Upper arch dimensional changes with clear aligners in the early mixed dentition : A prospective study.

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 t­test was chosen to compare T2-T1 changes. The level of significance was set at 5%. RESULTS: The 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.

Analysis of the Changes in Occlusal Plane Inclination in a Class II Deep Bite "Teen" Patient Treated with Clear Aligners: A Case Report.

Background: Optimal management of hypodivergent growing patients demands a strict control of vertical dimension and to exploit the growth potential. If a deep bite malocclusion causes a traumatic contact between the upper and lower incisors and affects the facial appearance, an early interceptive treatment is recommended. The aim of this case report is to outline the clinical management of the occlusal plane of a growing Class II division 1 deep bite patient treated with aligners and Class II elastics. Methods: The treatment lasted 11 months and was divided into two phases. Treatment goals included improvement of the soft tissue profile and basal bone relationships through an increase in the mandibular third of the face and a sagittal advancement of the mandible. The correction of the curve of Spee involved intrusion of the mandibular incisors and extrusion of the mandibular premolars. Results: The cephalometric analysis at the end of the treatment displayed significant differences in the skeletal and occlusal pattern along with aesthetic improvements. Conclusion: The final cephalogram showed a consistency between the planned tooth movement and the clinical results. Although definitive recommendations must be withheld until longer follow-up is available, the patient presented here shows that the treatment protocol yielded positive mandibular growth.

Enamel interproximal reduction during treatment with clear aligners: digital planning versus OrthoCAD analysis.

BACKGROUND: The aim of the study was to compare the amount of interproximal enamel reduction (IPR) provided on ClinCheck software with the amount of IPR carried out by the orthodontist during treatment with clear aligners. METHODS: 30 subjects (14 males, 16 females; mean age of 24.53 ± 13.41 years) randomly recruited from the Invisalign account of the Department of Orthodontics at the University of Rome "Tor Vergata" from November 2018 to October 2019, were collected according to the following inclusion criteria: mild to moderate dento-alveolar discrepancy (1.5-6.5 mm); Class I canine and molar relationship; full permanent dentition (excluding third molars); both arches treated only using Comprehensive Package by Invisalign system; treatment plan including IPR. Pre- (T0) and post-treatment (T1) digital models (.stl files), created from an iTero scan, were collected from all selected patients. The OrthoCAD digital software was used to measure tooth mesiodistal width in upper and lower arches before (T0) and at the end of treatment (T1) before any refinement. The widest mesio-distal diameter was measured for each tooth excluding molars by "Diagnostic" OrthoCAD tool. The total amount of IPR performed during treatment was obtained comparing the sum of mesio-distal widths of all measured teeth at T0 and T1. Significant T1-T0 differences were tested with dependent sample t-test (P < 0.05). RESULTS: In the upper arch, IPR was digitally planned on average for 0.62 mm while in the lower arch was on average for 1.92 mm. As for the amount of enamel actually removed after IPR performing, it was on average 0.62 mm in the maxillary arch. In the mandibular arch, the mean of IPR carried out was 1.93 mm. The difference between planned IPR and performed IPR is described: this difference was on average 0.00 mm in the upper arch and 0.01 in the lower arch. CONCLUSIONS: The amount of enamel removed in vivo corresponded with the amount of IPR planned by the Orthodontist using ClinCheck software.

Three-dimensional digital planning of class III decompensation with clear aligners: Hard and soft tissue augmentation with concomitant corticotomy to stretch the limits of safe orthodontic treatment.

