Published via DMIHER School of

Open Access Review Article Epidemiology and Public Health

Revolutionizing Smiles: Advancing Orthodontics

Through Digital Innovation
Received 06/06/2024
Ruchika Pandey 1, Ranjit Kamble 1, Harikishan Kanani 2
Review began 06/25/2024
Review ended 07/04/2024 1. Orthodontics and Dentofacial Orthopedics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of
Published 07/08/2024
Higher Education & Research, Wardha, IND 2. Pediatric Dentistry, Sharad Pawar Dental College and Hospital, Datta
© Copyright 2024 Meghe Institute of Higher Education & Research, Wardha, IND
Pandey et al. This is an open access article
distributed under the terms of the Creative
Corresponding author: Ruchika Pandey, ruchika938pandey@gmail.com
Commons Attribution License CC-BY 4.0.,
which permits unrestricted use, distribution,
and reproduction in any medium, provided
the original author and source are credited.
Abstract
DOI: 10.7759/cureus.64086
Orthodontics is undergoing a digital revolution, transforming traditional techniques with modern
technology. This evolution is driven by the need for precise diagnosis and treatment planning. Digital
platforms, including digital radiography and cone beam computed tomography (CBCT), are replacing
conventional methods, enhancing documentation, analysis, and appliance production. Three-dimensional
imaging enables customized treatment plans and appliance design using computer-aided design and
computer-aided manufacture (CAD/CAM). Integration of digital models and software facilitates treatment
simulation and patient communication. Digital videography enhances diagnostic capabilities. Embracing
digital processes is essential for improved patient care and practice efficiency in orthodontics. This review
article on digital orthodontics aims to provide a comprehensive overview and critical analysis of the current
advancements, technologies, applications, benefits, and challenges in the field of orthodontics utilizing
digital tools and technologies.

Categories: Dentistry
Keywords: digitization, digitalization, digital dentistry, cad cam, digital orthodontics

Introduction And Background

Orthodontics is a specialty that gets digitalized with the rest of the globe. Computer literacy has advanced
significantly, and the use of technology in orthodontics has increased dramatically. The limitations and
disadvantages of traditional orthodontic office management techniques were numerous. The requirement of
the future and the need of the hour is to own and operate a digital orthodontic office [1]. One of the most
complicated areas of dentistry is orthodontics and dentofacial orthopedics, which necessitates the
meticulous evaluation of a lot of data to arrive at an accurate diagnosis and develop a treatment plan. With
the introduction of modern technologies, it has undergone a tremendous metamorphosis. The field of digital
orthodontics comprises many methods and instruments that utilize digital platforms to improve patient
outcomes, treatment planning, and diagnosis. Significant effects of the recent digital revolution have also
been seen in orthodontics. Conventional physical imaging techniques have been supplanted by digital
radiography and digital photos, and concurrent cone beam computed tomography (CBCT) is being used more
and more [1].

Every area of orthodontics has been impacted by the present surge in digital processes in orthodontic
practices, which include changes to documentation, study casts, malocclusion analysis, smile design,
treatment planning, and orthodontic appliance production. Three-dimensional (3D) imaging of the face,
skeleton, and dentition makes it possible to plan treatments in three dimensions and to customize
orthodontic appliances using computer-aided design (CAD) and computer-aided manufacture (CAM).
Integrating digital models, CBCT, and 3D facial imaging with software enables the simulation of treatment
plans and fosters effective patient communication. Advances in digital videography have also made it
possible for clinicians to simultaneously record patients' oral and throat function, speech, and smiles [2].

Review
Digitalization in diagnosis
Orthodontic patients have precise, high-quality, and erectly posed 2D extraoral and intraoral pictures.
However, they are impacted by several factors, such as the distance and angle at which the photo is taken,
and do not have adequate diagnostic information. The conventional 3D topography of a patient's face
surface anatomy has recently been made possible by facial scanners. This, along with a digital model and
CBCT image, allows for creating a full 3D (dimensional) virtual patient [3].

A thorough evaluation of the patient's skeletal and dental structures made by digital imaging also makes it
easier to determine the patient's orthodontic demands. Orthodontists are highly skilled in accurately
assessing skeletal irregularities, occlusal connections, tooth alignment, and any dental pathology or
anomalies that may be present [3].

