Clear Aligners Research Articles

Knowledge and Awareness on Aligner Treatment Protocol Among General Dentists, and Non Orthodontic Specialists: A Questionnaire study

The general dental practitioners and other non-orthodontic specialists can play the role of orthodontic health educators. Dentists have the responsibility to recognize, diagnose, and manage or refer abnormalities in the developing dentition. Hence for proper counseling and referral, general dentists and non-orthodontic specialists must have adequate level of orthodontic knowledge. Aim and objective: This study aims to determine and evaluate the knowledge and attitude of general dentists and non-orthodontic specialists towards early orthodontic treatment. The objective of the study was to assess the knowledge of orthodontic treatment among general dentists and non-orthodontic specialists and to compare the knowledge of orthodontic treatment between the two groups. Material and methods: 308 dental professionals were included in the study. The participants were divided into three groups; Group I included general practitioners, Group II had non-orthodontic postgraduate students, and Group III had non- orthodontic specialists. The questionnaire included 20 closed-ended, multiple choice questions. The first five questions include; general information such as gender, age, educational qualification, years of clinical experience and attachment to educational institutions. The next fifteen questions depict the attitude and awareness of principles and practices in orthodontics. Results: The study highlights the need for better education for treatment concepts in aligner therapy to the general dentist and non-orthodontic specialist. Conclusion: Conduction of Continuing Education programs to update them regularly in newer treatment protocols might be of great help to the practitioners in providing meticulous care to their patients. Overall, clear aligners have revolutionized orthodontic treatment by offering improved aesthetics, patient acceptance, and quality of life.

Orthodontic re-treatment of class II malocclusion – Strategies for correction of anchorage loss

Orthodontic re-treatment may be required in cases of sub-optimal treatment outcomes. These outcomes may often be due to appliance-driven treatment plan, inadequate bio-mechanical considerations during treatment or poor operator skills. Common issues include anchorage loss, deepening of bite, incorrect extraction protocols, re-opened extraction spaces and loss of vertical control. To address these problems, traditional orthodontic appliances, skeletal anchorage systems, customized appliances, and clear aligners may offer a ray of hope, provided they are used judiciously. To effectively manage re-treatment techniques, it's important to have a solid understanding of the anatomic limits, biomechanics, and potential side effects. Proper case selection is extremely crucial for overall clinical success in such complex situations. Therefore, establishing guidelines and understanding the biomechanical perspectives of various appliance systems are essential to address these challenges in modern orthodontic practice.

Finite element analysis in the Dental Sciences: A Bibliometric and a Visual Study

Introduction and aimsFinite element analysis (FEA) is an incrementally practical and precise tool for the prediction of stress effects on different tissue structures and has therefore interested dental researchers for decades. This bibliometric and visualized study was aimed to assess the research progress related to FEA in the dental sciences in terms of research trends and frontiers. MethodsThe articles about FEA studies in this field during 1999 to 2024 were obtained from Web of Science Core Collection. Then, these results were analysed and plotted using Microsoft Excel, VOSviewer, and CiteSpace in order to find out the historical evolution, current hotspots, and future directions. ResultsTotal 2838 literature records related to the topic were retrieved from Web of Science Core Collection. The most active country and institution were USA (538 documents) and Universidade Estadual Paulista (140 documents), respectively. Baggi et al from University of Naples Federico II was the author with the most highly cited article (352 citations), which was published on the Journal of Prosthetic Dentistry in 2008. Dental Materials ranked first (231 documents) among the 10 journals with the greatest numbers of relevant publications. The top three trending keywords were ‘dental implant’, ‘stress distribution’, and ‘fracture’. The endocrown, clear aligner, and posterior edentulism were scientific frontiers in this field. ConclusionThe present study provides a comprehensive bibliometric analysis of research in the dental science by FEA approaches, which will identify active hotspots of scientific interest to guide further research endeavours.

In vitro comparison of the mechanical properties of single and triple layered clear aligner materials.

In vitro comparison of the mechanical properties of single and triple layered clear aligner materials.

