-skull analysis and Bergen analysis were examined for similarities and underlying common observations. MATERIALS/METHODS: Based on the cephalometric evaluation of 217 patients with different types of non-syndromal cleft formation, Delaire and Bergen analysis were compared using three statistical methods: correlation analysis, factor analysis, and cluster analysis. Reproducibility was assessed by Bland-Altman plots, intraclass correlation coefficients, mean absolute differences, and coefficients of variability. RESULTS: Although Delaire analysis and Bergen analysis are based on different concepts and landmarks, a majority of corresponding variables was found. Certain aspects of craniofacial base relation and craniospinal articulation are only assessed by Delaire analysis. All but one variable showed very good reproducibility. CONCLUSIONS: The inclusion of landmarks less compromised by or located outside the cleft area does not result in variables that provide a different assessment of the viscerocranial area. CLINICAL RELEVANCE: The findings contradict the concept of invalidity of landmarks compromised by the cleft defect or located within the affected cleft area. Within the scope of its viscerocranial field of view, Bergen analysis appears to be on a par with Delaire analysis in the diagnosis of cleft patients.

Influence of dental occlusion on oculomotory function-A pilot study.

The aim of this study was to examine the interaction between the oculomotory system and the stomatognathic system based on morphofunctional relationships between the corresponding cranial nerves, their core areas and the reticular formation as a "link" by means of optometric examinations. Test subjects (N = 100) were prospectively recruited and divided into two groups: a young-age (N = 53, age 6-16 years) and old-age group (N = 47, 23-78 years). We determined the horizontal range of convergence and divergence as well as the near convergence point. These optometrically measured parameters were recorded in both groups in the resting position, at maximal mouth opening and with bite-blocking via tin foils (0.5 mm and 1 mm), which were inserted occlusally of the first lower left molar. All oculomotory parameters were significantly altered by bite manipulation and maximal mouth opening. These effects could be observed regardless of age and gender and thus suggest an interaction between eye movement and the orofacial complex. Subjects with asthenopic symptoms showed no different reactions compared to healthy subjects. For a final statement on the correlation between the oculomotory and stomatognathic system, further investigations are necessary. An interdisciplinary cooperation between the different subject areas is recommended for further studies.

Modular 3D printable orthodontic measuring apparatus for force and torque measurements of thermoplastic/removable appliances.

The magnitude of forces and moments applied on teeth during orthodontic treatment is crucial to achieve the desired tooth movement. The aim of this study is to introduce a modular 3D printable orthodontic measurement apparatus (M3DOMA), which can be used for measurements of forces and moments acting on teeth during treatment with aligners. The measurement device was characterized regarding signal to noise ratio (SNR) of the sensors, repeatability of measurements, influence of thermoforming, as well as reliability. Forces and moments were evaluated for an activation range of 0.1-0.4 mm, comparing them among different activation patterns with two aligner thicknesses. The sensors exhibited a SNR from 13-33 dB. Repeatability with repeated measurements showed standard deviations ≤0.015 N and 0.769 Nmm. The influence of thermoforming represented by standard deviation of forces ranges from 0.019-0.147 N. The device showed a range of intra class correlation (ICC) for repeated measurements for all sensors from 0.932 to 0.999. Hence the reliability of the device has been proven to be excellent.

Validation of digital analysis of occlusion in primary and mixed dentition using GEDAS.

AIM: The present prospective clinical study aimed to validate the Greifswald Digital Analyzing System (GEDAS) as a method for digital assessment of the occlusion in primary and mixed dentition. MATERIALS AND METHODS: The reproducibility of GEDAS in primary and mixed dentition was assessed using the intraclass correlation coefficient (ICC). In addition, the acceptability of the method to the dentist, the child, and the parent/caregiver was assessed using a modified visual analog scale of faces, the Frankl behavior scale, and the 10-point Likert scale. In total, 20 participants aged between 3 and 9 years (mean age: 6; standard deviation: ± 1.74) with primary (n = 10) and mixed (n = 10) dentition were recruited. RESULTS: The ICC for the number of contact points in all teeth was 0.94 and for the area of contact points was 0.97, indicating good to excellent reproducibility. The average total number of contacts per bite registration per arch in the primary and mixed dentition was 36.5 (17 to 66) and 37.9 (9 to 74), respectively. The average of the total area of interocclusal contact area in the primary and mixed dentition was 25.55 mm2 (5.39 to 70.20) and 29.59 mm2 (2.80 to 78.53), respectively. During the procedure, the majority of dentists reported the child's behavior to be positive (85%) and found the procedure easy to perform (80%), short (6.0 min), and tolerable (80%). CONCLUSION: GEDAS is an occlusal analysis tool with good acceptability and reproducibility in children and could be considered for the planning and assessment of restorative and orthodontic treatment in the intermediate stages.

