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Liou YJ, Chen PR, Tsai TY, Lin S, Chou PY, Lo CM, Chen YR. Comparative Assessment of Orthodontic and Aesthetic Outcomes after Orthognathic Surgery with Clear Aligner or Fixed Appliance Therapy. Plast Reconstr Surg 2024; 154:162-172. [PMID: 37257129 DOI: 10.1097/prs.0000000000010786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Clear aligner therapy has an aesthetic advantage over fixed appliance therapy. However, to our knowledge, no study has objectively compared patient orthodontic and aesthetic outcomes between clear aligner and fixed appliance therapies administered after orthognathic surgery (OGS). METHODS This study included patients with no history of congenital craniofacial deformities who underwent surgery-first OGS and received clear aligner or fixed appliance therapy. The patients' grades on the Dental Health Component (DHC) and Aesthetic Component of the Index of Orthodontic Treatment Need and scores on the Peer Assessment Rating (PAR) index were calculated before OGS (T0), after OGS (T1), and after orthodontic therapy (T2). RESULTS This study included 33 patients (clear aligner therapy, n = 19; fixed appliance therapy, n = 14). No considerable between-group differences were noted in the DHC and AC grades at T0, T1, or T2. Furthermore, percentage of reduction in the PAR index score was more significant in the clear aligner group (74.4%) than in the fixed appliance group (63.2%) from T0 to T1 ( P = 0.035); however, no between-group differences were noted from T1 to T2 or from T0 to T2. Both groups exhibited substantially improved DHC grades, Aesthetic Component grades, and PAR index scores at T1 and T2. CONCLUSIONS Patient outcomes were similar between the clear aligner and fixed appliance groups after orthodontic therapy. However, the former group exhibited more favorable immediate results after OGS than did the latter group. Thus, as an adjunct therapy for patients with malocclusion, clear aligner therapy may be more effective than fixed appliance therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Yu-Jia Liou
- From the Department of Dentistry, Chang Gung Memorial Hospital at Keelung
| | - Pin-Ru Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Tzong-Yueh Tsai
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Susie Lin
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center
| | - Pang-Yun Chou
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
| | - Chiu-Mei Lo
- National Defense Medical University in Taipei
| | - Yu-Ray Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University
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Miloro M, Han MD, Kwon TG, Xi T, Borba AM, Reyneke JP, Caminiti M. Predicting the Future Focus of Orthognathic Surgery: Outcome-Driven Planning and Treatment With Function, Esthetics, and Occlusion as Key Indicators. J Oral Maxillofac Surg 2024:S0278-2391(24)00576-7. [PMID: 38981579 DOI: 10.1016/j.joms.2024.06.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 07/11/2024]
Abstract
As an international group of orthognathic surgeons, we believe the next big thing in orthognathic surgery will be a clinical and research focus on patient-oriented outcomes and improved quality of life. We expect to see advances in diagnosis and treatment planning, materials development, and patient management.
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Affiliation(s)
- Michael Miloro
- Daniel M. Laskin Professor and Department Head, Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL
| | - Michael D Han
- Associate Professor and Program Director, Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL
| | - Tae-Geon Kwon
- Professor, Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Tong Xi
- Associate Professor and Research Coordinator, Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, Netherlands; Adjunct Associate Professor, Faculty of Health, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Alexandre M Borba
- Program Director, Research Program in Integrated Dental Sciences Department, Faculty of Dentistry of the University of Cuiabá, Cuiabá, MT, Brazil; Staff, Department of Oral and Maxillofacial Surgery, General Hospital of Cuiabá, Cuiabá, MT, Brazil
| | - Johan P Reyneke
- Professor, Director, Faculty of Health Sciences, Department of Oral and Maxillofacial Surgery, University of Western Cape, The Centre for Orthognathic Surgery, Mediclinic, Cape Town, South Africa
| | - Marco Caminiti
- Associate Professor, Head and Program Director, Oral and Maxillofacial Surgery, University of Toronto, Toronto, Canada.
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3
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Xiao X, Wu Z, Yeweng S. The Efficiency of Segmental Le Fort I Surgery in Clear Aligner Therapy of Skeletal Class III Deformity: A Pilot Study. J Craniofac Surg 2024; 35:e341-e345. [PMID: 38451107 DOI: 10.1097/scs.0000000000010041] [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: 09/24/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION The purpose of this study was to investigate the efficiency of segmental Le Fort I osteotomy in clear aligner therapy of skeletal Class III deformities and to explore whether Le Fort I segmental osteotomy was effective for maxillary incisor axis correction and reduced the duration of perioperative orthodontics. MATERIALS AND METHODS Patients who had skeletal Class III deformities (ANB<0) treated with extraction of the maxillary first premolars, segmental Le Fort I osteotomy, and clear aligners therapy were included in this retrospective study. We measured the amount of tooth extraction space that was closed by surgery and recorded the preoperative orthodontic and total treatment duration. Lateral cephalograms were analyzed to measure changes of maxillary incisor inclination before treatment (T0), 1 week before surgery (T1), 1 week after surgery (T2), and after total orthodontic treatment (T3). Statistical analyses were performed, and the P value was set at 0.05. RESULTS The sample was composed of 15 patients aged 19 to 30 (M=22.9) years. The average preoperative orthodontic treatment duration was 16.2±5.22 mo, with 33.5 pairs of clear aligners. The gap at the extraction site decreased from 5.42±1.57 mm to 0.80±0.62 mm on average after surgery. U1-SN and U1-NA(deg) increased sparingly with preoperative decompensation, decreased in quantity after surgery, and then slightly increased with postoperative compensation (T20.05). CONCLUSIONS Le Fort I segmental osteotomy assisted decompensation of the upper anterior teeth and reduced the duration of preoperative orthodontics with clear aligners.
