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Queirós C, Gonçalves M, Ferreira S, de Castro I, Azevedo RMS, Pinho T. Comparison of Upper Central Incisor Torque in the ClinCheck ® with and without CBCT Integration: A Cross-Sectional Study. Dent J (Basel) 2024; 12:269. [PMID: 39195113 DOI: 10.3390/dj12080269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/05/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
Controlling root movement is one of the greatest challenges in orthodontic treatment with aligners, like Invisalign® aligners. Cone Beam Computed Tomography (CBCT) integration into ClinCheck®, enabling bone and root visualisation, allows a more accurate follow-up of the teeth position. This study aims to compare torque measurements of the upper central incisors with and without CBCT and relate them to the upper incisor inclination and facial biotype. In a sample of 70 teeth, torque measurements were obtained by importing images into AutoCAD® software (version 2024). The angle between the tooth's long axis with CBCT duplicate and the tooth's long axis without CBCT was obtained to assess the difference. Statistically significant differences between torque measurements with and without CBCT were found, as well as between these measurements and the inclination of the upper incisors. No statistically significant differences were found among the facial biotypes. The average values of 27.8° ± 3.4° and 21.5° ± 3.2° were obtained for the angle between the axes. Torque without CBCT was lower than torque with CBCT, for the same tooth. The angle between the axes had a similar mean for both teeth. CBCT integration into ClinCheck® allows for a more correct torque measurement.
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Affiliation(s)
- Cíntia Queirós
- Oral Pathology and Rehabilitation Research Unit (UNIPRO), University Institute of Health Science (IUCS), CESPU, 4585-116 Gandra, Portugal
| | - Maria Gonçalves
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, University Institute of Health Sciences-CESPU, 4585-116 Gandra, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal
| | - Sofia Ferreira
- Oral Pathology and Rehabilitation Research Unit (UNIPRO), University Institute of Health Science (IUCS), CESPU, 4585-116 Gandra, Portugal
| | - Inês de Castro
- Oral Pathology and Rehabilitation Research Unit (UNIPRO), University Institute of Health Science (IUCS), CESPU, 4585-116 Gandra, Portugal
| | - Rui M S Azevedo
- Associate Laboratory i4HB-Institute for Health and Bioeconomy, University Institute of Health Sciences-CESPU, 4585-116 Gandra, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, Forensics and Biomedical Sciences Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), 4585-116 Gandra, Portugal
| | - Teresa Pinho
- Oral Pathology and Rehabilitation Research Unit (UNIPRO), University Institute of Health Science (IUCS), CESPU, 4585-116 Gandra, Portugal
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Dai F, Sang Y, Zeng J, Wang H, Pan Y, Zhao J, Xu T, Shu G. How accurate is predicted root movement achieved in four first-premolar extraction cases with Invisalign? Orthod Craniofac Res 2024. [PMID: 39137241 DOI: 10.1111/ocr.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVES This study aims to compare the achieved and predicted root movements in adults after four first-premolar extractions and Invisalign treatment. MATERIALS AND METHODS Thirty-three consecutive adults (22 Class I, 9 Cusp-to-cusp Class II and 2 Cusp-to-cusp Class III) from a single clinical division who completed the first series of aligners after premolar extractions were included in this retrospective study. A pretreatment cone-beam computed tomography model was registered onto the pretreatment surface-scanned dental model (SSDM) to locate the pretreatment root apices of the whole dentition. These were copied and transferred to the predicted and achieved post-treatment SSDMs to acquire the locations of the predicted and achieved post-treatment root apices. The differences between predicted and achieved root movements (DPARMs) were tested using the paired t-test or Wilcoxon signed rank test. RESULTS In the anteroposterior direction, posterior root movements of maxillary and mandibular anterior teeth were poorly achieved (3.24-5.74 mm DPARMs, p < .05). In the vertical direction, roots of maxillary anterior teeth achieved greater intrusion (0.70-0.93 mm DPARMs, p < .05), while those of mandibular incisors achieved less intrusion (0.57-0.65 mm DPARMs, p < .05) than predicted. In the mediolateral direction, lateral incisor roots did not move distally (-0.65 to -0.96 mm DPARMs, p < .05), while those of canines did not move buccally, compared with the prediction (-0.75 mm DPARMs, p < .05). CONCLUSIONS In the four first-premolar extraction treatments with Invisalign, root movements were not achieved as predicted, particularly for anterior teeth in the anteroposterior direction.
