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ORTHODONTIC SECTION

CUSTOMIZED NOVEL APPLIANCE FOR

INDIVIDUAL TOOTH MOVEMENT IN THE

ERA OF INVISIBLE ORTHODONTICS: AN

OVERVIEW

Shakfi Rahman, Sana Bint Aziz, Ashish Kumar Singh, Puneet Batra

INTRODUCTION
Recent advancements in orthodontics focus on enhancing the
standards of orthodontic practices, through ingenious technologies.
1
Major developments in the past two decades include embracing the
computer-aided design and manufacturing (CAD/CAM), digital
scanning, and 3D printing. These technologies have significantly
2
impacted orthodontics, beginning with virtual treatment planning and
3D scanning. Initially applied to clear aligners and indirect bonding
3
systems, these tools have enabled more precise and customised
orthodontic treatments. 4
The incorporation of precision digital orthodontics has transformed
various appliances . Clear aligners, for instance, offer an aesthetic
5
alternative to traditional labial fixed appliances and have grown in
popularity due to their changeable nature, which reduces risks such
as white spot lesions and root resorption. They also minimize
6,7
the frequency of dental clinic visits and chair time. However, clear
aligners require patient compliance and are less productive for certain
movements, such as rotations and extrusions. 8
The advent of 3D-printed brackets has enhanced labial fixed
appliances by providing a more customized solution for each tooth,
potentially reducing the need for wire adjustments and finishing Fig 1: Unique features of the Brava appliance
bends. Lingual appliances have also benefited from digital advances,
9
making them more acceptable to patients with customized bracket California, aims to simplify lingual orthodontics. It is a novel fixed
systems as well as archwires, though they still present challenges such lingual appliance which uses a different approach and aims to address
as complex bracket positioning and increased chair time with monthly orthodontic treatments within a shorter time duration as compared to
appointments .10,11 conventional orthodontic treatments. Along with being an aesthetic
To enhance the overall experience of the orthodontic therapy by appliance, it professes to allow good oral hygiene and cause minimum
reducing the number of appointments, treatment duration, aesthetic hindrance with the oral hygiene procedures.
considerations along with resolution of complex treatment; the need The Brava+ appliance, an improvised version of the initially
of the hour is inclusion of newer advanced technologies like Cone introduced Brava appliance, features custom base brackets with
Beam Computed Tomography (CBCT), 3D Simulation Software an indirect bonding protocol, which enables precise force delivery
and Artificial Intelligence (AI) into the mainstream orthodontics via mechanism and performs movement of teeth individually in all three
diagnosis, treatment planning and customized appliance development. planes, therefore, also known as Independent Movers (IM). The
TM
The present article explores one such newer innovation in detail appliance uses a compliant mechanism to move teeth to their final
encompassing its unique features including the pros and cons with a positions with minimal adjustments, potentially improving comfort
representative clinical case. and reducing the overall treatment time. 12

BRAVA+ APPLIANCE – BRIUS® FOR INDIVIDUAL TOOTH Unique Features of the Appliance (Figure 1)
MOVEMENT Redefining traditional methods, Brava+ addresses each tooth
A newer innovation, the Brava appliance by BRIUS® (California, individually unlike conventional braces that rely on archwires to move
USA), introduced by Dr. Mehdi Peikar in 2017 at Los Angeles, multiple teeth simultaneously. 13

54 Dental Practice I July-August 2024 I Vol 20 No 4