Individualized treatment is the gold standard of orthodontic therapy. Digital dentistry applications brought that goal closer. Most recently, 3D-printing with LightForce technology has made the goal of 100% customization achievable. Before 3D printing, companies were still striving to achieve as close to customization as possible. Notable brands like Insignia paved the way for this evolution.
When Insignia braces were developed, the concept focused on orthodontists’ increased emphasis on digital workflow and computer-aided smile design to create “patient-specific appliances.” John Piervencenti, Director of Professional Education and Sales for LightForce Orthodontics, notes that about 15 years ago, Insignia was one of the pioneers of custom orthodontics, combining a digital workflow and stock brackets with custom tips and angulations welded onto the bracket. “It filled a custom-goal,” says Piervencenti, “but there were downsides — the bracket could be a bit bulky and didn’t solve the ‘in-out’ dimensions.”
That type of design does have its stumbling blocks. North Carolina-based Orthodontist Grant G. Coleman, DMD, MS, explains, “The inability of the Insignia brackets to customize a base to fit the anatomy of each tooth is a drawback. Aberrations in tooth anatomy cannot be accounted for with a non-customized base, and this introduces the potential for error in bracket placement, leading to the need for future rebonds or finishing bends, or both.”
Everyone’s teeth, jaw, and facial structure are so unique that 100% customization makes sense for orthodontic treatment. Piervencenti says that LightForce brackets fulfill that goal because of the 3D- printing capability. “Everything is fully 3D-printed to be custom from the tooth surface of the bracket to the end. That results in a truly 100% custom base.”
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Dr. Coleman notes that LightForce “takes bracket customization to a level unachievable by Insignia and other indirect bonding systems. The 3D-printed, fully customized base of each bracket perfectly contours to the specific anatomy of each tooth, eliminating the possibility of a misfit or "wobbling" of the bracket.” He continues, “Also, significant rotations or malpositions are easily compensated for by the LightForce software's ability to position the bracket literally anywhere on the crown and altering the base to match the desired bracket slot position. Finally, there are no special wires, because all the first, second, and third order positions are already programmed into the bracket, making it a true straight-wire appliance.”
Insignia’s component of a robotic bent archwire adds to the individualization aspect. However, Piervencenti notes that with the LightForce system, the ability to custom print every part of the bracket eliminates the need for the robotic archwire. He adds that the robotic bends in the wire sometimes create defects that cause them to break. “While robotic archwires were advanced for their time and a good solution for Insignia, if they break, treatment stalls until the patient returns to the office, is re-scanned, and the information is sent back to the company to fabricate a new robotic archwire. That can stop treatment for 3 to 8 weeks while they are waiting.”
Dr. Coleman explains that the robotic archwire can sometimes be frustrating. “I found myself still doing significant detailing bends in the wires, even though Insignia provided ‘customized’ wires for each patient. The wires they provide are not smooth ovoid wires, but instead show multiple first-order angles/bends to compensate for the bracket positions.”
The customized indirect bonding delivery system is also integral to LightForce technology. “With LightForce, every part of our process is built from the ground up with a synergistic connection to the other parts. We create the digital smile plan, create the appliance, and once we know the geometry of the appliance, we create the 3D printed jig that marries to the appliance, so all the parts are custom 3D-printed for each other,” describes Piervencenti. “We don’t put together different technologies to reach this goal. One custom layer is built on another custom layer of the process.” Piervencenti says Insignia’s delivery system combines a standard indirect bonding system working with its custom system. “That creates variability.”
Dr. Coleman noted, “I did a tremendous number of Insignia cases over the course of a few years. Although the software was intuitive and relatively easy to use, that actual transfer of the brackets to the patient ended up being somewhat disappointing and did not seem to always represent where I had positioned the tooth in the virtual setup. As time went on with my cases, I found myself having to reposition a large number of brackets for each case, as the expected positions from my virtual setup failed to occur.”
Orthodontists who appreciate the value of 3D-printed customization can seamlessly transition to the LightForce digital workflow.
LightForce and Insignia follow the same workflow — so clinicians can easily enter patient information and instructions. LightForce workflow looks like this:
1. Enter patient information
2. Take intraoral scan and upload STL files (from scanners such as Itero or 3Shape)
4. Indicate your treatment strategy details. Specify slot height and hook preferences, if needed.
5. Approve or modify treatment plan
6. Review and submit
7. Receive LightForce IDB 3D printed trays with custom brackets and wires
The evolution of customization has taken place over many years, and now, it is a must-have for precision tooth movement. Insignia appreciated the value of individualized treatment, and as a result, was one of the pioneers in custom orthodontic treatment systems. As a 100% custom system created by 3D-printing technologies, LightForce has taken customized bracket technology to the next level with the 3D-printing aspect. Piervencenti shows LightForce as a multi-faceted and synergistic system. He sums up, “We see LightForce as a platform for fully customized 3D-printed tooth moving tools that goes well beyond brackets. With this technology, the possibilities are limitless.”