OPENING CEREMONY

Dr. Francesco GARINO - EAS President
Dr. Tommaso CASTROFLORIO - EAS Scientific Chairman
Dr. Werner Schupp - Journal of Aligner Orthodontics Editor
Dr. Werner Schupp - Journal of Aligner Orthodontics Editor

Past and present Invisalign treatment

Past and present Invisalign treatment
1. Brief review of the early development of Invisalign in 1997-8, evolution of attachments, tracking and staging of movement with finite element models, materials, software development and treatment efficacy.
2. New protocol for class III treatment.
3. Health benefits of Invisalign

The cutting edge of the Airnivol system: the prediction of biomechanical response

The predictability of a successful orthodontic treatment is important for both our patients and ourselves. Documented treatment outcomes in the literature may be an excellent way to help predict specific patient outcomes, and, from a theoretical point of view, an evidence-based approach should make our aligner treatment more predictable. Unfortunately, the scarce quality of the evidence still makes our clinical activity an experience-based practice.
This lecture will focus on the application of biomechanics and FEM simulation studies to build a reliable clinical protocol for the aligner therapy.

Aligner force gradation using foil thickness variation - an experimentally validated approach

In the last two decades, new aligner systems utilizing CAD/CAM methods for the design and fabrication process have been introduced. These systems are usually based on two fundamentally different concepts. In the first approach (realized e.g. in the Invisalign sytem), setup steps are minimized to values ≤0.2 mm so that stiffer aligners of uniform thickness can be used. The second approach (realized e.g. by CA digital) corrects malpositioned teeth in larger steps with relative tooth displacements ranging between 0.5 - 1 mm. To maintain the force and moment values applied to the teeth at an appropriate force level during ongoing alignment, this approach uses a sequence of three aligners with increasing thickness per setup step (recommended are 0.5- / 0.625- / 0.75-mm). Guidelines for both the “optimum” movement ranges of single teeth in each treatment step and selection of thermoplastic foil thickness are rather empirical in nature and have not been sufficiently experimentally evaluated. In a series of experiments we systematically evaluated the second approach by studying the interrelation between the amount of displacement of single teeth in the setup and the resulting 3D force-moment systems applied to the teeth. Aligners with a thickness between 0.3 - 0.75 mm were tested. From the results we conclude that thinner aligners may have the potential to reduce or even prevent overloading the teeth during aligner treatment observed in previous experimental and clinical studies. Based on our experimental data we suggest a novel sequence including the 0.4-mm, 0.5-mm and 0.75-mm aligners for future clinical application, because such sequence achieves the most regular force gradation within one setup step

The speaker did not give permission to record his lecture for either un-approved publication content reasons, or incomplete research content reasons.

F22 biologic teeth aligners

The most recent articles on the efficacy of aligners in achieving orthodontic movement have demonstrated that this type of appliance still has some important limitations. Nevertheless, aligners continue to grow in popularity among patients, for whom aesthetic and removable solutions are highly desirable. Traditional fixed appliances are no longer well tolerated by either adults or young patients, and it is therefore vital to find ways to meet their expectations.
In this lecture it will be shown how F22 aligners can successfully resolve simple and even complex cases. The staging, the use of vibrations for tooth movement acceleration and the means of using miniscrews alongside aligners in maxillary contraction, crowding and class II cases will be dis-cussed. The efficacy of F22 aligners as an aesthetic solution will be demonstrated by clinical case discussion.

Modern Eclectic Orthodontics: change the way you approach Aligner design with Suresmile Elemetrix

This lecture will explain a modern hybrid appoach to orthodontic treatment. A digital workflow showing a way to combine diagosis and treatment simulation will be discussed. A method to seemlessly combine fixed and aligner treatment will be shown. Simple and cost-effective solutions to common orthodontic problems will be illustrated by case presentations.

Clear aligner and tooth movement

Clear Aligner technology has evolved over the last 15 years, with these appliances continually being modified to increase the range of tooth movements that they can achieve. This lecture will review the different aligner generations, discuss tooth movement in general and specifically discuss the movements produced by aligners. Current research involving attempts to increase the rate of tooth movement and growth modification will also be presented.

