issn 1868-3207 • Vol. 1 • Issue 1/2021 1/21 aligners international magazine of aligner orthodontics p r e v i e w opinion Accelerated aligners with photobiomodulation case report Clear aligner orthodontic treatment of a complex malocclusion trends & applications Printing clear aligners in-house–how accessible is it?

editorial | Dr Antonello Francesco Pavone Private practice in Rome, dedicated to the management of interdisciplinary and aesthetic treatment in prosthodontics and implantology In order to restore aesthetics, function and structure while respecting biology, an interdisciplinary approach is neces- sary, especially in adult patients. Only the synergy between various disciplines, such as restorative dentistry, prosthet- ics, periodontics and in particular orthodontics, can create an adequate balance of therapeutic objectives in adult pa- tients. Drs Werner Schupp and Julia Aubrich correctly said in their book: “since the anatomy of the teeth cannot be changed orthodontically, then orthodontics cannot by itself create perfect occlusal patterns in teeth with native or acquired defects”.1 As a restorative dentist, one can also add: since the position of the teeth cannot always be cor- rectly modified with restorative treatment, such treatment will not always be able to rehabilitate misaligned teeth by obtaining an adequate compromise between aesthetics, function, structure and biology. Thus, it is important to un- derstand the limits of any discipline and the importance of working together to achieve a perfect final result. The major difference between orthodontists and restorative dentists is that the latter think of teeth mainly in terms of shape and size, while the former think in terms of position and occlusion. Orthodontic and prosthodontic issues are crowding, rotated teeth, insufficient or excessive interdental spacing, and inter-arch incoherence. When these problems exist in adult patients, restorative or prosthetic treatment cannot be performed such that a good balance between the four fundamental parameters of aesthetics, function, structure and biology can be respected and obtained. How can very rotated and overlapping teeth be adequately restored? Technically, the treatment would be very complex to carry out, and in the long term, the crowded teeth could have greater periodontal and functional problems after resto- ration. Inter-arch incoherence would inevitably have greater risks of functional and mechanical problems. The advantages and benefits of orthodontics for restor- ative and prosthetic dentistry are minimal biological impact on tooth structure and involvement of fewer teeth, better proportion and dimension of the definitive restorations, adequate self-cleaning of the mouth, flow of food and escape of food along the inlays of the correctly aligned crowns, and an occlusion that avoids temporomandibular disorder and improves the mechanical long-term result of treatment. As a restorative and prosthodontic dentist, I hope that aligners facilitate access to orthodontic treatment for adult patients who need to be treated and that my peers in- creasingly realise that proceeding without a holistic inter- disciplinary approach both entails greater technical com- plications in carrying out the work and reduces the possibility of achieving the ideal therapeutic goals. All treatment for the adult patient today requires a complete knowledge of the masticatory system, of alternative ther- apies, of adequate medical diagnostics and of interdisci- plinary planning. General, restorative and prosthetic dentists should always first consider recreating arches aligned with a “U” and not a “V” shape and with an adequate anterior overjet, in order to allow aesthetic restorations in the anterior but with a sat- isfactory long-term prognosis. Lengthening the incisal margins for aesthetic reasons in mouths with V-shaped arches and with crowded mandibular anterior teeth means great risks of mechanical failure in the short term. This is why orthodontics truly is the key to restorative success and aligners the best way to convince our adult patients to undergo orthodontic treatment. Many mouths today show localised wear due to mis- aligned teeth. Only orthodontics can allow these mouths, through adequate realignment, to be able to receive struc- tural restoration only where needed. Wear in crowded dentition provokes asymmetrical and asynchronous loss of tissue and consequently localised and sectorial com- pensatory eruption. Thus, orthodontic treatment before restorative care is absolutely unavoidable. Restorative treatment without prior orthodontics is not only complex and somewhat unreasonable but also a diagnostic and planning error. 1 Schupp W, Haubrich J. Aligner orthodontics: diagnos- tics, biomechanics, planning, and treatment. London: Quintessence Publishing; 2016. 358 p. aligners 1 2021 03

