OSIM, verb · planning the forces on every tooth
Commercially available aligners deliver about half of the plan. Two decades ago, OSIM measured what moves teeth: every push and twist on every tooth of the arch, all at once. OSIM 2.0 is our answer: an aligner method planned by the orthodontist, with nothing glued to the teeth, on software that plans, makes and tracks every aligner. It is in daily clinical use.
One line of reasoning
Two decades ago, OSIM measured the forces that move teeth. BioLign, OSIM 2.0, plans those forces before any aligner is made.
How the noun became a verb
OSIM · noun · 2003–2009
The Orthodontic Simulator: a lab instrument with a force sensor under each of 14 teeth, recording every push and twist across the arch at once.
It measured the forces.What the noun taught
OSIM · verb · 2017–
To plan a treatment by its forces: plan the pushes you want, cancel the ones you don't, and move the arch together.
It plans the forces.The instrument measured what the orthodontist now plans. First, OSIM measured. Now, we OSIM.
Commercially available aligners deliver about half of the movement they plan. Add-ons such as attachments and enamel filing have not closed the gap. BioLign uses none of them.
The current evidence → Aetiology · OSIMOSIM measured all 14 teeth at once and showed that a push on one tooth spreads across the arch, wanted and unwanted. 37 papers since, six of them on aligners.
The history of OSIM → Treatment · BioLignOur aligner method (MIAP), in daily use since 2017, on the BioLign platform: we plan, make and track every aligner ourselves.
Method, platform, results →Diagnosis · The Aligner Problem · half the plan, plus bells and whistles
Across the 361 peer-reviewed studies in our evidence registerR, accuracy has barely improved in a decade. The gap is filled with new plans, more aligners and more months.
Bar: range across studies · dot: the middle · tap a row for its source
The Aligner Problem · what the industry adds
The industry's answer to the gap is add-ons: attachments (small tooth-coloured bumps glued to the teeth), IPR (filing enamel between the teeth), “optimised” features, gadgets, and refinement after refinement. Attachments do change aligner forces in the lab. But in patients, studies show no consistent gain in accuracy from attachments, IPR or gadgets, and refinements are still the norm. Each add-on costs the patient something: attachments are glued to etched enamel and ground off at the end; IPR removes enamel for good.
“Optimised” attachments did no better than standard ones5; attachments did not improve the accuracy of canine rotation6, and rotations fell short with or without them7. The evidence is mixed: a 2025 expert panel still rates attachments moderately effective9.
Cost: enamel etched and glued; ground off at the end.
In one study, filing enamel did not help canines rotate as planned6; a review of studies found rotations fell short with or without it7.
Cost: healthy enamel removed, permanently.
Vibration and light-therapy devices showed no consistent benefit across seven randomised trials8.
Cost: devices, fees, patient time.
94–99% of patients are re-planned at least once34: even with the add-ons, the first plan rarely holds.
Cost: rescans, more aligners, more months.
Rotations reached 41.8% of plan in small steps (1.5° or less per aligner) but only 23% in bigger ones, as summarised by a 2025 expert panel9.
What the evidence does support is smaller steps per aligner (staging) and more hours of wear. Both come down to force: how much each aligner delivers, and for how long. So BioLign designs the force system first, instead of adding extras. So stop guessing the plan. OSIM it.
Aetiology · OSIM · the force system rules
OSIM, the Orthodontic Simulator, was conceived by Dr. Hisham Badawi in 2003 and built at the University of Alberta with Dr. Roger Toogood. Seeing every tooth's forces at once changed how Dr. Badawi moves teeth: the whole arch together, not one tooth at a time.
The idea written down: a force sensor under each of 14 teeth, set in an arch.
First recording of the forces on all 14 teeth at once.
OSIM published in AJODO↗
Our own aligner method (MIAP) in daily use at Smile Elements.
Aligner forces measured on OSIM↗
OSIM 2.0: the method, the software and in-house aligner making, together.
“One of the more impressive 3-dimensional instruments.”
Turpin DL, Editor. Am J Orthod Dentofacial Orthop 2009;136:141–2 ↗OSIM · the recordings
Recordings from the OSIM laboratory, 2007–2009: the instrument, live loading, and the force readings for all 14 teeth.
Force recordings © 2009 Hisham Badawi, OSIM laboratory, University of Alberta. Red crowns mark the teeth carrying the largest measured loads.
