This document discusses the history and applications of robotics in orthodontics. It describes several robotic systems that have been developed to assist with tasks like wire bending (SureSmile, LAMDA), digital bracket placement, and stereolithography model production. Studies show that treatment with the SureSmile robot results in lower scores on the American Board of Orthodontics grading system and shorter treatment time compared to conventional treatment. Overall, robotics is playing an increasing role in orthodontics to improve precision and efficiency.

1. Robotics in
orthodontics
BY-RABAB KHURSHEED

2. CONTENTS
 Introduction
 History
 Robotics in dentistry
 Robotics in orthodontics
 Sure smile wire bending robot
 Sterilithography
 3-D printing
 Lingual wire bending robot

3. introduction
 Orthodontics has always strived to improve efficacy and efficiency of
appliances. since its inception, many modalities have been changed and
improved over time to increase the same. robots have been introduced in
orthodontics to increase precision to the highest degree.
 Charles burstone said the practice of conventional orthodontics has
always been “appliance driven”

4.  The word robot was introduced to the public by the Czech interwar writer Karel
Čapek in his play R.U.R. (Rossum's Universal Robots), published in 1920

5.  A machine, capable of carrying out
a complex series of actions automatically,
especially one programmable by a computer
 The robot institute of America in 1979 defined
Robot as “A re programmable, multifunctional
manipulator designed to move material ,parts,
tools or specialized devices through various
programmed motion for the performance of
variety of tasks .

6. History
 250 BC Ctesibius of Alexandria, physicist and inventor from Egypt
 Al- Jazari In the medieval period(1136-1206), Father of robotics
 Leonardo da vinci ,the renaissance period , Italy (1452-1519)
 Hisashige Tanaka 1796
 The first electronic autonomous Robots(1948)- William Grey Walter . Elmer and
Elsie
 The first truly modern Robot- George Devol (1954)- Unimate
 German based company KUKA built the world's first industrial robot (1983)

7. Robotics in medicine
 1985: a robot , the PUMA 560, was used to place a needle for a brain
biopsy using CT guidance
 1988: the PROBOT , developed at the imperial college London was sued to
perform prostatic surgery
 1992: the ROBODOC from integrated surgical systems was introduced to
mill out precise fittings in the femur for hip replacement.
 1997: A reconnection of the fallopian tubes was successfully performed
using ZEUS
 1998: Dr. Friedrich Wilhelm Mohr using the da vinci surgical system,
performed the first robotically assisted bypass
10.5005/jp-jornals-10007-1146 Review article, role of robotics in whipples
surgery, WJOLS

8. ROBOTICS IN DENTISTRY
 Prosthodontics has seen the use of robots for implant
placements in patients with robots.
 a frame is clamped onto a patient's jaw and very thin
needles penetrate the gum to determine the location
of the bone. This data is wirelessly transmitted to a PC,
which combines it with CT scan data to configure a set
of drill guides. The guides are then attached to the
frame and finally the dentist presses a button to start the
drilling in the precise location required.

9. Nano robots or nanobots is finding its way in many fields of
dentistry, including
 Anesthesia
 Nano composites
 Nanorobotics dentrifices
 Nano adhesives
 Non surgical incision material

10. Robotics in orthodontics
SureSmile technology was designed to substantially reduce errors in treatment
resulting from appliance management. It provides image-capturing, three-
dimensional visualization tools for diagnosis, monitoring, and patient
communication, along with precision appliances that can help the
orthodontist deliver truly customized care in a patient-centered practice.
Features of SureSmile technology includes:
 OraScanner
 Wire bending robot
 Digital bracket placement
SureSmile gives the clinician powerful tools to deliver consistent, high-quality
care to all patients, regardless of practice volume
Sure smile technology

11. 3-D
Ora
scanner
Virtual
setup
Wire bending
by suresmile
robot

12. OraScanner : Acquires six unblurred images per second with as many as 3,500 three-dimensional
measuring points per image. The accuracy of each point is better than 50 microns; the linear
error of scan is no greater than 0.1mm per tooth.

