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Upper arch dimensional changes with clear aligners in the early mixed dentition

A prospective study

Dimensionsänderungen mit Clear Alignern im frühen Wechselgebiss im Oberkiefer

Eine prospektive Studie

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Background

One goal of orthodontic treatment in mixed dentition is to expand the maxillary arch to allow proper tooth alignment and a correction of sagittal and vertical malocclusions. However, for most treatment protocols, expected outcome is not really clear to allow for a standardization of phase I orthodontic treatments. This lack of information makes it difficult for clinicians to predict tooth movements, including transverse expansion efficacy with Invisalign® (Align Technology, Santa Clara, CA, USA) in children. Therefore, the aim of the present study was to evaluate the transverse maxillary arch development with the Invisalign First System® in growing subjects.

Methods

The study group included 23 subjects (9 females, 14 males, mean age 9.4 ± 1.2 years). Patients were treated nonextraction with Invisalign First System® clear aligners with no auxiliaries other than Invisalign® attachments. Transverse interdental widths were measured only in the upper arch on each model at the start (T1) and at the end (T2) of treatment. A paired t‑test was chosen to compare T2–T1 changes. The level of significance was set at 5%.

Results

The greatest increase of maxillary width was detected at the level of the upper first deciduous molars (+3.7 ± 1.4 mm; P < 0.001), followed by the level of the second deciduous molars (+3.4 ± 1.6 mm; P < 0.001) and by the deciduous canine (+2.6 ± 2.0 mm; P < 0.001). Upper first molars showed a greater expansion in the intermolar mesial width (+3.2 ± 1.2 mm; P < 0.001) than in the intermolar distal (+1.7 ± 1.2 mm; P < 0.001) and transpalatal width (+1.2 ± 1.2 mm; P < 0.01).

Conclusions

The Invisalign First System® can be considered effective in growing patients who require maxillary arch development. The greatest net increase was detected at the level of upper first deciduous molars, whereas the upper first molars showed a greater expansion in the intermolar mesial width due to a rotation that occurs around its palatal root.

Zusammenfassung

Hintergrund

Ein Ziel der kieferorthopädischen Behandlung im Wechselgebiss ist die Erweiterung des Oberkieferbogens, um eine korrekte Zahnaufstellung und eine Korrektur sagittaler wie vertikaler Malokklusionen zu ermöglichen. Bei den meisten Behandlungsprotokollen ist das erwartete Ergebnis jedoch nicht wirklich klar, um eine Standardisierung der kieferorthopädischen Behandlungen der Phase I zu ermöglichen. Dieser Mangel an Informationen macht es für Kliniker schwierig, Zahnbewegungen vorherzusagen, einschließlich der Wirksamkeit der transversalen Expansion mit Invisalign® (Align Technology, Santa Clara, CA, USA) bei Kindern. Ziel der vorliegenden Studie war es daher, die transversale Oberkieferbogenentwicklung mit dem Invisalign First System® bei heranwachsenden Probanden zu untersuchen.

Methoden

Die Studiengruppe umfasste 23 Probanden (9 weiblich, 14 männlich, Durchschnittsalter 9,4 ± 1,2 Jahre). Die Patienten wurden ohne Extraktion mit klaren Alignern aus dem Invisalign First System® behandelt, ohne weitere Hilfselemente mit Ausnahme von Invisalign®-Attachments. Die transversalen interdentalen Breiten wurden nur im oberen Bogen an jedem Modell zu Beginn (T1) und zum Ende (T2) der Behandlung gemessen. Für den Vergleich der T2-T1-Veränderungen wurde ein gepaarter t‑Test gewählt. Das Signifikanzniveau wurde auf 5% festgelegt.

Ergebnisse

Die größte Zunahme der Oberkieferbreite wurde auf der Ebene der oberen ersten Milchmolaren (+3,7 ± 1,4 mm; p < 0,001) festgestellt, gefolgt von der Ebene der zweiten Milchmolaren (+3,4 ± 1,6 mm; p < 0,001) und vom Milcheckzahn (+2,6 ± 2,0 mm; p < 0,001). Die oberen ersten Molaren zeigten eine größere Expansion in der intermolaren mesialen Breite (+3,2 ± 1,2 mm; p < 0,001) als in der intermolaren distalen (+1,7 ± 1,2 mm; p < 0,001) und transpalatalen Breite (+1,2 ± 1,2 mm; p < 0,01).

