Effect of clear aligner type on maxillary full-arch intrusion: 3D analysis using finite element method.

BACKGROUND: Vertical maxillary excess (VME) is one of the most common reasons for seeking orthodontic treatment. Total intrusion with aligners is a promising alternative to surgery in some cases. Considering the elastic deformation of aligners, this study aimed to evaluate the possible desirable and undesirable teeth displacements during full maxillary arch intrusion using clear aligners and temporary anchorage devices (TADs). METHODS: The maxillary arch and clear aligners were modeled in SolidWorks. Four aligner brands including Leon, Duran, Duran Plus, and Essix Plus were selected based on their material properties. Anterior and posterior intrusion forces of 80 and 300 g were applied from attachments between the canines and first premolars and between the first and second molars, respectively. Vertical and anteroposterior tooth displacements were determined. RESULTS: The greatest intrusion was recorded at the buccal of the second molar, followed by the first molar. The lowest value was measured at the palatal of the molars with all aligners except Duran, which indicated minimal intrusion in the central incisor. All teeth were mesially displaced at the incisal/occlusal except incisors that moved distally. All apices showed distal movement. CONCLUSIONS: Total intrusion using clear aligners may be accompanied by other tooth movements, including buccal tipping and mesial-in rotation of the molars, retrusion of incisors, and mesial movement of other teeth.

Content analysis of AI-generated (ChatGPT) responses concerning orthodontic clear aligners.

OBJECTIVES: To assess the accuracy of ChatGPT answers concerning orthodontic clear aligners. MATERIALS AND METHODS: A cross-sectional content analysis of ChatGPT generated responses to queries related to clear aligner treatment (CAT) was undertaken. A total of 111 questions were generated by three orthodontists based on a set of predefined domains and subdomains. The artificial intelligence (AI)-generated (ChatGPT) answers were extracted and their accuracy was determined independently by five orthodontists. The accuracy of answers was assessed using a prepiloted four-point scale scoring rubric. Descriptive statistics were performed. RESULTS: The total mean accuracy score for the entire set was 2.6 ± 1.1. It was noted that 58% of the AI-generated answers were scored as objectively true, 18% were selected facts, 9% were minimal facts, and 15% were false. False claims included the ability of CAT to reduce the need for orthognathic surgery (4.0 ± 0.0), improve airway function (3.8 ± 0.5), achieve root parallelism (3.6 ± 0.5), alleviate sleep apnea (3.8 ± 0.5), and produce more stable results compared to fixed appliances (3.8 ± 0.5). CONCLUSIONS: The overall level of accuracy of ChatGPT responses to questions concerning CAT was suboptimal and lacked citations to relevant literature. Ability of the software to offer current and precise information was limited. Therefore, clinicians and patients must be mindful of false claims and relevant facts omitted in the answers generated by ChatGPT.

Surgery first with clear aligners for a Class II patient: Case report and literature review.

Orthognathic surgery has undergone multiple modifications in timing approaches, among them, surgery first represents an approach that potentially reduces length of time and shows earlier results in facial changes, nevertheless, it has been used mostly to treat Class III skeletal anomalies. Also, fixed appliances orthodontics is the most common choice, however, recent literature shows clear aligners can achieve the same results. This paper presents a case of a 20-year-old female with a skeletal Class II treated with surgery first and clear aligners protocol, with a literature review of surgery first in Class II patients; evidencing that this approach can be suitable to achieve satisfactory and stable results, although larger patient samples are needed.

Cigarette smoke and tobacco heating aerosol on the aging of clear aligners.

