Efficacy of clear aligner wear protocols in orthodontic tooth movement-a systematic review.

BACKGROUND AND OBJECTIVES: Different expedited aligner wear protocols are currently in practice. This review was undertaken to systematically appraise the available evidence on the comparative efficacy of orthodontic tooth movement (OTM) across the different wear protocols. SEARCH METHODS: Two assessors conducted comprehensive searches of electronic databases, including MEDLINE (via PubMed), Scopus, Embase, Web of Science, Google Scholar, Directory of Open Access Journals, Cochrane Library, OpenGrey, and Clinical Trial Registry, till 18 February 2024. Titles and abstracts were independently screened. SELECTION CRITERIA: Prospective or retrospective studies comparing expedited wear protocols with the conventional 14-day protocol were included. DATA COLLECTION AND ANALYSIS: A pre-piloted data extraction form was used. Risk of bias (RoB) assessment employed the Cochrane RoB 2.0 tool for randomized-controlled trials (RCTs) and the Newcastle-Ottawa scale for non-RCTs. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation Pro tool. RESULTS: Six studies, including 3 RCTs and 3 non-RCTs, were selected from 9076 records. Four studies (two RCTs and two retrospective cohort) found no statistically significant difference (P > 0.05) in the OTM efficacy between expedited and conventional protocols. Two studies (one RCT and one prospective cohort) found greater efficacy (P < 0.05) with the 14-day protocol, with the RCT reporting greater efficacy for certain movements, such as maxillary posterior intrusion, maxillary posterior distal tipping and buccal torquing, and mandibular posterior intrusion and extrusion. One RCT reported statistically insignificant difference (P > 0.05) in pain perception between the 10-day and 14-day protocols. Two studies demonstrated low RoB, two moderate, and two high RoB. The evidence level was very-low for OTM efficacy and high for pain perception. Meta-analysis was precluded due to significant heterogeneity among the studies. CONCLUSIONS: Within the limitations of the study, the 7-day, 10-day, and 14-day protocols did not show any significant difference in OTM efficacy, except for certain movements that exhibited superior outcomes with the 14-day wear. Hence, a 'hybrid aligner-wear protocol', based on clinical judgement, might serve a better alternative in complex situations. REGISTRATION: PROSPERO CRD42021288179.

Early Interceptive Correction for Anterior Crossbite Using a Removable Appliance: A Pediatric Case Study.

Anterior crossbite is a malocclusion that occurs for a variety of reasons, causes significant issues, and may be corrected in a variety of ways. Early recognition and timely intervention are crucial in managing anterior dental crossbites during the mixed dentition stage. The purpose of this report is to assist general dentists and pediatric dentists in distinguishing between cases within their scope of practice and those requiring referral to orthodontists and treating this condition immediately to prevent future complex treatment and improve patient aesthetics and function. This case report highlights the treatment of an eight-year-old patient with class III incisors on a skeletal class I base, presenting with an anterior crossbite. The patient was treated successfully using an upper removable appliance, showcasing a non-invasive and effective approach to correcting dental malocclusions early. The rapid correction of the crossbite within six weeks underscores the importance of early intervention and the potential for general dentists and pediatric dentists to manage such conditions efficiently, improving patient outcomes in aesthetics and function.

Accuracy of Invisalign® aligners in adult patients: a retrospective study of angular tooth movements

ABSTRACT Objective: This retrospective study aimed to assess the predictability of Invisalign® aligners regarding rotational, mesio-distal and buccal-lingual tip movements. Methods: Two materials were included in the analysis - EX30, used until 2013; and SmartTrack, in current use. The study comprised 56 adult patients treated with Invisalign Comprehensive. Data sample were assessed on three sets of digital models; model 1 - initial, model 2 - predicted, and model 3 - achieved. Sixty reference points were marked in each dental arch, and two reference planes assisted the superimposition. The degree of rotation, mesio-distal and buccal-lingual tip was obtained via trigonometric calculations, through a previously published validated method. The accuracy of outcomes was compared according to the types of tooth movement and teeth groups,and the influence of predetermined variables on movement accuracy was also investigated. Results: Rotation and mesio-distal tip did not present any significant difference when comparing EX30 and SmartTrack groups. Only buccal-lingual tip presented a significant difference, incisor and canine groups treated with EX30 aligners presented an increase in accuracy (p= 0.007 and p = 0.007, respectively). For each additional degree planned for rotation movements, there was an increase of 0.35° in the discrepancy, and an increase of 0.40° and 0.41° for mesio-distal and buccal-lingual tip, respectively. EX30 and SmartTrack discrepancies were compared by multilevel linear regression. Conclusion: EX30 aligners reached higher accuracy for buccal-lingual tip in anterior teeth. However, for rotation and mesio-distal tip, SmartTrack and EX30 are similarly accurate. The total amount of planned movement has a significant impact on accuracy rates, with a decrease in accuracy for every additional degree.

