Interview with Dr Isabel Flores Allen – "Virtual planning lets us create precise treatment plans quickly, reducing time from days to just minutes." Interview with Dr Isabel Flores Allen

Dr Flores Allen is the CEO of her clinic, co-founder of Master Aligner, and an influential figure in orthodontic education. (Photo: Dr Isabel Flores Allen)

Dr Isabel, can you share a bit about your background and what led you to specialize in orthodontics, particularly with clear aligners and digital technologies?
Thank you for your question. My experience in orthodontics is deeply rooted in my passion for this specialty since the beginning of my dental medicine training. From an early stage, I was convinced that I wanted to specialize in orthodontics, which led me to continuously seek innovations and differentiated approaches for my patients.

The introduction of clear aligners into my practice arose from the need to offer an alternative that not only met the aesthetic expectations of patients but also provided an effective and comfortable treatment. Since 2014, I have been working with aligners, being one of the pioneers in Portugal in this technique.

Additionally, my personal experience as a woman and during pregnancy made me realize the importance of the quality of life that virtual planning and the flexibility of aligners can offer. This method not only benefits patients by providing them with a less invasive and more adaptable treatment to their lifestyle but also allows us, as professionals, to better manage our time and practice. In summary, it is a mutually advantageous situation for all parties involved.

Your lecture focuses on virtual planning for aligner treatments. How has this process evolved with the advent of digital technology, and what key steps are involved?
The process of virtual planning for aligner treatments has evolved significantly with the advent of digital technology. In the early stages of my practice, impressions were made using silicone, which were then digitized, and only afterward was a digital plan presented. This process, from obtaining the impressions to presenting the plan, took several days.

Over time, these impressions were replaced by digital scanners, which revolutionized orthodontic practice. What previously took days can now be accomplished in just 15 minutes, allowing the scan to be available on the platform for case development. More recently, we have been able to integrate cone beam computed tomography (CBCT) into the process, enabling the combination of digital scanning with three-dimensional analysis of the bony structures.

This technological evolution is remarkable, as it allows us to plan dental movements, particularly root movements, with unprecedented precision, knowing exactly what our bony limits are. The integration of these technologies not only optimizes treatment time but also enhances the effectiveness and safety of orthodontic procedures.

What key takeaways do you hope delegates will gain from your lecture on virtual planning and communicating with CAD designers?
In this lecture on virtual planning and communication with CAD designers, delegates will gain several key insights. First, they will develop a comprehensive understanding of the virtual planning process for aligner treatments, including the steps from initial data collection to the creation of the digital treatment plan. Second, they will enhance their ability to communicate effectively and accurately with CAD designers, ensuring that clinical expectations are clearly conveyed and properly understood. Additionally, delegates will learn how to proficiently interpret digital simulations generated by CAD software, while recognizing both the potential and limitations of digital tools. Moreover, they will grasp the importance of aligning clinical expectations with digital outcomes, and how to adjust the treatment plan when necessary to achieve optimal results. Finally, delegates will identify common challenges that may arise in the transition from virtual planning to clinical execution, and develop strategies to resolve these issues, minimizing errors and the need for additional aligners.

Effective communication between the orthodontist and the CAD designer is critical. What are some strategies for ensuring both parties are aligned to achieve successful treatment outcomes?
Effective communication is extremely important, but the most crucial aspect is the diagnostic work carried out by the doctor. I often state, recurrently and even exaggeratedly, that if we ask the CAD designer to position a tooth in the ear with distalization, he will do so. will do, displacing a suitable molar 6 or 7 mm.

For this reason, I affirm that doctors will never be replaced; Although machines possess vast knowledge, human experience and understanding are extremely difficult for an automated system to replicate.

Briefly, communication must be clear, direct and numerical. It is essential to provide specific values for the desired movements. For example, you cannot simply request the distalization of a tooth; it must be specified: "Please distalize tooth 16 until reaching class I molar, with a maximum distalization of 4 mm."

