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Clear Orthodontic Aligners Treatment: Current State and Future Possibilities

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Dentistry and Oral Sciences".

Deadline for manuscript submissions: closed (20 March 2024) | Viewed by 29668

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Special Issue Editors

Dr. Simone Parrini

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Department of Orthodontics, Dental School, University of Turin, 10126 Turin, Italy
Interests: clear aligner; orthodontic; esthetics; finite element analysis
Special Issues, Collections and Topics in MDPI journals

Dr. Gabriele Rossini

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Prof. Dr. Andrea Deregibus

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Special Issue Information

Dear Colleagues,

We are inviting submissions to this Special Issue on “Clear Orthodontic Aligners Treatment: Current State and Future Possibilities”.

Clear aligner treatment (CAT) is becoming a topic of growing importance in contemporary orthodontics, as a great number of patients seek this kind of approach. Scientific literature today still lacks high-quality papers with definitive results on the real efficiency of CAT. In this Special Issue, we invite submissions exploring various aspects of CAT from clinicians’ point of view but also from patients’ point of view. We ask for scientific research focused on the predictability of movements, efficacy of staging protocols, CAT in children and in teenage patients, quality of life in patients treated with CAT, changes in oral microbiome, and future prospectives.

Both theoretical and experimental studies are welcome, as well as comprehensive review and survey papers.

Dr. Simone Parrini
Dr. Gabriele Rossini
Prof. Dr. Andrea Deregibus
Guest Editors

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Keywords

clear aligner
esthetics
finite element analysis
predictability
patient perception
oral microbioma
tooth movement

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Published Papers (10 papers)

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Research

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10 pages, 2622 KiB

Open AccessArticle

Upper First Molar and Second Premolar Distalization with Clear Aligner and Interradicular Skeletal Anchorage: A Finite Element Study

by Tommaso Castroflorio, Simone Parrini, Gabriele Rossini, Bianca Nebiolo, Flavia Gavetti, Vincenzo Quinzi, Nicola Derton, Mario Alessandro Greco and Andrea Deregibus

Appl. Sci. 2023, 13(17), 9695; https://doi.org/10.3390/app13179695 - 28 Aug 2023

Cited by 2 | Viewed by 2128

Abstract

Background—Upper molar distalization with a clear aligner is a debated topic in the scientific literature. One of the main issues is the loss of anchorage, so Class II elastics or the application of miniscrews are recommended. The aim of this study is to evaluate, through Finite Element Method (FEM) analysis, the effects of the application of the interradicular miniscrew as an anchorage device. Methods—A maxillary arch model from the second molar to second molar, which was obtained from a Cone Beam Computed Tomography (CBCT) and 0.2 mm distalization of the upper second premolar and upper first molar, was simulated. Therefore, nine different anchorage configurations were analyzed, with a miniscrew simulated between the upper first and second molars. Results—Considering the anchorage of a Class I elastic on the first premolar, the resulting side effect was a buccal movement of the canine. When the Class I elastic was anchored on the canine, distal displacement of the canine was observed. The distalization movements of second premolars and first molars were more efficient when the elastics were parallel to the occlusal plane. A greater anterior anchorage loss was observed when the elastic was anchored on the canine, with a proclination of the upper central incisor 30% higher than in the simulation, in which the elastic was on the first premolar. Conclusion—The use of interradicular buccal skeletal anchorage could reduce issues of patient compliance, provide a consistent intraoral anchorage unit and allow the desired tooth movements, reducing unwanted movement of the anterior teeth. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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13 pages, 3652 KiB

Open AccessArticle

A Spectrophotometry Evaluation of Clear Aligners Transparency: Comparison of 3D-Printers and Thermoforming Disks in Different Combinations

by Francesca Cremonini, Margherita Vianello, Anna Bianchi and Luca Lombardo

Appl. Sci. 2022, 12(23), 11964; https://doi.org/10.3390/app122311964 - 23 Nov 2022

Cited by 7 | Viewed by 2111

Abstract

(1) Background: the aim of this study was to investigate the transmittance levels of aligners in relation to different thermoforming disks and printers after 14 days of in vitro aging. (2) Methods: the transmittance level of 18 aligners was investigated. Three printers were used to create the aligner: Carbon L1, Prodways LD20 and RapidShape D100+. Each printer produced 6 aligners: three were made of Zendura FLX material and three of Scheu Ca Pro+. Each sample was subjected to spectrophotometry analysis of its transmittance levels, for a total of 54 measurements at T0. Then, all samples were aged in vitro at a constant temperature in artificial saliva supplemented with food coloring for 14 days each. The spectrophotometry protocol was repeated, and the same 54 measurements were collected at T1 (after aging). The resulting data were analyzed and compared by means of ANOVA (p < 0.05). (3) Results: all tested aligners revealed lower transmittance values after aging. Scheu CA Pro+ aligners showed higher transparency at T0, but a significant worsening of its aesthetic at T1. On the other hand, Zendura FLX aligners presented slightly reduced transmittance levels before aging, which, however, remained more stable after 14 days, showing no significant difference. In the specific, aligners produced by Prodways LD20 printers showed better optical properties than the others, both at T0 and T1. (4) Conclusions: Differences in pre-and-post-aging optical properties of aligners are influenced by the manufacturing process. Both the thermoplastic disks and the printers, thanks to new technologies, played a positive role in the final transparency of the product, which improved in all values compared to previous studies. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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9 pages, 683 KiB

