NARRATIVE LITERATURE REVIEW Digital orthodontics: Present and future Nearchos C. Panayi, a,b,c Spyridonas Efstathiou, c Isidora Christopoulou, d Georgia Kotantoula, e and Ioannis A. Tsolakis f,g Nicosia and Limassol, Cyprus, Zurich, Switzerland, Athens and Thessaloniki, Greece, and Cleveland, OH Digital technology has been at the forefront of many innovations in everyday life in recent years. The devel- opment of computer-aided design software, 3-dimensional (3D) printers, surface and volume scanners, and printing resins has had an impact on dentistry and orthodontics. These tools are all already in the arma- mentarium of the orthodontist, enabling the technological advancement of orthodontic appliances, diagno- sis, and treatment. Digital technology has not only helped in the development of the concept of in-office orthodontic laboratories but also allowed the customization of most orthodontic appliances. Orthodontic imaging and analysis software is responsible for gathering all digital data obtained by digital units and the clinical examination. Surface scanners are the key to the entire digital workflow, providing a digital impres- sion in which all appliances will be designed and manufactured. Computer-aided design software is used to design customized appliances that will be manufactured later using 3D printing technology. Metal printing is a technology performed in special laboratories that enables the customization of various metallic appli- ances but cannot be used in an orthodontic office. All other orthodontic appliances can be designed and manufactured in the orthodontic office, including thermoformed aligners and directly printed aligners. Lately, software advancements have allowed customized lingual and labial orthodontic brackets to be designed and printed in the orthodontic office. To guarantee the security of both patients and orthodontic staff, certain regulations pertaining to the installation of laboratories in orthodontic offices must be devel- oped. In the last few years, orthodontics has made use of artificial intelligence. Nevertheless, artificial intel- ligence will only be an assistant in orthodontic treatment and will never replace orthodontists. (Am J Orthod Dentofacial Orthop Clin Companion 2024;4:14-25) O rthodontics is a specialty that combines the knowledge and applications of theory. In essence, biology is combined with mechanics, hence the term biomechanics. 1 Biology is an entirely different subject that has to do a little with mechanics, whereas mechanics is the science that enables orthodontists to move teeth predictably and desirably. Special orthodontic appliances are used to apply forces and moments for tooth movement, although until recently, those appliances (ie, brackets) were only made by companies in a “one-size-fits-all” manner, and others were manufactured in orthodontic laboratories using the traditional analog method. In recent years, digital technology has caused an evolu- tion in engineering and consequently changed many aspects of our daily lives, including medicine and dentistry. Conse- quently, orthodontics, as a specialty of dentistry, followed this digitization path, transforming many of its aspects from analog to digital. Surface scanning (intraoral) changed the traditional impression-taking process, whereas volume scanning invention enabled the 3-dimensional (3D) render- ing of the human skull. Computer-aided design (CAD) soft- ware allowed the design of customized appliances; artificial intelligence (AI) helped several procedures to become auto- mated; and additive manufacturing (3D printing) allowed the manufacturing of complex geometric objects. Moreover, novel resins for 3D printing have been developed, and a Department of Dentistry, European University Cyprus, Nicosia and Limassol, Cyprus, Zurich, Switzerland, and Athens and Thessaloniki, Greece. b Clinic of Orthodontics and Pediatric Dentistry, Center of Den- tal Medicine, University of Zurich, Zurich, Switzerland. c Private practice, Limassol, Cyprus. d Department of Orthodontics, School of Dentistry National and Kapodistrian University of Athens, Athens, Greece. e Private practice, Athens, Greece. f Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece. g Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH. Address correspondence to: Nearchos C. Panayi, Depart- ment of Dentistry, European University Cyprus, Nicosia, Cyprus, 232 Leontiou A’, office 11, 3020, Limassol, Cyprus.; e-mail, N.Panayi@euc.ac.cy 14 AJO-DO CLINICAL COMPANION