Review Article Invisalign: A Transparent Braces

Abstract

In current scenario not only adults have Influence of appearance in their professional and personal lives but also children have influence of the same. Appearance does count at any age. The face and the teeth have also come to play a part in his presentation to the outside world. To enhance this desire, attention has been given to correct malformations of teeth. In earlier times this was done by crude methods. And then evolved the concept of braces; fixed on the labial surfaces. Esthetic requirements repels adult patient from accepting traditional metallic look orthodontic appliance. Tooth colored brackets and wires gained popularity for a few decades but gradually declined owing to its own disadvantages. Orthodontists have given a new dimension by shifting from the labial to the lingual so as to give rise to the concept of Invisible braces or Lingual Orthodontics.

Full text

Kumar K et al. Invisalign.
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Journal of Advanced Medical and Dental Sciences Research |Vol. 6|Issue 7| July 2018
Review Article
Invisalign: A Transparent Braces
Kislaya Kumar1, Shivani Bhardwaj2, Vishal Garg3
1Intern, Teerthanker Mahaveer Dental College and Research Centre, Uttar Pradesh, India
2Associate Dental Surgeon, Delhi, India
3Intern, Maulana azad Institute Of Dental Science, Delhi, India
ABSTRACT:
In current scenario not only adults have Influence of appearance in their professional and personal lives but also
children have influence of the same. Appearance does count at any age. The face and the teeth have also come to play a
part in his presentation to the outside world. To enhance this desire, attention has been given to correct malformations
of teeth. In earlier times this was done by crude methods. And then evolved the concept of braces; fixed on the labial
surfaces. Esthetic requirements repels adult patient from accepting traditional metallic look orthodontic appliance.
Tooth colored brackets and wires gained popularity for a few decades but gradually declined owing to its own
disadvantages. Orthodontists have given a new dimension by shifting from the labial to the lingual so as to give rise to
the concept of Invisible braces or Lingual Orthodontics.
Key words: Clear Aligner, Esthetic Brackets, Invisalign, Lingual Orthodontics.
Received: 20 February 2018 Revised: 22 March 2018 Accepted: 24 March 2018
Corresponding Author: Dr. Kislaya Kumar, Intern, Teerthanker Mahaveer Dental College and Research Centre,
Uttar Pradesh, India
This article may be cited as: Kumar K, Bhardwaj S, Garg V. Invisalign: A Transparent Braces. J Adv Med Dent Scie
Res 2018;6(7):144-147.
INTRODUCTION
Now a days, not only adults have Influence of appearance
in their professional and personal lives but also children
have influence of the same. The maloccluded patients
when think about the correction of their malaligned
teeth,the first thing that come totheir mind are braces and
wires. However, according to the demands and needs of
the patients.dentistry has been revolutionised.Dentists are
concerned about the aesthetics and it is the major
concerns among patients whotakes orthodontic treatment.
To tackle the increasing aesthetic insist for an alternative
to conventional braces, researchers have
developedseveral solutions, such ascomposite braces,
ceramic, lingual orthodontics and clear aligners.Clear
aligners are the new age Aesthetic Orthodontic treatment
.The demand of invisalign is increasing now a days due to
its estheticdemand for those patients who are indisposed
of wearing usual orthodontic appliances. Invisaligners are
thin transparent removable unobserved plastic aligners for
successful moving of teeth into their required position.
In the late 1990s, Invisalign was introduced by Align
Technology Inc. Impression are taken to allow the
construction of accurate cast which can be scanned to
produce a virtual 3D model. This 3-D model can then be
manipulated by the dentist and malocclusion is nearly
treated using proprietary software. Then it can be used to
produce a series of clear plastic aligners that steadily
correct themalocclusion. The patient is instructed to wear
such aligner for approximately 20 hours per dayand is
supposed to change approximately every two weeks.
Each aligner will shift the teeth around 0.25 to 0.3mm.1
In current years, the figure of teenager patients looking
for orthodontic treatment has increased, so the aesthetics
of the orthodontic appliance has become a topic of
interest. The orthodontic patient today demands a
beautiful smile at the end of treatment, but is equally
concerned withappearance during the treatment. Tomeet
this need for an attractive bracket, the manufacturers also
started doing work by first decreasing the size and profile
of metal brackets, they further introduce a toothcoloured
ceramic brackets and ‘Invisible’ or ‘lingual’ brackets.
Due to increasing estheticdemands of adolescent patients
and clinical simplification in customising lingual
Journal of Advanced Medical and Dental Sciences Research
@Society of Scientific Research and Studies
Journal home page: www.jamdsr.com doi: 10.21276/jamdsr UGC approved journal no. 63854
(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805 SJIF (Impact factor) 2017= 6.261; Index Copernicus value 2016 = 76.77