Xxxxxx | aligners 1 2021 05

opinion | Semiconductor emitting incoherent light Semiconductor emitting collimated light through (typical LED) a lens (light rays as parallel as possible) Figs. 1a & b: Differences between (a) a typical LED and (b) the ATP38. Vp = Positive voltage; Vn = Negative voltage; E = Energy. Fig. 2: Before (left) and after (right). The case was solved over three months with 12 clear aligners (Smilers) and photobiomodulation therapy (with the ATP38), applied every week for six minutes every time aligners were changed. Three-month treatment with twelve aligners lead to better results. Looking back, it was a smart deci- sion. In the past decade, the practice has grown and we have become a globally recognised centre for complex cases. When it comes to orthodontics, we always try to solve complex issues without surgery when possible. It is amazing what you can do with a highly skilled ortho- dontist who works calmly and has an in-depth know- ledge of biology and mechanics. Notwithstanding, as the clinical director of a leading dental centre, part of my job is to bring in new technolo- gies and techniques that can improve the workflow at the practice. I spend a great deal of time attending con- gresses around the globe, speaking to very clever people, and over the years, I have learned how to filter the noise from the facts. I thought it would be useful to share what we have discovered over the past year and a half about a relatively new system on the market that combines clear aligners, obviously a software-driven technique, with advanced photobiomodulation. This is in effect a non-invasive method for an accelerated orthodontic treatment. What has happened in the last two decades around the concept of clear aligners and the associated technology has truly rocked the foundations of the dental world, and without a doubt, the race for the best system has been one that is only paralleled by the implant industry. If you look at things from a larger perspective, very few compa- nies have recently gained so much press in social and traditional media as industry giants Invisalign and Smile- DirectClub, two of the few companies that have pro- moted their products directly to the final consumer. I have always been a big fan of anything that brings dentistry to mainstream media. These companies have done a great deal to inspire people to straighten their teeth and fix their smiles. Obviously, in the case of direct-to-consumer aligner com- panies, there is always a disclaimer that the patient must have a clean bill of oral health before receiving ortho- dontic treatment. However, publicly traded companies are usually highly focused on profits, like most large busi- nesses should be, and perhaps the focus on acquiring new clients is a little too financially driven, and in a clinical aligners 1 2021 07

opinion | Figs. 4a & b: Upper jaws, before (left) and after (right). The case was solved over two months with eight clear aligners (Smilers) and photobiomodulation therapy (with the ATP38), applied every week for six minutes every time aligners were changed. After eighth aligner and photobiomodulation technicians without even looking. The patient knows no difference between these aligners and those fabricated by a team that spent hours analysing and discussing the case with peers after all appropriate diagnostic tools were utilised. The box looks the same, the steps look the same, and in many simple cases, the results might be good. I doubt however that this will be the case with complex cases or cases with underlying problems such as thin biotype and bone loss, that can only be visualised with a digital CBCT, combined with a good perio probing, when only an intra-oral scan was sent in. We live in a world where things are rapidly changing and consumers are becoming more aware of their rights. This is why I believe that systems that do treatment planning using the largest amount of data possible, always using radiographs or CBCT scans, and that are focused on un- derstanding the situation at the end of care and not just the beginning will be the most successful in the future. Hopefully things will change soon in this regard and the public will understand that, in orthodontics, it is the final result, not the volume of sales, that should define success. We are physicians of the mouth. If we do things properly we can dramatically improve our patients’ lives. It is time to slow down and remember what our job is all about. We should not be in a rush to make money before taking care of our patients. Let us get back to understanding what has happened in the industry over the past decade or so. In recent years, I have slowly started to understand that there has to be more to orthodontics than just fixing teeth. I, and many leading dentists