13. The scanner has a video camera which receives back the distorted grid of light emmited
on the teeth, has a defogger
Structured white light

14. software
 3D visualization
 Measurments
 Communication
 Decision making by simulation
 Bracket placement
 Setup and arch wire design
 Quality and outcome assessment
 Patient management

15. The software allows the operator to
diagnose, plan treatment, and simulate the
result.
The dentition can be viewed from
preselected perspectives, such as frontal,
lateral, posterior, or occlusal views.
Information regarding wire sizes, materials,
and brackets (manufacturer and
prescription) is supplied for the treatment
plan. The operator can consider various
treatment alternatives by moving the teeth
with the mouse or with selected menus, by
extracting teeth, or by reducing teeth
mesially or distally to simulate interproximal
disking. The changes in the x, y, and z
coordinates of individual teeth with the
planned therapy can be displayed to show
tooth movement and to estimate case
difficulty. Interarch contact and relations,
such as overbite
and overjet, can be viewed.

16. Once a goal or a treatment target is
chosen, the operator can implement
therapy by “virtual bracket placement”
and select the archwire sequence and
progression.
If a prescription is desired, the software will
account for the tip, the torque, and the
offset built into the prescription. Wire-size
selections include .016 to .020 round wires,
.016 × .016 square wires, and .019 × .025
rectangular wires. The material properties
of the wires (modulus of elasticity and
stiffness) can be input with software’s
advanced features, which will predict
approxiate force values applied to each
tooth. This
“virtual force gauge” can be used to help
the operator select the archwires (force-
driven wire selection)

17. The operator can run and modify various treatment scenarios
and simulate treatment until the optimal treatment plan is
found. It allows the clinician to move the teeth to a corrected
or target position, place the virtual brackets, and select the
appropriate archwire sequences.

18. Digital bracket placement : Accurate to 0 ±25
microns. The accuracy of the
stereolithography model is 0 ±25 microns. Accuracy of
in vivo bracket
placement is 0 ±.1mm

20. WIRE
BENDING
ROBOT

22. The archwires are produced with a wire-bending robot in
the sizes and shapes selected by the orthodontist. Our
investigations into the precision of the bends with stainless
steel wire show less than 1° of error in bends and twists.
1st order, 2nd order and 3rd order bends can be given.
Force sensors are present

24. Case reports

27. Efficacy of suresmile over
conventional methods
The research shows that the SureSmile process results in a lower mean ABO
OGS score and a reduced treatment time than conventional approaches with
great potential to both decrease treatment time and improve quality.
 Three diplomates of the American Board of Orthodontics provided
 study casts of 62 patients whose orthodontic treatment was consecutively
completed.
 Patients treated using the SureSmile process and a conventional
approach were anonymized and randomized prior to independent scoring
by two ABO OGS calibrated examiners.
Efficiency and Effectiveness of SureSmile”, Alana K. Saxe, DMD; Lenore J.
Louie, MSc, DMD; James Mah, DDS, MSc, DMSc, World J Orthod-2010

28.  The ABO OGS score for the SureSmile patients was 4.4 points lower
than for those treated conventionally .
 Furthermore, treatment with the SureSmile process was shorter
(14.7 months vs 20.0 months).
The SureSmile process results in a lower mean ABO OGS score and
a reduced treatment time than conventional approaches. The
approach has great potential to both decrease treatment time
and improve quality.

