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Meade MJ, Weir T. A Cross-Sectional Survey of the Use of Clear Aligners by General Dentists in Australia. Clin Exp Dent Res 2024; 10:e919. [PMID: 38973205 PMCID: PMC11228346 DOI: 10.1002/cre2.919] [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: 12/24/2023] [Revised: 03/26/2024] [Accepted: 06/02/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVES The primary aim of the investigation was to survey clear aligner therapy (CAT) use among general dentists in Australia. A secondary aim was to evaluate the factors that influenced general dentists in Australia not to provide CAT. MATERIAL AND METHODS General dentists registered with the Australian Health Practitioner Regulation Agency were invited to participate in a structured cross-sectional electronic survey. The survey covered demographics, preferred CAT systems and practices, relevant treatment planning and retention protocols, patient-reported CAT issues, pertinent respondent opinions, and reasons for not providing CAT. Descriptive statistics were computed via GraphPad Prism v10 (GraphPad Software Inc., La Jolla, CA, USA). RESULTS Most of the 264 (n = 172; 65.2%) respondents indicated that they provided CAT. The majority (n = 82; 58.6%) reported that they treated between 1 and 20 patients with CAT annually. Invisalign was the most used system (n = 83; 61.2%), with 55 (41.7%), indicating that they used more than one system. Most (n = 124; 98.4%) were comfortable using CAT for mild crowding, whereas 73.4% (n = 94) were not comfortable in treating severe crowding with CAT. The median (IQR) number of patients per respondent treated with extraction of a permanent incisor or premolar was 0 (0). Issues regarding tooth positions were reportedly always or mostly in need of change in the initial treatment plan by 68.7%. Problems regarding patient compliance with CAT wear protocols (n = 67; 45.6%) and the predictability of treatment outcomes (n = 31; 21.1%) were the most identified themes of the free-text comments. Over 80% of those who did not provide CAT indicated that they preferred to refer to an orthodontist for management. CONCLUSION Almost two-thirds of the respondents provided CAT. Invisalign was the most used system. The majority use CAT combined with nonextraction treatment. Most of those who did not provide CAT preferred to refer to an orthodontist for patient management.
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Affiliation(s)
- Maurice J. Meade
- Orthodontic Unit, Adelaide Dental SchoolThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Tony Weir
- Orthodontic Unit, Adelaide Dental SchoolThe University of AdelaideAdelaideSouth AustraliaAustralia
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Miranda E Paulo D, Moreira-Santos LF, Tavares MC, Weir T, Meade MJ, Flores-Mir C. Clear aligner therapy practices among orthodontists practicing in Canada. Prog Orthod 2024; 25:27. [PMID: 38972901 PMCID: PMC11228011 DOI: 10.1186/s40510-024-00525-3] [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: 04/14/2024] [Accepted: 05/18/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The acceptability and preference for clear aligner therapy (CAT) has been increasing among orthodontists, but there is still a lack of consensus regarding CAT best practices. Consequently, this study aimed to investigate CAT practices among orthodontists practicing in Canada. METHODS The survey was conducted among orthodontists practicing in Canada using a modified previously published survey. Sixty orthodontists participated (6.1% response rate). It consisted of 11 sections with open and closed questions related to demographic information and particularities about using or not using CAT. The survey responses were exported from REDCap to a Microsoft Excel (Microsoft, Redmond, Wash) spreadsheet, then statistically analyzed using SPSS software (SPSS for Windows, version 21.0; IBM Inc., Armonk, NY, USA). The comments were categorized under themes and subthemes. Data were organized in descriptive statistics, expressing frequencies and percentages. RESULTS Almost 30% of the orthodontist's annual caseload was treated with CAT, most frequently prescribed to adult patients. Case complexity and patient cooperation were the factors that most influenced the decision to prescribe CAT. Almost half of orthodontists reported sometimes combining CAT with adjunctive fixed appliances. CONCLUSIONS Most orthodontists prescribe CAT, and its use is based on the malocclusion's complexity. Orthodontists who do not prescribe CAT believe that fixed appliance therapy has superior treatment outcomes.
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Affiliation(s)
| | | | - Maisa Costa Tavares
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Tony Weir
- Orthodontic Unit, Adelaide Dental School, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, Australia
| | - Maurice J Meade
- Orthodontic Unit, Adelaide Dental School, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, Australia
| | - Carlos Flores-Mir
- Department of Dentistry, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, 5-528, T6G 1C2, Canada.