around the world, have for quite some time been using aligners as a pretreatment requisite in order to establish a minimally invasive treatment protocol. One of the first to make this possible was the Digital Smile Design (DSD) methodology, which was pioneered by Dr Christian Coachman, a Brazilian dentist and dental technician, and really took the dental world by storm. It initially started with planning full-arch smiles and then reverse-engineered the treatment steps, thanks to an interdisciplinary software program, NemoStudio. This was very well received around the world, by the dental indus- try and by patients, and has now become a household brand. DSD is, in effect, an architect of smiles. It is no longer necessary to explain what a new smile will look like or to use complicated manual mock-ups; everything is software-driven using 3D printing. That is why I believe Invisalign made a move to collaborate with the DSD brand, and they have been doing a good deal to promote this concept of treatment plan acquisition. My team and I were one of the first in the world to employ DSD planning in treating a case in order to tell Invisalign what we wanted based on the final anatomy of the veneers before we had even started the treatment. We started to work on the case in early 2018, and the results were incredible.1 (We have published a few articles on this matter.) It is with great pleasure that I am seeing more dentists using DSD and of course clear aligners as a pretreatment for large, complex cases that will later involve pros- thodontics with or without dental implants, regardless of the fact that it adds to the cost and to the timing of each procedure. For me, it is no longer acceptable to grind healthy enamel simply to fix the tooth position so that you can place your ceramic restorations fast. We owe it to our patients to be as minimally invasive as possible. We all know that a natural, healthy tooth is the best kind of tooth and I argue with my patients that want “same day” veneers and try to convince them for a slower approach with aligners, bleaching, saving them enamel and cash as well. I must give credit to the biomimetic groups around the world and to the Facebook page Style Italiano, for their work, which really boosted the concepts of minimally aligners 1 2021 09

opinion | Although it has been proved an efficient technique in cases of mild to moderate crowding, not all patients want to have surgery. Piezo-incisions and micro-perforations are alternative techniques; however, they are still consid- ered invasive. Minimally invasive techniques too have been developed to accelerate orthodontic movements. A possibility could be using chemical agents such as parathyroid hormone or osteocalcin to increase the bone turnover and stimu- late rapid tooth movement. Nevertheless, these methods appear to be invasive and do not represent a solution to patients who do not want to be subjected to injections, apart from being an expense for the dental office. Physi- cal stimulation methods such as high-frequency and low-magnitude forces (vibration) are non-invasive tech- niques designed to be used at home with the aim of increasing and prolonging osteoclastic activity in the periodontal ligament. However, these methods require a great deal of compliance from patients. More recently, the application of heat, light and minute electric currents and an electromagnetic field during or- thodontic treatment have demonstrated an increase in the rate of tooth movement. In this field of research, low- level light therapy or light-emitting diodes (LEDs) has been demonstrated to be an effective minimally invasive technique. The application of a specified set of wave- lengths for an appropriate duration has been shown to be a means of accelerating orthodontic movement. This therapy is also known as photobiomodulation therapy. Its objective is to activate cells at a mitochondrial level and to make them produce more energy, adenosine triphos- phate, which is essential for cell repair and regeneration. There are several LED devices in the market; however, the ATP38 (Swiss Bio Inov) has proved to be the most ef- ficient owing to the semiconductor on the site of light emission, which focuses and energises the light in a similar way to a laser beam, rather than dispersing the light as other LEDs do. For the past year, we have exclusively been using this French system, patient acceptance has been 100% and my team absolutely loves it. We are managing to stream- line the planning with complex cases, from the smile design to the orthodontic planning and the implant plan- ning. But what really makes this quite awesome is the combination with the ATP38. To the best of my knowl- edge, there is nothing quite like it on the market today! And that is not marketing; that is simply a fact. We owe it