Open AccessArticle

Comparison of Root Parallelism in Extraction Cases Treated with Clear Aligners vs. Fixed Appliances

by Tianjin Tao, Hengyan Liang, Xinyu Yan, Qi Fan, Qingsong Jiang, Fan Jian, Hu Long and Wenli Lai

Appl. Sci. 2022, 12(22), 11756; https://doi.org/10.3390/app122211756 - 18 Nov 2022

Cited by 4 | Viewed by 4235

Abstract

In the process of orthodontic treatment, root parallelism is related to the relapse of extraction spaces, black triangles, and periodontal health. However, there are few studies on root parallelism in extraction cases with different types of appliances. The objective was to compare the root parallelism in extraction cases treated with clear aligners vs. those treated with fixed appliances by measuring the differences per extraction site and to access the root-movement control capacity of both orthodontic appliances. A retrospective study was conducted on cases in which the first premolars were extracted, treated by clear aligner appliance (“Invisalign” system, 28 patients) or fixed appliance (30 patients). The angulations of the tooth axis (canines, the second premolars, the first molars, and the second molars) were measured to analyze and compare the difference in root parallelism between the two orthodontic appliances. The percentage of root parallelism between the canine and second premolar in both groups had no significant difference. However, judging from the average angle difference value, the fixed appliance might have a greater range in root angulation adjustment than the aligner. In the angulation categories, the aligner mainly showed root apical divergence, while the fixed appliance mainly showed root apical convergence. The dental crown of the molars was mainly non-tipping in both groups, but it could be observed that the dental crown of the maxillary molars had a tendency toward mesial inclination. In conclusion, the same root parallelism and root inclination were obtained in tooth extraction cases whether treated by clear aligners or fixed appliances. This study provides clinicians with more information on the performance of clear aligners and fixed appliances. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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8 pages, 466 KiB

Open AccessArticle

Lower Molar Distalization Using Clear Aligners: Bodily Movement or Uprighting? A Preliminary Study

by Elisa Rota, Simone Parrini, Kamy Malekian, Giovanni Cugliari, Gianluca Mampieri, Andrea Deregibus and Tommaso Castroflorio

Appl. Sci. 2022, 12(14), 7123; https://doi.org/10.3390/app12147123 - 14 Jul 2022

Cited by 8 | Viewed by 3590

Abstract

Background: Lower molar distalization is considered to be one of the most difficult movements to obtain with clear aligners. The aim of this study was to evaluate the possibility to distalize the lower molars using clear aligners in adults without miniscrews. Material and methods: rx cephalograms of 16 patients (8 males, 8 females; mean age of 25.6 years), who underwent lower molar distalization, were analyzed. Cephalograms were taken before the beginning of treatment (T0) and after the end of treatment (T1). Dental and skeletal changes between T0 and T1 were evaluated. The level of significance was set at p < 0.05. Results: At T1, the lower second molar moved distally 2.47 mm, but there was a significant tipping (p = 0.027); the same result was found at the first molar, with a mean distal movement of 1.16 mm and a significant tipping (p = 0.003). No significant changes were detected on the sagittal and vertical skeletal variables. Conclusion: Clear aligner therapy can provide more distal tipping than bodily movement in the lower molars when a distalization is programmed. This movement could be sufficient to correct the initial malocclusion and gain a class I molar relationship. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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12 pages, 3804 KiB

Open AccessArticle

Class II Treatment in Growing Patients: Preliminary Evaluation of the Skeletal and Dental Effects of a New Clear Functional Appliance

by Francesca Cremonini, Francesca Cervinara, Giuseppe Siciliani and Luca Lombardo