29. Clinical outcomes for patients finished with
the suresmile method compared to the
conventional fixed orthodontic therapy
 Used ABO Sstandards and cast radiographic evaluation to evaluate 63
consecytive patients(manual wire bending), v/s susecuent series of 69
patients with suresmile by the same orthodontist.
 Compared with conventional finishing,SS patints had significant lower
discrypency index,and better cast radiographic score.
 Ss patients were treated in less time

30. SURESMILE QT
 Lingual treatment offered by sure smile.

31. LAMDA -Lingual Archwire Manufacturing
and Design Aid
 Developed by Alfredo Gilbert in 2011
 The irregular lingual dental anatomy and small interbracket distances
make manual wire-bending difficult, especially in cases involving anterior
crowding.
 The software was developed in the Research and Development
Department of Smile Center Dental Specialties in Mexico City, using the
Microsoft Visual Studio 2008, Designed to use in office,either before or after
bracket bonding
 The Robot makes only 1st order bends

32. Archwire design for patients with no
brackets
 Digital occlusal photograph of the cast is taken
and loaded into the LAMDA software
 Click on the location of the wire’s distal end and
continue around the arch, clicking on each
location where a bend is needed.
 Allow sufficient space for the desired bracket
depth.
 The LAMDA software assigns x and y coordinates to
each point, using pixels as the unit of measurement.
 Bends to the left marked positive and bends to the
right marked negative.

33. Archwire design for patients with
brackets
 Occlusal photograph of patients arch is taken
 A 1cm line is drawn on the occlusal mirror to help in
calibration to pixels.
 Passive archwire can be fabricated by tracing the exact
positions of the bracket
 An active archwire can be made with required adjustments.
 Occlusal photographs should be taken at each
appointment, so that LAMDA can be used to determine the
caliber and design of the next archwire.

34. LAMDA wire bending robot
 Gantry robots like the one used in the LAMDA
system have the ability to move an end effector
(the device or tool at the end of a robotic arm) in
multiple planes of space with great precision,
though with limited degrees of freedom.
 their axes of control are linear and at right angles
to each other
 it is relatively simple, compact, and inexpensive to
manufacture.
 incorporates a heater that can raise the
temperature of a nickel titanium archwire to 600°F.
 The robot manufactures stainless steel archwires in
about five minutes and nickel titanium archwires in
about six minutes

35. Efficacy of the LAMDA system
 15 lingual orthodontic specialists were presented with a single patient’s
pretreatment plaster cast and occlusal photograph and asked to bend
one archwire manually and one using the LAMDA system.
 A 16th orthodontist performed a blind evaluation of the 30 archwires,
assigning a score between zero and 10 to each wire based on how well it
adapted to the cast. The mean score for the 15 manually bent archwires
was 6.9; the mean score for the 15 archwires designed and manufactured
with the LAMDA system was 9.0

36. Case report –LAMDA
 lingual treatment of a female patient who presented with four missing
upper premolars.
 The difference in buccolingual thickness between the canines and first
molars makes wire-bending especially difficult in this kind of case.

37. Bending Art System
 BAS - It is the first ever developed robotic CAD / CAM system for the
fabrication of customized orthodontic arch wires.
 Prof. Helge Fischer-Brandies invented this in 1984 and his co-worker Dr.
Wolfgang Orthuber, together with an engineering company developed
this hardware and software.
 1st prototype of BAS was manufactured in 1993.
 It is used for fabrication of both labial and lingual orthodontic wires.

38. COMPONENTS
 Components of BAS are:
1. Stereoscopic camera
2. Personal computer and its software
3. Arch wire bending device
Fischer-Brandies H, Orthuber W, Pohle L, Sellenrieck D , Vollbogentechnik mit dem
“bending art system”, J Orofac Orthop-1996,
Fischer-Brandies H, Orthuber W, Pohle L, Menzel E, J Orofac Orthop-,1997

39. Procedure
 Before inserting camera– stainless steel measuring plates should be inserted
into bracket slots and tubes of molar attachments. They are secured in place
with elastomeric ligatures. These plates are available in different sizes for .018”
and .022” bracket system
 Each dental arch is scanned as two quadrants; the computer merges the left
and right side.
 Scan takes about 20 mins
 Bending process starts after programming all desired bends.
 The time taken to complete the bending process is 5-7 min.
 It can be used to work with both round as well as rectangular wires.
 Wire may be S.S., TMA or Ni-Ti alloy.

