Color fading of the blue compliance indicator encapsulated in removable clear Invisalign Teen® aligners

Comparison of the efficiency of initial dental alignment with Invisalign® aligners changed every 7 or 14 days in mature adults: Randomized clinical trial

OBJECTIVE

To compare the anterior crowding correction after sequential use of the first 5 aligners between two aligner exchange protocols (7 and 14 days) in mature adult patients.

MATERIALS AND METHODS

Thirty-six patients over 35 years who received orthodontic treatment with Invisalign® were randomly allocated to two different aligner replacement sequence protocols: Group 1: exchange every 7 days (n = 18); and Group 2: exchange every 14 days (n = 18). All patients were scanned with iTero Element 5D® (Align Technology) in two treatment times: at pre-treatment (T1) and after using the first five aligners (T2). Little's Irregularity Index (LII) and arch widths were evaluated with OrthoCAD software. Intra and intergroup comparisons were performed with the dependent and independent t-tests. The results were considered significant for P < .05.

RESULTS

Thirty-five patients completed the study. Both groups' maxillary and mandibular Irregularity Indexesi were significantly lower at T2. There was no significant difference in inter-canine, inter-premolar, and intermolar distances. G2 (14 days) presented a greater decrease in mandibular irregularity than G1 (7 days).

CONCLUSION

Both exchange protocols (7 and 14 days) effectively correct anterior crowding in the initial phase of orthodontic treatment with aligners in mature adult patients. However, the 14-day exchange protocol provided a greater correction in mandibular anterior crowding in the evaluated period than the 7-day exchange protocol.

Treatment Efficiency of Maxillary and Mandibular Orovestibular Tooth Expansion and Compression Movements with the Invisalign® System in Adolescents and Adults

OBJECTIVES

Aligners are an effective and esthetic orthodontic treatment option for permanent and mixed dentition. There are only a few studies dealing with the effectiveness of orovestibular tooth movement using aligners and applying adequate examination methods. In the present retrospective study, the aligner efficiency of orovestibular movements for the entire dentition was systematically evaluated using 3D superimposition, taking into account the influence of jaw, tooth type and Invisalign® system.

METHODS

Group 1 (n = 18 adults, Invisalign®) and Group 2 (n = 17 adolescents, Invisalign® Teen) were treated with Invisalign® Ex30 aligner material and Invisalign® specific auxiliary means. In this non-interventional retrospective study, pre- and post-treatment maxillary and mandibular plaster cast models were scanned and superimposed with ClinChecks® via Surface-Surface Matching Algorithm on unmoved teeth providing stable references. Effectivity of planned versus clinically realized movements was evaluated for each tooth. Statistics were performed with a t-test and Bonferroni-Holm correction (α = 0.05).

RESULTS

Orovestibular movement efficiency was excellent without statistical significance regarding jaw, tooth type or Invisalign® system. Mandibular translational tooth movements were highly effective, and outstanding for premolars (91-98%). Maxillary translational tooth movements were successful for incisors and premolars, but less effective for canines and molars. Almost all teeth were moderately or very effectively corrected by crown tipping, performing better for mandibular (70-92%) than maxillary (22-31%) canines as much as for adolescent upper front teeth (81-85%) and lower canines (92%).

CONCLUSIONS

Aligners are able to effectively implement translational orovestibular movements, supported by tilting the crowns for even more efficient implementation of the movements. This phenomenon was observed in our studies for all teeth in both jaws, regardless of the Invisalign® system used. Treatment planning should nevertheless take into account the individual patient parameters with regard to the movements to be performed in order to make the aligner therapy as successful as possible in terms of realizing the desired therapeutic goal.

Wearable Orofacial Technology and Orthodontics

Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual's current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw's functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual's current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.

Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review

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.

Comparison of objective wear time between monoblock and twin-block appliances measured by microsensor

OBJECTIVES

To assess the objective compliance levels in skeletal Class II patients with mandibular retrognathia wearing monoblock and twin-block appliances.

MATERIALS AND METHODS

A prospective clinical study was conducted with 30 patients between 10 and 15 years old who were equally divided into two study groups. Group 1 was treated with monoblock, and group 2 was treated with twin-block appliances. The patients were instructed to wear their appliance for 15 hours per day. Wear times were monitored by a microsensor. (TheraMon; MCTechnology, Hargelsberg, Austria) for an average of six appointments. Patients were also instructed to record their wear times on a chart, and this record was admitted as subjective wear time. Statistical analysis was performed with the data derived from both the patients' charts and the monitoring records.