How to cite this article

Pandey R, Kamble R, Kanani H (July 08, 2024) Revolutionizing Smiles: Advancing Orthodontics Through Digital Innovation. Cureus 16(7): e64086.
DOI 10.7759/cureus.64086
 Published via DMIHER School of
Epidemiology and Public Health

Intraoral Scanners

Intraoral scanners have revolutionized orthodontic practices by replacing traditional impression materials
with precise 3D imaging of patients' dentition. These scanners generate realistic digital models instantly,
saving time, space, and costs associated with conventional methods (Figure 1). They also serve as potent
marketing tools, enhancing communication with patients. Popular options include the TRIOS Classic
(3Shape, Copenhagen, Denmark), CEREC Omnicam (Dentsply Sirona, Charlotte, North Carolina), and iTero
Element (Align Technology, San Jose, California). Extraoral scanners offer a comfortable alternative,
particularly for patients with a strong gag reflex, capturing detailed facial morphology without intraoral
discomfort [4].

FIGURE 1: Traditional vs. digital workflow

Image credits: Ruchika Pandey

Laser Scanning

A non-invasive technique for capturing soft tissue and facial morphology, laser scanning is useful for
evaluating facial symmetry in patients with cleft lip and palate, as well as teenagers. It has demonstrated a
low error rate in precisely measuring changes in soft tissues after therapy. Its disadvantage, though, is that it
takes a long time to scan, which makes it difficult for pediatric situations. However, a recent study found
that it can still be appropriate for preschoolers with the proper planning [5].

Magnetic Resonance Imaging (MRI)

When evaluating craniofacial anomalies, MRI is a useful diagnostic technique that provides thorough
information on both soft and hard structures, especially in the temporomandibular joint (TMJ). It is
commonly used for upper airway studies and 3D imaging of TMJ anatomy. In particular, MRI is useful for
assessing velopharyngeal function because it yields precise information on airway mobility and space,
especially in patients with cleft palates. Recent studies have shown the usefulness of MRI in numerous
orthodontic applications and have compared its effectiveness to conventional 3D imaging techniques such as
CBCT and CT despite early reservations regarding its applicability and cost [5].

CBCT Scans

CBCT scans can be used when a thorough assessment of the skeletal and oral structures is necessary.
Orthodontists can evaluate tooth roots, bone morphology, and any pathology that could affect treatment
planning with the help of computed tomography (CBCT), which produces 3D images of the teeth, jaws, and
surrounding tissues. The basic 3D reconstruction's multiplanar reformatting (MPR) enables investigations of
any chosen plane in 2D or 3D views [6]. To analyze the spatial disposition (angle, length, and diameter) of
mini-implants, infra-zygomatic crest screws, and orthodontic components, raw CBCT axial images are
rendered into 3D reconstructed models. It is necessary to receive the raw CT or CBCT data in the DICOM®
(Digital Imaging and Communication in Medicine) extension [7]. Currently, a variety of software
applications can be used to register (superimpose) patient CBCT scans and scanned pictures of patient
dental casts. The end product is a 3D computerized composite image of the skull that includes the occlusion.
This image serves as the foundation for virtual planning in orthognathic surgery. Surgical guides, splints,

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personalized plates, and prostheses can be used to transmit the virtual plan to the operation room through
subtractive or additive direct digital manufacturing procedures [8].

Digital Models

Transitioning to 3D virtual or digital orthodontic models has many benefits, including improved precision
and easier practitioner communication. These virtual models provide accurate measurements, ease
interdisciplinary treatment planning, and lessen the wear and breakage problems that come with plaster
models. The ability to conduct thorough space analysis and generate indirect bracket bonding setups
provides orthodontic practice with even more efficiency. Additionally, the ease with which these virtual
models may be shared via email encourages cooperation between various dental specialties, which
eventually improves patient care. Furthermore, patients' comprehension of the course of therapy and its
results can be substantially enhanced using virtual treatment objective (VTO) communication. These virtual
models provide unmatched flexibility, whether acquired directly from intraoral scanning or indirectly
through plaster models. The software's capacity to work with models in several spatial planes facilitates in-
depth inspection and analysis, which improves treatment planning and communication to a greater extent
[1,9].