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Alansari R, Vaiid N. Why do patients transition between orthodontic appliances? A qualitative analysis of patient decision-making. Orthod Craniofac Res 2024; 27:439-446. [PMID: 38149336 DOI: 10.1111/ocr.12750] [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] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To gain an in-depth understanding of patients' decision-making processes when choosing to transition to a different orthodontic appliance (OA). METHODS This was a retrospective qualitative study using one-on-one in-depth semi-structured interviews. Patients were recruited through purposive convenience sampling. Participants who had elected to transition from and to one of these OAs: metal brackets, tooth-coloured brackets, or clear aligners before the end of treatment were recruited. Recruitment ceased when data saturation was achieved. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Twenty-three adult participants (12 males, 11 females) with their ages ranging from 18 to 52 years were interviewed. The analysis of the data revealed that participants perceived two reasons for the transition: (1) insufficient initial information and (2) evolving life circumstances and personal style. Data analysis of participants who expressed a notable discrepancy between their expectations and the reality of the OA they chose revolved around three themes: (a) health benefits and threats, (b) personal control, and (c) financial considerations. Data analysis of participants who described transitioning between OAs due to changes in personal circumstances and style, revealed two themes: (a) change in personal values and motivations and (b) change in social and psychological influence. CONCLUSIONS This qualitative study highlighted the complex multifactorial nature of patient decision-making when choosing and transitioning OAs. Orthodontists can benefit from understanding these factors to engage in thorough patient-centered counselling, provide tailored treatment recommendations, and optimize the choice of appliances.
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Affiliation(s)
- Reem Alansari
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nikhillesh Vaiid
- Department of Orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Private Practice, Mumbai, India
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Meade MJ, Weir T, Seehra J, Fleming PS. Clear aligner therapy practice among orthodontists in the United Kingdom and the Republic of Ireland: A cross-sectional survey of the British Orthodontic Society membership. J Orthod 2024; 51:120-129. [PMID: 37830274 PMCID: PMC11141077 DOI: 10.1177/14653125231204889] [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: 02/03/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To investigate clear aligner therapy (CAT) practice among orthodontists in the British Orthodontic Society (BOS). DESIGN A cross-sectional online survey. METHODS An electronic survey was distributed to members of the BOS in 2022. The survey comprised questions regarding respondent demographics, general use of CAT, the choice of proprietary CAT appliances, CAT planning, case selection, treatment protocols and orthodontist-reported CAT problems. RESULTS Overall, there were 233 (19.5%) respondants with the majority (n = 121, 53.1%) being female. Most respondents reported practising in England (n = 171, 74.7%). The majority (n = 177, 77.3%) indicated that they used CAT in their practice, with 48.1% (n = 81) treating 1-20 patients with CAT annually. The most frequently prescribed CAT system was Invisalign (n = 138, 81.2%). One to three changes to the initial digital treatment plan were made by 72.9% (n = 121) with final tooth positions being the most common reason for adjustment (64.4%). Most (n = 97, 60.3%) rarely or never performed premolar extractions with CAT. Of the respondents, 23 12.7%) reported that they always or mostly used a remote monitoring system in conjunction with CAT, with a wide range of aligner change protocols reported. The median number of months required to complete non-extraction CAT reported by the respondents was 12. Most respondents (n = 77, 51.7%) did not feel that CAT provides superior outcomes compared with fixed appliance therapy. CONCLUSION CAT practice varied widely among the surveyed orthodontists. A predilection for the use of Invisalign and utility in less severe cases was noted.