Use of Clear Aligners with a Surgery-First Approach for Treatment of the Anterior Open Bite: A Systematic Review and Comparison with Conventional Fixed Appliances

Use of Clear Aligners with a Surgery-First Approach for Treatment of the Anterior Open Bite: A Systematic Review and Comparison with Conventional Fixed Appliances

Efficiency of clear aligners with nickel titanium wires for treating mandibular incisor crowding.

Patients who are allergic to nickel, which is present in stainless steel brackets and wires, commonly utilise clear aligners. The objective of this research was to compare the management of mandibular incisor crowding with nickel titanium (NiTi) wires and clear aligners. A random division of forty participants into two groups of twenty samples each was made. Participants in group B received transparent aligners, whereas those in group A received NiTi arch wires. We assessed malocclusion using Little's irregularity index. A survey instrument was utilised to document the degree of discomfort. Patients were routinely recalled every one, two, and three months. The mean score for groups A and B was 2.86 mm and 2.88 mm at baseline, 1.71 mm and 1.52 mm at one month, 1.02 mm and 1.23 mm at two months, and 0.72 mm and 0.48 mm at three months, respectively. The difference wasn't that big (p > 0.05). In groups A and B, the mean change in Little's irregularity index score was 1.19 mm and 1.21 mm at one month, 0.55 mm and 0.51 mm at two months, and 0.26 mm and 0.45 mm at three months, respectively. The difference wasn't that big (p > 0.05). For groups A and B, the corresponding mean discomfort scores were 2.6 and 2.3 at baseline, 2.2 and 1.8 after one month, 1.6 and 1.5 at two months, and 1.1 and 0.9 at three months. Since p > 0.05, the difference was not significant. The results of this study showed that NiTi wires and clear aligners worked just as well to treat cases of mandibular anterior crowding.

Class III correction and enhanced periodontal health with aligner treatment in a 53-year-old patient.

In this case report, we describe the successful camouflage treatment of a 53-year-old female with dental and skeletal Class III malocclusion combined with anterior crossbite, gingival recession, and mobility of the lower incisors, using clear aligners. The treatment involved periodontal debridement followed by orthodontic treatment. The mandibular posterior teeth were distalized to correct the anterior crossbite and to establish Class I molar relationships. During treatment, the mandibular incisors were intruded, and the mandibular occlusal plane underwent a clockwise rotation due to slight extrusion of the maxillary buccal segments and distalization of the mandibular posterior teeth. Following treatment, all objectives were achieved, including resolution of the anterior crossbite, significant reduction of gingival recession and tooth mobility, and improved functional occlusion. The dental and skeletal Class III malocclusion was corrected, and the marginal alveolar bone dehiscence was significantly reduced. The results remained stable over a 3-year retention period, with enhanced molar intercuspation and gingival growth progression. This case adds to the evidence supporting the adaptability and effectiveness of clear aligners in treating orthodontic patients with compromised periodontium. The treatment outcomes support that orthodontic treatment using clear aligners, combined with periodontal monitoring, can assist in managing alveolar bone defects, gingival recession, and tooth mobility.

Analysis of the Forces and Moments in Canine Bodily Movement with Different Clear Aligners’ Extraction Space Designs

This study aimed to optimize space closure efficiency by comparing the forces and moments exerted by different designs of clear aligners (CAs) during the movement of maxillary canines into the premolar extraction space. The forces and moments were measured using a multi-axis force/moment transducer on the maxillary right canine. The CAs were fabricated from thermoformed polyethylene terephthalate glycol. The following four edentulous space designs were tested: the edentulous space was left intact (Group 1); the edentulous space was replaced with a premolar pontic (Group 2); the edentulous space was replaced with a half-sized premolar pontic (Group 3); and the edentulous space was replaced with a rectangular column beam (Group 4). The maxillary right canine was moved 0.25 mm distally. All groups experienced buccodistal and intrusive forces; compared with the other groups, Group 1 showed significantly greater intrusive and smaller distal forces, and Group 4 showed significantly greater distal forces. All groups experienced distal tilting, lingual inclination, and mesial rotational moments. These findings suggest that modifying the thickness and extent of the adjacent teeth in the edentulous area of the CA can improve local stiffness, thereby reducing the tipping of the teeth into the edentulous space. This study emphasizes the importance of the CA design in controlling forces and moments for effective orthodontic treatment.

