orthodontics In summary

“The reality is none of us use light continuous forces.”
 
“Friction is awesome. Friction is great, we would be miserable if there was no friction… (with) uncontrolled movement everywhere”
 
“Segmented arch mechanics are very tough to gain three-dimensional control over the tooth.”
 
“The last major landmark in fixed appliance and in orthodontics was the pre-adjusted edgewise appliance.”
 
“The root is not moving according to the wish of the orthodontist (with aligners)”
 
I’m joined by Madhur Upadhyay for a deepexploration of biomechanics, biology, and the true limits of orthodontic innovation. We examine advances in appliances, aligners, and digital workflows and why they have, as of yet, not improved speed or quality of clinical outcomes,and innovation is still governed by the same biological constraints that dictated tooth movement a century ago. However progress has been significant in workflows for both fixed and aligner therapy.
 
We also discuss why complex biomechanics arerarely implemented in routine practice, whether pre-adjusted appliances were the last major landmark innovation, and what aligners can, and cannot, achieve in terms of root control in terms of biomechanics. The conversation extends toartificial intelligence in diagnosis and treatment planning, asking whether automation enhances clinical care or gradually replaces critical thinking. We conclude with thoughts of micro and nano-plastics and the focus needed on this topic in orthodontics.
 
Please like and subscribe if you find it useful!
 
Please visit the website for this interview podcast:
https://orthoinsummary.com/the-hidden-biomechanics-of-fixed-appliances-aligners-orthodontics-in-interview-madhur-upadhyay/
 
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Publications by Madhur Upadhyay
Biomechanics of clear aligners: hidden truths & firstprinciples 2022 https://doi.org/10.1016/j.ejwf.2021.11.002
ClearAligners in Extraction-Based Orthodontic Treatment: A Systematic Review andMeta-Analysis 2026 DOI: 10.1111/ocr.70052
 
 
 
#OrthodonticsInSummary
# Madhurupadhyay
#Orthodontics
#biomechanics
#TADs
#OrthodonticsInInterview
#FarooqAhmed
#OrthodonticBiomechanics
#DentalEducation
 
Farooq Ahmed
🕒Timestamps of Key Questions & Answers
01:43 Are We Overestimating Orthodontic Innovation?
02:41 If Technology Has Advanced, Why Is Fixed Appliance Treatment No Quicker?
08:55 Why Are Aligners Still Only 50% Predictable?
12:23 Why Are Biomechanical Set Ups of Cantilevers Unpopular In ClinicalPractice?22:41 Have Bracket Prescriptions Stopped Innovation?
26:42 MBT vs Roth – Does Prescription Really Matter?
28:22 Can Aligners Truly Move Roots,  OrIs It Just Tipping?
33:37 Is Software Innovation Just a Distraction from Aligner Material Limits?
36:15 AI in Orthodontics, Will It Replace Clinical Thinking?
43:00 What Are The Most Misunderstood Concepts in Biomechanics
51:07 The Micro and nano-plastic in Aligners

MISMARPE / DOME what is it?
 
Join me for a look at maxillary expansion combining both surgery with miniscrews. Seemingly opposite ideas have been brought together to offer potentially greater versatility in expansion, with less surgical complexity andcomplications.
 
 
 
MISMARPE – minimally invasive surgery miniscrew assistedrapid palatal expansion Haas 2021
Or
DOME Distraction Osteogenesis Maxillary Expansion Liu2017
 
Protocol
·     Osteotomy
o  Anterior vertical incision interdental toperiform fossa
o  Lateral incisions to the base of zygomaticprocess of maxilla
o  Without releasing the pterygomaxillary suture
o  Activate in surgery up to 20x ensure diastema
o  Duration 24 minutes (14.4-32) Junior 2021
o  Less pain – Mild on VAS
·     Expansion
o  7 days no expansion
o  Expansion of rate 0.25 - 0.50 mm,
§ Some until diastema and slow to 0.25 per day
 
 
Advantages
 
·     Less osteotomies required
·     Under sedation or local anaesthetic
·     Greater anchorage for force delivery throughminiscrews
·     Less intra-operative haemorrhage – due to a lackof pterygopalatine disjunction
·     Parallel expansion – Lin 2015 Vs V shapeexpansion
 
Age
Limitation of MARPE was age, with 20-30 years females 94% 20-30years males 80%, MARPE success 30-37 = 20% Olivera 2021, MISMARPE 96% successage 20-59, 24 patients majority over 30 years old Piccoli 2023.
 