How can orthodontists accurately interpret digital simulations, and what should they be cautious about when transitioning from virtual planning to clinical reality?
When we analyze virtual planning, we have to understand that biomechanical models are being represented and not biological reality. It is up to us, as doctors, to be able to interpret all the planning and make the necessary changes, for the same diagnosis, for example, for a class II div 1 diagnosis, in an adult the treatment plan can be orthognathic surgery or camouflage with distalization or with extractions, depending on the mm of this same distalization. If it is a child or a teenager with the same diagnosis, we may only have to perform mandibular advancement with wings or, at the same time as we advance, we may also be performing distalization and we have a class II correction not only with advancement of the mandible. but also a correction at the cost of distalization. As a CAD designer, he does what we tell him to do without taking into account age, facial or gingival biotype. We doctors are sovereign. It is a communication that needs a lot of orthodontic knowledge firstly and secondly a path that has to be worked on, shaped and studied in all the cases we are doing.

What common challenges do orthodontists face in the shift from digital planning to clinical execution, and how can these be overcome to ensure predictable results?
Orthodontists face several challenges when transitioning from digital planning to clinical execution for aligner treatment. It is very important to know how to interpret not only the movements but also all the values that are attached to the movement table when we are planning the case.

One of the main challenges is the discrepancy between the idealized virtual planning and the patient's actual biological response. Although planning software offers accurate simulations of tooth movement, the biological response varies from patient to patient, resulting in deviations from the initially predicted results.

Another challenge is patient compliance with the use of aligners. The success of the treatment depends on the patient wearing the aligners for the recommended time daily. Lack of adherence can compromise planned progression, making adjustments necessary during treatment.

Furthermore, small manual adjustments, which are easy to perform in conventional treatments with fixed appliances, can be more complex with aligners, as each stage of the movement is previously defined digitally. This requires greater precision in the initial diagnosis and during clinical follow-up.

To overcome these challenges and ensure predictable results, orthodontists can adopt several strategies. First, the use of remote monitoring systems allowing immediate adjustments to the treatment plan. Furthermore, carrying out periodic and detailed reviews of treatment, aligning expectations with clinical reality, is essential.

Constant communication with the patient, clarifying the importance of adhering to the use of aligners and the possible consequences of deviations from the schedule, is also a key factor. Finally, the orthodontist's experience in using digital technology, combined with a personalized approach and continuous refinement of the treatment plan, contributes significantly to obtaining more predictable results.

Could you explain what "Aligned Foam" is and how it enhances aligner treatments? Also, what future advancements in digital orthodontics do you think will significantly impact the field?
Aligned Foam is a specialized product used in conjunction with orthodontic aligners to enhance treatment. Curaprox’s Aligner Foam is designed to remineralise and protect the teeth during the treatment. The aligner foam has some key ingredients, such as hydroxyapatite that creates a protective barrier, Hyaluronic Acid designed to restore the moisture, and some natural ingredients that brings antibacterial, antioxidant and anti-inflammatory properties. All these ingredients will help with protecting teeth, plaque-fighting action, reducing bad breath, a common concern for those wearing aligners for extended periods and moisture teeth surfaces. The foam can be applied directly to the aligners before putting them back.

As for future advancements in digital orthodontics with aligners, artificial intelligence (AI) is expected to play an increasingly significant role in personalizing treatments. AI and 3D printing of highly individualized aligners are already facilitating more precise and predictable treatment planning, allowing for real-time adjustments based on the patient's progress. Another significant advancement may be the development of more advanced biocompatible materials that better adapt to the oral physiology, increasing both comfort and the effectiveness of the aligners.

Moreover, the integration of sensors within the aligners themselves to continuously monitor the progress of tooth movement could provide real-time feedback to both orthodontists and patients, ensuring immediate adjustments if necessary and potentially reducing overall treatment time. These combined advancements are poised to transform digital orthodontics, making treatments faster, more efficient, and more comfortable.

Thank you.