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Affiliation(s)
- Fanfan Dai
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Yanhui Sang
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Jingjing Zeng
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Hongjian Wang
- Shanghai Bondent Technology Co., Ltd, Shanghai, China
| | - Yichun Pan
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Fourth Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jianhui Zhao
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Tianmin Xu
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China
| | - Guang Shu
- Second Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Xiao T, Su JY, Lei J, Zhang X, Yu J, Nie XP, Ying QH, Hou JX, Guo J. Effectiveness of different intrusion modes of maxillary anterior teeth with mini-implants in clear aligner treatment: a three-dimensional finite element analysis. BMC Oral Health 2024; 24:758. [PMID: 38956625 PMCID: PMC11218253 DOI: 10.1186/s12903-024-04537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The intrusion of maxillary anterior teeth is often required and there are various intrusion modes with mini-implants in clear aligner treatment. The objective of this study was to evaluate the effectiveness of maxillary anterior teeth intrusion with different intrusion modes, aiming to provide references for precise and safe intrusion movements in clinical practice. METHODS Cone-beam computed tomography and intraoral optical scanning data of a patient were collected. Finite element models of the maxilla, maxillary dentition, periodontal ligaments (PDLs), clear aligner (CA), attachments, and mini-implants were established. Different intrusion modes of the maxillary anterior teeth were simulated by changing the mini-implant site (between central incisors, between central and lateral incisor, between lateral incisor and canine), loading site (between central incisors, on central incisor, between central and lateral incisor, between lateral incisor and canine), and loading mode (labial loading and labiolingual loading). Ten conditions were generated and intrusive forces of 100 g were applied totally. Then displacement tendency of the maxillary anterior teeth and CA, and stress of the PDLs were analyzed. RESULTS For the central incisor under condition L14 and for the canine under conditions L11, L13, L23, and L33, the intrusion amount was negative. Under other conditions, the intrusion amount was positive. The labiolingual angulation of maxillary anterior teeth exhibited positive changes under all conditions, with greater changes under linguoincisal loading. The mesiodistal angulation of canine exhibited positive changes under labial loading, while negative changes under linguoincisal loading except for condition L14. CONCLUSIONS The intrusion amount, labiolingual and mesiodistal angulations of the maxillary anterior teeth were affected by the mini-implant site, loading site, and loading mode. Labial and linguoincisal loading may have opposite effects on the intrusion amount of maxillary anterior teeth and the mesiodistal angulation of canine. The labiolingual angulation of the maxillary incisors would increase under all intrusion modes, with greater increases under linguoincisal loading.
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Affiliation(s)
- Tian Xiao
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Jing-Yuan Su
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Jie Lei
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Xin Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Jian Yu
- Department of Radiology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Xiu-Ping Nie
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Qiao-Hui Ying
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China
| | - Jun-Xiang Hou
- R&D center, Wuxi EA Medical Instruments Technologies Ltd, Wuxi, 214174, China
| | - Jie Guo
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Research Center of Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, Shandong University, No.44-1 Wenhua Road West, Jinan, Shandong, 250012, China.
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Song JH, Lee JH, Joo BH, Choi YJ, Chung CJ, Kim KH. Treatment outcome comparison of Invisalign vs fixed appliance treatment in first premolar extraction patients. Am J Orthod Dentofacial Orthop 2024; 165:399-413. [PMID: 38142394 DOI: 10.1016/j.ajodo.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION In this study, we compared the dentitional changes after Invisalign and conventional orthodontic treatment with 4 first premolar extractions. METHODS This retrospective study included 57 patients whose orthodontic treatment involved the extraction of 4 first premolars because of bialveolar protrusion. A total of 27 patients were treated with Invisalign (mean age, 25.5 ± 5.2 years) and 30 patients with the fixed appliance (mean age, 24.4 ± 5.8 years). The angular and linear changes of the maxillary and mandibular central incisors, second premolars, first molars, and second molars were measured from the recordings on the basis of the lateral cephalograms taken before and after treatment. The angular changes of the canines and second premolars were measured using panoramic radiographs. RESULTS The overbite and interincisal angle increased significantly in the Invisalign group compared with in the conventional fixed appliance group (P <0.05). The maxillary central incisors showed increased lingual tipping in the Invisalign group (P <0.05), whereas there was no statistically significant difference in the angular change of the mandibular incisors between groups (P >0.05). The maxillary first and second molars showed mesial tipping in the Invisalign group (P <0.05). The maxillary second premolars, first and second molars, and the mandibular second molars showed mesial movement in the Invisalign group (P <0.05). CONCLUSIONS The Invisalign group showed more statistically significant lingual tipping of the maxillary central incisors, distal tipping of the maxillary canines, and mesial tipping of the maxillary first and second molars after maximum retraction of the anterior teeth compared with the fixed appliance group.
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Affiliation(s)
- Ji-Hye Song
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Hyun Lee
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Bo-Hoon Joo
- The Institute of Clear Aligner Center of The STAR 28 Dental Group, Seoul, South Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Chooryung J Chung
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea.
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Kang J, Jeon HH, Shahabuddin N. Does aligner refinement have the same efficiency in deep bite correction?: A retrospective study. BMC Oral Health 2024; 24:338. [PMID: 38491450 PMCID: PMC10943900 DOI: 10.1186/s12903-024-04099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Refinements are very common in clear aligner treatments. The aim of this study is to assess whether the predictability of deep overbite correction is similar over several refinements using clear aligners (Invisalign, Align Technology, San Jose, Calif) and examine the accuracy of vertical movement and inclination change of individual teeth. METHODS This retrospective study included 20 deep bite patients (7M and 13F; 32.63 ± 11.88 years old; an initial overbite of 5.09 ± 0.98 mm), consecutively treated from September 2016 and March 2023, who completed at least two sets of aligners, including refinements. The initial, predicted, and achieved models were exported from ClinCheck or OrthoCAD (Cadent Inc, Carlstadt, NJ) and superimposed via best-fit surface-based registration using SlicerCMF (version 4.9.0; cmf.slicer.org). We also examined 15 out of 20 patients who completed treatments. The overbite correction and changes in vertical movement and inclination for individual teeth were measured. Descriptive statistics and a paired t-test or Wilcoxon signed-rank test were performed. P < 0.05 was considered statistically significant. RESULTS The mean accuracy of overbite correction was 37.63% after 1st set, followed by 11.19%, 6.32%, and 13.80% (2nd-4th sets), respectively. There were statistically significant differences between the predicted and achieved vertical movements and inclination changes for all teeth for the 1st and 2nd sets. For the completed cases, the mean overbite correction was 38.54% compared to the initially planned overbite correction, which is similar to one of the 1st set. Still, the vertical movements and inclination changes of all teeth present statistically significant differences between the initially planned and finally achieved movements except for maxillary lateral incisor torque. CONCLUSIONS The most overbite correction occurs during the 1st set of aligners, and refinement treatment does not significantly improve the deep bite correction.