Where is the limit? Complex cases with Invisalign

Chapter IX the end of the brackets.
Brakets dominate the galaxy after attempting to destroy the peaceful Republic of the aligners they have decided to send their ruthless legions to assume military control of orthodontics.
Only General Manuel Román and his group of fighters of the ALIGNERS´S RESISTANCE oppose the growing tyranny convinced that it will return and restore the spark of hope in the struggle.
As the braces followers head toward the rebel base, the brave heroes organize a counterattack.

Motion and aligners

Orthodontics is a facial, skeletal and dental speciality. None of those three areas can be isolated in an Ortho treatment as all of them are in a complete interrelation.
The orthodontist is responsible of the facial harmony of the face of the patient.
Carriere Motion Appliance is a Sagital corrector that will work into the correction of our Class II and Class III cases in a minimally invasive approach for non extraction orthodontics.
The use of the Carriere Motion Appliance as a non-extraction, predictable and minimally invasive distalization approach for Class II and Class III malocclusions will be discussed. Aspects as principles developed by nature for optimization of material and force with elegance of forms will be studied as well as the reduction of a design to an extreme for maximum function optimization. The result will be a nature-objectified design that will simplify dramatically the Orthodontic Aligner Therapy in complex cases.

Mixed dentition treatment with aligners

James Mah will focuses on expanding the scope of aligner therapy with combination treatments and early treatment appliances to offer a greater aesthetic choice for patients. He will also touch on the use of fixed appliances at certain stages of treatment (i.e. severe rotations, patient preferences) and early treatment aesthetic appliances. This lecturer will review aesthetic rapid palatal expanders, Class II and Class III correctors.

Enjoy early orthodontics with CA-Clear Aligner

Tipical aligners worldwide application is commonly related to adolescents’ o adults’ particular types of malocclusion.
It is possible to enlarge aligners’ indications also to early othodontic treatments in order to make them easier, faster, cheaper and less invasive than traditional fixed appliance-double-fase treatment.
Dentoalveolar anterior and posterior crossbite can be successfully treated with modified CA Aligner provided with a central screw in order to achieve maxillary expansion combined with anterior aligment or mandibular repositioning if necessary, avoiding or simplifying 2nd stage orthodontic finalization.
Moreover, management of serial extractions could be easily dealed with progressive soft clear aligners on the basis of a particular early protocol; it allows torque control and intrusion/extrusion biomechanics in order to promote a gentle guide to normal occlusion in concert with extraction pattern.
Staged Power Grip, elastics mechanics and digital settings allow more detailed biomechanics regarded to particularly complicated early cases.

Treatment of Class II in growing patients by aligners

Treatment strategies for CI II growing patients depends on Bone age, Mandibular growth potential, and the severity of the malocclusion. Indeed, it is the initial orthodontic diagnosis that determines whether the class II should be corrected by an activator, by molar distalization or by dentoalveolar compensation.
Recently, the integration of the mandibular advancement system into the invisalign aligners has allowed to create a new generation of Mandiublair activators. It has many advantages over other activator systems ; It allows teeth alignement and favors mandibular growth with vertical control and stability of the position of the lower incisors. The patient compliance is higher compared to others systms because it is more aesthetic, more hygienic and more comfortable.

Management of impacted teeth with aligners: achieving success and predictability

Treatment strategies for CI II growing patients depends on Bone age, Mandibular growth potential, and the severity of the malocclusion. Indeed, it is the initial orthodontic diagnosis that determines whether the class II should be corrected by an activator, by molar distalization or by dentoalveolar compensation.
Recently, the integration of the mandibular advancement system into the invisalign aligners has allowed to create a new generation of Mandiublair activators. It has many advantages over other activator systems ; It allows teeth alignement and favors mandibular growth with vertical control and stability of the position of the lower incisors. The patient compliance is higher compared to others systms because it is more aesthetic, more hygienic and more comfortable.