Digitalization in treatment planning

In orthodontics, treatment planning software improves treatment efficiency and results by gathering and
evaluating patient data from multiple sources, including radiographs, digital impressions, and clinical
assessments. It consists of virtual model analysis for tracking advancement, cephalometric analysis for
assessing skeletal relationships, and digital imaging techniques for modeling therapy effects [10]. The
program interfaces with practice management systems to simplify workflow and enables the customization
of treatment regimens based on unique patient features. It also offers educational tools that can be used
effectively and promotes multidisciplinary collaboration. In orthodontic practice, treatment planning
software enhances professional judgment, communication, and patient satisfaction overall.

Three major kinds of orthodontic software are available, each meeting a distinct need: programs for creating
3D digital models, modeling orthodontic treatments, and conducting analysis and treatment programming.
Depending on the situation, an orthodontic digital workflow can call for utilizing all three technologies at
once, or it might just call for employing one or the other [11].

Modern dental scanners incorporate machine learning and artificial intelligence to precisely discern
textures and colors, which expedites file preparation. With its ability to provide visualization tools for
patient communication, orthodontic software for treatment simulation is a logical progression in workflow.
These methods require little input data, whether modeling clear aligner or bracket treatments [12].

A wide range of features are available in orthodontic practice software and digital treatment planning
systems, such as digital imaging, tools for case presentation and treatment planning, morphing capabilities
for treatment outcome visualization, intraoral and extraoral image capture, and cephalometric analysis.
Cephalometric analysis has been transformed by artificial intelligence (AI), which has increased efficiency
and accuracy over manual techniques. AI applications include skeletal age determination, TMJ evaluation,
extraction decision-making, planning orthognathic surgery, and treatment result prediction. Practitioners
can assess various treatment approaches, such as replacement versus extraction in cases of missing teeth or
extraction versus non-extraction treatment choices. They also make applications for oral and maxillofacial
surgery easier [13].

Digitalization in appliance fabrication

In orthodontics, CAD is revolutionary. The field of orthodontics has dramatically changed with the adoption
of CAD software and the digitization of the oral cavity. Through this procedure, dentists can digitally design
and modify appliances before using 3D printers to manufacture them. Because of scanners, computers, and
printers, conventional orthodontic labs are evolving into digital ones with less equipment and a cleaner
atmosphere.

This technology even enables in-office production, where everything from planning to printing may occur in
the orthodontist's office. The central component of this digital lab is the computer, which manages all design
and printing functions. With the precise customization made possible by this technology, every patient's
particular needs can be fully met. Orthodontists can create a wide range of appliances, including the newest
ones: digital models, customized brackets with torque specific to the patient, machine-milled indirect
bonding trays, robotically bent archwires, occlusal splints, orthodontic bands, and thermoformed and
printed aligners. These days, the usage of aligners in orthodontic treatment has significantly increased since
the advent of CAD/CAM technology. Most appliances can be printed using VAT technology, or for metal
appliances, powder bed fusion printers can be contracted out to handle the printing [14].

The use of 3D printers and intraoral scanners eliminates the need for dental impressions and processes such
as gypsum casting in various orthodontic workflows, resulting in a fully digitalized workflow. Some

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innovative brands in 3D printing for orthodontics include Stratasys (Eden Prairie, Minnesota), which is a
leading maker of 3D printers and materials used in a range of industries, including orthodontics. Stratasys
provides a variety of 3D printers that can be used to make orthodontic models, aligners, and surgical guides.
EnvisionTEC (Gladbeck, Germany) is a company that focuses on 3D printing for medical and dental
purposes. EnvisionTEC provides a variety of 3D printers that are ideal for orthodontics. Carbon3D (Redwood
City, California) is a company that specializes in high-speed 3D printing technology. Carbon3D (Digital
Light Synthesis) printers can produce high-quality orthodontic models and aligners. Desktop Metal
(Burlington, Massachusetts) is a 3D printing firm focusing on metal. Desktop Metal's (Studio System)
technology may be used to make custom orthodontic brackets or other metal components [15].

Dentists can also simulate treatment outcomes with CAD software, which provides them with a clear
understanding of what to expect prior to beginning treatment. This increases accuracy and facilitates a
better understanding of the procedure for the patients. CAD speeds up the production process, saving
patients' wait periods. It also saves time and resources by enabling simple adjustments when necessary [16].

