Join me for look at the orthodontic -periodontal interface, the latest evidence looking at the effects of orthodontic tooth movement as well what periodontal surgery can offer in recession management. This podcast is a summary of Christos Kassaro and Anton Spurrier’s excellent lecture, as part of the AngleNet Webinar Series.

Timestamp

0:44 – At 1-year recession risks of orthodontics

2:30 – At 15-year recession risks of orthodontics

4:37 – Retainer relapse: "X" & "Twist" effects

5:13 – Biomechanics: Using mixed bracket slots for torque

6:17 – Perio surgery principles & donor sites

7:54 – Flap designs: Full vs. split-thickness

8:14 – Surgical techniques: MCAT vs. LCT

9:27 – Timing: Surgery before vs. after ortho?

10:33 – Surgical adjuncts: Hyaluronic acid

Orthodonticaetiology at 2 time points:

1.    During active orthodonticmovement 

2.    During retention phase

Kloukos2025

1year follow up study of adult orthodontic patients Vs  control

·     1 year post debond of non-extractiontreatment at 67% greater incidence of recession within the orthodontic group (IRR = 1.67,95% CI: 1.05, 2.67, P = 0.03). Five main findings:

1.    Recessionlocation: canines and first premolars,

2.    Proclination:incisor proclination of 6.35o with no recession

3.    Recessionin control group: increased but less than orthodonticgroup

4.    Recessionquantity: Generally small at 1 mm

5.    Reductionin recession for some: Both groups showedsome patients had a reversal of their recession

Long term though what do we see?

·     Gebistorf 2018 Swiss group

·     At 15 years 77% of orthodonticpatients had 1-14 areas of recession,

·     Control group who had 62%.

·     Greater recession on lingual aspectthan labial

·     2.73 x more recession with crossbitescorrected (95% CI, 0.28-5.17; P = 0.029)  

·     Crowding in controls: 3 mm =  3.29 x more recessions (95% CI, 0.73-5.68; P =0.012)

Orthodontics onaverage does not compromise long term health or function, but may compromise aesthetics

Fixed Braided Retainers

‘X’effect (torque) or twist effect (proclination) unwanted movement from wire activation

·     Not relapsed as new movement 

·     Occurrence: 2.7% (n=221 patients) –Renkema 2011

Treatment‘X’ effect

1-   Differentialslot side

                                     i.     Affectedtooth - .18 slot with -17 degrees of torque

                                   ii.     Remainingteeth.22 slot with 0 torque

                                 iii.     Sideeffect of intrusion of incisor, due to slot differences

Periodontal Surgery concepts:

Indication: inadequate gingiva = <2 mm Zhong 2025

·     Wound healing

o   Flapdesign to enhance wound stability – avoid vertical releasing incisions

·     Connective tissue graft, harvest itfrom the palate.

o   Keratinizedtissue and quantity

o   Mostavailable, quick healing Karring 1975

o   fibroblastfrom the palate biological potential to inducekeratinization. 

Surgicaltechniques:

1-   Fullthickness: mucosa, connective tissue and includes periosteal layer

2-   Splitthickness: mucosa and connective tissue

·     

Timingof surgery

Surgeryafter orthodontics

·     Only when the teeth are in the correctposition

·     Favorable environment for the woundhealing. 

·     Usual timing of surgery

Surgerybefore orthodontics

·     Require more tissue for the orthodonticmovement:

Adjuststo surgery

1-   Amelogenins attach proteins to the rootsurface. 

2-   Hyaluronicacid promotehealing through attracting proteins. 

Expert consensus on orthodontic treatment of patients with periodontal disease. Zhong2025

https://pmc.ncbi.nlm.nih.gov/articles/PMC11965299/

Contributions

Contents:Shanya Kapoor

Editedand produced: Farooq Ahmed

“The reality is none of us use light continuous forces.”

“Friction is awesome. Friction is great, we would be miserable if there was no friction… (with) uncontrolled movement everywhere”

“Segmented arch mechanics are very tough to gain three-dimensional control over the tooth.”

“The last major landmark in fixed appliance and in orthodontics was the pre-adjusted edgewise appliance.”

“The root is not moving according to the wish of the orthodontist (with aligners)”

I’m joined by Madhur Upadhyay for a deepexploration of biomechanics, biology, and the true limits of orthodontic innovation. We examine advances in appliances, aligners, and digital workflows and why they have, as of yet, not improved speed or quality of clinical outcomes,and innovation is still governed by the same biological constraints that dictated tooth movement a century ago. However progress has been significant in workflows for both fixed and aligner therapy.