Unexpected complication of bonded retainers and retention protocols

The purpose of this lecture is to discuss the controversial issue of long-term stability of orthodontic treatment results. Long-term stability is often considered to be a myth. Therefore, long-term retention with fixed retainers is indicated as one of the approaches to tackle this problem. Fixed retainers, despite many advantages, do have some disadvantages as we may encounter a reasonable number of common complications, such as bond failure or wire fracture. In addition to that, unexpected complications may occur, some with severe manifestations that require orthodontic retreatment and reconstructive periodontal surgery.
Attendees of this lecture will be able to define the problems that may occur during the retention period, to recognize and distinguish the types of unexpected complications of lower fixed retainers, and also will be able to assess the risks associated with unexpected complications and propose necessary treatment.

Interproximal reduction: how, what and when

Interproximal reduction (IPR) is the selective mechanical removal of enamel from between the teeth to achieve orthodontic goals.
This presentation will cover:
• When IPR is indicated.
• How to identify the indications for IPR.
• How to plan IPR for simple, complex and also for periodontally compromised cases.
• A logical set of steps and considerations you can implement as the doctor so that your patients can benefit the most from using this technique during your clear aligner therapy.
• When to stage IPR so that you are able to gain clinical efficiencies in clear aligner therapy and so it is super easy and you get predictable results,
• How to communicate with your clear aligner technician to stage the digital set-up so you can perform the IPR successfully and at the best time.
• What non-expensive IPR equipment I actually use in my private clinic to perform IPR.
• How to perform IPR in a safe, simple and consistent way.
• A video demonstration of me performing IPR on a patient.
• Possible pitfalls to be aware of when performing and planning IPR

Accelerated Aligner Therapy: the SoftPulse technology in the daily clinical practice

Since reliable and precise tooth movements are essential for ideal orthodontic treatment results, can clinicians offer the same or even better patient outcomes with Invisalign as they do with standard wire and bracket systems? Can they be confident in the predictability of the desired movements and outcomes? During this lecture, Dr. Ibrahim will explore some difficult treatment goals and walk you through her journey of integrating Accelerated Invisalign as her preferred treatment modality for all patients. Through a series of case reviews, she will show how integrating AcceleDent with Invisalign treatment helps ensure that the programmed movements in the aligners will be expressed more predictably during the treatment period. She will discuss how Align Technology’s innovations with the software, materials and features built into the aligners also help ensure that she’s able to provide the same, and more often, better control of tooth movement, more efficient patient care and enhanced results than with standard fixed appliances, more predictably.

Accelerated Aligner Orthodontics – Getting better results faster

Dr. Daher has more than 4 year experience testing and using different methods of acceleration. Today he is a user and key opinion leader of Biolux Research’s Light Accelerated Orthodontics product, OrthoPulse.
In his session Dr. Daher will talk about the scientific background of OrthoPulse and photobiomodulation. He will share as well his experience on how OrthoPulse helps accelerate his cases as well as increase the overall comfort of treatment for the patient and improve as well the predictability of the treatment.
Dr. Daher will present both the science and some case examples.

Extended CA-Clear Aligner indications with auxiliaries

In many cases, aligner therapy is the perfect answer to the demand of our patients for invisible orthodontic treatment. However, certain tooth movements are challenging or even impossible to achieve if only aligners are used. With a combination of different treatment strategies and auxiliaries, it is still possible to master also these cases while the benefits and the comfort of aligner treatment -for both the patient and the orthodontist- is maintained. If auxiliaries are used, the indication for aligner therapy is considerably extended. In this lecture, different approaches, including bone anchorage devices, for achieving difficult tooth movements with CA CLEAR-ALIGNER therapy are presented. Also, the CA CLEAR-ALIGNER system and its specific benefits for the patient and the orthodontist will be explained.

Not only plastics. Auxiliaries in aligner orthodontics

With bonded appliances alone, using only braces and wires, not all cases can be solved - often auxiliaries are essential. The same is true for orthodontic treatments with aligners. Auxiliaries in combination with aligners improve the predictability of planned movements and are mandatory in order to achieve good results for both intermediate and difficult cases. This lecture shows the most commonly used auxiliaries and how to improve their effectiveness. A focus is set on the biomechanics when controlling mesial movements of molars. Clinical examples demonstrate the range of the possibilities when using not only plastics.