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Affiliation(s)
- Jessica Kang
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA, 19104-6030, USA
| | - Hyeran Helen Jeon
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA, 19104-6030, USA.
| | - Nishat Shahabuddin
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Philadelphia, PA, 19104-6030, USA
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Kravitz ND, Hansa I, Vaid NR, Moshiri M, Adel SM. Does age influence deep overbite correction with Invisalign? A prospective study evaluating mandibular incisor intrusion in adolescents vs adults. Angle Orthod 2024; 94:145-150. [PMID: 37939782 PMCID: PMC10893929 DOI: 10.2319/050223-320.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE To compare the accuracy of mandibular incisor intrusion with Invisalign (Align Technology, Santa Clara, Calif) in adolescents to that in adults. MATERIALS AND METHODS This prospective clinical study included 58 patients treated with either Invisalign Teen or Invisalign Full. Mandibular central and lateral incisors were measured on digital models created from intraoral scans. Predicted values were determined by superimposing the initial and final ClinCheck models, and achieved values were determined by superimposing the initial ClinCheck models and the digital models from the final scans. Individual teeth were superimposed with a best-fit analysis and measured using Compare software (version 8.1; GeoDigm, Falcon Heights, Minn). RESULTS The mean accuracies of mandibular incisor intrusion were 63.5% in adolescents and 45.3% in adults, and this difference was statistically significant. The amounts of achieved intrusion were 1.7 mm in adolescents and 0.9 mm in adults, and this difference was also statistically significant. Overall, there was a weak negative correlation between age and accuracy; as age advanced, the accuracy of mandibular incisor intrusion diminished slightly. CONCLUSIONS Mandibular incisor intrusion with Invisalign is significantly more accurate in adolescents than in adults. Orthodontists could contemplate reducing the degree of overcorrection for mandibular incisor intrusion in adolescents with deep overbites undergoing Invisalign Teen but still implementing the reverse curve of Spee mechanics.
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Zhu L, Liu L, Wang W, Deng WW. Effects of different patterns of movement for correcting a deep curve of Spee with clear aligners on the anterior teeth: a finite element analysis. BMC Oral Health 2024; 24:217. [PMID: 38341537 PMCID: PMC10859030 DOI: 10.1186/s12903-024-03906-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To analyse the anterior teeth effects of clear aligners on five different patterns of mandibular molar movement and to define the most effective configuration to be implemented with clear aligners through finite element analysis. METHODS A three-dimensional mandibular model with a deep overbite in the mandible was constructed using cone beam computerized tomography (CBCT) data. The model included the mandibular dentition, mandibular periodontal ligaments, attachments, and aligners. Five models were created: (1) configuration A: second molar distalization (0.25 mm); (2) configuration B: second molar distalization (0.25 mm), first molar extrusion (0.15 mm); (3) configuration C: second molar distalization (0.25 mmm), first and second premolar extrusion(0.15 mm); (4) configuration D: second molar distalization (0.25 mm), first molar and first/second premolar extrusion(0.15 mm); and (5) configuration E: second molar distalization (0.25 mm), first molar and first/second premolar extrusion (0.15 mm), first molar and first/second premolar expansion (0.15 mm). RESULTS In all configurations, the anterior teeth exhibited labial tipping and the mandibular central incisor of configuration E showed the highest labial tipping. Configuration E demonstrated a relatively minor impact on mandibular molars distalization compared with configuration A. Configuration A showed the highest distal displacement value, and configuration E produced the lowest displacement value. Configuration E caused the highest periodontal ligament (PDL) pressure of the central and lateral incisors. The differences in the canines between configurations C and D,were not significant, and the stress distribution differed among the five groups. CONCLUSIONS All patterns utilizing clear aligners facilitated mandibular molar distalization. Extruding the premolars and second molar distalization at the same time had little impact on second molar distalization; When expansion and extrusion were simultaneously performed during the distalization of mandibular molars, our prime consideration was the alveolar bone on the labial side of the anterior teeth to prevent the occurrence of gingival recession, dehiscence, and fenestration. Due to the lack of consideration for periodontal tissues in this study, clinical protocols should be designed based on the periodontal status of the mandibular anterior teeth.