RESUMO Objetivo: Esse estudo retrospectivo teve como objetivo aferir a previsibilidade dos alinhadores Invisalign em relação aos movimentos de rotação e inclinações mesiodistal e vestibulolingual. Material e Métodos: Foram incluídos dois materiais nessa análise: EX30®, utilizado até 2013; e SmartTrack®, atualmente em uso. Esse estudo avaliou 56 pacientes tratados com Invisalign Comprehensive. Os dados foram avaliados em três pares de modelos digitais; modelo 1 - inicial, modelo 2 - planejado, e modelo 3 - alcançado. Foram marcados 60 pontos de referência em cada arcada, sendo a sobreposição realizada com auxílio de planos de referência. O grau de rotação e inclinações mesiodistal e vestibulolingual foi obtido por cálculos de trigonometria, usando um método validado publicado anteriormente. Os resultados foram comparados de acordo com os tipos de movimento dentário e grupos de dentes, também foi investigada a influência de variáveis predeterminadas na confiabilidade dos movimentos. Resultados: Os movimentos de rotação e inclinação mesiodistal não apresentaram diferença estatística, quando comparados os grupos EX30® e SmartTrack®. Somente a inclinação vestibulolingual apresentou diferença estatisticamente significativa, sendo que os grupos de incisivos e caninos tratados com alinhadores EX30® apresentaram um aumento na previsibilidade(p= 0,007 e p= 0,007, respectivamente). Para cada grau adicional planejado para movimento de rotação, ocorreu um aumento de 0,35° na discrepância, e aumentos de 0,40° e 0,41° para as inclinações mesiodistal e vestibulolingual, respectivamente. As discrepâncias entre EX30® e SmartTrack® foram comparadas por regressão linear multinível. Conclusão: Os alinhadores EX30® alcançaram maior previsibilidade para a inclinação vestibulolingual em dentes anteriores. No entanto, para rotação e inclinação mesiodistal, SmartTrack® e EX30® apresentaram previsibilidade similar. A quantidade total de movimento planejado apresenta influência significativa nas taxas de previsibilidade, com diminuição na acurácia para cada grau adicional.

Gingerol and Chitosan-Based Coating of Thermoformed Orthodontic Aligners: Characterization, Assessment of Anti-Microbial Activity, and Scratch Resistance: An In Vitro Study.

Aim To prepare and characterize a 6-gingerol-incorporated chitosan biopolymer for coating on thermoformed aligners and evaluate its scratch resistance and antimicrobial activity. Material and methods In this in vitro study, 6-gingerol extract was prepared, incorporated with chitosan biopolymer into a coating solution and characterized using nuclear magnetic resonance imaging spectroscopy (NMR). Twenty thermoformed aligner samples were exposed to UV radiation for surface activation, then coated with a crosslinking agent. These were divided into four groups of five. The control group consisted of samples dip-coated in a chitosan solution for 15 minutes. The three test groups consisted of samples dip coated in a gingerol-chitosan coating solution, with each group representing the following time periods of dip coating: five, 10, and 15 minutes. The crosslinking of the coating with the aligner material was confirmed by a Fourier transform infrared spectroscopy (FTIR) test. A scratch test was carried out to evaluate the wear resistance of the coating, and the antibacterial properties of the coating were tested using a Disc Diffusion test. Results The NMR analysis confirmed the presence of 6-gingerol in the extract. The coating of 6-Gingerol on aligners was confirmed by FTIR spectroscopy. The wear resistance of aligners coated for 5 minutes, 10 minutes, and 15 minutes was 1.8 ± 0.09 N, 2.3 ± 0.021 N, and 3.06 ± 0.17 N, respectively, and the difference was statistically significant (p<0.05). The aligner coated for 15 minutes exhibited the widest zone of inhibition of up to 2.38 ± 0.44 mm against Streptococcus mutans, and the difference was statistically significant (p<0.05).​​​​​​ No antibacterial effect was found against E. Coli. Conclusion A novel coating material with 6-gingerol extract incorporated in chitosan biopolymer was prepared and characterized, followed by coating on thermoformed aligners. The coating showed antibacterial activity against Streptococcus mutans, and both the antimicrobial activity and wear resistance increased with coating duration.