Class III : Lower arch sequential distalization protocol

Sequential lower distalisation is applied in the lower arch to treat a series of class III malocclusions of diverse complexity.
Bevellled attachments are placed at the lingual Surface of lower incisors in order to increase aligner fitness and serve as an anchorage unit during sequential distalization of lower molars and premolars.
Sequential attachment is placed at the stage when lower second and first molars finish distalisation .The purpose is to increase aligner fitness and anchorage for the upcoming lower premolars and anterior teeth.
The clinical goals of sequential distalisation is to go from Class III to Class I molar and canine and also to achieve space in order to reestablish anterior overjet, overbite and an interincisal angle within the norma (130 degrees).
With “Esthetic Start Motivation“ patients achieve short term lower anterior esthetic results keeping high motivation and full time aligner wear during total treatment time.

The speaker did not give permission to record his lecture for either un-approved publication content reasons, or incomplete research content reasons.

Biomechanics and aligners orthodontics

The fundamentals of biomechanics in orthodontics and their application in clear aligner treatment will be presented. The mechanics of SmartForce features, SmartTrack material, and SmartStage technology as used in the Invisalign System is discussed. An engineering approach to advancing the capabilities of the Invisalign System in treating all types of malocclusions will be presented.

Strategic anchorage management in complex cases with aligners

We have seen a rising demand in recent years, especially from adults, for inconspicuous and natural feeling orthodontic appliances. When the Invisalign system was introduced, it had limitations such as the inability to control root movement and to move larger teeth over substantial distances. Advances in the Strategic Anchorage control for Aligner and the introduction of a Biomechanics of Aligner Orthodontics, however, have expanded the range of treatment possibilities from mild crowding to more difficult extraction cases.
(1) High Canine, Anterior Crowding: Four 1st Premolars Extraction
(2) High Canine, Anterior Crowding and Open bite: Four Premolars Extraction
(3) High Canine, Anterior Crowding, hope less Lower 1st Molars:Upper 1st Premolars, Lower 1st Molars Extraction.
(4) High Canine, Anterior Crowding:Non Extraction, Upper Molars Distalization and Expansion.
(5) Skeletal Class III, Open bite: Non Extraction, Lower Molars Distalization with using TADs.

Interdisciplinary approach in clear aligner treatment

Orthodontics is not just for children and adolescents. Incresing numbers of adults have been referred to orthodontists to correct malocclusion and above all to improve the restorative treatments goals. In many istances, there is a need for a combination of restorative and orthodontic care to achieve ideal form and function.
Align the teeth first not only helps reduce the amount of tooth structure that is removed, it can also aid in improved oral hygiene and healthier periodontium.
Patients seeking cosmetic restorative dentistry will often decline conventional orthodontics because of unesthetic appereance of the appliance. Invisalign could help the patients to accept interdisiplinary treatment with invisalign. After orthodontic treatment, restorative dentistry could created ideally proportioned restorations to provide improved esthetics with a less aggressive impact on tooth structure and get a better occlusal function.

The speakers did not give permission to record their lecture for either un-approved publication content reasons, or incomplete research content reasons.

Aligner therapy and periodontal health

Fixed orthodontic appliances (FOA) temporarily interfere with periodontal health of patients, as the appliance complicates oral hygiene. Prevention of oral inflammation is considered to be a key element of good oral and systemic health. Therefore, strict oral hygiene measures and special diet are necessary to minimize periodontal inflammation.
In this presentation, oral health conditions of orthodontic patients will be discussed and on basis of our findings some strategies will be argued which could be helpful to improve the oral health conditions during FOA.
First, the effect of additional oral hygiene instructions and diet advices in a closely spaced interval will be discussed. Second, advantage of an alternative for FOA, Invisalign, which offers not only the advantage of better esthetics but also the convenience of removal during food and beverage consumption, as well as oral care will be introduced.

Digital Smile Design

“Even though I’m not an orthodontist, improving the digital smile design process made me a huge fan of this amazing specialty and understand better the importance of integrating it into our interdisciplinary cases. Improving facial analysis and facially driven smile design projects, increases the awareness of how we can benefit from tooth movement, creating more conservative, functional and esthetic outcomes.

