1
|
Wolf D, Farrag G, Flügge T, Timm LH. Predicting Outcome in Clear Aligner Treatment: A Machine Learning Analysis. J Clin Med 2024; 13:3672. [PMID: 38999238 DOI: 10.3390/jcm13133672] [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: 05/17/2024] [Revised: 06/11/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Machine learning (ML) models predicting the risk of refinement (i.e., a subsequent course of treatment being necessary) in clear aligner therapy (CAT) were developed and evaluated. Methods: An anonymized sample of 9942 CAT patients (70.6% females, 29.4% males, age range 18-64 years, median 30.5 years), as provided by DrSmile, a large European CAT provider based in Berlin, Germany, was used. Three different ML methods were employed: (1) logistic regression with L1 regularization, (2) extreme gradient boosting (XGBoost), and (3) support vector classification with a radial basis function kernel. In total, 74 factors were selected as predictors for these methods and are consistent with clinical reasoning. Results: On a held-out test set with a true-positive rate of 0.58, the logistic regression model has an area under the ROC curve (AUC) of 0.67, an average precision (AP) of 0.73, and Brier loss of 0.22; the XGBoost model has an AUC of 0.67, an AP of 0.74, and Brier loss of 0.22; and the support vector model has a recall of 0.61 and a precision of 0.64. The logistic regression and XGBoost models identify predictors influencing refinement risk, including patient compliance, interproximal enamel reduction (IPR) and certain planned tooth movements, for example, lingual translation of maxillary incisors being associated with the lowest risk of refinement and rotation of mandibular incisors with the highest risk. Conclusions: These findings suggest moderate, well-calibrated predictive accuracy with both regularized logistic regression and XGBoost and underscore the influence the identified factors have on the risk of refinement in CAT, emphasizing their importance in the careful planning of orthodontic treatment and the potential for shorter treatment times, less patient discomfort, and fewer clinic visits. Identification of at-risk individuals could support tailored clinical decision-making and enable targeted interventions.
Collapse
Affiliation(s)
- Daniel Wolf
- Independent Researcher, Berlin 13089, Germany
| | - Gasser Farrag
- Straumann Group-etkon GmbH, Lochhamer Schlag 6, 82166 Gräfelfing, Germany
| | - Tabea Flügge
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lan Huong Timm
- DrSmile-DZK Deutsche Zahnklinik GmbH, Königsallee 92a, 40212 Düsseldorf, Germany
| |
Collapse
|
2
|
Medeiros RB, Santos RF, Mendes-Miguel JA, Rothier EKC, Mendes FM, Dominguez GC. Accuracy of arch expansion with two thermoplastic materials in Invisalign® patients: EX30® and SmartTrack®. Dental Press J Orthod 2024; 29:e2423212. [PMID: 38865514 PMCID: PMC11163956 DOI: 10.1590/2177-6709.29.2.e2423212.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/25/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE The purpose of this retrospective study was to compare accuracy of arch expansion using two different thermoplastic materials in Invisalign aligners: EX30® (Polyethylene Terephthalate Glycol, or PETG) and SmartTrack® (polyurethane). METHODS The study sample comprised 65 adult patients consecutively treated with Invisalign from two private practices: group 1 - treated with EX30® (358 teeth) and group 2 - treated with SmartTrack® (888 teeth). Six hundred and twenty-three measurements were assessed in three digital models throughout treatment: model 1 - initial, model 2 - predicted tooth position, and model 3 - achieved position. Sixteen reference points per arch were marked and, after best alignment, 2 points per tooth were copied from one digital model to another. Linear values of both arches were measured for canines, premolars, and first molars: on lingual gingival margins and cusp tips of every tooth. Comparisons were performed by Wilcoxon and Mann-Whitney test. RESULTS Both termoplastic materials presented significant differences between predicted and achieved values for all measurements, except for the lower molar cusp tip in the SmartTrack® group. There is no statistical difference in the accuracy of transverse expansion between these two materials. Overall accuracy for EX30® aligners in maxilla and mandible were found to be 37 and 38%, respectively; and Smarttrack® presented an overall accuracy of 56.62% in the maxilla and 68.72% in the mandible. CONCLUSIONS It is not possible to affirm one material expands better than the other. Further controlled clinical studies should be conducted comparing SmartTrack® and EX30® under similar conditions.
Collapse
Affiliation(s)
- Raquel Bueno Medeiros
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Ortodontia (São Paulo/SP, Brazil)
| | - Renata Faria Santos
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Ortodontia (São Paulo/SP, Brazil)
| | - Jose Augusto Mendes-Miguel
- Universidade Estadual do Rio de Janeiro, Faculdade de Odontologia, Departamento de Ortodontia (Rio de Janeiro/RJ, Brazil)
| | | | - Fausto Medeiros Mendes
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Odontopediatria (São Paulo/SP, Brazil)
| | - Gladys Cristina Dominguez
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Ortodontia (São Paulo/SP, Brazil)
| |
Collapse
|
3
|
Medeiros RB, Santos RF, Mendes-Miguel JA, Rothier EKC, Mendes FM, Dominguez GC. Accuracy of Invisalign® aligners in adult patients: a retrospective study of angular tooth movements. Dental Press J Orthod 2024; 29:e2423237. [PMID: 38775600 PMCID: PMC11104947 DOI: 10.1590/2177-6709.29.2.e2423237.oar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/22/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This retrospective study aimed to assess the predictability of Invisalign® aligners regarding rotational, mesio-distal and buccal-lingual tip movements. METHODS Two materials were included in the analysis - EX30, used until 2013; and SmartTrack, in current use. The study comprised 56 adult patients treated with Invisalign Comprehensive. Data sample were assessed on three sets of digital models; model 1 - initial, model 2 - predicted, and model 3 - achieved. Sixty reference points were marked in each dental arch, and two reference planes assisted the superimposition. The degree of rotation, mesio-distal and buccal-lingual tip was obtained via trigonometric calculations, through a previously published validated method. The accuracy of outcomes was compared according to the types of tooth movement and teeth groups,and the influence of predetermined variables on movement accuracy was also investigated. RESULTS Rotation and mesio-distal tip did not present any significant difference when comparing EX30 and SmartTrack groups. Only buccal-lingual tip presented a significant difference, incisor and canine groups treated with EX30 aligners presented an increase in accuracy (p= 0.007 and p = 0.007, respectively). For each additional degree planned for rotation movements, there was an increase of 0.35° in the discrepancy, and an increase of 0.40° and 0.41° for mesio-distal and buccal-lingual tip, respectively. EX30 and SmartTrack discrepancies were compared by multilevel linear regression. CONCLUSION EX30 aligners reached higher accuracy for buccal-lingual tip in anterior teeth. However, for rotation and mesio-distal tip, SmartTrack and EX30 are similarly accurate. The total amount of planned movement has a significant impact on accuracy rates, with a decrease in accuracy for every additional degree.