Expansion amount
·     Direct comparison show no significant differenceda Silva 3mm, and no difference in molar angulation 2023
 
Indicated for:
·     Failed MAPRE
·     Age- greater 30 females and 25 for males
Could MISMARPE / DOME replaceSARPE?

Direct To Print Aligners,Will It Change Clear Aligner Therapy? 8 MINUTE SUMMARY
 
In this episode, I review direct-to-print alignersand how the material offers potential biomechanical advantages through itsmaterial properties when compared with conventional thermoplastic aligners. Theunique feature of force recovery of the material and current emerging evidence.The episode also explores the current limitations of the evidence base anddiscusses why, despite theoretical advantages, direct-to-print aligners havenot yet entered routine clinical practice. This podcast is based on a recent lectureby Jean-Marc Retrouvey.
 
Timestamp
00:27 – What are direct-to-print aligners?
01:10 – How do direct-to-print aligners deliver force?
02:39 – Push and pull forces and adaptation
03:58 – Reactivation with heat, unique force recovery
05:09 – Variable aligner thickness
07:08 – Why haven’t direct-to-print aligners changed aligner therapy yet?

 
 
Material photopolymer resins
 
Force delivery – Push and Pull
Engage with undercuts not possible with thermoformedaligners
o  Deliver forces to areas seen as non-engagedsurfaces
§ Non-engaged surface – greater displacement thanTFA (Hertan 2022)
 
Force delivery – Adaptation
·     Closer adaptation 20-30% more accurate 30um or 0.03mm (48 um Graphy Zendura, Essix Ace and DPA Koenig2022).
·     Uniform thickness
                                                                                            i.        TFA Non-uniform thickness – due thermal process, thinner areasend of aligner
                                                                                         ii.        TFA sharp distribution around attachment / transition
 
Force delivery material properties
·     TFA Stress relaxation – Reduce force with time,12 hours reduce 60%, DPA reduce to around 50%, but with recovery increase to75% Xu 2025
                                                                                            i.        Moment to force ratio more sustained for bodilymovement, in vitro study
 
 
·     Thickness customisation
o  Creating a force couple: 0.8 labial, Vs 0.5mmlingual , creating moment within the aligner
 
 
 
Direct to Print Aligners 2 types: Shape memory Vs Activememory
·      Similarclaims:
1.       Re-activate force recovery through heating inwater reactivation and reverse stress relaxation and creep
2.       Customise thickness, trimlines and auxiliaries
3.       Less attachments
4.       Speed of printing aligner
5.       Less wastage
 
·      Shapememory: Graphy 2019
1.       Transition temperature – low 45 degrees, from30-45 degrees = increase temperature = reduce force. Re-activates inside themouth to maintain properties. Choi 2025
 
·      Activememory LuxCreo 2022
1.       Transition temperature – high 60 degrees =maintain elasticity
2.       Re-activated with warm water  = restores mechanical properties
 
 
Challenges:
 
1.       Little clinical research to support biomechanicalsuperiority
2.       Loss of force from insertion Xu 2025 50% in 12hours
3.       Effectiveness seems camparable for mild to moderatecases:
a.       PAR change DPA 86%, refinement of 40% VanessaKnode 2025,
b.       PAR change TFA 88.9% Jaber 2022, refinement of 70-94%Ladewig 2005, Kravitz 2023
 
 
 
See Jean-Marc Retrouvey’s lecture in full: https://www.youtube.com/watch?v=j7fJmxgXHqU
 
Previous podcast on Direct To Print Aligners February2024
https://orthoinsummary.com/direct-to-print-aligners-are-they-really-different-to-normal-aligners-8-minute-summary/
 
#aligneronorthodontics
#directtoprint
#orthodontics
#orthodonticsinsummary
#Farooqahmed
#Orthodontics
#Luxcreo
#graphy
#clearalignertherapy

Has MARPE Found Its Place?
 
