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(A) Initial ClinCheck ® , (B) final ClinCheck ® and (C) superimposition of A and B. The ClinCheck ® simulation shows the degrees of correction of the rotations. (E) Initial intra-oral photo on the lower arch, (F) final intra-oral photo on the lower arch and (D) summary of changes of (E) and (F). The correction of the rotations on the ClinCheck ® and on the photos are similar.
Source publication
The present adult patient case report shows the correction of a crossbite malocclusion and severe tooth rotations treated with the Invisalign system.
A 27-year-old female with a dental crossbite (24, 34), severe rotations of two lower incisors (more than 40 degrees) and malalignment of the upper and lower arches is described. The Invisalign system...
Context in source publication
Context 1
... recent years, increasing numbers of adult patients have sought orthodontic treatment 1 and expressed a desire for aesthetic alternatives to conventional fixed appliances. 2 The possibility of using clear overlay appliances to achieve an orthodontic result was introduced in 1946, when Kesling 3 devised the concept of using a series of thermoplastic tooth positioners to progressively move malaligned teeth to impoved positions. In 1997, Align Technology (Santa Clara, CA, USA) adapted and incorporated modern technologies to introduce the Invisalign system which made Kesling’s concept a feasible, efficent and effective orthodontic treatment option. In 2000, Boyd et al. 4 published the first case report on the use of clear aligners and indicated that the primary benefit of the Invisalign appliance was the superior aesthetics during treatment, compared with metal braces. The Invisalign system 5,6 is based on a clear sequential appliance (aligners) made from a translucent thermoplastic material, which is worn for at least 20 hours per day. According to current protocols, the appliances are replaced on a bi-weekly regimen which incorporates a progressive alignment of up to 0.25 mm translation or up to 2 degrees of rotation per tooth per aligner. Malocclusions treated with the Invisalign system initially involved only mild crowding of 3-6 millimetres. 7 Recent data has expanded the use of this appliance to incorporate molar distalisation, 8 extraction cases, 9 the treatment of open bites, 10 crossbites, 7 deep bites, 11 Class II 8 and Class III corrections 12 and orthodontic-periodontic problems. 13 Rotation is an orthodontic movement reported to be difficult to achieve and control with the Invisalign system. Previous studies 14,15 have demonstrated that aligners were not able to control the rotation of canines requiring rotational movements greater than 15 degrees, which underlined the fact that the effectiveness of canine derotation was questionable. Recently, many new biomechanical features have been promoted by Align Technology to improve the predictability of aligner treatment. In particular, the G3 and G4 platforms introduced a collection of newly engineered attachments to improve control of desired tooth movements, including dental rotation and root tipping. The present case report describes an adult patient in whom the correction of a crossbite malocclusion with severe tooth rotations was successfully achieved with the Invisalign system. A 27-year-old female patient with a dental crossbite (24, 34), severe rotations of two lower incisors (more than 40 ° ) and malalignment of the upper and lower arches presented for orthodontic treatment (Figure 1). Informed consent was obtained from the patient who underwent examination and record taking. This involved clinical, orthodontic and temporomandibular disorder (TMD) evaluations, 16 a radiographic assessment (panoramic), lateral cephalometry (Figure 2), stone casts, intra-oral (Figure 1) and extra-oral photos, and upper and lower arch impressions to generate a ClinCheck ® assessment. The clinical examination revealed a molar and canine Class I relationship, an overjet of 1 mm, an overbite of 2.5 mm, a crossbite between teeth 24 and 34, upper and lower crowding, and severe rotations of lower incisors (32 rotated 45 ° and 42 rotated 44 ° ). The assessment of the temporomandibular joints 17 revealed no signs and/or symptoms of TMD. Cephalometric analysis showed a skeletal Class I-III relationship according to Steiner 17,18 with an ANB angle of -1 degree (mean of 2 ° ± 2 ° ), a hypodivergent craniofacial form indicated by a SN-GoGn angle of 27 degrees (mean of 32 ° ± 4 ° ), an interincisal angle of 145 degrees (mean of 135 ± 5 ), a counterclockwise growth rotation according to Siriwat and Jarabak, 19 with a PostHt/AntHt ratio of 72% (mean of 60-64%) and a