Collapse
Affiliation(s)
- Raquel Bueno Medeiros
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Ortodontia (São Paulo/SP, Brazil)
| | - Renata Faria Santos
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Ortodontia (São Paulo/SP, Brazil)
| | - Jose Augusto Mendes-Miguel
- Universidade Estadual do Rio de Janeiro, Faculdade de Odontologia, Departamento de Ortodontia (Rio de Janeiro/RJ Brazil)
| | | | - Fausto Medeiros Mendes
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Odontopediatria (São Paulo/SP, Brazil)
| | - Gladys Cristina Dominguez
- Universidade de São Paulo, Faculdade de Odontologia, Departamento de Ortodontia (São Paulo/SP, Brazil)
| |
Collapse
|
4
|
Abdelemam AA, Abdelrahman HH, Hassan MG. #clearaligners and social media: An in-depth analysis of clear aligners' content on Instagram. Orthod Craniofac Res 2024; 27:259-266. [PMID: 37854022 DOI: 10.1111/ocr.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Clear aligners-related posts are popularized on social media platforms to educate patients and peers and to market aligners in dental practices. This study aimed to characterize the account credentials and content of the top-performing posts to understand the spread of clear aligners-related information on Instagram. MATERIALS AND METHODS This cross-sectional web-based study analysed 13 Instagram clear aligners-related hashtags. Content analysis was performed for the "Top 10 posts" listed under the "Top" section for each hashtag within Instagram, as sorted by Instagram's algorithm. Data were analysed for the poster's background, credentials, role, post format, content, and engagement level ratio. Duplicate posts and those not relevant to clear aligners were excluded. Quantitative and qualitative analyses of the collected data were conducted. RESULTS A total of 29 192 596 posts mentioned the selected hashtags, of which 130 posts were screened in this study. Most posts were authored by dentists (n = 84), 79.8% of them were orthodontic specialists. Self-promotional posts comprised 90.2%, while educational posts accounted for only 8.9%. Interestingly, the number of likes and comments received on posts by patients (n = 19, median = 112, IQR = 340) was significantly higher than those posted by dentists (n = 84, median = 93, IQR = 81.75) (P = .004). CONCLUSION More than 29 million posts about clear aligners were identified on Instagram. Orthodontists are the leading authors of aligners hashtags. However, the majority of the posts are self-promotional and have nonfactual information. Social media awareness among orthodontic specialists may help provide more evidence-based content about clear aligners and can act as an interactive networking and health communication platform.
Collapse
Affiliation(s)
- Ahmed A Abdelemam
- Department of Orthodontics, Faculty of Dentistry, Assiut University, Assiut, Egypt
| | - Hams H Abdelrahman
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed G Hassan
- Department of Orthodontics, Faculty of Dentistry, Assiut University, Assiut, Egypt
- Division of Bone and Mineral Diseases, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
5
|
Çokakoğlu S, Nalçacı R, Altıntaş SH, Atıcı F. Can a Self-etching Primer be Effective in Bonding Aligner Attachments to Different Types of Ceramics? Turk J Orthod 2024; 37:30-35. [PMID: 38556950 PMCID: PMC10986456 DOI: 10.4274/turkjorthod.2023.2022.173] [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: 11/29/2022] [Accepted: 03/19/2023] [Indexed: 04/02/2024]
Abstract
Objective This in vitro study aimed to evaluate the effectiveness of pretreatment with a self-etching primer for bonding aligner attachments to lithium disilicate (LD) and monolithic zirconia (MZ) ceramics. Methods Forty ceramics, including LD (n=20) and MZ (n=20), were divided into four study groups according to the surface pretreatments: LD specimens pretreated with universal primer (Monobond Plus, MP) after hydrofluoric acid etching (Group 1); MZ ceramics pretreated with MP after sandblasting (Group 2); LD ceramics pretreated with self-etching ceramic primer (Monobond etch & prime, MEP) (Group 3); and MZ ceramics pretreated with MEP after sandblasting (Group 4). The aligner composite (GC Aligner Connect) and universal adhesive (GPremio Bond) were used to prepare the resin attachments. The bond strength was evaluated by micro-shear bond strength (SBS) testing (0.1 mm/min) after thermocycling, and the remnant adhesive was scored according to the resin attachment remnant index (RARI). The SBS data were analyzed using ANOVA and Tukey tests, and the RARI scores were analyzed using the chi-square test. Results Group 1 had the lowest SBS, and group 2 had the highest SBS. There were significant differences between the groups in terms of bond strength (p<0.05). The RARI scores showed no significant differences, regardless of the pretreatment and ceramic type. Conclusion The use of a self-etching primer increased the bond strength of resin attachments on LD ceramics. For zirconia ceramics, both ceramic primers are recommended for aligner attachment bonding.
Collapse
Affiliation(s)
- Serpil Çokakoğlu
- Pamukkale University Faculty of Dentistry, Department of Orthodontics, Denizli, Turkey
| | - Ruhi Nalçacı
- Üsküdar University Faculty of Dentistry, Department of Orthodontics, İstanbul, Turkey
| | - Subutay Han Altıntaş
- İstinye University Faculty of Dentistry, Department of Prosthodontics, İstanbul, Turkey
| | - Fatih Atıcı
- Private Practice, Medicaldent Oral and Dental Health Polyclinic, İzmir, Turkey
| |
Collapse
|
6
|
Martina H, Stefano Adriana AD, Ernesto B, Alessandra I, Roberto AV, Gabriella G. Lower molar distalization using clear aligners: Is it effective? A systematic review. J Orthod Sci 2024; 13:11. [PMID: 38516119 PMCID: PMC10953721 DOI: 10.4103/jos.jos_174_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/09/2024] [Accepted: 01/24/2024] [Indexed: 03/23/2024] Open
Abstract
Distalization is one of the most useful movements in orthodontic treatments. The aim of this systematic review is to analyze the effectiveness of lower molar distalization using clear aligner therapy (CAT). An electronic search was made from January 2012 to October 2022 using PubMed, Scopus, and LILACS databases without language limitations. This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist. The search strategy resulted in 151 studies. A screening was performed to remove duplicates, and all the studies that did not respond to our questions for the title or abstract. Three studies underwent full text analysis. From the evaluation of the studies included in this review, it is possible to state that lower molar distalization is a clinical solution, but it is not a full bodily movement. CAT can provide more specifically a distal tipping movement. This is confirmed analyzing the discrepancy between expected movement and obtained movement. CAT can be considered a valid therapeutic option in patients with dental class III malocclusion, but it is obtained as a tipping movement instead of a body movement. Over-correction should be considered during the planning of the therapy.
Collapse
Affiliation(s)
- Horodynski Martina
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Roma RM, Italy
| | - A. De Stefano Adriana
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Roma RM, Italy
| | - Bottone Ernesto
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Roma RM, Italy
| | | | - A. Vernucci Roberto
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Roma RM, Italy
| | - Galluccio Gabriella
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Roma RM, Italy
| |
Collapse
|
7
|
Paim J, Souza LFDD, Fialho T, Borba DBDM, Freitas KMSD, Cotrin P, Neis VB, Ohira E. Assessment of patients' knowledge and preferences for the use of orthodontic aligners. J Orthod 2024:14653125241229456. [PMID: 38323415 DOI: 10.1177/14653125241229456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To evaluate the knowledge and preference of patients treated at a Dental School in Jaraguá do Sul, Brazil, about using aligners and the reasons for choosing this device as a treatment option. DESIGN A cross-sectional study. PARTICIPANTS A total of 82 participants aged 18-45 years recruited at a screening clinic. METHODS A questionnaire was completed in person using a tablet with digital forms. RESULTS Almost half of the participants (49%) knew about aligners; 40% were aged 18-24 years, and 77% were female. When observing the images of the types of orthodontic appliances, the aligners had an acceptance rate of 80%. Among the reasons that led to the preference for choosing aligners, 68% cited aesthetics and 42% comfort. CONCLUSION Recently, clear aligners have become a popular choice for orthodontic treatment, particularly among adults. Despite their popularity and effectiveness, many patients still need more information about aligner treatment. Over half of the respondents did not know what orthodontic aligners were. Younger participants had more knowledge about aligners than older participants. Patients still need more knowledge about the types of appliances available for orthodontic treatment. When presented with images of the kinds of devices available, almost 80% of participants showed greater satisfaction with aligners.
