Introduction to LightForce

Part 1 3D-Printing the Next

Generation
of Fixed Appliances
ALEXANDER WALDMAN
MAZYAR MOSHIRI
CHRISTINA BONEBREAK-JACKSON
 Introduction
• Computer-assisted design and manufacturing (CAD/CAM)
technology has changed the landscape of dentistry over the
past few decades.

• Despite the rapid proliferation of CAD/CAM-produced clear

aligners in recent years, however, traditional labial fixed
appliances remain the most common form of orthodontic
treatment around the world.
• Most labial fixed appliance systems in use today follow a one-size-fits-all
approach, with stock brackets mass-produced by analog manufacturing
techniques such as injection molding.

• These systems apply the same prescription to every patient, without

accounting for individual tooth anatomy or malocclusion type.

• The resulting undesirable or incomplete tooth

movements may limit the clinician’s ability to
achieve an ideal orthodontic outcome within a
reasonable timeframe, and may require
significant detailing adjustments that involve
bracket repositioning, wire bending, or the
addition of auxiliaries.
• The deficiencies of standard brackets point to an obvious and
timely opportunity for a comprehensive, fully customized fixed
appliance solution.

• In response to this need, various CAD/CAM methods of

customization have been introduced, including custom slot milling,
robotic wire bending, and digital setup of analog brackets.
• Additive manufacturing represents the most recent evolution of
CAD/CAM technology in orthodontics.

• By enabling complete customization of fixed appliances through

3D printing, this technology provides virtually infinite options for
individualized treatment and offers an array of unique digital
solutions to enhance clinical practice.
 Why 3D Printing?
• Three-dimensional printing is a well-suited
manufacturing technique for fixed appliances
because it excels at producing small, complex
geometries at scale.
• The capability of fabricating digitally designed,
3D-printed brackets with anatomically unique
bases and individualized prescriptions marks
the beginning of a new generation of
customized labial appliances.
• The digital ecosystem of 3D printing also
empowers clinicians to develop a fully digital
workflow and virtual treatment plan for every
fixed appliance patient.
• Beyond the clinical benefits, 3D printing encourages the process
of orthodontic product development.

• It facilitates dynamic product evolution, since hardware

improvements (the printed objects) can change at the rapid pace
of software development.

• New bracket features can be digitally designed, printed, tested,

and clinically implemented within weeks.

• This stands in contrast to traditionally manufactured brackets,

which require a significant investment of time and financial
resources to update or change.
 3D Printing Techniques
• Light cured resin

1. Stereolithography (SLA)
• Light sensitive polymer cured layer by layer by a scanning laser in a vat of
liquid polymer

2. Photojet
• Light sensitive polymer is jetted onto a build platform from an inkjet type
print-head, and cured layer by layer on an incrementally descending
platform.

3. DLP (digital light processing)

• Liquid resin is cured layer by layer by a projector light source. The object
is built upside down on an incrementally elevating platform.
Dawood, A.; Marti Marti, B.; Sauret-Jackson, V.; and Darwood, A.: 3D printing in dentistry, Br. Dent. J. 11:521-529, 2015.
 Powder binder

• Plaster or cementaceous material set by drops of (colored) water from

'inkjet' print head.
• Object built layer by layer in a powder bed, on an incrementally
descending platform.

Dawood, A.; Marti Marti, B.; Sauret-Jackson, V.; and Darwood, A.: 3D printing in dentistry, Br. Dent. J. 11:521-529, 2015.
Sintered powder

1. Selective laser sintering (SLS) for polymers.

Object built layer by layer in powder bed. Heated build chamber raises
temperature of material to just below melting point. Scanning laser then
sinters powder layer by layer in a descending bed.

2. Selective laser sintering (SLS) - for metals and metal alloys.

Also described as selective laser melting (SLM) or direct metal laser
sintering (DMLS). Scanning laser sinters metal powder layer by layer in a
cold build chamber as the build platform descends. Support structure used
to tether objects to build platform.

3. Electron beam melting (EBM)

Heated build chamber. Powder sintered layer by layer by scanning
electron beam on descending build platform.
Dawood, A.; Marti Marti, B.; Sauret-Jackson, V.; and Darwood, A.: 3D printing in dentistry, Br. Dent. J. 11:521-529, 2015.
 Thermoplastic
• Fused deposition modelling (FDM)
• First 3DP technology, most used in 'home' printers. Thermoplastic
material extruded through nozzle onto build platform.

Dawood, A.; Marti Marti, B.; Sauret-Jackson, V.; and Darwood, A.: 3D printing in dentistry, Br. Dent. J. 11:521-529, 2015.
LightForce System
• The first 3D-printed fixed appliance system was introduced in
2019 by LightForce Orthodontics.

• LightForce brackets are manufactured from 3D-printed

polycrystalline alumina and are fully customized for all teeth,
including the molars.
• LightPlan cloud-based software enables individualized digital
treatment planning: the virtual setup of the dentition in LightPlan
results in a fully customized bracket prescription for each patient.

• Other features of the system include a selection of three slot

sizes (.018", .020", or .022"), as well as multiple bidimensional
combinations, a choice of two color options (translucent or
white), customizable digital bite turbos, and a precise indirect
bonding system.
• The anatomical custom bases and dimensionally accurate slots of
the LightForce system create an effective straightwire appliance.

• This distinguishes LightForce from previous customized systems,

in which customization was primarily or partially achieved by
means of robotically bent, patient-specific wires.