to our patients to continuously up our game and keep searching for things that can improve their lives, faster, better and more affordably. We might sometimes have to invest a little more money in the beginning in order to save a great deal of time in the long run and to obtain consistently better results, which is, without a doubt, the best practice builder known to the dental industry. Staying ahead of the game and staying relevant are criti- cal to staying successful. You cannot do that without new technologies and great companies that are willing to work incredibly hard so that we can all have better, stress free lives. Acknowledgement I am grateful to Dr Ana Paz for her contribution to this article. Dr Paz is a full-time biological dentist and heads the scientific research and development department at the White Clinic in Lisbon in Portugal. She was an early adopter of photobiomodulation therapy in combination with clear aligners in a clinical setting. Clinical note The ATP38 device can be used in combination with any clear aligner system, as well as traditional orthodontic ap- pliances. Editorial note: This article originally appeared in ortho–in- ternational magazine of orthodontics, Volume 5, issue 2/2020. Reference: 1 Stanley M, Gomes Paz A, Miguel I, Coachman C. Fully digital workflow, integrating dental scan, smile design and CAD-CAM: case report. BMC Oral Health. 2018 Aug 7;18(1):134. about Dr Miguel Stanley is the clinical director of the White Clinic, a high- technology, advanced dental clinic founded 20 years ago. He is a passion- ate advocate for high-quality dental care, and his career has consequently been focused on restoring smiles with his interdisciplinary team, using state- of-the-art technology, software and materials, according to a strong sense of ethics and in pursuit of minimal invasiveness to better protect his patients. For this reason, he created the No Half Smiles treatment philosophy and Slow Dentistry, both aimed at improving the patient experience and the overall quality of care. Based on his training in implant dentistry, cosmetic dentistry and functional occlu- sion, Dr Stanley has developed an advanced biological compre- hensive dentistry approach to his work that incorporates the full scope of action of modern dentistry. Dr Stanley has given over 200 keynote lectures in more than 50 countries, and his lec- tures are critically acclaimed by dentists of all ages and spe- cialties for the open dialogue an simple and engaging manner in which complex cases are presented. He was nominated one of the top 100 dentists in the world by his peers in 2020. aligners 1 2021 11

case report | Initial (T1) Figs. 1a–h: Pretreatment photographs showing the patient’s initial smile aesthetics and malocclusion. Fig. 2: Pretreatment panoramic radiograph. Fig. 3: Pretreatment cephalometric radiograph. quickly. Treatment options to correct the tooth size dis- crepancy with mandibular arch interproximal reduction or bonding of the maxillary lateral incisors were presented. Additional treatment options to correct the Class II mal- occlusion on the left side and reduce the excess overjet were also presented. The patient and her mother both wanted to avoid bonding of the maxillary lateral incisors owing to long-term maintenance of the restorations, and they both wanted to minimise interproximal reduction (IPR). The patient was not concerned with addressing the Class II occlusion on the left side and was primarily look- ing for an aesthetically pleasing smile. With patient- and parent-limited goals for treatment in consideration, a treatment plan with the following treat- ment goals was established: 1. Resolve crowding. 2. Resolve excess overbite. 3. Improve overjet. 4. Improve mandibular midline. 5. Improve smile aesthetics. 6. Reduce office visits utilising remote monitoring. In addition to CBCT, other orthodontic records were taken, intra-oral digital including photographs and aligners 1 2021 13

case report | Fig. 6: Delivering ClearCorrect aligners. Fig. 7: Introducing and demonstrating the DentalMonitoring app. Fig. 8: DentalMonitoring remote monitoring of treatment progress. office for evaluation of treatment progress at her third of- fice visit. At this visit, it was determined that additional improvement in tooth position could be achieved, includ- ing midline correction, additional correction of mandibu- lar arch crowding, and improvement of canine guidance. The engagers were removed, and progress records were taken, including photographs (Fig. 9) and new intra-oral digital impression scans. The progress records were sent to ClearCorrect, and a treatment revision was request- ed. A total of four additional aligners with attachments on the canines were planned, to aid extrusion for improved canine guidance (Fig. 10). IPR of the mandibular central