Collapse
Affiliation(s)
- Joice Paim
- Dental School, UNISOCIESC, Jaraguá do Sul, SC, Brazil
| | | | - Tiago Fialho
- Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | | | | | | | | | - Eduardo Ohira
- Dental School, UNISOCIESC, Jaraguá do Sul, SC, Brazil
| |
Collapse
|
8
|
Mendes Ribeiro SM, Aragón MLSDC, Espinosa DDSG, Shibasaki WMM, Normando D. Orthodontic aligners: between passion and science. Dental Press J Orthod 2024; 28:e23spe6. [PMID: 38198351 PMCID: PMC10768648 DOI: 10.1590/2177-6709.28.6.e23spe6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/10/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. METHODS Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. CONCLUSIONS There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.
Collapse
Affiliation(s)
| | | | | | | | - David Normando
- Universidade Federal do Pará (UFPA), Departamento de Ortodontia (Belém/PA, Brazil)
| |
Collapse
|
9
|
Lin G, Chen M, Guo N, Shi X. Three-dimensional measurement and analysis of Mandibular Molar Distalization assisted by micro-implant anchorage combined with clear aligner. Pak J Med Sci 2024; 40:455-460. [PMID: 38356811 PMCID: PMC10862430 DOI: 10.12669/pjms.40.3.7759] [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: 02/25/2023] [Revised: 05/15/2023] [Accepted: 11/16/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To investigate the effect of micro-implant anchorage combined with a clear aligner on the efficiency of mandibular molar distalization and the protection of anterior teeth anchorage, provide reference for clinical scheme design. Methods This is a prospective study. Seventeen patients who were treated in the Orthodontics Department of the Hospital of Stomatology affiliated to Fujian Medical University from 2019 to 2021 and used Invisalign clear aligners to move mandibular molars distally were included and divided into two groups according to anchorage types: Group-A and Group-B. Group-A (ten cases) were treated without micro-implant anchorage, while Group-B (seven cases) were treated with micro-implant anchorage nails for enhanced anchorage. The effect of micro-implant anchorage on crown and root distal movement of mandibular molars and the difference in three-dimensional movement between mandibular molars and mandibular central incisors were analyzed. Results The crown distalization efficiency of mandibular first and second molars in Group-B was 68.66% and 71.02%, respectively, which were higher than those in Group-A(p<0.05). The mandibular central incisors in Group-A showed labial displacement and a small amount of elongation, while those in Group-B showed less anchorage loss(p<0.05). In Group-A, the crown was tilted in the distal direction and moved in the buccal direction during mandibular molar distalization(p<0.05). While in Group-B, the crown was tilted in the distal directio (p<0.05) and the mandibular second molar was depressed(p<0.05). Conclusion In the process of mandibular molar distalization assisted by micro-implant anchorage combined with a clear aligner, better protects the anchorage of the mandibular central incisor and improves the efficiency of the molar crown distalization.
Collapse
Affiliation(s)
- Gengbing Lin
- Gengbing Lin, Department of Stomatology, Fujian Provincial People’s Hospital, Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Mengwei Chen
- Mengwei Chen, Department of Orthodontics, Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University & Institute of Stomatology, Fujian Medical University, Fuzhou 350004, Fujian, China
| | - Nan Guo
- Nan Guo, Department of Stomatology, Fujian Provincial People’s Hospital, Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350004, Fujian, China
| | - Xie Shi
- Xie Shi, Department of Orthodontics, Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University & Institute of Stomatology, Fujian Medical University, Fuzhou 350004, Fujian, China
| |
Collapse
|
10
|
Kircelli BH, Kilinc DD, Karaman A, Sadry S, Gonul EY, Gögen H. Comparison of the bond strength of five different composites used in the production of clear aligner attachments. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101481. [PMID: 37080356 DOI: 10.1016/j.jormas.2023.101481] [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: 01/24/2023] [Revised: 04/04/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023]
Abstract
AIM The aims of this study were to measure and compare shear bond strength (SBS) and manipulation time (MT) among five different composite resins (CR; two flowable and three highly viscous) which are used in the production of clear aligner attachments. MATERIAL AND METHODS This in vitro experiment study comprised of 150 extracted premolars which were divided into 5 equal groups. Predictor variables were CRs; Tetric Evo Ceram (Ivoclar VivadentAG, Liechtenstein) (Group 1), Tetric NCeram; (Ivoclar VivadentAG, Liechtenstein) (Group 2), Tetric N-Flow (GC Dental Products, Tokyo, Japan) (Group 3), G-aenial Universal Injectable (GC Dental Products, Tokyo, Japan) (Group 4), GC Aligner Connect (GC Dental Products, Tokyo, Japan) (Group 5), respectively. Outcome variables were; SBS and MT for each CR attachment in each group of teeth. Oneway ANOVA was used to compare the groups. Levene's test was used to determine variance homogeneity. In terms of variance homogeneity, Bonferroni tests were used as a post-hoc test for multiple group comparisons. RESULTS SBS was statistically different between study groups (p < 0.001). Average SBS values are found to be 16.6 ± 3.6 MPa for Tetric Evo Ceram; 20.7 ± 5.4 MPa for Tetric NCeram; 21.0 ± 4.0 MPa for Tetric N-Flow; 18.9 ± 5.0 MPa for G-aenial Universal Injectable; and 17.4 ± 3.5 MPa for GC Aligner Connect. The values in the Tetric Evo Ceram group were significantly lower than the Tetric N-Ceram group (p = 0.004) and the Tetric N-Flow group (p = 0.001). Mean value of shear bond strength in the GC Aligner connect group were significantly lower than in the Tetric N-Ceram group (p = 0.047) and in the Tetric N-Flow group (p = 0.017). Flowable composite had a significantly shorter manipulation time than the high viscous one; mean 1,08 ± 0,22 min to mean 4,57 ± 0,51 min, respectively. CONCLUSION Although SBSs of CRs tested in the study was found to be statistically different, they all quite exceeded the accepted clinically sufficient value of 6-8 MPa. Besides, flowable composite required substantially less time to manipulate than the high viscosity composite.
Collapse
Affiliation(s)
| | | | - Ahmet Karaman
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey
| | - Sanaz Sadry
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey
| | - Enes Yusuf Gonul
- Department of Orthodontics, Faculty of Dentistry, Istanbul Aydin University, Istanbul, Turkey
| | - Hakan Gögen
- Department of Orthodontics, Faculty of Dentistry, European University of Lefke, Turkey
| |
Collapse
|
11
|
Rouzi M, Jiang Q, Zhang H, Li X, Long H, Lai W. Characteristics of oral microbiota and oral health in the patients treated with clear aligners: a prospective study. Clin Oral Investig 2023; 27:6725-6734. [PMID: 37775585 DOI: 10.1007/s00784-023-05281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES In this prospective clinical study, the effect of clear aligners on periodontal health and oral hygiene was examined. As the same time, microbial changes of the aligner tray and subgingival microbiota community were investigated. METHODS The study recruited fifteen patients, and clinical parameters were recorded at three different time points: before the initiation of aligner treatment (T0), 1 month after treatment onset (T1), and 3 months after treatment onset (T3). Plaque samples were collected from the inner surface of aligners and subgingival sulcus at each of these time points. The microbial composition of the samples was analyzed using 16S rRNA gene sequencing, and changes were evaluated based on the abundance of amplicon sequence variants (ASVs). RESULTS Reduction in plaque index and improvement in periodontal health were observed. In aligner tray plaque samples, the relative abundance of Streptococcus increased significantly, as well as the richness and diversity of microbiota decreased substantially as the duration of treatment time. In subgingival plaque samples, alpha and beta diversity of microbiota did not change significantly. CONCLUSIONS During the clear aligner treatment, the patients' periodontium remained in a healthy condition, and clear aligner treatment had no significant impact on the composition of subgingival microbiota. The structure of the aligner tray microbiota altered significantly at both phylum and genus levels and attracted a unique and less diverse microbiota community. CLABSINABSICAL RELEVANCE Clear aligner treatment has no significant impact on periodontal health and subgingival microbiota composition of patients.