RESULTS

The mean wear time by the patients was 10.67 ± 3.93 hours, which was less than the 15 hours prescribed by the orthodontist, with no difference between the two appliances (P > .05). The regular use rate, which included the days with a wear time of 8 hours or more per day, was 75%. Compliance levels decreased by 35% throughout the six control appointments. Patients declared that their wear time was more than their objective wear time by an average of 3.76 hours.

CONCLUSIONS

Despite their different designs, there was no significant difference between the monoblock and twin-block appliances in terms of compliance.

Factors Influencing Patient Compliance during Clear Aligner Therapy: A Retrospective Cohort Study

Compliance is highly relevant during clear aligner therapy (CAT). In this retrospective cohort study, we assessed compliance and associated covariates in a large cohort of CAT patients. A comprehensive sample of 2644 patients (75.0% females, 25.0% males, age range 18–64 years, median 27 years), all receiving CAT with PlusDental (Berlin, Germany) finished in 2019, was analyzed. Covariates included demographic ones (age, gender) as well as self-reported questionnaire-obtained ones (satisfaction with ones’ smile prior treatment, the experience of previous orthodontic therapy). The primary outcome was compliance: Based on patients’ consistent use of the mobile application for self-report and aligner wear time of ≥22 h, patients were classified as fully compliant, fairly compliant, or poorly compliant. Chi-square test was used to compare compliance in different subgroups. A total of 953/2644 (36.0%) of patients showed full compliance, 1012/2644 (38.3%) fair compliance, and 679/2644 (25.7%) poor compliance. Males were significantly more compliant than females (p = 0.000014), as were patients without previous orthodontic treatment (p = 0.023). Age and self-perceived satisfaction with ones’ smile prior to treatment were not sufficiently associated with compliance (p > 0.05). Our findings could be used to guide practitioners towards limitedly compliant individuals, allowing early intervention.

The Effect of High-Frequency Vibration on Tooth Movement and Alveolar Bone in Non-Growing Skeletal Class II High Angle Orthodontic Patients: Case Series

This study presents a novel technique utilizing high-frequency vibration to shorten treatment time and preserve alveolar bone in challenging orthodontic cases that have been treated with Invisalign^® clear aligners. Four non-growing orthodontic patients (age range 14–47 years old) with Class II skeletal patterns (convex profiles with retrognathic mandibles) who sought correction of their crowded teeth and non-surgical correction of their convex profiles were included in this study. These patients were treated using Invisalign clear aligners together with high-frequency vibration (HFV) devices (120 Hz) (VPro5™) that were used by all patients for five minutes per day during active orthodontic treatment. Vertical control and forward rotation of the mandible for each patient was achieved through pre-programming the Invisalign to produce posterior teeth intrusion. Successful forward rotation of the mandibles achieved in all patients led to improvement of their facial convex profiles (apical base relationship (ANB) improved 2.1 ± 0.5 degrees; FMA (Frankfurt mandibular plane angle) improved 1.2 + 1.1 degrees). Dental decompensation was achieved by lingual tipping of the lower incisors and palatal root torque of upper incisors. The use of HFV together with Invisalign facilitated achieving these results within a 12 ± 6 months period. In addition, more bone labial to the lower incisors after their lingual movement was noted. In conclusion, the use of HFV concurrent with SmartTrack Invisalign aligners allowed complex tooth movement and forward mandibular projection without surgery in non-growing patients with skeletal Class II relationships. The clinical impact and implications of this case series are: (1) the use of HFV facilitates complex orthodontic tooth movement including posterior teeth intrusion and incisor decompensation; (2) forward mandibular projection of the mandible and increased bone formation labial to lower incisors can be achieved in non-growing patients that may minimize the need for surgical intervention in similar cases or gum recession due to lower incisors labial inclination.

Comparison of the Stress Strain Capacity between Different Clear Aligners

Background:

The rife use of aesthetic appliance in orthodontic treatment requires the study of the properties of the materials they are made of.

Objective:

The aim of the present study was to evaluate the dimensional stability of clear aligners made of three different materials after the application of in-vivo dynamic stress and in-vitro static stress.

