Recent advances in orthodontics

1. Recent advances in Orthodontics
By
Dr. Ashok kumar A
MDS

2. CONTENTS
• Introduction
• Recent advances in Brackets
• Recent advances in Bonding materials
• Recent advances in Orthodontic wire
• Recent advances in Software
• Recent advances in Digital orthodontics
• Recent advances in appliances
• Recent advances in robotics
• Recent advances in Bioengineering
• Conclusion
• References

3. Introduction
• There has been tremendous progress in orthodontics since Edward Angle first popularised
the fixed orthodontic appliance.
• Recent years have seen an increased demand for orthodontic treatment from both
adolescents and adults , and in addition, patient and clinician expectations of treatment
outcomes also continue to rise .
• Technological & material advancements in orthodontics has made possible a constant
improvement in the quality of orthodontic treatment ultimately benefiting the patient.

4. Technological infusions that have been game
changers in orthodontics
Up in the Air:Orthodontic technology unplugged! 2017 APOS Trends in Orthodontics

5. Recent advances in Brackets

6. Fabrication of orthodontic brackets
• A new material containing hard alumina nanoparticles embedded in polysulfone was
introduced in year 2012 (UC3M) for making orthodontic brackets.
• The rigidity of the material increases the strength of the brackets & also reduces
frictional and mechanical resistance of the brackets to orthodontic wires along with
maintaining the transparency of the brackets.
• Coating with NPs also improve their properties like:
 Titanium dioxide because of its photocatalytic properties
 Ni-P -WS2 nanoparticles to Reduce friction.
 Zno and Cuo nanoparticles for antibacterial properties
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7. Smart brackets with nanomechanical sensors
• Knowledge of the 3D force-moment systems applied for OTM is important for the
predictability of the course of tooth movement & reduction of traumatic side effects.
• Nanomechanical sensors can be fabricated and be incorporated
into the base of orthodontic brackets in order to provide real-time
feedback about the applied orthodontic forces.
• Allows the orthodontist to adjust the applied force to be within
biological range to efficiently move teeth with minimal side effects.
Smart bracket for multidimensional force and moment measurement.
J Dent Res 86(1):73–78
Lapaki et al 2007 - “smart” bracket
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8. APC –Adhesive Coated Appliance System
• The only orthodontic bonding system that precoats each bracket with adhesive.

9. Wild Smiles braces
• Dr. Clarke Stevens, a practicing orthodontist from Omaha, wanted kids to be able to express
themselves with their braces. Colored bands were already available, so he decided to focus
on the brackets that attach to the teeth, and WildSmiles braces were the result.
• Different bracket shapes can be combined, and colored bands can be added, giving child the
ability to be creative with their smile.

10. Self ligating bracket
• Decreased plaque accumulation compared to conventional
brackets & decreased friction between bracket and arch wire
• Decreased chair time for arch wire changes
• Use of light forces & Possibly faster tooth movement

11. Recent advances in Bonding materials

12. 6th Generation –Self etching primer
• Eliminate wash & dry step after
etching , so collagen collapse by air
drying is avoided.
• Hydrophilic primers- Ortho
Solo, Assure, MIP bond in a slightly
wet environment.
7th Generation - They are first , No mix self etch adhesive provided in single
container combining all steps –Etching , priming , adhesion in bonding .
8th Generation – Voco America introduced Futurabond DC ( nano-sized filler -12 nm
that increases penetration of resin monomer & hybrid layer thickness )

13. Color Change Adhesive
• Color changing adhesive for enhanced bracket
positioning and flash clean-up
• One of the most advantage of these CCAs is
visibility of any adhesive remnant at bracket
seating as well as identifiable cleanup of
adhesive remnants after debonding