Investment casting with FFF (fused filament fabrication)-printed appliances: the intermediate step.

OBJECTIVE: Some modifications of orthodontic appliances such as the rapid maxillary expansion (RME) device with a Hyrax screw or Herbst are fabricated using traditional investment casting (lost-wax casting). This is precise but very labor-intensive. New technologies enable us today to use direct selective laser sintering (SLS) to produce freeform metallic structures. These machines are very expensive and only available in specialized laboratories. The aim of this investigation was to combine fused filament fabrication (FFF) 3D printing with wax-based filaments to produce orthodontic appliances via investment casting. METHOD AND MATERIALS: For demonstration purposes, a lingual arch, a palatal arch, and an RME appliance were digitally designed based on an intraoral scan. The *.stl files were sliced and printed with a dual-nozzle FFF printer. The object was printed with a wax-based filament especially suited for investment casting, and support structures were printed with water-soluble polyvinyl-alcohol (PVA) filament. The printed objects were cast in metal and finished. RESULTS: All appliances were successfully cast and polished. They were provisionally placed intraorally. The fit was clinically very good and comparable to traditionally crafted appliances. The printing and handling of the parts made of these special filaments is challenging. CONCLUSION: With this experiment, the successful production of investment casting using FFF printing was shown for the first time.

SHIP-MR and Radiology: 12 Years of Whole-Body Magnetic Resonance Imaging in a Single Center.

The Study of Health in Pomerania (SHIP), a population-based study from a rural state in northeastern Germany with a relatively poor life expectancy, supplemented its comprehensive examination program in 2008 with whole-body MR imaging at 1.5 T (SHIP-MR). We reviewed more than 100 publications that used the SHIP-MR data and analyzed which sequences already produced fruitful scientific outputs and which manuscripts have been referenced frequently. Upon reviewing the publications about imaging sequences, those that used T1-weighted structured imaging of the brain and a gradient-echo sequence for R2* mapping obtained the highest scientific output; regarding specific body parts examined, most scientific publications focused on MR sequences involving the brain and the (upper) abdomen. We conclude that population-based MR imaging in cohort studies should define more precise goals when allocating imaging time. In addition, quality control measures might include recording the number and impact of published work, preferably on a bi-annual basis and starting 2 years after initiation of the study. Structured teaching courses may enhance the desired output in areas that appear underrepresented.

Association between coronal caries and malocclusion in an adult population.

PURPOSE: Only a few but conflicting results have been reported on the association between malocclusions and caries. We investigated this association using data from the population-based cross-sectional Study of Health in Pomerania (SHIP). METHODS: Sagittal, vertical and transversal intermaxillary relationship, space conditions and sociodemographic parameters of 1210 dentate subjects (median age 30 years, interquartile range 25-35 years) were collected. Caries was assessed with the Decayed-Missing-Filled Surfaces index but analyzed as ordered outcome (four levels: sound, enamel caries, caries, tooth loss) in ordinal multilevel models, taking into account subject, jaw, and tooth level simultaneously. RESULTS: Anterior open bite ≤3 mm (odds ratio [OR] = 2.08, 95% confidence interval [CI]: 1.19-3.61), increased sagittal overjet of 4-6 mm (OR = 1.31, CI: 1.05-1.64), distal occlusion of ½ premolar width (OR = 1.27, CI: 1.05-1.53) and distal 1 premolar width (OR = 1.31, CI: 1.06-1.63) were associated with adjusted increased odds for a higher outcome level (caries). Anterior spacing (OR = 0.24, CI: 0.17-0.33), posterior spacing, (OR = 0.69, CI: 0.5-0.95), posterior crowding (OR = 0.57, CI: 0.49-0.66) and buccal nonocclusion (OR = 0.54, CI: 0.33-0.87) were associated with a lower outcome level (caries). CONCLUSION: The results from this population-based study suggest that a connection between caries and malocclusion exists to a limited extent in young adults. The associations with caries are contradictory for several malocclusion variables. Distal occlusion (OR = 1.31, CI: 1.06-1.63) and related skeletal anomalies displayed positive associations with caries whereas crowding did not. Orthodontic treatment of anterior crowding would probably not interfere with caries experience. These aspects should be considered for patient information and in treatment decisions.