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Affiliation(s)
- Lin Zhu
- Graduate School of Dalian Medical University, Dalian, China
| | - Lin Liu
- Department of Orthodontics, DaLian Stomatological Hospital, DaLian, China.
| | - Wei Wang
- Urumql DW Innovation InfoTech Co., Ltd., Urumqi, Xinjiang, China
| | - Wen Wen Deng
- Department of Orthodontics, DaLian Stomatological Hospital, DaLian, China
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Li M, Shen S, Zhao Z, Wang B, Yu H. The application of a fully digital approach in the treatment of skeletal class III malocclusion: a preliminary study. BMC Oral Health 2023; 23:237. [PMID: 37095513 PMCID: PMC10124042 DOI: 10.1186/s12903-023-02918-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Skeletal malocclusion patients have facial malformations and occlusal dysfunctions that require orthodontic-orthognathic joint treatment, while the combination treatment takes time and requires close communication between surgeons and orthodontists. Thus, improving the efficiency and effectiveness of the combination treatment is necessary, and it is still a challenge. Now, digital technology provides us with an excellent alternative. Despite the widespread use of digital technology in orthognathic surgery simulation and clear aligner orthodontic therapy, it has not been fully integrated into the combined orthognathic and orthodontic treatment process, and the components remain independent. METHODS A fully digital approach to seamlessly integrating various parts of the combined treatment through digital technology was investigated in this study in order to achieve an efficient transition. Five patients with skeletal Class III malocclusion were enrolled, and all made fully digital treatment plans at the beginning of actual implementation, which included the design of pre-surgical orthodontic, orthognathic surgery, and post-surgical orthodontic. Then, every aspect of the clinical operation was carried out in accordance with the fully digital routine. After the entire treatment process was completed, the skeleton and dentition discrepancy between virtual planning and the actual result was evaluated. RESULTS All participants completed the fully digital treatment process, and no complication was observed. The linear deviation of the skeletal anatomy was less than 1 mm, and the angular deviation was less than 1 degree. Except in one case in the lower dentition, the deviation of the virtual dental design from the real alignment was less than 2 mm. Furthermore, with one exception of maxillary anterior-posterior dimension, the linear deviations of the skeleton were not statistically significant. Therefore, the simulation accuracy of the fully digital approach was clinically acceptable. CONCLUSIONS The digital treatment approach is clinically feasible and has achieved satisfactory results. The discrepancy between virtual design of the entire digital process and actual post-treatment situation was acceptable in clinic. A fully digital approach was proved effective in the treatment of skeletal Class III malocclusion, with which the efficient transition of treatment procedures was realized.
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Affiliation(s)
- Meng Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shunyao Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhiyang Zhao
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China
| | - Bo Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
| | - Hongbo Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Center for Stomatology and National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, Shanghai, China.
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Yan X, Zhang X, Ren L, Yang Y, Wang Q, Gao Y, Jiang Q, Jian F, Long H, Lai W. Effectiveness of clear aligners in achieving proclination and intrusion of incisors among Class II division 2 patients: a multivariate analysis. Prog Orthod 2023; 24:12. [PMID: 37009943 PMCID: PMC10068686 DOI: 10.1186/s40510-023-00463-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/14/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND The predictability of incisor movement achieved by clear aligners among Class II division 2 patients is poorly understood. The aim of this retrospective study was to determine the effectiveness of clear aligners in proclining and intruding upper incisors and its influencing factors. METHODS Eligible patients with Class II division 2 malocclusion were included. For clear aligner therapy, three types of incisor movements were designed: proclination, intrusion and labial movement. Pre-treatment and post-treatment dental models were superimposed. The differences between predicted and actual (DPA) tooth movement of incisors were analyzed. Univariate and multivariate linear regression were used to analyze the potential influencing factors. RESULTS A total of 51 patients and their 173 upper incisors were included. Actual incisor proclination and intrusion were less than predicted ones (both P < 0.001), while actual labial movement was greater than predicted one (P < 0.001). Predictability of incisor proclination and intrusion was 69.8% and 53.3%, respectively. Multivariate linear regression revealed that DPA of proclination was significantly positively associated with predicted proclination (B = 0.174, P < 0.001), ipsilateral premolar extraction (B = 2.773, P < 0.001) and ipsilateral canine proclination (B = 1.811, P < 0.05), while negatively associated with molar distalization (B = - 2.085, P < 0.05). The DPA of intrusion was significantly positively correlated with predicted intrusion (B = 0.556, P < 0.001) while negatively associated with labial mini-implants (B = - 1.466, P < 0.001). The DPA of labial movement was significantly positively associated with predicted labial movement (B = 0.481, P < 0.001), while negatively correlated with molar distalization (B = - 1.004, P < 0.001), labial mini-implants (B = - 0.738, P < 0.001) and age (B = - 0.486, P < 0.05). CONCLUSIONS For Class II division 2 patients, predicted incisor proclination (69.8%) and intrusion (53.3%) are partially achieved with clear aligner therapy. Excessive labial movement (0.7 mm) of incisors may be achieved. Incisor movement is influenced by predicted movement amount, premolar extraction, canine proclination, molar distalization, mini-implants and age.
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Affiliation(s)
- Xinyu Yan
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Xiaoqi Zhang
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Linghuan Ren
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Yi Yang
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Qingxuan Wang
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Yanzi Gao
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Qingsong Jiang
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Fan Jian
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Hu Long
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China.
| | - Wenli Lai
- Department of Orthodontics, State Key Laboratory of Oral Diseases and National Clinical Center for Oral Research, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Ren Min Nan Road, Chengdu, 610041, China.