14. Nanocomposites And Nanoionomers
• Nanoparticles of reduced size are being used as fillers to reduce polymerization
shrinkage and to improve the mechanical properties of strength .
• Uysal et al (2010) - evaluated the bond strength of nanocomposites and nanoionomers
shown that these nanomaterials may be suitable for bonding in orthodontics as they fulfill
the shear bond strength ranges for clinical acceptability
Types of fillers:
• Nanoclusters
• Nanoparticles
Silica nanosized filler
Titanium dioxide and
Nano zirconia
Techniques
Flame pyrolysis,
Flame spray pyrolysis,
Sol–gel processes.
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15. 15

16. Recent advances in Orthodontic wire

17. Copper NiTi alloy wires
• Introduced by Rohit Sachdeva and Suchio Miuasaki in 1994. This alloy contains 50%-60%
Of copper and 0.2%-0.5% chromium , in addition to Ni-Ti added to
bring down the TTR to oral temperature.
• Copper is added to enhance the thermal properties of
a nickel-titanium alloy.
Super cable –Hanson 1993 - superelastic NiTi coaxial wire
• Seven Niti strands woven together in a long, gentle spiral to maximize flexibility and
minimise force delivery
• This wire was specially developed to be used with SPEED self-ligating bracket sysrem.

18. Nickel-free austenitic SS & TMA Wires
• The steel is alloyed with 15%-18% chromium, 3%- 4% molybdenum, 10% -14%
manganese and about 0.9% nitrogen to compensate for the nickel.
These wires are available as a single-, triple- or six-strand SS wires and TMA (Connecticut
New Arch ,CNA) arches, for example Noninium or Rematitan wires by Dentauram
Titanium-niobium-aluminium (Ti-Nb-Al) alloy
• It has the best mechanical performance among these nickel-free shape memory and
superelastic alloys, was developed as a result of advances in processing technology.
• The Ti-Nb-Al wires can be used as a substitute for Ni-Ti wires.
• The Ti-Nb-Al expansion spring exerted lighter and continuous force and facilitated safe and
efficient tooth movement.

19. Bioforce archwire
• Superelastic shape memory nickel titanium wire that provides gradually increasing forces
from anterior ( Light force to incisor & canines , moderate forces to bicuspids) to posterior
segment ( Molars- Physiologic Heavy forces), all within one archwire.
• By ion beam implantation process , nitrogen replaces nickel on the top and changes the
surface to titanium nitride.
• BioForce wires with Ion Cuard result in a significant reduction
in friction during tooth movement.

20. Dual flex archwire
• The Dual Flex-l: It consists of an anterior section made of 0.016-in. round titanal and a
posrerior section made of 0.016-in. round steel
• The Dual Flex-2: It consists of a flexible front segment composed of a 0.016 x 0.022-in.
rectangular titanal and a rigid posterior segment of round 0.018-in. steel
• The Dual Flex-3: It consists of a flexible anterior part of a 0.017 X 0.025-in. titanal
rectangular wire and a posterior part of 0.018 square steel wire.
• The Dual Flex-2 and 3 wires provide anterior anchorage and
control molar rotation during the closure of posterior spaces and
initiate considerable torque in the anterior segment.

21. Optiflex wires
• Talass introduced the first optiflex wire (Ormco,USA)
to combine optimum mechanical properties with a highly
aesthetic appearance.
Plastic-coated NiTi
• Plastic covered, tooth coloured superelastic nickel-titanium archwires are available as
Nitanium (Tooth Tone).
• It is claimed to have lower friction and blends with natural dentition as well as ceramic,
plastic and composite brackets. It is stain and cracks resistant.