Does craniofacial morphology affect third molars impaction? Results from a population-based study in northeastern Germany.

OBJECTIVES: It is still not clear why impaction of third molars occurs. Craniofacial morphology and facial parameters have been discussed to be strong predictors for third molar impaction. Thus, this study aimed to investigate the effect of craniofacial morphology on erupted or impacted third molars in a German population sample. MATERIALS AND METHODS: Erupted and impacted third molars in 2,484 participants from the Study of Health in Pomerania were assessed by whole-body magnetic resonance imaging. Markers of facial morphology were determined in 619 individuals of those participants in whose 421 participants (16.7%) had at least one impacted third molar. Craniofacial morphology was estimated as linear measurements and was associated in a cross-sectional study design with impacted and erupted third molars by multinomial logistic regression models. Erupted third molars were used as reference outcome category and regression models were adjusted for age and sex. RESULTS: Maximum Cranial Width (Eurion-Eurion distance) was significantly associated with impacted third molars (RR: 1.079; 95% confidence interval 1.028-1.132). This association was even more pronounced in the mandible. Individuals with a lower total anterior facial height (Nasion-Menton distance) and a lower facial index also have an increased risk for impacted third molars in the mandible (RR 0.953; 95% confidence interval 0.913-0.996 and RR: 0.943; 95% confidence interval 0.894-0.995). No significant associations of third molar status with facial width (Zygion-Zygion distance), and sagittal cranial dimension (Nasion-Sella distance; Sella-Basion distance) were observed. CONCLUSION: Individuals with an increased maximal cranial width have a higher risk for impaction of third molars in the mandible and in the maxilla. Individuals with a lower anterior total anterior facial height and lower facial index also have an increased risk for third molars impaction in the mandible. These findings could help orthodontic dentists, oral surgeons and oral and maxillofacial surgeons in decision-making for third molars removal in their treatment. These findings highlight the necessity of an additional analysis of the maximal cranial width by the Eurion- Eurion distance.

New insights in the link between malocclusion and periodontal disease.

AIM: We aimed to investigate associations between malocclusions and periodontal disease by comparing it to that of smoking in subjects recruited from the population-based cross-sectional study "Study of Health in Pomerania." MATERIALS AND METHODS: Sagittal intermaxillary relationship, variables of malocclusion and socio-demographic parameters of 1,202 dentate subjects, 20-39 years of age, were selected. Probing depth (PD) and attachment loss (AL) were assessed at four sites by tooth in a half-mouth design. Analyses were performed with multilevel models on subject, jaw and tooth level. RESULTS: Distal occlusion determined in the canine region, ectopic position of canines, anterior spacing, deep anterior overbite and increased sagittal overjet were associated with AL (p-value <0.05). Associations between malocclusions and PD: deep anterior overbite with gingival contact (odds ratio [OR] = 1.40, 95% CI: 1.08-1.82; p-value = 0.0101) and anterior crossbite (OR = 1.75, 95% CI: 1.29-2.38; p-value = 0.0003). Regarding crowding, only severe anterior crowding was compatible with a moderate to large association with PD (OR = 1.93, 95% CI: 0.89-4.20). Compared to smoking, the overall effect of malocclusions was about one half for AL and one-third for PD. CONCLUSION: Malocclusions or morphologic parameters were associated with periodontal disease.

Fully digital workflow for presurgical orthodontic plate in cleft lip and palate patients.

OBJECTIVE: In most cases, according to our treatment concept, a presurgical orthodontic treatment (POT) is performed on patients with cleft lip and palate (CLP). The aim of this case report is to demonstrate a completely digital workflow for the production of a palate plate. MATERIALS AND METHODS: For the assessment of the maxillary arch, a digital impression of the jaw was made on two patients with an intraoral scanner (Cerec Omnicam Ortho). After reconstruction of a virtual model from the scan data, appropriate areas of the jaw could be blocked out and a plate constructed. This was printed with a DLP three-dimensional (3D) printer (SHERA EcoPrint D30) with class IIa biocompatible material. After minor surface finishing, the plates could be incorporated in the patients' mouths. RESULTS: The scans could be performed in a short time without affecting the very young patients. All clinically relevant areas for the production and digital measurement of the models could be recorded. The plates showed an extremely good fit, and there were no differences in wear compared with a conventionally manufactured plate. CONCLUSION: For the first time, a risk-free digital impression of the edentulous jaw in CLP babies with a subsequently completely digitally constructed and 3D-printed palatal plate could be shown.

