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      A systematic review of the accuracy and efficiency of dental movements with Invisalign®

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          Abstract

          We are currently living in an era where the use of computer-aided design/computer-aided manufacturing has allowed individualized orthodontic treatments, but has also incorporated enhanced digitalized technology that does not permit improvisation. The purpose of this systematic review was to analyze publications that assessed the accuracy and efficiency of the Invisalign® system. A systematic review was performed using a search strategy to identify articles that referenced Invisalign®, which were published between August 2007 and August 2017, and listed in the following databases: MEDLINE, Embase, Cochrane Library, Web of Knowledge, Google Scholar, and LILACS. Additionally, a manual search of clinical trials was performed in scientific journals and other databases. To rate the methodological quality of the articles, a grading system described by the Swedish Council on Technology Assessment in Health Care was used, in combination with the Cochrane tool for risk of bias assessment. We selected 20 articles that met the inclusion criteria and excluded 5 due to excess biases. The level of evidence was high. Although it is possible to treat malocclusions with plastic systems, the results are not as accurate as those achieved by treatment with fixed appliances.

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          Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review.

          To assess the scientific evidence related to the efficacy of clear aligner treatment (CAT) in controlling orthodontic tooth movement.
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            How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign.

            The purpose of this prospective clinical study was to evaluate the efficacy of tooth movement with removable polyurethane aligners (Invisalign, Align Technology, Santa Clara, Calif). The study sample included 37 patients treated with Anterior Invisalign. Four hundred one anterior teeth (198 maxillary and 203 mandibular) were measured on the virtual Treat models. The virtual model of the predicted tooth position was superimposed over the virtual model of the achieved tooth position, created from the posttreatment impression, and the 2 models were superimposed over their stationary posterior teeth by using ToothMeasure, Invisalign's proprietary superimposition software. The amount of tooth movement predicted was compared with the amount achieved after treatment. The types of movements studied were expansion, constriction, intrusion, extrusion, mesiodistal tip, labiolingual tip, and rotation. The mean accuracy of tooth movement with Invisalign was 41%. The most accurate movement was lingual constriction (47.1%), and the least accurate movement was extrusion (29.6%)- specifically, extrusion of the maxillary (18.3%) and mandibular (24.5%) central incisors, followed by mesiodistal tipping of the mandibular canines (26.9%). The accuracy of canine rotation was significantly lower than that of all other teeth, with the exception of the maxillary lateral incisors. At rotational movements greater than 15 degrees, the accuracy of rotation for the maxillary canines fell significantly. Lingual crown tip was significantly more accurate than labial crown tip, particularly for the maxillary incisors. There was no statistical difference in accuracy between maxillary and mandibular teeth of the same tooth type for any movements studied. We still have much to learn regarding the biomechanics and efficacy of the Invisalign system. A better understanding of Invisalign's ability to move teeth might help the clinician select suitable patients for treatment, guide the proper sequencing of movement, and reduce the need for case refinement.
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              Treatment outcome and efficacy of an aligner technique – regarding incisor torque, premolar derotation and molar distalization

              Background The aim of this study was to investigate the efficacy of orthodontic treatment using the Invisalign® system. Particularly, we analyzed the influence of auxiliaries (Attachment/Power Ridge) as well as the staging (movement per aligner) on treatment efficacy. Methods We reviewed the tooth movements of 30 consecutive patients who required orthodontic treatment with Invisalign®. In all patients, one of the following tooth movements was performed: (1) Incisor Torque >10°, (2) Premolar derotation >10° (3) Molar distalization >1.5 mm. The groups (1)-(3) were subdivided: in the first subgroup (a) the movements were supported with the use of an attachment, while in the subgroup (b) no auxiliaries were used (except incisor torque, in which Power Ridges were used). All tooth movements were performed in a split-mouth design. To analyze the clinical efficacy, pre-treatment and final plaster cast models were laser-scanned and the achieved tooth movement was determined by way of a surface/surface matching algorithm. The results were compared with the amount of tooth movement predicted by ClinCheck®. Results The overall mean efficacy was 59% (SD = 0.2). The mean accuracy for upper incisor torque was 42% (SD = 0.2). Premolar derotation showed the lowest accuracy with approximately 40% (SD = 0.3). Distalization of an upper molar was the most effective movement, with efficacy approximately 87% (SD = 0.2). Conclusion Incisor torque, premolar derotation and molar distalization can be performed using Invisalign® aligners. The staging (movement/aligner) and the total amount of planned movement have an significant impact on treatment efficacy.
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                Author and article information

                Journal
                Korean J Orthod
                Korean J Orthod
                KJOD
                Korean Journal of Orthodontics
                Korean Association of Orthodontists
                2234-7518
                2005-372X
                May 2019
                21 May 2019
                : 49
                : 3
                : 140-149
                Affiliations
                [a ]Private Practice, Valencia, Spain.
                [b ]Department of Orthodontics, School of Dentistry and Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
                [c ]Doctoral School, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
                [d ]School of Dentistry and Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
                Author notes
                Corresponding author: Lidia Galan-Lopez. Professor, Department of Orthodontics, School of Dentistry and Medicine, Doctoral School, Catholic University of Valencia San Vicente Mártir, C/Quevedo, 2. 46001 Valencia, Spain. Tel +34-963637412, lidia.galan@ 123456ucv.es
                Author information
                https://orcid.org/0000-0001-7360-2609
                Article
                10.4041/kjod.2019.49.3.140
                6533182
                31149604
                3e1ddb3a-33c0-4aeb-bd6a-da64fcc76793
                © 2019 The Korean Association of Orthodontists.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 June 2018
                : 20 September 2018
                : 05 October 2018
                Categories
                Review Article

                Dentistry
                clear aligners,invisalign®,invisible orthodontics,treatment outcomes
                Dentistry
                clear aligners, invisalign®, invisible orthodontics, treatment outcomes

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