Deep overbite reduction in adolescent patients treated with Invisalign: A retrospective analysis.

INTRODUCTION: Data regarding the efficacy of deep overbite correction with clear aligner therapy in adolescent patients are lacking. This study aimed to investigate the efficacy of deep overbite reduction in adolescent patients treated with Invisalign (Align Technology, San Jose, Calif) aligners. METHODS: This retrospective study investigated a sample of 102 patients aged 10-17 years from a large database. All patients had completed wear of a prescribed series of Invisalign aligners with planned overbite reduction on a nonextraction basis. The predicted, pretreatment, and posttreatment overbite measurement values were obtained from Align Technology's ClinCheck digital facility. Linear modeling, with Bland-Altman plots, was used to compare the effect of age, the use of bite ramps, and the adoption of the eighth-generational (G8) protocol on the difference between predicted and achieved overbite measurements. RESULTS: A total of 102 patients with a mean ± standard deviation age of 13.94 ± 1.53 years satisfied the selection criteria. A mean ± standard deviation of 41.38 ± 30.43% of the predicted overbite reduction was achieved. There were no differences in the predictability of overbite reduction between patients who were aged <14 years or those aged 14-17 years (P = 0.73), between patients prescribed and not prescribed bite ramps (P = 0.25), or between patients prescribed the G8 protocol and not prescribed the G8 protocol (P = 0.65). CONCLUSIONS: The average achieved overbite was less than half of what was planned by the orthodontists via the ClinCheck facility. The age grouping, the provision of bite ramps, and the G8 protocol appear to have little influence on the efficacy of overbite reduction in adolescent patients.

Invisalign Lite: a cross-sectional investigation of orthodontist treatment-planning practices.

OBJECTIVES: To survey treatment-planning practices of orthodontists related to the Invisalign Lite clear aligner appliance (Align Technology, San Jose, Calif). MATERIALS AND METHODS: Patients satisfying inclusion and exclusion criteria and treated with Invisalign Lite were selected from a database containing more than 17,000 patients. Relevant data regarding treatment-planning practices were obtained from Align Technology's treatment-planning facility, ClinCheck, and evaluated. RESULTS: Most (n = 135; 79.9%) patients were female and had a median (interquartile range [IQR]) age of 30.5 (23.8, 43.1) years. The median (IQR) number of aligners for the sample was 23.0 (14, 28) for the maxilla and 24 (14, 28) for the mandible. Most (n = 122; 72.2%) patients required at least one additional series of aligners. More locations for interproximal reduction (IPR) were prescribed in the mandible (mean 1.91 [1.78]) than in the maxilla (1.03 [1.78]; P < .024) in the initial accepted plan of all patients. More teeth were prescribed composite resin (CR) attachments in the maxilla (P < .0001) in the initial accepted plan of all patients. Issues regarding tooth position protocols (n = 50; 53.3%) and requirement for additional IPR (n = 68; 45.3%) were reasons for treatment plan changes before acceptance of the initial treatment plan by orthodontists. CONCLUSIONS: More than 7 of 10 patients required at least one additional series of aligners after the initial series of Invisalign Lite aligners was completed. Prescription of IPR was more common in the mandible, and prescription of CR attachments was more common in the maxilla.

Predicted overbite and overjet changes with the Invisalign appliance: a validation study.

OBJECTIVES: To investigate whether the predicted changes in overbite (OB) and overjet (OJ) in Align Technology's (Santa Jose, Calif) digital treatment plan for the prescribed course of treatment with the Invisalign appliance were consistent with those same changes in OB and OJ measured with the Geomagic Control X (Geomagic US, Research, Triangle Park, NC) metrology software system. MATERIALS AND METHODS: Geomagic Control X software was used to determine OB and OJ differences between the pretreatment and predicted outcome. STL files for patients satisfying inclusion criteria and undergoing nonextraction orthodontic treatment with the Invisalign appliance. The differences were compared, using the Bland-Altman analysis, to the corresponding data provided by Align Technology's digital treatment-planning interface, ClinCheck. RESULTS: Data regarding 76 adult patients who satisfied strict inclusion criteria were assessed. The Shapiro-Wilks test indicated normality (P > .05). The Bland-Altman analysis showed high levels of agreement between the two measurements, with a bias range of -0.131 to 0.111 for OB and -0.393 to 0.03 for OJ recorded. CONCLUSIONS: Clinicians and researchers can be confident that measurement data provided by Invisalign's ClinCheck digital treatment-planning facility concerning OB and OJ changes from the initial to the predicted treatment outcome are valid.

Predictability of anterior open bite treatment with Invisalign.

