Search Results (22)

Background: Distalization is a fundamental orthodontic strategy for correcting Class II and Class III malocclusions, particularly in cases where specific dental or skeletal conditions favor its application. Recent technological advances have enabled complex dental movements to be performed using clear aligners, aided by digital planning platforms such as ClinCheck^®. Methods: This retrospective study aimed to evaluate the accuracy of ClinCheck^® in predicting molar and canine distalization outcomes with the Invisalign^® system and to identify clinical factors influencing treatment predictability. Thirty patients with complete permanent dentition and at least 2 mm of programmed distalization were selected. Planned movements were extracted from the Invisalign^® Doctor Site and compared to achieved outcomes using Geomagic^® Control X™ software. Occlusal improvements were assessed using the Peer Assessment Rating (PAR) index. Results: The results revealed significant discrepancies between the programmed and achieved distalization, with mean deviations greater than 1 mm in both arches. Skeletal anchorage with mini-screws significantly improved distalization outcomes in the maxillary arch; however, no significant effect was observed in the mandibular arch. Additionally, no significant associations were found between distalization outcomes and skeletal pattern (ANB angle) or facial biotype. Conclusions: Clear aligners are effective in achieving substantial occlusal improvements, particularly when combined with personalized digital planning and supplementary strategies such as skeletal anchorage. Mandibular cases demonstrated greater reductions in PAR scores, emphasizing the potential of aligners in complex distalization treatments. Full article

Background: The use of aligner therapy for open bite and deep bite correction has increased in contemporary society. There is no evidence that unify the results present the in literature regarding a real comparison between clinical outcomes and the results predicted by the ClinCheck software 3.0 (Align Technology, Santa Clara, CA, USA). Furthermore, the literature shows conflicting data about the protocols and not all authors compare the programmed movements and the clinical results obtained for the overbite correction. Therefore, the aim of this systematic review is to assess the predictability of ClinCheck in the correction of vertical discrepancies by comparing the planned outcomes with the actual clinical results performed with clear aligners. Methods: The research question focused on the effectiveness of ClinCheck in predicting the actual correction of deep bite AND open bite in adult patients. Five electronic databases (PubMed, Scopus, Embase, Web of Science and Cochrane Library) were investigated, with the following keywords: overbite AND aligners. A quality assessment was performed using the Newcastle-Ottawa scale, while the risk of bias was evaluated using the ROBINS-I tool 2.0. PROSPERO ID: CRD420251078610. Results: Out of a total of 838 records initially screened, seven studies fulfilled the inclusion criteria and were ultimately selected for this systematic review. The analysis focused on assessing the divergence between the overbite correction predicted by ClinCheck and the outcomes observed in clinical practice. Conclusions: ClinCheck demonstrated a predictability of 62.1% for overbite correction in open bite cases and 41.5% in deep bite cases. However, not all studies report the planned tooth movements. Among the studies that addressed this aspect, the majority reported no significant association between the overbite correction predicted during treatment planning and the results ultimately achieved—except for one study, which demonstrated significant accuracy in achieving absolute extrusion in the correction of open bite. Full article

Background/Objectives: Previous studies on clear aligner therapy (CAT) in mixed dentition primarily focused on the predictability of maxillary arch expansion. However, limited evidence is available regarding mandibular arch changes, particularly in relation to inter-arch coordination. This study aims to evaluate the effectiveness and predictability of dental expansion in both the upper and lower arches using Invisalign First^® aligners. Methods: A retrospective analysis was conducted with 15 participants. Dental expansions were assessed before and after treatment using iTero intraoral scans processed with 3D analysis software. Measurements were compared to the predicted movements planned in ClinCheck^®. Data normality was verified (Shapiro–Wilk test), descriptive statistics were calculated, and paired t-tests were performed to compare clinical and predicted expansions, with significance set at 0.05. Results: Clear aligners achieved effective dento-alveolar expansion in both arches. Predictability was higher at the cusp level than at the gingival level, indicating a tendency toward tipping movements rather than bodily expansion. The study also highlighted mandibular expansion outcomes and gingival-level discrepancies, providing new insights compared to the previous literature. Minor differences between predicted and achieved movements were observed, partly attributable to natural growth and deciduous tooth exfoliation. Conclusions: Clear aligners are effective in achieving maxillary and mandibular arch expansion in mixed dentition, with good predictability at the coronal level. Overengineering buccal root torque may help promote bodily expansion and reduce cuspal–gingival discrepancies. Further studies with larger sample sizes are needed to optimize treatment planning and predictability. Full article