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10
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Liu JQ, Zhu GY, Wang YG, Zhang B, Yao K, Zhao ZH. Different biomechanical effects of clear aligners in closing maxillary and mandibular extraction spaces: Finite element analysis. Am J Orthod Dentofacial Orthop 2023; 163:811-824.e2. [PMID: 36964108 DOI: 10.1016/j.ajodo.2022.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 03/26/2023]
Abstract
INTRODUCTION Compared with fixed treatments, clear aligners (CAs) have the advantages of comfort, esthetics, and hygiene, and are popular among patients and orthodontists. However, CAs exhibit control deficiencies in extraction patients because of insufficient root control and retention effects. These deficiencies can magnify biomechanical differences in bimaxillary dentition, further causing different orthodontic requirements between maxillary and mandibular dentition. This study aimed to elaborate on the biomechanical characteristics of bimaxillary dentition in extraction space closure and provided feasible biomechanical compensation strategies for use in clinical practice. METHODS We constructed a 3-dimensional (3D) bimaxillary model based on patient data. Several 3D modeling-related software was used to generate a standard first premolar extraction model, CAs, and attachments. Subsequently, finite element analysis was performed to demonstrate the biomechanical effects. RESULTS The maxillary and mandibular dentition showed a roller coaster effect during space closure. Compared with the maxillary dentition, the mandibular posterior teeth exhibited stronger relative anchorage causing greater anterior teeth retraction. The tipping and vertical movements of the anterior teeth were related to tooth length. The longer the anterior tooth, the less tipping and greater vertical displacement occurred. Generally, when having the same retraction distance, the mandibular dentition exhibited greater retroclination and fewer extrusions. Both mechanical and retention compensations should be considered to prevent these unwanted tipping movements. Adding specific attachments to bimaxillary dentitions compensated for the retention and root control deficiencies of CAs. CONCLUSIONS When applying CAs to extraction patients, different biomechanical effects can present in the bimaxillary dentition because of specific dentition morphologies. To effectively treat these patients, mechanical compensation through overcorrection of the target position should be designed on the basis of bimaxillary control deficiencies, and retention compensation by adding specific attachments should also be considered according to the overcorrections.
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Affiliation(s)
- Jun-Qi Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Guan-Yin Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi-Gan Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bo Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ke Yao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhi-He Zhao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Zhu GY, Zhang B, Yao K, Lu WX, Peng JJ, Shen Y, Zhao ZH. Finite element analysis of the biomechanical effect of clear aligners in extraction space closure under different anchorage controls. Am J Orthod Dentofacial Orthop 2023; 163:628-644.e11. [PMID: 36801091 DOI: 10.1016/j.ajodo.2022.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Clear aligners (CAs) have attracted increasing attention from patients and orthodontists because of their excellent esthetics and comfort. However, treating tooth extraction patients with CAs is difficult because their biomechanical effects are more complicated than those of traditional appliances. This study aimed to analyze the biomechanical effect of CAs in extraction space closure under different anchorage controls, including moderate, direct strong, and indirect strong anchorage. It could provide several new cognitions for anchorage control with CAs through finite element analysis, further directing clinical practice. METHODS A 3-dimensional maxillary model was generated by combining cone-beam computed tomography and intraoral scan data. Three-dimensional modeling software was used to construct a standard first premolar extraction model, temporary anchorage devices, and CAs. Subsequently, finite element analysis was performed to simulate space closure under different anchorage controls. RESULTS Direct strong anchorage was beneficial for reducing the clockwise occlusal plane rotation, whereas indirect anchorage was conducive for anterior teeth inclination control. In the direct strong anchorage group, an increase in the retraction force would require more specific anterior teeth overcorrection to resist the tipping movement, mainly including lingual root control of the central incisor, followed by distal root control of the canine, lingual root control of the lateral incisor, distal root control of the lateral incisor, and distal root control of the central incisor. However, the retraction force could not eliminate the mesial movement of the posterior teeth, possibly causing a reciprocating motion during treatment. In indirect strong groups, when the button was close to the center of the crown, the second premolar presented less mesial and buccal tipping but more intrusion. CONCLUSIONS The 3 anchorage groups showed significantly different biomechanical effects in both the anterior and posterior teeth. Specific overcorrection or compensation forces should be considered when using different anchorage types. The moderate and indirect strong anchorages have a more stable and single-force system and could be reliable models in investigating the precise control of future tooth extraction patients.