Collapse
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
| | - Qingsong Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Haoxin Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Xiaolong Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, 610041, China
| | - Hu Long
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, 610041, China.
| | - Wenli Lai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, 14 Renmin South Road Third Section, Chengdu, 610041, China.
| |
Collapse
|
12
|
Bellocchio AM, Portelli M, Ciraolo L, Ciancio E, Militi A, Peditto M, Barbera S, Nucera R. Evaluation of the Clinical Variables Affecting Attachment Reproduction Accuracy during Clear Aligner Therapy. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6811. [PMID: 37895792 PMCID: PMC10607942 DOI: 10.3390/ma16206811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate some of the clinical variables that influence the accuracy of reproducing the planned attachment shape. The following clinical variables were considered: the template material, type of composite, and pressure application on the template during attachment curing. METHODS In this study, the evaluated materials for the thermoplastic transfer template construction are Erkolen 0.8 (polyethylene: PE) and Erkodur 0.8 (polyethylene terephthalate glycol-PET-G), and two types of composite resins: Enaflow (light-curing low-viscosity composite resin) and Enamel plus dentina HRI (light-curing high-viscosity composite resin). Two different light-curing lamps were used: Valo cordless color with no pressure and push light pressure (SCS). The 26 models included in the study were imported into the 3 Shape Ortho System 2022 (ver. 85.0.20 3 Shape, Denmark), and attachments were virtually placed on the dental elements of the first premolar and on both sides of the first upper molars. The accuracy of the attachment reproduction was evaluated through linear and angular evaluations against the reference model (MCAD). Three physical models were obtained: model A (MA), which was printed with attachments; model B (MB) with attachments made with a PE template; and model C (MC) with attachments made with a PET-G template. RESULTS The results showed statistically significant differences (p < 0.05) between the PE and PET-G templates with greater precision using the PET-G template. Statistically significant differences (p < 0.05) were found among the high-viscosity composite and low-viscosity composite with pressure curing. CONCLUSIONS In light of the obtained data, using a PET-G template is recommended. The pressure application during composite curing reduces the reproduction accuracy with a low-viscosity composite.
Collapse
Affiliation(s)
- Angela Mirea Bellocchio
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (M.P.); (L.C.); (E.C.); (A.M.); (M.P.); (S.B.); (R.N.)
| | | | | | | | | | | | | | | |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Putrino A, Marinelli E, Zaami S. The Power of Customized Clear Aligners in Closing Molar Edentulous Spaces: Clinical and Medico-Legal Considerations in a Scoping Review and Case Report. J Pers Med 2023; 13:1389. [PMID: 37763156 PMCID: PMC10532605 DOI: 10.3390/jpm13091389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Successful closure of edentulous spaces with clear aligners (CAs) is influenced by many factors. CAs are tailored orthodontic devices whose predictability may have relevant medico-legal implications. This study presents a scoping review about missing molar space closure (MMSC) with CAs and a clinical case. This study aims to highlight the feasibility of molar space closure by mesialization with CAs without hybrid supports. Following PRISMA Sc-review guidelines, English-written randomized/non-randomized/observational clinical studies on PubMed, Scopus, Cochrane and Lilacs were searched. An 18-year-old patient, with upper and lower edentulous spaces due to the loss of two first molars, was rehabilitated with CAs (Sorridi®, Sorridi srl, Latina, Italy) without hybrid supports and attachments. The therapy was carried out over 10 months. Currently, there are no studies documenting MMSC by mesialization with only CAs. Existing articles document the closure of premolar or incisor spaces. The upper and lower left second molars replaced the missing first molars, and erupting third molars replaced adjacent teeth. The biomechanical effects in space closure with CAs related to extraction cases appear as priorities of clinical/medico-legal interest. Our case turns attention to this movement of CAs without attachments/hybrid supports, indicating that even such a complex treatment can be comfortable for patients and safely predictable for specialists.
Collapse
Affiliation(s)
- Alessandra Putrino
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy;
| | - Enrico Marinelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy;
| |
Collapse
|
15
|
Ma S, Wang Y. Clinical outcomes of arch expansion with Invisalign: a systematic review. BMC Oral Health 2023; 23:587. [PMID: 37620781 PMCID: PMC10464440 DOI: 10.1186/s12903-023-03302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE This study aims to assess the scientific evidence regarding the clinical outcomes of Invisalign therapy in controlling orthodontic tooth movement. MATERIALS AND METHODS An electronic search was conducted on PubMed, Cochrane Library, Web of Science, Embase, and Scopus from November 2015 to November 2022 to identify relevant articles. Methodological shortcomings were highlighted, and an evaluation of the quality of the included studies was completed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. RESULTS Fifteen non-randomized controlled trials were included in the analysis. Most non-randomized controlled trials (n=11; 73%) were rated with a moderate risk of bias according to the ROBINS-I tool. There were statistically significant differences between the pretreatment and posttreatment arches. The average expansion was significantly different from that predicted for each type of tooth in both the maxilla and mandible. Furthermore, the efficiency decreased from the anterior area to the posterior area in the upper arch. CONCLUSION Despite the fact that arch expansion with Invisalign® is not entirely predictable, clear aligner treatment is a viable option for addressing dentition crowding. The efficacy of expansion is greatest in the premolar area. More research focusing on treatment outcomes with different materials of aligners should be conducted in the future. Overcorrection should be considered when planning arch expansion with Invisalign. In the maxilla, the expansion rate decreases from the anterior to the posterior, and presetting sufficient buccal root torque of posterior teeth may result in improved efficiency of expansion.
Collapse
Affiliation(s)
- Songyang Ma
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, People's Republic of China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, People's Republic of China
| | - Yunji Wang
- Department of Orthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, People's Republic of China.
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, People's Republic of China.