(1) The aim was to evaluate the predictability of treatment outcomes using clear aligner therapy (CAT) and ClinCheck Web 1.4 (Align Technology, Inc., San Jose, CA, USA) software in mandibular incisor intrusion in both children and adults with deep bite malocclusion. (2) This study included healthy children and adults with skeletal Class I or mild to moderate Class II/III malocclusions, mild to moderate dental crowding (<5 mm), and deep overbite (OB) who underwent CAT. Pre-treatment (T1) and post-treatment (T2) orthodontic treatment records were assessed and compared to initial planned ClinCheck movements. The cephalometric parameters evaluated included bodily intrusion (Centroid-C point), IMPA, L1-NB, and L1-A-Po. Clinical expression of CAT was compared to ClinCheck predictions using paired sample t-tests, and differences between growing and non-growing groups were assessed using a repeated measures ANOVA with Tukey post hoc analysis. (3) The sample included 48 patients (mean age 19.79 ± 11.78 years), including 18 adults (mean age 30.28 ± 13.79 years) and 30 children (mean age 13.5 ± 2.05 years). The predicted vertical mandibular incisor movement (intrusion) was significantly higher using ClinCheck (2.32 mm) compared to clinical treatment (0.22 mm). The angular movements of IMPA, L1-NB, and L1-APo were all significantly higher using ClinCheck (4.6°) compared to clinical expression of 0.79°, 0.55°, and 1.21°, respectively. There were no significant differences between children and adults with respect to vertical or angular tooth movements. (4) CAT and ClinCheck software significantly overpredicts orthodontic tooth movements related to mandibular incisor intrusion in both adults and children with no statistical difference between the groups. Full article

Background: This study evaluated the number of aligners that Invisalign ClinCheck™ Pro Software estimates for correcting different malocclusion traits. Methods: This retrospective study included 157 non-extraction patients over the age of 12 years old with easy to mild malocclusions who were treated with Invisalign aligners. The Index of Complexity, Outcome, and Need (ICON) was used to evaluate the malocclusion complexity level. The number of aligners (upper, lower, and total) required to correct the malocclusion was compared based on sex, ICON level, molar and canine class, occlusal asymmetry, overbite, overjet, crowding, incisor inclination, and Bolton discrepancy. A Mann–Whitney U test (for comparisons between two groups) or a Kruskal–Wallis test (for comparisons between three or more groups) (p < 0.05) was used to evaluate differences in the number of aligners across variable categories. Results: ICON, molar class, overbite, and overjet presented significant differences (p < 0.05) in the number of aligners (upper, lower, and total) required to correct a malocclusion. Canine class and lower dental crowding showed significant differences in the lower and total number of aligners (p < 0.05). Conclusions: The number of aligners increases when the malocclusion presents any of the following elements: the absence of molar or canine class I, an altered overjet or overbite, severe lower crowding, or a higher complexity level. The clinician should consider these malocclusion traits when estimating the number of aligners needed for correction. Full article

The aim of this study is to retrospectively investigate the predictability of maxillary arch expansion with Invisalign ^® First in mixed dentition. In a sample of 64 treated patients, 3D digital models from the ClinCheck^® software were compared with post-treatment digital models. Predicted maxillary expansion was related to the final outcome of expansion. At the cuspidal level, there was observed a predictability of 59.68% for deciduous canines, 63.77% for first deciduous molars, 66.99% for second deciduous molars, and 55.61% for first permanent molars. At the gingival level, there was observed a predictability of 49.87% for deciduous canines, 53.11% for first deciduous molars, 53.36% for second deciduous molars, and 45.16% for first permanent molars. The difference between the predicted and achieved expansion was statistically significant (p < 0.05). Within the present limitations, our results suggest that, with Invisalign^® First, it is possible to expand the upper arch in mixed dentition in an effective and predictable way. Clear aligners could represent a new and valid alternative for arch expansion in growing patients. Full article