Three-dimensional morphology of first molars in relation to ethnicity and the occurrence of cleft lip and palate.

OBJECTIVES: This study aims to describe morphological peculiarities of maxillary and mandibular first molars in Europeans, Asians and Europeans with cleft lip and palate. MATERIAL AND METHODS: Reflex microscopy was used to obtain three-dimensional morphometric landmarks from 40 models (11 Europeans and 13 Asians without cleft lip and palate, 16 Europeans with unilateral cleft lip and palate). The cases were examined using traditional morphometry and geometric morphometry, and visualized using thin-plate splines. RESULTS: Classic morphometry showed no right/left differences in the study groups and no significant differences with regard to the cleft side in patients with cleft lip and palate. In Asians, a significantly greater mesiodistal width was found. Geometric morphometry showed an enlarged centroid size in Asians (maxilla and mandible). In cleft patients, the cleft site did not appear to impact the morphology of first molars. CONCLUSION: Unilateral clefting did not affect the size and shape of molars; however, characteristic ethnicity-based differences were in fact identified. The results are relevant for orthodontic treatment with preadjusted appliances, and prosthetic CAD/CAM restorations.

A completely CAD/CAM individual transmission device for electronic mandible movement registration.

The connection of a device for the registration of mandibular movements depends on the coupling of the teeth with a paraocclusal adapter. This is normally done by individualizing a prefabricated metal support, either directly on the patient or in the dental laboratory. The goal was to create an individual paraocclusal adapter by means of additive computer-assisted design/computer-assisted manufacturing (CAD/CAM) procedures, and to test it clinically. Starting from intraoral scans of the maxillary and mandibular teeth, an individual paraocclusal adapter was constructed by combining an adapter piece adapted to the tooth and jaw shape with a prefabricated standard part. This article describes step by step the design using the 3D CAD software, up until production by means of 3D printing. Initial clinical experience is also discussed.

Estimating effects of craniofacial morphology on gingival recession and clinical attachment loss.

OBJECTIVES: Evidence on possible associations between facial morphology, attachment loss and gingival recession is lacking. We analysed whether the facial type, which can be described by the ratio of facial width and length (facial index), is related to periodontal loss of attachment, hypothesizing that a broad face might be associated with less gingival recession (GR) and less clinical attachment loss (CAL) than a long face. MATERIALS AND METHODS: Data from the 11-year follow-up of the population-based Study of Health in Pomerania were used. Periodontal loss of attachment was assessed by GR and CAL. Linear regression models, adjusted for age and gender, were used to assess associations between specific landmark based distances extracted from magnetic resonance imaging head scans and clinically assessed GR or CAL (N = 556). RESULTS: Analysing all teeth, a higher maximum cranial width was associated with a lower mean GR (B = -0.016, 95% CI: -0.030; -0.003, p = 0.02) and a lower mean CAL (B = -0.023, 95% CI: -0.040; -0.005, p = 0.01). Moreover, a long narrow face was significantly associated with increased mean GR and CAL (facial index, P for trend = 0.02 and p = 0.01, respectively). Observed associations were more pronounced for incisors and canines than for premolars and molars. CONCLUSION: This study revealed craniofacial morphology, specifically the cranial width and the facial index, as a putative risk factor for periodontal loss of attachment.

3D-printed orthodontic brackets - proof of concept.

Today, orthodontic treatment with fixed appliances is usually carried out using preprogrammed straight-wire brackets made of metal or ceramics. OBJECTIVE: The goal of this study was to determine the possibility of clinically implementing a fully digital workflow with individually designed and three-dimensionally printed (3D-printed) brackets. MATERIALS AND METHODS: Edgewise brackets were designed using computer-aided design (CAD) software for demonstration purposes. After segmentation of the malocclusion model generated based on intraoral scan data, the brackets were digitally positioned on the teeth and a target occlusion model created. The thus-defined tooth position was used to generate a template for an individualized arch form in the horizontal plane. The base contours of the brackets were modified to match the shape of the tooth surfaces, and a positioning guide (fabricated beforehand) was used to ensure that the brackets were bonded at the correct angle and position. The brackets, positioning guide, and retainer splint, digitally designed on the target occlusion model, were 3D printed using a Digital Light Processing (DLP) 3D printer. The archwires were individually pre-bent using the template. RESULTS: In the treatment sequence, it was shown for the first time that, in principle, it is possible to perform treatment with an individualized 3D-printed brackets system by using the proposed fully digital workflow. Technical aspects of the system, problems encountered in treatment, and possible future developments are discussed in this article.