BACKGROUND: The treatments with clear aligners (CA) showed an exponential higher percentage in the last years being almost invisible with major patient acceptability and a resulting improvement in quality of life. CA are composed of thermoplastic polyurethane not inert but subjected to changes due to heating and humidity, chewing forces, and prolonged exposure to enzymes in saliva in the oral cavity and external factors. Cigarette smoke (CS) and the aerosol produced by tobacco products with reduced health risks may be considered among the external factors affecting CA. The purpose of this study was the assessment of optical properties (absorbance and transmittance) and roughness of CA after in vitro aging due to exposition to CS and THS2.2, compared to controls. The secondary objective will be the investigation of CS and THS2.2 effects on resin composite inside aligners used for attachments during treatment with CA. METHODS: A total number of 60 CA units will be used and equally divided in three different groups (20 in each): CS group exposed to reference cigarettes smoking, THS2.2 group exposed to aerosol from 20 heat-not-burn sticks, and control group, CG to pure air only. The aligners will present ten introflection for the attachments on the anterior part. In accordance with ISO standard 3402, 3R4F cigarettes and THS2.2 tobacco sticks must undergo conditioning for a minimum of 48 hours and a maximum of 21 days at a temperature of 22±1 °C and a relative humidity of 60±3%. RESULTS: Using spectrophotometry, the optical characteristics (absorbance and transmittance) of each aligner will be evaluated after aging (Jasco UV-vis V630PC, Tokyo, Japan). Each aligner will be cut with a rotating saw from canine to canine prior to the measurements in order to lop off the lingual region and displaying the labial barrier. The absorbance and transmittance measurements will be collected and statistically analyzed with a significance of P<0.05. CONCLUSIONS: Surface roughness of the aligners and attachments inside them will be assessed by 3D scanning microscopy (Infinite Focus G4h). Color of resin composite will be assessed using the (CIE Lab) Commission Internationale de l'Eclairage L*a*b* color space by means of Olympus CrystalEyef dental spectrophotometer. Clinicians should advise patients to refrain from smoking and drinking coffee or tea while wearing aligners for two reasons: first, the color change is unacceptably noticeable when wearing aligners, and second, the material's chemical composition may be slightly altered, which could affect the intended dental movements.

The use of clear aligners in orthognathic surgeries: a case series.

Pre- and postoperative fixed orthodontic appliances are the customary and standard practice for patients with treatment planned for undergoing orthognathic surgery. Traditionally, most patients undergoing orthognathic surgeries are in their late teens. Although these patients still compose the greatest pool of the orthognathic surgery population, many patients seek orthognathic surgery later in life. This older patient population often has different concerns and goals than the younger patient population. One of these concerns is often the aesthetic appearance of fixed appliances and the time required to wear these appliances pre- and postoperatively. Today, removable orthodontic appliances consisting of a series of clear aligners have gained immense popularity due to their aesthetic appeal over traditional braces. Additional benefits of removable orthodontic appliances include improved oral hygiene leading to a decreased risk of gingivitis. Whereas clear aligner systems are commonly used in the nonsurgical orthodontic population, there has been limited use of Invisalign in the orthognathic surgery population. In this article, we present a case series of 5 patients who successfully underwent orthognathic surgery using clear aligners for pre- and postoperative orthodontic treatment.

Cierre de mordida abierta con alineadores / Open bite closure with aligners

Los avances tecnológicos referidos a los alineadores nos demuestran que pueden ser utilizados tanto en tratamientos simples como en maloclusiones complejas, como en este caso de una mordida abierta. En este artículo presentamos un caso clínico de una paciente de 36 años, quien concurre a la consulta expresando no estar conforme con su estética y con el funcionamiento de su boca.

Protocolo biodigital aplicado al tratamiento de Ortodoncia con alineadores: caso clínico / Biodigital protocol applied to orthodontic treatment with aligners: a clinical case

En la actualidad, contamos con softwares de diseño que nos permiten planificaciones precisas y eficientes de nuestros tratamientos; por lo tanto, nuestros diagnósticos deben estar a la altura. En este artículo presentaremos un caso clínico que se ha desarrollado en el marco de la Diplomatura en Ortodoncia con Alineadores de la Sociedad Argentina Ortodoncia (SAO), donde trabajamos cada pieza dentaria de manera independiente, mediante la técnica de Ortodoncia con alineadores. Teniendo en cuenta que contamos con un stock óseo reducido, utilizamos como aliado un gran recurso: la tomografía computada de haz cónico (CBCT). Esta nos garantiza trabajar con seguridad en casos donde las limitaciones óseas nos dificultan los movimientos dentarios.

