Combined DNA applianceTM and InvisalignTM Therapy without Interproximal Reduction: A Preliminary Case Series

Full text

Dave Singh, J Clin Case Rep 2013, 3:5
DOI: 10.4172/2165-7920.1000271
Volume 3 • Issue 5 • 1000271
J Clin Case Rep
ISSN: 2165-7920 JCCR, an open access journal
Open Access
Case Report
Combined DNA ApplianceTM and InvisalignTM Therapy without Interproximal
Reduction: A Preliminary Case Series
Dave Singh G*
Biomodeling Solutions, LLC, USA
*Corresponding author: Dr. Dave Singh G, Professor, DDSc PhD BDS,
Biomodeling Solutions, LLC, Cornell Oaks Corporate Center, 15455 NW Greenbrier
Parkway, Commons Building, Suite 250, Beaverton, OR 97006, USA, Tel: 503-
430-7529/7536; Fax: 866-201-3869; E-mail: info@biomodelings.com
Received March 29, 2013; Accepted April 17, 2013; Published April 19, 2013
Citation: Dave Singh G (2013) Combined DNA ApplianceTM and InvisalignTM
Therapy without Interproximal Reduction: A Preliminary Case Series. J Clin Case
Rep 3: 271. doi:10.4172/2165-7920.1000271
Copyright: © 2013 Dave Singh G. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Introduction
e Daytime-Nighttime Appliance (DNA applianceTM) system is
designed to correct maxillo-mandibular underdevelopment in both
children and adults [1]. e DNA appliance is preferred where xed
orthodontic appliances are not indicated. In some respects it represents
a new generation of biomimetic appliances that are relatively easier
to adjust as they putatively rely on gene-environmental interactions,
secondary to temporo-spatial patterning [2] to achieve their eects.
Typically, a DNA appliance consists of 6 patented, anterior 3-D
Axial SpringsTM, a midline actuator (such as omega loops or screws),
posterior occlusal rests, and a round labial bow (Figure 1).
e DNA appliance is preferentially worn during the evenings and
at nighttime, but not during the day, and not while eating. e aim of
the DNA appliance protocol is to harness circadian growth hormone
rhythms that are encoded within the human genome [3].
e Invisalign system (Align Technology, Inc., Santa Clara, CA) has
been available for several years, and represents another alternative to
traditional orthodontics. In this procedure a wide range of orthodontic
movements are achieved in an innovative way [4]. According to Phan
and Ling [5] patients seeking orthodontic treatment are motivated by
esthetic considerations, but clinicians should recognize some of the
limitations of this technique before choosing it as the treatment option.
For example, while aggressive preparation is not required to obtain
the desired result, nite amounts of enamel are removed through
Interproximal Reduction (IPR) to achieve the best possible outcomes.
In this regard, Boyd [6] suggests that IPR be undertaken when there is:
better access to interproximal contacts; there is no signicant overlap
between teeth or until the teeth is aligned (to avoid removing enamel
at an angle). In this way, a variety of malocclusions can be successfully
treated, including moderate crowding, Class II division 1 malocclusions,
and deep overbite. However, palatal expansion may be used instead
of IPR as a primary way to provide space to resolve crowding. In a
previous study, Singh [7] suggested that biomimetic appliances might
best be deployed prior to the use of aligners. erefore, the aim of this
case series was to use the DNA appliance for foundational correction
prior to the use of clear Invisalign aligners.
Study Design, Subjects, Interventions and Settings
In this prospective, longitudinal study, a female population
between the ages of 23 to 38 years was selected. Subject A was 33 years
of age with a narrow upper arch and anterior crowding. Subject B was
23 years of age with upper and lower crowding, and increased overjet.
is subject had a history of orthodontic treatment followed by relapse.
Subject C was 38 years of age with a posterior crossbite. She also had a
Figure 1: A typical acrylic-based DNA appliance, consisting of 6 patented,
anterior 3-D Axial SpringsTM (constructed from DNA wireTM), a midline actuator
(screw), posterior occlusal rests, and a round labial bow. The DNA appliance
is preferentially worn during the evenings and at nighttime, but not during the
day, and not while eating.
Abstract
Objective: To use a biomimetic appliance prior to the use of removable clear aligners to reduce the necessity for
interproximal reduction in the correction of malocclusions.
Subjects: Three adult females aged 23-38yrs. Subject A had a narrow upper arch and mandibular retrognathia;
Subject B had crowding and an increased overjet; Subject C had anterior and posterior crossbite.
Intervention: All subjects were given optional treatment plans of DNA appliance therapy followed by Invisalign
to improve the occlusion.
Results: Subject a showed improved mandibular positioning, with improved facial soft tissues. Subject B
showed improved posterior occlusion with an increase in upper and lower arch width, resulting in improved facial
soft tissues and smile esthetics. Subject C showed improved posterior occlusion, correction of the anterior crossbite
and a corrected midline.
Conclusions: All three subjects that complied with a non-xed, DNA appliance/Invisalign protocol showed
functional and cosmetic improvements in occlusion without any interproximal reduction.
Journal of Clinical Case Reports
J
o
u
r
n
a
l
o
f
C
l
i
n
i
c
a
l
C
a
s
e
R
e
p
o
r
t
s
ISSN: 2165-7920

