One of the key factors affecting the final results of treatments with commercial aligners is that many orthodontists rely on virtual technicians—who are mostly not orthodontists—to design movement protocols. This can have several impacts:
Lack of clinical personalization: Virtual technicians don’t have the specialized orthodontic biomechanics training that orthodontists have. This can lead to movement decisions based on generic protocols without proper adaptation to each patient’s dental and periodontal anatomy. Standard movements are often applied without considering specific clinical factors, such as bone support loss or the precise location of the center of rotation for each tooth.
Limitations in adjusting complex biomechanics: Movements like root torque, controlled intrusion of molars or premolars, and expansion in patients with periodontal issues require in-depth biomechanical knowledge. However, virtual technicians often use default configurations and apply standard forces, which can lead to unpredictable results, tipping, or loss of anchorage.
Inadequate movement sequences: In complex cases, such as distalization or sequential expansion, poor adjustment of movement sequences can result in unwanted displacements like extrusion, coronal tipping, or space loss. Orthodontists who design their own treatment plans can adjust the stages to meet clinical objectives, while virtual technicians often follow standard sequencing, which may compromise treatment predictability.
Risk of losing control in tracking: When the movement protocol is not precisely adjusted, aligners commonly lose tracking in the later stages of treatment. This happens because planned movements aren’t fully aligned with the forces needed to maintain a firm fit between the aligner and teeth, a problem that can worsen if intermediate adjustments aren’t made.
Suboptimal attachment designs: Virtual technicians typically configure attachments in standard positions and shapes, without considering more advanced configurations, such as beveled attachments or attachments with larger active surfaces, which help better control complex movements. Orthodontists can specify the type and placement of attachments, but if this task is left to technicians, control over specific movements may be compromised.
In conclusion, while virtual technicians can speed up the aligner design process, the lack of orthodontic oversight at each stage can reduce the quality of results. To improve predictability and achieve more precise case completion, many orthodontists are taking a more active role in planning, or even opting for "In Office" systems where they have full control over treatment design and execution.
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