As a Smile Designer/Technician, I had 3 issues related to orthodontic treatments: first, understand which cases could benefit from tooth movement and how they would benefit; second, convince the restorative dentist about this benefit; third, help the dentist educate and motivate the patient about this beautiful option and increase case acceptance. DSD helps in all 3 matters, creating a visual understanding about the interdisciplinary relationship, improving team communication and developing an emotional link between the patient and the comprehensive solution.
You don’t need to be a biomechanics expert to understand that aligners are the future when it comes to moving teeth. The main reasons why I believe in that is because the future of predictable and high quality treatments will also bring digital planning and virtual treatment simulations to the table. Testing virtually the options before touching the patients mouth. When approving a virtual treatment, the only way we can translate the ortho part of it into reality in a consistent way is through aligners. Thats the main reason why I love to see how professionals from all over the world are embracing aligner technology and creating solutions for all different types of situations.”

Clinical considerations for the use of skeletal anchorage devices in orthodontics

In this presentation the speaker will introduce the the use of skeletal anchorage in orthodontics.
The following items will discussed:
- ideal structural characteristics of miniscrews (treads design, material, core design, head design, etc.)
- anatomical guidelines for miniscrew insertion and complications
- combination of miniscrews and different orthodontics appliances
- digital planning for palatal miniscrew insertion

TADs anchorage management in aligner therapy

Orthodontic treatment with aligners has now days been incorporated in almost every orthodontic practice. The rising demand for aligner therapy is evident, as a growing number of patients requests this specific treatment modality, even for the more complex cases. It is well established that aligners can perform efficient and effective tooth movements within a specific range; however, large bodily tooth movements may sometimes exceed the range of aligner effectiveness. In order to assist these movements and also to reinforce anchorage requirements, temporary anchorage devices (TADS) can play an important role. TADS have become popular due to their unique biomechanical properties, minimal invasiveness and lack of potential complications. Additionally, palatal TADS offer serious advantages compared to buccal ones, such as increased stability and lower failure rates. The combination of TADS and aligners can take place in various modalities, based on treatment preferences and needs. The two of them can act synergistically in a very effective way and expand the borders of invisible orthodontic treatment.

TAD borne sliders and aligners, problems and solutions

The spectrum of aligner therapy seems to be limited if it comes to difficult tasks like bodily movement of teeth, forced eruption of impacted teeth, and molar intrusion. TAD borne appliances provide the opportunity of a pre-aligner therapy to modify a difficult case into an easy case that can be finished with aligners in a significantly shorter treatment time. Their small size allows mini-implants to be inserted in a variety of sites. Currently, the alveolar process is the most preferred insertion site. However, due to the varying bone quality and the risk of root contact, the survival rate of implants inserted in the alveolar ridge still needs improvement. Other regions, such as the anterior palate, provide much better conditions for a TAD insertion, since the amount and quality of the available bone is far superior. Utilizing TAD´s in the anterior palate eliminates the risk of root injury and takes the implants out of the path of tooth movement.
In this lecture, reasonable combinations of aligners and TADs as well as possible problems that may occur are shown.

Surgery First using Skeletal Anchorage and Aligners

Since most of the Class III patients who underwent Surgery First (SF) show Class II open bite immediately after orthognathic surgery due to no presurgical orthodontics and occlusal interference at the molar region, the Skeletal Anchorage System (SAS) biomechanics utilizing titanium anchor plates is indispensable for distalization and intrusion of the maxillary posterior teeth, and mesialization of the mandibular posteriors during postsurgical orthodontic treatment. In addition to SAS, we are recently applying aligners to reduce treatment time of multi-bracket system in order to raise the QOL during postsurgical treatment. As the SF patients need quick three-dimensional molar movement immediately after surgery, it seems to be less beneficial to completely eliminate MBS in post-surgical orthodontics at the present time. But, there is no question about that the application of aligners to detailing and finishing is very friendly to patients. In this presentation, I will discuss the advantages of our SF using SAS and aligners.

What is the future for Invisalign treatment?

1. Accelerated treatment with surgery first and Invisalign
2. Recent development of 3-D integrated model with intraoral color scan, 3-D color video and CBCT.
3. Mixed Dentition treatment
4. Improved protocols for various types of Premolar extraction treatment.