counterclockwise growth rotation according to Bjork 21 of 387 degrees (mean of 396 ° ± 6 ° ). Invisalign treatment was planned to correct the dental crossbite, the severe rotations of 32 and 42 and the upper and lower malalignment. The final ClinCheck ® (version 2.9, Align Technology Inc., Santa Clara, CA, USA) provided 17 aligners for the upper arch and 23 aligners for the lower arch (Figures 3 and 4). The duration of therapy was assessed to require approximately 12 months. Each aligner was to be worn for two weeks. No inter-proximal reduction (IPR) was indicated for the correction of the crowding. Retention attachments were planned on several upper teeth (13, 14, 23, 24, 26, 27) and on several lower teeth (32, 33, 34, 36, 42, 43, 44, 45). Treatment progress was checked every 4 weeks (2 aligners every month) using the ClinCheck ® analysis to evaluate changes, patient compliance and bonded attachment stability. A new aligner was inserted at each appointment. The precise relationship and connection between the attachments, the aligner and the teeth, provided an indication of the positive progress of treatment. As compliance is critical in all orthodontic therapy, the patient was instructed to wear the aligners full time, except for eating and tooth brushing. The aligners were worn for a minimum of 20 hours per day. A patient with a dental crossbite, severe rotations of lower incisors and malalignment of the upper and lower arches was treated with the Invisalign appliance. Patient compliance was high throughout treatment and excellent oral hygiene was maintained. The molar and canine Class I relationships were maintained, as well as the overjet. The overbite improved (2.5 mm pretreatment, 1 mm post-treatment); the dental crossbite, the crowding (Figure 5) and the severe tooth rotations (with a mean of 2 ° of correction per aligner) were corrected (Figure 6). No obvious root resorption was radiographically evident at the end of therapy (Figure 7). A lower fixed retainer was bonded from the right first premolar to left first premolar to maintain lower incisor alignment. Retention in the upper arch was provided by the last aligner used as a nocturnal removable retainer. In 2003, Joffe 20 defined the criteria for selecting Invisalign patients and emphasised that caution should be taken in specific malocclusions involving severe tooth rotations (more than 20 ° ). In the presented case, a correction of 45 degrees and 44 degrees for teeth 32 and 42 respectively, was achieved with 23 lower aligners, using accepted treatment protocols. The rotated incisors were derotated approximately 2 degrees per aligner and the final result was achieved in 12 months. This result may be due to the recent significant improvement in Invisalign technology which has allowed the treatment of more difficult malocclusions over a shorter time. The introduction of the G3 and G4 platforms with new smart force features has also potentially allowed more predictable tooth movement. The Invisalign system can be a useful therapeutic tool to correct a dental malocclusion involving severe rotations. The presented case confirmed that: 1. The correction of a crossbite in an adult patient is possible with clear aligners. 2. Severe tooth rotations of lower incisors (up to 45 ° ) can be corrected with clear aligners. The logistical support of Equipe Dentale Srl was greatly ...
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This case report describes the treatment of an adult with Class II division 2 malocclusion. The patient had class II molar and class II canine relationships, retroclined upper incisors, excessive deep bite and severe crowding. The patient was treated by incisor protrusion. Auto rotation of mandible was noticed after initial levelling and aligning o...
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The attempt of this article was to assess reliability of Little’s Irregularity Index (LII) as for stability of the treatment outcomes in adults with crowded mandibular incisors. LII was measured on a digital cast prior to an orthodontic treatment (T1) of the 302 patients thus allowing us to establish the treatment plan, which called for (a) expansi...
Citations
... Clear aligners emerge as the times require. Clear aligners have currently been used for more complex orthodontic tooth movements, including tooth rotation, molar distalization, and dental expansion with the advancement of attachments and materials, and their application scope has been extended from non-extraction to extraction cases [4,[16][17][18]. Therefore, according to the requirement of this patient, we chose clear aligners to overcome the aesthetic defects in the orthodontic treatment process. ...