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Affiliation(s)
- Guan-Yin Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bo Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ke Yao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wen-Xin Lu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jia-Jia Peng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yu Shen
- School of Basic Medical Sciences, Chengdu University, Chengdu, China
| | - Zhi-He Zhao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Li Y, Xiao S, Jin Y, Zhu C, Li R, Zheng Y, Chen R, Xia L, Fang B. Stress and movement trend of lower incisors with different IMPA intruded by clear aligner: a three-dimensional finite element analysis. Prog Orthod 2023; 24:5. [PMID: 36775824 PMCID: PMC9922685 DOI: 10.1186/s40510-023-00454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/02/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND During the intrusion of lower incisors with clear aligners (CAs), root disengagement from the alveolar bone often occurs, resulting in serious complications. This study aimed to determine the potential force mechanism of the mandibular anterior teeth under the pressure of CA, providing theoretical data for clinical practice. METHODS In this study, a 3D finite element model was established, including the CA, periodontal ligament, and mandibular dentition. Incisor mandibular plane angles were set as 5 groups: 90°, 95°, 100°, 105°, and 110°. The 4 mandibular incisors were intruded by 0.2 mm, while the canines were the anchorage teeth. The stress, force systems, and potential movement trends of mandibular anterior teeth were obtained. RESULTS The compressive stress of the incisors was concentrated in the lingual fossa, incisal ridge, and apex. With the increase in IMPA, the moment of central incisors changed from lingual crown moment to labial crown moment, with the turning point between 100° and 105°, but the center of resistance (CR) was always subjected to the force toward the lingual and intrusive direction. The force and moment toward the labial side of the lateral incisors were greater than those toward the central incisors. The canines always tipped distally and received extrusive force with no relationship with IMPA. CONCLUSIONS With the increase in the initial IMPA, the direction of labiolingual force on the mandibular incisors was reversed. However, the root of the lower incisors always tipped labially, which indicated fenestration and dehiscence.
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Affiliation(s)
- Yixin Li
- grid.16821.3c0000 0004 0368 8293Department of Orthodontics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, 500 Quxi Road, Shanghai, 200011 China
| | - Shengzhao Xiao
- grid.16821.3c0000 0004 0368 8293Department of Orthodontics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, 500 Quxi Road, Shanghai, 200011 China
| | - Yu Jin
- grid.16821.3c0000 0004 0368 8293Department of Orthodontics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, 500 Quxi Road, Shanghai, 200011 China
| | - Cheng Zhu
- grid.16821.3c0000 0004 0368 8293Department of Orthodontics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, 500 Quxi Road, Shanghai, 200011 China
| | - Ruomei Li
- grid.16821.3c0000 0004 0368 8293Department of Orthodontics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, 500 Quxi Road, Shanghai, 200011 China
| | - Yikan Zheng
- grid.16821.3c0000 0004 0368 8293Translational Medicine Research Platform of Oral Biomechanics and Artificial Intelligence, Department of Orthodontics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, Shanghai, 200011 China
| | - Rongjing Chen
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, 500 Quxi Road, Shanghai, 200011, China.
| | - Lunguo Xia
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, 500 Quxi Road, Shanghai, 200011, China.
| | - Bing Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine;College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology, 500 Quxi Road, Shanghai, 200011, China.
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Shahabuddin N, Kang J, Jeon HH. Predictability of the deep overbite correction using clear aligners. Am J Orthod Dentofacial Orthop 2023; 163:793-801. [PMID: 36681525 DOI: 10.1016/j.ajodo.2022.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The objective of this study was to investigate the predictability of overbite correction in patients with deepbite using the clear aligners (Invisalign, Align Technology, San Jose, Calif) and examine the accuracy of vertical movement and inclination change of individual teeth. METHODS This retrospective study included 24 deepbite patients (10 males and 14 females; aged 32.8 ± 11.9 years; an initial overbite of 5.20 ± 0.95 mm; an average treatment period of 11.04 ± 4.14 months) consecutively treated from September 2016 and completed before August 2021. SmartTrack materials were used for all patients. The initial, predicted, and achieved final models were exported from ClinCheck and superimposed via best-fit surface-based registration using Slicer CMF (version 4.9.0; cmf.slicer.org). The overbite correction, changes in vertical movement, and inclination for individual teeth were measured. Descriptive statistics and a paired t test or Wilcoxon signed-rank test were performed. P <0.05 was considered statistically significant. RESULTS Mean overbite correction was 33%, with a 1.15 mm improvement after the first set of aligners. All teeth demonstrated statistically significant differences between planned and achieved amounts in vertical movement and inclination change, with the largest difference in maxillary central incisors. Mandibular incisor intrusion and mandibular premolar extrusion had similar accuracies. Regarding inclination change, maxillary central incisors showed the lowest accuracy of 13.3%. CONCLUSIONS Clear aligner treatment showed an average of 33% overbite correction. Overcorrection and additional refinement treatments are needed in most patients with a deepbite.
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Affiliation(s)
- Nishat Shahabuddin
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jessica Kang
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Hyeran Helen Jeon
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa.
