The Importance of Digital Workflow In Modern Orthodontics

Ronan Sean McCann BDS – Dentist with a special interest in aligner orthodontics. Originally from Belfast, Ireland – Ronan moved to Glasgow to complete his undergraduate studies in dentistry, where he still lives and works. Orthodontics has always been his passion within the dental field, particularly clear aligner therapy. Ronan has obtained a postgraduate diploma in Clear Aligner Orthodontics from the City of London Dental School and is soon to complete his full master’s degree at the end of 2024. He will be the first clinician in Scotland with this level of qualification relating to aligners. He is also an accredited member of the Aligner Dental Academy and is part of the clinical team that helps to onboard and train new Invisalign providers. This accreditation is the only one of its kind in the UK and demonstrates the dedication to excellence in clear aligner therapy – through continuing education, patient care and commitment to delivering optimal results.

Through this article, Ronan highlights the transformative impact of digital technology on orthodontic treatment, focusing on how tools like intraoral scanners, the iTero scanner, and software like ClinCheck have improved patient care.

It is an exciting time to be a clinician providing orthodontic treatment. I have exclusively used the Invisalign system to help hundreds of patients boost their confidence, improve their oral health and generally better their lives.

The rapid advancements in digital technology i.e. intra oral scanning, photography, CAD/CAM, have transformed the orthodontic world. Traditional impressions, traditionally disliked by patients and prone to defects, have largely been replaced by intra-oral scanners. THE CONSULTATION At my consultation appointments, after hearing the patient’s main concerns, the first thing we do is take an intra-oral scan on an iTero scanner. The immediate visual feedback provided by the scan provides the foundations for the discussion with the patient. I like to ‘co-diagnose’ with the patient – this allows the patient to become involved with creating a problem list. They can point to specific areas of crowding/spacing/ crossbites/wear and slowly build a picture of what it is they want to get out of their treatment. I feel this immediately builds a sense of trust as the patient is not being told what they need, but rather they are part of the team.

The Consultation

At my consultation appointments, after hearing the patient’s main concerns, the first thing we do is take an intra-oral scan on an iTero scanner. The immediate visual feedback provided by the scan provides the foundations for the discussion with the patient.

I like to ‘co-diagnose’ with the patient – this allows the patient to become involved with creating a problem list. They can point to specific areas of crowding/spacing/ crossbites/wear and slowly build a picture of what it is they want to get out of their treatment. I feel this immediately builds a sense of trust as the patient is not being told what they need, but rather they are part of the team.

iTero can show the patient an estimated simulation of how their teeth may look after alignment through the ‘Outcome Simulator Feature’. We can now go one step further with for our patients with the ‘Outcome Simulator Pro’ – this allows the patient to visualise how their aligned teeth would look facially, by taking a smiling facial photo on the Invisalign Practice App, this instantly transfers to the iTero screen and uses AI to create the aligned smile right in front of their eyes. This is a great motivational tool and can evoke an emotional response at the very first appointment. Many patients attend consultations feeling nervous, not even knowing if treatment is possible, and leave feeling excited at the prospect of what may lie ahead for them. This is the power of digital dentistry.

The Treatment Planning

ClinCheck is the treatment planning software used for Invisalign. It allows clinicians to form a bespoke 3D treatment plan to cater for their patient’s needs and concerns. With ClinCheck, clinicians can visualise how the teeth are likely to look at the end of alignment before beginning. This is a more precise prediction tool compared to the outcome simulator pro. The majority of Invisalign patients are adults and will have tooth wear because of a pathological occlusion over many years. ClinCheck will allow us to see which teeth may require restorative work post-orthodontics. This can then be relayed to the patient, further enhancing the patient’s experience and consent. The patient also feels more involved with their treatment leading to higher satisfaction and compliance.

The software also has many features which allow us to assess the movements required and how challenging they may be e.g. large rotations/torque. A very useful feature is found in the ‘tooth movements table’ tool. This tool illustrates every single movement to every single tooth during treatment – it is not necessary to analyse all the values available, however, a value will be highlighted in bold and underlined. This is known as the ‘leading movement’ – the requested movement in the current treatment plan which is deemed to be the most challenging. Clinicians can then alter the plan to enhance efficiency, or they can relay this information to the patient and manage expectations.

Remote Monitoring

Invisalign has recently updated its remote monitoring software known as ‘Virtual Care’. It is a telehealth tool integrated into Invisalign’s workflow and is designed to allow remote monitoring and communication between patients and their clinicians throughout treatment.

The patient uses their smartphone and the Invisalign app to take photos of their teeth generally weekly. The app prompts the patient to take photos from different angles using cheek retractors.

The clinician instantly receives the photos and can assess the patient’s progress remotely. The fit of the aligners is generally assessed and the patient can be prompted to move on to the next set of aligners if everything is satisfactory. In the case of any issues, the clinician can advise the patient on how to rectify this e.g. return to previous aligners for a few days or book an appointment to have things checked over.

From a patient’s point of view, this is a much more convenient way to have their treatment monitored. It avoids regular trips to the practice, time out of work, and time out of their life outside of work. Because checks are taking place every week as opposed to every 4-8 weeks, issues can be picked up immediately and corrected, not giving things a chance to progress further.

In Conclusion

As aforementioned, it is an exciting time to be practising dentistry/orthodontics. Technology is developing at a rapid rate, and it has never been easier to diagnose, create personalised treatment plans and improve patient outcomes.

Digital dentistry is here to stay; the shift towards it encourages continual education and growth across the world. You can find educational courses all over and the majority will be utilising some form of digital workflow.

Technology has not only made the dental field more efficient and effective but has also reinvigorated the profession with new possibilities. Get on board or get left behind!