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Journal of Advanced Medical and Dental Sciences Research |Vol. 6|Issue 7| July 2018
appliances, the indication of lingual orthodontics today is
extended to adolescents apart from young patients.2
INDICATIONS
• Malaligned and Mild crowded teeth (1-5 mm)
• Deep overbite (Class II div 2 cases )
• Spacing problems (1-5 mm)
• Narrow arches.
• Tip molar distally
• Lower incisor extraction for severe crowding cases.
ADVANTAGES
• The trays are aesthetic as it is clear and also comfortable
as no metal brackets or wires are there whichlead to
laceration of mouth
• Clear aligners are invisible and it gives confidence to
patient to smile.
• Technically much easier than lingual appliances
• Better oral hygiene as compared to fixed because
• Ideal for retreatment
• Shorter dental appointments..
• More précised treatment duration than braces
•Avoiding extractions of premolars by creating
interdental space via interproximal reduction
•Less frequent trips to the dental chair by allowing the
patients to replace their aligners on their own every few
weeks
DISADVANTAGES
•removable in nature.
•patient motivation required.
•it should be worn 22 hrs/ day.
•devicesshould be removed during meals.
•poor patient compliance
•missed appointments, deprived oral hygiene and
excessive bone enlargement lengthen treatment time and
affect quality results.1
• increase in price.
New Straight Wire Technique
The new lingual straight-wire (LSW) technique in
199516was developed by Takemoto and Scuzzo on
Mushroom shaped arch wires as it requires inset bends
and vertical steps between canines and premolars so
requiring complicated wire bending. A new light lingual
system was introduced in 2009 which is narrower
mesiodistally than the previous one Swhich increases the
interbracket distance and thus reduces both the force
transmitted by the arch wire and resistance to sliding
mechanics. The thinner bracket pad, places the bracket
slots much closer to the lingual tooth surfaces, further
increasing the interbracket distance.2
The new gingival-offset slot position reduces in-out
thickness,avoiding occlusal trauma from the opposing
teeth and thus enhancing patient comfort .
New LSW appliance works on sliding techniques and
uses a planar arch form to make arch coordination less
difficult. It eliminates the requirement for inset bends
between canines and1st premolars.
With a round Sentalloy® NiTi wire, Passivefunction is
achieved as it freelyslides for efficient leveling and
alignment.
With the introduction of a full-size Resolve® Beta-Ti
wire, full control is provided by active function which
enables full expression of the bracket’s torque and
achievement of the required result.3
Dentaurum has come up with the World‘s first: Nickel
free Lingual Brackets called Magic©. Due to the magic®
bracket's sole geometrical form, arch wires can be
inserted occlusally. The innovative combination of
occlusal and horizontal slot guidelines enables the arch
wire to be automatically pressed into the slot.
Clear Aligners
Another development to the Invisible orthodontic
treatment is the Clear Aligner Therapy. Clear aligner
treatment falls into two basic categories. The 1stcategory
consists of thermoformed appliances, sometimes known
as Essix Retainers (RaintreeEssix, Dentsply Corp.,
York, PA), that are made by making adjustments to the
tooth positions on models and fabricate one or more
aligners to treat a minor malocclusion.Now there are
other commercially available aligners as well, CA®
CLEAR-ALIGNER technique 29(SCHEU-DENTAL)
and CLEARPATH(ClearPath Orthodontics ®).2
Current Technique
Fixed orthodontic appliances have been the principle
fibre of orthodontic biomechanical procedure. However
the unwillingness to wear buccal braces as it has
pitiableestheticlead to the invention of alternative
treatment options for the adult population. Essix
retainers,, lingual orthodontics,Trutain retainers and
Invisalign appliances are some of the current treatment
options.
Because of their detachable nature,Trutain retainersand
Essix retainers are indicated for mild nonskeletal
malocclusions. Essix appliances have usually been used
as anterior retainers from cuspid to cuspid. They are made
from vacuformed plastic sheets which extends into
gingival undercuts. With minor changes, it can achieve
small tooth movements, and provide as temporary bridges
and bite planes.3
What is the Invisalign Appliance?
The Invisalignis made up of a transparent, thin plastic
material formed with CAD-CAM laboratory techniques.
The aligners are analogous to the splints that cover the
clinical crowns as well as the marginal gingiva. Each
aligner is planned to move the teeth a maximum of about
0.25 to 0.3 mm over a 2-week period. Excellent
observance is mandatory as the appliance has to be worn
a minimum of 20 to 22 hours a day and each aligner
should be worn 400 hours to be effective.
Clinician Involvement
Although diagnostic preparation for treatment with the
Invisalign appliance is similar to that for treatment with
conventional fixed orthodontic appliances, clinicians play
a more limited role during treatment with the Invisalign
appliance. Preparation includes initial assessment,
diagnosis, treatment planning and completion of
pretreatment records (e.g., panoramic and lateral
cephalometric radiographs, bite registration, photos and