22. Marsenol - Tooth colored Nickel Titanium wire coated with an elastomeric poly tetra
fluroethyl emulsion exhibiting all the same working characteristics of an uncoated super elastic
Nickel Titanium wire, manufactured by Glenroe technologies
Fiber reinforced composite arch wires - fabricated using a procedure called pultrusion.
Fiber bundles are pulled through an extruder, in which they are wetted with a monomer resin &
then cured with heat and pressure resulting in polymerization.
• Circular or rectangular wires are formed during curing. This may be shaped into a different
morphology by further curing, a process known as beta staging.
• Property - High elastic recovery, high tensile strength, low weight, excellent formability,
excellent esthetics because of their translucency

23. Fabrication of Hollow Wires
• Spherical NiTi particles are coated over a textile or a polymer fiber via electrospinning.
Then, the fiber is removed from inside thus producing a hollow wire.
Advantage :
• Possibly reducing the material needed for the wire production.
• They may deliver lighter and more continuous force.
• The bending properties can be customized by inserting another wire into the hollow core.
NiTi/Ni-TiO2 nanoparticles - ultrasonic spray pyrolysis (USP).
Synthesis of NiTi/Ni-TiO2 composite nanoparticles via Ultrasonic Spray Pyrolysis. Materials & Technology Majeric et al. (2015)
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24. Shape memory polymers
• Carbon Nanotubes or Nanofibers & organic-exfoliated Nanoclay are used as fillers.
• SMPs materials have the ability to memorize a macroscopic equilibrium shape and
then be manipulated and fixed to a temporary shape under specific conditions of
temperature and stress.
• Polymers activated by the body temp or by light (photoactive nanoparticles).
• In addition, the SMP materials are clear, colourable,
and stain resistant, providing the patient a more
aesthetically appealing.
Gunes S and Jana C. “Shape memory polymers and their nanocomposites:
a review of science and technology of new multifunctional materials”.
Journal of Nanoscience and Nanotechnology(2008)
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25. Recent advances in Software

26. Orthodontic apps for smartphones
The World of Orthodontic apps. Gupta et al APOS Trends Orthod 2017;7:73-9.

27. Orthodontic Apps

28. Patient
Apps

29. Artificial intelligence and Machine learning
• AI as a science is very broad and encompasses various fields, including reasoning, natural
language processing, planning, and machine learning (ML)
• Work in AI started back in 1943,but it was not until 1956 that the term “Artificial
intelligence” was first used during a conference held at dartmouth college.
• A few years later, the term “machine learning” was officially applied to a checkers-playing
program, considered one of the first successful self-learning tools.
• ML is not intended to mimic human behavior ,it
supplements human intelligence by performing tasks
that are beyond human capabilities
Applications of artificial intelligence and machine learning in orthodontics
Saeed N. Asiri et AL APOS Trends in Orthodontics2020

30. ML FOR DIAGNOSIS AND ORTHODONTIC TREATMENT
PLANNING
• Extraction decision making predicting the extraction decision 80% (Wang et al 2010) and
93% (Jung SK et al 2016, Tang T et al 2019 (Anchorage requirement – 83 % )
• 5–15% better accuracy of landmark detection with ML (Leonardi et al 2008)
• Determining the growth status of patients (Buschang PH et al 2017)
• Overlook diagnosing a lesion, tumor & canine impaction by OPG , lateral ceph
(Laurenziello M et al 2017) & CBCT (Yilmaz et al 2017 )
• Predicting the size of unerupted teeth (Moghimi S, et al 2017)
• To determine the forces needed to align teeth (Omran LN, et al 2018)
Applications of artificial intelligence and machine learning in orthodontics
Saeed N. Asiri et AL APOS Trends in Orthodontics2020

31. • Used to predict the change in lip curvature after orthodontic treatment with or without
extractions. (Nanda SB et al 2017)
• Predictions of treatment outcomes in Class II and Class III patients (Zarei A et al 2006)
• To classify patients craniofacial growth as either normal or abnormal (Perez SV et al 2016)
Scope and performance of artificial intelligence technology in orthodontic
diagnosis, treatment planning, and clinical decision-making - A systematic review

32. Recent advances in Digital orthodontics

33. • It started to make its way into dental and orthodontic offices with the introduction of
computerized scheduling in the 1974.
• In last three decades most offices have now become paperless , digital photography
and 3D radiography & intraoral scans
• To perform virtual treatment planning as well as translate the plans into treatment
execution with digitally driven appliance and placement using various CAD/CAM
techniques , indirect bonding trays and also custom made brackets & to
robotically bent wires.
Digital technology in orthodontics