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Muro MP, Caracciolo ACA, Patel MP, Feres MFN, Roscoe MG. Effectiveness and predictability of treatment with clear orthodontic aligners: A scoping review. Int Orthod 2023; 21:100755. [PMID: 37086643 DOI: 10.1016/j.ortho.2023.100755] [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: 11/24/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION In an ideal clinical setting, orthodontic therapy with clear aligners (CA) should improve the patients' initial malocclusion and must guarantee equivalence between the results predicted and those obtained clinically to be considered an effective treatment. Therefore, this scoping review aimed to identify the orthodontic literature concerning the effectiveness and predictability of CA treatments. METHODS A systematic computerized search was performed in 3 databases: PubMed, Scopus, and Embase. Inclusion criteria selected observational and clinical studies performed in at least 10 adult orthodontic patients, whose results of CA treatment's effectiveness and/or predictability were assessed. RESULTS The 3 database computerized searches resulted in 1,553 articles, and 169 full texts were considered potentially relevant. After applying the eligibility criteria, 33 studies were included. Most studies (76%) were designed as cohort studies and have been published in the last 5 years (79%). The majority included only non-extraction treatments (73%), and 79% reported results achieved with the Invisalign® system. The most predictable movement was the buccolingual tipping, while the least predictable movements were rotation, intrusion, and extrusion. Aligner treatment was effective for mild to moderate crowding resolution, and the success of overbite correction still seems to be limited. CONCLUSIONS The studies have demonstrated improvement of initial malocclusion through CA treatments. Still, predictability degree is overestimated and does not accurately reflect the occlusion immediately at the end of treatment. In future studies, there should be an effort to broaden the utilization of alternative aligner systems beyond Invisalign® and broadly disseminate their outcomes to strengthen clear aligners evidence base.
Collapse
Affiliation(s)
| | | | - Mayara Paim Patel
- Dental Research Division, School of Dentistry, Guarulhos University, Guarulhos, São Paulo, Brazil
| | | | - Marina Guimarães Roscoe
- Department of Biomaterials and Oral Biology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
18
|
Malpartida-Pacheco MI, Dulanto-Vargas JA. [Comparison of the outcome of orthodontic dental movement using aligners versus fixed orthodontics: a review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2023; 11:e154. [PMID: 38288450 PMCID: PMC10809973 DOI: 10.21142/2523-2754-1102-2023-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/29/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction The aligners have become a preferred alternative in terms of orthodontic treatment, surpassing the choice of conventional brackets, due to the comfort and aesthetics that the aligners represent, however, the final result with this system continues to be a controversial issue. The objective of this review was to verify the effectiveness of the treatment completed with aligners versus conventional brackets. Materials and methods An exhaustive search was carried out in the PubMed, ScienceDirect, Scopus and Embase databases up to the date of January 5, 2023, including comparative studies that evaluated the final result and treatment time of the aligners compared to conventional braces. Two researchers carefully selected the articles evaluated and analyzed different key topics on the subject. Results In this study, 8 articles were included, according to the studies, the vast majority did not find significant differences in completion between the compared groups. In addition to this, the treatment time in 3 articles was faster with aligners, in 3 articles it was faster with conventional brackets, and in one article no significant difference was found, so it is not yet established whether a system is faster than the other. Conclusions Both aligners and conventional fixed orthodontics had good results at the end of orthodontic treatment and presented a similar treatment time, however, the majority of treated cases belonged to malocclusions of medium to low complexity, so these cannot be generalized. findings to all malocclusions.
Collapse
Affiliation(s)
- Mónica Ivette Malpartida-Pacheco
- División de Ortodoncia, Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur División de Ortodoncia Universidad Científica del Sur Lima Peru
| | - Julissa Amparo Dulanto-Vargas
- Research Group in Dental Sciences, Carrera de Estomatología, Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur Carrera de Estomatología Universidad Científica del Sur Lima Peru
| |
Collapse
|
19
|
Wang Y, Chen J, Qin S, Han X, Liao L, Sima X, Guo W. An in vivo evaluation of clear aligners for optimal orthodontic force and movement to determine high-efficacy and periodontal-friendly aligner staging. Heliyon 2023; 9:e15317. [PMID: 37113787 PMCID: PMC10126945 DOI: 10.1016/j.heliyon.2023.e15317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Objectives To investigate the effect of aligner displacement on tooth movement and periodontal health to improve the efficiency of aligner treatment and explore the mechanism in vivo. Methods A two-tooth site was established by a finite element (FE) model to virtually evaluate aligner staging. A randomized controlled experiment was conducted when the tooth sites in beagles were treated with fixed or aligner appliances with different movement and force, and tooth movement and internal structure were recorded during the alignment. After sacrificing five dogs, bone-periodontal ligament (PDL)-tooth specimens were removed and processed to conduct uniaxial compression and tensile tests as well as micro-CT imaging and histological analysis. Results Three displacements of 0.25, 0.35 and 0.45 mm were obtained from FE analysis and applied in beagles. In general, aligners had poorer performance on movement compared to fixed systems in vivo, but the aligner with a staging of 0.35 mm had the highest accuracy (67.46%) (P < 0.01). Loaded with severe force, fixed sites exhibited tissue damage due to excess force and rapid movement, while aligners showed better safety. The PDL under a 0.35-mm aligner treatment had the highest elastic modulus in the biomechanical test (551.4275 and 1298.305 kPa) (P < 0.05). Conclusions Compared to fixed appliances, aligners achieve slightly slower movement but better periodontal condition. Aligners with an interval of 0.35 mm have the highest accuracy and best PDL biomechanical and biological capacities, achieving the most effective and safest movement. Even with complexity of oral cavity and lack of evaluation of other factors, these results provide insight into faster displacement as a method to improve the efficacy of aligners.
Collapse
Affiliation(s)
- Yuru Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School/Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jie Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School/Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Siwen Qin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School/Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xue Han
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School/Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lijun Liao
- Sichuan Hospital of Stomatology, Chengdu, China
| | - Xiutian Sima
- Department of Neurosurgery, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Corresponding author. Department of Neurosurgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu 610041, China.
| | - Weihua Guo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China School/Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Corresponding author. Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, No. 14, 3rd Sec., Ren Min Nan Road, Chengdu 610041, China.
| |
Collapse
|
20
|
Quinzi V, Orilisi G, Vitiello F, Notarstefano V, Marzo G, Orsini G. A spectroscopic study on orthodontic aligners: First evidence of secondary microplastic detachment after seven days of artificial saliva exposure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 866:161356. [PMID: 36603638 DOI: 10.1016/j.scitotenv.2022.161356] [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: 10/25/2022] [Revised: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Clear orthodontic aligners have recently seen increasing popularity. The thermoplastic materials present several advantages, even if it is known that all plastic products can be subjected to environmental and mechanical degradation, leading to the release of microplastics (MPs). Their ingestion could cause oxidative stress and inflammatory lesions. This study aims to evaluate the potential detachment of MPs by clear aligners due to mechanical friction simulated with a 7-day protocol in artificial saliva. The study was performed on orthodontic clear aligners from different manufacturers: Alleo (AL); FlexiLigner (FL); F22 Aligner (F22); Invisalign® (INV); Lineo (LIN); Arc Angel (ARC), and Ortobel Aligner (OR). For each group, two aligners were immersed in artificial saliva for 7 days and stirred for 5 h/day, simulating the physiological teeth mechanical friction. After 7 days, the artificial saliva was filtered; then, filters were analyzed by Raman Microspectroscopy (RMS) and Scanning Electron Microscopy (SEM), respectively to chemically identify the polymeric matrix and to measure the number and size of the detected MPs. RMS spectra revealed that AL, FL, LIN, ARC, and OR aligners were composed by polyethylene terephthalate, while F22 and INV ones by polyurethane. SEM analysis showed that the highest number of MPs was found in ARC and the lowest in INV (p < 0.05). As regards MPs' size, no statistically significant difference was found among groups, with most MPs ranging from 5 to 20 μm. Noteworthy, a highly significant correlation (p < 0.0001) was highlighted between the distribution of MPs size and the different typologies of aligners. This in vitro study highlighted for the first time the detachment of MPs from clear aligners due to mechanical friction. This evidence may represent a great concern in the clinical practice since it could impact human general health.