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Affiliation(s)
- Maurice J Meade
- Orthodontic Unit, Adelaide Dental School, Adelaide Health and Medical Sciences Building, University of Adelaide, Adelaide, SA, Australia
| | - Tony Weir
- Orthodontic Unit, Adelaide Dental School, Adelaide Health and Medical Sciences Building, University of Adelaide, Adelaide, SA, Australia
| | - Jadbinder Seehra
- Centre for Craniofacial Development & Regeneration, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, UK
| | - Padhraig S Fleming
- Division of Public and Child Dental Health, Dublin Dental University Hospital, Dublin, Ireland
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Peruga M, Lis J. Correlation of sex hormone levels with orthodontic tooth movement in the maxilla: a prospective cohort study. Eur J Orthod 2024; 46:cjae025. [PMID: 38764143 DOI: 10.1093/ejo/cjae025] [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] [Indexed: 05/21/2024]
Abstract
BACKGROUND Sex hormones secreted during the menstrual cycle and the application of orthodontic forces to teeth can affect the metabolism of periodontal ligaments. This study aimed to determine whether there are any differences in orthodontic tooth displacement during the menstrual cycle and when using hormonal contraceptives and whether the amount of female sex hormones influences the efficiency of tooth displacement. METHODS A total of 120 women aged between 20 and 30 years with Angle Class II requiring transpalatal arch (TPA) to derotate teeth 16 and 26 were included in this study. The participants were divided into two groups: group A, which included women with regular menstruation, and control group B, which included women taking monophasic combined oral contraceptives. Group A was divided into subgroups according to the moment of TPA activation: menstruation (A1), ovulation phase (A2), and luteal phase (A3) (examination I). On intraoral scans, measurement points were marked on the proximal mesial cusps of teeth 16 and 26, and the intermolar distance (M1) was determined. The change in the position of the measurement points 6 weeks after activation (examination II) made it possible to determine the derotating extent of teeth 16 (O16) and 26 (O26) and the widening of the intermolar distance (M2-M1). In examinations I and II, tooth mobility in the alveoli was assessed using Periotest based on the periotest values (PTV) PTV1 and PTV2, respectively. RESULTS A significant difference in all parameters was observed among groups A1, A2, and A3 (P < 0.001). Group A3 showed the highest values of parameters O16, O26, and M2-M1, and group A2 showed the lowest values, which did not differ from the control group (P = 0.64). PTV2 and PTV1 were the highest in group A3 and the lowest in groups A1 and B. Intergroup differences were statistically significant (P < 0.001). CONCLUSIONS With the quantification of changes in tooth mobility in the alveoli during the menstrual cycle in women undergoing orthodontic treatment, it was possible to determine that female sex hormones affect the effectiveness of orthodontic treatment, and the optimal moment for TPA activation is the luteal phase of the menstrual cycle.
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Affiliation(s)
- Małgorzata Peruga
- Orthodontics Clinic, Dental Center of the Ministry of the Interior and Administration in Łódź, Północna 42, 91-425 Łódź, Poland
| | - Joanna Lis
- Department of Dentofacial Orthopaedics and Orthodontics, Wroclaw Medical University, Krakowska 26, 50-425 Wrocław, Poland
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Meade MJ, Weir T. Planned and achieved overjet and overbite changes following an initial series of Invisalign® aligners: A retrospective study of adolescent patients. Int Orthod 2024; 22:100888. [PMID: 38805975 DOI: 10.1016/j.ortho.2024.100888] [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: 04/14/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The aim of the present study was to compare the changes in overjet and overbite measurements achieved in adolescent patients following an initial series of Invisalign® aligners (Align Technology, San Jose, California) with those planned by orthodontists via its ClinCheck® digital treatment planning facility. METHODS Data provided by Align regarding patients who had completed an initial series of Invisalign® aligner treatment and were less than 18-years old were assessed in relation to pre-treatment, planned and achieved overjet and overbite measurements. Descriptive statistics, Wilcoxon rank-sum, Mann Whitney calculations were computed. RESULTS A total of 290 patients satisfied inclusion criteria. The median (interquartile range (IQR)) age was 14.17 (13,15.42) years. The median achieved overjet and overbite changes were less than those planned (p<0.01) with 53.33% of the planned median overjet increase achieved and 52.94% of planned median overjet reduction achieved. Additionally, 58.33% of the planned median overbite increase was achieved and 55.55% of the planned median overbite reduction was achieved. A total of 21.52% patients recorded no change or an increase from pre-treatment to the achieved overjet where reduction was planned, whereas 41.67% recorded no change or a reduction in overjet where increase was planned. A total of 18.72% recorded no change or an increase in overbite where reduction was planned, whereas 20.75% recorded no change or a reduction in overbite where increase was planned. CONCLUSIONS Less than 60% of the planned overjet and overbite changes per patient were achieved. Between 18.72 and 41.67% of patients experienced no change or changes in overjet and overbite in the opposite direction to that planned. This is likely to be clinically significant.
