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Phone: +49t/3 89 69 76Email: info@kline-europe.de www.klineinternational.net www.kline-europe.de www.facebook.com/klineuropeGermanyLabor:K LINE Europe GmbH Lilienthalstrae 7040474 Dsseldorf Germany

SMART PATH FROM SCIENCE TO SMILES

K Clear Aligner

Dr. Ahmed Metwally

Contents

Introduction Kline Objective and challenge

Brief of clear aligner treatment

Advantages

Brief history of clear aligner treatment

Impression techniques and digitization

Smart Force features and Attachments

Biomechanics

Clear Collection instruments for clear aligner treatments

A Clinical Case Treated with Clear Aligners

Periodontal considerations

Summary

ObjectiveK Line has been built to change the way people think in dentistry, we think of ourselves as artists not business people. We always put in our minds that thinking different and being unique is one of the key points of our success. K Line has been and always will be delivering massive value to thousands and thousands of peopleChallengeK Line is implementing new ideas into the field of dentistry and showing dentistry the other side of the coin. Many new products are emerging lately at K Line . With such a broad spectrum of services and positive signs from the market, K Line found itself in an optimal position for initiating growth. But in order to grow, K Line needed to streamline its business. The company required a system that could enable faster throughput without compromising its high standards and without costly expansion of their technician staff and facilities. K Line has succeeded in implementing this model, to bring its clients best quality with a very competing cost.With plenty of experience of the company founders, we managed to combine the energy and passion of youth combined with the expertise we have to bring out the best blend of services.In a market focusing on high tech, prices have been jumping much to some extents that would make it difficult to serve many patients, yet we focused on bringing highest tech in manufacturing and services with a very affordable price.We realized that a very good distribution protocol was mandatory for our growth, so we decided to build a very concrete distribution business module by which we help spread our services in same quality consistency and maintain the prices all over the world.K Line Europe GmbHLilienthalstrae 7040474 DsseldorfTel 1: +49 (0)21193896976Tel 2: +49 (0)21165859944Website : www.kline-europe.deemail : info@kline-europe.de

Kline K clear Clear aligner TreatmentK ClearAligners are removable orthodontic dental appliances that can be used in many cases that need teeth straightening, space closure, mild Class II or III cases and etc..Teeth straightening has never been that easy:A.Deliver aligners in phases as instructed by our professionals to your patient.B. Teeth move according to previously planned tooth movement by our specialists on3D designing softwareC. After nearly each 2 weeks, the aligner is changed to the following one in the correctsequence.After the patient feels satisfied with the results once the treatment isfinished, the retention phase follows.We provide aesthetic lingual permanent retainers upon request or as standarda removable retainer.

Introduction

K ClearAligners are an alternative to traditional braces and are designed to help guide teeth into their proper position. Similar to braces, clear aligners use a gradual force to control tooth movement, but without metal wires or brackets.

The aligners are made of a strong plastic material and are fabricated to fit each person's mouth. If a series of aligners are made, each aligner moves the teeth a little bit more into place until the desired movement is completed.

Aligners are worn for at least 21 hours a day to reach the desired maximum effectiveness.

Each aligner is worn for one two weeks before changing to the next one. The length of treatment with aligners depends upon the severity of each case.

The appliance is currently recommended for adults and for adolescents with fully erupted permanent teeth who meet an acceptable standard of compliance.

Excellent compliance is mandatory since the appliance has to be worn a minimum of 20 to 22 hours a day and each aligner should be worn 400 hours to be effective.

Aligners are not only esthetically pleasing to adult patients but, because they are easily removed, extremely safe. In the future, aligners are likely be used in even more complex cases involving rotations, deep overbites, open bites, and unusual extractions.

Further clinical investigations are needed into the effects of accelerated tooth movement in such cases.

K Line Clear Aligners are nearly invisible orthodontic removable appliances.

They are a wireless, bracket-less technique that evolved in the past few years to serve dentistry and orthodon- tics.K Line Clear Aligners are thermoplastic appliances worn by the patients teeth, in a sequence addressedby our company to achieve the desired result of tooth movement in the predetermined timeframe.

K Line Clear Aligners can treat simple, mild and moderatecases which resemble more than 60% of orthodontic cases; mostly it con-centrates on the aesthetic results that could be achieved for anterior mal-alignments.

