Scanner impressions, .stl files and e-mail/cloud delivering to the lab have literally made the world a frontierless* little village.
This is something that the most orthodontics are experiencing since a long time with Invisalign and their clear aligners conceived and produced in Costa Rica and shipped all over the world. Only recently they are opening new production centers closer to their final customer.
Anyway, what we care as orthodontists is the final product to be of excellent quality. Everyone of us wants to use the best possible appliance (in terms of production quality) as a tool to align our patient teeth, it doesn’t really matter where it comes from.
The world of aligners has been the first one to be concerned by the digital/3D shift because aligners exist only as customized appliances. Some classic-school dental technician keep doing manual setups, while the rest of the world works with virtual setups on a screen. Aligners are nowadays produced almost everywhere in the world as many local enterprises or dental labs have the skills to project and manufacture clear aligners. The scenario is likely to become more interesting as some of the first invisalign registered patents have recently expired.**
After aligners, is up to lingual braces to take the second position in terms of customization, as most major brands like Incognito, Win or Ebrace produce fully customized and setup based appliances. Production centers are based in Germany (Incognito and Win), and China (Ebrace).
Last but not least vestibular braces have basically only Insignia on the scene with fully customized braces and wires, while Suresmile propose to customize wires only. Conception and production is made in US.
What about traditional appliances (RPE, TPA, lingual arches but also Herbst and Twin-Blocks or plates)? It’s not that easy to find a digitally oriented orthodontic lab who is ready to work in a digital environment. Not to say it’s hard. For a lab working digital is not having a lab-scanner (that’s an encouraging first good step). Being 3D oriented means having the technical capability of virtual designing appliances on the screen and manufacturing them properly, in order to avoid most of the classical manual work. It’s an highly precise and customized manufacturing process that, for instance, let the orthodontist work in a band-free environment. This is most welcome on the patient side. To find a lab, Facebook helped me in figuring out in Ortodonzia Estense (Italy) one excellent lab completely devoted to digital. Of course it’s not the only one, but still a few digitally oriented lab exist per country (in Italy also Il Progetto, provides nice lab works, while in Switzerland Orthoficience is on the right track).
What happens if something goes wrong and the lab is not next door? The same things that happens when an aligner doesn’t fit. You ask your manufacturer for a new one. What happens if an appliance need reparations? It’s easier to build a new one, rather than sending back the appliance to be repaired (even if they hardly break). It’s simply a different organization of your own work. Those of us working extensively with Invisalign are already used to this scenario.
In my clinical practices in Switzerland 🇨🇭 and Italy 🇮🇹 here’s what I use:
Vestibular braces – Insignia made in the US 🇺🇸
Clear aligners – Invisalign made in Germany 🇩🇪 (for Switzerland) and in Costarica 🇨🇷(for Italy)
Fixed retainers – Memotain made in Germany 🇩🇪
Fixed and removable appliances – Ortodonzia Estense made in Italy 🇮🇹
There will be enough time to speak of all of this appliances extensively and enter into minor details. By now it’s enough to share the feeling that as 3D orthodontists we are really citizens of the world.
This may be one of the major mental shift to do by approaching the 3D world. We feel safer in having production the next door. This will be the case in a few years, but until that time let’s go global! 🌎🌍🌏
* shipping total time may sometimes depend on the customs clearing process and charges may apply according to local rules. Anyway you never pay double taxes, but you may figure out that some extra-charges have been added by customs police. This is the case for instance in Switzerland where I live.
When enterprises pre-negotiate customs clearing charges (this is the case of Invisalign and Insignia), this is more than welcome as it saves extra-bureaucracy/time
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