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Affiliation(s)
- Xiufeng Xiao
- Department of Zhong Shang Square Outpatient, School of Stomatology
| | | | - Sanjie Yeweng
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, PR, China
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Bastidas-Castillo DA, Ramirez-Naranjo P. Surgery first with clear aligners for a Class II patient: Case report and literature review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101672. [PMID: 37898300 DOI: 10.1016/j.jormas.2023.101672] [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: 09/21/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
Orthognathic surgery has undergone multiple modifications in timing approaches, among them, surgery first represents an approach that potentially reduces length of time and shows earlier results in facial changes, nevertheless, it has been used mostly to treat Class III skeletal anomalies. Also, fixed appliances orthodontics is the most common choice, however, recent literature shows clear aligners can achieve the same results. This paper presents a case of a 20-year-old female with a skeletal Class II treated with surgery first and clear aligners protocol, with a literature review of surgery first in Class II patients; evidencing that this approach can be suitable to achieve satisfactory and stable results, although larger patient samples are needed.
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Affiliation(s)
- Dario Andres Bastidas-Castillo
- Department of Orthodontics, University Cooperativa of Colombia, Pasto, Colombia; Department of Facial Surgery, Clinica LLanogrande, Rionegro, Colombia.
| | - Pamela Ramirez-Naranjo
- Department of Facial Surgery, Clinica LLanogrande, Rionegro, Colombia; Department of Oral and Maxillofacial surgery, Clinica Las Vegas, Medellin, Colombia
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5
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Dastgir R, Bemudez PF, Valiathan M, Baur DA, Quereshy FA. The use of clear aligners in orthognathic surgeries: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:e22-e40. [PMID: 38160198 DOI: 10.1016/j.oooo.2023.07.016] [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: 05/25/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 01/03/2024]
Abstract
Pre- and postoperative fixed orthodontic appliances are the customary and standard practice for patients with treatment planned for undergoing orthognathic surgery. Traditionally, most patients undergoing orthognathic surgeries are in their late teens. Although these patients still compose the greatest pool of the orthognathic surgery population, many patients seek orthognathic surgery later in life. This older patient population often has different concerns and goals than the younger patient population. One of these concerns is often the aesthetic appearance of fixed appliances and the time required to wear these appliances pre- and postoperatively. Today, removable orthodontic appliances consisting of a series of clear aligners have gained immense popularity due to their aesthetic appeal over traditional braces. Additional benefits of removable orthodontic appliances include improved oral hygiene leading to a decreased risk of gingivitis. Whereas clear aligner systems are commonly used in the nonsurgical orthodontic population, there has been limited use of Invisalign in the orthognathic surgery population. In this article, we present a case series of 5 patients who successfully underwent orthognathic surgery using clear aligners for pre- and postoperative orthodontic treatment.
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Affiliation(s)
- Ramtin Dastgir
- Research Fellow, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Paul F Bemudez
- Faculty, Ascension Macomb-Oakland Hospital-Warren Campus, Detroit, MI, USA
| | - Manish Valiathan
- Professor and Director, Department of Orthodontics, Case Western Reserve University, Cleveland, OH, USA
| | - Dale A Baur
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Faisal A Quereshy
- Professor and Program Director, Department of Oral and Maxillofacial Surgery, Case Western Reserve University, Cleveland, OH, USA.
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6
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Meazzini MC, Demonte LP, Cohen N, Battista VMA, Rabbiosi D, Autelitano L. The Use of Clear Aligners in Multi-Segmental Maxillary Surgery: A Case-Control Study in Cleft Lip and Palate and Skeletal Class III Patients. J Clin Med 2024; 13:1329. [PMID: 38592173 PMCID: PMC10931644 DOI: 10.3390/jcm13051329] [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: 02/01/2024] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Maxillary hypoplasia and mandibular asymmetry may be corrected with orthognathic surgery after growth completion. For most stable results, some cases may require segmental Le Fort I osteotomies. Unfortunately, Invisalign's software (6.0 version) still has some inherent limitations in predicting outcomes for complex surgeries. This study explores the potential of aligners, particularly in multiple-piece maxillary osteotomies in both cleft and non-cleft patients. Method: Thirteen patients who underwent pre-surgical treatment with Invisalign were retrospectively matched in terms of diagnosis, surgical procedure, and orthodontic complexity with thirteen patients treated using fixed appliances. Virtual curves following the lower arch were employed to guide the correct pre-surgical positions of the upper teeth with a simple superimposition technique. The amount of impressions required in both groups to achieve satisfactory pre-surgical alignment of the segmented arches was compared. Results: one or no refinement phases were needed in the Invisalign group to reach an acceptable pre-surgical occlusion, while the amount of pre-surgical impressions needed to reach adequate coordination with fixed appliance treatment was slightly higher (p > 0.05). Conclusions: it appears that clear aligner could serve as an effective treatment for individuals necessitating segmental Le Fort I osteotomies when aided by the suggested simple superimposition approach.
