ArticleLiterature Review

Invisalign: current guidelines for effective treatment

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Abstract

Invisalign is an increasingly popular technique for aligning teeth and correcting malocclusions orthodontically. This article analyzes the current professional literature published on Invisalign and the benefits and risks of using the technique for both patients and doctors. The steady increase in the number of cases treated with Invisalign and where the technique is going in the future is investigated. Ten guidelines for Invisalign treatment and patient selection are given, along with case examples.

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... They have become popular alternatives to traditional orthodontics for their comfort, esthetics, and removability which contributes significantly to oral hygiene. 4 In fact, these aligners have demonstrated efficacy in aiding orthognathic surgery for dentofacial deformities, which share some technical similarities with MMA for OSA. 5 The average MMA and orthognathic patient cohorts nonetheless differ in key areas such as age, medical comorbidities, average BMI, and the degree of surgical repositioning. ...
... 10 Furthermore, SCAs may reduce the overall treatment time for cases requiring mild to moderate dental realignment. 4 Because of the discomfort associated with traditional orthodontics, the use of SCAs may also help reduce the perceived barriers to treatment in many individuals at risk of OSA complications. ...
... Despite its advantages, SCAs are less effective in treating large inter-and intra-dental arch discrepancies and require careful patient selection. 4 They also require good patient compliance, as these removable appliances require consistent use for 20 to 22 hours each day. 5 And because SCAs are readily removable, additional intraoperative measures like Erich arch bars are required to facilitate MMF. ...
Preprint
Maxillomandibular advancement (MMA) is a surgical intervention that reduces the symptoms of obstructive sleep apnea via anterior repositioning of the upper and lower jaws. Pre-operative orthodontic alignment is often a critical component in aiding MMA. Orthodontia are important in intraoperative anchorage for intermaxillary fixation, healthy post-operative occlusion, and post-operative skeletal stability. Sequential clear aligners (SCA) refer to removable orthodontic appliances that are replaced at regular intervals to stimulate dental migration without the use of bonded hardware. These aligners have demonstrated efficacy in aiding orthognathic surgery for dentofacial deformities, which share some technical similarities with MMA for OSA. Here, we explore the treatment protocol for MMA followed by post-operative SCA treatment. Our experiences show that post-operative orthodontic treatment with SCAs results in similarly successful post-operative surgical outcomes given that the patient’s pre-operative occlusion is stable.
... The history of clear aligner therapy dates back to 1945 when tooth positioners were introduced to refine the final stages of orthodontic treatment after appliance removal (1). In 1997, two Stanford students founded Align Technology in a Californian garage; in 1999, Invisalign was born (1), yet the market now supports a variety of other clear aligner technologies (e.g. ...
... The history of clear aligner therapy dates back to 1945 when tooth positioners were introduced to refine the final stages of orthodontic treatment after appliance removal (1). In 1997, two Stanford students founded Align Technology in a Californian garage; in 1999, Invisalign was born (1), yet the market now supports a variety of other clear aligner technologies (e.g. OrthoClear, ClearCorrect). ...
... OrthoClear, ClearCorrect). To date, almost four million patients have been treated with clear aligner therapy (1). Due to the nature of its popularity with both patients and practitioners, it is critical for the oral health-care provider to fully understand the importance of case selection and the nature of webbased diagnosis (2)(3)(4). ...
... Clear aligners are gaining popularity over traditional fixed orthodontics in the orthodontic market because of their transparency and comfort; hence, many clear aligner products have become available. 6,7 The present case report introduces a treatment innovation for a patient with a skeletal class III gummy smile that combines the SFA and clear aligners, with the total treatment being completed within 8 months. The treatment process was designed digitally, which improved the accuracy of the treatment plan and the precision of surgical execution, thus improving the overall treatment outcome. ...
Article
Full-text available