PURPOSE: Three-dimensional diagnosis has shown that orthodontic therapy could potentially move the roots of the teeth outside the original bone structure. The purpose of these case studies was to test the possibility of obtaining correct three-dimensional tooth positioning with clear aligners, thereby modifying the periodontal structure accordingly, at the same time. METHODS: Regenerative Corticotomy (RC) was performed with clear aligners on ten adult patients (40 anterior teeth) with skeletal Class III malocclusion, for dental decompensation, prior to the orthognathic surgery. The CBCT examinations were performed before treatment (T0) and 1 year after orthognathic surgery (T1). The vertical and the horizontal hard tissue changes, the width of keratinized gingiva, the incisors proclination (IMPA) and the percentage of inclination compared to the planning were analyzed. RESULTS: The distance between the Cemento-Enamel Junction (CEJ) and the Bone Marginal Level (BML) decreased in average from 5.5 â€‹± â€‹3.2 â€‹mm to 1.39 â€‹± â€‹0.53 â€‹mm. The horizontal changes were at the 3 â€‹mm level 1.42 â€‹± â€‹0.5 â€‹mm, at the 5 â€‹mm level 1.98 â€‹± â€‹0.66 â€‹mm and at the 7 â€‹mm level 2.70 â€‹± â€‹0.87 â€‹mm. The width of Keratinized gingiva changes were on average 1.42 â€‹± â€‹0.36 â€‹at T0 and 4.16 â€‹± â€‹2.25 â€‹at T1. All the changes were statistically significant with p â€‹< â€‹0,05. The mean proclination based on IMPA values was +9.16 +-1.19°. The mean difference of the incisor's proclination compared to the digitally planned was -1 +-0.6° (89.87 +- 6.46%). CONCLUSION: Clear Aligners with three-dimensional digital planning seems to be reliable in controlling teeth movements in the pre-orthognathic decompensation phase. Regenerative Corticotomy seems to have the ability to improve the periodontal tissues despite proclination.

Maxillary arch development with Invisalign system.

OBJECTIVES: To evaluate tooth movements during maxillary arch expansion with clear aligner treatment. MATERIALS AND METHODS: The study group included 28 subjects (16 females, 12 males, mean age 31.9 ± 5.4 years) collected prospectively from January 2018 to May 2019. Inclusion criteria were European ancestry, posterior transverse discrepancy of 3-6 mm, permanent dentition stage, presence of second permanent molars, mild or moderate crowding, and good compliance with aligners. Treatment protocol included nonextraction strategies, application of Invisalign clear aligner system, and no auxiliaries other than Invisalign attachments. Linear and angular measurements were performed before treatment (T1), at the end of treatment (T2), and on final virtual models (T2 ClinCheck). A paired t-test was used to compare T2-T1 and T2-T2 ClinCheck changes. The level of significance was set at 5%. RESULTS: Statistically significant differences were found for all measurements, except for ones at the upper second molars. The greatest increase in maxillary width was detected at the upper first and second premolars: +3.5 mm for the first premolar and +3.8 mm for the second premolar at T2. Comparison of T2-T1 angular outcomes showed statistically significant changes in the inclinations of all teeth except for the second permanent molars. T2-T2 ClinCheck showed significant differences for both linear and angular measurements for maxillary canines, resulting in poor predictability. CONCLUSIONS: Maxillary arch development revealed a progressive reduction of the expansion rate and buccal tipping in the anterior, lateral, and posterior regions, with the greatest net increase at the first and second premolars. Clinical attention should be paid to maxillary canine movements, and overcorrection should be planned for them during dentoalveolar expansion.

Indication of clear aligners in the early treatment of anterior crossbite: a case series.

INTRODUCTION: Anterior crossbite (AC) is defined as a reverse sagittal relationship between maxillary and mandibular incisors. According to an evidence-based orthodontic triage, the treatment need of AC is indicated if any occlusal interference is forcing the mandible towards a Class III growth pattern. Removable and fixed appliances have been suggested to correct AC. OBJECTIVE: The present report aims at presenting the benefits of an alternative therapy for the early treatment of anterior crossbite using clear aligners. METHODS: Two cases of anterior crossbite corrected using clear aligners in 8-years-old children are presented. RESULTS: In both cases, AC was successfully corrected within 5 months. At the end of the treatment, overjet and overbite were corrected. No major discomfort or speech impairment was noticed by the parents. CONCLUSIONS: Due to the perceived shortcomings of alternative approaches, the use of clear aligners for correcting AC in mixed dentition should be considered as a comfortable and well tolerated appliance for young patients.

Indication of clear aligners in the early treatment of anterior crossbite: a case series

ABSTRACT Introduction: Anterior crossbite (AC) is defined as a reverse sagittal relationship between maxillary and mandibular incisors. According to an evidence-based orthodontic triage, the treatment need of AC is indicated if any occlusal interference is forcing the mandible towards a Class III growth pattern. Removable and fixed appliances have been suggested to correct AC. Objective: The present report aims at presenting the benefits of an alternative therapy for the early treatment of anterior crossbite using clear aligners. Methods: Two cases of anterior crossbite corrected using clear aligners in 8-years-old children are presented. Results: In both cases, AC was successfully corrected within 5 months. At the end of the treatment, overjet and overbite were corrected. No major discomfort or speech impairment was noticed by the parents. Conclusions: Due to the perceived shortcomings of alternative approaches, the use of clear aligners for correcting AC in mixed dentition should be considered as a comfortable and well tolerated appliance for young patients.

