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Clear Aligner Orthodontic Therapy:
Entry Point for In-office Digital Dentistry?

By Arthur R. Volker, DDS and Angel De Leon

Introduction While the incorporation of in-office digital
The evolution and incorporation of digi- dentistry offers many benefits to the clini-
tal dentistry has changed the landscape of cian and their patients, the initial invest-
not only the dental office, but of the dental ment may be cost prohibitive, especially
laboratory as well. According to the Na- if the office does not do enough units of
tional Association of Dental Laboratories, indirect restorations to justify the expense.
the number of dental laboratories has de- However, one potentially viable entry point
creased in the United States over the past to the use of digital dentistry that may offer
19 years. This may be due in part to the a favorable return on investment (ROI) in-
1
fact that smaller volume labs may not be volves the use of the 3D printer. Figure 3. Intraoral scan.
able to afford the higher cost of digital ma- The 3D printer is versatile and can be used
chinery or may be unfamiliar with how to to print models, stents, and surgical guides. digital laboratory (Lab Pronto, Blue Sky
use them. Additionally, there is a small, but They tend to have a low price point, mak- Bio, Libertyville, Il). Alternatively, PVS
growing number of clinicians and techni- ing them quite equitable. Perhaps the great- impressions could have been taken and
cians collaborating by creating dental labs est ROI from the purchase of a 3D printer shipped to the lab.
within dental offices. 2 involves the in-office fabrication of clear
orthodontic aligners. The following case re- Once at the laboratory, incremental ortho-
One advantage that digital dentistry of- port will outline the protocol used to do so. dontic movements were calculated and
fers is a reduction in the workforce need- mapped by orthodontic software. The net
ed, as many tasks such as scanning, virtual Case Report result was the creation of a Stereolithogra-
mounting and margin preparation can be A 25-year-old male in good overall and phy (STL) file that contains a virtual model
performed quickly by a single trained tech- dental health presented to the office un- of each sequential step in the orthodontic
nician via the design software. In fact, in the happy with the appearance of the “spaces process (Figure 4). In this case, 12 aligners
time it takes for a single impression to fin- between my teeth” (Figure 2). Slight dias-
ish a disinfection protocol, a technician can
digitally prepare multiple cases for design.
The design aspect can progress even more
efficiently, as there is no need for an analog
wax-up, or ancillary procedures such as in-
vestment / divestment or pindexing.

The second advantage of the digital lab is
the greatly reduced physical space needed.
The author’s in-office laboratory shown in
Figure 1 demonstrates the smaller footprint Figure 2. Initial presentation showing
needed for a fixed prosthetic laboratory. It diastema in anterior region. Figure 4. STL file of proposed successive
is contained in one room and includes a orthodontic movement.
bench scanner, a wet mill, a dry mill, a 3D temas were noted in the anterior. The pa- were prescribed, so the STL file contained
printer and several ovens. tient had been given the option of crowns 12 upper and 12 lower models. It should be
and veneers with another office but was un- noted that there are orthodontic software
comfortable at “having my modules available if the clinician wishes to
teeth drilled”. He also had control the orthodontic movements them-
orthodontic therapy as a selves.
teenager but was admitted-
ly non-compliant with his At the office, the STL file was download-
removable retainer. It was ed, and prepared for printing using a po-
decided to treat this case sitioning software (PreForm, Form Labs,
with clear aligners as only
slight tipping movements
would be needed.

The patient was scanned
using an intraoral scanner
(Trios3, 3Shape Copenha-
Figure 1. In-office laboratory with equipment contained in gen, Denmark) (Figure 3).
one room. The scan was then emailed
directly to a full-service
www.nysagd.org l Fall 2021 l GP 20 Figure 5. Models taken from the printer.