Citation: Dave Singh G (2013) Combined DNA ApplianceTM and InvisalignTM Therapy without Interproximal Reduction: A Preliminary Case Series. J
Clin Case Rep 3: 271. doi:10.4172/2165-7920.1000271
Page 2 of 2
Volume 3 • Issue 5 • 1000271
J Clin Case Rep
ISSN: 2165-7920 JCCR, an open access journal
history of prior orthodontic treatment but mandibular growth during
her teenage years had occurred aer her orthodontic treatment had
nished, and she now wished to avoid jaw surgery for her current
orthodontic correction. All subjects were given optional treatment
plans of traditional, xed orthodontics with brackets or a combined
DNA appliance/Invisalign protocol. All subjects chose the combined
therapy, in which the rst phase of treatment was undertaken with an
acrylic-based DNA appliance (Figure 1), followed by a second nishing
phase using Invisalign full with renements. e protocol followed was
that the subjects wore the DNA appliance for about 16 hrs each day
(during the early evening and nighttime, but not during the day, and
not while eating). is phase lasted for 6 months on average, followed
by a phase of Invisalign therapy that lasted for a further 6 months on
average. All patients were treated by the same clinician (Dr. Ataii).
Results
Subject A: Showed improved anterior occlusion and resolution of
lower anterior crowding, as well as an improved facial so tissue prole
in less than a year (Figure 2).
Subject B: e overjet was reduced to within normal limits. In
addition, the intermolar width increased by 2.5 mm in both the
upper and lower arches, resulting in a better so tissue prole, and
improvements in smile esthetics (Figure 3).
Subject C: Showed correction of the anterior crossbite and a
corrected midline (Figure 4).
Discussion
e DNA appliance is a biomimetic system for craniofacial
correction in children and adults [1,2]. e Invisalign System is a
series of clear plastic aligners that move a patient’s teeth in small
increments from their original state to an improved, treated state
[8]. e concept of Interproximal Reduction (IPR) has gained much
momentum over the past decade or so; in line with newer methods of
orthodontic correction. However, enamel thickness has anthropologic
signicance. For example, in primates enamel thickness is negatively
correlated with extension rate. is mechanism seems to ensure that
there is sucient time for enamel maturation to be completed before
tooth eruption takes place [9]. e corollary of that conjecture is that
the nite amount of human enamel laid down has to last the lifetime
of the individual. erefore, IPR may not be the optimal solution for
tooth alignment requirements. An alternative method for providing
space to accommodate a full dentition of 32 permanent teeth is via
palatal expansion. In this procedure new bone volume is produced
to resolve crowding, even in adults patients [2]. Kravitz et al. [10]
demonstrated the ecacy of tooth movement with removable aligners,
and we conclude that all three subjects in this present preliminary
study benetted from a combination protocol of the DNA appliance
worn only during the evening and nighttime, followed later by the use
of Invisalign aligners.
References
1. Singh GD, Lipka G (2009) Case Report: Introducing the Wireframe DNA
applianceTM. J Am Acad Gnathol Orthop. 26: 8-11.
2. Singh GD, Krumholtz JA (2009) Epigenetic orthodontics in adults. The
Appliance Therapy Group, Chatsworth, CA, USA.
3. Proft WR, Frazier-Bowers SA (2009) Mechanism and control of tooth eruption:
overview and clinical implications. Orthod Craniofac Res 12: 59-66.
4. Smallwood TW (2009) Invisalign and porecelain: the contemporary restorative
powerhouse. Alpha Omegan 102: 148-151.
5. Phan X, Ling PH (2007) Clinical limitations of Invisalign. J Can Dent Assoc 73:
263-266.
6. Boyd RL (2008) Esthetic orthodontic treatment using the invisalign appliance
for moderate to complex malocclusions. J Dent Educ 72: 948-967.
7. Singh GD (2010) Epigenetic orthodontics: Developmental mechanisms of
functional (formational) orthodontic appliances. J Amer Orthod Soc 10: 16-26.
8. Duong T, Kuo E (2006) Finishing with invisalign. Prog Orthod 7: 44-55.
9. Shellis RP (1998) Utilization of periodic markings in enamel to obtain information
on tooth growth. J Hum Evol 35: 387-400.
10. Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B (2009) How well does
Invisalign work? A prospective clinical study evaluating the efcacy of tooth
movement with Invisalign. Am J Orthod Dentofacial Orthop 135: 27-35.
(a)
(b)
Figure 2: Subject A showed improved anterior occlusion and resolution of
lower anterior crowding, as well as an improved facial soft tissue prole in
less than a year.
(a)
(b)
Figure 3: Subject B, showing the overjet reduced to within normal limits. The
intermolar width increased by 2.5mm in both the upper and lower arches,
resulting in a better soft tissue prole, and improvements in smile esthetics.
(a)
(b)
Figure 4: Subject C showed correction of the anterior and posterior crossbites,
and a corrected midline.