RESUMO Introdução: A mordida cruzada anterior (MCA) é definida como uma relação sagital reversa entre os incisivos superiores e inferiores. De acordo com a evidência científica, o tratamento da MCA é indicado em casos em que a interferência oclusal favorece o crescimento mandibular em direção a um padrão de Classe III. A literatura descreve diversos aparelhos removíveis e fixos para a correção dessa má oclusão. Objetivo: A presente série de casos tem como objetivo apresentar os benefícios de uma terapia alternativa para o tratamento precoce da MCA por meio do uso de alinhadores transparentes. Métodos: Apresentação de dois casos de MCA tratados com alinhadores transparentes em crianças de 8 anos de idade. Resultados: Em ambos os casos, a MCA foi corrigida com sucesso em um período de 5 meses. Ao fim do tratamento, obteve-se sobressaliência e sobremordida ideais. Segundo o relato dos pais, nenhum grande desconforto ou comprometimento na fala foi observado. Conclusões: Tendo em vista os problemas associados a algumas abordagens alternativas, o uso de alinhadores transparentes para correção da MCA durante a dentição mista pode ser considerado confortável e bem tolerado por pacientes jovens.

Surgery First and Invisalign System: Combined Digital Approach.

PURPOSE: The aim of the present paper is to verify the long-term results in dental and skeletal stability in terms of symmetry, occlusion and functional balance by the association between the IS and the SF technique. METHODS: In this paper, the authors described 12 cases of severe class III malocclusion treated by the association between the IS and the SF technique. RESULTS: At 1 year of post-orthodontic follow up, the patients present an Angle class I occlusal relationship, no deep bite, no scissor or cross-bite and no open bite. No one patient referred TMJ discomfort nor severe post-surgical complications and no surgical-orthodontic relapse occurred. The surgical and occlusal results are stable in terms of stability in all patients. CONCLUSION: The results of this study suggest the validity of our protocol in management of class III malocclusion patients.

Orthodontic treatment of class three malocclusion using clear aligners: A case report.

Class III malocclusion is a growth-related challenging condition for orthodontists. We present a case of a 11-year-old girl with a skeletal class III malocclusion with bilateral cross bite, and a functional shift of the lower dental midline. A multiphase clear aligners' treatment was scheduled with the aim of removing all dental interferences which involved an anterior displacement of the mandible. At one-year follow-up, clear aligners' therapy resulted in skeletal and dental improvements. Clear aligners therapy represents a valid alternative to fixed appliance therapy in the early interception of class III malocclusion. The present manuscript was prepared following the CARE guidelines.

Clear aligners' effects on aesthetics: evaluation of facial wrinkles.

BACKGROUND: To evaluate the facial aesthetic effects of orthodontic treatment performed with clear aligners and to compare it to an untreated control group, on lower third facial ageing in adult patients through the use of the Wrinkle Severity Rating Scale (WSRS) at the beginning (T0) and at the end (T1) of the study period. MATERIAL AND METHODS: A clear aligners treated group (TG) of 68 patients was compared to a control group of 33 untreated patients (UG). Each group was divided in 2 subgroups according to age: subgroup 1 if under 40 years of age and subgroup 2 if over. Facial aesthetics of the lower third was evaluated at T0 and T1 by a panel of five aesthetic experts with WSRS. RESULTS: Statistically significant changes were found in all subgroups comparing WSRS scores at T0 and T1. The between group comparisons revealed that wearing clear aligners produces a statistically relevant improvement in lower third facial aesthetics both in younger (p< 0.05) and older (p< 0.001) patients. CONCLUSIONS: The present retrospective cohort study has successfully shown that malocclusion therapy conducted through the use of clear aligners in a population of adults affected by dental crowding has beneficial effects on lower third facial ageing. Key words:Orthodontics, clear aligners, facial aesthetics, facial wrinkles, compliance.