Influence on interradicular bone volume of Invisalign treatment for adult crowding with interproximal enamel reduction: a retrospective three-dimensional cone-beam computed tomography study

Effectiveness of dental arch expansion in the orthodontic treatment with clear aligners: a scoping review

BACKGROUND

The clinical protocol and effectiveness of dental expansion with Clear Aligner Therapy (CAT), especially among adults is still unclear. There is a need to map and explore knowledge gaps of dental expansion with CAT among children and adults.

OBJECTIVE

This scoping review explores the extent and depth of the available literature regarding the effectiveness and predictability of CAT in performing orthodontic expansion in both children and adults.

METHODS

The following databases were consulted as sources of information: PubMed, MEDLINE, Embase, Web of Science, Scopus, LILACS, COCHRANE Library, and ProQuest Dissertations & Thesis, in which the search was limited to studies on children or adults requiring transverse arch expansion and using clear orthodontic aligners. Two independent reviewers assessed the citations and extracted data, which was then synthesized in a narrative format.

RESULTS

Over all, 698 citations were retrieved, and 33 were included. Among these, 3 were systematic reviews, 4 were cohort studies, 2 were case-control studies, and 24 were case series. Eighty-five percent of the included studies were published in the last 5 years. Despite different protocols and measurement methods, aligners were effective for arch expansion in adults and children, and the expansion predictability was greater for the lower arch than for the upper arch. The evidence suggests that arch width increment is more predictable in the premolar region and less predictable in the canine and second molar areas, with high variability across studies.

CONCLUSIONS

Orthodontic aligners have demonstrated effectiveness in expanding arches in both adults and children. However, the literature suggests a decrease in arch width toward the posterior region, and there is no evidence of skeletal gains. To provide more conclusive evidence, randomized controlled clinical studies are warranted.

REGISTRATION

This review was registered in the Open Science Framework database (DOI: https://doi.org/10.17605/OSF.IO/6EG8F).

Effect of interproximal enamel reduction on interradicular bone volume in clear aligner therapy: a three-dimensional cone-beam computed tomography study

OBJECTIVES

To assess the effect of inter-proximal enamel reduction (IPR) on interradicular bone volume and incisal inclination in patients undergoing clear aligner therapy (CAT).

MATERIALS AND METHODS

The study sample consisted of 60 cases which underwent orthodontic CAT, in a private clinic in Dammam, KSA. A total of 120 CBCT scans (60 pre-treatment and 60 post- treatment) were measured using the CS 3D Imaging software to examine bone volume (using height, width, and depth of the interproximal area) and incisal inclination. The corresponding ClinCheck models were collected to determine the amount and locations of interproximal reduction performed. Little's Irregularity Index values were measured using OrthoCAD software. Paired sample t-test was used to address the measurements of bone height, width, depth, bone volume, and inclination of upper and lower incisors before and after IPR.

RESULTS

IPR did not affect the upper or lower bone volume except at LR3-2 and UL 2 - 1 where a significant difference between the bone volume with and without IPR was detected (p = 0.02 and p = 0.04 respectively). Upper and lower incisor inclination showed a statistically significant decrease after IPR. There was no correlation between IPR and bone volume difference between upper and lower teeth except at LR3-2 and UL 2 - 1.

CONCLUSIONS

IPR had no significant effect on inter-radicular bone volume except at areas of lower right canine-lateral and at areas of upper left central-lateral. There was a positive correlation between the amount of IPR and incisal inclination.

CLINICAL RELEVANCE

The current study findings suggest that while IPR has a minimal and localized effect on bone volume in certain areas, it plays a role in adjusting incisal inclination, highlighting its significance in the careful planning of orthodontic treatment using clear aligners.

Evaluation of the Consistency of Two Interproximal Reduction Methods in Clear Aligner Therapy: A Preliminary Study

Objective

To compare the consistency of two interproximal reduction (IPR) methods in terms of the amount of planned and performed IPR during clear aligner therapy (CAT).

Methods

Thirty-four patients who received IPR using hand-operated abrasive strips (Group 1, 20 patients, 162 teeth) and motor-driven 3/4 oscillating segmental disks (Group 2, 14 patients, 134 teeth) during CAT were included in this preliminary study. The consistency between the planned and performed IPR amounts was evaluated within and between groups for teeth and quadrants.

Results

In Group 1, the amount of IPR performed on teeth numbers 22 and 43 and in the upper left quadrant was found to be statistically less than that of planned. On the other hand, the amount of performed IPR was statistically higher on tooth number 44 and in the upper right quadrant, whereas it was statistically less on tooth number 33 when compared with the planned amount in Group 2. The inconsistency between the planned and performed IPR amounts were statistically significant only in Group 1 and for teeth numbers 11, 21, 32, 33, and 43. No significant difference was found when the same parameter was compared between the groups.

Conclusion

The consistency of IPR was found to be better with the motor-driven oscillating disk system than with the hand-operated IPR strip system.