What areK LineClear Aligners?

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Clear Aligner - Case flow chart

ThermoformAn intelligent tool recommended for all clear alignthat helps to decrease the patient refinement stage at endof a treatment. The pliers are used to create or modify forcepoints, to create space, to create slots or to form hooks inaligners. Force points generate pressure and guidance tomove teeth into the final position. Another application is toincrease retention of the aligner at certain sites on demand.195,00contour thsubgingival ledge.One pack contains 10 double-sided st .Diamond bursOur burs have the unique feature of leastto provide a uniform proximal teeth surfacpreserve the aesthetic contours of patient9,00

ElasticsElastics are mostly used in cases requiring class II orclass III elastics, or extrusions and intrusions.They are provided in several sizes 1/4, 1/8, and 3/16.Clear buttonsPre-fabricated buttons help to hook elastics on for variousindications, e.g.: class II or class III elastics, intrusions orextrusions.One pack contains 4 buttons.20,00K Line Clear AligneYour patients aligner safe box iIf your patient looses it, you careplacement box any time.3,00K Line cleanser tabletsFor better hygiene, we recommend all patients to usecleanser tablets to clean their aligners. The tabletse with an effervescent effect, to be used onceand disinfect the aligners.

Carriere distalizerSome cases require urgent distalizatiosegments prior to an aligner treatmerecommend using Carriere Distalizer.6,00 Quantity:Quantity:Quan15,00 Quantity:195,00 QuQuantity:

&&&Lab reportAccessories and marketing materialClear aligners (sent in phases) Before and after treatment modelsbbCase registration on K Line PortalSilicon impression(s) + bite registrationORintra-oral scans (STL-files( RadiographsClinical photos (intra-oral & extra-oral( a3D-scannerproduces digital file of impressionsaTreatment is split into individual treatments stepscPractitionerapproves treatment plancAligners aresorted, disinfected and packed upK LINE dentists use 3D-planning software to simulate treatment outcome Aligners are fabricated using digital and manual techniquesPlease send physical data via mail to K LINE Europe GmbH (address see below) and manage your patients cases by uploading any digital files to K LINE Portal (http://www.klineinternational.net/doctor.php).*Requires a maximum of 3-5 working days!*Requires a maximum of 14 working days after treatment plan sign-off!STEP 1Clinical data acquisitionSTEP 2Digital treatment plan production*STEP 3Aligner production*STEP 4Aligner delivery

&&&

We will make it easy for you:Just simply gather rough data (clinical photos, impression or models and panoramic radiograph) for your case to be submitted on our portal. We will assess the case data and revert back to you with a predicted treatment plan.11kline-europe.deHowto send us your first case data?

K LINE PORTALWe always recommend our clients t establish use their accounts on our website portal for a better professional data collection ,better treatment planning and communication between the dentists and our professional supportTo access K Line portal, kindly follow these simple steps:

1. Visit www.klineinternational.net and login using your K Line login account.

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3. Filling out the general information for the patient and save afterwards

2. Click here to add a new caser. Mustermann13kline-europe.de

4. Uploading Radiographs, Pictures and any other documents

NB: Please dont forget to save the uploaded files.14kline-europe.de

A good impression helps to ensure proper identification of tooth anatomy and the manufacture of aligners that fit and deliver precise force on the teeth desired to be moved.We need both arches captured perfectly in your impressions to reach at least the 2ndpermanent molars.The impression should extend more than 2mm beyond the free gingival margin on the buccaland lingual surfaces.Using polyvinyl siloxanetwo phase technique or polyether are recommended.INSURING BEST QUALITY THROUGH IMPRESSION TAKING

115kline-europe.deTaking accurate impressions:

All teeth are included in both impressionsGingival margins can be clearly identified16kline-europe.deNB:

If any of the aspects are not visible in you impression, we highly recommend taking a new impression.If it is your first time to send K Line impressions, kindly take 2 impressions per arch, we will pick the better one.CHECKINGTHE IMPRESSIONS FOR:2

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-Wax bite horse shoe bites (more preferable)-Rubber bite used in overseas cases3Take Biteregistration