Collapse
Affiliation(s)
- Vincenzo Quinzi
- Università degli Studi dell'Aquila, Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Piazza Salvatore Tommasi, 67100 L'Aquila, Italy
| | - Giulia Orilisi
- Università Politecnica delle Marche, Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Via Tronto 10, 60126 Ancona, Italy
| | - Flavia Vitiello
- Università Politecnica delle Marche, Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Via Tronto 10, 60126 Ancona, Italy
| | - Valentina Notarstefano
- Università Politecnica delle Marche, Dipartimento di Scienze della Vita e dell'Ambiente, Via Brecce Bianche, 60131 Ancona, Italy
| | - Giuseppe Marzo
- Università degli Studi dell'Aquila, Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Piazza Salvatore Tommasi, 67100 L'Aquila, Italy
| | - Giovanna Orsini
- Università Politecnica delle Marche, Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche, Via Tronto 10, 60126 Ancona, Italy.
| |
Collapse
|
21
|
Galluccio G, De Stefano AA, Horodynski M, Impellizzeri A, Guarnieri R, Barbato E, Di Carlo S, De Angelis F. Efficacy and Accuracy of Maxillary Arch Expansion with Clear Aligner Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4634. [PMID: 36901642 PMCID: PMC10002100 DOI: 10.3390/ijerph20054634] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
The aim of this work was to evaluate the efficacy and accuracy of maxillary arch transverse expansion using the Invisalign® clear aligner system without auxiliaries other than Invisalign attachments. Knowing the accuracy of a movement through a clear aligner system allows the clinician to plan the treatment with greater precision and to achieve the expected result faster. The study group included 28 patients with a mean age of 17 ± 3.2 years. The treatment protocol for all the selected patients included the application of the Invisalign® clear aligner system without auxiliaries, except for the Invisalign® attachments; in no case were tooth extraction or interproximal enamel reduction (IPR) performed. Linear measurements of the expansion were assessed before treatment (T0), at the end of treatment (T1), and on final virtual models by ClinCheck® (TC). A paired t-test was used to compare T0-T1 and T1-TC differences. A paired t-test was applied, and one normality was validated with the Shapiro-Wilks test. If normality was not met, the nonparametric test (Mann-Whitney U test) was applied. The level of significance was set at 5%. Statistically significant differences were found for all measurements at T0-T1. The results showed an average accuracy of efficacy of 70.88%. The differences in predictability between the various vestibular measurements (intercanine, inter-premolar, and intermolar) were not statistically significant, while they were for gingival measurements. The overall accuracy of the expansion treatment was 70%, regardless of tooth type.
Collapse
|
22
|
Jedliński M, Mazur M, Greco M, Belfus J, Grocholewicz K, Janiszewska-Olszowska J. Attachments for the Orthodontic Aligner Treatment-State of the Art-A Comprehensive Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4481. [PMID: 36901488 PMCID: PMC10001497 DOI: 10.3390/ijerph20054481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In recent years the burden of aligner treatment has been growing. However, the sole use of aligners is characterized by limitations; thus attachments are bonded to the teeth to improve aligner retention and tooth movement. Nevertheless, it is often still a challenge to clinically achieve the planned movement. Thus, the aim of this study is to discuss the evidence of the shape, placement and bonding of composite attachments. METHODS A query was carried out in six databases on 10 December 2022 using the search string ("orthodontics" OR "malocclusion" OR "Tooth movement techniques AND ("aligner*" OR "thermoformed splints" OR "invisible splint*" AND ("attachment*" OR "accessor*" OR "auxill*" AND "position*"). RESULTS There were 209 potential articles identified. Finally, twenty-six articles were included. Four referred to attachment bonding, and twenty-two comprised the influence of composite attachment on movement efficacy. Quality assessment tools were used according to the study type. CONCLUSIONS The use of attachments significantly improves the expression of orthodontic movement and aligner retention. It is possible to indicate sites on the teeth where attachments have a better effect on tooth movement and to assess which attachments facilitate movement. The research received no external funding. The PROSPERO database number is CRD42022383276.
Collapse
Affiliation(s)
- Maciej Jedliński
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
- Department of Dental and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Marta Mazur
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
- Department of Dental and Maxillofacial Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Mario Greco
- Department of Paediatric Dentistry, University of L’Aquila, 67100 L’Aquila, Italy
| | - Joyce Belfus
- Faculty of Dentistry, Universidad de los Andes, Santiago 7620001, Chile
| | - Katarzyna Grocholewicz
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| | | |
Collapse
|
23
|
Clear Aligners and Smart Eye Tracking Technology as a New Communication Strategy between Ethical and Legal Issues. Life (Basel) 2023; 13:life13020297. [PMID: 36836654 PMCID: PMC9967915 DOI: 10.3390/life13020297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Smart eye-tracking technology (SEET) that determines visual attention using smartphones can be used to determine the aesthetic perception of different types of clear aligners. Its value as a communication and comprehension tool, in addition to the ethical and legal concerns which it entails, can be assessed. One hundred subjects (50 F, 50 M; age range 15-70) were equally distributed in non-orthodontic (A) and orthodontic (B) groups. A smartphone-based SEET app assessed their knowledge of and opinions on aligners. Subjects evaluated images of smiles not wearing aligners, with/without attachments and with straight/scalloped gingival margins, as a guided calibration step which formed the image control group. Subsequently, the subjects rated the same smiles, this time wearing aligners (experimental images group). Questionnaire data and average values for each group of patients, and images relating to fixation times and overall star scores, were analyzed using these tests: chi-square, t-test, Mann-Whitney U, Spearman's rho, and Wilcoxon (p < 0.05). One-way ANOVA and related post-hoc tests were also applied. Orthodontic patients were found to be better informed than non-orthodontic patients. Aesthetic perception could be swayed by several factors. Attachments scored lower in aesthetic evaluation. Lips distracted attention from attachments and improved evaluations. Attachment-free aligners were better rated overall. A more thorough understanding as to the opinions, expectations and aesthetic perception of aligners can improve communication with patients. Mobile SEET is remarkably promising, although it does require a careful medicolegal risk-benefit assessments for responsible and professional use.
Collapse
|
24
|
Jia L, Wang C, Li L, He Y, Wang C, Song J, Wang L, Fan Y. The effects of lingual buttons, precision cuts, and patient-specific attachments during maxillary molar distalization with clear aligners: Comparison of finite element analysis. Am J Orthod Dentofacial Orthop 2023; 163:e1-e12. [PMID: 36435687 DOI: 10.1016/j.ajodo.2022.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study aimed to analyze the biomechanical effects of the combined use of clear aligners (CA) and auxiliaries (precision cuts, lingual buttons, and patient-specific attachments) on mesial tipping and extrusion of the premolars during maxillary molars distalization. METHODS Three-dimensional finite element method was employed to simulate clinical scenarios of CA with different auxiliaries for molar distalization. As such, 200 g of distal force was applied to the microimplants from the notches, lingual buttons, and hooks. Orthodontic tooth movement and the hydrostatic pressure in the periodontal ligament were compared. RESULTS Adding auxiliaries can provide the maxillary arch anchorage and promote the distal tipping of premolars and retroclination of maxillary incisors. In contrast, this effect was more pronounced in patient-specific attachment applications than in other types of auxiliaries. The independent application of the CA caused mesial tipping and extrusion of the premolar and also caused the incisor proclination. CONCLUSIONS The anchorage loss caused by the CA alone could be alleviated with the assistance of auxiliaries. Notably, patient-specific attachments further reinforce the anchorage of the anterior arch by incorporating anchor teeth as 1 anchorage unit.