We currently find design softwares that allows us to plan our treatments accurately and efficiently; therefore, our diagnoses must be up to par. In this article we will present a clinical case that has been developed within the framework of the Subspeciality in Orthodontics with Aligners Argentine Society of Orthodontics (SAO), where we work, through the orthodontic technique with aligners, each tooth independently. Considering that we have a reduced bone stock, we use as an ally a great resource, the cone beam computed tomography (CBCT), which guarantees us to work safely in these cases where bone limitations hinder tooth movements.

Harnessing the Power of PAOO and Invisalign: An Interdisciplinary Approach to Orthodontic Care.

The present article explores the benefits of combining periodontally accelerated osteogenic orthodontics (PAOO) with Invisalign for optimal orthodontic treatment outcomes. PAOO is an interdisciplinary dental technique that minimizes complications and accelerates tooth movement while enhancing various orthodontic treatments. In conjunction with Invisalign, PAOO provides a discreet and comfortable solution for patients seeking to improve their smile. The study presents two challenging cases successfully treated using this combined approach, emphasizing the technique's potential to reduce treatment times and improve orthodontic outcomes. The interdisciplinary approach of PAOO ensures long-term success and stability by preserving periodontal structures and addressing potential bony defects. By incorporating bone grafting materials, PAOO helps prevent common concerns in traditional orthodontic treatments, such as bony defects and gingival recession. Furthermore, the combination with Invisalign offers a more aesthetically pleasing and comfortable treatment experience, allowing patients to maintain their self-esteem and confidence throughout the treatment. Despite the potential advantages, dental professionals must manage patient expectations and address potential complications to ensure the best possible results. Overall, the integration of PAOO and Invisalign demonstrates a viable alternative for patients who do not want to proceed with orthognathic surgery, enhancing patient satisfaction and overall treatment outcomes.

Orthognathic surgery and aligners. A comparative assessment of periodontal health and quality of life in postsurgical orthodontic treatment with aligners versus traditional fixed appliances: a randomized controlled trial.

BACKGROUND: Removable clear aligners have become very popular in the last few decades, but they are still little used in the field of orthognathic surgery (OS). The objective of this study was to compare periodontal health and quality of life (QoL) associated to postsurgical orthodontic treatment. MATERIAL AND METHODS: Patients with dentofacial deformities undergoing OS were randomly allocated to receive postsurgical orthodontic treatment with either fixed orthodontic appliances or Invisalign. The main outcomes were periodontal health and QoL. Plaque index, probing depth and bleeding on probing were assessed as periodontal health indicators. QoL was assessed through the Orthognathic Quality of Life Questionnaire (OQLQ-22) and the Oral Health Impact Profile (OHIP-14). Data were analyzed before surgery and end of treatment. Total duration of treatment was also recorded. RESULTS: Twenty-eight patients were randomized, (16 women, 12 men). Periodontal assessment showed better outcomes for the Invisalign group: bleeding on probing (p=0.013), plaque index (p=0.001) and probing depth (p<0.001). The QoL questionnaires showed significant differences in favor of the Invisalign group: OHIP-14 (p=0.004) and OQLQ-22 (p=0.002). Total duration of treatment was similar in both groups (p=0.575). CONCLUSIONS: Compared to traditional orthodontics with fixed appliances, patients managed with clear aligners after OS (surgery-first approach) had better periodontal health and QoL outcomes.

Comparison of the bond strength of five different composites used in the production of clear aligner attachments.

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.

Clear Aligners Treatment of Class III Subdivision with an Extraction of a Lower Bicuspid.

The aim of this study was to show a case of a Class III subdivision adult patient treated with clear aligners (CA) and the extraction of a lower bicuspid. A 19-year-old male with a class III canine and molar relationship on the right side and a deviation of lower dental midline to the left asked for an aesthetic treatment. He refused orthognathic surgical procedures, so he was offered a camouflage orthodontic treatment with the extraction of lower right first premolar to achieve a canine Class I relationship and to center the lower midline. The treatment was performed with clear aligners and the use of Class III elastics to maintain distal anchorage on the right side during the canine distalization. At the end of the treatment, the occlusal objectives were achieved.

Clear aligners combined with orthognathic surgery: a case series.