34. Digital and computerised cephalometrics
• Robert Murray Ricketts (father of computerised orthodontics) spent a significant time in
the development of computerised cephalometric systems , integration of growth prediction
data and visual treatment objectives (VTO).
• Digital cephalometric systems that were developed in 1970s-1980s used 'Disc Operating
Systems' (DOS) , later it was upgraded .
Digital Cephalometrics - Computerised Cephalometrics
Method of image acquisition
Charge Coupled Device (CCD) or
Complemenrary metaloxide semiconductor (CMOS)
Digital radiography (dR)
Photostimulable phosphor plate (PSP)
Computed radiography (CR)
Direct
Indirect

36. 3D Skeletal imaging – CT & CBCT
The first CT scanner was invented by Sir Godfrey N.Hounsfield in 1967.
Xray tube & detector scan the skull image slice by slice of same thickness in axial direction
from head to neck & each slice is stacked over one another in an orderly manner will give us the
3D image of the skull.
• To detect impacted teeth and oral
abnormalities
• Airway & Facial analysis
• Assessment of alveolar bone height &
volume
• TMJ morphology
• Lateral and frontal Ceph views
• Skeletal views & 3D review of dentition

37. 3D cephalometric analysis
• The first 3D cephalometric analysis was introduced by parket al. in 2006
Software tools for 3D evaluation
Mimics (Materialize Co., Belgium)
Dolphin (Dolphin Imaging Systems)
AMIM (Mercury Computer Sys.Germany)
Vitrea (Vital Images Inc.,Plymouth, MN)
Maxilim (Medicim, Sint-Nikaas, Belgium)
Anatomage (San Iose, CA)

39. Cephalometrics without X-rays
• Sonic digitisation is the process of digitisation of face/skull without making the
cephalogram. The system uses sound waves to record the position of a landmark.
• This concept was first introduced in orthodontics by Dolphin Imaging System (USA).
• The system makes use of a headholder (like the one used in cephalostat) to orient the
skull/face. A camera grabs the digital image of the face .
• The DIGIGRAPH sonic digitisation is more accurate
for soft tissue surface landmarks and values of linear
measurements but relatively less precise than cephalometric
for other skeletal and dental parameters.
The DigiGraph Work Station, Part 2: Clinical Management JCO 1990

40. Non-radiation 3D face scanning
3D topography evaluation without hazards of the X-rays (Frey M et.al 2011) have been
made to measure the 3D complexity of the human face, it includes stereophotogrammetry
,image subtraction technique, laser scanning, light luminance scanning and video systems .
Laser scanning
Widely used in anthropometric studies. The first laser scanning system for routine clinical
use was introduced by Moss et al. in 1991.
Drawbacks
• Laser scanning systems are longer capture duration (8-10 s),
• Lack of ability to record soft tissue texture, and
• Need for safety of eyes during scanning, which may interfere with natural facial expression

41. Stereophotogrammetry
• Stereophotogrammetry is a method that utilises means of triangulation and using two
cameras in stereo configuration for recording depth, to create 3D face image
• 3dMD face analysis system can capture facial contours in
180-200 degrees from ear to ear in the ultra-fast speed of fewer
than 1.5 ms that means cameras can record the images unaffected by
the movement, which is unavoidable in children
• The system accurately documents the patient's natural head
position and multiple facial expressions noninvasively during various
stages of treatment cycle
1. 3dMD
2. Axis three
3. Di3D
4. Genex
5. 3D-shape
6. Fuel 3D

42. '4D'imaging
• The assessment and quantification of facial muscle movements are critical for diagnosis,
treatment planning and evaluation of surgical outcome in patients with facial deformities such
as cleft lip and palate. For this purpose the motion capture stereophotogrammetry systems
were introduced.
• Four-dimensional (4D) facial imaging can be defined as a time sequence of 3D models of
facial animations.
• The 4D technology acquires accurate 3D surface information at approx. 60 frames/sec from
various coordinated standpoints for up to a l0-min long resolution cycle.
3dMDfaceTM dynamic system (3dMD, Atlanta, GA)
4D capture system (DI3DTM), Dimensional Imaging,