The manufacturing of orthodontic appliances has changed due to CAM, mainly due to its accurate and
effective milling procedure. CAD software is used for digital design at the outset, which enables precise
customization based on each patient's requirements [17].

After the design is complete, CAM software transforms the digital model into instructions that the milling
machine can understand, preparing it for milling. The appliance is carved out of a metal or ceramic block
during the milling process. Because of the extreme precision of this procedure, appliances fit and operate
flawlessly. Additionally, CAM makes careful quality control during manufacture possible, guaranteeing that
every appliance fulfills precise specifications for the best possible treatment results. Patient wait times are
decreased, and CAM makes quicker procedures possible, which is more efficient and faster than previous
methods [18].

Aligners

Today's widely utilized clear aligners are usually made via a procedure that starts with virtual modeling and
finishes with 3D printing. This makes use of CAM technology and either additive or subtractive
manufacturing methods. Currently, the predominant technique is 3D printing, which has benefits such as
increased accuracy, lower costs, and possibly less environmental influence. A noteworthy development is
the ability to directly 3D print from digital designs, which enables customized thickness and spatial control
of aligners along the arch. 3D printing can be done using various materials, while photopolymerization from
clear resins shows promise. All things considered, this procedure improves precision, expedites output, and
provides long-term advantages for orthodontic care [19].

Clear aligners have revolutionized orthodontics by offering a discreet alternative to conventional fixed
appliances. Recent advancements have significantly enhanced their effectiveness, comfort, and
customization, making them a compelling choice for patients seeking a cosmetically pleasing approach. One
key area of progress is the development of innovative materials that improve both comfort and treatment
efficiency. For instance, Ghost PU Aligner (Pū) Sheets represent a major leap forward. These sheets, crafted
from a highly durable polyurethane, provide an ideal balance of flexibility and strength. This allows them to
exert consistent and controlled force on teeth, leading to faster and more predictable results. Additionally,
visual tests confirm excellent color stability, even after exposure to common staining agents such as coffee,
wine, and nicotine [19].

Invisalign appliances, particularly, have undergone a remarkable transformation since their inception. The
current eighth-generation aligners represent a significant evolution from their first-generation
counterparts. The most noteworthy advancement lies in material advancements, such as the introduction of
SmartTrack, a multi-layered material combining aromatic thermoplastic polyurethane and co-polyester.
Furthermore, the latest generation boasts "SmartForce" features, which allow for incorporating various
attachments and auxiliaries based on simulations generated by clinical software. Software enhancements
also play a crucial role. These advancements include the ability to integrate CBCT scans, utilize separate
software for extraction and mixed dentition cases, and facilitate lower jaw advancement for correcting
Skeletal Class II malocclusions [20].

Lingual Orthodontics

Lingual orthodontics has been transformed by CAD/CAM technology, especially in the milling part of
appliance construction. Digital impressions of the patient's teeth are the first step, and CAD software is used
to convert them into exact 3D models. With the aid of these computerized models, orthodontists may create
lingual brackets and wires that are specifically suited to each patient's anatomy and course of treatment.
Once the design is finished, the milling machine is prepared for milling using CAM software to convert the
digital model into instructions. Using a milling technique, the brackets and wires are carved out of a block of
material, such as titanium, stainless steel, or gold. With this process, the best fit and effectiveness are
ensured for the duration of treatment, and the highest level of accuracy and precision in creating lingual

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orthodontic equipment is achieved [21].

Archwire Fabrication

One significant advancement in orthodontic therapy is using robotics to bend and manufacture archwires.
In the past, archwires had to be manually bent, which is a tedious and uncertain process. However, the
application of robotic technology has revolutionized this significant aspect of orthodontic therapy. There
are limits to hand bending; robotic alternatives offer accuracy and automation. With the use of intricate
algorithms and programming, these robots can precisely bend archwires in compliance with the individual
treatment plans for each patient. Ensuring wire size, curvature, and force delivery homogeneity improves
treatment outcomes. Moreover, robotic archwire bending increases treatment efficiency by reducing the
amount of time and manpower required during production. In addition to improving patient comfort,
orthodontists can concentrate more on treatment planning [22,23].