Schlussfolgerungen

Das Invisalign First System® kann bei wachsenden Patienten, bei denen eine Erweiterung des Oberkieferzahnbogens erforderlich ist, als effektiv angesehen werden. Die größte Nettozunahme wurde auf der Ebene der oberen ersten Milchmolaren festgestellt, während die oberen ersten Molaren eine größere Erweiterung der intermolaren mesialen Breite aufgrund einer Rotation zeigten, die um ihre palatinale Wurzel auftritt.

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Abbreviations

CI:

Confidence interval

ICC:

Interclass correlation coefficient

IPR:

Interproximal reduction

RME:

Rapid maxillary expander

SD:

Standard deviation

SPSS:

Statistical Package for the Social Sciences

References

  1. Galan-Lopez L, Barcia-Gonzalez J, Plasencia E (2019) A systematic review of the accuracy and efficiency of dental movements with Invisalign. Korean J Orthod 49:140–149

    Article  Google Scholar 

  2. Abraham KK, James AR, Thenumkal E, Emmatty T (2016) Correction of anterior crossbite using modified transparent aligners: an esthetic approach. Contemp Clin Dent 7:394–397

    Article  Google Scholar 

  3. Blevins R (2019) Phase I orthodontic treatment using Invisalign first. J Clin Orthod 53:73–83

    Google Scholar 

  4. Staderini E, Meuli S, Gallenzi P (2019) Orthodontic treatment of class three malocclusion using clear aligners: a case report. J Oral Biol Craniofac Res 9:360–362

    Article  Google Scholar 

  5. Harris K, Ojima K, Dan C, Upadhyay M, Alshehri A, Kuo CL, Mu J, Uribe F, Nanda R (2020) Evaluation of open bite closure using clear aligners: a retrospective study. Prog Orthod 21:23

    Article  Google Scholar 

  6. Khosravi R, Cohanim B, Hujoel P, Daher S, Neal M, Liu W et al (2017) Management of overbite with Invisalign appliance. Am J Orthod Dentofacial Orthop 151:691–699

    Article  Google Scholar 

  7. Frongia G, Castroflorio T (2012) Correction of severe tooth rotations using clear aligners: a case report. Aust Orthod J 28:245–249

    Google Scholar 

  8. Staderini E, Patini R, Meuli S, Camodeca A, Guglielmi F, Gallenzi P (2020) Indication of clear aligners in the early treatment of anterior crossbite: a case series. Dental Press J Orthod 25:33–43

    Article  Google Scholar 

  9. McNamaraa JA (2000) Maxillary transverse deficiency. Am J Orthod Dentofacial Orthop 117:567–570

    Article  Google Scholar 

  10. McNamara JA Jr., Lione R, Franchi L, Angelieri F, Cevidanes LHS, Darendeliler MA, Cozza P (2015) The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod 16:33

    Article  Google Scholar 

  11. Eichenberger M, Baumgartner S (2014) The impact of rapid palatal expansion on children’s general health: a literature review. Eur J Paediatr Dent 15:67–71

    Google Scholar 

  12. Tollaro I, Baccetti T, Franchi L, Tanasescu CD (1996) Role of posterior transverse interarch discrepancy in class II, division 1 malocclusion during the mixed dentition phase. Am J Orthod Dentofacial Orthop 110:417–422

    Article  Google Scholar 

  13. Ricketts RM (1969) Occlusion-the medium of dentistry. J Prosthet Dent 21:39–60

    Article  Google Scholar 

  14. Marshall SD, Southard KA, Southard TE (2005) Early transverse treatment. Semin Orthod 11:130–139

    Article  Google Scholar 

  15. Slakter MJ et al (1980) Reliability and stability of the orthodontic patient cooperation scale. Am J Orthod 78:559–563

    Article  Google Scholar 

  16. Houle JP, Piedade L, Todescan R Jr, Pinheiro FH (2017) The predictability of transverse changes with Invisalign. Angle Orthod 87:19–24

    Article  Google Scholar 

  17. Solano-Mendoza B, Sonnemberg B, Solano-Reina E, Iglesias-Linares A (2017) How effective is the Invisalign system in expansion movement with Ex300 aligners? Clin Oral Investig 21:1475–1484