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Affiliation(s)
- Maurice J Meade
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, Australia.
| | - Tony Weir
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
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D'Antò V, Rongo R, Casaburo SD, Martina S, Petrucci P, Keraj K, Valletta R. Predictability of tooth rotations in patients treated with clear aligners. Sci Rep 2024; 14:11348. [PMID: 38762583 PMCID: PMC11102536 DOI: 10.1038/s41598-024-61594-2] [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: 12/30/2023] [Accepted: 05/07/2024] [Indexed: 05/20/2024] Open
Abstract
Clear aligners are employed daily for the treatment of several malocclusions. Previous clinical studies indicated low accuracy for the correction of tooth rotations. The aim of this study was to evaluate the predictability of tooth rotations with clear aligners. The sample comprised 390 teeth (190 mandibular; 200 maxillary), measured from the virtual models of 45 participants (21 men, 24 women; mean age: 29.2 ± 6.6 years old). For each patient, pre-treatment (T0) digital dental models (STL files), virtual plan (T1) and post-treatment digital dental models (T2) of both the mandibular and maxillary arches were imported onto Geomagic Control X, a 3D metrology software which allows angular measurements. Rotations were calculated by defining reproducible vectors for all teeth in each STL file and superimposing both T0 with T1 to determine the prescribed rotation, and T0 with T2 to determine the achieved rotation. Prescribed and achieved rotations were compared to assess movement's accuracy. The Wilcoxon signed-rank test and paired t-test were used to assess differences between the prescribed and achieved movements (P < 0.05). The overall predictability of rotational movement was 78.6% for the mandibular arch and 75.0% for the maxillary arch. Second molar accuracy was the lowest in both arches. Clear aligners were not able to achieve 100% of the planned movements.
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Affiliation(s)
- Vincenzo D'Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy.
| | - Roberto Rongo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
| | - Sossio Dario Casaburo
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
| | - Stefano Martina
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Via Al-Lende, 84081, Baronissi, Italy
| | - Paolo Petrucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
| | - Kreshnik Keraj
- Department of Prosthodontic, Faculty of Dental Medicine, University of Medicine, Rruga e "Dibrës", AL1005, Tirana, Albania
| | - Rosa Valletta
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, School of Orthodontics, University of Naples Federico II, Via Pansini, 5, 80131, Naples, Italy
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Meade MJ, Weir T. Clinical efficacy of the Invisalign mandibular advancement appliance: A retrospective investigation. Am J Orthod Dentofacial Orthop 2024; 165:503-512. [PMID: 38231167 DOI: 10.1016/j.ajodo.2023.11.008] [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: 09/01/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION This retrospective investigation aimed to determine whether the achieved changes in the treatment of Class II malocclusion were the same as those planned after the prescribed wear of an initial phase of Invisalign treatment with the mandibular advancement appliance (MAA) (Align Technology, Santa Jose, Calif). METHODS All patients treated with the MAA and who satisfied inclusion/exclusion criteria were selected from a database of 16,500 patients treated with clear aligners by 16 orthodontists. The pretreatment, planned, and achieved overjet measurements were documented from data provided in Align Technology's software facility, ClinCheck. Changes in intermaxillary anteroposterior (AP) first permanent molar (FPM) relationships were evaluated using Geomagic Control X (3D systems, Rock Hill, SC) metrology software. RESULTS Most of the 195 patients who satisfied the inclusion criteria were females (n = 104; 53.3%). The mean age was 12.62 ± 2.20 years. The pretreatment overjet was reduced from 6.49 ± 2.86 mm to 4.61 ± 2.22 mm after prescribed MAA wear, which was 42.5% of the planned outcome. The pretreatment AP FPM reduced from 3.14 ± 1.95 mm to 2.24 ± 2.51 mm, which was 31.3% of that planned. Thirty-eight (19.5%) patients experienced an increase in overjet where a reduction was planned. CONCLUSIONS Less than half of the planned overjet reduction and less than a third of the planned AP FPM correction were achieved with the MAA. Almost 20% of patients completed the MAA phase of treatment with an increased overjet despite a reduction being planned.
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Affiliation(s)
- Maurice J Meade
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Tony Weir
- Orthodontic Unit, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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Meade MJ, Blundell H, Meade EA, Giulieri C, Weir T. Invisalign Lite: a cross-sectional investigation of orthodontist treatment-planning practices. Angle Orthod 2024; 94:280-285. [PMID: 38639458 PMCID: PMC11050456 DOI: 10.2319/102223-712.1] [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: 10/01/2023] [Accepted: 01/01/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES To survey treatment-planning practices of orthodontists related to the Invisalign Lite clear aligner appliance (Align Technology, San Jose, Calif). MATERIALS AND METHODS Patients satisfying inclusion and exclusion criteria and treated with Invisalign Lite were selected from a database containing more than 17,000 patients. Relevant data regarding treatment-planning practices were obtained from Align Technology's treatment-planning facility, ClinCheck, and evaluated. RESULTS Most (n = 135; 79.9%) patients were female and had a median (interquartile range [IQR]) age of 30.5 (23.8, 43.1) years. The median (IQR) number of aligners for the sample was 23.0 (14, 28) for the maxilla and 24 (14, 28) for the mandible. Most (n = 122; 72.2%) patients required at least one additional series of aligners. More locations for interproximal reduction (IPR) were prescribed in the mandible (mean 1.91 [1.78]) than in the maxilla (1.03 [1.78]; P < .024) in the initial accepted plan of all patients. More teeth were prescribed composite resin (CR) attachments in the maxilla (P < .0001) in the initial accepted plan of all patients. Issues regarding tooth position protocols (n = 50; 53.3%) and requirement for additional IPR (n = 68; 45.3%) were reasons for treatment plan changes before acceptance of the initial treatment plan by orthodontists. CONCLUSIONS More than 7 of 10 patients required at least one additional series of aligners after the initial series of Invisalign Lite aligners was completed. Prescription of IPR was more common in the mandible, and prescription of CR attachments was more common in the maxilla.
