Figure 1
(a) Removable Invisalign Teen H Aligner equipped with two dark blue compliance indicators. (b) Site of aligners with enclosed ‘‘fast’’ compliance indicators. The color intensity of the blue compliance indicator is shown in 1b before treatment (dark blue), in 2b during treatment (light blue), and in 3b after treatment (clear) of the aligner in the aqueous environment (see Table 1).
Source publication
To evaluate the color fading in aqueous solutions of the blue dot wear-compliance indicators of the Invisalign Teen® System outside the oral cavity.
The compliance indicators in the Invisalign Teen aligners were tested for color resistance in various aqueous models with no saliva involved.
Color fading was observed as a function of time, pH, and te...
Context in source publication
Context 1
... different color fading is based on the different amount of the diffused dye determined by the pore sizes of the polymer. The blue dots are embedded in the vestibular part of the molar segments of the aligners (Figure 1). Wear time is determined by assessing the way in which the compliance indicators change color as the aligner is worn. ...
Citations
... For clear aligner therapy to be successful, compliance is essential. A poor treatment outcome would arise from noncompliant patients 13 . The wearing time of removable retainers has been changed from full-time to part-time during the night only 14,15 . ...
... In order to achieve these movements, aligner therapy requires higher patient compliance compared to multibracket therapy due to the removability of the devices, but the advantages outweigh the disadvantages, particularly from a patient perspective [2]. To mention the most relevant aspects, dental hygiene, caries control and speaking without limitations are possible and devoid of difficulty, and furthermore the high wearing comfort as much as the invisibility of the appliances make aligners attractive not only for adults but also for adolescents [3][4][5][6][7][8]. Since 2009, the option of aligner treatment is no longer restricted to adults or adolescents with full second dentition, but also available for teenagers with mixed dentition and erupting teeth due to the launch of Invisalign ® Teen by Align Technology Inc. (Santa Clara, CA, USA). ...
... Investigations revealed that teenagers treated with aligners feature better compliance in oral hygiene, less plaque, and fewer gingival inflammatory reactions than the ones under fixed appliance therapy [3]. However, no data on the effectiveness of treatment with Invisalign ® Teen exist to date, as such studies only focused on the compliance of adolescents wearing aligners [8,9]. ...
Objectives:
Aligners are an effective and esthetic orthodontic treatment option for permanent and mixed dentition. There are only a few studies dealing with the effectiveness of orovestibular tooth movement using aligners and applying adequate examination methods. In the present retrospective study, the aligner efficiency of orovestibular movements for the entire dentition was systematically evaluated using 3D superimposition, taking into account the influence of jaw, tooth type and Invisalign® system.
Methods:
Group 1 (n = 18 adults, Invisalign®) and Group 2 (n = 17 adolescents, Invisalign® Teen) were treated with Invisalign® Ex30 aligner material and Invisalign® specific auxiliary means. In this non-interventional retrospective study, pre- and post-treatment maxillary and mandibular plaster cast models were scanned and superimposed with ClinChecks® via Surface-Surface Matching Algorithm on unmoved teeth providing stable references. Effectivity of planned versus clinically realized movements was evaluated for each tooth. Statistics were performed with a t-test and Bonferroni-Holm correction (α = 0.05).
Results:
Orovestibular movement efficiency was excellent without statistical significance regarding jaw, tooth type or Invisalign® system. Mandibular translational tooth movements were highly effective, and outstanding for premolars (91-98%). Maxillary translational tooth movements were successful for incisors and premolars, but less effective for canines and molars. Almost all teeth were moderately or very effectively corrected by crown tipping, performing better for mandibular (70-92%) than maxillary (22-31%) canines as much as for adolescent upper front teeth (81-85%) and lower canines (92%).
Conclusions:
Aligners are able to effectively implement translational orovestibular movements, supported by tilting the crowns for even more efficient implementation of the movements. This phenomenon was observed in our studies for all teeth in both jaws, regardless of the Invisalign® system used. Treatment planning should nevertheless take into account the individual patient parameters with regard to the movements to be performed in order to make the aligner therapy as successful as possible in terms of realizing the desired therapeutic goal.
... 39 It is important to highlight that the compliance indicators' fading pattern is unsuitable as an objective measure of wear time. 40 We are aware that the Compliance Indicator is not the best validator for using aligners and that there are several reasons for the decrease in colour, which can lead to mistakes regarding the exclusive use of this to confirm the patient's commitment. ...
Objective
To compare the anterior crowding correction after sequential use of the first 5 aligners between two aligner exchange protocols (7 and 14 days) in mature adult patients.