43. Non-radiation imaging techniques
Magnetic resonance imaging (MRI)
• NMR phenomena were discovered by Bloch and Purcell in 1946
• MRI uses non-ionizing radiation to produce an MR image, the patient is placed inside a
large magnet, which induces a relatively strong external magnetic field.
• This causes nuclei of many atoms in the body including hydrogen, to align themselves with
the magnetic field. After application of RF signal,energy is released from the body,& detected
and used to construct the MR image by the computer.

44. MRI applications in orthodontics
• In the diagnosis of TMJ disorders ( Dentisrty - First by Helms et al. in 1984 ). Disc
position, condylar erosions ,adhesions, perforations & joint effusion & disc displacement
(accurate as arthro-tomography )
• In evaluating the TMJ adaptations following functional appliances (Orthodontics - the
first MRI, a study of TMJ following Herbst appliance therapy -1998)
• In evaluating the jaw muscles and craniofacial morphology.
• It has also been used in measuring the cross-sectional area & muscle volume in response
to myofunctional appliance. 3D reconstruction of jaw muscles is possible using software
applications like 3D Doctor (Able Software Corp., Lexington, USA).

45. Ultrasonography - Nano -LIPUS devices
Ultrasound is a form of mechanical energy that is transmitted through and into biological
tissues as an acoustic pressure wave at frequencies above the limit of human hearing, is used
widely in medicine as a therapeutic, operative, and diagnostic tool . ( 2.5-15 MHz )
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46. • The device will be easily mounted on a bracket or a plastic removable crown. An
energy sensor can also be used that will ensure the LIPUS power is reaching the target
area of the teeth roots within the bone.
• LIPUS - Enhance bone growth into Ti porous–coated implants for osseointegration and
bone healing after fracture and after mandibular distraction osteogenesis and has also
used for stimulating mandibular cartilaginous growth.
• Based on the observation that LIPUS can promote dental tissue formation in rabbits,
El Bialy et al. concluded that it may also be used to treat root resorption.
46

48. 3D digital dental scanners
Contact scanners
The contact scanners map the surface of an
object through physical touch using probe
like instruments.
Coordinate measuring machine
Non-contact scanners
The non-contact scanners use radiation or light
source and detect its reflection or distortion.
3D laser scanners , Photogrammetry,
Interferometric techniques ,Structured light
method, Confocal microscopy

49. 3D digital models
• E-models are three-dimensional (3D) digital models that help to eliminate the need for
traditional plaster models in orthodontic practice
• Duret first introduced the concept of scanning dental arch in 1973.
• The first orthodontics scanning system was developed by OrthoCAD (Cadent,USA) in
1999 and followed by E-models (Geodigm Corp.,USA) in 2001.
• The first 3D intraoral scanner was introduced by CEREC(Siemens, Germany). It was
based on the technology using an infrared camera and use of optical powder (Tio2) on
the teeth to creare a 3D model & recent scanners upgraded ( do not require powdering).
1.Intraoral scanners
2. Impression/model scanners
3. 3D CT-based
Direct & Indirect method

50. Intraoral scanners
1. iTero*, Cadent Inc., Carlstadt, USA
2. CEREC AC Bluecam ,Germany
3. Lava -3M ESPE, St. paul, USA
4. Trios - by 3SHAPE A/S (Denmark)
5. Lythos ,Ormco Corporation
6. CS 3500, Carestream
7. PlanScan marketed by Planmeca
3D desktop scanners
1.Ortho Insight 3D (Motion ViewSoftware)
2. R series, 3 Shape (Denmark)
3. Maestro 3D (ACE Solutions,ltaly)