Bibliometric Analysis of Maxillary Expansion Publications Trends.

Maxillary expansion is a common treatment in clinical orthodontics and can be performed in a wide age range using different methods. This bibliometric analysis aims to provide an overview of research on maxillary expansion. A literature search was performed in the Web of Science database, and publications related to maxillary expansion between 1970 and 2023 were included. Data, including titles, abstracts, keywords, countries, regions, and references, were exported and analyzed within the scope of the bibliometric indicators. The study was conducted on 2633 publications. Between 1970 and 2023, research on maxillary expansion showed a general upward trend in the number of publications. From the analyzed publications, we observed that rapid maxillary expansion (RME) was the most common type of maxillary expansion, accounting for 78% of all publications. Most publications originated from the United States (24.3%), and these articles were also the most cited (17180). Lorenzo Franchi contributed the most publications (85, 3.2%) and was cited 2830 times for maxillary expansion. The highest number of publications was from the University of Sao Paolo (119), and the most cited institution was the University of Florence (3287). The bibliometric indicators showed a rapid increase in the number of published works on the topic of maxillary expansion, particularly in recent years. Advances in patient evaluation (3D imaging, modeling) and application methods (mini-screws, clear aligners) appear to have helped to maintain the popularity of maxillary expansion. We also observed that maxillary expansion is associated with several other specialties in addition to dentistry.

An Assessment of the Mechanical Deformation Behavior of Three Different Clear Aligner Materials: A Digital Image Correlation Analysis

Introduction: The present study aimed to investigate the deformation behavior of three different clear aligner systems, CA® Pro+ Clear Aligner (Scheu Dental, Iserlohn, Germany), Taglus Premium (Taglus Company, Mumbai, India), and Spark Trugen (Ormco Corp., Orange, CA, USA), under compression testing, using the digital image correlation (DIC) technique. Materials and Methods: A total of 15 patients were treated with each of the three aligner systems, resulting in 45 sets of aligners. Each aligner set was fixed on the 3D-printed dental arches and then in an articulator. Then, the samples were subjected to occlusal forces using a purpose-built test stand to allow for controlled force application and precise displacement determination. The DIC technique was used for capturing the deformation behavior, providing detailed strain and displacement fields. Statistical analysis was performed using one-way ANOVA and Bonferroni post hoc tests with a significance of 0.05. Results: The results indicate that the Spark system exhibited the most substantial rigid displacement. Furthermore, the elastic deformation values of the Spark and Taglus systems were significantly higher than those of the CA Pro+ system (p > 0.05). Conclusions: The Spark Trugen clear aligner system demonstrated a lower stability to rigid displacement and elastic deformation under compression testing compared to the Scheu CA® Pro+ Clear Aligner and Taglus Premium. All three tested clear aligner systems showed an increased resistance to elastic displacement and rigid deformation in the mandibular arch.

Towards Sustainable Orthodontics: Environmental Implications and Strategies for Clear Aligner Therapy.

The increasing concern over environmental sustainability has prompted various industries to reassess their practices and explore greener alternatives. Dentistry, as a significant contributor to waste generation, is actively seeking methods to minimize its environmental footprint. This paper examines the environmental implications of clear aligner therapy (CAT) in orthodontics and explores strategies to prioritize sustainability in aligner manufacturing and usage. CAT has gained popularity as a viable alternative to traditional fixed appliances due to advancements in biomaterials and computer-aided design (CAD) and manufacturing (CAM) technologies. The global market for clear aligners is expanding rapidly, with significant growth projected in the coming years. To address these challenges, this paper proposes adopting the principles of reduce, reuse, recycle, and rethink (4Rs) in orthodontic practices. Strategies such as minimizing resource consumption, incorporating recycled materials, and promoting proper aligner disposal and recycling can significantly reduce environmental harm. This paper explores emerging technologies and materials to mitigate the environmental impacts of CAT. Additionally, initiatives promoting aligner recycling and repurposing offer promising avenues for reducing plastic waste and fostering a circular economy. In conclusion, while CAT offers numerous benefits in orthodontic treatment, its environmental impact cannot be overlooked. By implementing sustainable practices and embracing innovative solutions, the orthodontic community can contribute to a more environmentally conscious future while continuing to provide quality care to patients.