Controlling root movement is one of the greatest challenges in orthodontic treatment with aligners, like Invisalign^® aligners. Cone Beam Computed Tomography (CBCT) integration into ClinCheck^®, enabling bone and root visualisation, allows a more accurate follow-up of the teeth position. This study aims to compare torque measurements of the upper central incisors with and without CBCT and relate them to the upper incisor inclination and facial biotype. In a sample of 70 teeth, torque measurements were obtained by importing images into AutoCAD^® software (version 2024). The angle between the tooth’s long axis with CBCT duplicate and the tooth’s long axis without CBCT was obtained to assess the difference. Statistically significant differences between torque measurements with and without CBCT were found, as well as between these measurements and the inclination of the upper incisors. No statistically significant differences were found among the facial biotypes. The average values of 27.8° ± 3.4° and 21.5° ± 3.2° were obtained for the angle between the axes. Torque without CBCT was lower than torque with CBCT, for the same tooth. The angle between the axes had a similar mean for both teeth. CBCT integration into ClinCheck^® allows for a more correct torque measurement. Full article

Objectives: The purpose of this preliminary study was to determine the differences between planned and actual maxillary molar movements after the completion of treatment with an initial set of clear aligners including sequential maxillary molar distalization. Methods: The data records of 14 non-growing patients who completed orthodontic treatment with sequential maxillary molar distalization using clear aligners were retrospectively evaluated (n= 14, 4 males and 10 females, 33.61 ± 8.57 years). Data on planned tooth movements were obtained from ClinCheck software (ClinCheck Pro version 5.3). The amounts of actual tooth movements were obtained by performing superimposition of lateral cephalograms taken before and after treatment. The amounts of distal translation and tipping between planned and actual maxillary molar movements were compared with the paired Student’s t-test. Results: The statistically significant differences between planned and actual translation movements of maxillary first and second molars were shown after completing treatment with the first series of aligners (p < 0.05). The average actual amount of molar distalization on maxillary first molars was less than the planned amount by 1.32 ± 0.42 mm. Similarly, the average actual amount of molar distalization on maxillary second molars was less than the planned amount by 1.57 ± 0.45 mm. The accuracy for molar distalization, namely, the percentage of actual distal translation to planned movement, was 40.11% for maxillary first molars and 35.39% for maxillary second molars. However, the difference between the planned and actual angulation movements was not significant (p > 0.05). Conslusions: In conclusion, the amounts of actual distal translation of maxillary molars through the utilization of clear aligners were significantly lower than planned. However, there were no statistically significant differences between the degrees of actual and planned molar angulation movement. Full article

Background: The attainment of precise posterior occlusion alignment necessitates a deeper understanding of the clinical efficacy of aligner therapy. This study aims to determine whether the treatment goals defined in the virtual planning of aligner therapy are effectively implemented in clinical practice, with a particular focus on the influence of distalization distances on potential vertical side effects. Methods: In this retrospective, non-interventional investigation, a cohort of 20 individuals undergoing Invisalign^® treatment was examined. Pre- and post-treatment maxillary clinical and ClinCheck^® casts were superimposed utilizing a surface–surface matching algorithm on palatal folds, median palatine raphe, and unmoved teeth as the stable references. The effectivity of planned versus clinical movements was evaluated. Groupings were based on distalization distances, planned vertical movements, and Class II elastic prescription. Statistics were performed with a two-sample t-test and p-value < 0.05. Results: Clinically achieved distalization was significantly lower than virtually planned distalization, regardless of additional vertical movements, where a lack of implementation was contingent upon the extent of distalization, with no mitigating effects observed with the application of Class II elastics. Intriguingly, no adverse vertical side effects were noted; however, the intended intrusions or extrusions, as per the therapeutic plans, remained unattainable regardless of the magnitude of distalization. Conclusions: These findings underscore the imperative for future investigations to delve deeper into the intricacies surrounding translational mesio-distal and vertical movements, thereby enhancing predictability within orthodontic practice. To facilitate successful clinical implementation of vertical and translational movements via aligners, the incorporation of sliders emerges as a promising strategy for bolstering anchorage reinforcement. Full article