In 2019, LightForce Orthodontics (LightForce, Burlington, Massachusetts) revolutionized braces with the
first 3D-printed system. Unlike traditional one-size-fits-all brackets, LightForce uses LightPlan software to
create fully customized brackets for each tooth, including molars, using 3D-printed polycrystalline alumina.
This allows for a more precise fit and treatment plan, potentially reducing treatment time and
appointments. LightForce also offers customizable features such as slot size, color, and bite turbos for
increased comfort and control. By leveraging 3D printing and focusing on customization, LightForce
provides a more efficient and potentially more comfortable path to a beautiful smile [24].

Surgical Splint

Technological developments have completely changed the production of surgical splints and preoperative
planning. By improving the assessment of complicated abnormalities, preoperative planning quality can be
improved by switching from 2D to 3D imaging. Surgeons can engage with 3D pictures using various software
programs, which simulate surgery and anticipate postoperative outcomes. Using CAD/CAM technology,
surgical splints ensure optimal results by preventing errors encountered in older approaches. Furthermore,
CBCT technology helps assess the results of combination orthodontic and surgical therapies. These
polymethyl methacrylate splints provide precise guidance during surgery to provide the best possible
outcome [25].

Retainers

Following orthodontic treatment, retention is essential to preventing tooth recurrence. There are several
approaches available, each with advantages and disadvantages. Studies indicate that the use of digital
techniques yields better results than normal procedures when it comes to creating lingual retainers. While
CAD/CAM retainers have smoother surfaces and lessen plaque buildup and inflammation, stainless-steel
retainers are known to enhance plaque accumulation and gingival inflammation. Because fixed lingual
retainers require less patient cooperation than traditional removable ones, they have supplanted them; an
alternative option is invisible retainers, providing reduced breakage, a perfect fit, and an optimum transfer
to the intended place. Retainers that are thinner and thicker have greater bending resistance than ordinary
ones. Because they are simple, quick, affordable, and repeatable, 3D-printed retainers are a promising
replacement for metal ones [26].

Other Appliances and Auxiliaries

An important development in orthodontic technology is the use of digital fixed appliances, which enable
accurate and personalized treatment plans. Fully digital lingual arches, trans-palatal arches, sectional space
holders, and customized anchorage structures are just a few examples. Lingual tongue spurs can be used for
tongue-thrusting habits, and Herbst and Forsus appliances can be used to treat faulty positioned mandibles.
Furthermore, Class III appliances can also be digitally customized, offering design freedom in accordance
with clinical requirements. The development of digital bands lessens patient discomfort by eliminating the
necessity for separator elastics because they are perfectly tailored to fit tooth surfaces. Digital bands reduce
the chance of gingival inflammation because they snugly conform to the edges of teeth without stretching
between contact areas like traditional bands do [27].

The Digital Titanium Herbst (DTi Herbst, Sheboygan, Wisconsin) appliance is a leading-edge orthodontic
device that addresses jaw discrepancies using innovative materials and digital design. Unlike previous
Herbst equipment, which is frequently composed of metal, DTi Herbst uses titanium, a biocompatible,
robust, and perhaps more pleasant material. The digital aspect is addressed through the use of CAD and
CAM processes. This enables each DTi Herbst device to be custom-designed for a precise fit depending on
the patient's specific requirements. This digital approach has the potential to not only enhance comfort but
also lead to shorter treatment times [28].

By simplifying the design and manufacturing process, digital removable appliances, such as vacuformed
retainers, are revolutionizing orthodontic therapy. 3D printing advancements hope to print high-quality

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plastic directly, eliminating the need for thermoforming entirely. Precise digital modeling is beneficial for
functional equipment, which is necessary for bite correction. Technicians guarantee precise appliance
construction using virtual design and bite registration in an ideal mandibular position. It is possible to
incorporate extra elements, such as labial arches or Adams clasps, into the design without notice. Michigan
splints, which are essential for treating joint diseases, can be customized through digital design. Digitally
designed tongue educators for lingual training conform to the palate and improve treatment results [27]. A
table summarizing a few research and case reports is provided below to support the literature evidence
[Table 1]. Further investigation is necessary to reach a definitive judgment.