We also discuss why complex biomechanics arerarely implemented in routine practice, whether pre-adjusted appliances were the last major landmark innovation, and what aligners can, and cannot, achieve in terms of root control in terms of biomechanics. The conversation extends toartificial intelligence in diagnosis and treatment planning, asking whether automation enhances clinical care or gradually replaces critical thinking. We conclude with thoughts of micro and nano-plastics and the focus needed on this topic in orthodontics.

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Please visit the website for this interview podcast:

https://orthoinsummary.com/the-hidden-biomechanics-of-fixed-appliances-aligners-orthodontics-in-interview-madhur-upadhyay/

.

Publications by Madhur Upadhyay

Biomechanics of clear aligners: hidden truths & firstprinciples 2022 https://doi.org/10.1016/j.ejwf.2021.11.002

ClearAligners in Extraction-Based Orthodontic Treatment: A Systematic Review andMeta-Analysis 2026 DOI: 10.1111/ocr.70052

#OrthodonticsInSummary
# Madhurupadhyay
#Orthodontics

#biomechanics

#TADs

#OrthodonticsInInterview

#FarooqAhmed

#OrthodonticBiomechanics

#DentalEducation

Farooq Ahmed

🕒Timestamps of Key Questions & Answers
01:43 Are We Overestimating Orthodontic Innovation?
02:41 If Technology Has Advanced, Why Is Fixed Appliance Treatment No Quicker?
08:55 Why Are Aligners Still Only 50% Predictable?
12:23 Why Are Biomechanical Set Ups of Cantilevers Unpopular In ClinicalPractice?22:41 Have Bracket Prescriptions Stopped Innovation?
26:42 MBT vs Roth – Does Prescription Really Matter?
28:22 Can Aligners Truly Move Roots,  OrIs It Just Tipping?
33:37 Is Software Innovation Just a Distraction from Aligner Material Limits?
36:15 AI in Orthodontics, Will It Replace Clinical Thinking?
43:00 What Are The Most Misunderstood Concepts in Biomechanics
51:07 The Micro and nano-plastic in Aligners

MISMARPE / DOME what is it?

Join me for a look at maxillary expansion combining both surgery with miniscrews. Seemingly opposite ideas have been brought together to offer potentially greater versatility in expansion, with less surgical complexity andcomplications.

MISMARPE – minimally invasive surgery miniscrew assistedrapid palatal expansion Haas 2021

Or

DOME Distraction Osteogenesis Maxillary Expansion Liu2017

Protocol

·     Osteotomy

o  Anterior vertical incision interdental toperiform fossa

o  Lateral incisions to the base of zygomaticprocess of maxilla

o  Without releasing the pterygomaxillary suture

o  Activate in surgery up to 20x ensure diastema

o  Duration 24 minutes (14.4-32) Junior 2021

o  Less pain – Mild on VAS

·     Expansion

o  7 days no expansion

o  Expansion of rate 0.25 - 0.50 mm,

§ Some until diastema and slow to 0.25 per day

Advantages

·     Less osteotomies required

·     Under sedation or local anaesthetic

·     Greater anchorage for force delivery throughminiscrews

·     Less intra-operative haemorrhage – due to a lackof pterygopalatine disjunction

·     Parallel expansion – Lin 2015 Vs V shapeexpansion

Age

Limitation of MARPE was age, with 20-30 years females 94% 20-30years males 80%, MARPE success 30-37 = 20% Olivera 2021, MISMARPE 96% successage 20-59, 24 patients majority over 30 years old Piccoli 2023.

Expansion amount

·     Direct comparison show no significant differenceda Silva 3mm, and no difference in molar angulation 2023

Indicated for:

·     Failed MAPRE

·     Age- greater 30 females and 25 for males

Could MISMARPE / DOME replaceSARPE?

Direct To Print Aligners,Will It Change Clear Aligner Therapy? 8 MINUTE SUMMARY

In this episode, I review direct-to-print alignersand how the material offers potential biomechanical advantages through itsmaterial properties when compared with conventional thermoplastic aligners. Theunique feature of force recovery of the material and current emerging evidence.The episode also explores the current limitations of the evidence base anddiscusses why, despite theoretical advantages, direct-to-print aligners havenot yet entered routine clinical practice. This podcast is based on a recent lectureby Jean-Marc Retrouvey.

Timestamp

00:27 – What are direct-to-print aligners?

01:10 – How do direct-to-print aligners deliver force?