Materials and Methods
Thirty‐six patients over 35 years who received orthodontic treatment with Invisalign® were randomly allocated to two different aligner replacement sequence protocols: Group 1: exchange every 7 days (n = 18); and Group 2: exchange every 14 days (n = 18). All patients were scanned with iTero Element 5D® (Align Technology) in two treatment times: at pre‐treatment (T1) and after using the first five aligners (T2). Little's Irregularity Index (LII) and arch widths were evaluated with OrthoCAD software. Intra and intergroup comparisons were performed with the dependent and independent t ‐tests. The results were considered significant for P < .05.
Results
Thirty‐five patients completed the study. Both groups' maxillary and mandibular Irregularity Indexesi were significantly lower at T2. There was no significant difference in inter‐canine, inter‐premolar, and intermolar distances. G2 (14 days) presented a greater decrease in mandibular irregularity than G1 (7 days).
Conclusion
Both exchange protocols (7 and 14 days) effectively correct anterior crowding in the initial phase of orthodontic treatment with aligners in mature adult patients. However, the 14‐day exchange protocol provided a greater correction in mandibular anterior crowding in the evaluated period than the 7‐day exchange protocol.
... Investigate the short-term optical, chemical and morphological changes in Invisalign appliances E Schott and Göz, 2011 [316] Experimental in vitro study • 7 Invisalign TeenH aligners (A) were obtained directly from the manufacturer (Align Technology Inc, Santa Clara, Calif) • 14 Invisalign TeenH aligners (B) were provided by an orthodontic office that routinely uses the InvisalignH system Color fading of the blue compliance indicator encapsulated in removable clear Invisalign TeenH aligners • Color fading was observed as a function of time, pH, and temperature while compliance indicators were stored in drinking water or sour soft drinks and in conjunction with the use of cleaning tablets and a dishwasher Experimental in vitro study 60 CA produced by three manufacturers (Invisalign, Angelalign, and Smartee) Colour stabilities of three types of orthodontic clear aligners exposed to staining agents • Three manufacturers (Invisalign, Angelalign, and Smartee) ...
Background
Over the last two decades, clear aligners have become a mainstay in contemporary orthodontic practice primarily due to improvements in digital and 3D printing technologies, a growing interest in esthetic orthodontics, especially in the adult population, and aggressive manufacturer marketing internationally.
Material and Methods
PubMed, Google Scholar, Cochrane Library, and EMBASE databases were searched from January 1998 to November 2021. The search terms used were “Invisalign” OR “clear aligner.” A total of 7000 records were searched, of which 369 potentially relevant articles were retrieved in full. 190 studies met the selection criteria following screening and were included in the scoping review.
Results
This review scopes and analyses published orthodontic literature about CA according to a year-wise distribution into 3 groups, 2001–2010/2011–2020/2021. Most of the studies were published in the period between 2011 and 2020, with 138 studies accounting for 73%. The year 2021 followed, with 31 studies accounting for 16%, which was greater than the number of studies published in 10 years from 2001 to 2010. Studies were also classified based on the study designs with most of the published studies representing the lowest level of evidence including case reports, case series, narrative reviews, expert opinions, and editorials accounting for 137 studies, whereas case-control studies were the least reported studies with only 4 studies reported in the literature. In addition, they were categorized into seven main domains: (1) Biological considerations associated with clear aligner therapy (CAT), (2) Treatment outcomes considerations associated with CAT, (3) Geometrical considerations associated with CAT (clinical), (4) Biomechanical considerations associated with CAT (Laboratory/Finite element analysis), (5) Biomaterial considerations associated with CAT, (6) Patient education and experience and aesthetic and social perception of CAT, and (7) Miscellaneous. Treatment outcome considerations associated with CAT had the greatest percentage representing 36% of the total published domains, while the final place was occupied by the biomechanical considerations associated with CAT accounting for only 4% of the published domains about CAT.
Conclusion
Treatment outcome was the domain most commonly reported by studies accounting for (36%). Most of the published studies are at the lowest level of evidence including case reports, case series, narrative reviews, and expert opinions. The vast majority of studies utilized only a single clear aligner brand. There is a greater need for research that studies CAT from a holistic perspective.
... Although not an objective monitoring method, clear aligners embedded with a food-grade dye (erioglaucine disodium salt) that dissolves when exposed to saliva are an available option for compliance monitoring. A subjective evaluation of color change (five shades from dark blue to clear) is used to obtain a visual representation of wear time [71,72]. However, not much is known about whether these colorimetric compliance indicators are affected by intraoral pH and temperature. ...
Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual’s current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw’s functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual’s current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.
... Compared with minimal-invasive detection using microneedles, non-invasive continuous detection Miniaturized sensor technologies for long-term monitoring of orthodontics. a Monitoring the compliance of wearing dental braces based on the degree of pigment diffusion from polymer pores and force required for orthodontics 33,36 . b Wearable devices to monitor pH and temperature of saliva 38 . ...