The Role of Interproximal Reduction (IPR) in Clear Aligner Therapy: A Critical Analysis of Indications, Techniques, and Outcomes

Interproximal reduction (IPR) has become a standard practice in orthodontic treatment, particularly in the clear aligner therapy. It became an integral part of the digital plan when using clear aligners. Given the irreversible nature of IPR, precise planning and performance is essential. This article aims to analyze and summarize the existing literature on IPR in the context of clear aligners. The goal is to help clinicians to gain essential knowledge for safely and effectively navigating IPR. The review critically examines different perspectives found in the literature, covering indications, methods, and outcomes. Topics exploring the impact of IPR on treatment outcomes include space gaining, addressing tooth size discrepancies, tooth shape adjustments, resolving malocclusion, and enhancing aesthetics. Emphasizing precision of the procedure by the clinician and awareness of contraindications, the article also discusses the impact of IPR on patients. This includes considerations like increased pulp temperature, susceptibility to cavities due to changes in enamel roughness, effects on soft tissues, and post-IPR tooth sensitivity.

Comparison of the accuracy of three interproximal reduction methods used in clear aligner treatment

OBJECTIVES

To comparatively assess 3 interproximal reduction (IPR) methods used in clear aligner treatment with regard to accuracy, and patient perception of discomfort and anxiety.

MATERIALS AND METHODS

A total of 42 patients, treated with the Invisalign® system, were included in this prospective trial and received one of the following IPR methods: hand-operated abrasive strips (group 1; 14 patients, 150 teeth), motor-driven 3/4 oscillating segmental discs (group 2; 14 patients, 134 teeth), or motor-driven abrasive strips (group 3; 14 patients, 133 teeth). Accuracy was evaluated using the difference between planned and executed IPR. Anxiety and discomfort levels experienced by the patients were evaluated using a questionnaire of 17 questions.

RESULTS

The accuracy of IPR was high in groups 2 and 3; however, it was low in group 1 with the executed IPR significantly less than the planned amount. On quadrant-level, executed IPR was significantly less in the upper left quadrant in group 1, and significantly more in the upper right quadrant in group 2. The difference between planned IPR and executed IPR was significant for teeth 11, 21, 32, 33, and 43 in group 1, indicating deficiency. The average difference between planned IPR and executed IPR was 0.08 mm for group 1, 0.09 mm for group 2, and 0.1 mm for group 3. Anxiety and discomfort levels did not differ between the methods, but a negative correlation was observed between age and discomfort and anxiety levels.

CONCLUSIONS

The overall accuracy of the 2 motor-driven IPR methods was found to be better than the hand-operated system. Maxillary central incisors and mandibular canines were more prone to IPR deficiency when hand-operated abrasive strips were utilized. Patients were similarly comfortable with all 3 methods, and discomfort and anxiety levels decreased with age.

CLINICAL RELEVANCE

Motor-driven methods have proven to be more effective when compared to the hand-operated ones by means of precision, speed, and patient comfort. If the clinician favors a hand-operated method, it may be advised to perform slightly more IPR especially on mandibular canines and maxillary central incisors.

Evaluation of interproximal reduction in individual teeth, and full arch assessment in clear aligner therapy: digital planning versus 3D model analysis after reduction

Aim

To evaluate the correspondence between the interproximal reduction (IPR) performed clinically and that programmed in ClinCheck® and further assess which teeth showed an amount of implemented IPR (I-IPR) that corresponds with that programmed in ClinCheck®.

Materials and methods

Pre- (T0) and post-treatment (T1) ClinCheck® digital models for 75 subjects (30 males and 45 females), mean age (38 ± 15) years, were included. To calculate the amount of I-IPR, Ortho Analyzer software (3Shape, Copenhagen, Denmark) was used to measure the mesiodistal widths for the maxillary and mandibular teeth from second premolar to the contralateral second premolar on the initial (T0) and final (T1) STL models. I- IPR performed by tooth was obtained by comparing the mesiodistal width of each tooth at T0 and T1. The amount of programmed IPR (P-IPR) in ClinCheck® was compared to that implemented clinically using the following formula: IPR difference = (P-IPR) − (I-IPR).

Results

Statistically significant differences were observed between the average value of digitally programmed and implemented IPR per tooth for both the maxillary (p < .0001) and mandibular (p < .0001) teeth. The mean P-IPR for the maxillary teeth was 0.28 ± 0.16 mm versus the mean I-IPR of 0.15 ± 0.15 mm. In the mandibular arch, the mean P-IPR was 0.31 ± 0.17 mm, while the I-IPR was 0.17 ± 0.16 mm. The mean I-IPR was consistently lower than the mean P-IPR regardless of teeth and sites (p < 0.0001). The difference between the P-IPR compared to the I-IPR was larger for mandibular anterior teeth than for maxillary anterior teeth (p = 0.0302) and larger for maxillary posterior teeth than mandibular posterior teeth (p = 0.0059).

Conclusion

The amount of implemented-IPR in clear aligner therapy is less than that digitally programmed for most teeth. Regardless of the regions, I-IPR was consistently lower than that programmed. Mandibular anterior teeth and maxillary posterior teeth showed greater discrepancy between P-IPR and I-IPR than the maxillary anterior and mandibular posteriors. Further prospective studies are needed to determine the factors affecting the precision of IPR and the clinical implications of a significantly reduced I-IPR on treatment outcomes.