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polyvinyl siloxane impressions), all of which must be
sent to Align Technology in California where simulated
virtual treatment is formulated by proprietary 3-
dimensional CAD-CAM technology. Clinicians then
download the virtual treatment set-up from the Internet to
evaluate the proposed final positioning of the teeth.
Clinicians can request modifications at this time, but once
the aligners are made, they cannot alter the appliance
during the treatment.4
Extraction Cases
Patients following premolar extractions is not suitablefor
Invisalign appliance because it cannot keep the teeth
upright during space closure and also leads to limited
movemsnts due to Bonded restorative attachments. 4
Occlusion
It has been suggested that removable appliances have
limited potential to correct buccal malocclusion. The lack
of interarch mechanics may describe this limitation. In
2003, Clements and others10 demonstrated that
correcting buccal occlusions with appliances similar to
the Invisalign appliance was least successful; for some
patients, their buccal occlusions were worse after
treatment. Djeu and others12 found that fixed appliances
were superior to the Invisalign appliance for treating
buccolingual crown inclinations, occlusal contacts,
occlusal relationships, and overjet. Only 20.9% of their
patients treated with the Invisalign appliance met the
predetermined passing standard, compared with the 47%
of those who had fixed appliances.
IntermaxillaryAppliances
Theremovable clear Invisalign appliance around the teeth
decreases the use of interarch mechanics (e.g., Class II
and Class III elastics). Some practioners are using elastics
on buttons bonded to the buccal surfaces as adjuncts to
tooth movement.
Treatment Time
The treatment duration is prolonged as the treatment plan
must include the chronologicalmovements for every tooth
from starting to end of the treatment.
If changes are required once the treatment starts,
significant additional span and documentation are
required to alter the treatment plan. In addition, the lag
time between formulating a treatment plan and inserting
the appliance can be up to 2 months.3
CLINICAL METHOD
Study models are preparedpreclinically. With the help of
polyvinyl material, impression is done and bite is
recorded and then it is sent to Invisalign office. A well
developed technology is used. With the help of highly
sophisticated software and 3D scan technology, a virtual
patient is created. Also other software like ‘Tooth shaper’
& ‘Autobite tool’ is used to identify the shape of the teeth
and put them in centric relation.2.
With the help of other software like ClinCheck set-up,
diagnosis and treatment planning is done which is also
used to evaluate the need for IPR, extraction, expansion,
distalization and proclination. It also show treatment
limits to patient as it evaluates the anchorage with
superimposition or surgical simulation tools. Aligners
other than Invisalign are Clear path aligners, Inman
aligners, NuvolaAndFantasmino System, ClearPath
Aligners are USFDA approved.
Dental aligners are a modern alternative to braces, for
teeth that are in need of straightening.1To align front teeth
quickly and safely for cosmetic purpose, the Inman
Aligner is used which has Nickel Titanium coil springs
that influence two aligner bows that gently resist each
other, guiding the teeth intotheir new site.1
CONCLUSION
Now a days, not only adults have Influence of facade in
their professional and personal lives but also children
have the same. Theesthetic of patients wearing invisalign
increases due to its transparent nature. Patients should be
well educated about the advantages and disadvantages of
clear aligner therapy. TheInvisalign appliance can provide
an excellent esthetic during treatment,comfort of wear,
ease of use , and superior oral hygiene.
INVISALIGN BRACES TRADITIONAL BRACES CERAMIC BRACES
REFERENCES
1. Thukral R, Gupta A. Invisalign: Invisible Orthodontic
Treatment- A Review. Journal of Advanced Medical and
Dental Sciences Research. 2015;3(5): S42-S44.
2. Jaiswal RK, Bhagchandani J, Agarwal S, Mehrotra R,
Chaudhari A. Invisible Orthodontics..journal of dentofacial
sciences,.2014; 3(3): 47-53.
3. Phan X, Ling PH. Clinical Limitations of Invisalign. JCDA.
2007; 73(3): 263-266.
4. Rossini G; Parrini S; Castroflorio T; Deregibus A;
Debernardi CL. Efficacy of clear aligners in controlling
orthodontic tooth movement:A systematic review. Angle
Orthodontist. 2015; 85(5): 881-889.
Source of support: Nil Conflict of interest: None declared
This work is licensed under CC BY: Creative Commons Attribution 3.0 License.