Long-term effects of orthodontic interceptive expansion treatment : A retrospective study.

PURPOSE: The aim of this retrospective cohort study was to evaluate the long-term effects of interceptive orthodontic treatment with a removable expansion plate, based on transversal, sagittal, and vertical parameters. METHODS: A total of 90 patients needing interceptive treatment due to a crossbite or space deficiency were included. Records consisting of clinical photos, radiographs, and digital dental casts were collected for evaluation at two time points: the start of interceptive treatment (T0) and the start of comprehensive treatment (T1). Molar occlusion, overjet, overbite, presence and type of crossbite, mandibular shift, and transversal measurements were recorded for comparison. RESULTS: After expansion with removable appliances, a significant increase in intermolar width was achieved and could be maintained over the observation period (p < 0.001). However, no significant changes regarding overjet, overbite, or molar sagittal occlusion were observed. Crossbite correction was successful in 86.9% of patients with unilateral crossbite and in 75.0% of patients with bilateral crossbite (p < 0.001). CONCLUSION: Early expansion with a removable expansion plate is a successful method to correct crossbites and increase intermolar width in the early mixed dentition phase. Results remain stable until the start of comprehensive treatment in the permanent dentition.

Candida Species in Children Undergoing Orthodontic Treatment with Removable Appliances: A Pilot Study.

The purpose of this study was to analyze the effect of orthodontic treatment with removable appliances on the growth of Candida spp. in children undergoing orthodontic treatment. The study included 60 patients of equal numbers as to gender from the orthodontics department of the Pomeranian Medical University in Szczecin, Poland. All patients were aged 6-12 years and were qualified for orthodontic treatment with removable appliances. The following examinations were performed on the day of treatment initiation (T1) and 6 months after the start of treatment (T2); a collection of oral swabs for culture on Sabouraud's medium and the identification of fungal colonies using the VITEK®2 YST. At T1, 42 (70%) subjects, were free of Candida, while after 6 months of treatment, the number decreased to 25 (41.67%). Two types of fungi, C. albicans and C. parapsilosis, predominated in the test performed at T1. The study at T2 showed that C. albicans most frequently colonized the oral cavity in 23 children (38.33%). Three new strains C. dubliniensis, C. kefyr, and C. krusei were identified at T2. Statistical analysis showed a significant correlation between the culture results and the age of the patient at T2. Patients older than 9 years had significantly more positive tests. Orthodontic treatment with removable appliances contributes to increased oral colonization by Candida spp.

Orthodontic aligners: between passion and science

ABSTRACT Introduction: The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. Methods: Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. Conclusions: There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.

RESUMO Introdução: As vantagens e desvantagens do uso de alinhadores ortodônticos têm sido reportadas com base mais na experiência clínica e opinião de experts do que em evidências científicas. Outro aspecto importante é que os alinhadores estão em processo de evolução constante. Assim, torna-se importante obter evidências recentes, que abranjam as novas atualizações na tecnologia de confecção, no desenvolvimento de novos protocolos de planejamento para as movimentações, a incorporação e desenho dos attachments e o auxílio da ancoragem esquelética. Métodos: As evidências encontradas em seis bases de dados eletrônicas (CINAHL, MEDLINE, EMBASE, Psych Info, Biblioteca Cochrane e Biblioteca Joanna Briggs) serão apresentadas por meio de perguntas e respostas. Conclusões: Há evidências de que os alinhadores apresentam diferentes níveis de dificuldade para realizar cada tipo de movimento, sendo os movimentos rotacionais e verticais os mais difíceis de serem executados. Quanto à percepção da dor causada pela movimentação dentária, parece haver menos impacto no início do tratamento, mas os alinhadores produzem mais alterações fonoarticulatórias e parecem exigir mais tempo de tratamento em casos mais complexos. Não há evidência de diferença na estabilidade pós-tratamento, e os alinhadores não impedem a ocorrência de reabsorção radicular, apesar da incidência e a gravidade da reabsorção poderem ser menores, facilitam a higiene bucal, reduzindo o risco de manchas brancas, cáries e doenças periodontais. Dada a evidência conflitante, a liberação de bisfenol-A pelo alinhador não pode ser negada. É preciso encontrar soluções que reduzam o impacto ambiental do descarte dos alinhadores. Há uma necessidade urgente de ensaios clínicos randomizados bem desenhados.

