Seeing the beauty of orthodontics

tomasso orthodonticsDr Tommaso Castroflorio talks about his aspirations, the future and explains how the visual element plays an important role in dentistry today.


Dr Tommaso Castroflorio

Qualifications: DDS, PhD, specialist in orthodontics

Position: Researcher, aggregate professor and vice-director of the specialisation school in orthodontics at the University of Turin

Dental interests: Orthodontics and oral physiology

Interest out of dentistry: trekking and skiing on the Alps, travelling across the world

More and more patients demanding quicker treatment times. Italian orthodontist Dr Tommaso Castroflorio decided that Invisalign was a treatment that he wanted to adopt into his practice.

‘I love working with Invisalign because it’s a comfortable aesthetic orthodontic appliance suitable for children, teens and adults. Like every orthodontic appliance, you should always keep potentials and limitations in mind, when planning treatments. It all depends on the quality and quantity of orthodontic tooth movement required. Also on the compliance possibilities offered by the patient,’ he explains.

Tommaso graduated in 1998 from the University of Torino, where he grew up. He continues to live and work there. He is only an hour away from the picturesque Alps and an hour from the Liguria sea. Therefore, he also decided to pursue his postgraduate degree in orthodontics in the same place.

Bracco & Sforza

He attributes some of his success to Professor Pietro Bracco. Pietro was the dean of the orthodontics at that time. He provided him with some words of wisdom. ‘He was everything one could look in a good mentor and was such a great role model,’ recalls Tommaso.

‘He always said “If you are only interested in fixed appliances, you are purely looking at orthodontics with one eye. If you are only interested in removable appliances, you are also looking at orthodontics with one eye. Diagnosis is the key: if you can diagnose, you can see the beauty of orthodontics with both eyes”.’

He started studying for his PhD in 2003 at the University of Milan. Here he met another great mentor: Professor Chiarella Sforza. ‘She was the perfect guide to conduct a project involving the lab of the anatomical department of the University of Milan and the centre for sensory-motor interaction of the University of Aalborg in Denmark in order to clarify some aspects of masticatory muscles response in chronic orofacial pain conditions. I’m still an avid learner and I’m trying to show the beauty of orthodontics to my students.’

Working with Invisalign

‘I was certified by Align Tech in 2008. I only started to treat cases with Invisalign the year after. At this point they introduced the Poweridge feature’ he explains. ‘When I saw the feature, I understood that finally, someone was introducing the biomechanics paradigm into  designing aligners.

‘And a few months later, I discovered that John Morton, the engineer that worked with Professors Burstone and Nanda at the University of Connecticut, was the inventor of those features and of many other features that, along the years, have improved the predictability of aligner treatments with Invisalign.’

Tommaso says despite the limitations, the introduction of Invisalign in his practice has really improved the patient experience from the start of their journey: sharing information and providing a visualisation of teeth movement. ‘The visual element plays an important role in our contemporary media culture,’ he adds.

‘In the last years I’ve authored and co-authored several research papers about Invisalign orthodontics. Carrying out research in this field is really fascinating. As an orthodontist I think that Invisalign orthodontics was too much banalised from the orthodontic community. At least in the past. This attitude was one of the reasons why aligner orthodontics was proposed to general practitioners before. It is also why it is proposed directly to “consumers” now.

‘All the efforts that researchers are doing in the field are devoted to underline that aligner orthodontics are a mature orthodontic technique with some limitations, like any other orthodontic technique. For this reason, it requires competences that from a diagnostic point of view and from a planning point of view only an orthodontist has.’

Digital dentistry

Dr Castroflorio thinks that digital dentistry is a natural evolution of the profession. ‘Conventional approaches in the dental field have worked well for decades and they are still working well. However, when I was looking for a simpler, faster and more efficient workflow, digital dentistry showed its large potential.’

He explains that technological innovations touch virtually every aspect of our daily lives. Therefore he cannot understand colleagues who are reluctant to step into this new and exciting way of working. ‘Digital dentistry is not only CADCAM, it’s considerably more. Digital data that we can generate in our daily practice can enhance the communication flow with patients and colleagues as never before.

‘The 3D data integration makes the diagnostic process and treatment planning more accurate and complete. It provides an effective communication tool and a method for patients to visualise the simulated outcomes. It instils motivation and encourages compliance in order to achieve the desired treatment outcome,’ he argues.

‘Education is continuously transformed by new technologies in how we teach and in how we learn. The digital workflow is a fresh and novel way of thinking, learning and delivering our services.’

Sharing the knowledge

He recently spoke at the Align Technology conference in Valencia. He explains: ‘One of the most recent innovations provided by Align is the so-called ‘mandibular advancement’ feature. It’s an altered shape of the upper and lower aligners producing a “twin-block” effect, making this solution available for the treatment of growing class II patients with retrognathic mandible.

‘I presented research conducted at the University of Torino where we analysed the dentoskeletal effects of this kind of appliance in a group of 45 growing patients comparing the cephalometric measurements with those obtained from a control group of 40 growing untreated patients matched for age, sex and malocclusion to the study group.’

His team considered the growth stage accordingly to the cervical vertebrae maturation index and also the effects in the pre-pubertal and in the pubertal spurt stages. Their results showed skeletal effects of the appliance in the study group with variation of the skeletal landmarks showing a significant correction of the class II malocclusion.


When asked about his views on fixed braces vs short term solutions, Tommaso answers: ‘Short-term solutions often represent the answer to a consumer request, not to a patient request. We should always keep in mind that we are treating patients and not selling appliances. Therefore, the key is always the diagnosis.

If the result of the diagnostic process supports a short-term solution, I’ll go for it. If the result does not support this kind of approach, I don’t go for it. And if the patient cannot understand or can’t afford the fees, I prefer to lose the patient.

‘I think that orthodontists should improve their communication skills not only in their practices, but also as a category with respect to their communities. The orthodontic education of general practitioners should be improved with particular reference to the ethical conduct of short-term cosmetic orthodontic treatments, so that clinical standards and the safety of patients are maintained, if not enhanced.’

So, where does he see the future of orthodontics? ‘Technology and biologic scientific discoveries will push boundaries of what could be possible in our daily clinical practice,’ he responds. ‘I think that very soon we will be able to obtain a virtual copy of each patient. This will enhance our diagnostic possibilities.

‘The creation of a virtual copy of each patient is dependent upon the integration of 3D media files and the possibility of their fusion into a unique and replicable model. CBCT data, obtained with lower exposure rates than the actual ones, will be used as a platform onto which other inputs can be fused with acceptable clinical accuracy.


‘These data sources include light-based surface data such as photographic facial images or high-resolution surface models of the dentition produced by direct scans intraorally. The integration of hard and soft tissues can provide a greater understanding of the interrelationship of the dentition and soft tissues to the underlying osseous frame.’ 

He explains that with novel 3D superimpositions techniques, clinicians will be able to simulate the outcome of both the osseous structures and the soft tissue post-treatment. And from a biological point of view, the definition of possible predictors of patient response to different treatment modalities will be a game changer.

‘With a sample of saliva, we will know if the patient will be a good or a bad responder to our mechanics,’ ’ he adds.

‘However as mentioned before we have always to keep our feet on the ground. We must remember that diagnosis is always the key. Technology without control is nothing.’

In a personal context, what are his plans for the future? Unsurprisingly, Tommaso is on a mission to expand his horizons in every aspect of his life. ‘I wish to continue spending as much time as I can with my wife and my three children. I also want to continue in a professionally rewarding career and to travel as much as humanly possible!’ he concludes.

This article first appeared in Orthodontic Practice magazine. You can read the latest issue here. 

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