Radiographic requirements4

Panoramic x-rayLateral cephalometricX-ray

a-Frontalb-Lateralc-LateralClinical Photos5Intraoral photosd-Occlusaluppere-Occluallower

Extraoral photos18kline-europe.de

DiagnosisandCase selection1. Cases with crowding:BEFOREAFTER

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Spaced TeethUp to 6mmBEFOREAFTER

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BEFOREAFTER

Cross bites (simple, mild and moderate(

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ProtrusionsBEFOREAFTER

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BEFOREAFTERDeep Bites

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There are severe cases, with no treatment option with clear aligners.)Certification and further clear aligner education is recommended for best case selection(.NOT INDICATED CASES

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Before discussing the problems you may face during and after treatment, you should put in mind the following:

Teeth movement = Space + Force+ Time

Insufficient Space may be due to:

-Insufficient IPR-Effect of insufficient force system/ points of contact in the aligner and/or attachment-Treatment plan that limits the suc- cess of creating space required

That will cause:-Tooth will not move-Incomplete seating of the aligner will occur-Active Forces increase25kline-europe.deIPS AND TRICKS TO ACHIEVE IDEAL OUTCOMESThat can be prevented by correct IPR )Interproximal reshaping (

Check the Interproximal ContactIf the contact is tight; relieve it bystripping.T

Aligner lag or lost tracking is most often characterized as an air gap between the incisal or occlusal of teeth and the plastic, indicating teeth are not following the prescribed tooth movementOrthodontic Practice US Volume 6 Numbers 3 & 4

Aligner Chewies are held tightly been specific lagging teeth for 10-15 seconds. This process is repeated for 5 minutes, 2-3 times daily, especially when changing to a new pair of aligner trays

nsufficientforce maybedue to:I-Lack of correct engager to aligner contact-Insufficient time for the mo- vementThat will cause:-No case Progress-Incorrect teeth movements

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During treatment considerations Aligner fitting29kline-europe.deCONTENT MANAGEMENT CONSIDERATIONS

TEETH MOVEMENT

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POST- TREATMENT CONSIDERATIONS

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Traditional orthodontic treatment isnt over when the braces come off, and clear aligner treatment is no different. After straightening their teeth, patients need to wear a retainer to prevent them from relapsing.

There are a lot of retention protocols. Generally; we recommend long term retention.We start with full time wear of removable retainer for about one year and then night wear for the following years.Additional fixed retention through lingual wire be preferable.34kline-europe.deFINALLY, DONT FORGET TO PREVENT RELAPSE

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AdvantagesClear aligners are removable so it is easier for you to brushand floss after meals.

Clear aligners are easier to keep clean.

Clear aligners are comfortable and less likely to irritate yourgums and cheeks.

Clear aligners can prevent tooth wear from grinding.

Why choose K Line?There could be several providersfor removable orthodontic appliances, we try our best to make our product distinguished through the following :High tech used in many aspects of manufacturing and services supplied to you and your patient.Flexible services upon need.High quality materials used to manufacture the clear aligners ( CE certified Made in Germany )4. Our treatment plans are based upon profound science through professionals over 8 years in the clear aligner business.5. Very competitive prices.

What have you been missing? Faster treatments & great results! Expected treatment results

Friendly forces

Tried by thousands of doctors and patients

Why do many practitioners change to K Clear provided from K Line Europe?Our aligners have a 2-3 mm coverage above the gingiva.Better AnchorageBetter retentionBetter precise tooth movementAs per our aligner designs we need only a few engagers.Our engagers ensure reliable anchorage and helps in specific tooth movements.We use Ball forces to perform challenging tooth movements with aligners.Our KLINA aligner material offers almost persistent constant forces over the entire wear period of 2 weeks.The perfect balance between elasticity and hardness is necessary to stretch the periodontal ligament, to the extent where cell changes are obvious.KLINA X has soft inner surface and a harder outer surface, ensures long lasting friendly and comfortable forces.Less Engagers Material: KLINA & KLINA X

Better prices for you

Our treatment supervisors haveover 8 years of experience with clear aligner treatments.Professional and scientific communication.The treatment plans are prepared only by dental and orthodontic experts

No hidden costs.Simple cost structure.

1.Aligner Design

5 .and your patients

Precise Ball forces

4.

