Assessment of the Brava CAD/CAM Independent Force and Moment System to Achieve Predictable Outcomes

Brius Technologies has developed the Brava® Independent Mover System (Brava), a novel orthodontic appliance designed to enhance treatment efficiency, function, and aesthetics. This system uses lingualized brackets connected to Nickel Titanium (NiTi) arms to move teeth independently and simultaneously. However, no studies have evaluated the accuracy of simulated vs. actual orthodontic treatment with Brava. The first aim of this study is to assess the precision of Brava Plus system in achieving predicted outcomes for maxillary and mandibular treatment using the American Board of Orthodontics (ABO) Discrepancy Index (DI) and Cast-Radiograph Evaluation (CRE) to evaluate digital stereolithographic (.stl) files. The collected .stl files include maxillary and mandibular digital scans for pre-treatment (T0), post-treatment (T1), and a virtual simulation of treatment (TV). This analysis was performed on a set of records from 28 patients treated with a single Brava Plus appliance. No additional Brava appliances or finishing aligners were used in this study sample. The Brava Plus appliance achieved a mean ABO-DI reduction of 4.04 points, though it fell short of the planned 6.86-point reduction outlined in the Brius planning software. While overbite and crowding demonstrated statistically significant improvements, aligning closely with the planned treatment outcomes, other DI variables—including overjet, anterior and lateral open bite, occlusion, lingual and buccal posterior crossbites, and the "other" category—showed no significant changes between initial (T0) and post-treatment (T1) assessments. Overjet and occlusion showed significant discrepancies between planned (TV) and post-treatment (T1) outcomes, indicating that the Brava Plus appliance did not fully align with the treatment projections generated by the Brius software. These findings suggest that while the Brava Plus appliance effectively reduces certain aspects of malocclusion, its overall impact on DI score may be limited in comparison to initial treatment projections. Significant differences in ABO-CRE scores were observed for overall CRE, alignment, marginal ridges, overjet, occlusal contacts, and occlusal relationships (P < .001), with a mean discrepancy of 15.57 points between post-treatment and virtual treatment models. In contrast, buccolingual inclination and interproximal contacts showed no significant differences between post-treatment and virtual models The second aim of this study is to assess the precision of Brava system in achieving predicted outcomes for maxillary and mandibular arch expansion. This analysis was performed on a second data set of 30 patients treated with a single Brava appliance. No additional Brava appliance or finishing aligners were used in this study sample. The analysis of transverse expansion with Brava showed significant variability depending on the type of tooth, reference points, and dental arch analyzed. The Brius Planning Software generally predicted more bodily expansion than the Brava system can achieve, with greater dental tipping observed in the maxillary premolars and all mandibular teeth than predicted. Incorporating overcorrection and additional buccal root torque during the planning phase may enhance clinical outcomes for transverse expansion with Brava.