This case report introduces digital surgery-first approach orthognathic surgery assisted by three-dimensional virtual planning and combined with invisible orthodontic treatment for a 21-year-old female patient with a skeletal Class III high-angle gummy smile malocclusion. We explored the clinical significance of the widespread application of digital technology for rapid development of the orthodontic/orthognathic field. The regional acceleratory phenomenon and clear aligners were used to achieve fast and aesthetic tooth movement after surgery. The treatment lasted only 8 months, and the patient was satisfied with the aesthetic results. The results remained stable after 1 year of follow-up. This case report highlights the advantages of combining a digital design and a surgery-first approach to produce accurate, rapid, safe, stable, and fulfilling cosmetic results. The combination of the surgery-first approach and clear aligners can facilitate patient-oriented surgical orthodontic treatment.
Article
Purpose: The aim of the present paper is to verify the long-term results in dental and skeletal stability in terms of symmetry, occlusion and functional balance by the association between the IS and the SF technique. Methods: In this paper, the authors described 12 cases of severe class III malocclusion treated by the association between the IS and the SF technique. Results: At 1 year of post-orthodontic follow up, the patients present an Angle class I occlusal relationship, no deep bite, no scissor or cross-bite and no open bite. No one patient referred TMJ discomfort nor severe post-surgical complications and no surgical-orthodontic relapse occurred. The surgical and occlusal results are stable in terms of stability in all patients. Conclusion: The results of this study suggest the validity of our protocol in management of class III malocclusion patients.
Article
Introduction The purpose of this study was to evaluate and compare smile treatment outcomes between patients treated with Invisalign clear aligners (Align Technology, Santa Clara, Calif) and those treated with traditional fixed appliances by integrating variables such as lip symmetry, smile index, smile cant, buccal corridors, and gingival display into smile outcome evaluation. Methods Records from 58 patients, 29 of whom received Invisalign treatment (mean age 19.03 years) and 29 of whom received traditional fixed-appliance treatment (mean age 13.83 years), were compared for their smile outcome. Pretreatment scores, posttreatment scores, and differences between within-group smile score before and after treatment were determined for each group. Fifteen variables comprised the smile outcome, and the data were analyzed with the Mann-Whitney U test and the Wilcoxon t test for 2 dependent samples. Results Six variables within the fixed-appliance group presented with better smile scores than those within the Invisalign group; buccal corridors (%) (mean difference = 8.42%), buccal corridors (mm) (5.35 mm), smile cant (0.42°), maxillary dental midline (0.21 mm), gingival display (0.56 mm), and smile index (1.09%) for P <0.05. Invisalign performed better on 2 variables that determined maxillary incisor position (1.26 mm) and inclination (2.09°). No significant difference (for P = 0.05) was shown between pretreatment and posttreatment scores for either of the 2 groups. Conclusions Using the 15 variables in this study, the results suggested that for patients with Class I nonextraction, treatment with traditional fixed appliances changes the patient's smile more than Invisalign treatment, and fixed appliances appear to be more effective in improving the variables that quantify posttreatment smile outcome.
Article
Aim: Precise bonding of attachments in aligner treatment is crucial to achieve the intended tooth movement. Thus, we evaluated five different bonding protocols for attachments used in aligner treatments with the goal of identifying the most precise protocol. Methods: One ellipsoid and one rectangular attachment were exemplarily chosen and examined. All attachments were bonded using the same template aligner, which was produced by thermoforming. The bonding process was repeated 30 times with each protocol for statistical analysis. The protocols differed in the type of composite used (high viscous, low viscous), the additional application of a perforation in the attachment reservoir, and the use of a two-phase procedure with high viscous composite. All bonded attachments were laser scanned and compared to the attachments of a master model using a surface/surface matching algorithm to determine the precision, i.e., highest aberrations (maximum vertical distance) between the attachment of the master and results obtained from the various bonding protocols. Furthermore, the excessive amounts of composite bonded around the attachments were measured and compared. Results: The two-phase procedure had a median aberration of 0.13 mm and a median amount of excessive composite of 7.40 mm2 (ellipsoid attachment). With the low viscous composite without a perforation in the template reservoir, similar results were achieved (median 0.13 mm) regarding the maximum vertical distance, but had an excess area of 33.50 mm2. Conclusion: In this in vitro study, the bonding protocol influenced the precision of bonded attachments. The bonding protocol with high viscous composite without a perforation in the attachment reservoir was the most inaccurate. The use of a low viscous composite or attachments made by a two-phase procedure with high viscous composite revealed more precise results.
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