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      Clinical effectiveness of Invisalign® orthodontic treatment: a systematic review

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          Abstract

          Background

          Aim was to systematically search the literature and assess the available evidence regarding the clinical effectiveness of the Invisalign® system.

          Methods

          Electronic database searches of published and unpublished literature were performed. The reference lists of all eligible articles were examined for additional studies. Reporting of this review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

          Results

          Three RCTs, 8 prospective, and 11 retrospective studies were included. In general, the level of evidence was moderate and the risk of bias ranged from low to high, given the low risk of bias in included RCTs and the moderate ( n = 13) or high ( n = 6) risk of the other studies. The lack of standardized protocols and the high amount of clinical and methodological heterogeneity across the studies precluded a valid interpretation of the actual results through pooled estimates. However, there was substantial consistency among studies that the Invisalign® system is a viable alternative to conventional orthodontic therapy in the correction of mild to moderate malocclusions in non-growing patients that do not require extraction. Moreover, Invisalign® aligners can predictably level, tip, and derotate teeth (except for cuspids and premolars). On the other hand, limited efficacy was identified in arch expansion through bodily tooth movement, extraction space closure, corrections of occlusal contacts, and larger antero-posterior and vertical discrepancies.

          Conclusions

          Although this review included a considerable number of studies, no clear clinical recommendations can be made, based on solid scientific evidence, apart from non-extraction treatment of mild to moderate malocclusions in non-growing patients. Results should be interpreted with caution due to the high heterogeneity.

          Electronic supplementary material

          The online version of this article (10.1186/s40510-018-0235-z) contains supplementary material, which is available to authorized users.

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          Most cited references35

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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

                Contributors
                0030 210 746 4280 , dimitrios.kloukos@zmk.unibe.ch
                Journal
                Prog Orthod
                Prog Orthod
                Progress in Orthodontics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1723-7785
                2196-1042
                28 September 2018
                28 September 2018
                2018
                : 19
                : 37
                Affiliations
                [1 ]GRID grid.414012.2, Department of Orthodontics and Dentofacial Orthopedics, , 251 Hellenic Air Force General Hospital, ; P. Kanellopoulou 3, 11525 Athens, Greece
                [2 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, Department of Orthodontics, , University Hospital Ghent P8, University of Ghent, ; C. Heymanslaan 10, B-9000 Ghent, Belgium
                [3 ]ISNI 0000 0001 0726 5157, GRID grid.5734.5, Department of Orthodontics and Dentofacial Orthopedics, , University of Bern, ; Freiburgstrasse 7, CH-3010 Bern, Switzerland
                Author information
                http://orcid.org/0000-0002-0665-238X
                Article
                235
                10.1186/s40510-018-0235-z
                6160377
                30264270
                b8bae7f9-f19a-4dab-8b73-24a665763d6a
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 29 June 2018
                : 27 July 2018
                Categories
                Review
                Custom metadata
                © The Author(s) 2018

                orthodontics,invisalign,aligner,clinical efficiency
                orthodontics, invisalign, aligner, clinical efficiency

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