51. 3D volumetric analysis, and clinical implications
of the upper airway and sinuses
Non radiation methods
Acoustic reflection
MRI
Radiation methods
Fluoroscopy
CT
CBCT

52. Clinical implication of volumetric airway analysis
• Mandibular advancement in skeketal base II malocclusion
• Rapid maxillary expansion & maxillary protraction
• Orthognathic surgery
• Extraction therapy & effecys on airway
The Hitachi MercuRay(Japan) has a stationary mode of a 10 sec recording, which can
evaluate real time movement of oral & pharyngeal region, & proves to be useful in evaluating
amount of the airway changes in mid sagittal view of an awake subject while sitting upright .
3D airway evaluation in 387 subjects from one university orthodontic clinic using CBCT
Chiang CC et al .Angle Ortho 2012

53. The 3D triad in orthodontics
• When these 3D technologies are combined using 3D software
programmes, 3D virtual orthodontic/surgical planning can be
performed digitally. The integrated approach using these 3D data
not only provides a smooth digital workflow in orthodontics but
may also offer reduced errors related to materials, appliance
fabrication and operator skills
Craniofacial Skeleton
Dentition
Soft Facial Tissue Face Scanner Intraoral Scanner
CBCT

54. Recent advances in Appliances

55. Customized Appliances
• Orthodontic appliances that are custom made to fit each individual patient’s teeth, and
designed to move teeth from their initial malocclusion to a pre-determined outcome.
• Invisalign, first introduced by Align Technology, Inc (USA) in 1997, is a technique
that uses a series of customized transparent, removable aligners, which are designed
and created using advanced computer technology, to orthodontically straighten teeth

56. Suresmile® system
• SureSmile, a product of OraMetrix (Richardson, TX, USA), is an orthodontic digital system
that uses an optical intraoral scanner to acquire a 3D digital model of teeth and brackets.
Customized arch wires are robotically formed to incorporate all necessary bends to exert
forces and moments to achieve the desired position of teeth. Custom wires are used in non
custom brackets to achieve an individualized treatment outcome.

57. Incognito™ system - fully customized lingual bracket system.
• Laboratory or digital set up is used to predetermine the desired positions of teeth. All
lingual brackets are individually designed to closely adapt to lingual anatomy of all teeth.
• Custom arch wires are robotically formed to incorporate all necessary bends to exert forces
and moments to achieve the desired position of teeth.

58. • Ormco®’s Insignia™ - One of the most comprehensive CAD/CAM orthodontic
appliances on the market, which was available in standard and self-ligating applications with
optional use of esthetic ceramic brackets
• The organization offers patient-specific brackets, indirect-bonding transfer jigs,
and custom archwires.
• The custom archwires are made by a printing robot that uses the system provided to trace
and bend the wire accordingly, the robot is very accurate and has a very small error margin

59. Robotics arch wire
bending
Cartesian type archwire bending robot
(LAMDA)
Lingual archwire manufacturing and design aid
Motoman up6

60. Bio MEMS/NEMS for Orthodontic Tooth Movement &
Maxillary Expansion
• Concept - Animal experiments indicated that when 15–20 μA of low direct current (DC) was
applied to the alveolar bone to modifying the bioelectric potential osteoblasts and PDL cells,
there is increased concentrations of the second messengers, cAMP and cGMP, leads to
accelerated bone remodeling.
Nanorobotics- Futuristic Approach
• Nanorobotics are self-sufficient machines which are functional at the nanoscale.
• Nanorobots with specific motility mechanisms would
navigate through periodontium to remodel it directly
allowing accelerated orthodontic tooth movement.