OSIM · the concepts
Dr. Badawi named these three ideas from the OSIM recordings and taught them in his lectures. They link the lab to the clinic.
A push on one tooth does not stay there. Through the wire, or the aligner, it spreads around the arch and pushes on the neighbours too.
Measured, not assumed: with elastic ties, the push reached nearly every tooth; with passive (self-ligating) brackets, mostly the neighbours.Every brace or aligner delivers both: pushes that move a tooth where it should go, and pushes that spread to teeth that should stay put. A good plan accounts for both.
Our hypothesis: unplanned pushes are a big reason plans fall short and refinements follow.Sequential: move teeth one at a time, holding the rest still as an anchor. Simultaneous: move the whole arch together, with the pushes balanced against each other, the way OSIM shows teeth behave.
First used with self-ligating braces; now applied to aligners in MIAP.“Teeth don't know what's pushing them. They respond to a force system.”
Dr. Hisham BadawiOSIM · the evidence
From 2008 to 2026, OSIM and its sister instruments produced 37 peer-reviewed papers and 14 graduate degrees, on braces, whole-arch forces and aligners. Every paper is listed below, with a link.
Every earlier platform measured one or two teeth. OSIM measured fourteen, in all six components. The only other full-arch platform followed five years after the founding paper.
| Platform | Teeth at once | Components per tooth | Full arch | First disclosed |
|---|---|---|---|---|
| OSIM · University of Alberta | 14 | 6 | Yes | 2005 |
| OMSS / HexMeS · University of Bonn | 2 | 6 | No | 1991 |
| RMS · HHU Düsseldorf | 1 | 6 | No | 2004–05 |
| Hexapod set-up · Ulm University | 1–2 | 6 | No | 2011 |
| Multi-tooth platform · Sant'Anna, Pisa | 14 | 6 | Yes | 2014 |
| ROSS / HOSEA · LMU Munich | 1 | 6 | No | 2022–23 |
Sant'Anna, Pisa builds a full-arch multi-tooth platform and lists OSIM in its state-of-the-art table.
Tokyo (Lai et al.) describes its rig as a modification of OSIM.
Peking University (Liu and Hu): 14 six-axis sensors on a full arch.
Army Medical University: 14 Nano17 sensors in an in vitro orthodontic simulator.
Indiana University: 14 load-cell sites, one per tooth.
Industry: an Ormco patent family tests its archwires on OSIM. Later per-tooth sensing-arch patents follow from Angelalign, 3M/Solventum, uLab Systems and Indiana University.
Papers by other groups are independent works by their own authors; listing them implies no authorship or endorsement. Paper list from the laboratory record; titles shortened for display; citation counts, field-weighted impact and countries from OpenAlex, November 2026. Platform comparison from first public disclosures.
Treatment · BioLign · prescribe the force system
BioLign is OSIM 2.0: what the lab measured, turned into a way of treating patients, then into software. The table below links each BioLign choice to where it came from, and says plainly what we have shown so far and what we have not.
To plan a treatment by its forces: plan the pushes you want on every tooth, cancel the ones you don't, and step the arch so it moves together, before a single aligner is made.
Etymology: from OSIM, noun, the Orthodontic Simulator (University of Alberta, 2007), the first published instrument to measure every push and twist on every tooth of a full arch. What the instrument measured, the orthodontist learned to plan. Coined by Dr. Hisham Badawi.
“Don't animate the plan and hope. OSIM it.”
Guessing the plan
OSIM-ing the plan
Numbered references are listed on the Diagnosis tab.
BioLign · the method
The method: Minimally Invasive Aligner Protocols, practised daily at Smile Elements Orthodontics in Calgary since 2017, with aligners made in-house since 2022 and taught to specialists through the Smile Elements Academy.
Not one tooth at a time: movements are planned across the whole arch, so teeth move together the way OSIM shows they behave, with the unwanted pushes cancelled in the plan.
6–12 aligners per bout, with in-office and virtual checks.
Nothing glued to the teeth; almost no enamel filing.
Planning variables, both arches
14 teeth × 6 readings per arch, against 20 per arch with MIAP.
BioLign · the platform
BioLign is OSIM 2.0 in the clinic: three connected apps, so a case moves from orthodontist to lab to patient without being re-entered. In full clinical operation at Smile Elements; not yet offered for sale, pending regulatory clearance.