incisor contact point was planned to resolve rotation of the mandibular right central incisor and to improve the mandibular midline. It was agreed that the patient would discontinue use of the DentalMonitoring app during the treatment revision owing to her demanding schedule, but would stay very consistent and compliant with her ClearCorrect aligners. The patient completed her revision aligners in six weeks and was not seen during the revision aligner sequence. An office visit was scheduled at the completion of the re- vision aligner sequence, and at this visit, the engagers were removed and the patient was placed into final reten- tion with retainers made by ClearCorrect (Fig. 11). Treatment results Treatment was completed in a total of six months and a total of 16 sets of aligners, and the patient came to the office only five times from the initial consultation to final retention. While her appointments to the office were mi- nimised, her progress was tracked throughout treatment on an individual basis using the DentalMonitoring app. The final treatment results addressed the patient’s chief complaint and fulfilled the goals and expectations of both the patient and her mother. The crowding and excess overbite were relieved, and the patient reported that the discomfort in her mandibular anterior teeth was resolved. The patient indicated that her aesthetics were greatly im- proved and that she was incredibly pleased with her over- all treatment results and experiences of using both clear aligners and remote monitoring technology. aligners 1 2021 15

case report | Final (T3) Figs. 11a–h: Final photographs at the completion of treatment. Conclusion about ClearCorrect aligners were able to deliver the treatment results that the patient and her mother were expecting in a limited amount of time. The use of ClearCorrect align- ers allowed the patient to avoid injury to the teeth during contact sports that can be caused when wearing tradi- tional fixed appliances. The use of the clear aligners in combination with attachments and IPR was able to re- solve the crowding and provide excellent incisor intrusion to reduce the excess overbite and relieve the traumatic occlusion causing the patient’s initial discomfort. The use of selective IPR was also able to correct the mandibu- lar midline. There was an overall improvement in smile aesthetics. The high level of patient compliance with the aligners and the use of the DentalMonitoring app to cus- tomise the aligner wear schedule allowed the patient to complete treatment more quickly than initially anticipated, exceeding the expectations of both the patient and her mother. Editorial note: This article originally appeared in ortho– international magazine of orthodontics, Volume 6, issue 2/2021. Dr Melissa Shotell is a board- certified orthodontist and practises in a multi-specialty practice in Sonora in California in the US focusing on the interplay of orthodontics and restor- ative treatment. She received all of her dental training in the US. Dr Shotell received her DMD at Nova Southeastern University in Florida in the US and a general practice resi- dency certificate from the Ohio State University in Columbus in Ohio in the US. After spending years in general practice treating a broad range of patients, Dr Shotell completed a certificate and master’s degree in orthodontics at Loma Linda University in California. There, she focused her training on cutting-edge 3D imaging technology for diagnosis and treatment planning for interdisciplinary dentistry. Dr Shotell considers education to be her passion and regularly consults and lectures on dental technology, clear aligner therapy, or- thodontics, in-office clear aligners, office efficiency and workflow, and teamwork. She shares tips and tricks on or- thodontics and clear aligners on social media as alignerbee. aligners 1 2021 17

case report | Fig. 2: Initial panoramic radiograph. of 10 mm. The roots of teeth #31, 33 and 43 appeared to be close to the buccal border of the cortical bone. Both arches were constricted in the premolar–molar area. Radiographic analysis revealed normal root structure and morphology. A root remnant present in the area of ex- tracted tooth #38 was discovered (Fig. 2). Cephalometric analysis exposed a Class I skeletal pattern with slightly increased proclination of maxillary and mandibular inci- sors (Fig. 3). The treatment of choice for this patient was Invisalign clear aligners (Align Technology). The orthodontic treat- ment plan was formed based on the following objectives: • to eliminate the cross bite on the left side and establish a Class I molar and canine relationship; • to expand the arches and provide an anatomical form; and • to resolve the crowding and align the maxillary and mandibular incisors with the minimum amount of in- terproximal reduction