(Dr. Hangorsky) Hello and welcome. Orthodontics is the dental specialty dealing with the correction of irregularities of the teeth, such as malocclusion, often by the use of braces. The purpose of this treatment is to ensure a proper form and function of the dentition. Like many other medical entities, orthodontic therapy has been undergoing significant changes influenced by the rapidly emerging technology, one of which is the exciting field of clear aligner therapy. To discuss this new emerging area is Dr. Sam Kadan. Dr. Kadan is a Magna Cum Laude dependent graduate who completed his orthodontic specialty training at the University of Rochester, Eastman Institute for Oral Health. He's board-certified in orthodontics with extensive clinical experience and he is a faculty member at the department of orthodontics at the University of Pennsylvania School of Dental Medicine. Welcome, Dr. Kadan. (Dr. Kadan) Thank you. (Dr. Hangorsky) So, perhaps you could start by providing a general overview of the dental domain we are going to discuss. Tell us, what is clear alignment therapy? (Dr. Sam Kadan) So, the last 20 years, we've had a lot of advances in technology that enabled the use of what's called clear aligners, these are thermoplastic materials that are used to straighten teeth. They work by gently applying forces to the teeth throughout the use of a series of clear aligners. These are worn by patients and changed periodically, typically once a week, to make changes in the tooth position. They are also removable, which means people are able to remove them and go about special occasions, weddings or dinners, without showing that they are actually doing anything about their teeth. They've become very popular, and that's what we're going to be discussing today. We're going to discuss the technology, how they work, their limitations, and the innovative aspect of these aligners and the future of technology, and how it's going to affect orthodontics. (Dr. Hangorsky) Perhaps it's appropriate to tell us, what is the technology that enabled this technique to take place? Would you discuss a little bit? (Dr. Kadan) The clear align technology has been around for about 20 years+. It used to be that we would have to take molds of the teeth, which is an imprint of the teeth, in order to create these aligners. The new development that happened over the past 15 years is the 3D CAD/CAM technology, in which we use a device to capture 3D video of the teeth and the oral tissue. That enables the lab to create a 3D rendering of that. That enabled us through advanced AI-enabled software to move the teeth on these 3D models and create a progressive straightening of these teeth every step of the way and pausing, and creating these trays that enable these trays to move the teeth. Think like a movie where you stop and pause the movie, and you do a 3D print of that stage. Over time, you'll have a succession of clear aligners that are taking us from a crowded mouth to a straightened mouth. That technology is very impressive. (Dr. Hangorsky) My question is, how does this technique address the clinical needs of population? Because the question could be asked, why to put braces and suffer with them for so many years, where if you can put something that's clear and invisible? Are there advantages, disadvantage if you could tell us? (Dr. Kadan) Yes, they are becoming very popular. For obvious reasons, aesthetic considerations, and comfort, they don't have any pokey wires. There are no food restrictions with these, so patients do like them. They're becoming more popular with teens these days, my son included. The advantages are, in addition to what I've mentioned is that we can see the patients less frequently than with braces. There are no emergencies, no wires poking. With braces, if the wrong foods, you can pop a brace off, and then you'd have to show up at the office so we're able to see these patients sometimes every 3-4 months as opposed to every 6-8 weeks. It creates more availability in our schedule to see more patients with this type of technology. (Dr. Hangorsky) Are there some limitations? Because one could say you could eliminate braces altogether at this point. (Dr. Kadan) Yes, there are some limitations as of now. The technology has improved tremendously, and we're able to treat very complex cases using clear aligner technology. However, there are certain cases where we would have to combine a hybrid treatment where we would have to use hardwired auxiliaries and fixed appliances to still aid certain movements. I must say that over 90 percent of the cases can now be treated with Invisalign. Yes, the technology is geared to taking over probably braces in the next 20, 30 years. But as of now, there are certain limitations to this. (Dr. Hangorsky) Perhaps you could discuss, what are the limitations of clear alignment therapy. You discuss the advantages. But what would be the limitation? Are there any cases which would not be appropriate to be treated by this approach? (Dr. Kadan) So, there are certain cases that we still don't have that much control over the movement through the clear aligner technology. For example, molar uprighting it's still not great with this technology. The root control. Torque control is still not as good as with fixed appliance therapy. Now, there are certain things that clear aligner therapy does better than with braces, for example. Open bite treatment is much better with clear aligner therapy than with braces. Just because the way it works just lends itself to certain cases better than others. For example, open spaces. If you have some spaces between your teeth, clear aligners can do a better job and quicker than braces, traditional braces. Here are examples of cases that were treated using clear aligner therapy. As you can see, we could treat very complex cases. (Dr. Hangorsky) This seems like an excellent approach to orthodontic treatment. How do you think this is going to affect future orthodontic therapy? Will this make it more accessible to more patients? Is this going to be cheaper? Because right now orthodontic therapy is reasonably expensive. Will that somehow change the nature of the specialty? (Dr. Kadan) I think it will, and it already has. We are going to have more advancement in this technology to the point where we could do more complex movements, and thereby eliminating the need for fixed appliances altogether. Advances in AI are also making it possible to perform teledentistry with clear aligners. Making it possible to reduce the visits to the orthodontists while still being supervised by an orthodontist. In office 3D printing of clear aligners, will give orthodontists and patients the ability to get these aligners the same day as the initial console. What will happen is that a patients will walk through our door and they will get their clear aligner therapy that same day, thanks to the 3D printer technology that we have available. The accessibility is going to increase to the population. I think by orthodontists being able to print these aligners in the office, it's going to make it more affordable. The technology is also enabling us to see the patients less frequently, which will open up our schedule to enable us to see more patients. That will drive the cost down over the long term, and it will make it more accessible to more population. Right now probably less than 3% of the population is being treated by orthodontists in this country. There's a huge demand and huge opportunity to reach other people. (Dr. Hangorsky) Since we discuss the impact on dental education, do you think that this is something that should be taught routinely in dental school or is it really more appropriate to graduate programs? (Dr. Kadan) I know for a fact that we teach this technology in our graduate program here at Penn. I believe the dental students are exposed to clear aligner therapy and protocols. Light cases should be able to be treated by general dentists. But for complex cases and more ideal results, orthodontist will be the place to treat these cases. But yes, it should be definitely a part of the curriculum. (Dr. Hangorsky) Well, thank you very much for coming here today. I appreciate it. (Dr. Kadan) Thank you.