    Article  Google Scholar 

  18. Zheng M, Liu R, Ni Z, Yu Z (2017) Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis. Orthod Craniofac Res 20:127–133

    Article  Google Scholar 

  19. Zhou N, Guo J (2020) Efficiency of upper arch expansion with the Invisalign system. Angle Orthod 90:23–30

    Article  Google Scholar 

  20. Giancotti A, Pirelli P, Mampieri G (2017) Correction of class II malocclusions in growing patients by using the Invisalign® technique: rational bases and treatment staging. J Orthod Endod 3:4–12

    Article  Google Scholar 

  21. Germane N, Lindauer SJ, Rubenstein LK, Revere JH Jr, Isaacson RJ (1991) Increase in arch perimeter due to orthodontic expansion. Am J Orthod Dentofacial Orthop 100:421–427

    Article  Google Scholar 

  22. Paoloni V, Gastaldi G, Franchi L, De Razza FC, Cozza P (2020) Evaluation of the morphometric covariation between palatal and craniofacial skeletal morphology in class III malocclusion growing subjects. BMC Oral Health 20:1–8

    Article  Google Scholar 

  23. Laganà G, Di Fazio V, Paoloni V, Franchi L, Cozza P, Lione R (2019) Geometric morphometric analysis of the palatal morphology in growing subjects with skeletal open bite. Eur J Orthod 41:258–263

    Article  Google Scholar 

  24. Bishara SE, Jakobsen JR, Treder J, Nowak A (1997) Arch width changes from 6 weeks to 45 years of age. Am J Orthod Dentofacial Orthop 111:401–409

    Article  Google Scholar 

  25. Boyd RL (2008) Esthetic orthodontic treatment using the invisalign appliance for moderate to complex malocclusions. J Dent Educ 72:948–967

    Article  Google Scholar 

  26. Azaripour A, Weusmann J, Mahmoodi B, Peppas D, Gerhold-Ay A, Van Noorden CJF, Willershausen B (2015) Braces versus Invisalign®: gingival parameters and patients’ satisfaction during treatment: a cross-sectional study. BMC Oral Health 15:69

    Article  Google Scholar 

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Authors’ Contribution

RL, VP and SM contributed to the acquisition of data, analysis, and interpretation of data. CP contributed to the statistical analysis conception. RL and PC made substantial contributions to conception and design. PC made critical revision. ECL helped in drafting of manuscript/prepared the manuscript for submission and conception of the study. All authors read and approved the manuscript.

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Authors and Affiliations

  1. Department of Dentistry, UNSBC, Tirana, Albania

    Roberta Lione, Chiara Pavoni & Paola Cozza

  2. UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy

    Roberta Lione & Paola Cozza

  3. Department of Systems Medicine, University of Rome “Tor Vergata”, Viale Oxford 81, 00133, Rome, Italy

    Roberta Lione, Elisabetta Cretella Lombardo DDS MS, Valeria Paoloni PhD, Chiara Pavoni & Paola Cozza

  4. Department of Aging, Neurological, Orthopedic and Head–Neck, Catholic University of Sacred Heart, Rome, Italy

    Simonetta Meuli PhD

Authors
  1. Roberta Lione
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  2. Elisabetta Cretella Lombardo DDS MS
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  3. Valeria Paoloni PhD
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  4. Simonetta Meuli PhD
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  5. Chiara Pavoni
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  6. Paola Cozza
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Corresponding author

Correspondence to Elisabetta Cretella Lombardo DDS MS.

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Conflict of interest

R. Lione, E. Cretella Lombardo, V. Paoloni, S. Meuli, C. Pavoni and P. Cozza declare that they have no competing interests.

Ethical standards

The study project was approved by Ethical Committee at the University of Rome “Tor Vergata” (protocol number: 163.20) and informed consent was obtained from the patients’ parents for the inclusion in the publication and for the use of their images.

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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Lione, R., Cretella Lombardo, E., Paoloni, V. et al. Upper arch dimensional changes with clear aligners in the early mixed dentition. J Orofac Orthop 84, 33–40 (2023). https://doi.org/10.1007/s00056-021-00332-z

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  • DOI: https://doi.org/10.1007/s00056-021-00332-z

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