Clinical audit of an artificial intelligence (AI) empowered smile simulation system: a prospective clinical trial.

Smile aesthetics is an important factor to consider during orthodontic treatment planning. The aim of the present study is to assess the predictability of Invisalign SmileView for digital AI smile simulation in comparison to actual smile treatment outcomes, using various smile assessment parameters. A total of 24 adult subjects (12 females and 12 males; mean age 22 ± 5.2 years) who chose to be treated using Invisalign were prospectively recruited to have their pretreatment smiles captured using the Invisalign SmileView to simulate their new smiles before treatment was started. Patients were then treated using upper and lower Invisalign aligners with average treatment time of 18 ± 6 months. Full post-treatment records were obtained and full smile frame images of simulated smile and actual final smile of each subject were evaluated by an independent examiner using an objective assessment sheet. Ten smile variants were used to assess the characteristics of the full smile images. Significance level was set at P < 0.05. The ICC for the quantitative parameters showed that there was an overall excellent & good internal consistency (alpha value > 0.7 & > 0.9). The Independent t test was performed amongst the quantitative variables. The P value was not significant for all except maxillary inter canine width (P = 0.05), stating that for the five variables namely; philtrum height, commissure height, smile width, buccal corridor and smile index, actual mean values were similar to the simulation mean values. For the qualitative variables, the Kappa value ranged between 0.66 and - 0.75 which showed a substantial level of agreement between the examiners. Additionally, the Chi square test for the qualitative variables, revealed that the P value was found to be significant in all except lip line. This implies that only the lip line values are comparable. More optimal lip lines, straighter smile arcs and more ideal tooth display were achieved in actual post treatment results in comparison to the initially predicted smiles. Five quantitative smile assessment parameters i.e., philtrum height, commissure height, smile width, buccal corridor, and smile index, could be used as reliable predictors of smile simulation. Maxillary inter canine width cannot be considered to be a reliable parameter for smile simulation prediction. A single qualitative parameter, namely the lip line, can be used as a reliable predictor for smile simulation. Three qualitative parameters i.e., most posterior tooth display, smile arc, and amount of lower incisor exposure cannot be considered as reliable parameters for smile prediction.Trial Registration number and date: NCT06123585, (09/11/2023).

Distalization using efficient attachment protocol in clear aligner therapy-A case report.

To describe an esthetic orthodontic treatment using aligners in an adult patient with dental class II malocclusion associated with crowding. A 25-year-old female patient with skeletal class I, bilateral class II relation, increased overjet and overbite and crowding in both arches presented for orthodontic treatment. The patient refused conventional fixed multibracket treatment in favor of aligners. Pre- and post-treatment records are presented. Treatment objectives were achieved in 10 months, and the patient was satisfied with the functional and esthetic outcomes. Combining aligners with appropriate attachment location and geometry is an efficacious means of resolving orthodontic issues such as class II malocclusion in a time frame comparable to that of conventional fixed orthodontics. Staging in distalization increases the predictability of movement. Furthermore, this system is associated with optimal oral hygiene and excellent esthetics.

Correction of anterior open bite of varying severity using clear aligner therapy-A case series.

In open bite cases, a comprehensive diagnostic differentiation is crucial in determining the best corrective therapy. In non-surgical open bite treatment, fixed appliances, either labial or lingual, are usually employed. With the addition of extra-radicular screws, more sophisticated orthodontic movements may now be performed without the necessity for orthognathic surgery. Clear aligner therapy, on the contrary, has grown in popularity as a treatment option for more complex cases, such as open bite malocclusions. This article discusses three cases with an anterior open bite that were treated using various mechanics as dictated by the malocclusion. Case 1 was addressed wholly using clear aligner therapy, with careful consideration of attachment geometry and mechanics. Case 2 with clear aligner therapy, attachment geometry selection, and vertical elastics; and Case 3 with clear aligner therapy, attachments, and temporary anchorage devices.

Customized adjuncts with clear aligner therapy: "The Golden Circle Model" explained!

Clear aligners are the most debated infusion of technology into the orthodontic stratosphere and currently account for a sizable chunk of the orthodontic commercial market. Data indicate that a series of plastic aligners alone cannot resolve all the variants of malocclusion routinely treated by our specialty. Current literary consensus exists that the discrepancy between the predicted and actual clinical outcomes with clear aligner therapy (CAT) is around 50% or more, necessitating midcourse corrections, refinement, or additional aligners, or even a conversion to fixed appliances before the end of treatment. A practical panacea to improve the predictability of CAT is the addition of creative and customized adjuncts to CAT. This article, inspired by the "Golden Circle Model", addresses questions such as the "WHY, HOW, and WHAT" of adjuncts used in combination with CAT and depicts an "inside out" approach (from WHY to WHAT) to present the rationale, stepwise clinical workflow, and the advantages of these adjuncts. The bootstrap, mini pin-supported mesialization or distalization, Yin-Yang attachments, Beneslider, Mesialslider, BMX Expander, and Computer-Aided Design (CAD) / Computer-Aided-Manufacturing (CAM)...based innovative appliance designs among others, are presented as adjuncts to CAT in this article. These adjuncts can either be used concomitantly with the aligners or planned as a separate phase of treatment before the commencement of the actual CAT, based on the type of tooth movement required and whether the planned tooth movement is indicated for a single tooth or a group of teeth. An astute clinician who wishes to expand the repertoire of malocclusions that can be successfully managed by CAT should judiciously plan the inclusion of such adjunct appliances in their aligner treatment planning.

