Accuracy evaluation of orthodontic movements with aligners: a prospective observational study.

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.

Rapid palatal expansion: the role of microcirculation.

AIM: Transverse palate modifications fall under expansive orthopedic therapy of the upper maxilla. The only practical approach to the problem on the transverse plane is that of performing the expansion of the maxillary arch through an opening of the median palatal suture. It is important to understand the changes of the vascular network in midpalatal suture following the starting of rapid maxillary expansion. It is critical to maintain the blood supply and circulation for the osteogenesis and bone remodeling after the expansion. The aim of this research was to evaluate the effects of rapid orthopedic expansion (REP) at the microcirculatory level through capillaroscopic examination. METHODS: Fifteen patients in their developing years between 9 and 15 years of age (average age 12.16 years) were examined. The application of the REP was the first step in the planning of orthopedic-orthodontic treatment which foresaw further stages in the odonto-osseous movement. The method of Biomicroscopic Video-Imaging of the microcirculation of oral mucosa is performed through the technique of computerized capillaroscopy and the related software. RESULTS: From the results it is evident that immediately after achieving the expansion of the upper maxilla (t1), a slight decrease in the number of vessels per mm² can be observed. In addition, a slight ectasia can be observed in these vessels in comparison to t0. Comparing the videocapillaroscopic images of t1 and t2, an increase in the capillaries per mm² can be observed. CONCLUSION: Ectasia of the capillaries, though subject to strictly individual variables, can be considered perfectly normal and it is compatible with the normal biology and physiology of vessel microcirculation.