INTRODUCTION: Anterior open bite correction with Invisalign has been claimed to have relatively good predictability because of the proposed function of clear aligners to function as occlusal bite-blocks, limiting extrusion of the posterior teeth or possibly even intruding posterior teeth. This proposal, however, remains relatively unsubstantiated. The objective of this study was to investigate and determine the accuracy of Invisalign treatment in correcting anterior open bite by comparing the predicted outcome from ClinCheck to the achieved outcome for the initial aligner sequence. METHODS: A retrospective study used pretreatment and posttreatment intraoral scans and predicted outcomes (ClinCheck) stereolithography files of 76 adult patients from private specialist orthodontic practices. Inclusion criteria comprised nonextraction treatment, with a minimum of 14 dual arch Invisalign aligners. Geomagic Control X software was used to measure overbite and overjet in the pretreatment, posttreatment, and predicted outcomes stereolithography files for each patient. RESULTS: Approximately 66.2% of the programmed open bite closure was expressed compared with the prescribed ClinCheck outcome. The use of posterior occlusal bite-blocks and prescribed movement of teeth via anterior extrusion, posterior intrusion, or a combination of the 2 made no difference to the efficacy of open bite closure. Two-week aligner changes resulted in 0.49 mm more bite closure on average. CONCLUSIONS: The prescribed bite closure in ClinCheck software overestimates the bite closure that is clinically achieved.

Predictability of overbite control with the Invisalign appliance comparing SmartTrack with precision bite ramps to EX30.

INTRODUCTION: Although the Invisalign appliance has reported difficulty in achieving the overbite outcomes predicted by ClinCheck software (Align Technology, Santa Clara, Calif), the effect of modifications to the material and components of the appliance are largely unquantified. This study aimed to investigate and determine the accuracy of Invisalign in correcting a deep overbite by comparing the predicted outcome from ClinCheck to the achieved posttreatment outcome for treatment groups that use different components of the appliance system. METHODS: A retrospective study was conducted using pretreatment and posttreatment intraoral scans and predicted outcomes (ClinCheck) stereolithography files of 2 groups of consecutively treated adult patients from private specialist orthodontic practices, 1 group treated with EX30 material with no bite ramps (n = 29) and 1 treated with the newer SmartTrack material and precision bite ramps (n = 39). Inclusion criteria comprised nonextraction treatment, with a minimum of 14 dual arch Invisalign aligners using a 2-weekly aligner change protocol. Geomagic Control X software (3D Systems, Rock Hill, SC) was used to measure overbite in the pretreatment, posttreatment, and predicted outcome stereolithography files for each patient. Results were compared with a previously published treatment group that used SmartTrack material and no precision bite ramps. RESULTS: The regression coefficient analysis indicated that for both groups, the deeper the pretreatment overbite and the greater overbite reduction projected according to ClinCheck, there is a linear increase in the discrepancy of overbite expression posttreatment. ClinCheck overpredicted overbite reduction in 96.6% of patients with precision bite ramp in which, on average, 43.4% of the prescribed overbite reduction was expressed. For EX30 patients, ClinCheck overpredicted overbite reduction in 87.2% of patients in which, on average, 55.1% of the prescribed overbite reduction was expressed. CONCLUSIONS: The use of precision bite ramps does not appear to significantly improve the ability of SmartTrack material to predictably open the bite. SmartTrack material with or without bite ramps does not appear to produce better bite opening predictability than that seen with EX30 material.

Predictability of overbite control with the Invisalign appliance.

INTRODUCTION: Control of overbite is considered essential in achieving ideal orthodontic outcomes. Questions have been raised regarding the accuracy of ClinCheck software (Align Technology, Santa Clara, Calif) in predicting posttreatment outcomes with Invisalign, with the paucity of well-researched literature available on this topic. This research aimed to investigate and determine the accuracy of Invisalign (Align Technology) in correcting a deep overbite by comparing the outcomes predicted by ClinCheck with achieved posttreatment outcomes. METHODS: A retrospective study was conducted using pretreatment and posttreatment intraoral scans and predicted outcome (ClinCheck) stereolithography files of 42 adult patients consecutively treated with Invisalign from January 2014 and completed before July 2018, selected from the files of 1 experienced orthodontist. Patients included in the study were treated without extractions and with a minimum of 14 dual arch Invisalign aligners using a 2-weekly aligner change protocol. The pretreatment, posttreatment, and predicted outcome stereolithography files for each patient were imported into Geomagic Control X (3D Systems, Rock Hill, SC) software to measure overbite. RESULTS: The deeper the patient's initial overbite and the greater the amount of programmed reduction in overbite according to ClinCheck, the greater the discrepancy in overbite expression posttreatment. ClinCheck over-predicted overbite reduction in 95.3% of patients in which, on average, only 39.2% of the prescribed overbite reduction was expressed. CONCLUSIONS: Overbite reduction may result in suboptimal outcomes when using the Invisalign appliance unless remedial measures are employed. The deeper the initial overbite, the more challenging it is to achieve the prescribed posttreatment overbite.