The goal of this study was to describe a series of orthognathic surgery cases in which a clear aligner system was used for orthodontic treatment. A total of 16 cases were undertaken. A majority of the patients were female (68.75%), and the mean age of the patients was 26.78 years (SD 10.85 years). The most frequent malocclusion was Class II (56.25%), mainly caused by mandibular retrognathism (80.00%). Most of the patients were treated with single-jaw surgeries (56.15%). Orthodontic buttons and elastics were used for maxillomandibular fixation in 81.25% of the patients. The mean (SD) treatment period was 19.00 (1.11) months, and the postsurgical follow-up varied from 6 months to 10 years. Good results were achieved with orthognathic surgery and the adjunctive use of clear aligners, and no damage was noted during the orthosurgical treatment. Since clear aligners provide an esthetic, removable appliance and may be more acceptable to patients than conventional orthodontic appliances, the use of clear aligners in orthognathic surgery is a promising alternative to traditional orthodontics.

Yttrium aluminum garnet-based filler resin composites used as clear aligner attachments.

The objective of this study was to develop a novel resin composite containing yttrium aluminum garnet (Y3Al5O12, YAG) nanoparticles for clear aligner attachments. After the silanization of YAG, their Fourier-transform infrared (FT-IR) and thermogravimetric (TGA) analyses were performed. By conducting flexural and compressive strength measurements, the optimal YAG concentration was selected for the subsequent experiments. Next, Vickers microhardness values, fluidities, attachment volumes, conversion degrees, and volumetric shrinkages of the resin were determined. The obtained FT-IR and TG results revealed that γ-methacryloxypropy ltrimethoxysilane coupling agent was successfully grafted onto the surface of YAG, which enabled their use as inorganic fillers. Furthermore, adding 9 wt% YAG in the resin can increase Vickers hardness and fluidity, reduce polymerization shrinkage, and enhance the restoration of the clear aligner attachment shape on the premise of guarantee proper flexural and compressive strength of the resin, which can help control tooth movement and increase orthodontic efficiency.

Do patients treated with Invisalign have less swelling after orthognathic surgery than those with fixed orthodontic appliances?

INTRODUCTION: Patients treated with perioperative Invisalign for orthognathic surgery may experience less postoperative swelling than those with fixed appliances because of a lack of mucosal irritation from bonded brackets and wires. The aims of this study were to (1) compare facial swelling after orthognathic surgery in subjects with Invisalign to those with fixed appliances using 3-dimensional (3D) subtraction imaging and (2) determine if the type of operation influences differences in swelling. METHODS: This is a retrospective case-control study. To be included in the case group (Invisalign), patients had to have had: (1) LeFort I and/or bilateral sagittal split osteotomies, with or without genioplasty, (2) perioperative orthodontic treatment using Invisalign, and (3) 3D photographs at postoperative timepoints 1 week (T1), 3-4 weeks (T2), and 5-7 weeks. A sex and operation-matched control group with fixed appliances (standard) was also included. The primary outcome variable was the volume of facial swelling, measured by subtraction imposition of the T1 and T2 3D images using reference images (5-7 weeks). RESULTS: Twenty-two subjects (36% female; mean age 20.7 ± 3.15 years) were included: Invisalign (n = 11) and standard (n = 11). For each group, 7 subjects had 1 operation (LeFort I or bilateral sagittal split osteotomies), and 4 had bimaxillary surgery ± genioplasty. At T1, the Invisalign group had significantly less swelling than the standard group (17.52 ± 10.79 cm3 vs 37.53 ± 14.62 cm3; P <0.001). By T2, the differences were no longer significant (6.62 ± 5.19 cm3 for Invisalign; 5.85 ± 4.39 cm3 for standard, P = 0.728). CONCLUSION: Subjects with Invisalign had significantly less facial swelling in the first postoperative week than those with fixed appliances.

Assessment of the occlusal outcomes in patients treated with orthognathic surgery and clear aligners.