Objectives: Aligners are an effective and esthetic orthodontic treatment option for permanent and mixed dentition. There are only a few studies dealing with the effectiveness of orovestibular tooth movement using aligners and applying adequate examination methods. In the present retrospective study, the aligner efficiency of orovestibular movements for the entire dentition was systematically evaluated using 3D superimposition, taking into account the influence of jaw, tooth type and Invisalign^® system. Methods: Group 1 (n = 18 adults, Invisalign^®) and Group 2 (n = 17 adolescents, Invisalign^® Teen) were treated with Invisalign^® Ex30 aligner material and Invisalign^® specific auxiliary means. In this non-interventional retrospective study, pre- and post-treatment maxillary and mandibular plaster cast models were scanned and superimposed with ClinChecks^® via Surface–Surface Matching Algorithm on unmoved teeth providing stable references. Effectivity of planned versus clinically realized movements was evaluated for each tooth. Statistics were performed with a t-test and Bonferroni–Holm correction (α = 0.05). Results: Orovestibular movement efficiency was excellent without statistical significance regarding jaw, tooth type or Invisalign^® system. Mandibular translational tooth movements were highly effective, and outstanding for premolars (91–98%). Maxillary translational tooth movements were successful for incisors and premolars, but less effective for canines and molars. Almost all teeth were moderately or very effectively corrected by crown tipping, performing better for mandibular (70–92%) than maxillary (22–31%) canines as much as for adolescent upper front teeth (81–85%) and lower canines (92%). Conclusions: Aligners are able to effectively implement translational orovestibular movements, supported by tilting the crowns for even more efficient implementation of the movements. This phenomenon was observed in our studies for all teeth in both jaws, regardless of the Invisalign^® system used. Treatment planning should nevertheless take into account the individual patient parameters with regard to the movements to be performed in order to make the aligner therapy as successful as possible in terms of realizing the desired therapeutic goal. Full article

The Invisalign^® system (SmartForce^® G8) aims to guarantee aesthetics and provide good orthodontic treatment results. Dentoalveolar expansion is possible with clear aligners and can be used to correct dentoalveolar crossbite, resolve crowding or modify the arch shape. Despite the treatment’s effectiveness, there is still disagreement among professionals concerning its true clinical potential. This study aimed to analyze the effectiveness and predictability of coronal tooth expansion movement in permanent dentition in patients who had completed the first phase of treatment with Invisalign^® orthodontic aligners. Materials and Methods: The tooth movement tables of 75 previously selected cases were analyzed in terms of dental-arch width and expansion efficiency, through the Invisalign^® platform, considering the pre-treatment (T0), planned treatment (TP) and post-treatment models (T1) using ClinCheck Pro^® 6.0 software. All patients were treated by an orthodontic specialist and Invisalign^® Diamond Provider in a private practice (T.P.). Results: Difference between T1 and T0: for each maxillary and mandibular measurement, there was a statistically significant difference between pre- and post-aligner treatment values. The greatest amount of expansion occurred in both the upper and the lower premolars. Difference between TP and T1: for each maxillary measurement, statistically significant differences were verified for the molar and canine. At the mandibular level, statistically significant differences were only verified in the first molar. Conclusions: The Invisalign^® clear aligners are effective for simultaneous intra-arch expansion in both jaws. Full article

Background: Clear aligners (CA) are used 22 h daily, creating a bite-block effect. This work aims to (i) analyze occlusal changes before the beginning of treatment, after the first set of CA and after the use of additional aligners; (ii) compare planned occlusal contacts with the ones obtained after the first set of CA; (iii) analyze the occlusal changes occurred after reaching the orthodontic goals after 3 months of using CA only at night; (iv) evaluate and characterize which tooth movements did not allow the treatment to be completed at the end of the first set of aligners, and finally (v) verify the possible relation between the changes in occlusal contact and areas and parameters such as case complexity and facial biotype. Materials and Methods: A quantitative, comparative, and observational longitudinal cohort study design was implemented to evaluate the clinical data and the complexity levels of cases receiving CA. A non-probabilistic and convenience sample of 82 individuals was recruited. The orthodontic malocclusion traits were classified as simple, moderate, or complex corrections based on the basis of the Align^® recommendations with the Invisalign^® evaluation tool. According to the Invisalign^® criteria, patients need only one complex problem for their case to be classified as complex. Meshlab^® v. 2022.02, ClinCheck^® version Pro 6.0, My-Itero^® version 2.7.9.601 5d plus, and IBM^® SPSS Statistics software (Statistical Program for Social Sciences), version 27.0 for Windows were the software^® used. Results: A statistically significant decrease in area and occlusal contacts number were observed from before the start of orthodontic treatment (T0) to the end of treatment (T1). The changes in the occlusal area (from T0 to T1) were statistically different between hyperdivergent (28.24 [15.51–40.91]) and hypodivergent (16.23 [8.11–24.97]) biotypes (p = 0.031). A significant difference between the hyperdivergent (4.0 [2.0–5.0]) and normodivergent (5.5 [4.0–8.0]) group was found in T1 for the anterior contacts (p = 0.044). Anterior contacts obtained were significantly higher than the planned (p = 0.037) Between T1 and T2 statistically significant increases of occlusal areas, posterior and total contacts were observed. Conclusions: Occlusal contact and area were decreased, either at the end of the first set or after the use of additional aligners. Anterior occlusal contacts obtained were higher than planned as opposed to posterior occlusal contacts obtained. The hardest tooth movements to achieve to complete the treatment were distalization, rotation, and posterior extrusion. After completing orthodontic treatment (T1) to 3 months after (T2) using additional aligners only at night, posterior occlusal contacts were significantly increased, which could be due to the natural settling of the teeth in this period. Full article