Collapse
Affiliation(s)
- Lurong Jia
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Chunjuan Wang
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Lingjie Li
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yao He
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Chao Wang
- Stomatological Hospital of Chongqing Medical University, Chongqing, China; Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China.
| | - Jinlin Song
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China; Stomatological Hospital of Chongqing Medical University, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
| | - Lizhen Wang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, School of Engineering Medicine, Beihang University, Beijing, China
| |
Collapse
|
25
|
Occlusal Plane Modification in Clear Aligners Treatment: Three Dimensional Retrospective Longitudinal Study. Dent J (Basel) 2022; 11:dj11010008. [PMID: 36661545 PMCID: PMC9857834 DOI: 10.3390/dj11010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
The purpose of the present study was to evaluate: (i) maxillary occlusal plane changes after clear aligners therapy with a 3D measurement technique; and (ii) as a secondary outcome, if such changes were correlated to the patient’s 1axilla-mandibular divergence. 3D maxillary models of 32 patients (7 males and 25 females; mean age 22.3 +/− 3.4 year) treated with clear aligners were analyzed. The angle (α) between a reference palatine plane and a maxillary occlusal plane was measured. Five angular cephalometric measurements (NSL/MP; PP-OP; OP-MP; PP-MP; PFH/AFH%) were performed and related to Δα. The subjects were further divided into three groups according to facial divergence. After aligner treatment, Δα increased in hyperdivergent patients and decreased in hypodivergent patients (p < 0.05). Δα showed a significant positive correlation with NSL/MP (rho = 0.44) and negative correlation with PFH/AFH% (rho = −0.53). Aligners treatment produced a counterlockwise rotation of the maxillary occlusal plane, even if this rotation occurs differently depending on divergence.
Collapse
|
26
|
Baxmann M, Timm LH, Schwendicke F. Who Seeks Clear Aligner Therapy? A European Cross-National Real-World Data Analysis. Life (Basel) 2022; 13:life13010065. [PMID: 36676013 PMCID: PMC9867317 DOI: 10.3390/life13010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/29/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
A key step prior to clear aligner therapy (CAT) is the clinical examination and case selection, which includes understanding the specific orthodontic problem to be managed and the wider evaluation of oral health. Seeking CAT may further differ along sociodemographic parameters or across countries, as may perceived orthodontic treatment needs and oral health. We aimed to characterize patients seeking CAT across five European countries. Anonymized real-life data from one large CAT provider (DrSmile, Berlin, Germany) was retrospectively sampled for the period 1 November 2021−31 December 2021. A total of 15,015 patients (68.4% females, 31.6% males, with an age range of 18−81 years, median 30.0 years) were included. The cross-national comparison revealed a significant difference in gender distribution (p < 0.001/Chi-square), with the highest proportion of males in Italy (434/1199, 36.2%) and the lowest in Poland (457/1600, 28.6%); generally, more females sought CAT. The largest motivational factor in all countries for seeking CAT was crowding, in both males and females. By and large, patients paid out of pocket for CAT. The prevalence of caries, periodontitis, and craniomandibular dysfunction as well as the numbers of missing teeth were generally low, albeit with significant differences between sociodemographic groups and countries for caries and periodontitis. Patients seeking CAT showed a low prevalence in oral conditions but differed in their sociodemographic characteristics across countries. Dentists and orthodontists should consider these country-specific differences when planning CAT.
Collapse
Affiliation(s)
| | - Lan Huong Timm
- DrSmile-DZK Deutsche Zahnklinik GmbH, Königsallee 92a, 40212 Düsseldorf, Germany
- Correspondence:
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany
| |
Collapse
|
27
|
Cheng Y, Liu X, Chen X, Li X, Fang S, Wang W, Ma Y, Jin Z. The three-dimensional displacement tendency of teeth depending on incisor torque compensation with clear aligners of different thicknesses in cases of extraction: a finite element study. BMC Oral Health 2022; 22:499. [DOI: 10.1186/s12903-022-02521-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Despite the popularity of clear aligner treatment, the effect of the thickness of these aligners has not been fully investigated. The objective of this study was to assess the effects of incisor torque compensation with different thicknesses of clear aligner on the three-dimensional displacement tendency of teeth in cases of extraction.
Methods
Three-dimensional finite element models of the maxillary dentition with extracted first premolars, maxilla, periodontal ligaments, attachments, and aligners were constructed and subject to Finite Element Analysis (FEA). Two groups of models were created: (1) with 0.75 mm-thick aligners and (2) with 0.5 mm-thick aligners. A loading method was developed to simulate the action of clear aligners for the en masse retraction of the incisors. Power ridges of different heights were applied to both groups to mimic torque control, and the power ridges favoring the translation of the central incisors were selected. Then, we used ANSYS software to analyze the initial displacement of teeth and the principle stress on the PDL.
Results
Distal tipping, lingual tipping and extrusion of the incisors, distal tipping and extrusion of the canines, and mesial tipping and intrusion of the posterior teeth were all generated by clear aligner therapy. With the 0.5 mm-thick aligner, a power ridge of 0.7 mm could cause bodily retraction of the central incisors. With the 0.75 mm-thick aligner, a power ridge of 0.25 mm could cause translation of the central incisors. Aligner torque compensation created by the power ridges generated palatal root torque and intrusion of the incisors, intrusion of the canines, mesial tipping and the intrusion of the second premolar; these effects were more significant with a 0.75 mm-thick aligner. After torque compensation, the stress placed on the periodontal ligament of the incisors was distributed more evenly with the 0.75 mm-thick aligner.
Conclusions
The torque compensation caused by power ridges can achieve incisor intrusion and palatal root torque. Appropriate torque compensation with thicker aligners should be designed to ensure bodily retraction of anterior teeth and minimize root resorption, although more attention should be paid to the anchorage control of posterior teeth in cases of extraction.
Collapse
|
28
|
Fan D, Liu H, Yuan CY, Wang SY, Wang PL. Effectiveness of the attachment position in molar intrusion with clear aligners: a finite element study. BMC Oral Health 2022; 22:474. [PMID: 36348394 PMCID: PMC9644447 DOI: 10.1186/s12903-022-02472-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
Objective To evaluate the biomechanical effects of different attachments’ position for maxillary molar intrusion with clear aligner treatment by finite element analysis. Methods Cone-beam computed tomography images of a patient with supra-eruption of the maxillary second molars were selected to construct three-dimensional models of the maxilla, periodontal ligaments, dentition, and clear aligner. The models were divided into four groups depending on the attachment location on the first molar: (1) no attachment (NA), (2) buccal attachment (BA), (3) palatal attachment (PA), and (4) bucco-palatal attachment (BPA). After applying an intrusion of 0.2 mm on the second molar, displacements and stress distributions of the teeth, aligner, and periodontal ligament were analyzed with the finite element software. Results All groups displayed equivalent movement patterns of aligners. The NA and BA groups showed buccal tipping of the second molar, while the PA group showed palatal tipping. The BPA group had the highest intruding value and the lowest buccal/palatal tipping value. All groups showed mesial tipping of the second molar. Stress distribution in the periodontal ligament strongly correlated with the attachment position. The BPA group showed the best stress distribution. Conclusion Combined BA and PA could effectively prevent buccal and palatal tipping and showed the best efficiency in intruding the second molar. The second molar showed an unavoidable tendency to tip mesially, regardless of the attachment position.