Frequently, orthodontic treatment involves symmetrically extracting premolars to correct severe crowding or protrusion. Nevertheless, in some cases, a more reasonable alternative may be to remove teeth with poor prognoses to improve protrusion and relieve crowding. A middle-aged woman sought treatment for dental protrusion and crowding. Her mandibular right first molar had been treated with root canal therapy due to pulpitis, but she still felt uncomfortable. In addition, her maxillary left second premolar had become carious. Extractions of the maxillary right first premolar and left second premolar, as well as mandibular right first molar and left first premolar were chosen to resolve the occlusion problems. The patient opted for clear aligners on the demands of esthetics as well as comfort. Following orthodontic treatment, the patient attained properly aligned teeth, a pleasing smile, and a facial profile that exhibited greater harmony. This case report demonstrates that, under proper planning, clear aligners are capable of handling challenging cases, including those involving middle-aged individuals and molar extractions.
... As clear aligner technology has made dramatic progress in recent years, its use has become more practical even in mild-to-severe malocclusion cases. 1,2 According to Hennessy and Al-Awadhi, 3 clear aligner treatment (CAT) can achieve expansion, constriction, intrusion, extrusion, tipping, buccolingual tipping, and rotation of the anterior dentition through tooth movement. 3 Unfortunately, the overall accuracy of CAT's tooth movement is reported to be only 41%. ...
Objectives
To analyze the effects of maxillary tooth distalization by clear aligner (CA) treatment with variations in the angular direction of the distalization force, presence of attachments, and force-application method used.
Materials and Methods
A finite element model containing alveolar bone, dentition, and periodontal ligament was constructed. Analytical model groups were as follows: (1) distalization with buttons (without attachments), (2) buttons on canines (with attachments), (3) precision cuts on the canines (without attachments), and (4) precision cuts on the canines (with attachments). A distalization force of 1.5 N was applied to the button or precision cut at −30°, −20°, −10°, 0°, 10°, 20°, and 30° to the occlusal plane.
Results
As the direction of force approached +30°, the dentition inclined posteriorly. The posterior movement pattern was significantly influenced by the presence of an attachment and the direction of force, rather than the area where the force was applied. Distal inclination was dramatically reduced with attachments. A disengagement or deformation of the CA may reduce the distalization efficiency of the dentition or move the dentition in an inappropriate direction.
Conclusions
Attachments for efficient distalization by the CA are necessary. The use of miniscrews in the direction of force parallel to the occlusal plane is more advantageous than the use of Class II elastics. Due to CA deformation, distalization with the button on the canines can be more effective for distal movement of the maxillary dentition.
... 6 Numerous successful cases supporting that clear aligner therapy can treat almost any orthodontic condition ranging from mild to severe malocclusions have been reported. 6,7 White spot lesions (WSLs) are defined as occasional white or ashy grey lesions of a small surface area limited to tooth enamel. 8 The difference in the refractive index between healthy enamel and demineralised area results in a lesion of milky-white opaque appearance that is readily distinguishable from the surrounding healthy enamel. ...
Objectives: To determine if an association exists between the prevalence of white spot lesions (WSLs) and orthodontic treatment using clear aligners.
Methods: Electronic databases were searched with no restrictions on year. Article selection criteria included human clear aligner studies conducted during the permanent dentition and with a full description of the applied technique and oral hygiene status.
Results: The search strategy resulted in a total of 4177 articles. After title and abstract screening, 156 relevant articles were identified from which five remained after the application of the exclusion criteria. The articles were mostly classified as having a low risk of bias.
Conclusions: Clear aligner therapy induces a lower development rate of new WSLs than orthodontic treatment by fixed appliances. In patients who have poor oral hygiene and/or existing WSLs, clear aligner treatment could be recommended.
... With the advancement of attachments and materials, CAT is currently used for more complex orthodontic tooth movements, including molar distalization, dental expansion, and tooth rotations. [3][4][5] Alveolar bone defects are often manifested in adults before the initiation of OT. 6 Palomo et al 7 have defined alveolar bone fenestrations (ABFs) as areas in which the tooth root is denuded of bone, and the root surface is covered only by periosteum and gingiva, whereas denuded areas involving the alveolar margin have been defined as alveolar bone dehiscences (ABDs). 7,8 The prevalence of ABDs has been reported to vary between 7%-89%, [9][10][11][12] whereas the prevalence of ABFs ranges between 5%-61%. ...