The objective was to evaluate the accuracy of ClinCheck^® reliability in the sagittal, vertical, transverse, and arch length dimensions before and after Invisalign^® (Align Technology, Santa Clara, CA, USA) treatment. This retrospective study was conducted on 206 patients who underwent dual-arch clear aligner therapy exclusively with Invisalign^®. Digital models were obtained from iTero^® scanners from three different private practices where the treatment plans were performed and executed by multiple orthodontists with varying degrees of experience. The ClinCheck^® models of the initial, achieved, and predicted outcome were obtained from Align Technology^® and the values were compared using Pearson correlation (p < 0.05) to determine if predicted values were correlated with achieved values. ANOVA was used to compare the different centers. The highest reliabilities were associated with interincisal angle (96.23%), upper intercanine width (97.97%), lower intercanine width (97.67%), upper intermolar width (97.58%), and lower intermolar width (97.72%) (p < 0.001). The lowest reliabilities were associated with arch length parameters in which the upper was 38.79% and the lower at 30.02% (p = 0.03, p < 0.001). However, there were no statistically significant differences between the centers in terms of the accuracy of treatment provided. The mean predicted accuracy of Invisalign^® was 76.85% overall; however, Invisalign^® providers may need to exaggerate the digital tooth movements to achieve the desired outcome. Full article

The aim of this work was to evaluate the efficacy and accuracy of maxillary arch transverse expansion using the Invisalign^® clear aligner system without auxiliaries other than Invisalign attachments. Knowing the accuracy of a movement through a clear aligner system allows the clinician to plan the treatment with greater precision and to achieve the expected result faster. The study group included 28 patients with a mean age of 17 ± 3.2 years. The treatment protocol for all the selected patients included the application of the Invisalign^® clear aligner system without auxiliaries, except for the Invisalign^® attachments; in no case were tooth extraction or interproximal enamel reduction (IPR) performed. Linear measurements of the expansion were assessed before treatment (T0), at the end of treatment (T1), and on final virtual models by ClinCheck^® (TC). A paired t-test was used to compare T0-T1 and T1-TC differences. A paired t-test was applied, and one normality was validated with the Shapiro–Wilks test. If normality was not met, the nonparametric test (Mann–Whitney U test) was applied. The level of significance was set at 5%. Statistically significant differences were found for all measurements at T0-T1. The results showed an average accuracy of efficacy of 70.88%. The differences in predictability between the various vestibular measurements (intercanine, inter-premolar, and intermolar) were not statistically significant, while they were for gingival measurements. The overall accuracy of the expansion treatment was 70%, regardless of tooth type. Full article

Purpose: The primary aim was to evaluate dentoalveolar expansion with Invisalign clear aligners comparing linear measurements in ClinCheck vs. cone beam computed tomography (CBCT). This would enable an assessment of to what extent expansion gained from Invisalign clear aligners was due to buccal tipping and/or bodily translation of the posterior teeth. The study also evaluated the predictive value of Invisalign ClinCheck^® (Align Technology, San Jose, CA, USA) to final outcomes. Methods: The orthodontic records of thirty-two (32) subjects comprised the sample to conduct this study. Linear values of the upper arch width were measured for premolars and molars at two different points (occlusal and gingival) utilized for ClinCheck^® measurements and three different points for CBCT measurements before (T₀ and after treatment (T₁). Paired T-tests at a significance level of 0.05 were used for analyses. Results: Expansion was found to be possible with Invisalign clear aligners. However, more expansion was measured at the cusp tips compared to gingival margins (p < 0.0001), indicating more tipping was occurring than bodily translation. ClinCheck^® also showed a significant overestimation of the amount of expansion capable, with nearly 70% expression in the first premolar area, and the expression decreased as one moved posteriorly with only 35% expressed at the first molar area (p < 0.0001). Conclusions: Dentoalveolar expansion with Invisalign is achieved through buccal tipping of posterior teeth and bodily translation; and there is a significant overestimation of the amount of expansion achieved between ClinCheck^® and clinical results. Full article