Dental Asia Jan/Feb 2019

Clinical Feature JANUARY / FEBRUARY 2019 DENTAL ASIA 39 chemical structure and mechanical properties, suggesting differences in their clinical behavior outcomes and performances. 9 Digital workflow A scanned STL impression file (stereolithography) and completion of a prescription form can formulate a free online treatment plan in two to three days. Digital impression techniques are considered a clinical alternative to conventional impressions for orthodontic and fixed dental restorations. 13 Dentists with no experience can undergo a one-day hands-on training course that will enable them to become a Nuvola user. As a registered user on the Nuvola Web, the patient’s details can then be uploaded, allowing for ongoing communication with the lab in Italy and monitoring of each case’s production progress. NuvolaView is a 3D video that displays the entire process of the treatment from the beginning to the end in an interactive format. From there, the single or double arch 3Dmodels can be manipulated to ensure that movements are in line with the desired result. There is also a video guide to interproximal reduction (IPR) and techniques required to apply the attachments. Flugge evaluated the precision of iTero scanning and found out that the iTero intraoral scanner is less accurate than model scanning. He suggested that the intraoral conditions (saliva and limited space) contribute to the inaccuracy of a scan, with recordedmedian deviations of 37μm. 12 Finally, Akyclcin studied 60 dry skulls and scanned the maxillary and mandibular arches using the iTero scanner. Direct digital acquisition of the dental arches with a chairside scanner provided almost 1-to-1 diagnostic information of the investigated anatomy, which was superior to the conebeam CT measurements. 11 Conclusion Reports on the Nuvola system provide information that allows dentists an alternative tool to treat their patients. Nevertheless, the scientific papers available are not sufficient enough to draw a more evidence-based conclusion. It is recommended that more research be conducted on new products. The concept “Disruptive Innovation” applies to any new medical services, technology and products. Initially, the disruptive product is usually not on par with existing products, but may be satisfactory for many users provided it ismore economical, and is likely to improve over time. From the user’s point of view, the product should be: 1. Te c h n o l o g i c a l l y s i mp l i f i e d , standardised and provide solutions. 2. Based on business models that are affordable, accessible and profitable. 3. Backed by research that reinforce each other and form the infrastructure. 14 From the clinician’s point of view, the treatment outcome should be predictable and safe to use with no complications. DA References: 1. Mehta F, Mehta S 2014, Aligners: the rapidly growing trend in orthodontics around the world. Indian Journal of Basic and Applied Medical Research; September 2014: Vol.-3, Issue- 4, P. 402-409 2. Ercoli F, Tepedino M, Parziale VandLuzi C 2014, A comparative study of two different clearaligner systems 3. Lombardo L, et al. 2017, Predictability of orthodontic movement with orthodontic aligners: a retrospective study. Prog Orthod. 18:35. 4. Szuhanek C. & Grigore A. 2016, Vacuumformed thermoplastic aligners in orthodontics. DAAAM Int Scientific Book pp. 307-314 5. Zhang X, He L, Guo H et al 2015, Integrated three-dimensional digital assessment of accuracy of anterior tooth movement using clear aligners Korean J Orthod. Nov;45(6):275-281. 6. Nelson G 2005 Invisalign Summit 2005, Part I, Pacific Coast Society of Orthodontists Bulletin Winter. 7. Boyd RL, Oh H, Fallah M, Vlaskalic V 2006, An update on present and future considerations of aligners. J Calif Dent Assoc. Oct;34(10):793-805. 8. Elkholy F, PanchaphongsaphakT, Kilic F, Schmidt F, LapatkiB 2015, Forces and moments delivered by PET-G aligners to an upper central incisor for labial and palatal translation, Journal of Orofacial Orthopedics November, Volume 76, Issue 6, pp 460–475 9. Alexandros A el at 2015, Chemical and mechanical characteristics of contemporary thermoplastic orthodontic materials, Australian Orthodontic Journal Volume 31 Issue 2 (Nov) 10. Tepedino M, Paoloni V, Cozza P, Chimenti C 2018, Movement of anterior teeth using clear aligners: a three-dimensional, retrospective evaluation, Progress in orthodontics 19.9 11. Akyclcin S et al 2013, Diagnostic accuracy of impression-free digital models, American Journal of Orthodontics and Dentofacial Orthopedics, Volume 144, Issue 6, December, Pp 916-922 12. Flugge T et al 2013, Precision of intraoral digital dental impressions with iTero and extraoral digitization with the iTero and a model scan American Journal of Orthodontics and Dentofacial Orthopedics Volume 144, Issue 3, September 2013, p. 471 13. Seelbach P, Brueckel C, Wöstmann B 2013, Accuracy of digital and conventional impression techniques and workflow Clinical Oral Investigations September, Volume 17, Issue 7, pp 1759–1764 14. Christensen C M, Grossman J & Hwang J 2009, A Disruptive Solution for Health Care, In the Innovator’s Prescription McGraw-Hill p.441 The NuvolaView About the Author Dr. Ng, is the Hon. a/Clinical Professor at the Faculty of Dentistry, University of Hong Kong in 2017 and also in Private Practice. Dr. Kevin NG , BDS(Adelaide), MDS, DDPH(Sydney), MSc.Imp.(Leeds), FRACDS, FHKAM(DS), FHKCDS(Comm. Dent) DipImpDent(RCS,England)

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