Methods:

Three different aligners made of different materials (PET-G; PET; SmartTrack®), prepared on the dental arch of the same patient, were tested. For each material, three aligner samples were manufactured: one to be used in-vivo, one to be tested in-vitro, and one to be used as a control.

To evaluate the effects of the dynamic stress produced in-vivo, each aligner was worn by a single patient 22 hours per day, followed by a wash-out period of two weeks. To evaluate the effects of static stress, each aligner was exposed to the in-vitro continuous force of 50N. The tested and control aligners were scanned, then linear measurements were taken to evaluate their dimensional stability after different types of stresses.

Results:

PET seems to have the lowest percentage of deformation; PET-G and SmartTrack® showed a reduced deformation going from the posterior to the anterior area. The contact with human saliva induces a greater deformation.

Conclusion:

Different materials show different behavior following application of static stresses and dynamic stresses in the oral cavity. PET showed the highest dimensional stability.

Effect of supplemental vibration on orthodontic treatment with aligners: A randomized trial

INTRODUCTION

Supplemental vibration has been reported to accelerate orthodontic tooth movement and reduce discomfort. Our purpose was to investigate the effects of AcceleDent on Invisalign treatment. This randomized clinical trial was carried out in 2 orthodontic private practices with a 1:1 allocation ratio.

METHODS

Adult patients who were beginning their orthodontic treatment were randomly allocated to either an active (A) or a sham (B) AcceleDent Aura device (OrthoAccel Technologies, Inc. Houston, TX). All patients were placed on a 1-week aligner change regimen, and fit was evaluated every 3 weeks. The outcomes were the ability to complete the initial set of aligners and the incisor irregularity measurements for those who completed their regimen of aligners. In addition, aligner compliance, pain levels, and oral health-related quality of life data were gathered from questionnaires. The subjects, investigators, and assessors were all blinded to the treatment arms.

RESULTS

Twenty-seven subjects were randomized into 2 groups (A and B), 1 subject discontinued treatment, and 13 subjects were analyzed in each group. The Fisher exact test showed no significant difference in completion rates between the 2 groups (group A, 77%; group B, 85%; P = 1). Independent-sample t tests showed no significant difference between the final irregularity index or change in irregularity index between the 2 groups. Compliance was similar in both groups. The Wilcoxon rank sum test showed minimal differences in pain levels. Quality of life responses were similar in both groups. No serious harm was observed.

CONCLUSIONS

We found no evidence that the AcceleDent Aura device impacts the ability to complete a series of aligners with a 1-week change regimen or the final alignment achieved in adult patients. It also had no significant effect on the reduction of orthodontic pain or oral health-related quality of life parameters when used with Invisalign.

Maxillary molar distalization with aligners in adult patients: a multicenter retrospective study

Background

The aim of the present study was to test the hypothesis that bodily maxillary molar distalization was not achievable in aligner orthodontics.

Methods

Forty lateral cephalograms obtained from 20 non-growing subjects (9 male, 11 female; average age 29.73 years) (group S), who underwent bilateral distalization of their maxillary dentition with Invisalign aligners (Align Technology, Inc., San José, CA, USA), were considered for the study. Skeletal class I or class II malocclusion and a bilateral end-to-end class II molar relationship were the main inclusion criteria. Cephalograms were taken at two time points: (T0) pretreatment and (T2) post-treatment. Treatment changes were evaluated between the time points using 39 variables by means of paired t test. The level of significance was set at P < 0.05.

Reproducibility of measurements was assessed by the intraclass correlation coefficient (ICC).

Results

The mean treatment time was 24.3 ± 4.2 months. At the post-treatment point, the first molar moved distally 2.25 mm without significant tipping (P = 0.27) and vertical movements (P = 0.43). The second molar distalization was 2.52 mm without significant tipping (P = 0.056) and vertical movements (P = 0.25). No significant movements were detected on the lower arch. SN^GoGn and SPP^GoGn angles showed no significant differences between pre- and post-treatment cephalograms (P = 0.22 and P = 0.85, respectively).

Conclusions

Aligner therapy in association with composite attachments and class II elastics can distalize maxillary first molars by 2.25 mm without significant tipping and vertical movements of the crown. No changes to the facial height were revealed.

Finite element method analysis of the periodontal ligament in mandibular canine movement with transparent tooth correction treatment

Background

This study used the 3D finite element method to investigate canine’s displacements and stresses in the canine’s periodontal ligament (PDL) during canine’s translation, inclination, and rotation with transparent tooth correction treatment.