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Affiliation(s)
- Maria Costanza Meazzini
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
| | - Leonardo Paolo Demonte
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
- Department of Orthodontics, University Vita-Salute, San Raffaele Hospital, 20132 Milano, Italy
| | - Noah Cohen
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
| | - Valeria Marinella Augusta Battista
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
| | - Dimitri Rabbiosi
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
- Università degli Studi dell’Insubria, Circolo and Fondazione Macchi Hospital, 21100 Varese, Italy
| | - Luca Autelitano
- Regional Center of Cleft Lip and Palate, Department of Maxillo Facial Surgery, Santi Paolo and Carlo Hospital, Via di Rudinì 8, 20142 Milan, Italy; (M.C.M.); (N.C.); (V.M.A.B.); (D.R.); (L.A.)
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Zammit D, Ettinger RE, Sanati-Mehrizy P, Susarla SM. Current Trends in Orthognathic Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2100. [PMID: 38138203 PMCID: PMC10744503 DOI: 10.3390/medicina59122100] [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: 10/01/2023] [Revised: 11/14/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
Orthognathic surgery has evolved significantly over the past century. Osteotomies of the midface and mandible are contemporaneously used to perform independent or coordinated movements to address functional and aesthetic problems. Specific advances in the past twenty years include increasing fidelity with computer-assisted planning, the use of patient-specific fixation, expanding indications for management of upper airway obstruction, and shifts in orthodontic-surgical paradigms. This review article serves to highlight the contemporary practice of orthognathic surgery.
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Affiliation(s)
- Domenick Zammit
- Department of Pediatric Surgery, Division of Plastic Surgery, McGill University Health Center, Montreal Children’s Hospital, Montreal, QC H3Z 1X3, Canada;
| | - Russell E. Ettinger
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA 98105, USA
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Paymon Sanati-Mehrizy
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Srinivas M. Susarla
- Department of Surgery, Division of Plastic Surgery, University of Washington, Seattle, WA 98105, USA
- Craniofacial Center, Seattle Children’s Hospital, Seattle, WA 98105, USA
- Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA 98195, USA
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8
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Rouzi M, Zhang X, Jiang Q, Long H, Lai W, Li X. Impact of Clear Aligners on Oral Health and Oral Microbiome During Orthodontic Treatment. Int Dent J 2023; 73:603-611. [PMID: 37105789 PMCID: PMC10509397 DOI: 10.1016/j.identj.2023.03.012] [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: 12/23/2022] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
The demand for clear aligners has risen over the past decade because they satisfy patients' desire for less noticeable and more comfortable orthodontic appliances. Because clear aligners are increasingly used in orthodontics, there is a big push to learn more about the physiologic and microbial changes that occur during treatment. The present work highlighted further links between clear aligners and changes in oral health and the oral microbiome and provided plaque control methods for clear aligner trays. Existing literature revealed that clear aligners have no significant influence on the structure of the oral microbiome during orthodontic therapy. Clear aligner treatment demonstrated promising results in terms of controlling plaque index, gingival health, and the prevalence of white spot lesions. Nevertheless, grooves, ridges, microcracks, and abrasions on the aligner surface would provide a prime environment for bacterial adherence and the development of plaque biofilms. A combination of mechanical and chemical methods seems to be a successful approach for removing plaque biofilm from aligners whilst also preventing pigment adsorption.