02:39 – Push and pull forces and adaptation

03:58 – Reactivation with heat, unique force recovery

05:09 – Variable aligner thickness

07:08 – Why haven’t direct-to-print aligners changed aligner therapy yet?

Material photopolymer resins

Force delivery – Push and Pull

Engage with undercuts not possible with thermoformedaligners

o  Deliver forces to areas seen as non-engagedsurfaces

§ Non-engaged surface – greater displacement thanTFA (Hertan 2022)

Force delivery – Adaptation

·     Closer adaptation 20-30% more accurate 30um or 0.03mm (48 um Graphy Zendura, Essix Ace and DPA Koenig2022).

·     Uniform thickness

                                                                                            i.        TFA Non-uniform thickness – due thermal process, thinner areasend of aligner

                                                                                         ii.        TFA sharp distribution around attachment / transition

Force delivery material properties

·     TFA Stress relaxation – Reduce force with time,12 hours reduce 60%, DPA reduce to around 50%, but with recovery increase to75% Xu 2025

                                                                                            i.        Moment to force ratio more sustained for bodilymovement, in vitro study

·     Thickness customisation

o  Creating a force couple: 0.8 labial, Vs 0.5mmlingual , creating moment within the aligner

Direct to Print Aligners 2 types: Shape memory Vs Activememory

·      Similarclaims:

1.       Re-activate force recovery through heating inwater reactivation and reverse stress relaxation and creep

2.       Customise thickness, trimlines and auxiliaries

3.       Less attachments

4.       Speed of printing aligner

5.       Less wastage

·      Shapememory: Graphy 2019

1.       Transition temperature – low 45 degrees, from30-45 degrees = increase temperature = reduce force. Re-activates inside themouth to maintain properties. Choi 2025

·      Activememory LuxCreo 2022

1.       Transition temperature – high 60 degrees =maintain elasticity

2.       Re-activated with warm water  = restores mechanical properties

Challenges:

1.       Little clinical research to support biomechanicalsuperiority

2.       Loss of force from insertion Xu 2025 50% in 12hours

3.       Effectiveness seems camparable for mild to moderatecases:

a.       PAR change DPA 86%, refinement of 40% VanessaKnode 2025,

b.       PAR change TFA 88.9% Jaber 2022, refinement of 70-94%Ladewig 2005, Kravitz 2023

See Jean-Marc Retrouvey’s lecture in full: https://www.youtube.com/watch?v=j7fJmxgXHqU

Previous podcast on Direct To Print Aligners February2024

https://orthoinsummary.com/direct-to-print-aligners-are-they-really-different-to-normal-aligners-8-minute-summary/

#aligneronorthodontics

#directtoprint

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#Farooqahmed

#Orthodontics

#Luxcreo

#graphy

#clearalignertherapy

Has MARPE Found Its Place?

Join me for our first podcast of 2026 looking at Miniscrew AssistedExpansion, and where this treatment modality currently stands in clinicalpractice. With discussions of different designs (MSE Vs MARPE), rapid andslow activation protocols, orthopaedic effects, and predictors of success.   Thispodcast is a summary based on an excellent lecture from Angle-Net by DanieleCantarella and Benedict Wilmes.

01:18 – MSE vs MARPE designs: key differences
03:55 – Anchorage, bone quality, and force delivery
05:29 – Skeletal effects: parallel suture split and expansion amounts
06:42 – Asymmetry, resistance areas, and biomechanics
07:00 – Class III correction: where MARPE really adds value
09:26 – Rapid vs slow activation and what actually happens to bone
10:28 – Predicting success: age limits, failure rates, and when to considersurgery

#MARPE

#MSE

#expansion

#orthodontics

#orthodonticsinsummary

#Farooqahmed

#Orthodontics

#dentalpodcast
#orthodonticcommunity

Reflections on 20 years in Orthodontics | Orthodontics In Interview | BJÖRN LUDWIG

“We focused so much ontechnology that maybe we neglected diagnostics.”

“Anecdotal is inspiring,but we need evidence for the average orthodontist.”

“If we don’t protectacademic journals, orthodontics becomes vulnerable,  legally and professionally.”

“Orthodontics grows whenwe are open, critical, and enquiring.”

In this special episode, I’m joined by BjörnLudwig for a reflective conversation recorded during the few weeks of hispublic speaking career, as he brings his landmark Ortho 50 series to aclose. We look back on two decades of clinical practice, academic leadership,and contribution to the orthodontic community, and ask whether modernorthodontics has truly improved on the outcomes of the 1990s.