Author Year Research/Article

Nucera et 2023 Presented two cases where Digital Bonded Twin Block was used to correct skeletal class II malocclusion in children with mixed dentition. It is a new approach to orthodontic treatment for skeletal malocclusion in

al. [29] children. It offers the potential benefit of removing reliance on patient cooperation for wear time.

Guidice 2020 Presented a case report on how orthodontists can plan maxillary skeletal expander placement based on a patient's specific anatomy using CBCT scans. The digital plan helps ensure mini-screws (tiny screws used

et al. [30] for anchorage) are placed in optimal positions for bone thickness and biomechanical effects.

Fiorillo et 2023 Presented a study on a new technique for bonding orthodontic brackets using computer-aided design and manufacturing (CAD/CAM). It utilizes a customized 3D-printed transfer tray and a special adhesive for

al. [31] accurate bracket placement. The research found this technique generally accurate, although with slightly higher error rates for brackets on back teeth.

ElShebiny 2024 Did a study to investigate the use of 3D printing technology by orthodontists in North America. According to the study, around 75% of orthodontists in North America use 3D printing technology in some way. The

et al. [32] primary reasons orthodontists use 3D printing are self-interest and research. Orthodontists mainly use 3D printers to create plastic retainers from printed models.

Pouliezou 2024 Presented an article discussing the growing importance of digital models in orthodontics. These combine facial scans, jaw structures (craniofacial), and teeth information from a patient to create a virtual

et al. [33] representation. Different digital scans (CBCT, dental scans, facial scans) are merged using specific software.

Awad et 2022 Did a study to evaluate how much facial soft tissue changes after orthognathic surgery. Realistic expectations can improve patient satisfaction. It can be concluded that the VSP system IPS CaseDesigner predicts the

al. [34] patient’s operative soft tissue accurately.

TABLE 1: Few research and case reports to support the literature

Challenges and limitations

Despite the fact that digitization has completely changed orthodontic practices and has many advantages,
there are still some significant obstacles to overcome. First, the substantial upfront costs associated with
software, hardware, and training provide a financial challenge, especially for smaller clinics. Furthermore,
orthodontists and staff may need to invest time and money due to the steep learning curve involved in
mastering digital tools and software. Even with great accuracy promised, mistakes and variances in digital
impressions, CAD/CAM designs, and 3D printing can still occur, necessitating careful calibration and cross-
checking. Incorporating digital technology into current workflows may lead to inefficiencies and the need to
modify procedures.

Considering the difficulties brought on by regulatory requirements and cyber dangers, it is essential to
protect sensitive patient data in digital records. The standardization and platform compatibility issues that
impede collaboration and data transfer necessitate a planned approach, such as training practitioners on
cybersecurity measures and informing them about breaches, access controls, data encryption, etc.
Developing a culture of effective teamwork via education and communication is crucial given the varying
degrees of digital technology adoption among patients. It is essential for practitioners to give preference to
patient education. Adherence to changing standards is crucial in order to fulfill legal responsibilities, thus
adding to the difficulty of practice management. For digital hardware and software to perform at their best,
regular maintenance and professional assistance are also essential. With these challenges, if digital
orthodontics is developed with caution and flexibility, it has the potential to greatly enhance patient care
and productivity with innovations and advancements.

Conclusions
Digital orthodontics transforms the discipline by providing professionals with innovative instruments and
methods to enhance patient care. Intraoral scanners, 3D imaging, and CAD are examples of digital
technology that simplify patient-orthodontist communication while simplifying diagnostic and treatment
planning. Through the adoption of this technology and continued education and training, practitioners may
enhance patient outcomes and deliver high-quality care. Data security has to be prioritized in order to
protect patient privacy. All things considered, digital orthodontics presents a wonderful opportunity for
practitioners to raise their standards and improve treatment efficacy.

Additional Information

2024 Pandey et al. Cureus 16(7): e64086. DOI 10.7759/cureus.64086 6 of 8

 Published via DMIHER School of
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Author Contributions
All authors have reviewed the final version to be published and agreed to be accountable for all aspects of the
work.