and without further increase of incisal proclination. The first ClinCheck plan consisted of 53 aligners for planned posterior sequential distalisation of approxi- mately 4 mm on the maxillary left side, expansion of 2 mm per quadrant and alignment in the anterior area, as Figs. 4a–c: Initial ClinCheck simulated outcome. Fig. 3: Initial cephalometric radiograph. well as selective interproximal reduction (IPR) of 0.25 mm per tooth surface in the mandibular arch and between 0.10 mm and 0.15 mm in the maxillary right mandibular arch (Fig. 4). Topical fluoride application was planned in the areas of IPR after the procedure. Class II elastics were used on the left side to assist with distalisation. The aligner change interval was seven days and subsequently five days, and an accelerating vibratory orthodontic device was used in order to increase speed and predict- ability of the movement. Overcorrection aligners were not used. aligners 1 2021 19

case report | Figs. 6a–e: Final intra-oral photographs. the vibratory appliance, and the aligner interval was set at five and then three days. The final aligners were used only for 12 hours per day in order to allow the final passive posterior open bite closing. would have been able to confirm this finding). The ceph- alometric analysis revealed that the maxillary and man- dibular incisors had maintained their positions (initial mandibular incisor to APog line: 14 mm; final mandibular incisor to APog line: 13 mm; Fig. 8). Treatment results Conclusion After a period of 11 months and a total number of 66 max- illary and mandibular aligners, the case was finished and all the treatment goals had been accomplished. A bilat- eral Class I relationship had been achieved, the arches were symmetrical and the crowding had been resolved (Fig. 6). According to the final panoramic radiograph (Fig. 7), the roots were parallel and there was no evidence of root resorption (although only periapical radiographs Clear aligners were efficient in satisfying our treatment goals. During the distalisation phase, as the aligner en- capsulates the incisors, it provides good control of the position of the crowns and helps avoid unwanted procli- nation. Controlled movement of the mandibular incisors in a lingual direction while alleviating the crowding with the help of IPR helps prevent buccal displacement of the Fig. 7: Final panoramic radiograph. aligners 1 2021 21

aligners 1 2021 23

trends & applications | possibility of same-day replacements and improved compatibility with xed appliances for hybrid treatments. “The ability to provide aligners on the same day or even in the same week is huge. Our busy adult clientele love it,” Kaltschmidt explained. She said that integrating 3D print- ing is inevitable once a practice has begun using intra- oral scanners and that doing so has allowed Bellevue to take control of its workflow. “3D printing has allowed us to be in control of our own work ow, and with that, the possibilities are endless. We are able to provide aesthetic treatment options for our patients and keep the cost down by not accruing large laboratory fees from third-party companies. This includes in-house clear aligners, lingual braces and hy- brid treatment using a combination of both. 3D printing has truly changed the way we practice,” Kaltschmidt said. “We’re so used to next-day delivery with Amazon and other services, why should straightening teeth be any different?” Riolo asked in a press note. “Orthodontists have the technology and clinical expertise to expedite care in ways that major corporations cannot deliver. This is why we decided to adopt these technologies early on.” “The investment for orthodontists and dental profes- sionals to get started (with a 3D printer) can be anywhere from $500 to $20,000 or more,” Kaltschmidt said. “Tech- nology is advancing so quickly, and the cost of 3D printers will continue to come down. Our advice for those interest- ed in getting started with 3D printing is to spend less on the printer and invest more time into refining your digital worflow. You will begin to notice the differences when you go from analog to digital.” “Orthodontists can de nitely brand their own aligners and they absolutely should,” Kaltschmidt continued. “The product you design and manufacture in your of- fice as an orthodontist is a superior product in the end, and you should package and brand your aligners to reflect that. In-house aligners give the practitioner full con- trol over workflow, time to delivery, trim line and choice of aligner materials.” Last year, Riolo and Kaltschmidt founded the Tooth Movement 3D-printing educational community in order to share their expertise on using 3D-printing technology for orthodontic applications like clear aligner therapy. Kaltschmidt said that demand from within the dental community for