Introduction: This study aimed to assess the association between nonextraction clear aligner therapy (CAT)
and the presence of alveolar bone dehiscences (ABDs) and fenestrations (ABFs) in adults with mild-tomoderate
crowding. Methods: Cone-beam computed tomography images from 29 adults were obtained before
and immediately after nonextraction CAT. Total root lengths were evaluated in axial and cross-sectional slices.
Linear measurement for dehiscence (LM-D) was defined as the distance between the alveolar crest to the
cementoenamel junction of each root (critical point set at 2 mm). Linear measurement for fenestration (LM-F)
was recorded when the defect involved only the apical one-third of a root (critical point set at 2.2 mm).
Counts of ABDs/ABFs and magnitudes of LM-Ds/LM-Fs were recorded before and immediately after
nonextraction CAT at buccal and lingual root surfaces. Binary logistic regression analyses and repeated
measures analyses of variance were performed. Results: Counts of ABDs/ABFs and magnitudes of LM-Ds/
LM-Fs increased at most jaw locations and root surfaces. Nonextraction CAT was associated with an
increased presence of ABDs and ABFs. Nonextraction CAT was associated with a higher magnitude of LMDs
but not LM-Fs. Conclusions: Immediate posttreatment cone-beam computed tomography scans showed
that nonextraction CAT is associated with increased ABDs and ABFs in adults with mild-to-moderate
crowding.
... Many authors reported that today the clear aligners are able to treat almost every malocclusion in adult patients, from mild to severe [5][6][7], but few authors have reported on the use of sequential clear aligners in mixed dentition [3,4,8]. In 2019, Blevins [3] described three cases with the Invisalign First System ® used to treat dental crowding, class II malocclusion, deepbite and anterior crossbite. ...
Background
One goal of orthodontic treatment in mixed dentition is to expand the maxillary arch to allow proper tooth alignment and a correction of sagittal and vertical malocclusions. However, for most treatment protocols, expected outcome is not really clear to allow for a standardization of phase I orthodontic treatments. This lack of information makes it difficult for clinicians to predict tooth movements, including transverse expansion efficacy with Invisalign® (Align Technology, Santa Clara, CA, USA) in children. Therefore, the aim of the present study was to evaluate the transverse maxillary arch development with the Invisalign First System® in growing subjects.Methods
The study group included 23 subjects (9 females, 14 males, mean age 9.4 ± 1.2 years). Patients were treated nonextraction with Invisalign First System® clear aligners with no auxiliaries other than Invisalign® attachments. Transverse interdental widths were measured only in the upper arch on each model at the start (T1) and at the end (T2) of treatment. A paired t‑test was chosen to compare T2–T1 changes. The level of significance was set at 5%.ResultsThe greatest increase of maxillary width was detected at the level of the upper first deciduous molars (+3.7 ± 1.4 mm; P < 0.001), followed by the level of the second deciduous molars (+3.4 ± 1.6 mm; P < 0.001) and by the deciduous canine (+2.6 ± 2.0 mm; P < 0.001). Upper first molars showed a greater expansion in the intermolar mesial width (+3.2 ± 1.2 mm; P < 0.001) than in the intermolar distal (+1.7 ± 1.2 mm; P < 0.001) and transpalatal width (+1.2 ± 1.2 mm; P < 0.01).Conclusions
The Invisalign First System® can be considered effective in growing patients who require maxillary arch development. The greatest net increase was detected at the level of upper first deciduous molars, whereas the upper first molars showed a greater expansion in the intermolar mesial width due to a rotation that occurs around its palatal root.
... [2] However, several researchers have successfully demonstrated how the present appliances can correct and treat almost all diseases, ranging from mild to severe malocclusion, with better periodontal status. [3][4][5] Despite the known effectiveness of conventional methods practiced across the world, the shortcomings associated with these methods cannot be overlooked. For instance, the conventional methods in dentistry are inconvenient and even painful, often posing difficulty in cleaning. ...
Background:
Although several researchers have analyzed the dental identity of patients experience with corrective methods using fixed and removable appliances, the consequences stay debatable. This meta-analysis intended to verify whether the periodontal status of removable appliances is similar to that of the conventional fixed appliances.