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Affiliation(s)
- Maierdanjiang Rouzi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoqi Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Qingsong Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Hu Long
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wenli Lai
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Xiaolong Li
- Department of Orthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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9
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AlMogbel A. Clear Aligner Therapy: Up to date review article. J Orthod Sci 2023; 12:37. [PMID: 37881665 PMCID: PMC10597356 DOI: 10.4103/jos.jos_30_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 10/27/2023] Open
Abstract
The advantages of Clear Aligners Therapy (CAT) include the braces being virtually invisible, comfortable to wear, and removable for eating and brushing; that way, CAT can be used to treat a wide range of orthodontic issues. In 1999, the company Align Technology introduced the frst commercial clear aligner system called Invisalign. The Invisalign system was initially only available to orthodontists, but later became available to general dentists as well. The system quickly gained popularity among patients who were looking for a more discreet and comfortable alternative to traditional braces. In 2000, Align Technology received FDA clearance for the Invisalign system, which further increased its popularity. The biomechanics of clear aligners involve the use of custom-made tooth aligners that are specifcally shaped to guide teeth into desired positions. These aligners are typically made from flexible materials such as polyurethane or ethylene vinyl acetate and are adjusted to apply the necessary forces for tooth movement. Attachment devices, such as power ridges or buttons, are often used to enhance or assist in specifc tooth movements and for retention of the aligner. The use of attachments allows for the exertion of desired force on the teeth, which is crucial for the success of Clear Aligner Therapy. CAT should be used if patients are concerned about the esthetic appearances of their teeth-for example, actors and other individuals that rely on their appearances in public in a professional context-and if the misalignment is not severe, so that clear aligners can still work. One should not use CAT in cases of severe crowding or spacing issues that require extractions. If the patient has complex jaw discrepancies or skeletal issues or if teeth need to be moved extensively in multiple directions, CAT is likely not going to be strong enough. In conclusion, Clear Aligner Therapy is a safe, effective, and convenient orthodontic treatment option that offers patients a virtually invisible way to achieve a straighter, more beautiful smile. With continued advancements in technology and a growing body of research supporting its effectiveness, the future of Clear Aligner Therapy looks bright.
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Affiliation(s)
- AbdulMajeed AlMogbel
- Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah 52571, Saudi Arabia
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10
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Khashashneh M, Ratnayake J, Choi JJE, Mei L, Lyons K, Brunton P. The Effect of 10% Carbamide Peroxide Dental Bleaching on the Physical Properties of Invisalign Aligners: An In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16114125. [PMID: 37297258 DOI: 10.3390/ma16114125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
The high aesthetic demands of patients have increased their requests to align their teeth using clear aligners, including Invisalign. Patients also want to have their teeth whitened for the same purpose; the use of Invisalign as a bleaching tray at night has been reported in few studies. However, whether 10% carbamide peroxide affects the physical properties of Invisalign is unknown. Therefore, the objective of this study was to evaluate the effect of 10% carbamide peroxide on the physical properties of Invisalign when used as a bleaching tray at night. Twenty-two unused Invisalign aligners (Santa Clara, CA, USA) were used to prepare 144 specimens to test their tensile strength, hardness, surface roughness, and translucency. The specimens were divided into four groups: a testing group at baseline (TG1), a testing group after application of bleaching material at 37 °C for 2 weeks (TG2), a control group at baseline (CG1), and a control group after immersion in distilled water at 37 °C for 2 weeks (CG2). Statistical analysis was conducted using a paired t-test, Wilcoxon signed rank test, independent samples t-test, and Mann-Whitney test to compare samples in CG2 to CG1, TG2 to TG1, and TG2 to CG2. Statistical analysis showed no statistically significant difference between the groups for all physical properties, except for hardness (p-value < 0.001) and surface roughness (p-value = 0.007 and p-value < 0.001 for the internal and external surface roughness, respectively), which revealed a reduction in hardness values (from 4.43 ± 0.86 N/mm2 to 2.2 ± 0.29 N/mm2) and an increase in surface roughness (from 1.6 ± 0.32 Ra to 1.93 ± 0.28 Ra and from 0.58 ± 0.12 Ra to 0.68 ± 0.13 Ra for the internal and external surface roughness, respectively) after 2 weeks of dental bleaching. Results showed that Invisalign can be used for dental bleaching without excessive distortion or degradation of the aligner material. However, future clinical trials are required to further assess the feasibility of using Invisalign for dental bleaching.
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Affiliation(s)
- Majd Khashashneh
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
- Faculty of Dentistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Jithendra Ratnayake
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Joanne Jung Eun Choi
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Li Mei
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Karl Lyons
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Paul Brunton
- DVCA, Curtin Perth, Curtin University, Bentley, WA 6102, Australia
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11
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Guntaka PK, Kiang K, Caprio R, Parry GJ, Padwa BL, Resnick CM. Authors' response. Am J Orthod Dentofacial Orthop 2023; 163:591-592. [PMID: 37142353 DOI: 10.1016/j.ajodo.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 05/06/2023]
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Scheffer Castilhos J, Gasparello GG, Sgarbi D, Tanaka OM. Questions regarding whether patients treated with Invisalign have less swelling after orthognathic surgery than those with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop 2023; 163:590-591. [PMID: 37142352 DOI: 10.1016/j.ajodo.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
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13
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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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Zhou G, Yu F, Yu H, Xia L, Yuan L, Fang B. Treatment of skeletal class III malocclusion using a combined clear aligner and surgery-early approach : Assessment based on the American Board of Orthodontics Objective Grading System. J Orofac Orthop 2023:10.1007/s00056-023-00458-2. [PMID: 36867218 DOI: 10.1007/s00056-023-00458-2] [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: 03/26/2022] [Accepted: 01/10/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE To evaluate whether clear aligner therapy (CAT) combined with a surgery-early approach can achieve good therapeutic effects in patients with skeletal class III malocclusion. METHODS Thirty consecutive skeletal class III malocclusion cases treated with clear aligners combined with early surgery were selected. Treatment time, lateral cephalograms and American Board of Orthodontics Objective Grading System (ABO-OGS) scores of the treatment models were measured to evaluate the treatment efficiency, facial profile, and occlusion. RESULTS The results showed that early surgery was achieved after 7.71 months of presurgical orthodontics, on average. ANB decreased by 5.57° (P < 0.001), and STissue N Vert to Pog' decreased by 7.29 mm (P = 0.001), both reaching normal values. The posttreatment ABO-OGS scores were 26.600 on average, meeting its standards. CONCLUSIONS With the assistance of CAT, early surgery can be accomplished in patients with skeletal class III malocclusion, improving their facial profile and achieving functional occlusion.