Invisalign treatment with mandibular advancement: A retrospective cohort cephalometric appraisal.

Objective: To examine the skeletal, dental, and soft-tissue cephalometric effects of class II correction using Invisalign's mandibular advancement feature in growing patients. Materials and Methods: A retrospective cohort clinical study was performed on cases that were started between 2017 and 2019. A total of 32 patients (13 females, 19 males), with an average age of 13 years old (9.9-14.8 years) had undergone Invisalign treatment (Align Technology, Inc., San Jose, CA) wherein the mandibular advancement phase was completed were included. Photos, digital study models, and cephalograms were taken once during the patients' initial visit and again upon completing the mandibular advancement phase of treatment. The number of aligners worn and the time of treatment in months was recorded for each subject. Cephalometric analysis was performed and overjet and overbite were measured. Statistical analysis was performed using SPSS statistical software (version 25; SPSS, Chicago, Ill) and the level of significance was set at P <0.05. Descriptive statistics were performed to generate means and differences for each cephalometric measurement as well as patient data including age, treatment time, and aligner number. Differences between measurements from patients before treatment (T1) and after treatment (T2) with the mandibular advancement feature were evaluated using a paired t -test. Results: All 32 patients had multiple jumps staged for the precision wings, i.e., incremental advancement. The average length of treatment for the MA phase was 9.2 months (7.5-13.8 months) and the average number of aligners used during this time was 37 (30-55). Statistically significant differences between T1 and T2, in favor of class II correction, were observed in the ANB angle, WITS appraisal, facial convexity, and mandibular length. The nasolabial angle, overjet, and overbite also showed statistically significant changes between T1 and T2. Conclusion: Invisalign aligners with the mandibular advancement feature took approximately 9 months for 1.5 mm of overjet correction. The lower incisor angulation was maintained during class II correction. The minimal skeletal changes are in favor of class II correction.

[Orthognathic treatment and aligners, which protocol?] / Traitement orthognathique et aligneurs, quel protocole ?

Digital dental technologies for design, simulation and fabrication are constantly evolving. It is possible to digitally simulate dental movements, as well as displacements of both arches and to produce thermoformed splints manufactured from this simulation. The authors present the coupling of intraoral 3D scanning with low-dose radiation 3D radiography that allows for a very precise surgical setup, preparation of repositioning aligners, and fabrication of osteosynthesis plates. The orthodontic-surgical management protocol with aligners used by the first author will be described in detail. The authors present, through clinical cases, the progress made in orthognathic surgery thanks to 3D and the Invisalign® thermoformed tray system. Looking at the three clinical cases presented, it can be seen that the average treatment time was much less than the average time for usual orthodontic-surgical protocols.

[Treatment of class II for growing patients by clear aligners: which protocol?] / Traitement des classes II pour les patients au cours de la croissance par gouttières thermoformées : quel protocole ?

INTRODUCTION: Skeletal class II, frequently associated with retromandibular and overjet > 2 mm, lead to functional and aesthetic damage, that orthodontic treatment has to correct. The aim of this article is to describe a treatment protocol by aligners for class II growing patients according to the value of the class II and the maturity state of cervical vertebrae. MATERIALS AND METHODS: Through clinical cases, this article will present three different therapeutic approaches depending on the growth state. RESULTS: The study of the auxologic potential and determination of the bone age (radiological analysis of the maturation of the cervical vertebrae) will allow to determine the best moment to treat class II and the most appropriate therapeutic attitude according to growing state. DISCUSSION: This study before treatment is essential to adapt an individualized clinical protocol to each patient. In this way, aligners are devices that respond well to this imperative because they are customizable in view of the strategy and the treatment plan considered by the practitioner. We must keep in mind, however, that with any therapy, it is essential to ensure good patient compliance.

[Perception of pain in orthodontic treatment with thermoformed aligners]. / Douleur dans les traitements orthodontiques par aligneurs thermoformés.

INTRODUCTION: The aim of this study was to assess pain generated during orthodontic treatment with aligners in terms of intensity, duration and characteristics. MATERIALS AND METHODS: The sample consisted of 106 patients. Pain was analyzed according to intensity and characteristics using the Saint Antoine Pain Questionnaire (French Mac Gill questionnaire). For statistical analysis, Student tests were performed. RESULTS: 84% of patients experienced low to moderate pain, with a significantly higher intensity in women. Thirty-one per cent of patients consumed analgesics, although no established correlation was observed between intensity of pain and analgesics. For 53% of patients, duration of pain was ≤ 2 days; for 15% of patients, the pain lasted 7 days. Among patients aged ≥ 40 years, duration of pain was significantly lower than in those aged < 40 years. Ten characteristics of pain were selected as described by at least one third of patients. CONCLUSION: Orthodontic treatments with aligners cause mild to moderate pain, which usually lasts 2 to 3 days, but may last 7 days. This pain is described as a sensation of "compression", "twinges", "squeezing", "tightness", "stretching", "cutting", and as being "tiresome", "bothersome", "unpleasant", or even "a nuisance".