Collapse
|
29
|
Wu E. The application of in-office aligners in the combination treatment protocol. Semin Orthod 2022. [DOI: 10.1053/j.sodo.2022.10.004] [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: 11/06/2022]
|
30
|
Roberts WE, Chang CH, Chen J, Brezniak N, Yadav S. Integrating skeletal anchorage into fixed and aligner biomechanics. J World Fed Orthod 2022; 11:95-106. [DOI: 10.1016/j.ejwf.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
|
31
|
Ye N, Brown B, Mantell S, Heo Y, Larson B, Fok A. Validation of finite element models for orthodontic aligners. J Mech Behav Biomed Mater 2022; 134:105404. [DOI: 10.1016/j.jmbbm.2022.105404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
|
32
|
Putrino A, Abed MR, Lilli C. Clear aligners with differentiated thickness and without attachments - A case report. J Clin Exp Dent 2022; 14:e514-e519. [PMID: 35765362 PMCID: PMC9233912 DOI: 10.4317/jced.59618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background Most clear aligner systems use straight or scalloped gingival margin aligners that are replaced weekly and that mainly use attachments to guide many movements. Yet in the literature some studies show the effectiveness of the aligner margin extended beyond the gingival margin, and divots instead of attachments and the biological advantage given by the use of aligners with differentiated thickness. Material and Methods A female patient (23 years old) with a pronounced proclination of the upper and lower incisors and moderate crowding who was treated with aligners weekly replaced with differentiated thickness, divots, no attachments and a straight margin beyond the gingival margin. Results The therapy was carried out in 5 months and did not need any refinements. A total of 40 aligners were used (20 with soft thickness and 20 with hard thickness for each arch). Conclusions Invisible aligners without attachments and with other therapeutic strategies such as divots and differentiated thickness are a valid alternative to traditional aligners that cannot be ignored. Key words:Orthodontics, clear aligners, appliances design.
Collapse
Affiliation(s)
- Alessandra Putrino
- DDS, Specialist in Orthodontics, PhD Researcher, Post-doc Programme in New Technologies and Law at MICHR - "Mediterranea International Centre for Human Rights Research", Reggio Calabria; Università degli Studi di Roma "La Sapienza"
| | - Maria-Rosaria Abed
- DDS, Specialist in Orthodontics, PhD Researcher , Private practice in Madrid, Spain
| | - Carlo Lilli
- DDS, Specialist in Orthodontics , Private practice in Lodz, Poland
| |
Collapse
|
33
|
Inchingolo AD, Patano A, Coloccia G, Ceci S, Inchingolo AM, Marinelli G, Malcangi G, Di Pede C, Garibaldi M, Ciocia AM, Mancini A, Palmieri G, Rapone B, Piras F, Cardarelli F, Nucci L, Bordea IR, Scarano A, Lorusso F, Giovanniello D, Costa S, Tartaglia GM, Di Venere D, Dipalma G, Inchingolo F. Treatment of Class III Malocclusion and Anterior Crossbite with Aligners: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050603. [PMID: 35630020 PMCID: PMC9147027 DOI: 10.3390/medicina58050603] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023]
Abstract
The article describes the orthodontically treated case of a 25-year-old patient with skeletal and dental class III malocclusion, anterior crossbite, which caused functional and aesthetic problems, occlusal trauma, and incisor wear. Treatment with transparent aligners was proposed to meet the patient's needs, using the sequential distalization protocol. While sequential distalization is well documented for class II malocclusion treatment in maxillary arch teeth, further investigations are necessary for class III malocclusions. In fact, lower teeth movements are more complex due to mandibular bone density and the presence of the third molars, which are often extracted to perform distalization. In addition, the use of intermaxillary elastics helps control the proclination of the anterior teeth as a reaction to distalizing forces. At the end of the treatment, the patient reached molar and canine class I and positive overjet and overbite. The inclination of lower incisors and the interincisal angle have improved, resulting in aesthetic and functional enhancement.
Collapse
Affiliation(s)
- Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Assunta Patano
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Giovanni Coloccia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Sabino Ceci
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Grazia Marinelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Chiara Di Pede
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Mariagrazia Garibaldi
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Anna Maria Ciocia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Giulia Palmieri
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Biagio Rapone
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Fabio Piras
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Filippo Cardarelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 6, 80138 Naples, Italy;
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: (I.R.B.); (F.L.); Tel.: +40-744-919-319 (I.R.B.); +39-328-213-2586 or +39-087-1355-4100 (F.L.)
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
- Correspondence: (I.R.B.); (F.L.); Tel.: +40-744-919-319 (I.R.B.); +39-328-213-2586 or +39-087-1355-4100 (F.L.)
| | - Delia Giovanniello
- Department of Thoracic Surgery, Hospital “San Camillo Forlanini”, 00152 Rome, Italy;
| | - Stefania Costa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, 98125 Messina, Italy;
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy;
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.P.); (G.C.); (S.C.); (A.M.I.); (G.M.); (G.M.); (C.D.P.); (M.G.); (A.M.C.); (A.M.); (G.P.); (B.R.); (F.P.); (F.C.); (D.D.V.); (G.D.); (F.I.)
| |
Collapse
|
34
|
Bilello G, Fazio M, Amato E, Crivello L, Galvano A, Currò G. Accuracy evaluation of orthodontic movements with aligners: a prospective observational study. Prog Orthod 2022; 23:12. [PMID: 35399128 PMCID: PMC8995220 DOI: 10.1186/s40510-022-00406-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background Since their introduction in orthodontics, clear aligners have been appreciated by patients, including adults, for their comfort and low aesthetic impact. Despite the enormous mobilization of financial resources all over the world aimed at producing new product lines, few clinical studies or high-quality evidence have been produced regarding the real effectiveness of such treatment. Given the few limited kinds of research on the subject, this study aims to produce and critically evaluate other data, to establish the concrete reliability of clear aligners in orthodontic therapy. Results Significant sample sizes were obtained for intrusion, vestibulo/lingual (V/L) crown tipping, and rotation. The overall accuracy for rotation resulted in 86%, ranging from 96% for maxillary central incisors to 70.4% for mandibular first premolars. The intrusion was registered only for anterior teeth; mean predictability was 92%, with the worst result being 86.7% for mandibular canines and the best being 98% for mandibular central incisors. V/L tipping was the most accurate movement: 93.1% of the prescribed movement was completed. Maxillary central incisors showed the lowest accuracy (80.7%), while mandibular central incisors were the highest (97.5%). Conclusions The present study provided reassuring data in support of the accuracy of the Invisalign® system. Vestibulo/lingual tipping was the most predictable movement, while rotation of canines, premolars, and lateral incisors were the least predictable. Intrusion resulted highly predictable up to 2 mm. When careful treatment planning follows a correct diagnosis, together with the use of auxiliary features and refinements, the planned results can be achieved in a clinically successful way. Authors believe that there is a major need for greater samples to overcome bias related to variables if we want to answer the unsolved questions, such as the predictability of severe malocclusions treatment.
Collapse
|
35
|
Timm LH, Farrag G, Baxmann M, Schwendicke F. Factors Influencing Patient Compliance during Clear Aligner Therapy: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10143103. [PMID: 34300269 PMCID: PMC8303492 DOI: 10.3390/jcm10143103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Lan Huong Timm
- Sunshine Smile, Windscheidstraße 18, 10627 Berlin, Germany;
- Correspondence:
| | - Gasser Farrag
- Sunshine Smile, Windscheidstraße 18, 10627 Berlin, Germany;
| | | | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197 Berlin, Germany;
| |
Collapse
|