Appl. Sci. 2022, 12(11), 5622; https://doi.org/10.3390/app12115622 - 1 Jun 2022

Cited by 5 | Viewed by 2605

Abstract

Objective: The purpose of this retrospective preliminary study was to analyze the skeletal and dentoalveolar effects of a new clear functional appliance in a sample of patients close to growth spurt with class II malocclusion attributable to mandibular retrusion. Materials and methods: A sample of growing patients underwent functional Class II correction using F22^® (Sweden and Martina, Due Carrare (PD), Italy) Young, realized combining the aesthetic characteristics of the F22^® clear aligner with the structural features of a functional appliance. For each patient, a digital setup was performed by a single operator to plan a mandibular advancement to the therapeutic position. Cephalometric analysis before and after treatment was performed. The purpose of the statistical analysis was to evaluate dental and skeletal changes associated with F22^® Young device, and whether there were statistically significant differences in anatomical measurements between the beginning and end of treatment. Results: 15 patients, 7 females and 8 males of average age 10.3, were treated with the F22^® Young appliance for an average period of 10 months ± 0.5 (maximum 11.5 months, minimum 10.5 months). The data showed that the SNB angle increase was statistically significant from T0 to T1, leading to a reduction in the ANB angle. Values for the mandible length, both total (Co-Gn) and at the base (Go-Pg), significantly increased. Conclusions: According to this preliminary study, F22^® Young appliance is effective in promoting mandibular advancement when used near the pubertal growth peak. The device is comfortable and aesthetic, which certainly promoted patient compliance, a key factor for treatment success. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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9 pages, 578 KiB

Open AccessArticle

The Efficacy and Predictability of Maxillary First Molar Derotation with Invisalign: A Prospective Clinical Study in Growing Subjects

by Roberta Lione, Valeria Paoloni, Francesca Chiara De Razza, Chiara Pavoni and Paola Cozza

Appl. Sci. 2022, 12(5), 2670; https://doi.org/10.3390/app12052670 - 4 Mar 2022

Cited by 14 | Viewed by 3015

Abstract

To analyze the derotation of maxillary mesio-rotated first permanent molars in subjects with Class II edge-to-edge dental malocclusion in mixed dentition treated with Invisalign Clear Aligners (CA). In total, 36 patients (16 males, 20 females, 9.9 ± 1.9 years) treated with CA are enrolled from the Department of Orthodontics. Inclusion criteria are the following: Caucasian ancestry, mixed dentition, molar Class II edge-to-edge, no tooth/craniofacial anomalies, no caries/periodontal diseases. Pre-treatment (T1) and post-treatment (T2) digital casts, and final ClinCheck representations (T2ClinCheck) are acquired. The Henry’s angle (HA) is used to assess maxillary first molars rotation. The molars with an HA > 11° are taken (53 teeth). Five measurements are performed at T1, T2, and T2ClinCheck: Henry’s angle (HA), mesiobuccal-expansion (MBE), distobuccal-expansion (DBE), mesiobuccal-sagittal (MBS), and distobuccal-sagittal (DBS). A paired t-test was used to compare T2-T1 and T2ClinCheck-T2. The T2-T1 shows a distal-rotation (difference −6.3°) with an expansion of 2.2 mm for MBE and 1.5 mm for DBE. At T2, the mesiobuccal cusps show a distal movement of 1.0 mm and the distobuccal cusps of 0.9 mm. The HA’s T2ClinCheck-T2 difference is −4.2°. In the sagittal plane, the difference is 0.9 mm for the MBS and 0.7 mm for the DBS. The expansion showed the highest predictability (60% HA, 52.6% MBS, and 56.25% DBS). The CA effectively produces an arch expansion and upper molars’ distal rotation. Upper molar derotation provides a 1 mm of gain in arch perimeter and occlusal improvement. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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Review

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13 pages, 1771 KiB

Open AccessReview

Comparative Evaluation of Postoperative Facial Swelling and Occlusion in Orthognathic Treatment with Clear Aligners versus Fixed Orthodontic Appliances: A Systematic Review

by Stacy Ann Rosenberg, P. Emile Rossouw, Basir A. Barmak, Dimitrios Michelogiannakis and Fawad Javed

Appl. Sci. 2023, 13(21), 11675; https://doi.org/10.3390/app132111675 - 25 Oct 2023

Cited by 1 | Viewed by 1124

Abstract

The purpose of this systematic review was to assess the postoperative facial swelling (FS) and occlusion attained with clear aligner therapy (CAT) and fixed orthodontic therapy (OT) after orthognathic surgery (OS). The focused question was “Is there a difference in postoperative FS and occlusion attained with CAT and fixed OT after OS?” Indexed databases were searched up to and including October 2023 using different keywords. Original clinical studies that compared postoperative FS and occlusion attained with CAT and fixed OT after OS were included. Risk of bias (RoB) and quality of evidence were also assessed. Four retrospective studies were included. One study reported no difference in postoperative FS among patients that underwent CAT or fixed OT after OS. In one study, patients treated with CAT demonstrated less FS in the first post-surgical week than individuals that underwent fixed OT. In one study, postoperative occlusion was comparable among patients that underwent CAT or fixed OT, whereas in another, postoperative occlusion was better in patients that underwent fixed OT than CAT. All studies had a moderate RoB and none of the investigations were based on power-adjusted data. Based upon the sparsity and questionable quality of available evidence, there is a need to render a firm conclusion. However, it seems that CAT and fixed OT are comparable in relation to postoperative occlusion and FS after OS. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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15 pages, 648 KiB