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Kumari S, Goyal M, Kumar M, Khanna M, Yadav E, Singh T. Percentage of patients shifting to another treatment modality: An experience-guided decision. Dental Press J Orthod 2024; 29:e2423133. [PMID: 38567922 PMCID: PMC10983843 DOI: 10.1590/2177-6709.29.1.e2423133.oar] [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: 06/19/2023] [Accepted: 02/07/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE This study aimed to assess the frequency with which orthodontic patients decided to shift to another type of orthodontic appliance, among conventional metal brackets, ceramic brackets, lingual brackets and clear aligner, based on their personal experiences of pain, ulcers, bad breath, hygiene issues and social difficulties. MATERIAL AND METHODS This study comprises of patients seeking orthodontic treatment. The sample (n = 500; age group = 19-25 years) was divided equally into four groups based on the treatment modality: conventional metal brackets, ceramic brackets, lingual brackets and clear aligner. Patients rated the questionnaire using a visual analogue scale, to assess variables (such as pain, ulcer etc) that impact various treatment modalities. Subsequently, patients from all groups provided feedback regarding their treatment experiences, and expressed their preference for an alternative modality. Intergroup comparison among the four groups was done using one-way analysis of variance with Tukey's HSD post-hoc test (p ≤ 0.05). RESULTS Patients who received lingual brackets reported higher levels of pain and ulceration, as compared to those who received clear aligners. All four groups showed statistically significant differences for ulcers during treatment (p ≤ 0.05). Of the 125 patients who received conventional metal brackets, 28% expressed a preference for clear aligner therapy, while 20% preferred ceramic brackets. In the lingual group, 56% of 125 patients preferred clear aligner therapy, and 8% preferred ceramic brackets to complete their treatment. In the ceramic group, 83% did not want to switch, whereas 17% desired to switch to clear aligner, while in aligner group no patient desired to switch. CONCLUSIONS A higher percentage of patients from lingual brackets group chose to shift to clear aligners, followed by conventional metal brackets group and by ceramic brackets group, in this descending order. The clear aligner group demonstrated fewer issues than the other treatment modalities.
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Affiliation(s)
- Shivangi Kumari
- Teerthanker Mahaveer Dental College, Department of Orthodontics and Dentofacial Orthopaedics (Moradabad/Uttar Pradesh, India)
| | - Manish Goyal
- Teerthanker Mahaveer Dental College, Department of Orthodontics and Dentofacial Orthopaedics (Moradabad/Uttar Pradesh, India)
| | - Mukesh Kumar
- Teerthanker Mahaveer Dental College, Department of Orthodontics and Dentofacial Orthopaedics (Moradabad/Uttar Pradesh, India)
| | - Mannu Khanna
- Teerthanker Mahaveer Dental College, Department of Orthodontics and Dentofacial Orthopaedics (Moradabad/Uttar Pradesh, India)
| | - Ekta Yadav
- Teerthanker Mahaveer Dental College, Department of Orthodontics and Dentofacial Orthopaedics (Moradabad/Uttar Pradesh, India)
| | - Tanisha Singh
- Teerthanker Mahaveer Dental College, Department of Orthodontics and Dentofacial Orthopaedics (Moradabad/Uttar Pradesh, India)
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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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Wei M, Weir T, Kerr B, Freer E. Comparison of labio-palatal incisor movement between two wear protocols: a retrospective cohort study. Angle Orthod 2024; 94:151-158. [PMID: 37903503 PMCID: PMC10893922 DOI: 10.2319/063023-458.1] [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: 06/01/2023] [Accepted: 09/01/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVES To investigate the accuracy of the Invisalign appliance in achieving predicted angular tooth movement of the maxillary central incisors, to locate the center of rotation in a labio-palatal direction, and to investigate any difference between 1-weekly and 2-weekly wear protocols. MATERIALS AND METHODS This study involved a retrospective sample of two groups of 46 Class I adult subjects treated non-extraction with different protocols of 1-weekly and 2-weekly wear. The pretreatment, predicted outcome and achieved outcome digital models were superimposed and measured using metrology software. Angular and center-of-rotation measurements in the sagittal plane for the maxillary right central incisor were analyzed. RESULTS There was a statistically significant difference between predicted and achieved angular measurements (P < .005) for labial tooth movements regardless of wear protocol. For palatal movements, no statistically significant difference was observed (P > .05). A small amount of overexpression was observed in some cases. Regarding crown and root control, uncontrolled tipping was the most predictable. No statistically significant difference was found between predicted and achieved center of rotation, but the confidence interval was wide. No statistically significant difference (P > .05) was found between the two wear protocols for the parameters measured. CONCLUSIONS For maxillary central incisors, labial angular movements were not as accurate as palatal movements. Overcorrection could be recommended with careful clinical monitoring due to the possibility of overexpression. Control of root movements may be unpredictable, and further research is required to draw stronger conclusions. For the parameters measured in this clinical sample, there was no difference between the two wear protocols.