the limited courses on offer has been signi cant and that she and Riolo have worked mostly with orthodontists, members of the treatment team and recent graduates. “Many residents do not have any expo- sure to 3D printing while in their schooling,” she pointed out. Manufacturers are bullish on adoption of 3D printing in dentistry Advancements in 3D-printing technology have seen the quality of desktop models for dentistry climb while costs have fallen. According to Dr Baron Grutter, who owns a dental prac- tice in Kansas City, being able to offer clear aligner treat- ment at a lower cost has improved case acceptance at his practice for a product that is known for its high earn- ing potential. Grutter was an early adopter of 3D-printing technology in the dental practice and has manufactured “Orthodontists have the technology and clinical expertise to expedite care in ways that major corporations cannot deliver”— Dr Christopher Riolo, Bellevue Orthodontics his own clear aligners in-house for some time. He told the manufacturer SprintRay in its Practice Insights series last year that a return on the investment of a 3D-printing workflow can be made by selling as few as three or four cases. Growing demand for this technology from dentists is being met by companies manufacturing solutions that are tailored to a number of dental applications, including making clear aligners. Manufacturers predict that sales will climb this year and that integrated digital workflows will make the technology even more accessible. Lee Kwang Min, vice president of the Korean 3D-print- er manufacturer Carima, told the online trade journal 3D Printing Industry in 2019 “[2020] will be a full-scale di- gital dentistry year. The emergence of a variety of 3D scanning solutions with an affordable price range, which has been an obstacle to the spread of digital dentistry, will replace the milling machines in the market and, further- more, (will accelerate) the rapid adoption of 3D printers.” Min said that he expects that a collaborative approach between individual manufacturers of 3D printers, software and scanners will act to increase the accessibility and adoption of the technology by dentists. aligners 1 2021 25

industry | 3 Fig. 3: 3D-printed temporary bridge made of VarseoSmile Temp. (Image: © BEGO) fessionals who work tirelessly to improve and elaborate the existing printing techniques and to explore and exploit new possibilities. As far as SprintRay is concerned, 3D printing will be future-proof.” 3D-printing applications in dentistry Some of the 3D-printing technologies that are currently available and used in the dental industry include digital light processing, selective laser melting, stereolithography and fused deposition modeling. All areas of dentistry are covered by 3D printing, including printed study models, surgical guides, metal frameworks, dental prostheses, temporary crowns and bridges, permanent restorations, occlusal splints, aligners, and removable dentures. work, and ability to communicate with surgeons and dental technicians. The advantages of 3D printing over CAD/ CAM technology 3D printing, or additive manufacturing, consists of adding material. In contrast, milling is a method that involves sub- tracting material. Labor told DTI that additive manufactur- ing is more cost-effective than subtractive computer- aided manufacturing and explained that it produces less waste. Additionally, 3D printing is highly accurate, faster for many indications and offers increased production ef ciency since the user can produce printable solutions in volume. Prof. Markus Blatz, who is chair of the Department of Pre- ventive and Restorative Sciences and assistant dean for digital innovation and professional development at the University of Pennsylvania School of Dental Medicine in Philadelphia, US, previously told DTI that he believes 3D printing to be the future of restoration fabrication in dental laboratory technology and that it is likely to be used for all types of materials and restorations. In a previous interview with DTI (CAD/CAM 1/2021), prosthodontist Dr Ryan C. Lewis noted: “3D printing has changed the way that we produce surgical guides. 3D printers have become so accurate and inexpensive that any dentist can now afford to have them in his or her of ce and print surgical guides as well as casts for diag- nostic purposes or aligners at a relatively low cost.” He added that going back to traditional dentistry would have a significant impact on costs, ef ciency, quality of Finally, Labor stated that additive manufacturing boasts consistency, which is crucial for successful product fabrication. He explained: “3D-printing tech- nology has proved to be more accurate and more con- sistent in replicating consistency when mass-producing. When using the analog way of fabricating dental appa- ratus, you can never replicate a process with exacti- tude, and we all know how important consistency is in production.” Investing in new technology is a way of reaching and establishing high standards of patient care. As Patrick Thurm, the managing director and general manager for Europe at SprintRay noted, dentists and laborato- ries are currently seeking ef cient solutions for their prac- tices and their patients post-pandemic, and a 3D printer, such as the one from SprintRay, could be a great asset to dental practices, laboratories and patients. aligners 1 2021 27