40. Advantages:
 Precision arch wires
 Rapid fabrication
 Fabricate full size passive arch wires for
surgical cases
 T loop ,L loop construction
 Utility arches made
 Can be used for making lingual retainer
 Patient data base
Disadvantages:
 Time required for the insertion of
measuring plates and their
identification
 Clinical judgment still vital
 Steel wire easily deformed

41. Orthorobot
 A robot which places brackets on models with an accuracy of 0.02mm
 This is later bonded on the patients with indirect bonding technique

44. Objet 30 Orthodesk-Steriolithography
 Given by stratasys in 2011-12
 Eliminate physical impressions
 Easy interaction between lab and doctor
 Online storage of models in CAD designs and .slt format
 Accelerate production times
 Enjoy a clean, efficient process

46. CONCLUSION
 Robotics has crept into every technological industry including health
sciences and dentistry. It has helped reduce the required human resources
and work in a much ,more efficient way.
 The emergence of robotics in the field of orthodontics could open doors to
various aspects like use for mini implant placement, nano robots for teeth
alignment etc. Also various methods and techniques are yet to be
researched and implemented in orthodontics
 Robotics can’t be called as the future anymore, it is the present
orthodontic practice!!

47. Refrences
 Computer-assisted orthodontic treatment:The SureSmile process ,James Mah,
DDS, MSc, DMSc,a and Rohit Sachdeva, BDS, MScb, American Journal of
Orthodontics and Dentofacial Orthopedics, July 2001
 SureSmile Technology in a Patient-Centered Orthodontic Practice ,ROHIT C.L.
SACHDEVA, BDS, MDS , JCO , VOLUME XXXV NUMBER 4 ,2001
 Interview with a SureSmile doctor:Nicole M. Jane, Robert P. Scholz, American
Journal of Orthodontics and Dentofacial Orthopedics,April 2009
 Interview with an innovator: SureSmile Chief Clinical Officer Rohit C. L.
Sachdeva,Robert P. Scholza and Rohit C. L. Sachdeva, American Journal of
Orthodontics and Dentofacial Orthopedics,August 2010
 SureSmile: A Report of Clinical Findings,ROHIT SACHDEVA, BDS, MDS,JAMES F.
FRUGÉ, JR., DDS,ANDRÉ M. FRUGÉ, DDS,RICHARD INGRAHAM, DDS,WILLIAM D.
PETTY, DDS, MS,KATHRYN L. BIELIK, DDS,JAGDISH CHADHA, DDS, MS,PHUONG
NGUYEN, DDS, MS,J. LAWRENCE HUTTA, DDS,LARRY WHITE, DDS, MSD, JCO 2005

48.  DEPARTMENT OF REVIEWS AND ABSTRACTS,Alex Jacobson, DMD, MS, PhD,
American journal of orthodontics
 Orthodontic technolocity,Robert P. Scholz, American Journal of Orthodontics
and Dentofacial Orthopedics,March 2001
 Motion Planning for Archwire Bending Robot in Orthodontic Treatments,Zhang
Yongde1, a, Wei Chunge1, Jiang Jingang1, b, Jiang Jixiong1, Liu Yi2 and Wang
Yong,international journal of control and automation,2014
 An In-Office Wire-Bending Robot for Lingual Orthodontics,ALFREDO GILBERT,
DDS, MS, 2011 JCO
 ROBOTIC DENTISTRY-THE FUTURE IS AT THE HORIZON, Bhavna Jha Kukreja, Vidya
Dodwad , Tulika Singh, JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL
SCIENCES, vol 16 issue 16

49.  THE CUTTING EDGE, The SureSmile System in Orthodontic Practice JCO
2009.
 Bending Process Analysis and Structure Design of Orthodontic Archwire
Bending Robot , International Journal of Smart Home , Jiang Jin-gang*,
Zhang Yong-de, Jin Ming-liang and Wei chun-ge,2013