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Barashi MA, Habis RM, Alhazmi HA. Predictability of Orthodontic Space Closure Using Invisalign Clear Aligners: A Retrospective Study. Cureus 2024; 16:e56706. [PMID: 38646261 PMCID: PMC11032648 DOI: 10.7759/cureus.56706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Clear aligners have demonstrated success in achieving complex tooth movements. However, orthodontists have faced challenges related to the predictability of clear aligners. This retrospective study aimed to assess the predictability of ClinCheck® accuracy in space closure before and after Invisalign® treatment and to identify factors associated with the need for refinement. Methods Patient records from one private clinic in Makkah, Saudi Arabia, were analyzed, and a sample of 55 adult patients who had spacing and underwent Invisalign treatment were included. Data on demographic and orthodontic variables were collected, and a chi-square test was conducted to examine the association between the requirement for refinement and demographic as well as clinical/orthodontic factors. Furthermore, the initial and final space measurements were compared using paired t-tests across various demographic and clinical/orthodontic variables. Results After completing the treatment, 70.9% (N=39) of the cases did not require any orthodontic refinement. The mean final space measurement was higher for males compared to females (0.7 mm and 0.4 mm, respectively), individuals who received treatment in the upper compared to lower arch (0.5 and 0.4 mm, respectively), those with moderate compared to mild spacing (0.5 and 0.1 mm, respectively), and those with class III compared to class I Angle classification (0.9 and 0.3 mm, respectively). Additionally, patients with severe spacing had a significantly higher probability of requiring refinement compared to patients with mild spacing (adjusted odds ratio = 20.9; p < 0.05). Conclusion The study emphasizes the significance of careful patient selection and treatment planning, suggesting that orthodontists should consider overcorrecting in space closure when using clear aligners, especially in cases with more significant spacing.
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Meade MJ, Weir T. Predicted and achieved overjet and overbite measurements with the Invisalign appliance: a retrospective study. Angle Orthod 2024; 94:3-9. [PMID: 37839803 DOI: 10.2319/030923-161.1] [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: 03/01/2023] [Accepted: 07/01/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES To determine whether achieved outcome regarding overjet and overbite matched the predicted outcome following treatment with Invisalign (Align Technology, San Jose, Calif) aligner appliances. MATERIALS AND METHODS Data including pretreatment, predicted and achieved overjet, and overbite measurements provided by Align's digital treatment facility, ClinCheck Pro, were evaluated. Descriptive statistics, Mann-Whitney U-test, and Wilcoxon rank-sum intraclass correlation (ICC) test results were calculated. RESULTS From an initial sample of 600, 355 adult patients satisfied the inclusion and exclusion criteria. ICC scores for data input were excellent. Median (interquartile range [IQR]) age was 30.14 (23.33, 39.92) years and most (n = 259; 72.95%) were women. Almost one-third (n = 101; 28.45%) had undergone extraction as part of their treatment. More aligners were prescribed in the initial digital treatment plan for patients (median, 44; IQR: 35, 51.5; minimum, 17; maximum, 92) undergoing extractions as part of their orthodontic treatment than those who were not (median, 24; IQR: 18.25, 32; minimum, 13; maximum, 85) (P < .0001). Planned changes in overjet differed significantly from achieved outcomes (P < .001). Planned increases in overbite resulted in up to more than twice (222.72%) as much increase than predicted. Planned reduction of overbite achieved 8.69% of its predicted reduction in extraction cases. CONCLUSIONS Achieved overjet and overbite measurements differed significantly from the predicted outcomes at the end of an initial sequence of aligners. Planned increases in overbite resulted in greater overbite correction than predicted, particularly in extraction cases. Planned overbite reduction was challenging, especially in patients with extractions.