We discuss evidence versus clinicalexperience, the impact of technology on diagnosis and treatment planning, thepressures facing academic publishing, and the evolving role of key opinionleaders. Björn also speaks candidly about family, health, Oscar and legacy, andhis decision to step back from speaking in orthodontics, offering thoughtfulinsight into what really matters in an orthodontic career.

02:41 – Why is today’s orthodontics nobetter than the outcomes in the 1990s?

04:54 – How do we improve outcomes intoday’s clinical practice?

06:36 – Evidence vs experience: shouldwe trust trials or clinical experience?

09:13 – When research proves us wrong, howshould orthodontists respond?

11:19 – The role of your parents inshaping your orthodontic career

14:06 – As Editor-in-Chief of Kieferorthopädie,what changes have you seen over the last decade?

17:59 – Do Key Opinion Leaders help orharm orthodontics?

21:37 – Quick fire: proudest research, 3best clinical tools, and 3 biggest clinical regrets

27:52 – What advice would you give tothe next generation of orthodontists?

29:51 – Health, Ortho 50, and knowingwhen to step back

Click on the link below to view previous episodes, to refresh topics,pick up tricks and stay up to date.

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#OrthodonticsInSummary
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Farooq Ahmed

🕒Timestamps of Key Questions & Answers

“Even though the panelistswere huge aligner users, the statements are not so in favour of aligners, they are surprisingly reasonable.”

“It’s very difficult to find a real aligner experts without a conflict of interest. Almost impossible.”

“If you explain the differences honestly, most of my extraction patients choose fixed appliances. I’m not selling aligners.”

“Direct printing is the real breakthrough, but right now it has too many shortcomings to be a standard technology.”

“I am pessimistic. We must fight for our profession — against the idea that technology can replace orthodontists.”

In this episode, I’m joined by Vincenzo D'Antò, lead author and contributing author of this year’s two major consensusstatements on clear aligners. We explore the key findings from these landmark papers and how they translate into real-world clinical practice. Vincenzo shares his own views on aligners, their limitations, and his pragmatic approach to integrating hybrid mechanics, particularly skeletal anchorage, into alignertreatment. We discuss recent innovations in aligner therapy, distinguishing those with genuine clinical value from those that are ineffective. We also hear Vincenzo’s candid concerns about the future of orthodontics.

03:00 – Why did youcreate this Delphi aligner consensus?

05:03 – How were thealigner experts selected for the study?

06:51 – Do conflictsof interest affect aligner consensus statements?

11:49 – Crowding: Whydoes the Alharfi 2025 SR show better outcomes for aligners?

15:49 – 7 vs 10 vs 14days: How often should patients change aligners?

20:03 – Are complexmovement failures a design flaw or inherent to aligners?

22:19 – What trulylimits clear aligner biomechanics?

25:46 – Is hybridorthodontics the future of predictable aligner treatment?

29:35 – What hybridmechanics do you use most in practice?

32:05 – Can wereliably treat extraction cases with aligners?

36:03 – Is betterOHRQoL worth compromised occlusal outcomes?

39:11 – Do alignerswork for growing patients, or is this just marketing?

41:34 – Why ishigh-quality aligner research still so weak?

44:30 – Final advice:What should orthodontists focus on for the future?

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Please visit the website for this interview podcast:

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🕒Timestamps of Key Questions & Answers

Retention, What Should We Do Now?

Join me for a update on retention, I explore a review of currentliterature and what the changes are recommended to our retention protocols,research of stability,  critical look of retainerfailures and factors to consider in design and location of fixedretainers, as well as monitoring recommendations based on Clinical PracticeGuidelines. This podcast is based on recent literature as well as two excellentlectures from this year’s British Orthodontic Conference by Marie Cornelis(Australia) and Simon Littlewood (UK).

Recommendations for the maxilla:

·     Low risk of relapse = Removable retainer (polyethyleneor polyurethane)

·     High risk of relapse = Dual retention with fixedand removable retainers

·     Fixed retainer

o  3-3 if occlusion allows, most likely 2-2 designunless high risk of canine relapse

o  Location slightly gingival due to occlusalforces and account for Increase in overbite with age (Littlewood)

Recommendations for the mandible

Lower arch

o  Low risk of relapse = fixed retainers

o  High risk of relapse = dual arch

o  Fixed retainer 3-3

§ Position slightly incisal Mandible: slightlymore incisal, greater cleanability, less gingival inflammation  – Petsos 2023

Monitoring regime

·     1 month – fixed retainer (greatest timepoint offailure)