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Affiliation(s)
- Guoli Zhou
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Fei Yu
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Hongbo Yu
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Lunguo Xia
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Lingjun Yuan
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China
| | - Bing Fang
- Department of Orthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, 500 Quxi Road, 200011, Shanghai, China.
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Surgical Precision Analysis of Orthognathic Surgery Combined With Invisible Orthodontic. J Craniofac Surg 2023; 34:e190-e195. [PMID: 36745135 DOI: 10.1097/scs.0000000000009120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study aimed to explore the changes in hard tissue after applying invisible orthodontic-orthognathic treatment and the digital design, and to explore the accuracy of the treatment effect of maxillofacial tissue after invisible orthodontic treatment and orthognathic treatment. METHODS From September 2020 to January 2022, 25 patients with class III skeletal malocclusion and 7 patients with class II skeletal malocclusion, were treated with invisible orthodontic treatment and orthognathic combined treatment. Orthodontic treatment with preoperative invisible orthodontic treatment followed by orthodontic surgery. All patients had cephalometric lateral films after surgery to analyze orthognathic surgery's goals and surgical effects of orthognathic surgery and the digital design. Measure the angle of the sella-nasion-A point angle, angle of sella-nasion-B point, ANB angle, maxillary convex angle, mandibular plane (MP) angle, 1-SN angle, 1-MP angle, etc, and compare surgery outcome with digital design. RESULT All patients were satisfied with the effect and no complications occurred. Angle of sella-nasion-A point, angle of sella-nasion-B point, ANB angle, maxillary convex angle, MP angle, 1-SN angle, and 1-MP angle had no significant difference between the postoperative effect and the purpose of digital design ( P >0.05), there was no apparent deviation between the upper and lower jaw and the chin ( P >0.05). CONCLUSION The combined invisible orthodontic treatment and orthognathic treatment are accurate and effective, and are worthy of promotion. It supplements traditional orthognathic therapy and is suitable for corresponding patients.
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16
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Guntaka PK, Kiang K, Caprio R, Parry GJ, Padwa BL, Resnick CM. Do patients treated with Invisalign have less swelling after orthognathic surgery than those with fixed orthodontic appliances? Am J Orthod Dentofacial Orthop 2023; 163:243-251. [PMID: 36400644 DOI: 10.1016/j.ajodo.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients treated with perioperative Invisalign for orthognathic surgery may experience less postoperative swelling than those with fixed appliances because of a lack of mucosal irritation from bonded brackets and wires. The aims of this study were to (1) compare facial swelling after orthognathic surgery in subjects with Invisalign to those with fixed appliances using 3-dimensional (3D) subtraction imaging and (2) determine if the type of operation influences differences in swelling. METHODS This is a retrospective case-control study. To be included in the case group (Invisalign), patients had to have had: (1) LeFort I and/or bilateral sagittal split osteotomies, with or without genioplasty, (2) perioperative orthodontic treatment using Invisalign, and (3) 3D photographs at postoperative timepoints 1 week (T1), 3-4 weeks (T2), and 5-7 weeks. A sex and operation-matched control group with fixed appliances (standard) was also included. The primary outcome variable was the volume of facial swelling, measured by subtraction imposition of the T1 and T2 3D images using reference images (5-7 weeks). RESULTS Twenty-two subjects (36% female; mean age 20.7 ± 3.15 years) were included: Invisalign (n = 11) and standard (n = 11). For each group, 7 subjects had 1 operation (LeFort I or bilateral sagittal split osteotomies), and 4 had bimaxillary surgery ± genioplasty. At T1, the Invisalign group had significantly less swelling than the standard group (17.52 ± 10.79 cm3 vs 37.53 ± 14.62 cm3; P <0.001). By T2, the differences were no longer significant (6.62 ± 5.19 cm3 for Invisalign; 5.85 ± 4.39 cm3 for standard, P = 0.728). CONCLUSION Subjects with Invisalign had significantly less facial swelling in the first postoperative week than those with fixed appliances.