YouTube as an information resource for early orthodontic treatment with clear aligners

YouTube as an information resource for early orthodontic treatment with clear aligners

Accuracy of clear aligners in the orthodontic rotational movement using different attachment configurations.

To evaluate the accuracy of dental rotational movements using clear aligners with different attachment configurations. This retrospective study analysed 212 teeth from 89 patients undergoing Invisalign treatment. Digital models were analysed after the virtual treatment plan (ST1) and after the first treatment phase (ET1) to evaluate the effective clinical rotational movement. The rotational movements of incisors, canines, and bicuspids were measured using data from the Clincheck Movements Table. ST1 and ET1 were compared to determine the actual rotational movement achieved (ST1-ET1). The presence or absence of attachments (rectangular or optimized) on teeth was analysed. The accuracy of rotational movements among attachment types was compared using the Kruskal-Wallis test. Multiple linear regressions were conducted with accuracy as the dependent variable and tooth type, gender, and age as predictors. Optimized attachments had the highest median accuracy (70%), followed by rectangular (65%), and without attachment (63%), with no significant differences (p = .5). There were no significant differences across age groups, genders, or tooth types. Baseline accuracy was 68.62% (95% CI: 56.03-81.20, p < .001). Age was a significant predictor (estimate = -0.30, 95% CI: -0.58 - -0.03, p = .032), indicating decreased accuracy with increasing age. The model's R2 was 0.046, with an adjusted R2 of 0.003, indicating minimal variance explained. The addition of attachment configurations to clear aligners improves rotational accuracy, but not significantly. Further advancements in these configurations are needed to enhance the performance of the aligners.

Awareness Regarding Clear Aligner Disposal Among Orthodontists and General Dentists: A Cross-sectional Survey-based Study

Aim and Objective: To assess the awareness of clear aligner disposal among orthodontists and general dentists. Materials and Methods: A cross-sectional electronic survey (e-survey) was developed based on the use of Google Forms. The survey link was randomly disseminated across social media platforms consisting of orthodontists and general dentists. The responses were subsequently tabulated and analyzed using statistical analysis with the help of Statistical Product and Services Solution software version 23.0. The survey comprised questions consisting of demographics, frequency of usage of clear aligners, and awareness on disposal of clear aligners. Results: The survey gathered responses from 760 participants, including 374 orthodontists and 384 general dentists from the 1,000 dentists and orthodontists who were surveyed, revealing trends in clear aligner usage, disposal practices, and awareness. Orthodontists showed higher frequency and safer disposal practices. A knowledge gap exists among dental practitioners regarding biodegradation characteristics and disposal regulations. Both groups express a shared interest in environmentally responsible practices, emphasizing the necessity for education and comprehensive guidelines from aligner companies to mitigate environmental impact. Conclusion: Clear aligners are popular in orthodontic treatment which contributes to environmental concerns due to improper disposal. The study explored clear aligner disposal practices among general dentists and orthodontists. The study underscores the need for increased awareness among orthodontists and general dentists, emphasizing proper clear aligner disposal methods and the importance of comprehensive instructions from aligner companies.

Evaluation of white spot lesion (WSL) and periodontal (PDL) health between patients treated with clear aligners and conventional fixed orthodontic brackets: A systematic review

The primary objective of this systematic review is to evaluate and compare the incidence of white spot lesions between clear aligner and fixed Orthodontic therapy. Randomized clinical trials of parallel, block randomisation, computer based and stratified randomisation and split-mouth design, involving patients undergoing Orthodontic treatment are considered. Studies had to compare the WSLs and periodontal health between CA and FA groups were searched in the electronic databases PubMed and Cochrane Library. A summary of the overall strength of evidence available was assessed using the Grades of Recommendations Assessment. A total of 51 records were found, from which only 4 articles met the inclusion criteria and were subjected to analysis.Majority of the studies included in this review have positively correlated a potential decrease in WSLs and better periodontal health with the use of clear aligners. However, most of the studies lack a long-term duration and follow up. More clinical trials in this area are welcome in order to have a better conclusion in terms of which appliance therapy would provide optimal dental and periodontal health during and after Orthodontic therapy.