• Advantages of using fully customized brackets at the start of

treatment (instead of generating custom finishing wires in the
middle of treatment) include :
› the accuracy of indirect bonding
› the capacity to utilize a wider range of wires based on patient needs and
treatment challenges
› the ability to envision the end result at the start of treatment.
• Additionally, it is more biologically sound and mechanically
efficient to start with a customized bracket that moves the teeth
consistently toward the intended positions, rather than allowing
the initial bracket placement to move the teeth into unintended
positions and then correcting those positions with customized
wires at the end of treatment.
 The
The orthodontic practice submits digital records, LightForce
including an intraoral scan, photographs, digital
radiographs, and the prescription form. workflow
involves five
steps
The doctor reviews the initial LightPlan, edits the
treatment plan as needed using full-3D controls, and
approves the case for manufacturing.

The 3D-printed custom brackets and indirect

bonding trays are produced in LightForce’s
manufacturing facility. Brackets are preloaded in the
indirect bonding trays and sent to the orthodontic
practice, ready for bonding.

Indirect bonding is performed at the chair.

The clinician continues to manage the case.

 LightPlan Setup
• Based on the doctor’s submitted treatment
goals and general clinical preferences,
LightForce technicians create a virtual
treatment plan that represents the desired
treatment outcome.
• In reviewing the LightPlan, the doctor focuses
on the positions of the teeth, so that the
brackets will be designed by the software to
achieve the intended tooth movements.
• In essence, the virtual setup becomes the
individualized prescription for each patient.
• LightPlan is a robust clinical diagnostic and
treatment-planning tool that allows detailed
digital evaluation through such features as 3D
tooth controls, superimposition, keyboard
shortcuts, occlusal contacts, animation of
proposed movements, grid views, Bolton
analysis, and a Tooth Movement Table.

• In addition to the final occlusion and alignment,

the doctor can customize other features,
including the location and type of bracket hooks.
LightForce Brackets
• LightForce 3D-printing technology provides several novel
features:

1. The custom base fits perfectly on the labial surface of the tooth,
even in the presence of a significant anatomical anomaly. This
capability ensures consistently accurate alignment with straight
wires.
2. In contrast to conventional
methods of edgewise bracket
placement, the bracket need
not be centered on the facial
axis of the tooth, since any
rotation can be compensated
for by the custom anatomy of
the bracket base. Therefore,
almost any tooth can be
bonded indirectly at the start of
treatment, regardless of
crowding or rotation.
3. Torque prescription is independent
of vertical bracket position. This
means the wire does not have
to be positioned at the vertical
midpoint of the clinical crown, as
required with standard straight
wires. The wire can be moved
gingivally or occlusally according
to such factors as the gingival
margins or the occlusion. The
dissociation of torque and vertical
bracket position makes LightForce
an excellent tool for controllingthe
smile arc.
4. Because of the inherent accuracy of the 3D-printing process,
the slot dimensions are consistently accurate, ensuring
effective expression of the custom bracket prescription.
5. The precise anatomical adaptation of the bracket base to the
tooth surface allows optimal bond strength to be achieved with
minimal adhesive. This feature is especially appreciable in teeth
with significant anatomical variations of the buccal surfaces,
such as the first molars.
Case Report
• A 13-year-old male presented with the chief complaint of
crowding.
• Class I occlusion with a slightly hyperdivergent skeletal pattern
and mild proclination of the lower incisors.
• Anterior crowding was present in both arches, and the maxillary
lateral incisors were palatally displaced.
• The upper right lateral incisor was in crossbite with the lower
right lateral incisor and canine.
• A non extraction treatment protocol was planned, despite the
clinical challenge of maintaining appropriate torque of the upper-
and lower-incisor crowns in the presence of anterior crowding.

• The .020" LightForce slot size was selected, and the teeth were
set up in LightPlan to achieve ideal alignment, a canine-protected
occlusion, ideal torque, and an increased overbite.
• Indirect bonding of
LightForce brackets from
first molar to first molar
was completed at the
initial visit.
• The second molars were
directly bonded with
standard brackets at the
second visit.
• Vertical elastics were worn nightly from the upper canines to the
lower canines and first premolars during the first four months of
treatment.
• No bracket repositioning was needed. The final archwires were
upper .019" × .025" nickel titanium and lower .017" × .025" TMA.
• A single step-out bend was added to the final lower wire for
detailing of the left lateral incisor.
• A satisfactory occlusal and esthetic result was achieved in
precisely eight months of treatment, involving six scheduled
visits and one wire-maintenance visit.
• Cephalometric analysis confirmed good control of the dentition.
• A slight proclination of the upper and lower incisors was
attributable to the initial crowding and nonextraction treatment
plan.
• A supernumerary tooth was detected in the lower left quadrant,
and the patient was referred to an oral surgeon for evaluation.

Pretreatment Post-
Treatment
ANB 3.9° 2.5°
MP-SN 37.6° 38.4°
U1-NA 22.5° 24.0°
L1-NB 30.3° 33.2°
L1-GoGn 98.8° 101.8°
• Notably, the clinical outcome was strongly correlated with the
projected outcome in LightPlan.
• Fourteen months after treatment, the results remained stable
and the patient continued to display excellent esthetics.
• This case thus demonstrates the accuracy of the LightForce
system and its ability to harness the latest advances in digital
technology to plan and execute individualized orthodontic
treatment
 Conclusion
• LightForce 3D-printed fixed appliances represent a major
advancement in the evolution of the straight wire appliance.

• Full customization of labial orthodontic brackets with a complete

digital workflow opens new possibilities for treatment planning
and clinical case management.

• This cutting-edge advancement in CAD/CAM fixed appliance

technology facilitates precise treatment planning, individualized
outcomes, efficient treatment, and optimal treatment results.
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Thank you