Concept and design: Ruchika Pandey, Harikishan Kanani

Acquisition, analysis, or interpretation of data: Ruchika Pandey, Ranjit Kamble, Harikishan Kanani

Drafting of the manuscript: Ruchika Pandey

Critical review of the manuscript for important intellectual content: Ranjit Kamble, Harikishan
Kanani

Supervision: Ranjit Kamble, Harikishan Kanani

Disclosures
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the
following: Payment/services info: All authors have declared that no financial support was received from
any organization for the submitted work. Financial relationships: All authors have declared that they have
no financial relationships at present or within the previous three years with any organizations that might
have an interest in the submitted work. Other relationships: All authors have declared that there are no
other relationships or activities that could appear to have influenced the submitted work.

References
1. Alassiry A: Digital orthodontics- a contemporary view of futuristic practice . Int J Adv Res. 2021, 30:723-32.
10.21474/IJAR01/12758
2. Francisco I, Ribeiro MP, Marques F, et al.: Application of three-dimensional digital technology in
orthodontics: the state of the art. Biomimetics (Basel). 2022, 7:23. 10.3390/biomimetics7010023
3. Jackson TH, Kirk CJ, Phillips C, Koroluk LD: Diagnostic accuracy of intraoral photographic orthodontic
records. J Esthet Restor Dent. 2019, 31:64-71. 10.1111/jerd.12426
4. Lee SJ, Kim SW, Lee JJ, Cheong CW: Comparison of intraoral and extraoral digital scanners: evaluation of
surface topography and precision. Dent J (Basel). 2020, 8:52. 10.3390/dj8020052
5. Erten O, Yılmaz BN: Three-dimensional imaging in orthodontics. Turk J Orthod. 2018, 31:86-94.
10.5152/TurkJOrthod.2018.17041
6. White SC, Pharoah MJ: Oral radiology: principles and interpretation. Mallya S, Lam E (ed): Mosby, Maryland
Heights (MO); 2018.
7. Zhu F, Ji L, Zhou C, et al.: Accuracy of microimplant placement using a 3D guide plate for orthodontic
anchorage. Appl Bionics Biomech. 2023, 2023:9060046. 10.1155/2023/9060046
8. Jeon JH: Digital technology in orthognathic surgery: virtual surgical planning and digital transfer . J Korean
Assoc Oral Maxillofac Surg. 2019, 45:231-2. 10.5125/jkaoms.2019.45.5.231
9. Khaled K, Fayed M: Digital orthodontics: an overview. MSA Dental Journal. 2023, 2:49-53.
10.21608/msadj.2023.211756.1020
10. Baxi S, Shadani K, Kesri R, Ukey A, Joshi C, Hardiya H: Recent advanced diagnostic aids in orthodontics .
Cureus. 2022, 14:e31921. 10.7759/cureus.31921
11. Kumar G, Jyothikiran H, Nair N, et al.: Contemporary digital software applications in orthodontics: a review .
Int J Sci Res Arch. 2024, 11:288-301. 10.30574/ijsra.2024.11.2.0403
12. Liu J, Zhang C, Shan Z: Application of artificial intelligence in orthodontics: current state and future
perspectives. Healthcare (Basel). 2023, 11:2760. 10.3390/healthcare11202760
13. Kazimierczak N, Kazimierczak W, Serafin Z, et al.: AI in orthodontics: revolutionizing diagnostics and
treatment planning. J Clin Med. 2024, 13:344. 10.20944/preprints202312.1259.v1
14. Thawri SR, Paul P, Reche A, Rathi HP: 3D technology used for precision in orthodontics . Cureus. 2023,
15:e47170. 10.7759/cureus.47170
15. Ergül T, Güleç A, Göymen M: The use of 3D printers in orthodontics - a narrative review . Turk J Orthod.
2023, 36:134-42. 10.4274/TurkJOrthod.2022.2021.0074
16. Panayi NC, Efstathiou S, Christopoulou I, et al.: Digital orthodontics: present and future. Am J Orthod
Dentofacial Orthop. 2024, 4:14-25. 10.1016/j.xaor.2023.12.001
17. Grauer D, Wiechmann D, Heymann GC, Swift EJ Jr: Computer-aided design/computer-aided manufacturing
technology in customized orthodontic appliances. J Esthet Restor Dent. 2012, 24:3-9. 10.1111/j.1708-
8240.2011.00500.x
18. Abduo J, Lyons K, Bennamoun M: Trends in computer-aided manufacturing in prosthodontics: a review of
the available streams. Int J Dent. 2014, 2014:783948. 10.1155/2014/783948
19. Bichu YM, Alwafi A, Liu X, Andrews J, Ludwig B, Bichu AY, Zou B: Advances in orthodontic clear aligner
materials. Bioact Mater. 2023, 22:384-403. 10.1016/j.bioactmat.2022.10.006
20. Kau CH, Soh J, Christou T, Mangal A: Orthodontic aligners: current perspectives for the modern orthodontic
office. Medicina (Kaunas). 2023, 59:1773. 10.3390/medicina59101773
21. Gimenez C: Digital technologies and CAD/CAM systems applied to lingual orthodontics: the future is
already a reality. Dental Press J Orthod. 2011, 16:22-7. 10.1590/S2176-94512011000200002
22. Adel S, Zaher A, El Harouni N, Venugopal A, Premjani P, Vaid N: Robotic applications in orthodontics:
changing the face of contemporary clinical care. Biomed Res Int. 2021, 2021:9954615.