Join me for our first podcast of 2026 looking at Miniscrew AssistedExpansion, and where this treatment modality currently stands in clinicalpractice. With discussions of different designs (MSE Vs MARPE), rapid andslow activation protocols, orthopaedic effects, and predictors of success.   Thispodcast is a summary based on an excellent lecture from Angle-Net by DanieleCantarella and Benedict Wilmes.
 
01:18 – MSE vs MARPE designs: key differences
03:55 – Anchorage, bone quality, and force delivery
05:29 – Skeletal effects: parallel suture split and expansion amounts
06:42 – Asymmetry, resistance areas, and biomechanics
07:00 – Class III correction: where MARPE really adds value
09:26 – Rapid vs slow activation and what actually happens to bone
10:28 – Predicting success: age limits, failure rates, and when to considersurgery

#MARPE
#MSE
#expansion
#orthodontics
#orthodonticsinsummary
#Farooqahmed
#Orthodontics
#dentalpodcast
#orthodonticcommunity

Reflections on 20 years in Orthodontics | Orthodontics In Interview | BJÖRN LUDWIG

“We focused so much ontechnology that maybe we neglected diagnostics.”
 
“Anecdotal is inspiring,but we need evidence for the average orthodontist.”
 
“If we don’t protectacademic journals, orthodontics becomes vulnerable,  legally and professionally.”
 
“Orthodontics grows whenwe are open, critical, and enquiring.”
 
 
 
In this special episode, I’m joined by BjörnLudwig for a reflective conversation recorded during the few weeks of hispublic speaking career, as he brings his landmark Ortho 50 series to aclose. We look back on two decades of clinical practice, academic leadership,and contribution to the orthodontic community, and ask whether modernorthodontics has truly improved on the outcomes of the 1990s.
 
We discuss evidence versus clinicalexperience, the impact of technology on diagnosis and treatment planning, thepressures facing academic publishing, and the evolving role of key opinionleaders. Björn also speaks candidly about family, health, Oscar and legacy, andhis decision to step back from speaking in orthodontics, offering thoughtfulinsight into what really matters in an orthodontic career.
 
 
02:41 – Why is today’s orthodontics nobetter than the outcomes in the 1990s?
04:54 – How do we improve outcomes intoday’s clinical practice?
06:36 – Evidence vs experience: shouldwe trust trials or clinical experience?
09:13 – When research proves us wrong, howshould orthodontists respond?
11:19 – The role of your parents inshaping your orthodontic career
14:06 – As Editor-in-Chief of Kieferorthopädie,what changes have you seen over the last decade?
17:59 – Do Key Opinion Leaders help orharm orthodontics?
21:37 – Quick fire: proudest research, 3best clinical tools, and 3 biggest clinical regrets
27:52 – What advice would you give tothe next generation of orthodontists?
29:51 – Health, Ortho 50, and knowingwhen to step back
 
Click on the link below to view previous episodes, to refresh topics,pick up tricks and stay up to date.
 
 
Please like and subscribe if you find it useful!
 
#OrthodonticsInSummary
#BjörnLudwig
#Orthodontics
#ortho50
#TADs
#OrthodonticEvidence
#OrthodonticsInInterview
#FarooqAhmed
#OrthodonticBiomechanics
#OrthodonticResearch
#DentalEducation
 
Farooq Ahmed
 
🕒Timestamps of Key Questions & Answers