From any intraoral scanner, straight into the patient record. No file converting, no lock-in to one brand.
BioLign CloudMachine learning separates each tooth and cleans up the scan. The orthodontist writes the plan with MIAP and approves every movement.
BioLign3DMade in our own lab, with nothing glued to the teeth. Or use your own lab, with every step tracked online.
BioLign aligners · or your labPatients log wear on a timer in the app; the orthodontist sees it between visits.
BioLign TrackMachine-learning tooth separation and scan clean-up, MIAP planning tools, printable models. The orthodontist decides every movement. Works with any scanner.
Patient records, scheduling, plan review and approval, structured referrals, and a fabrication board from planning to delivery.
Wear timer, wear history, aligner changes with fit checks, reminders and messaging.
Every aligner, from digital model to packaged tray, in one lab.
Machine learning in OSIM 2.0 is clinical decision support, with the clinician in the loop as the sole author of every prescription.
BioLign · the results
With no attachments and almost no IPR, OSIM 2.0 patients were planned about a third as many aligners as patients on the market leader’s platform in the same practice. These numbers show plans being followed; they do not yet show how good the finished results are.
The same number of rounds on both.
263 patients (134 OSIM 2.0, 129 the market leader's platform). Every case included, no exclusions: mild, moderate and severe, all ages, all treatment scopes. A look back at past cases in one practice; patients were not randomly assigned. Aligners used shows the plan was followed; scoring of finished results (ABO) is next.
The Lineage · OSIM, 2002–2026
How a single idea passed from its originator to a laboratory, into industry, across research groups on four continents, into patents, and back into the clinic as a verb.
2002 → 2026 · scroll sideways →
Behind it: 170 private records, 2003–2026. Supplier quotes and drawings, the team's working emails, editors and reviewers, collaborators and industry partners. They show the work being done, by whom and when; their text is held in the case files.
Each bar spans the years its entries cover.
History Gallery · the OSIM laboratory
Video and photographs from the OSIM laboratory at the University of Alberta: the rig, its wiring, its sensors, and the forces it recorded.
Photographs and video © Hisham Badawi, OSIM laboratory, University of Alberta. Tap any photo to enlarge.
Education · monthly, live, open to clinicians worldwide
A live monthly webinar on the physics of aligner treatment: what the forces do, what the evidence supports, and where the orthodontist stays the author of the prescription. Peer to peer, with time for questions. No product is required to attend.
What we cover
Why a force placed on one tooth travels across the whole arch, and what that means for the plan.
Separating the movement you prescribed from the side effects the aligner delivers with it.
Moving teeth together or one stage at a time: what the measurements say about each.
What the published evidence does and does not support, and how our own consecutive cases compare.
Machine-learning clinical decision support, with the orthodontist in the loop as the sole author of every prescription.
Open discussion each session. Bring the case that did not track.
A gift to our local community. Calgary-area dental teams (dentists, hygienists and assistants) attend free, as our thanks to the colleagues we work beside.
This page stays open whenever you are ready. We will not email you unless you ask us to.
An open challenge
The instrument measured the forces; the method plans them. Most aligner treatment relies on attachments and IPR. The evidence for them is inconsistent, and without them our typical patient uses every planned aligner. Don't take our word for it. OSIM it.
134 patients in a row, every case included, treated with nothing glued to the teeth and almost no enamel filing: the typical patient used every planned aligner, with a third as many aligners, over the same number of rounds.
MIAP, the 263-case analysis and the technical monograph, every metric defined and its limits stated. On request.
OSIM 1.0 design files and build guide, in the open repository. Measure the force systems yourself.
De-identified case data for qualified researchers, under a data-use agreement. On request.
Join the proposed randomised trial: blinded, with finished results scored.
Challenges, critiques and collaboration: Smile Elements Orthodontics, Calgary · biolign@smileelements.ca
The future
OSIM's 2009 paper set out the next steps: computer-controlled tooth movement, a layer that mimics the ligament holding each tooth, and a model of tooth movement built from real measurements. That work continues, now in software.
Software that simulates the physics of tooth movement, built on a digital twin of the clinician.
A proposed randomised trial of MIAP at two universities: the kind of evidence the 2025 expert panel says the field needs.
OSIM 1.0 design files and build guide, so any lab can replicate the instrument.