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Affiliation(s)
| | | | | | - Gareth J Parry
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass
| | - Bonnie L Padwa
- Harvard School of Dental Medicine, and Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Mass
| | - Cory M Resnick
- Harvard School of Dental Medicine and Harvard Medical School, and Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Mass.
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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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M S, Gandedkar NH, kumar S, Kim YJ, Adel SM. AN INTEGRATED 3D-DRIVEN PROTOCOL FOR SURGERY FIRST ORTHOGNATHIC APPROACH (SFOA) USING VIRTUAL SURGICAL PLANNING (VSP). Semin Orthod 2022. [DOI: 10.1053/j.sodo.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Sabouni W, Gandedkar NH, Vaid NR. Clinical Application of Clear Aligner Treatment (CAT) in the Surgery-First Orthognathic approach (SFOA). Semin Orthod 2022. [DOI: 10.1053/j.sodo.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Cong A, Ruellas ACDO, Tai SK, Loh CT, Barkley M, Yatabe M, Caminiti M, Massaro C, Bianchi J, Deleat-Besson R, Le C, Prieto JC, Al Turkestani NN, Cevidanes L. Presurgical orthodontic decompensation with clear aligners. Am J Orthod Dentofacial Orthop 2022; 162:538-553. [PMID: 36182208 PMCID: PMC9531869 DOI: 10.1016/j.ajodo.2021.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Orthodontists, surgeons, and patients have taken an interest in using clear aligners in combination with orthognathic surgery. This study aimed to evaluate the accuracy of tooth movements with clear aligners during presurgical orthodontics using novel 3-dimensional superimposition techniques. METHODS The study sample consisted of 20 patients who have completed presurgical orthodontics using Invisalign clear aligners. Initial (pretreatment) digital dental models, presurgical digital dental models, and ClinCheck prediction models were obtained. Presurgical models were superimposed onto initial ones using stable anatomic landmarks; ClinCheck models were superimposed onto presurgical models using surface best-fit superimposition. Five hundred forty-five teeth were measured for 3 angular movements (buccolingual torque, mesiodistal tip, and rotation) and 4 linear movements (buccolingual, mesiodistal, vertical, and total scalar displacement). The predicted tooth movement was compared with the achieved amount for each movement and tooth, using both percentage accuracy and numerical difference. RESULTS Average percentage accuracy (63.4% ± 11.5%) was higher than in previously reported literature. The most accurate tooth movements were buccal torque and mesial displacement compared with lingual torque and distal displacement, particularly for mandibular posterior teeth. Clinically significant inaccuracies were found for the buccal displacement of maxillary second molars, lingual displacement of all molars, intrusion of mandibular second molars, the distal tip of molars, second premolars, and mandibular first premolars, buccal torque of maxillary central and lateral incisors, and lingual torque of premolars and molars. CONCLUSIONS Superimposition techniques used in this study lay the groundwork for future studies to analyze advanced clear aligner patients. Invisalign is a treatment modality that can be considered for presurgical orthodontics-tooth movements involved in arch leveling and decompensation are highly accurate when comparing the simulated and the clinically achieved movements.
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Affiliation(s)
- Amalia Cong
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Antonio Carlos de Oliveira Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra Khong Tai
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlene Tai Loh
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Barkley
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Marco Caminiti
- Division of Oral and Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Camila Massaro
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
| | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | - Romain Deleat-Besson
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Celia Le
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | | | - Najla N Al Turkestani
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich; Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich.
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21
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Retention Strategies for Segmental Lefort I Osteotomies Using Clear Aligners. J Craniofac Surg 2022; 34:1061-1063. [PMID: 36036500 DOI: 10.1097/scs.0000000000008941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022] Open
Abstract
Clear aligner therapy is becoming a mainstay of contemporary orthodontic treatment. As such wide-spread adoption and case-selection for surgical-orthodontic treatment in patients with Clear aligner therapy is increasing. Passive aligners generally lack adequate rigidity for retention of segmental movements in the immediate postoperative period. In this report we discuss our techniques for maintaining retention in the weeks after segmental maxillary osteotomies by use of a modified clear aligner orthognathic splint, and a custom palatal horseshoe splint, including the relative indications of each method.
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22
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Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review aims to analyze the multiple factors affecting patients’ level of compliance (how much they wear removable devices/clear aligners) during orthodontic treatments and to investigate the available methods and devices to monitor the appliance wearing time and to improve it. A literature search was conducted on electronic databases (Pubmed, Scopus, and Google Scholar). The results of the present study suggest that compliance indicators may misestimate the intraoral wearing time. Compliance is affected by patient-related factors (age, personality traits, the importance of personal appearance, self-perception of malocclusion), appliance-related factors (visibility, pain/discomfort), and clinician-related factors (trust, clear and complete communication, motivation). The motivation of pre-pubertal patients is mostly external, while adolescents/young adults have intrinsic motivation for orthodontic treatment. Patients’ self-reports tend to overestimate the appliance wearing time. Even if there is a lack of evidence, teledentistry might improve patients’ awareness of being monitored, thus increasing the time for which orthodontic devices are worn. Compliance is a key factor for clear aligner treatments, but high-quality studies focusing on this aspect are missing. Further studies should focus on how to handle the lack of cooperation and how to increase compliance in order to maximize the treatment’s results.