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Meade MJ, Ng E, Weir T. Digital treatment planning and clear aligner therapy: A retrospective cohort study. J Orthod 2023; 50:361-366. [PMID: 37002790 PMCID: PMC10693725 DOI: 10.1177/14653125231166015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To investigate the total number of digital treatment plan (DTPs) and aligners manufactured for clear aligner therapy (CAT) by Invisalign® from initial treatment planning to the completion of CAT. DESIGN A retrospective cohort study. MATERIAL AND METHODS A total of 30 patients, from each of 11 experienced orthodontists, who commenced treatment over a 12-month period, were assessed regarding the number of DTPs and aligners prescribed from initial planning to completion of CAT. Patients were categorised according to the number of aligners prescribed by the initial DTP into mild (<15), moderate (15-29) or severe (>29). RESULTS After the application of inclusion/exclusion criteria, 324 patients (71.9% women; median age = 28.5 years) undergoing non-extraction treatment with the Invisalign® appliance were assessed. The median number of initial DTPs was 3 (interquartile range [IQR] = 2, 1-9) per patient before acceptance by the orthodontist. Most (99.4%) patients required a refinement phase with a median of 2 (IQR = 2, 2-7) refinement plans recorded. A total of 9135 aligners per dental arch, was prescribed in the initial DTP of the 324 patients assessed and 8452 in the refinement phase. The median number of aligners per dental arch prescribed from the initial DTP was 26 (IQR = 12, 6-78) and from the refinement plans was 20.5 (IQR = 17, 0-132). CONCLUSION A median of three initial DTPs and two refinement plans were required for patients undergoing non-extraction treatment with the Invisalign® appliance. Patients were prescribed almost double the number of aligners initially predicted to manage their malocclusion.
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Affiliation(s)
- Maurice J Meade
- Orthodontic Unit, Adelaide Dental School, Adelaide, SA, Australia
| | - Elizabeth Ng
- Orthodontic Unit, Adelaide Dental School, Adelaide, SA, Australia
| | - Tony Weir
- Orthodontic Unit, Adelaide Dental School, Adelaide, SA, Australia
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Kau CH, Soh J, Christou T, Mangal A. Orthodontic Aligners: Current Perspectives for the Modern Orthodontic Office. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1773. [PMID: 37893491 PMCID: PMC10608554 DOI: 10.3390/medicina59101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Orthodontic aligners are changing the practice of orthodontics. This system of orthodontic appliances is becoming the mainstay appliance of choice for orthodontic offices in many countries. Patient preferences and lifestyle needs have made this appliance the primary choice when seeking care. In the early days, appliances lacked the efficiency and effectiveness of traditional bracket-wire systems, but modern systems are now able to handle a more comprehensive orthodontic caseload. Current systems provide newer biomechanical strategies and artificial intelligence-driven tooth movements for better outcomes. These improvements now mean that an orthodontist can be better prepared to manage a larger number of orthodontic malocclusions. This paper aims to discuss some of the evolution of orthodontic aligners and to describe to orthodontists the fundamentals of aligner therapy. In addition, it will provide an evidence-based outcome to the existing treatment outcomes in the current literature.