Comparison of fixed braces and clear braces for malocclusion treatment

BackgroundTo study and compare the effects of clear aligners without brackets and traditional fixed aligners in orthodontic treatment.MethodsThe samples were collected from January 2022 to April 2023. The control group (n = 26) received orthodontic treatment using traditional fixed appliances. The research group (n = 20) received orthodontic treatment using the clear aligners without brackets. Compare the therapeutic effects and related evaluation indicators between two groups.ResultsThe total effective ratio was compared between the 2 groups, and the study group was greater(P < 0.05). After treatment, the detected values of the periodontal condition indicators (plaque index, debris index, and gingival bleeding index), serum inflammatory factors (CRP, IL-6 and TNF-α) of the two groups, were less than before, also were all less than the control group. (P < 0.05). After therapy, in comparison of the control group, the value of mastication efficiency, comfort and psychological evaluation, sleep indicators and the points of the four dimensions of life quality in the study group was greater, and the detection results were obviously greater than before(P < 0.05).ConclusionIn the orthodontic therapy of sufferers with malocclusion, compared with the traditional fixed appliance, the clear aligners without brackets can enhance the treatment effects, improve the periodontal condition and masticatory function, and reduce the inflammatory responses, so that patients can feel more comfortable, thereby improving their psychology, sleep and quality of life. In the future, with the continual advancement of technology and people’s pursuit of beauty, the application of clear aligners without brackets in orthodontic treatment will become more and more extensive. The continuous introduction of new materials and new technologies will further improve the effects and comfort of the clear aligners without brackets, reduce treatment time and discomfort, and also reduce patients’ resistance to aligners, bringing patients a better treatment experience.

How reliable is the artificial intelligence product large language model ChatGPT in orthodontics?

To evaluate the reliability of information produced by the artificial intelligence-based program ChatGPT in terms of accuracy and relevance, as assessed by orthodontists, dental students, and individuals seeking orthodontic treatment. Frequently asked and curious questions in four basic areas related to orthodontics were prepared and asked in ChatGPT (Version 4.0), and answers were evaluated by three different groups (senior dental students, individuals seeking orthodontic treatment, orthodontists). Questions asked in these basic areas of orthodontics were about: clear aligners (CA), lingual orthodontics (LO), esthetic braces (EB), and temporomandibular disorders (TMD). The answers were evaluated by the Global Quality Scale (GQS) and Quality Criteria for Consumer Health Information (DISCERN) scale. The total mean DISCERN score for answers on CA for students was 51.7 ± 9.38, for patients was 57.2 ± 10.73 and, for orthodontists was 47.4 ± 4.78 (P = .001). Comparison of GQS scores for LO among groups: students (3.53 ± 0.78), patients (4.40 ± 0.72), and orthodontists (3.63 ± 0.72) (P < .001). Intergroup comparison of ChatGPT evaluations about TMD was examined in terms of the DISCERN scale, with the highest value given in the patients group (57.83 ± 11.47) and lowest value in the orthodontist group (45.90 ± 11.84). When information quality evaluation about EB was examined, it GQS scores were >3 in all three groups (students: 3.50 ± 0.78; patients: 4.17 ± 0.87; orthodontists: 3.50 ± 0.82). ChatGPT has significant potential in terms of usability for patient information and education in the field of orthodontics if it is developed and necessary updates are made.

Color Stability of Various Orthodontic Clear Aligner Systems after Submersion in Different Staining Beverages.