2024 Pandey et al. Cureus 16(7): e64086. DOI 10.7759/cureus.64086 7 of 8

 Published via DMIHER School of
Epidemiology and Public Health

10.1155/2021/9954615
23. Müller-Hartwich R, Präger TM, Jost-Brinkmann PG: SureSmile--CAD/CAM system for orthodontic
treatment planning, simulation and fabrication of customized archwires. Int J Comput Dent. 2007, 10:53-62.
24. Panayi NC: In-office customized brackets: aligning with the future . Turk J Orthod. 2023, 36:143-8.
10.4274/TurkJOrthod.2023.2023.21
25. Zinser MJ, Mischkowski RA, Sailer HF, Zöller JE: Computer-assisted orthognathic surgery: feasibility study
using multiple CAD/CAM surgical splints. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012, 113:673-87.
10.1016/j.oooo.2011.11.009
26. Firlej M, Zaborowicz K, Zaborowicz M, et al.: Mechanical properties of 3D printed orthodontic retainers . Int J
Environ Res Public Health. 2022, 19:5775. 10.3390/ijerph19095775
27. Ghislanzoni LH, Negrini S: Digital lab appliances: the time has come . J Clin Orthod. 2020, 54:562-9.
28. Farronato G, Santamaria G, Cressoni P, Falzone D, Colombo M: The digital-titanium Herbst . J Clin Orthod.
2011, 45:263-7.
29. Nucera R, Barbera S, Militi A, et al.: Digital bonded twin block a new no-compliance device to treat skeletal
class II malocclusion in mixed dentition: design, fabrication, and clinical management. Semin Orthod. 2023,
29:243-58. 10.1053/j.sodo.2023.05.006
30. Lo Giudice A, Quinzi V, Ronsivalle V, Martina S, Bennici O, Isola G: Description of a digital work-flow for
CBCT-guided construction of micro-implant supported maxillary skeletal expander. Materials (Basel). 2020,
13:1815. 10.3390/ma13081815
31. Fiorillo G, Campobasso A, Caldara G, et al.: Accuracy of 3-dimensional-printed customized transfer tray
using a flash-free adhesive system in digital indirect bonding: an in vivo study. Am J Orthod Dentofacial
Orthop. 2023, 164:505-15. 10.1016/j.ajodo.2023.02.017
32. ElShebiny T, Simon Y, Demko CA, Palomo JM: The uses of 3-dimensional printing technology in
orthodontic offices in North America. Am J Orthod Dentofacial Orthop. 2024, 166:76-80.
10.1016/j.ajodo.2024.03.014
33. Pouliezou I, Gravia AP, Vasoglou M: Digital model in orthodontics: is it really necessary for every treatment
procedure? A scoping review. Oral. 2024, 4:243-62. 10.3390/oral4020020
34. Awad D, Reinert S, Kluba S: Accuracy of three-dimensional soft-tissue prediction considering the facial
aesthetic units using a virtual planning system in orthognathic surgery. J Pers Med. 2022, 12:1379.
10.3390/jpm12091379

2024 Pandey et al. Cureus 16(7): e64086. DOI 10.7759/cureus.64086 8 of 8