Open AccessReview

Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review

by Ferruccio Torsello, Giorgia D’Amico, Edoardo Staderini, Luca Marigo, Massimo Cordaro and Raffaella Castagnola

Appl. Sci. 2022, 12(15), 7807; https://doi.org/10.3390/app12157807 - 3 Aug 2022

Cited by 11 | Viewed by 4895

Abstract

This review aims to analyze the multiple factors affecting patients’ level of compliance (how much they wear removable devices/clear aligners) during orthodontic treatments and to investigate the available methods and devices to monitor the appliance wearing time and to improve it. A literature search was conducted on electronic databases (Pubmed, Scopus, and Google Scholar). The results of the present study suggest that compliance indicators may misestimate the intraoral wearing time. Compliance is affected by patient-related factors (age, personality traits, the importance of personal appearance, self-perception of malocclusion), appliance-related factors (visibility, pain/discomfort), and clinician-related factors (trust, clear and complete communication, motivation). The motivation of pre-pubertal patients is mostly external, while adolescents/young adults have intrinsic motivation for orthodontic treatment. Patients’ self-reports tend to overestimate the appliance wearing time. Even if there is a lack of evidence, teledentistry might improve patients’ awareness of being monitored, thus increasing the time for which orthodontic devices are worn. Compliance is a key factor for clear aligner treatments, but high-quality studies focusing on this aspect are missing. Further studies should focus on how to handle the lack of cooperation and how to increase compliance in order to maximize the treatment’s results. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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Other

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13 pages, 1776 KiB

Open AccessSystematic Review

Root Resorption during Orthodontic Treatment with Clear Aligners vs. Fixed Appliances—A Systematic Review

by Francesco Inchingolo, Angelo Michele Inchingolo, Giulia Palmieri, Chiara Di Pede, Grazia Garofoli, Elisabetta de Ruvo, Alessio Danilo Inchingolo, Andrea Palermo, Antonio Mancini, Daniela Di Venere, Giuseppina Malcangi and Gianna Dipalma

Appl. Sci. 2024, 14(2), 690; https://doi.org/10.3390/app14020690 - 13 Jan 2024

Cited by 1 | Viewed by 2884

Abstract

The external apical root resorption that occurs during orthodontic treatment was the focus of this study, using either fixed appliances (FA) or clear aligners (CA). Using the Boolean keywords “APICAL ROOT RESORPTION” and “CLEAR ALIGNERS”, the study searched PubMed, Scopus, and Web of Science, with a restriction to English-language publications. A total of 50 publications were found by the computerized search, but after eliminating duplicates, completing reviews, and determining eligibility, only 9 papers could be used in the study. In conclusion, apical root resorption (ARR) is a frequent consequence of orthodontic tooth movement that mainly affects the lower incisors, which may compromise the success of the procedure and the health of the patient’s teeth. Several variables, including the type of tooth, have an impact on the severity of ARR. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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10 pages, 3508 KiB

Open AccessCase Report

Photobiomodulation and Orthodontic Treatment with Clear Aligners: A Case Report of Severe Crowding and Agenesis

by Eda Fani, Giulia Coli, Andrea Messina, Francesco Sampalmieri, Fabrizio Bambini and Lucia Memè

Appl. Sci. 2023, 13(16), 9198; https://doi.org/10.3390/app13169198 - 12 Aug 2023

Cited by 2 | Viewed by 1648

Abstract

This paper aims to demonstrate the effectiveness of photobiomodulation in accelerating orthodontic treatment with clear aligners in correcting an orthodontic malocclusion characterized by severe crowding and agenesis in an adult subject. An adult male patient with Class I malocclusion, a mild Class III skeletal base and severe crowding was treated with 88 Invisalign^® (Align Technology, Santa Clara, CA, USA) pairs of aligners replaced every 5 days in combination with an Orthopulse™ (Biolux Research, Vancouver, BC, Canada) photobiomodulation device for home use by the patient. The total orthodontic treatment time was 440 days. Orthopulse™ is a photobiomodulation device that generates continuous beams of near-infrared light (NIR—near-infrared) with a wavelength of 850 nm and a power of 42 mW/cm² to produce an average energy density on the surface of the silicone impression of 9.3 J/cm². The combined use of clear aligners and the Orthopulse™ device allowed the patient to replace the aligners according to an experimental 5-day protocol to speed up the orthodontic therapy and, thus, resolve the malocclusion in less time than the manufacturer’s standard. Full article

(This article belongs to the Special Issue Clear Orthodontic Aligners Treatment: Current State and Future Possibilities)

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