The new NimrodAligner: From straightforward to complex cases
As a dental practitioner, helping your patient choose the right alignment system from the many available to improve his or her smile can be very daunting. Whatever the patient’s lifestyle, the attributes typically desired are comfort, discreteness and the shortest treatment time possible. Depending on the case, it can sometimes be quite difficult to achieve all of these with one alignment system, as each is designed to achieve very specific and individual movements, and not all are designed to do this for the whole arch.
As an orthodontic laboratory, we are introduced to hundreds of very different cases on a weekly basis. More often than not patients will have specified that the above attributes are key to their decision-making process when we assess for the appliances that will be best suited to their particular case. After having been faced so regularly with the task of assisting our clients in making the decision that will benefit their patients in as many aspects as they can, we had a thought: what if the advantages of each of these alignment systems were combined and the disadvantages eliminated? It was from this that the idea for our brand new NimrodAligner stemmed.
Designed to move from 5-5 in all directions and widen the arch in the area of the molars too (Fig.1), the NimrodAligner consists of lingual and labial arch wires attached to individual cups seated on each tooth with the aid of a composite anchor, as well as a connecting bar for seating on the palate or the lingual area that is attached to molar cups. After having spent four years researching the most effective components and combining them using prototypes with 3-D printers, we have combined the biomechanics of straight wire, Clear Aligners and a spring aligner to reduce considerably the downsides of having treatment and focus more on the positive features.
Fixed brackets appear to be decreasing in popularity, particularly among adolescents, mostly because they are not particularly aesthetically pleasing and may therefore create embarrassment in public. Combined with hours of clinical time spent fitting and repositioning the individual brackets, hygienic problems owing to not being able to brush or floss properly, as well as the discomfort of their often sharp exterior both labially and lingually, it is no surprise that fixed brackets are not requested as often as more popular removable aligners. The biomechanics of the fixed brackets and arch wires is incorporated within the NimrodAligner, so clinical time is minimal. The removable appliance allows proper cleaning of the teeth and gingivae, and at only 2 mm in thickness (Fig.5)—as opposed to the standard 3–3.5 mm thickness of fixed brackets—the overall feel is very anatomically friendly.
Clear Aligners are the most anatomically friendly appliances on the market today and are mostly popular because of just how discreet they are. Despite these advantages, the force and pressure induced during the initial days of wear can be very painful. Although a sign that they are working as they should, the aligners tend to become passive as time passes and are typically only at their most active in just the first seven days. However, with the NimrodAligner, nickel-titanium wires ensure that the pressure is gentle, yet provides continuous support.
Multiple Clear Aligner trays can become very tedious for both patient and dentist, particularly when frequent appointments are necessary and stages of interproximal reduction (IPR) have to be carried out. IPR can be a significant factor in the progress of Clear Aligners, as each aligner is made to incorporate the necessary IPR after each stage and the fit of the following trays will be affected if not enough has been done. This is not a problem for the NimrodAligner, as it will not affect the fit of the appliance if there has been insufficient IPR at the previous appointment. The patient can continue to wear it and IPR can be completed where necessary at the next appointment.
Similarly, spring aligners can continue to be worn and fit correctly between appointments if not enough IPR has been done previously; however, they are widely known for movement limited to just four incisors. This may be good for labial/lingual movement using the squeeze effect and some rotation, but Clear Aligners can often be required to finish.
In some instances, a separate expansion appliance may be required prior to treatment, which essentially adds to the cost and overall treatment time. We have reduced this concern by offering this stage for such cases within the NimrodAligner. The arch can gain width in the area of the molars by presetting the molars in a wider position when it comes to making the movements on our 3-D system, and the connecting bar can act as a spring owing to its flexibility. The rest of the teeth will continue to be aligned during this process.
In more complex cases, however, for which a separate expansion appliance is unavoidable, two NimrodAligners will be provided. The caps will not fit on the teeth that are blocked in otherwise, so the initial appliance will create space for the blocked teeth. Once they have been exposed, the second appliance would be provided to sit on all of the teeth.
During our research and production stages, we aimed to create the ultimate removable orthodontic alignment system that could potentially be the answer to the prayers of dentists and patients alike. We have reduced clinical time dramatically by removing the time-consuming hassle of fitting appliances such as fixed brackets by providing a bespoke pre-aligned appliance that simply needs to be placed on the teeth. We have taken into consideration that multiple appliances can sometimes be necessary to achieve the desired result and have eliminated the need for this by designing the NimrodAligner in a way that allows the entire arch to move in any direction. Should expansion also be required, we have incorporated this too (Fig.1).
We have adapted the force and pressure of the movement to be effective for just 16 hours a day, allowing the patient to remove the appliance for an entire 8-hour working day if he or she wishes, in order to grant the roots sufficient time to recover. By combining all of the positive aspects of the orthodontic appliances mentioned above, the NimrodAligner may be suitable for most cases, from straightforward to complex.