D2 ORTHO TRIBUNE Dental Tribune Middle East & Africa Edition | 1/2020 Digital orthodontics Dr Anna Hajati, Sweden Digitalisation is the most revolutionary change in human existence of all time. It will have a more fundamental impact on our daily lives than the letterpress, invented by Johannes Gutenberg in the mid-fifteenth century, or the industrial revolution, begun in the UK in the second half of the 1700s. At this point, we are just about to see through the door to human- kind’s future. But what impact will digitalisa- tion have on orthodontic care? Looking back, we have already been using digital adminis- trative systems and images for decades, but it was not so long ago that digital orthodontics was implemented in the treatment process, through which we could create a virtual pa- tient from 3-D data, simulate a treatment plan, and design and manufacture tailored appli- ances. These capabilities are still employed by the minority of orthodontists. However, digi- tal orthodontics embraces the full digital pa- tient process, which is far more than a single digital treatment process resulting in a bracket system or a specific appliance. It incorporates an ecosystem that is far more complex and includes 3-D image acquisition; registration of different image sets and formats; segmen- tation of the anatomic structure of interest; simulation of bracket placement, occlusion, function and smile; online monitoring of the treatment course and hygiene; and design and manufacture of appliances. In essence, digital orthodontics is a matter of communication, using and transferring information. Digital communication and influ- ence Back in history, individuals with power over information, or the most influential, were the oldest and most experienced, and after the letterpress, this power shifted to the most educated (Figs. 1a–c). In the digital age, influ- ential power belongs to those who know how to write and communicate to a target popula- tion via the Internet and social media. Today, we see a full ecosystem of influencers—family and friends, co-workers, customers, bloggers, fans, vendors, publishers and celebrities—and together they have an impact on the informa- tion, insights and knowledge we take in. The closer the relation (like family and friends), the greater the influence, and if you invest greater resources or have many followers or fans, the wider the reach of your communication be- comes (Fig. 2). Most industries, including den- tistry, employ this ecosystem to build their brand to target the end-consumer directly. According to market research and advisory company Technavio, the top five key players in the dental CAD/CAM market are Danaher, Planmeca, Zimmer Biomet, Dentsply Sirona and Align Technology.1 They all use strategic communication in their marketing approach that is focused on creating and distributing valuable, relevant and consistent content, in a: Source: Shutterstock: 1294576171 b: Source: Shutterstock: 313825274 c: Source: Shutterstock: 492722590 Figs. 1a–c: Influential power has been transferred from the oldest (a), to the most educated (b), to those who can communicate successfully to a target audience (c). order to attract and retain a clearly defined target group. It can be described as a buying funnel, where the first part is aimed at attract- ing and creating awareness and continues on to build trust and then a desire that leads to customer action (Fig. 3). I will give a real-life example of how we have all been influenced. Back in 2009 when Ortodon- tiAkademin was founded, awareness of invis- ible orthodontic appliances as a treatment for adults was low. Adults searching for a better smile tended not to consider buccal orthodon- tic appliances that would be fully visible on their teeth. Many saw “instant orthodontics” as the only alternative (Fig. 4). The American television show Extreme Makeover, featur- ing the cosmetic dentist Dr Bill Dorfman, was so popular that awareness of cosmetic dental care and the desire for it started to grow—so too did the number of providers of cosmetic dentistry. Public awareness of adult ortho- dontics and invisible appliances, however, was still very low, and the clear aligner alternative, Invisalign (Align Technology), was disappoint- ing. Today, the public has become more aware of the invisible alternatives. Many orthodon- tists began to offer lingual appliances with the launch of Incognito (TOP-Service für Lingualtechnik) and general dentists began to offer clear aligners. Since then, the global invisible orthodontic market has grown considerably. According to Technavio, it will continue to increase in years to come.2 Fur- thermore, market forecasts from meticulous Source: Shutterstock: 215434141 Fig. 2: An influencer is a person with the ability to influence potential buyers of a product or service, by promot- ing or recommending the respective item or service. research indicate that the orthodontic market will be dominated by removable appliances up to 2023.3 The expected key drivers in these reports are the target population, adult ortho- dontic patients desiring improved smiles. The reason behind the current increased aware- ness, desire and demand from the population is the nature of modern communication, how we as professionals have been using it, as well as strategically consistent digital communica- tion by the industry. One can clearly perceive a direct association between the increased use of the Internet, including social media, and the increased interest in invisible orthodontic care by the adult population. Orthodontic patients have been an important target population for strategic digital commu- nication, as have general dentists and ortho- dontists. In an era of social marketing and big data, professionals need to be aware of what the product or service is. A lifestyle? A bracket system? Equipment? Software? Communication via 3-D images Regarding digital orthodontics, we also need to address the impact of 3-D imaging systems on market development. A direct prerequisite for the development of CAD/CAM-supported orthodontic appliances is the improved accu- racy and increased use of intra-oral scanners and availability of CBCT units. Since 3-D image equipment has been a natural part of patient- centred communication, planning and manu- facture, we have experienced an explosion of 3-D image capturing devices. According to Data Bridge Market Research’s forecast, al- most 100% growth is expected from 2017 to 2024.4 Three-dimensional image acquisition Fig. 3: The marketing funnel is a system of stages consumers or purchasers pass through to eventually make a buying decision. u Page D3 Source: Shutterstock: 1024702696