Methods

Finite element models were developed to simulate dynamic orthodontic treatments of the translation, inclination, and rotation of the left mandibular canine with transparent tooth correction system. Piecewise static simulations were performed to replicate the dynamic process of orthodontic treatments. The distribution and change trends of canine’s displacements and stresses in the canine’s PDL during the three types of tooth movements were obtained.

Results

Maximum displacements were observed at the crown and middle part in the translation case, at the crown in the inclination case, and at the crown and root part in the rotation case. The relative maximum von Mises and principal stresses were mainly found at the cervix of the PDL in the translation and inclination cases. In the translation case, tensile stress was mainly observed on the mesial and distal surfaces near the lingual side and compressive stress was located at the bottom of the labial surface. In the inclination case, tensile stress was mainly observed at the labial cervix and lingual apex and compressive stress was located at the lingual cervix and labial apex. In the rotation case, von Mises stress was mainly located at the cervix and inside the lingual surface, tensile stress was located on the distal surface, and compressive stress was detected on the mesial surface. The stress and displacement value rapidly decreased in the first few steps and then reached a plateau.

Conclusions

Canine’s movement type significantly influences the distribution of canine’s displacement and stresses in the canine’s PDL. Changes in canine’s displacement and stresses in the canine’s PDL were exponential in transparent tooth correction treatment.

INFLUENCE OF FRICTION IN TRANSPARENT TOOTH CORRECTION TREATMENT: FINITE ELEMENT METHOD

Objective: The objective was to evaluate the effect of frictional forces on the canine's translation and rotation in transparent tooth correction treatment. Materials and Methods: Based on computed tomography (CT) images of the teeth and their supporting tissues, solid models were used to build finite-element models. One canine was simulated translation and rotation in the buccolingual direction by aligners with different friction coefficients. Results: The change of the canine's rotation centers and periodontal ligament (PDL) stress with an increase of the friction coefficient in the two movement types were obtained. Conclusions: Friction coefficient has little effect on the canine's translation movement. While in rotation cases, the small friction coefficient seems to be helpful to gain the body movement type.

Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients

OBJECTIVE

To evaluate the influence of an app-based approach in a protocol for domestic oral hygiene maintenance in a group of adolescent patients wearing fixed multibracket appliances.

MATERIALS AND METHODS

Eighty adolescent patients scheduled to start an orthodontic multibracket treatment were randomly divided into two groups of 40. Plaque index (PI), gingival index (GI), white spots (WS), and caries presence were recorded in all patients, and they were instructed regarding domestic oral hygiene maintenance on the day of braces application (t0) and every 3 months (t1, t2, t3, t4) during the first year of treatment. Study group (SG) patients were enrolled in a WhatsApp chat room-based competition and instructed to share monthly with the other participants two self-photographs (selfies) showing their oral hygiene status.

RESULTS

SG patient participation in the chat room was regular and active throughout the observation period. At t2, t3, and t4, SG patients had significantly lower values of both PI and GI and a lower incidence of new WS and caries, compared with the control group.

CONCLUSION

Integration of new "social" technologies in a standard oral hygiene motivation protocol is effective in improving compliance of adolescent patients and in improving their oral health status during orthodontic multibracket treatment.

Patient compliance with Hawley retainers fitted with the SMART(®) sensor: a prospective clinical pilot study

OBJECTIVE

To evaluate the compliance of patients while wearing maxillary Hawley retainers embedded with SMART microsensors.

METHODS

The sample population consisted of 22 patients who were divided into an experimental (group A) and a control group (group B). Group A was informed that they would be monitored through the use of SMART microsensors, while group B was not informed that they would be monitored. After the delivery of the retainers (T0), the patients were evaluated at T1 and T2, represented by 6- and 12-week follow-up visits, respectively. At T1, group B was informed of our ability to monitor their compliance. Both groups continued wearing their retainers during T1 to T2.

RESULTS

During T0-T1, Group A wore their retainers for an average of 16.3 hours (SD 4.39), while group B wore their appliances for an average of 10.6 hours (SD 5.36, t  =  2.426, P  =  .027). Although group B increased their retainer wear by 0.5 hours/day from T1 to T2, this increase was not statistically significant.

CONCLUSIONS

Despite significant differences being noted between the two groups at T1, group B did not show significant mean changes in their wear time before and after becoming aware of the use of the SMART microsensor.