Utilizing Aligners to Solve the COVID-19-Affected Orthodontic Practice Conundrum!

Abstract

Dentists all around the world are facing a dilemma on whether to resume their practice or not and the ones who have made the effort to resume work, feel they are at high risk of getting infected by the coronavirus. A majority of dental treatments require the use of high-speed handpieces as well as ultrasonic scalers which can make it even more dangerous for the treating dentists and assistants as these release aerosols which could aid in virus transmission. High-quality personal protective equipment is hard to procure and, if so, is very expensive adding to the cost of running clinics during this period. One of the main issues plaguing dentists practicing orthodontics is the inability to see their patients regularly during this period, which can cause a lot of unwanted tooth movements. This is where aligners can be of big help as the entire treatment planning process can be done virtually and the treatment can be monitored without the need of the patient having to visit the clinic physically.

Introduction

Charles Darwin put forward the theory of evolution and the COVID-19 period is forcing people to adapt and evolve to a new way of living. While this virus was reported as early as December 2019 from Wuhan in China, it has since then spread to all corners of the globe and caused massive damage to life and property. ¹ The emotional and economic fallouts due to the novel coronavirus have been profound with humanity facing problems like never before. With dentists being in close proximity to the patients during treatment it always adds to the risk in terms of cross-infection, and the lockdown imposed by the governments in many countries on less essential treatments has brought dentistry to a standstill across the world.

Dentists all around the world are facing a dilemma on whether to resume their practice or not, and the ones who have made the effort to resume work, feel they are at high risk of getting infected by the virus. A majority of dental treatments require the use of high-speed handpieces as well as ultrasonic scalers which can make it even more dangerous for the treating dentists and assistants as these release aerosols which could aid in virus transmission. High-quality personal protective equipment is hard to procure, and if procured, is very expensive adding to the cost of running clinics during this period. ²

Problems Being Faced by Dentists

In countries where the virus spread has been less, dentists are only seeing patients for emergency procedures such as teeth requiring root canal treatment, traumatic teeth injury, or injuries caused by removed brackets or wires in patients undergoing fixed orthodontic treatment. One of the main issues plaguing dentists practicing orthodontics is the inability to see their patients regularly during this period which can cause a lot of unwanted tooth movements. This is where aligners can be of big help as the entire treatment planning process can be done virtually and the treatment can be monitored without the need of the patient having to visit the clinic physically.

There are a lot of dentists who have setup virtual consultations ³ during this time to help alleviate patients concerns, thereby making it easier for the patients to understand that their treatment is progressing as planned without exposing them to the risk of infection by having them come to the clinics. Aligners are extremely beneficial when it comes to virtual follow-ups as these can be monitored remotely. The entire treatment planning process can be done extensively by the dentist without having to spend lengthy consults with the patients, which also could be done virtually.

Aligner Movements

Alignment: As the name suggests, aligners are very useful when it comes to aligning teeth without flaring or tipping as would normally occur with fixed orthodontic treatment since the teeth are completely enveloped on all crown surfaces.

Expansion: Expanding the arches is a very easy process with aligners as physiological expansion can be easily achieved without the use of any fixed expanders.

Space closure: Minute spaces can be closed very easily with aligners, but closing large spaces needs careful planning as aligners have shown posterior open bites. This can be minimized by the proper placement of attachments as well as attempting to move fewer teeth at the same time so that anchorage is not compromised. ⁴

Intrusion: Since aligners cover the occlusal surface of the teeth, intrusive forces can be delivered very easily with aligners. The placement of horizontal attachments makes it very easy to direct forces along the long axis of the teeth.

Extrusion: Because aligners are removable appliances, the amount of extrusion that can be achieved with aligners is limited. Again, the use of horizontal attachments is useful when it comes to extruding teeth to some extent.

Uprighting: Since aligners are removable in nature and it is difficult to design them to fit below horizontal attachments, it is extremely hard to upright mesially tipped molars. Some degree of uprighting can be achieved by making use of horizontal attachments on the distal portion of the buccal surface of the molars as it is easier to engage the aligners with the attachments there.

Finishing: Great attention to detail can be paid with the use of aligners as each stage of aligners can be carefully planned till finishing to carefully achieving good occlusion and intercuspation. Aligners can be used to treat a variety of cases. They can be used to plan single-phase therapy for correction of cases with minor problems or as a part of two-phase therapy along with fixed appliances to correct more complex malocclusions. ⁵

Retainers: With the use of treatment planning software, it is very easy to deliver retainers to the patients after finishing. The dentist can either use the software to make retainers or print a cast to make vacuum retainers for the patient.

Recommendations for the Use of Aligners During the COVID-19 Period

While the benefits of using aligners are for all to see, these do require extensive planning and careful evaluation of the progress. This pandemic has forced us to adapt and think of new ways to plan and carry out treatments.

Some recommendations that could be incorporated into practices are as follows:

Careful patient screening and collection of records.

Keeping physical visits to the clinic should be kept as minimal as possible.

Making the most out of technology by planning treatments using various types of software.

Using treatment modalities such as aligners during this period to ensure treatment progresses even in these times without exposing anyone to the risk of infection.

Virtual consultations to ensure the treatment are followed-up.

Patients to be seen physically only with personal protective equipment of the highest standard.

Some more recommendations in regard to online education that could be implemented include the following:

Look for programs that are accredited so that continuing education points can be applied for.

While this may be an economically hard time one can make the most of it by engaging in knowledge-based learning programs.

Aligners require a lot of experience and practice as is the case with any treatment modality so try and familiarize with the use of various aligner software and understand their functionality as well as benefits.

These are some recommendations on how dentistry in general and orthodontics using aligners can be used to accommodate patients and help keep their treatment on track. We must ensure the safety of the patients, clinical staff, and ourselves during any procedure and minimize chances of cross-infection. The COVID-19 pandemic is going to be around for the foreseeable future and till the time a solution is found we must adapt to survive and thrive.