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Castroflorio T, Sedran A, Parrini S, Garino F, Reverdito M, Capuozzo R, Mutinelli S, Grybauskas S, Vaitiekūnas M, Deregibus A. Predictability of orthodontic tooth movement with aligners: effect of treatment design. Prog Orthod 2023; 24:2. [PMID: 36642743 PMCID: PMC9840984 DOI: 10.1186/s40510-022-00453-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/17/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUNDS The present study was designed to define: (1) which are the less predictable OTM with Invisalign aligners when the treatment plan is designed by expert operators, (2) if the presence and shape of attachments influence the predictability of OTM and (3) if patients' demographics influence OTM predictability. The sample comprises 79 prospectively recruited patients (mean age 30.8 years; SD 12.0; 23 M, 56 F), treated by expert operators with an average of 27 aligners (SD 15) in the maxillary arch and 25 aligners (SD 11) in the mandibular arch. Post-treatment digital models and final virtual treatment plan models were exported from ClinCheck® software as STL files and subsequently imported into Geomagic Qualify ®software, to compare final teeth positions. The differences were calculated and tested for statistical significance for each tooth in the mesial-distal, vestibular-lingual and occlusal-gingival directions, as well as for angulation, inclination and rotation. In addition, the statistical significance of categorical variables was tested. RESULTS The lack of correction was significant for all movements and in all group of teeth (P < 0.01) except for the rotation of maxillary first molar. The prescribed OTM, the group of teeth and movement, the frequency of aligner change and the use of attachment influence the outcome. The greatest discrepancies in predicted and achieved tooth position were found for angular movements and rotation of teeth characterized by round-shaped crowns, for a ratio of approximately 0.4° per 1° prescribed. Optimized attachments for upper canines and lower premolar rotation seem not working properly. Second molar movements are mostly unexpressed. Furthermore, changing the aligner every 14 days will reduce the lack of correction of the 12% with respect to 7 days aligner change. CONCLUSIONS Predictability of orthodontic movement with aligners still has limitations related to the biomechanics of the system: the shape of some attachments and the characteristics of aligner material need to be redefined. However, the results of this study allow to properly design the virtual treatment plan, revealing how much overcorrection is needed and which attachments are most effective.
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Affiliation(s)
- Tommaso Castroflorio
- Department of Surgical Sciences, Dental School of the University of Torino, Via Nizza 230, 10126, Turin, Italy
| | - Ambra Sedran
- Department of Surgical Sciences, Dental School of the University of Torino, Via Nizza 230, 10126, Turin, Italy.
| | | | | | | | | | - Sabrina Mutinelli
- Department of Neuroscience, School of Dentistry, Section of Pedodontics, University of Padova, Via VII Febbraio 2, 35122, Padua, Italy
| | | | | | - Andrea Deregibus
- Department of Surgical Sciences, Dental School of the University of Torino, Via Nizza 230, 10126, Turin, Italy
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Kravitz ND, Dalloul B, Zaid YA, Shah C, Vaid NR. What percentage of patients switch from Invisalign to braces? A retrospective study evaluating the conversion rate, number of refinement scans, and length of treatment. Am J Orthod Dentofacial Orthop 2022; 163:526-530. [PMID: 36539316 DOI: 10.1016/j.ajodo.2022.03.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION This retrospective clinical study aimed to determine what percentage of patients switched from Invisalign to braces to finish treatment. We also examined the number of refinement scans per treatment and the estimated vs actual length of treatment. METHODS Records from 500 patients (average age 33.6 years) that started with Invisalign Full or Invisalign Teen were gathered from 2 orthodontic offices and evaluated. Data was collected from the doctors' consultation notes, treatment notes, and Invisalign Web site databases. There were 2 independent variables: gender (male and female) and age groups (aged <20 years, 20-30 years, and >30 years). RESULTS One in every 6 patients (17.2%) switched from Invisalign to braces. Invisalign treatment required an average of 2.5 refinement scans, and only 6.0% of patients could complete their treatment without a single refinement scan. The average length of Invisalign treatment was 22.8 months, this was 5.1 months more than the estimated length. The average number of aligners was 64.1, but for the patients that switched to braces, the average number of aligners was 80.6 plus an additional 6.9 months of braces. There was no statistical difference between gender or age group and the conversion to braces. However, patients in the oldest age group had a significantly greater number of refinement scans. CONCLUSIONS We are likely overestimating an office's efficiency using Invisalign. On average, an Invisalign patient will require approximately 2-3 refinement scans and 2 years of treatment, and there should be a reasonable expectation that braces may be needed.
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Affiliation(s)
| | | | | | | | - Nikhilesh R Vaid
- Adjunct Professor, Department of Orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Liu JQ, Zhu GY, Wang YG, Zhang B, Wang SC, Yao K, Zhao ZH. Different biomechanical effects of clear aligners in bimaxillary space closure under two strong anchorages: finite element analysis. Prog Orthod 2022; 23:41. [DOI: 10.1186/s40510-022-00435-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Clear aligner (CA) treatment has been gaining popularity, but the biomechanical effects of CAs in bimaxillary dentition have not been thoroughly investigated. Direct and indirect strong anchorages are two common anchorage control methods, but the underlying biomechanical mechanism has not yet been elucidated. This study aimed to investigate the different biomechanical effects of CAs in closing the bimaxillary space under different anchorage controls, further instructing the compensation strategies design and strong anchorage choice in clinical practice.
Methods
Three-dimensional (3D) bimaxillary models of different anchorage controls were created based on cone-beam computed tomography and intraoral scan data. Four first premolars were extracted using 3D modeling software. Finite element analysis was conducted to simulate the space closure process of the CAs.
Results
In the two strong anchorage groups, the bimaxillary dentition presented different movement patterns during the space closure process, and the lower dentition was more vulnerable to elastic force. From the vertical view, direct strong anchorage with elastic force had the advantage of flattening the longitudinal occlusal curve and resisting the roller-coaster effects, whereas indirect strong anchorage could lead to a deep longitudinal occlusal curve. From the sagittal view, indirect strong anchorage with metallic ligaments had a greater instantaneous anchorage protection effect, particularly in the lower dentition, which reduced the mesial movement of the posterior teeth by nearly four times that of the direct anchorage group. In addition, indirect strong anchorage presented better anterior teeth torque/tipping control, while direct strong anchorage could aggravate lingual tipping of the upper central incisors. Due to the differences in anterior–posterior anchorage and arch shape, compared with the upper dentition, anchorage preservation and vertical control effects were amplified in the lower dentition.