·     3 month – removable retainer (motivation ofcompliance)

·     Every 3-4 months Wouters 2018

·     1 year retention necessary  Wouters 2018

·     Annual check-up Wouters 2018

o  Greater likelihood of compliance if annualcheck-up

o  General dentist

Improve compliance

·     2/3rds stop wearing after 4 years,All-Moghrabi 2018

·     Visual photo of relapse to patient and parentsincreased compliance Vs patient only or instructions only Lin 2015 (1.5Hrsgreater wear)

Clinical PracticeGuideline For Orthodontic Retention Wouters 2019 (open access paper)

“The purpose of Dental Monitoringisn’t to disconnect you from your patient, it’s to make sure you see them atthe right moment for the right reason.”

“Fix problems early andyou don’t have problems. If you intercept an issue straight away, you can oftenavoid side effects altogether.”

“If you don’t change yourprotocol, DM won’t reduce appointments, you do. The technology empowers smarterscheduling, not magic.”

“AI isn’t replacingorthodontists. It’s replicating their eyes, helping you catch what you’d wantto see, every single week.”

In this episode, I’m joined by PhilippeSalah, CEO and founder of DentalMonitoring. We explore the evolution of AI-based remote monitoring in orthodontics, how it aims to change the way we communicate with patients, provide data of our practice but also where the evidence remains mixed. Philippe addresses questions on reliability, patient compliance, and the impact on rapport when monitoring replaces in-personvisits. We discuss the real-world challenges of cost, protocol adaptation and workflow change, as well as the future role of AI, sustainability, and data-driven insight in clinical practice.

02:07 – How did youcome up with the concept of Dental Monitoring?

08:50 – How accurateis Dental Monitoring, and what happens if the AI misses something?

13:55 – Where do yousee the benefits of Dental Monitoring if studies show limited reduction invisits or treatment time?

18:56 – Is remotemonitoring less able to build patient rapport compared to in-person officevisits?

24:53 – DentalMonitoring comes at a financial cost, what is the return on investment forclinicians?

29:48 – Is DentalMonitoring for every patient, given compliance and scanning challenges?

33:02 – AI consumesglobal energy resources, how does Dental Monitoring address environmentalresponsibility?

36:52 – Tell us aboutDental Monitoring Insights and how it impacts clinical practice.

42:28 –What advicewould you give to orthodontists

Click on the link below to view previous episodes, to refresh topics,pick up tricks and stay up to date.

🕒Timestamps of Key Questions & Answers

#OrthodonticsInSummary
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Farooq Ahmed

“Will AI it replace the orthodontist? No. Will it replace the bad orthodontist? Hopefully, yes.”

“With AI, you could probably get prediction accuracy down to less than 10% , because it can analyze what the human brain cannot”

“Computers are designed to crunch data. That’s all they do. The rest is up to you.”

“AI is not going away. There are billions invested in this technology. You better get on with the program.”

“Don’t drive your car inreverse… Don’t go backwards.”

In this episode of Orthodontics in Interview,I’m joined by Jean-Marc Retrouvey, researcher and innovator in AI-drivenorthodontics. We explore the concept of the “virtual patient” and how artificial intelligence is reshaping orthodontic diagnosis, biomechanics, and aligner staging. Jean-Marc shares his candid thoughts on the pace of change inacademia versus industry, the role of AI in predictions within orthodontics, and how clinicians can embrace AI without losing their judgment. With insightsfrom his work in both universities and industry projects, Jean-Marc offers a compelling vision of how orthodontics will evolve in the AI-era.

·      01:47 What isthe “virtual patient” concept?

·      03:39 Wherewill AI impact clinicians, diagnosis vs outcomes?

·      07:21 Can AIbe our biomechanics co-pilot?

·      10:34 Why arealigner companies behind in AI?

·      12:57 Whatpractical changes will AI bring to aligner staging?

·      15:20 Why didyou say academia is too cautious for AI’s pace?

·      19:24 Shouldorthodontic AI education come from industry, and is that biased?

·      22:13 DoesRicketts’ 1983 “judgment over computers” still hold?

·      25:13 Will AIreplace clinician experience and literature in EBP?

·      30:44 Are weat risk of data overload with 3D/CBCT integration?

·      35:01 How dowe use AI responsibly given its environmental costs?

·      37:59 Why movefrom academia to industry, and what are you building at LuxCreo?

·      41:11 Whitepapers vs peer-review: what’s the real difference?

·      44:35 Your one piece of advice toorthodontists?

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