SureSmile® at 30: How Digital Solutions are Shaping the Future of Orthodontic Care

Sponsored by Dentsply Sirona

INTRODUCTION
Dentsply Sirona, the largest manufacturer of professional dental products and technologies, with more than 100 years of experience in oral healthcare, is celebrating the 30th anniversary of its innovative SureSmile® Digital Orthodontic system, which has transformed the field of orthodontics. More specifically, SureSmile® has played a pivotal role in treating malocclusion, a pervasive oral health issue associated with numerous diseases and conditions that may affect a patient’s overall health and quality of life. SureSmile® captures the abilities of today’s technological advancements to provide customized solutions for patients and streamlines processes for dental professionals.

THE IMPACT OF MALOCCLUSION ON PATIENT HEALTH
Malocclusion is broadly defined as the misalignment of the teeth and jaw, although it is generally referred to as crowded teeth, crossbite, overbite, underbite, or open bite.¹ Misaligned teeth can cause more than changes to a patient’s face and discomfort when chewing, however. The aesthetic impact of malocclusion can significantly affect patients' self-esteem, confidence, and social interactions. Studies have shown that malocclusion can lead to anxiety, depression, and interpersonal challenges related to concerns about appearance.²

Furthermore, researchers have identified a range of systemic health problems linked to malocclusion. The systemic spread of oral bacteria associated with malocclusion can lead to chronic inflammation, which has been linked to various gastrointestinal disorders, including acid reflux and leaky gut syndrome.³ Additionally, oral bacteria have been identified in Alzheimer's lesions⁴ and atherosclerotic plaques⁵. Periodontal disease, a common consequence of malocclusion, is also a well-established risk factor for cardiovascular disorders,⁶ stroke,⁷ and impaired glucose regulation⁸. Emerging research suggests that underdeveloped jaws and malocclusion may contribute to upper airway resistance and obstructive sleep apnea.⁹

These findings highlight the necessity of taking a holistic approach to oral health when assessing malocclusion. It's essential for dental professionals to consider patients' behaviors, attitudes, and other risk factors to develop comprehensive treatment plans that address both the functional and psychological aspects of malocclusion.

“Recent studies have revealed that 2 out of 3 US patients have some meaningful form of untreated malocclusion¹⁰, showcasing the widespread need for orthodontic care,” highlights Dentsply Sirona’s Chris Schlenk, Group Vice President of Orthodontic Aligner Solutions & Wellspect.

Chris Schlenk
Group Vice President, Orthodontic Aligner Solutions and Wellspect Healthcare
Dentsply Sirona

DENTSPLY SIRONA: ADVANCING DIGITAL ORTHODONTICS WITH INNOVATION & EXPERTISE
For over a century, Dentsply Sirona has been at the forefront of innovation. “Some of our landmark dental innovations include introducing the first dental X-ray unit, inventing in-office dental restorations, pioneering ultrasonic scaling, and developing the first electrical dental drill,” says Schlenk.

Each year, Dentsply Sirona leverages insights collected from research and collaboration with partners to develop more than 30 innovative, next-generation solutions. The company portfolio is a comprehensive range of brands and technologies organized into 5 main global business units encompassing over 40 distinct brands and technologies, demonstrating Dentsply Sirona's broad expertise and commitment to advancing dental and healthcare solutions.

“Innovation and technology are at the heart of everything we do,” says Schlenk. “Dentsply Sirona is a technology and innovation leader in part because we devote such significant resources to research and development. We spend approximately 4% of our annual sales in R&D and have a team of over 650 scientists and engineers working together with our customers and dental experts to understand their needs in practice and develop the solutions of tomorrow.”

The company’s commitment extends beyond product development, explains Schlenk. “We also prioritize education and training for dental professionals. We continue to invest in the implants community, helping professionals to grow their practices, and adopt new technology. We have 57 education centers in 35 countries, and we continue to invest significantly in clinical education resources to give dental professionals opportunities to train in person on the latest techniques and digital workflows as well as to experience the latest innovations.”

CELEBRATING 30 YEARS OF SureSmile® FOR MALOCCLUSION
Specifically through its SureSmile® Digital orthodontic platform, Dentsply Sirona has made significant strides in transforming orthodontic care, addressing the complexities of misaligned teeth with flexibility and efficiency.