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Marya A, Venugopal A, Karobari MI, Chaudhari PK, Heboyan A, Rokaya D. The Contemporary Management of Cleft Lip and Palate and the Role of Artificial Intelligence: A Review. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2202240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
Cleft management is an exhaustive process for the patient, the orthodontist, and the caregiver. In recent decades, a wide number of challenges have been addressed with the inclusion of various dental specialties for the detection, diagnosis, and treatment of orofacial clefts. The orthodontist plays a very pivotal role during the overall management of children with cleft lip and palate as they need to make critical decisions for when to intervene orthodontically and at what stage to set priorities for individual treatment goals.
Objectives:
The objectives of this study were to provide an in-depth review of the evolving role of various disciplines focusing on orthodontics in the management of cleft cases.
Methods:
A general search was carried out to identify the published data on cleft lip and cleft palate management on PubMed and Scopus until the 1st of June 2021 using keywords such as cleft lip, cleft palate, cleft orthodontics, naso-alveolar molding, and surgical cleft orthodontics. The related literature was then reviewed and analyzed.
Results:
With improvements in 3D modeling, CT scans of patients can be used to construct precise 3D models, and these can be utilized to demonstrate various clinical issues related to clefts. The orthodontist has a major role in the various stages and steps, follow-up, treatment care, and outcome assessment. With the advent of technological advancements and artificial intelligence, the role is only going to evolve and expand further in the management of the cleft lip and palate. Diagnostic techniques utilizing artificial intelligence to detect cleft during the prenatal period have also been tested and have been shown to have a high rate of accuracy. The evolution of distraction osteogenesis came into the limelight as a revolutionary modality for cleft treatment. Computer-assisted orthognathic surgery is a widely used modality for reshaping the osseous defects of the maxilla in patients with congenital clefts. With the development of additional modalities such as aligners, patients that need to undergo complex orthognathic surgeries can also be treated with aligners without compromising the outcomes.
Conclusion:
The cleft lip and palate can be managed by a multi-disciplinary team. Orthodontics has an important role in the overall management of a cleft affected individual as they must make critical decisions regarding orthodontic interventions as well as set priorities for each treatment goal. With the advent of technological advancements and artificial intelligence, the diagnosis and management of the cleft lip and palate have become simplified.
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Lin E, Julien K, Kesterke M, Buschang PH. Differences in finished case quality between Invisalign and traditional fixed appliances. Angle Orthod 2022; 92:173-179. [PMID: 35168256 PMCID: PMC8887409 DOI: 10.2319/032921-246.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/01/2021] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES To compare the treatment and posttreatment effects of Invisalign aligners that incorporated SmartForce features and attachments to traditional fixed appliances. MATERIALS AND METHODS This randomized controlled trial included 66 patients, 32 aligners, and 34 fixed-appliance patients. The median ages of the aligner and braces patients were 26.7 (interquartile range [IQR]: 9.8) and 25.9 (IQR: 16.6) years, respectively. Pretreatment occlusion was assessed using the ABO Discrepancy Index. Posttreatment (T1) and 6-month retention (T2) occlusions were quantified using the ABO Objective Grading System (OGS) scores. RESULTS The braces group finished treatment significantly (P < .001) earlier (0.4 years) than the aligner group. The median DI scores for the aligner and braces groups were 4.5 and 7.0, respectively, which was a statistically significant (P = .015), but clinically insignificant, difference. There were no statistically significant between-group differences for the total OGS scores or any of the individual component scores at debond (T1) or after 6 months of retention (T2). During the posttreatment period, alignment and overjet worsened significantly in the aligner group, while buccolingual inclinations and occlusal relations improved. Over the same period, alignment worsened in the braces group and buccolingual inclinations improved. There was no statistically significant between-group difference in posttreatment changes of the total OGS scores. CONCLUSIONS While patients with simple malocclusions require 4.8 months longer treatment times with aligners than traditional braces, the treatment and 6-month posttreatment occlusal outcomes are similar.