Enamel interproximal reduction during treatment with clear aligners: digital planning versus OrthoCAD analysis

BACKGROUND

The aim of the study was to compare the amount of interproximal enamel reduction (IPR) provided on ClinCheck software with the amount of IPR carried out by the orthodontist during treatment with clear aligners.

METHODS

30 subjects (14 males, 16 females; mean age of 24.53 ± 13.41 years) randomly recruited from the Invisalign account of the Department of Orthodontics at the University of Rome "Tor Vergata" from November 2018 to October 2019, were collected according to the following inclusion criteria: mild to moderate dento-alveolar discrepancy (1.5-6.5 mm); Class I canine and molar relationship; full permanent dentition (excluding third molars); both arches treated only using Comprehensive Package by Invisalign system; treatment plan including IPR. Pre- (T0) and post-treatment (T1) digital models (.stl files), created from an iTero scan, were collected from all selected patients. The OrthoCAD digital software was used to measure tooth mesiodistal width in upper and lower arches before (T0) and at the end of treatment (T1) before any refinement. The widest mesio-distal diameter was measured for each tooth excluding molars by "Diagnostic" OrthoCAD tool. The total amount of IPR performed during treatment was obtained comparing the sum of mesio-distal widths of all measured teeth at T0 and T1. Significant T1-T0 differences were tested with dependent sample t-test (P < 0.05).

RESULTS

In the upper arch, IPR was digitally planned on average for 0.62 mm while in the lower arch was on average for 1.92 mm. As for the amount of enamel actually removed after IPR performing, it was on average 0.62 mm in the maxillary arch. In the mandibular arch, the mean of IPR carried out was 1.93 mm. The difference between planned IPR and performed IPR is described: this difference was on average 0.00 mm in the upper arch and 0.01 in the lower arch.

CONCLUSIONS

The amount of enamel removed in vivo corresponded with the amount of IPR planned by the Orthodontist using ClinCheck software.

Quantitative evaluation of implemented interproximal enamel reduction during aligner therapy

OBJECTIVES

To investigate the correspondence between programmed interproximal reduction (p-IPR) and implemented interproximal reduction (i-IPR) in an everyday-practice scenario. The secondary objective was to estimate factors that might influence i-IPR to make the process more efficient.

MATERIALS AND METHODS

Fifty patients treated with aligner therapy by six orthodontists were included in this prospective observational study. Impressions were taken at the beginning of treatment and after the first set of aligners. Data on p-IPR, i-IPR and technical aspects of IPR were gathered for 464 teeth. Statistical analyses included the Wilcoxon signed-rank test, Kruskal-Wallis, and multilevel mixed regression.

RESULTS

Mean difference between p-IPR and i-IPR was 0.15 mm (SD: 0.14 mm; P = .0001), with lower canines showing the highest discrepancy. Use of burs and measuring gauges resulted in a smaller difference (respectively: coeff.: 0.09, P = .029; coeff.: -0.06, P = .013). IPR was performed more accurately on the mesial surface of teeth than on the distal surface. Round tripping before IPR resulted in a slightly more precise i-IPR compared to the previous alignment (coeff.: -0.021, P = .041).

CONCLUSIONS

Implemented IPR tends to be less than p-IPR, especially for lower canines and distal surfaces of teeth. Burs tend to provide more precise i-IPR, especially compared to manual strips; however, there is variation between the techniques. Using a measuring gauge tends to increase the precision of i-iPR. As several factors influence the implementation of IPR, particular attention must be paid during the procedure to maximize its precision.

Accuracy of interproximal enamel reduction during clear aligner treatment

Aim

The aim of the present study was to compare the accuracy of the actual space obtained through interproximal enamel reduction (IPR) compared to the amount of IPR planned through the digital setup during clear aligner treatment (CAT).

Materials and methods

A total of 10 clinicians were randomly recruited using the Doctor Locator by Align Technology (California). For each clinician, four consecutive patients treated with CAT and manual stripping were selected for a total of 40 subjects and 80 dental arches. For each patient, the amount of planned IPR and the amount of actual IPR performed were recorded. Each arch was considered individually. For each arch, the mesio-distal tooth measurements were obtained from second to second premolars.

Results

No systematic measurement errors were identified. In 25 cases, stripping was planned and performed in both arches; in 4 cases only in the upper arch and in the remaining 7 cases only in the lower arch. The difference between planned IPR and performed IPR was on average 0.55 mm (SD, 0.67; P = 0.022) in the upper arch and 0.82 mm (SD, 0.84; P = 0.026) in the lower arch. The accuracy of IPR in the upper arch was estimated to be 44.95% for the upper arch and 37.02% for the lower arch.

Conclusion

Overall, this study showed that the amount of enamel removed in vivo did not correspond with the amount of IPR planned. In most cases, the performed IPR amount was lower than planned. When considering the actual amount in millimeter, these differences may not be considered clinically relevant.