SureSmile® features 3D imaging technology that can create detailed, high-quality digital models of patient impressions. The platform is compatible with commonly used intraoral scanners, making it easy to integrate into existing digital workflows. All patient impressions are verified by the SureSmile® Data Integrity team, and intraoral and extraoral photos are used to set the correct global position of the model based on the natural position of the smile on a patient’s face. With an established link between patient records and 3D models, SureSmile® Digital Lab technicians use proprietary treatment planning software and visualization tools to customize patient treatment plans that efficiently treat malocclusion. All treatment models generated by the Digital Lab are then passed along to a Quality Control team to review.

“The SureSmile® Digital orthodontic system stands out in the orthodontic world for its comprehensive, versatile and customizable approach,” says Schlenk. “The system offers solutions for various treatment needs, from clear aligner cases to complex bracket treatments. This modular approach allows dental professionals to select the exact level of customization and control suited to each patient’s case.”

SureSmile® accommodates a wide range of orthodontic treatments, including labial and lingual bracket cases, and indirect bonding treatments. This adaptability makes it ideal for practices that handle diverse cases and require a single system that can manage them all. At the same time, the system’s advanced planning tools, like custom archwire and indirect bonding (IDB) design, robotically bent archwires, and full-service aligner options enable clinicians to execute predictible treatments tailored to each patient’s unique dental structure. SureSmile® also offers custom-made retainers that help preserve the position of the teeth, preventing them from shifting back to their original state after active phases of treatment are complete.

“Our holistic approach, from diagnosis to treatment planning and execution, has ultimately benefitted the oral health and overall well-being of over 1 million patients worldwide,” says Schlenk.

“I've been using SureSmile® since 2019. While there’s no perfect orthodontic system, SureSmile® brings us closer to that ideal by enhancing control over both braces and aligner cases,” comments Dr Josh Rowley, a specialist orthodontist based in Edinburgh, Scotland.

Josh Rowley, BDS, MFDS, DClinDent, Morth, MRACDS
Bite Dentistry
Edinburgh, UK

“SureSmile® has been particularly transformative in our multi-doctor setting,” adds Dr J. Peter Kierl, a specialist based in Edmond, Oklahoma, and a professor at the University of Oklahoma College of Dentistry.”

In 1994, SureSmile® was first developed by OraMetrix GmbH, an industry provider of innovative technology solutions designed to improve the predictability and efficiency of orthodontic care. Using innovative treatment planning software and a 2D/3D intra-oral camera system with the world’s first wire-bending system, SureSmile® set the stage for modern, digital orthodontic practice.

J. Peter Kierl, DDS, MS
Professor, University of Oklahoma College of Dentistry
Orthodontist, Kierl Orthodontics
Edmond, Oklahoma

By 2008, SureSmile® had evolved to leverage cone beam computed tomography (CBCT), which provided dental professionals with capabilities to assess patients’ teeth soft tissues and bone structure in the oral cavity. A first of its kind, SureSmile® made it possible for dental professionals to not only assess tooth alignment but to also explore the positioning of tooth roots and surrounding bone to more predictably treatment plan.

Soon after 2008, SureSmile® became the first system to support both lingual and labial orthodontic cases, giving dental professionals the ability to offer more tailored treatment plans. By 2015, a suite of software offerings had become available to dental professionals to respond to workflow inefficiencies. The SureSmile® Doctor Designed Treatment Planning software provided dental professionals with more control over treatment processes, while the Indirect Bonding System and Interdisciplinary Planning offerings opened the door to advanced treatment possibilities.

SureSmile® expanded its product offering in 2018 with the launch of SureSmile® Clear Aligners, based on the same orthodontic philosophy as the cutting-edge robotic wire bending products, offering doctors high level customization but in a more discreet form. The same year, Dentsply Sirona acquired OraMetrix to enhance its digital orthodontics portfolio. This acquisition aimed to integrate OraMetrix's advanced software solutions for 3D treatment planning and visualization, aiding in workflow efficiency and predictable outcomes. This strategy was part of Dentsply Sirona's effort to strengthen its position in the dental market by expanding its digital capabilities and offering comprehensive solutions for dental professionals.