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Advanced Digital 3D Technology in the Combined Surgery-First Orthognathic and Clear Aligner Orthodontic Therapy for Dentofacial Deformity Treatment. Processes (Basel) 2021. [DOI: 10.3390/pr9091609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Orthognathic surgery and orthodontic treatment are required for patients with dentofacial deformities to obtain an ideal facial esthetic with good functioning. Recently, characterized by the surgery-first approach, an integrated orthodontic–surgical treatment has been introduced as an emerging solution to dentofacial deformity treatment. The surgery-first approach is regarded to have less treatment time and quicker enhancement of a facial profile than the conventional orthodontic–surgical treatment. Moreover, the recent advances in computing and imaging have allowed the adoption of 3-dimensional (3D) virtual planning protocols in orthognathic surgery as well as digital orthodontic treatment, which enables a paradigm shift when realizing virtual planning properly. These techniques then allow the surgeon and orthodontist to collaborate, plan, and simulate the dentofacial deformity treatment before performing the whole procedure. Along this line, in this research article, we present an integrated treatment method for the realization of an effective deformity treatment. Specifically, we implemented the integrated 3D technique by combining it with the surgery-first orthognathic approach (SFOA) as a novel treatment method for the patients. The outcomes from the combined treatments of the patients with dentofacial deformity, in practice, have demonstrated that our proposed 3D technique in orthognathics and orthodontics using clear aligner therapy (e.g., Invisalign) can enhance the satisfactory level of the patient since the start of treatment then improve their quality of life. As a result, the combined techniques realize the novel integrated treatment method using 3D technology with the use of 3D imaging and modeling as a promising development trend of dentistry, which fits into the context of Dentistry 4.0 as a key enabler to the concept of sustainable dentistry development.
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Border M, Strait R, Vega L. Clear Aligner Orthognathic Splints (CAOS) and Custom Maxillary Fixation Plates for Surgery-First or Surgery-Only Cases. J Oral Maxillofac Surg 2021; 79:e6-e11. [PMID: 34215417 DOI: 10.1016/j.joms.2021.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Michael Border
- Resident, Vanderbilt University Medical Center Oral and Maxillofacial Surgery, Nashville, TN
| | - Rachel Strait
- Resident, Vanderbilt University Medical Center Oral and Maxillofacial Surgery, Nashville, TN
| | - Luis Vega
- Associate Professor, Vanderbilt University Medical Center Oral and Maxillofacial Surgery, Nashville, TN.
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Putrino A, Barbato E, Galluccio G. Clear Aligners: Between Evolution and Efficiency-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062870. [PMID: 33799682 PMCID: PMC7998651 DOI: 10.3390/ijerph18062870] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 12/21/2022]
Abstract
In recent years, clear aligners have diversified and evolved in their primary characteristics (material, gingival margin design, attachments, divots, auxiliaries), increasing their indications and efficiency. We overviewed the brands of aligners used in Italy and reviewed the literature on the evolution of clear aligners based on their characteristics mentioned above by consulting the main scientific databases (PubMed, Scopus, Lilacs, Google Scholar, Cochrane Library). Inclusion and exclusion criteria were established. The data were collected on a purpose-made data collection form and analyzed descriptively. From the initial 580 records, 527 were excluded because they were not related to the subject of the review or because they did not meet the eligibility criteria. The remaining 31 studies were deemed comprehensive for the purpose of the review, although the “gingival margin design” feature and “auxiliaries” tool are not well represented in the more recent literature. Current knowledge on invisible aligners allows us to have a much clearer idea of the basic characteristics of aligner systems. There remains a need to deepen the use of systems other than Invisalign™ to give greater evidence to aligners that are very different based on the characteristics analyzed here and that are very widespread on the market.
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28
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Okuda BC, Tabbaa S, Edmonds M, Toubouti Y, Saltaji H. Direct to consumer orthodontics: Exploring patient demographic trends and preferences. Am J Orthod Dentofacial Orthop 2020; 159:210-216.e2. [PMID: 33342673 DOI: 10.1016/j.ajodo.2019.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/01/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate market trends on the demographics most likely to select direct to consumer orthodontics and the reasoning behind their decisions. METHODS An internet-based cross-sectional survey was conducted. Data analysis was carried out using logistic regression models. RESULTS Total of 1573 surveys were completed. While 32.2% of those surveyed selected direct to consumer orthodontics over conventional orthodontics, 10.8% would select direct to consumer orthodontics for their children. Among parents who would seek direct to consumer orthodontics, only 27.8% would consider the same treatment for their children. The odds of seeking direct to consumer orthodontic treatment for divorced participants was 2.52 times higher than that for single participants, for participants with 4 children or more was 2 times higher than that for participant with no children, and in age group 46-59 years was 2.23 times higher than that for age group 18-26 years. Seventy three percent of consumers who selected direct to consumer orthodontics selected cost as an influencing factor. Convenience was also a major determining factor at 69.6%. CONCLUSIONS Cost, convenience, and perceived simplicity all appear to factor into a consumer's consideration of direct to consumer orthodontics. As annual household income, age, and education increases consumers are more likely to consider direct to consumer orthodontic treatment.
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Affiliation(s)
- Brady C Okuda
- Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Fla
| | - Sawsan Tabbaa
- Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Fla
| | - Michelle Edmonds
- Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Fla
| | - Youssef Toubouti
- Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, Jacksonville, Fla
| | - Humam Saltaji
- Orthodontic Graduate Program, School of Dentistry, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada.
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Bimaxillary Surgery with Occlusal Plane Alterations: A New Frontier for Gender Confirmation? Plast Reconstr Surg 2020; 146:518e-519e. [PMID: 32649603 DOI: 10.1097/prs.0000000000007191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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