OBJECTIVE: This retrospective two-centre study aimed to evaluate the occlusal outcomes in patients undergoing orthognathic surgery with clear aligners. METHODS: A retrospective chart review and occlusal outcomes for 15 patients (10 females and five males) with different types of dentofacial deformities in the anteroposterior, vertical and transverse dimensions, who underwent orthognathic surgery in conjunction with clear aligners were evaluated. Weighed Peer Assessment Rating (PAR) index scores of the pre-treatment and post-treatment digital models were used to assess initial complexity, final occlusal outcomes and degree of improvement with surgery and clear aligners. RESULTS: The mean post-treatment PAR score was 3.5 ± 2.54, which was a statistically significant improvement from the pre-treatment PAR score of 27.63 ± 12.09, an 87% improvement was achieved. All subcategories of the PAR index showed statistically significant improvement except for midline assessment component. CONCLUSIONS: Occlusal outcomes with aligners showed great improvement as indicated with the PAR index scores. Orthognathic surgical cases can be treated efficiently with aligners and future studies should compare occlusal outcomes between orthognathic surgical patients treated with clear aligners and those treated with fixed appliances.

Retention Strategies for Segmental Lefort I Osteotomies Using Clear Aligners.

Clear aligner therapy is becoming a mainstay of contemporary orthodontic treatment. As such wide-spread adoption and case-selection for surgical-orthodontic treatment in patients with Clear aligner therapy is increasing. Passive aligners generally lack adequate rigidity for retention of segmental movements in the immediate postoperative period. In this report we discuss our techniques for maintaining retention in the weeks after segmental maxillary osteotomies by use of a modified clear aligner orthognathic splint, and a custom palatal horseshoe splint, including the relative indications of each method.

Internet searches for Invisalign® orthodontic aligner: an infodemiological study using google trends tool / Buscas na internet sobre alinhador orodôntico Invisalign®: um estudo infodemiológico usando ferramenta google trends

Aim: to evaluate the internet searches for Invisalign® in Brazil and worldwide between 2018 and 2021, using the Google Trends tool. Methods: An infodemiological study was carried out. The relative search volume (RSV) for the term "invisalign" in Google platform was retrieved for each year of study, both in Brazil and worldwide, using a standard procedure. Results and Conclusion: Both in Brazil and worldwide, there was a statistically significant increase in RSV between 2018 and 2021 (all p <0.05), indicating progressively more interest in Invisalign® clear aligner on the internet.

Objetivo: avaliar as buscas na internet por Invisalign® no Brasil e no mundo entre 2018 e 2021, utilizando a ferramenta Google Trends. Métodos: Foi realizado um estudo infodemiológico. O volume relativo de busca (RSV) para o termo "invisalign" na plataforma Google foi recuperado para cada ano de estudo, tanto no Brasil quanto no mundo, utilizando um procedimento padrão. Resultados e Conclusão: Tanto no Brasil quanto no mundo, houve um aumento estatisticamente significativo do RSV entre 2018 e 2021 (todos p <0.05), indicando progressivamente mais interesse pelo alinhador transparente Invisalign® na internet.

Ortodoncia interceptiva con alineadores en un paciente con mordida cruzada en período de dentición mixta / Interceptive orthodontics with clear aligners in a patient with crossbite in a mixed dentition period

La mordida cruzada es una maloclusión que debe recibir tratamiento precoz ya que es potencial causa de desviaciones mandibulares, asimetría facial y trastornos de disfunción temporomandibular. En general se acompaña de la necesidad de estimulación del desarrollo transversal del maxilar superior. En este artículo presentamos un caso clínico tratado con alineadores en el que se planteó como objetivo de primera fase la expansión transversal, con el fin de corregir su mordida cruzada lateral y mejorar la posición de los caninos permanentes en etapa pre-eruptiva en una paciente de 9 años. Luego de dos etapas cortas de tratamiento con alineadores, los resultados fueron satisfactorios. El caso se acompaña de fotos, radiografías y renders iniciales y finales.

Crossbite is a type of malocclusion that must receive early treatment due to its potentiality of causing mandibular deviations, facial asymmetry, and temporomandibular disorders. Generally, it is accompanied by the need to stimulate the transverse development of upper jaw. In the following article, a clinical case will be presented in which a nine-year-old patient was treated with clear aligners in the first phase with the aim of performing the transversal expansion, to correct the lateral crossbite and improving the position of the permanent impacted canines in pre-eruptive stages. After two short treatment stages with clear aligners, the results were positive. The clinical case is complemented with its pertinent clinical photos, radiographies, and renders, both initial and final.