Most recently, in 2023, SureSmile® introduced the SureSmile® Simulator, powered by DS Core™. “The SureSmile® Simulator empowers dental professionals to transform treatment conversations,” says Schlenk. “By utilizing Primescan scan data, the Simulator generates personalized 3D visualizations of potential smiles following SureSmile® Clear Aligner treatment.”

The SureSmile® Simulator helps educate patients about the potential esthetic and oral health benefits of treatment and serves as a strong communication tool to help patients make informed decisions and understand the value of their investment, he explains.

“With the SureSmile® Simulator, we are taking aligner treatment with SureSmile® to the next level. When patients get an idea of what the outcome may look like before treatment, it boosts their relationship with their practitioner and provides the opportunity to make an educated decision about treatment,” Schlenk adds.

CONCLUSION
Dentsply Sirona's SureSmile® Digital orthodontic platform offers a compelling value proposition in the realm of orthodontic care.

“We understand that each patient's orthodontic journey is unique,” says Schlenk. “We are dedicated to providing an excellent treatment experience for both doctors and patients, from the initial tray to the final smile.”

“SureSmile® diagnostic tools enable me to plan more precisely, providing insights into a patient’s malocclusion that help me optimize their treatment journey. The ability to visualize the final outcome digitally has made my work more predictable and improved the quality of finishes for my patients,” says Dr Rowley.

Learn more about SureSmile® at www.suresmile.com/en/specialist-homepage

REFERENCES

1. Baskaradoss J, Bhagavatula P. Measurement and distribution of malocclusion, trauma, and congenital anomalies. Elsevier; 2021. doi:10.1016/B978-0-323-55484-8.00018-6.

2. Koskela A, Neittaanmäki A, Rönnberg K, et al. The relation of severe malocclusion to patients’ mental and behavioral disorders, growth, and speech problems. Eur J Orthod. 2021;43(2):159-164.

3. Koike S, Sujino T, Ohmori H, et al. Gastric emptying rate in subjects with malocclusion examined by [(13)C] breath test. J Oral Rehabil. 2013;40(8):574-581.

4. Liu S, Dashper SG, Zhao R. Association between oral bacteria and Alzheimer’s disease: A systematic review and meta-analysis. J Alzheimers Dis. 2023;91(1):129-150.

5. Tada S, Ikebe K, Kamide K, et al. Relationship between atherosclerosis and occlusal support of natural teeth with mediating effect of atheroprotective nutrients: From the SONIC study. PLoS One. 2017;12(8):e0182563. doi:10.1371/journal.pone.0182563.

6. Sanz M, Marco Del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases: Consensus report. J Clin Periodontol. 2020;47(3):268-288.

7. Costea CA, Christodorescu R, Soancă A, et al. Periodontitis in ischemic stroke patients: Case definition challenges of the new classification scheme (2018). J Clin Med. 2022;11(3):520. doi:10.3390/jcm11030520.

8. Aizenbud I, Wilensky A, Almoznino G. Periodontal disease and its association with metabolic syndrome: A comprehensive review. Int J Mol Sci. 2023;24(16):13011. doi:10.3390/ijms241613011.

9. American Orthodontic Society. How orthodontics affects your dental patient’s sleep apnea. American Orthodontic Society. Updated January 2, 2022. Accessed May 15, 2023. https://orthodontics.com/how-orthodontics-affects-patients-sleep-apnea/

10. Asiri SN, Tadlock LP, Buschang PH. The prevalence of clinically meaningful malocclusion among US adults. Orthod Craniofac Res. 2019;22(4):321-328. doi:10.1111/ocr.12328.

ⁱNo refinements were required in 3 out of 4 SureSmile aligner cases. Based on an internal analysis in excess of 150,000 global SureSmile® aligner cases started and completed between Jan 2021 - June 2023
ⁱⁱⁱRequires user to have a DS Core subscription and Primescan IOS. Displayed results are a simulation of potential aligner treatment and not a prescribed treatment plan, which must be directed by the dentist and complied with by the patient. Actual treatment outcomes may differ substantially.