Previsibilidade da expansão dentoalveolar em pacientes em dentadura mista com Invisalign First® / Dentoalveolar expansion predctability in mixed dentition patients with Invisalign First®

Resumo O objetivo da pesquisa foi avaliar a previsibilidade da expansão dentoalveolar do pacote Invisalign em pacientes com dentadura mista. Foram selecionados de maneira consecutiva 15 pacientes (9 meninos e 6 meninas) com média de idade de 7 anos e 10 meses com indicação de tratamento ortodôntico e necessidade de aumento transversal dentoalveolar do arco superior. Todos os pacientes foram tratados seguindo o mesmo protocolo de expansão, trocando os alinhadores a cada 7 dias. O tratamento seguiu até que o resultado desejado fosse alcançado. Os modelos digitais iniciais e finais foram exportados para o software Orthocad® (Align Technology, California, Estados Unidos da América) no qual as distâncias lineares inter primeiros molares permanentes, inter segundos molares decíduos, , inter primeiros molares decíduos e intercaninos foram medidas. A quantidade de expansão dentoalveolar planejada foi obtida no software ClinCheck, no qual o tratamento realizado para confecção dos alinhadores é elaborado e aprovado. O teste de normalidade Shapiro-Wilk foi realizado e o teste-t pareado e o teste de Wilcoxon foram utilizados para comparações pareadas. O nível de significância 5% (p>0,05) foi adotado para todos os testes. A maior quantidade de expansão foi observada na região dos primeiros molares decíduos (4,5mm), seguida pelos segundos molares decíduos (3,8mm), primeiros molares permanentes (3,4mm) e caninos decíduos (3,3mm). A maior previsibilidade ocorreu, respectivamente na região dos primeiros molares decíduos (99,5%), primeiros molares permanentes (98,9%), segundos molares decíduos (98.0%) e caninos decíduos (95,5%). Dessa forma se concluiu que o sistema Invisalign First é uma opção eficiente para expansão dentoalveolar em dentadura mista (AU)

Abstract The aim of the present research was to evaluate the predictability of dentoalveolar expansion with Invisalign package in patients with mixed dentition. Fifteen patients were consecutively selected (9 boys and 6 girls) with a mean age of 7 years and 10 months with indication for orthodontic treatment and need of upper arch transverse dentoalveolar expansion. All patients were treated following the same expansion protocol, changing aligners every 7 days. Treatment continued until the aimed result was achieved. The initial and final digital models were exported to Orthocad® software (Align Technology, California, United States of America) in which the linear intercanine distances, inter first deciduous molars, inter second deciduous molars and inter first permanent molars were measured. The amount of planned dentoalveolar expansion was obtained using the ClinCheck software, in which treatment for aligners manufacturing is elaborated and approved. The Shapiro-Wilk normality test was performed, and the paired t-test and the Wilcoxon test were used for paired comparisons. The significance level of 5% (p>0.05) was adopted for all tests. The greatest amount of expansion was observed in the region of the first deciduous molars (4.5mm), followed by the second deciduous molars (3.8mm), the first permanent molars (3.4mm) and deciduous canines (3.3mm). The greatest predictability occurred, respectively, in the region of the first deciduous molars (99.5%), the first permanent molars (98.9%), second deciduous molars (98.0%) and deciduous canines (95.5%). Thus, it was concluded that the Invisalign First system is an efficient option for dentoalveolar expansion in mixed dentition.(AU)

Factors Influencing Patient Compliance during Clear Aligner Therapy: A Retrospective Cohort Study.

Compliance is highly relevant during clear aligner therapy (CAT). In this retrospective cohort study, we assessed compliance and associated covariates in a large cohort of CAT patients. A comprehensive sample of 2644 patients (75.0% females, 25.0% males, age range 18-64 years, median 27 years), all receiving CAT with PlusDental (Berlin, Germany) finished in 2019, was analyzed. Covariates included demographic ones (age, gender) as well as self-reported questionnaire-obtained ones (satisfaction with ones' smile prior treatment, the experience of previous orthodontic therapy). The primary outcome was compliance: Based on patients' consistent use of the mobile application for self-report and aligner wear time of ≥22 h, patients were classified as fully compliant, fairly compliant, or poorly compliant. Chi-square test was used to compare compliance in different subgroups. A total of 953/2644 (36.0%) of patients showed full compliance, 1012/2644 (38.3%) fair compliance, and 679/2644 (25.7%) poor compliance. Males were significantly more compliant than females (p = 0.000014), as were patients without previous orthodontic treatment (p = 0.023). Age and self-perceived satisfaction with ones' smile prior to treatment were not sufficiently associated with compliance (p > 0.05). Our findings could be used to guide practitioners towards limitedly compliant individuals, allowing early intervention.