Methods:
Relevant literature was retrieved from the database of Cochrane library, PubMed, EMBASE, and CNKI until December 2019, without time or language restrictions. Comparative clinical studies assessing periodontal conditions between removable appliances and fixed appliances were included for analysis. The data was analyzed using the Stata 12.0 software.
Results:
A total of 13 articles involving 598 subjects were selected for this meta-analysis. We found that the plaque index (PLI) identity of the removable appliances group was significantly lower compared to the fixed appliances group at 3 months (OR = -0.57, 95% CI: -0.98 to -0.16, P = .006) and 6 months (OR = -1.10, 95% CI: -1.60 to -0.61, P = .000). The gingival index (GI) of the removable appliances group was lower at 6 months (OR = -1.14, 95% CI: -1.95 to -0.34, P = .005), but the difference was not statistically significant at 3 months (OR = -0.20, 95% CI: -0.50 to 0.10, P = .185) when compared with that of the fixed appliances group. The sulcus probing depth (SPD) of the removable appliances group was lower compared to the fixed appliances group at 3 months (OR = -0.26, 95% CI: -0.52 to -0.01, P = .047) and 6 months (OR = -0.42, 95% CI: -0.83 to -0.01, P = .045). The shape of the funnel plot was symmetrical, indicating no obvious publication bias in the Begg test (P = .174); the Egger test also indicated no obvious publication bias (P = .1).
Conclusion:
Our meta-analysis demonstrated that malocclusion patients treated with the removable appliances demonstrated a better periodontal status as compared with those treated with fixed orthodontic appliances. However, the analyses of more numbers of clinical trials are warranted to confirm this conclusion.
... To date, it has been devised in a variety of materials and thicknesses for efficient orthodontic treatment [3][4][5]. At present, the method for fabricating an aligner using a digital setup model designed by simulating tooth movement via a computer has become widespread, and orthodontic treatment by aligner has expanded the range of application from minor tooth movement to whole teeth orthodontic treatment to full jaw treatment [6][7][8][9]. With the spread of orthodontic treatment using thermoplastic orthodontic appliances, many experiments have been conducted to investigate the orthodontic force exerted by such appliances. ...
The aim of this study was to investigate the orthodontic force exerted by thermoplastic orthodontic appliances incorporating Eucommia ulmoides in terms of usefulness as the aligner-type orthodontic device. Erkodur, Essix C+ ® , Eucommia elastomer, and edgewise brackets were used (n = 3, each; thickness = 1.0 mm, each). The orthodontic force on the upper right incisor was measured every 24 h for two weeks using a custom-made measuring device. The force of the Eucommia elastomer (4.25 ± 0.274 N) and multi bracket system (5.32 ± 0.338 N) did not change from the beginning to the end (p > 0.01). The orthodontic force exerted by the Eucommia elastomer was lower than that of the multi-bracket orthodontic appliance from the beginning to the end. The force of Erkodur significantly decreased from the beginning to 24 h (6.47 ± 1.40 N) and 48 h (3.30 ± 0.536 N) (p < 0.01). The force of Essix C+ ® significantly decreased from the beginning (13.2 ± 0.845 N) to 24 h (8.77 ± 0.231 N) (p < 0.01). The thermoplastic orthodontic appliance made of Eucommia elastomer continuously exerted a constant orthodontic force for two weeks under water immersion conditions. The orthodontic force of Eucommia elastomer was found to be similar to the orthodontic force exerted by the multi-bracket orthodontic appliance with 0.019 × 0.025 in nickel-titanium wire. These results suggest that the Eucommia elastomer has possibly become one of the more useful materials to form thermoplastic orthodontic appliance exerting low continues orthodontic force.
... Furthermore, analysis of the force direction required for the tooth movement and adjustment of the amount of tooth movement by bonding an attachment to the tooth surface were determined for the correct force loading in an optimal direction 8,9) . Thus, at present, treatment using thermoplastic orthodontic appliances has been expanded from minor tooth movement to whole teeth orthodontic treatment [10][11][12][13] . ...
