## 3 RE Process as \"Game Changer\": Clinical Applications
### Treatment Plan
#### 3.2.2 Monitoring Systems  
One of the main advantages of using a digital setup is the possibility to progressively compare the achieved tooth movement with the planned movement. In this regard, a  
Figure 11: Orthodontic setup with programmed tooth movement and biomechanical principles using Invisalign system (Align Technology, San Jose, California, USA). (**A**), Pre-treatment occlusion; (**B**), pre-treatment digital reproduction of dental arches; (**C**), post-treatment digital project; (**D**), post-treatment occlusion (see the incomplete correction of the overbite compared to the digital project). Pink shapes over teeth’s surface are the digital representation of the attachments programmed to increase the predictability of dental movement and the aligners’ fitting. Dots at the gingival level represent the alert system indicating respectively low predictability (blue dot) and very low predictability (black dot) for the programmed movement. At certain steps, the usage of class II elastics was planned by requesting the introduction of specific “line cuts” into the aligner ((**C**), blue lines) for inter-maximillary elastics fitting.  
new intraoral scan can be taken at each stage of the treatment and superimposed with the corresponding digital staged model to thoroughly assess any possible deviation from the initial project and define the appropriate biomechanical modifications [19].  
Patients' monitoring can also be managed via remote applications by using tele-orthodontic systems. One of the first applications launched in the market is Dental Monitoring (Dental Mind, Paris, France) (Figure 12) which represents the first \"software as a Service\" projected for remote control of dental and orthodontic treatment. It consists of a portable device that hosts a smartphone camera (iOS, Android). The patient takes three sets of video scans using the camera (first two sets = side-to-side head movement to completely capture the dentition in both centric occlusion and centric relation; third set = upside-down head movement with wide mouth opening to detect occlusal view of both arches), afterward, the software is able to re-elaborate the scans and track tooth movement. In particular, the software tracks treatment progress alongside clinical appointments and provides specific alerts when cases of space closure, space opening, or dental expansion have been reached [27].  
Additionally, tele-orthodontics would be greatly advantageous for orthodontic treatment based on a virtual setup because it is possible to reduce simple controls while keeping important appointments, such as stripping, bracket/attachment or auxiliary placement, extraction, et cetera [27; 28]. Reducing the number of clinical appointments increases the efficiency of the treatment which is a main concern for both patients and clinicians [29; 30]. These assumptions have been recently confirmed by a recent study showing that subjects underwent clear aligners therapy, and the Dental Monitoring system required fewer number of appointments (about 23%) compared to the unmonitored group. Besides clinical efficiency, it is important to validate the accuracy of registering and transmitting quantitative data of orthodontic tooth movement. In this regard, there is only one study in literature addressing this topic, and the findings suggest the accuracy error is within the clinical  
Figure 12: Dental Monitoring system (Dental Mind, Paris, France).  
accepted error (0.50 mm) for transverse measurements [27]. Future studies are warmly encouraged to provide scientific evidence on the application of remote monitoring systems for tracking orthodontic movement.