... d Wearable patch attached onto teeth to detect oral microbiomes 37 . Figure used with permission from Schott, T. C. et al. 33 Copyright © Allen Press Inc, has greater application potential. Chen et al. integrated a skin-like electrochemical biosensor with twin channels, forming an ultrathin (~3 μm) nanostructured biosensor, to accurately monitor glucose in skin surface through transporting intravascular blood glucose to the skin surface in a noninvasive way with high sensitivity (130.4 μA mM −1 ) 51 . ...
Physiological monitoring can provide detailed information about health conditions, and therefore presents great potentials for personalized healthcare. Flexible miniaturized sensors (FMS) for physiological monitoring have garnered significant attention because of their wide applications in collecting health-related information, evaluating and managing the state of human wellness in long term. In this review, we focus on the time scale of human physiological monitoring, the needs and advances in miniaturized technologies for long-term monitoring in typical applications. We also discuss the rational sample sources of FMS to select proper strategies for specific monitoring cases. Further, existing challenges and promising prospects are also presented.
... A very good compliance is necessary to obtain successful results with clear aligner therapy [36,41], as the appliances should be worn 22 h per day and changed sequentially every 7, 10, 14 days [51]. An insufficient compliance may increase the treatment time and therefore may compromise the treatment outcome [35]. ...
... Yet, the evidence reported that wear-time monitoring by clinicians and caregivers does not necessarily boost compliance or increase the general amount of time spent wearing removable appliances [12]: if patients are informed that their wear-time is recorded, they tend to be more compliant but still wear the appliances for a shorter period than that prescribed by the given instructions [14,36]. ...
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.
... 16 It is a versatile device due to its small dimensions and ability to distinguish attempts to deceive the microsensor. 17 Using microsensors, many factors influencing compliance can be identified, such as age, gender, and psychological parameters related to the patient. Age seems to be an important factor, with younger patients being more compliant, while the influence of gender has had conflicting results. ...
... Age seems to be an important factor, with younger patients being more compliant, while the influence of gender has had conflicting results. [14][15][16][17][18] There are also treatment-related factors, such as appliance type, 11,[18][19][20][21] prescribed wear time, 10 doctor-patient relationship, 22 and monitoring awareness. 19 Clinicians have more control over treatment-related factors as they can be modified. ...
Objectives
To assess the objective compliance levels in skeletal Class II patients with mandibular retrognathia wearing monoblock and twin-block appliances.
Materials and Methods
A prospective clinical study was conducted with 30 patients between 10 and 15 years old who were equally divided into two study groups. Group 1 was treated with monoblock, and group 2 was treated with twin-block appliances. The patients were instructed to wear their appliance for 15 hours per day. Wear times were monitored by a microsensor. (TheraMon; MCTechnology, Hargelsberg, Austria) for an average of six appointments. Patients were also instructed to record their wear times on a chart, and this record was admitted as subjective wear time. Statistical analysis was performed with the data derived from both the patients' charts and the monitoring records.
Results
The mean wear time by the patients was 10.67 ± 3.93 hours, which was less than the 15 hours prescribed by the orthodontist, with no difference between the two appliances (P > .05). The regular use rate, which included the days with a wear time of 8 hours or more per day, was 75%. Compliance levels decreased by 35% throughout the six control appointments. Patients declared that their wear time was more than their objective wear time by an average of 3.76 hours.
Conclusions
Despite their different designs, there was no significant difference between the monoblock and twin-block appliances in terms of compliance.
... In more recent concepts these changes are suggested to be required after one to two weeks. Regularly changing aligners requires a high level of patient compliance [13,14]. Such compliance is further needed as they need to be worn near-permanently (minimum 22 h per day) [15]. ...
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.
... But though the visibility of the appliance is one of the principal concerns, this seems to be not the only one factor decisive to gain the correct use because, especially in the adolescents, the basic personality traits seem to play a more important role in this aspect (6). Bringing the action to the insertion of compliance control devices into the aligners seems not to change significantly in this aspect (7). ...
The introduction, in the late years of the last century, of clear aligners therapy (CAT) has drastically changed the approach' perspective to orthodontic treatment. Both patients and clinicians' expectations appear to be addressed with clear aligner therapy achieving an aesthetic appearance and fewer side effects, mainly due to the difficult maintenance of proper oral hygiene in the conventional fixed approach. Research has partially confirmed these key points of CAT but similarly revealed several limitations to the overall benefit of this treatment. Both the aforementioned key points of the CAT are currently under discussion: the aesthetic appearance is not uniform, due to the presence in some cases of extensive need for attachments, and the better periodontal conditions are certainly present in the CAT but mainly limited to the short term. This critical review of the state of the art clarifies the gray areas, such as to inform the researcher with the aim of elaborating an adequate study design in order to evaluate the advantages and limitations of this orthodontic approach.