m o c . k c o t s r e t t u h S / s l i e x p 2 3 © submission guidelines | Xxxxxx | How to send us your work Please note that all the textual compo- nents of your submission must be com- bined into one MS Word document. Please do not submit multiple files for each of these items: · · · · the complete article; all the image (tables, charts, photo- graphs, etc.) captions; the complete list of sources consulted and the author or contact information (biographical sketch, mailing address, e-mail address, etc.) In addition, images must not be embedded into the MS Word document. All images must be submitted separately, and details about such submission follow below under image requirements. Text length Article lengths can vary greatly—from 1,500 to 5,500 words—depending on the subject matter. Our approach is that if you need more or fewer words to do the topic justice, then please make the article as long or as short as necessary. We can run an unusually long article in multiple parts, but this usually entails a topic for which each part can stand alone because it contains so much information. In short, we do not want to limit you in terms of article length, so please use the word count above as a general guideline and if you have specific questions, please do not hesitate to contact us. Text formatting We also ask that you forego any special formatting beyond the use of italics and boldface. If you would like to empha- sise certain words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers. Please do not use underlining. Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line be- tween paragraphs. Please do not add tab stops. Should you require a special layout, please let the word processing pro- gramme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes or endnotes, please let the word process- ing programme do it for you automatically. There are menus in every programme that will enable you to do so. The fact is that no matter how carefully done, errors can creep in when you try to number footnotes yourself. Any formatting contrary to stated above will require us to remove such format- ting before layout, which is very time- consuming. Please consider this when formatting your document. Image requirements Please number images consecutively throughout the article by using a new number for each image. If it is imperative that certain images are grouped together, then use lowercase letters to designate these in a group (for example, 2a, 2b, 2c). Please place image references in your article wherever they are appropriate, whether in the middle or at the end of a sentence. If you do not directly refer to the image, place the reference at the end of the sentence to which it relates enclosed within brackets and before the period. In addition, please note: · We require images in TIF or JPEG for- mat. · These images must be no smaller than 6 × 6 cm in size at 300 DPI. · These image files must be no smaller than 80 KB in size (or they will print the size of a postage stamp!). Larger image files are always better, and those approximately the size of 1 MB are best. Thus, do not size large image files down to meet our require- ments but send us the largest files avail- able. (The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more space should there be room available.) that Also, please remember images must not be embedded into the body of the article submitted. Images must be submitted separately to the textual sub- mission. You may submit images via e-mail, via www.wetransfer.com or Dropbox directly to us. Please also send us a head shot of yourself that is in accordance with the requirements stated above so that it can be printed with your article. Abstracts An abstract of your article is not re- quired. Author or contact information The author’s contact information and a head shot of the author are included at the end of every article. Please note the exact information you would like to appear in this section and format it according to the requirements stated above. A short biographical sketch may precede the contact information if you provide us with the necessary informa- tion (60 words or less). Questions? Please contact Nathalie Schüller at n.schueller@dental-tribune.com. aligners 1 2021 29