A Knowledge-Based Algorithm for Automatic Monitoring of Orthodontic Treatment: The Dental Monitoring System. Two Cases.

BACKGROUND: In the dental field, digital technology has created new opportunities for orthodontists to integrate their clinical practice, and for patients to collect information about orthodontics and their treatment, which is called "teledentistry." Dental monitoring (DM) is a recently introduced orthodontic application that combines safe teledentistry with artificial intelligence (AI) using a knowledge-based algorithm, allowing an accurate semi-automatic monitoring of the treatment. Dental Monitoring is the world's first SaaS (Software as a Service) application designed for remote monitoring of dental treatment, developed in Paris, France, with Philippe Salah as the Co-founder and CEO. CASES PRESENTATION: This report describes two cases in which DM system was essential to achieve the control of certain movements: it was possible to follow the movement, even if complex, such as the anterior cross of an adult patient and a lack of space in the canine of the growing patient. The software analyzed the fit and retention of the aligner, thus ensuring correct biomechanics. They were treated during the COVID-19 pandemic lockdown with aligners. The first case is a growing patient who was monitored during an interceptive orthodontic treatment to manage a retained upper canine. The second case is an adult patient forced to finalize his treatment of upper lateral incisor crossbite. The software analyzed the fit and retention of the aligner, thus ensuring correct biomechanics. CONCLUSIONS: DM system appears to be a promising method, useful for improving the interaction between doctor and patient, generally acceptable and useful to patients, even in critical clinical situations, at least in cases with optimal compliance and ability to use the tool properly.

Use of Different Cleaning Methods for Removable Orthodontic Appliances: A Questionnaire Study.

OBJECTIVES: The aim of the present study is to assess the means and methods being suggested by Greek orthodontists to their patients for cleaning their removable devices. MATERIALS AND METHODS: A questionnaire survey was conducted among a total of 418 Greek orthodontists found from the registry of orthodontists in Greece. The clinicians were asked about the means and methods of daily cleaning they usually advise their patients for removable appliances. Furthermore, the questionnaire included questions related to possible complications of these devices and data about the use and type of applied devices. RESULTS: From 418 Greek orthodontists, 279 filled the questionnaire and participated in this study. All but one reported that they use removable appliances in their practice for patients of almost any age. All orthodontists recommend routine manual toothbrushing, but the majority of them also suggest at the same time other oral hygiene aids complementary to brushing, such as immersion in denture cleaners (70.06%), in disinfecting solutions (12.73%) and in vinegar (36.94%). Some 15% of all the practitioners advise the use of ultrasonic instruments for cleaning removable orthodontic appliances. At last, clinicians have faced complications from the use of removable devices in the oral cavity at a statistically significant percentage. The most usual is trauma of the mucosa, mycosis and hyperplasia. CONCLUSION: Greek orthodontists use removable orthodontic appliances, active or passive, in their practice. Brushing with a toothbrush and the use of cleaning products for removable prostheses are the preferred methods for cleaning removable orthodontic appliances regardless of the orthodontic specialty programme they had graduated from.

Photogrammetric Comparison of Facial Soft Tissue Profile before and after Protraction Facemask Therapy in Class III Children (6-11 Years Old).

STATEMENT OF THE PROBLEM: Achieving a normal soft tissue facial profile is considered to be the main concern of class III patients and the goal of most class III treatments. PURPOSE: The purpose of this study was to investigate the effects of facemask treatment on profile with photogrammetric method. MATERIALS AND METHOD: Before (T0) and after (T1) treatment photograms of 40 class III patients profiles (20 male and 20 female individuals) treated with protraction face mask that met the inclusion criteria were digitized and analyzed using Aesthetic Analyzer software. Selected linear and angular measurements were performed for each patient and the changes were noted. RESULTS: An increase in inferior facial height (p< 0.001) and inferior facial angle (p< 0.001) was observed. Nasal prominence and upper lip prominence also increased significantly (p< 0.001). Advancement of sub nasal area was observed to be significant in females (p< 0.05) in contrast to males. CONCLUSION: Remarkable advancement in the middle face and consequent fullness in the soft-tissue profile can be achieved by using protraction face mask. The response to treatment is not different between males and females.