This study aimed to compare the color changes in two different orthodontic clear aligner systems after submersion in various beverages for 14 days. The tested aligner systems were Taglus Premium made of polyethylene terephthalate glycol (the TAG group) and CA® Prodin+ made of a transparent copolyester and a thermoplastic elastomer (the PRO group). A total of 56 samples were firstly divided into two groups according to the tested system-TAG and PRO. Each group was subsequently divided in four subgroups according to immersion solution: A-artificial saliva, B-cola, C-coffee, D-red wine. Color measurements were performed on Days 1, 7 and 14 using a portable colorimeter and the CIE L*a*b* system. The obtained results showed significant color changes in both materials when exposed to coffee and red wine (p > 0.05). Samples in the PRO group showed a greater susceptibility to discoloration (higher ΔE values) when compared to the TAG group after submersion in cola (p = 0.025), coffee (p = 0.005) and red wine (p = 0.041) solutions. Statistical analysis revealed that all of the color parameters ΔL*, Δa*, Δb* and ΔE of both tested materials were affected by submersion in coffee solution for 14 days. In conclusion, the CA® Pro+ aligner system is more prone to staining compared to the Taglus material after submersion for 14 days in cola, coffee and red wine solutions. Submersion for 14 days in coffee solution alters all of the color parameters (ΔL, Δa, Δb and ΔE) of both tested aligner materials.

Evaluation of the effect of different attachment configurations on molar teeth in maxillary expansion with clear aligners – a finite element analysis

ObjectiveTo evaluate the effects of different attachment configurations with and without buccal root torque on expansion movements achieved with aligners through finite element analysis (FEA).MethodsFEA modelling was done with 0.25 mm buccal expansion force application to the maxillary molars with different attachment configurations: Eight models were tested (1) no attachment (NA), (2) horizontal attachment (HA), (3) gingivally beveled horizontal attachment (GHA), and (4) occlusally beveled horizontal attachment (OHA), as well as models with 6obuccal root torque, (5) no attachment (TNA), (6) horizontal attachment (THA), (7) gingivally beveled horizontal attachment (TGHA), and (8) occlusally beveled horizontal attachment (TOHA).ResultsThe first and second molars exhibited buccal tipping in all models. The highest amount of buccal tipping for the molars was observed in the NA (6CMB, 0.232 mm; 6CMP, 0.246 mm; 7CMB, 0.281 mm; 7CMP, 0.312 mm) and GHA (6CMB, 0.230; 6CMP, 0.245; 7CMB, 0.279 mm; 7CMP, 0.311 mm) models, respectively, while the least tipping was observed in the TOHA model (6CMB, 0.155 mm; 6CMP, 0.168 mm; 7CMB, 0.216 mm; 7CMP, 0.240 mm). In all groups, the buccal tipping of the second molars was higher than that of the first molars.ConclusionThis FEA study showed that expansion with aligners tip maxillary molars buccally and the use of occlusally beveled attachments and addition of buccal root torque reduces uncontrolled buccal tipping.

The Effects of Different Attachment Types and Positions on Rotation Movement in Clear Aligner Treatments: A Finite Element Analysis.

Aim Rotation of the mandibular premolars during aligner treatment is a difficult movement to achieve accurately. The purpose of this study is to compare the effects of different attachment types and positions used in clear aligner treatments on the rotation movement and retention of clear aligners in the rotated first premolar teeth. The study also addressed the stress values in periodontal ligaments (PDLs) with finite element analysis. Materials and methods For purposes of this research, we created a mandibular tooth model and modeled the premolar tooth with a 30° rotation. Twelve separate groups were created by attaching horizontal rectangular, vertical rectangular, ellipsoid, and semi-ellipsoid attachments to the premolar tooth in buccal, lingual, and combined buccal and lingual ways. A model without attachments was created to be used as the control group. An activation movement of 0.25 mm was applied to the first premolar tooth in all 12 models. The study evaluated clear aligner displacement, von Misses stress on the PDL, and tooth displacements using the finite element stress analysis method. Results It was found that the group with horizontal rectangular attachments placed on both the buccal and lingual sides had the highest stress value in the PDL (0.1971 MPa) and the highest displacement in the tooth (0.1267 mm). Conversely, the group with semi-ellipsoid attachments placed both buccally and lingually had the least displacement movement in clear aligners (0.1441 mm). Conclusion The results indicate that groups with attachments provided better retention than groups without attachments. Models with horizontal, rectangular attachments showed significantly more tooth displacement compared to other models. Horizontal rectangular attachments placed buccally and lingually combined to provide tooth movement in rotated mandibular first premolars can be recommended for clinical use.