Conclusions
The biomechanical effects of CAs differed between the two strong anchorage groups. Due to the differences in dentition morphology, anterior–posterior anchorage, and dental arch shape, CAs present different biomechanical effects in bimaxillary space closure. Orthodontists should consider the corresponding mechanical compensation according to specific anchorage control methods and dentitions.
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Zhang L, Lin S, Chen J, Huang L, Huang Z, Li H. Risk factors for midcourse correction during treatment of first series of aligners with Invisalign. Am J Orthod Dentofacial Orthop 2022; 162:e96-e102. [PMID: 35753893 DOI: 10.1016/j.ajodo.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION This study aimed to analyze risk factors for midcourse correction (MC) during the first series of aligners in treatments with Invisalign (Align Technology, Santa Clara, Calif). METHODS Three hundred and fourteen patients treated with Invisalign were divided into MC and non-midcourse correction groups according to whether they completed the first series of aligners. Differences between these groups were compared with independent sample t tests, chi-square tests, and Wilcoxon rank sum tests. A multivariate logistic regression analysis was performed to identify independent risk factors, including gender, age, extraction treatment, interproximal reduction, correction steps (steps in first series treatment), overbite, overjet, the curve of Spee, Angle classification, and crowding. RESULTS The percentage of females (86.3%), Angle Class I malocclusion (62.4%), and nonextraction (56.1%) was relatively higher in all 314 patients. More than half of the patients (73.6%) completed the first series of aligners. Differences between the groups in the number of patients with extraction, correction steps, and the curve of Spee were significant (P <0.05). The proportions of MC were 41.3% and 14.8% in extraction and nonextraction patients, respectively. More initially planned correction steps were seen in the MC group (53.4 ± 15.6 steps). Extraction (adjusted odds ratio, 0.375; P = 0.001) and correction steps (adjusted odds ratio, 1.06; P <0.001) were independent risk factors for MC. CONCLUSIONS Extraction and the number of initially planned correction steps are independent risk factors for MC. In patients with complex dentofacial abnormalities, such as extraction, MC may be needed to achieve predicted changes.
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Affiliation(s)
- Lu Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Shuang Lin
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiping Chen
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ling Huang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ziwei Huang
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China.
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Blundell HL, Weir T, Byrne G. Predictability of overbite control with the Invisalign appliance comparing SmartTrack with precision bite ramps to EX30. Am J Orthod Dentofacial Orthop 2022; 162:e71-e81. [PMID: 35750579 DOI: 10.1016/j.ajodo.2022.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although the Invisalign appliance has reported difficulty in achieving the overbite outcomes predicted by ClinCheck software (Align Technology, Santa Clara, Calif), the effect of modifications to the material and components of the appliance are largely unquantified. This study aimed to investigate and determine the accuracy of Invisalign in correcting a deep overbite by comparing the predicted outcome from ClinCheck to the achieved posttreatment outcome for treatment groups that use different components of the appliance system. METHODS A retrospective study was conducted using pretreatment and posttreatment intraoral scans and predicted outcomes (ClinCheck) stereolithography files of 2 groups of consecutively treated adult patients from private specialist orthodontic practices, 1 group treated with EX30 material with no bite ramps (n = 29) and 1 treated with the newer SmartTrack material and precision bite ramps (n = 39). Inclusion criteria comprised nonextraction treatment, with a minimum of 14 dual arch Invisalign aligners using a 2-weekly aligner change protocol. Geomagic Control X software (3D Systems, Rock Hill, SC) was used to measure overbite in the pretreatment, posttreatment, and predicted outcome stereolithography files for each patient. Results were compared with a previously published treatment group that used SmartTrack material and no precision bite ramps. RESULTS The regression coefficient analysis indicated that for both groups, the deeper the pretreatment overbite and the greater overbite reduction projected according to ClinCheck, there is a linear increase in the discrepancy of overbite expression posttreatment. ClinCheck overpredicted overbite reduction in 96.6% of patients with precision bite ramp in which, on average, 43.4% of the prescribed overbite reduction was expressed. For EX30 patients, ClinCheck overpredicted overbite reduction in 87.2% of patients in which, on average, 55.1% of the prescribed overbite reduction was expressed. CONCLUSIONS The use of precision bite ramps does not appear to significantly improve the ability of SmartTrack material to predictably open the bite. SmartTrack material with or without bite ramps does not appear to produce better bite opening predictability than that seen with EX30 material.
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Affiliation(s)
| | - Tony Weir
- Department of Orthodontics, The University of Queensland, Brisbane, Queensland, Australia
| | - Graeme Byrne
- School of Engineering and Mathematical Sciences, La Trobe University, Bendigo, Victoria, Australia
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Saif BS, Pan F, Mou Q, Han M, Bu W, Zhao J, Guan L, Wang F, Zou R, Zhou H, Guo YC. Efficiency evaluation of maxillary molar distalization using Invisalign based on palatal rugae registration. Am J Orthod Dentofacial Orthop 2021; 161:e372-e379. [DOI: 10.1016/j.ajodo.2021.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/01/2022]
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