The aim of this study was to identify a physical property suitable for evaluating the orthodontic force by analyzing the physical properties of thermoplastic materials. Four thermoplastic materials were used: Essix A+® Plastic (EA), DURAN® (DU), Erkodur (ER), and Essix C+® Plastic (EC). Finite element analysis (FEA), a water absorption test, constant strain loading test, X-ray diffraction (XRD) and Fourier transformation infrared spectroscopy analysis were conducted. FEA found a significant correlation between the elastic modulus and the orthodontic force. The water absorption of EC was significantly smaller than the other materials. EC showed no elastic modulus change. The XRD pattern indicated that EC was a crystalline polymer. FEA of thermoplastics showed that the elastic modulus is suitable for the evaluation of orthodontic force. The crystalline thermoplastic EC demonstrated a stable elastic modulus even under strain in a wet environment, suggesting the advantage of its use as an orthodontic aligner material.
... With development of material and computer design of tooth movement, the indication of clear aligners has been greatly enlarged. Many researchers reported successful cases to prove that the clear aligners today have been able to treat almost everything from mild to severe malocclusions [2,3]. Fixed braces have been the conventional and effective orthodontic appliance for over a hundred years. ...
Background
Align technology has developed greatly over past few years. Patients tended to prefer clear aligners over conventional brackets because of the superior comfort and esthetics, while the effectiveness of clear aligners was still controversial. The aim of this systematic review was to verify whether the treatment effectiveness of clear aligners was similar to the conventional fixed appliances.
Methods
A comprehensive search of the Pubmed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Clinical Trials Register databases for studies published through to August 20, 2018 was conducted. Comparative clinical studies assessing the effectiveness of clear aligners compared with braces were included.
Results
Eight papers were included in this study. Two of the included papers were randomized controlled trials and six were cohort studies. Clear aligners might not be as effective as braces in producing adequate occlusal contacts, controlling teeth torque, increasing transverse width and retention. While no statistically significant difference was found between two groups in Objective Grading System score (WMD = 8.38, 95% CI [− 0.17, 16.93]; P = 0.05). On the other hand, patients treated with clear aligners had a statistically significant shorter treatment duration than with braces (WMD = − 6.31, 95% CI [− 8.37, − 4.24]; P < 0.001).
Conclusion
Both clear aligners and braces were effective in treating malocclusion. Clear aligners had advantage in segmented movement of teeth and shortened treatment duration, but were not as effective as braces in producing adequate occlusal contacts, controlling teeth torque, and retention.
... Severe canine rotation more than 15°(clinically discernable amount of malrotation) is an orthodontic movement reported to be difficult to achieve and control with the Invisalign system [10]. When rotations are greater than 15°, the accuracy of the canine is significantly reduced [11]. ...
... Previous studies have reported that significant rotations of teeth particularly in the mandibular canines have not been achieved satisfactorily using the Invisalign system. [12] In this regard Gianluigi and Tommaso who carried out a treatment with Invisalign found that the rotation of mandibular canines only was achieved one third of the expected and the accuracy of canine rotation (more than 20 degrees) [10] was significantly lower than the rotation of the other teeth [9,13]. ...
Introduction: The Invisalign system has been used in the orthodontic treatment of numerous types of malocclusions. However some clinicians have reported difficulty incorrecting rotations particularly in canines and premolars using the Invisalign appliance system. This case report describes the orthodontic treatment of an adult patient with severe canine rotation (more than 45°) and crowding on upper and lower tooth.Methods: The clinical examination included extra-oral and intra-oral photographs, panoramic radiographic, lateral cephalometric, stone casts, and upper and lower arch analysis obtained from ClinCheck 3.0.The treatment planning was resolved the crowding in both upper and lower arches and the severe rotation of 33 tooth (46°) using Invisalign system as well as the canine and molar relationship, dental verticalization, adequate over jet, overbite and dental midline using the same system. The duration of the treatment was approximately eight months.Results: In Post-treatment extra oralphotographs, no significant changes were observed at the end of the treatment. Intraoral photographs showed an important and notable improved aesthetics. The canine relationship improved slightly and molar Class Irelationship was maintained. An increase in transverse diameter was observed at the level of first premolars, second premolars and first molars. The overbite was improved. The crowding and the severe canine rotation were corrected. No obvious root resorption was radiographically evident and slight cephalometric changes.Conclusion: The treatment with the Invisalign system resolved the complaint of our patient so this system could be considered as an option that offered good results in the treatment of upper and lower crowding of arches involving severe canine rotation.