Even difficult cases are often indicated for treatment.The teeth are brought into an aesthetic and functional stable position based upon logical and scientific tooth movements that could be accomplished with clear aligners.Online portal for case transmissions and controllingWhatsapp-ServiceSimulation video (3-5) working days Aligner fabrication (10-12) working daysTreatments can also beSpecial offered servicesFast deliveries and 3D simulation turn around timesWe send

ButtonsElasticsCarrier Motion DistalizerEngagersThermoforming pliers

Less errorEliminating undesired tooth movementsNo mid-course corrections required

5working days

10working days

6.Better treatment results7.combined with accessories

9.8.

10 . K Clear in Phases

Impression techniques and digitization

Scanned impressions of upper and lower arches and bite index in 3D

Bite registration converted to 3D models

Types of tooth movements Lateral movement

Torque

Rotation

Extrusion and intrusion

DigitizationThe Virtual SetupAfter the impression arrives at K Line Europe GmbH in Dsseldorf Germany they are scanned using an industrial CT scan to produce a 3D Virtual model.

Once the Virtual models are produced they are segmented using boundary recognition software to define individual teeth.

Once the interproximal surfaces of the teeth are assessed and virtual roots are placed and lastly the gingival margin also created using morphing type software.

The preparation work is finished and submitted to TREAT (K Line Europe GmbH).

It is a Proprietary software K Line Europe GmbH uses to simulate treatment and set the virtual model to allow the manufacture of the aligners.

Once the virtual model is completed and approved by the orthodontist , a series of plastic models is fabricated using stereolithography on which the aligners are then made by thermoforming process.

The software used by the orthodontist in the officeIt allows the orthodontist to view the treatment in all the aspects as well as superimpose one stage of treatment over another to visualize individual tooth movements so as to gauge the probability of accomplishing the desired movement that will be biologically feasible.

Clinical and Radiologic Examination of the teeth and periodontal tissues : -regular check-up for caries and existing restorations-control of the active periodontal problems -determine the need for extraction of impacted third molars and teeth with bad prognosis-rule out root resorption( orthodontic relapse cases)

Gingival Contouring

Smart Force features and Attachments.Designed to help you treat with confidence.

Smart Force Features are: Engineered to deliver the force systems necessary to achieve more predictable tooth movements.

Customized to each tooth using advanced virtual modeling, including such features as the width, long axis, and contour of the entire tooth. Positioned more precisely to deliver the necessary forces while eliminating interferences. automatically placed in accordance to the desired movement.

AttachmentsThe New Attachment Protocol allows for attachments to be passive or active. Passive attachments are for aligner retention and anchorage for intrusion.

Active attachments are used for rotations of rounded teeth, extrusion and root correction. Currently Align Technology has three types of attachments for commercial use: the ellipsoid, rectangular and the beveled attachment.

Ellipsoid attachments are often placed horizontally and are the default for anterior tooth extrusions. They are 1mm in thickness and placed between the cervical and middle third of the tooth.

Vertical rectangular attachments as seen in are the default for rotations of canines and premolars.

In addition, these attachments are used for root control on teeth adjacent to extraction spaces. For premolar extraction cases, the default is placement of two rectangular attachments distal to the space and one mesial to the extraction space.

Typically these attachments are 1mm thick, 2mm wide and either 3, 4 or 5 mm long.

The vertical rectangular attachments are very retentive, so take care when placing multiple attachments in one quadrant. The aligner can become too retentive for patient convenience. An interesting option is the beveled attachment for rotations.

Sometimes the rectangular attachments dont t perfectly and during rotation can put unintended forces on the tooth, resulting in side effects. Beveling the attachment can ease the t and make the attachment active, causing rotation.

In order to facilitate greater ease of insertion and removal as well as eliminate the all or none situation the beveled attachment was developed by rotating a portion of the rectangular attachment virtually into tooth surface. ( see fig)

The beveled attachment can be utilized in multiple orientations simply by having the technician rotate the attachment in a different manner.

There are theories that rotating the bevel in a specific directions will enhance specific movements.

An alternative to the attachments that help facilitate torque control is the power ridges. These are engineered corrugations placed at specific locations to enhance the undercut near the gingival margin of teeth undergoing torqueing movements.