61. 3-D Printing in Orthodontics
• A three-dimensional (3-D) printing is also known as additive manufacturing or desktop
fabrication. It is a process of making 3-D solid objects from a digital file.
MATERIALS USED TO PRINT 3-D OBJECTS
The known three PolyJet dental materials
Clear Bio-compatible (MED610)
Vero Dent Plus (MED690)
Vero Glaze (MED620)
Website with 3-D models
database:
• 3-D Marvels
•3-D Via • GrabCAD
• Google 3-D Warehouse
3-D modeling software which
can be downloaded for free:
1. Google SketchUp
2. Tinkercad.
3. Blender

62. PIEZOCISION
• Dibard and colleagues have developed a minimally invasive technique that combines
piezoelectric incisions and microincisions with selective tunneling that helps to produce hard
and soft tissue grafting
• The new approach has led to reduced orthodontic treatment time, minimal postoperation
discomfort, great patient acceptance, and enhanced or stronger periodontium.
• Histochemical studies have shown that piezocision is less invasive and less traumatic than
corticotomy procedures, and bone can regenerate in up to 8 weeks. However, one problem
associated with it is that it can create gingival defect.

63. Ideal Mini-Implant Surface Using Nanoparticles
• Currently, TADs are manufactured with smooth titanium surfaces because
• Biocompatible coatings like Titanium nanotubes are studied to evaluate if the nanotubular
layer can enhance initial osseointegration and can serve as an interfacial layer between the
newly formed bone and the TAD.
• To Improve the Primary Stability of TADs
Nanostenciled RGD(Arg-Gly-Asp)-gold patterns
Tricalcium phosphate (TCP) nanocoating
Ultrafine grain-sized titanium (UFG Ti)
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Complete osseointegration is a disadvantage that complicates their removal.
Lack of osseointegration is also one of the factors for the failure of TADs.

64. Recent advances in Bioengineering

65. Orthodontics in the year 2047 Genetically driven treatment plans
Havens, B. Wadhwa, S. and Nanda, R.:
J. Clin. Orthod. 41:549-556, 2007
Gene therapy for sutural growth disturbances:
• Mutations in FGFR2 have been linked to several human craniosynostosis
disorders, including Apert, & Crouzon syndromes.
• In cases of craniosynostosis involving mutations in FGFR2, temporarily blocking
FGFR2 signaling in the preosteoblasts within the sutural mesenchyme or providing
a different anti proliferation signal to these cells would allow normal sutural growth
without surgical intervention.

66. Gene therapy to enhance condylar growth using rAAV-VEGF
Objective: To test the hypothesis that the introduction of specific vascular growth inducing genes
would favorably affect mandibular condyle growth in rats over a limited experimental period
Result: Enhancement of mandibular condyle growth occurred in backward and upward direction
in VEGF group rather than control group.
Local RANKL gene transfer to the periodontal tissue accelerates orthodontic tooth
movement Kanzaki.H et al Gene Therapy 2006
Result – It was demonstrated that transfer of the RANKL gene to the periodontal-tissue ,activate
osteoclastogenesis and accelerated the amount of experimental Toot movement.
Local RANKL gene transfer might be a useful tool not only for shortening orthodontic
treatment, but also for moving ankylosed teeth where teeth, fuse to the surrounding bone .

67. Conclusion
• There have been many technological advances in orthodontics that have improved diagnosis,
treatment planning, treatment precision, and treatment efficiency.
• However, none of these advances are a substitute for sound diagnosis, and clinical judgment.
A high-tech customized orthodontic appliance that is capable of achieving excellent results
with high precision will still result in a bad outcome if the diagnosis and treatment plan are
not well thought out.

68. References
• Orthodontics, current principles and techniques by Graber & Vanarsdall -6th edition
• Contemporary orthodontics by William Proffit- 5th edition
• Up in the Air:Orthodontic technology unplugged! 2017 APOS Trends in Orthodontics
• Smart bracket for multidimensional force and moment measurement.J Dent Res 86(1):73–78
• The DigiGraph Work Station, Part 2: Clinical Management JCO 1990
• Shetty NJ, Swati P, David K. Nanorobots: Future in dentistry.Saudi Dent J. 2013; 25(2)
• Orthodontics – Diagnosis and mangement of malocclusion and dentofacial abnormalities –
Om Prakash Kharbanda – 3rd edition