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Affiliation(s)
- Chung How Kau
- Department of Orthodontics, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Jen Soh
- Private Orthodontic Practice, Braces & Aesthetics Dental Clinic Pte Ltd., Singapore 307506, Singapore;
| | - Teti Christou
- Department of Orthodontics, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Akanksha Mangal
- Orthodontic Clinical Fellowship, School of Orthodontics, Jacksonville University, Jacksonville, FL 32211, USA;
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Meng X, Wang C, Xu W, Wang R, Zheng L, Wang C, Aversa R, Fan Y. Effects of different designs of orthodontic clear aligners on the maxillary central incisors in the tooth extraction cases: a biomechanical study. BMC Oral Health 2023; 23:416. [PMID: 37349701 PMCID: PMC10288704 DOI: 10.1186/s12903-023-03106-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/05/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Controlling the 3D movement of central incisors during tooth extraction cases with clear aligners is important but challenging in invisible orthodontic treatment. This study aimed to explore the biomechanical effects of central incisors in tooth extraction cases with clear aligners under different power ridge design schemes and propose appropriate advice for orthodontic clinic. METHODS A series of Finite Element models was constructed to simulate anterior teeth retraction or no retraction with different power ridge designs. These models all consisted of maxillary dentition with extracted first premolars, alveolar bone, periodontal ligaments and clear aligner. And the biomechanical effects were analysed and compared in each model. RESULTS For the model of anterior teeth retraction without power ridge and for the model of anterior teeth no retraction with a single power ridge, the central incisors exhibited crown lingual inclination and relative extrusion. For the model of anterior teeth no retraction with double power ridges, the central incisors tended to have crown labial inclination and relative intrusion. For the model of anterior tooth retraction with double power ridges, the central incisors exhibited a similar trend to the first kind of model, but as the depth of the power ridge increased, there was a gradual decrease in crown retraction value and an increase in crown extrusion value. The simulated results showed that von-Mises stress concentration was observed in the cervical and apical regions of the periodontal ligaments of the central incisors. The clear aligner connection areas of adjacent teeth and power ridge areas also exhibited von-Mises stress concentration and the addition of power ridge caused the clear aligner to spread out on the labial and lingual sides. CONCLUSIONS The central incisors are prone to losing torque and extruding in tooth extraction cases. Double power ridges have a certain root torque effect when there are no auxiliary designs, but they still cannot rescue tooth inclination during tooth retraction period. For tooth translation, it may be a better clinical procedure to change the one-step aligner design to two-step process: tilting retraction and root control.
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Affiliation(s)
- Xuehuan Meng
- Stomatological Hospital of Chongqing Medical University, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
| | - Chunjuan Wang
- Stomatological Hospital of Chongqing Medical University, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
| | - Wenjie Xu
- Stomatological Hospital of Chongqing Medical University, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
| | - Rui Wang
- Stomatological Hospital of Chongqing Medical University, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China
| | - Leilei Zheng
- Stomatological Hospital of Chongqing Medical University, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China.
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China.
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, No.426 Songshibei Road, Yubei District, Chongqing, 401147, China.
| | - Chao Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, Beijing, 100083, China.
| | - Raffaella Aversa
- Advanced Material Lab, University of Campania, Luigi Vanvitelli, Caserta, Italy
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, Beijing, 100083, China
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D'Antò V, Valletta R, Di Mauro L, Riccitiello F, Kirlis R, Rongo R. The Predictability of Transverse Changes in Patients Treated with Clear Aligners. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1910. [PMID: 36903025 PMCID: PMC10004392 DOI: 10.3390/ma16051910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Arch expansion might be used to correct buccal corridors, improve smile aesthetics, resolve dental cross bite, and gain space to resolve crowding. In clear aligner treatment, the predictability of the expansion is still unclear. The purpose of this study was to evaluate the predictability of dentoalveolar expansion and molar inclination with clear aligners. In the study, 30 adult patients (27 ± 6.1 years old) treated with clear aligners were selected (treatment time: 8.8 ± 2.2 months). The upper and lower arch transverse diameters were measured for canines, first and second premolars, and first molars on two different sides (gingival margins and cusp tips); moreover, molar inclination was measured. A paired t-test and Wilcoxon test were used to compare prescription (planned movement) and achieved movement. In all cases, except for molar inclination, a statistically significant difference was found between achieved movement and prescription (p < 0.05). Our findings showed a total accuracy of 64% for the lower arch, 67% at the cusp level, and 59% at the gingival level, with a total accuracy of 67% for the upper arch, 71% at the cusp level, and 60% at the gingival level. The mean accuracy for molar inclination was 40%. Average expansion was greater at cusps of canines than for premolars, and it was lowest for molars. The expansion achieved with aligners is mainly due to the tipping of the crown rather than bodily movement of the tooth. The virtual plan overestimates the expansion of the teeth; thus, it is reasonable to plan an overcorrection when the arches are highly contracted.
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Affiliation(s)
- Vincenzo D'Antò
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Rosa Valletta
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Luigi Di Mauro
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, 80131 Naples, Italy
| | - Francesco Riccitiello
- School of Pediatric Dentistry, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, 80131 Naples, Italy
| | | | - Roberto Rongo
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Via Pansini, 5, 80131 Naples, Italy
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