The ridge function in two ways . The first is to stiffen the gingival third of the aligner to make it more resilient .

The other is to provide additional force as close to the gingival margin as possible to increase the effective moment arm of the aligner .

The obvious advantage to power ridges is that attachment need not be placed or removed and they are more esthetically acceptable to the patient.

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Various manufacturers

RotationsCorrecting rotations with aligner can be problematic.There are primary reasons for this.1) first is that aligners produce tooth movement by the plastic being slightly distorted and then elastically rebounding back to the predetermined shape and carrying the tooth with it.

Even with the properly designed attachment ,another problem with rotations is that the tooth root is not a cylinder, and because of dilacerations and root surface variations, there is no way the computer software can adequately estimate the true rotational long axis.

For this reason we need to use auxiliaries either before ,during or after aligner treatment in order to accomplish the rotational correction.

ExtrusionsExtrusion can also present problems with the aligners. The reasons for this is similar to that of rotations.

One method being used to overcome this problem with some promising results is to use the gingivally beveled attachment to provide a longer surface that can be elastically deformed and provide an extrusive force on the tooth.

Other auxiliaries can be used to facilitate specific movements. Class II and class III elastics are frequently needed just as they are with fixed appliances.

One can either attach the elastics directly to the aligner or attach elastics to buttons bonded to the teeth.

Mini screws can also be used effectively with the aligners in the same manners as they can with fixed appliances, either planned initially as part of the treatment or to help with movements that are not progressing as desired.

H highly placed canine

A Clinical Case Treated with Clear Aligners

Clinical Case A 26-year-old female presented with a Class I malocclusion and an orthognathic profile. She was in the permanent dentition with retroclined maxillary central incisors, moderate overbite, spacing distal to the maxillary canines and mild crowding in the mandibular arch Her primary concern was the alignment of her maxillary incisors and she refused to have fixed appliances. The treatment objectives using Kline were to align her front teeth, close space in the maxillary arch and alleviate crowding in the mandibular arch

IJO VOL. 22 NO. 2 SUMMER

Kline treatment involved 24 upper and 10 lower aligners. Attachments were placed on several teeth to achieve a more predictable tooth movement using aligners. The patient wanted to reduce treatment time as much as possible and was instructed to change the aligners every 10 days instead of 14 days.

After 8 months of initial treatment, a Case Refinement with 7 more aligners was needed to finish the maxillary arch. Once treatment was completed (Figure 7), a bonded lingual fixed retainer was placed on the maxillary incisors to prevent relapse

IJO VOL. 22 NO. 2 SUMMER

Pre - treatment Post - treatment

Periodontal considerationsThere is a body of evidence growing that orthodontic treatment with aligners has less detrimental periodontal impact than that of fixed appliances.

Miethke and Vogt and Miethke and Brauner compared the periodontal health of the patients who underwent the treatment with aligners to that of patients who underwent treatment with both labial and lingual fixed appliances

Boyd found that periodontal health could actually improve during the course of the treatment.

Advantages EstheticsComfortRemovabilityBonding to enamel defectsNo root resorptionLess pain and discomfortNon traumaticHygiene Can be used with any restoration or crownDoesn't alter speech

University of pacific and university of florida 77

Less chair time and armamentarium Good vertical controlFewer emergenciesPrecise control of each toothControls bruxismGreat for special patients Bleaching during treatment

References1) http://kline-europe.de/for-dentists/

2) Emperors New cloth Indian journal of dental sciences june 2011 ;2;3

3) Aligner INSTRUCTION MANUAL McGill University

4) Aligner Bio-Mechanics - ORTHODONTIC CLINICAL EDUCATION CORP.

5) orthodontics current principles and techniques Graber, Varnsdall,Vig

6) Orthodontic Treatment - Richard Bouchez

7) Clear Collection instruments for clear aligner treatments - Orthodontic Practice US Volume 6 Numbers 3 & 4

8) Smart Force features and Attachments

9) WWW.AMASI.COM

Tel 2: (+49) 0211 - 938 969 76info@kline-europe.de www.kline-europe.de www.klineinternational.net www.facebook.com/klineeuropeHeadquarters K Line Europe GmbH Lilienthalstrae 7040474 DsseldorfGermany

www.kline-europe.deThank You

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