Skip to main content
Log in

Patient survey on Invisalign® treatment comparen the SmartTrack® material to the previous aligner material

Patientenbefragung zur Einschätzung unterschiedlicher Schienenmaterialien bei der Therapie mit Invisalign®-Schienen

  • Original Article
  • Published:
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

An Erratum to this article was published on 13 January 2017



In 2013, a novel material SmartTrack® was introduced to replace the previous material used for Invisalign® aligners. We conducted this study to test how this transition was accepted by patients during ongoing Invisalign® treatment.


We surveyed a total of 72 patients (68 % women, 32 % men, mean age: 29.3 ± 9.2 years) who had worn the new material for a mean of 6 months. They completed a questionnaire with 25 items that compared both materials in terms of pain, pressure upon insertion, comfort, mucosal irritation, phonetics, discoloration, and taste.


On a numerical rating scale (NRS) ranging from 0 to 10, the new aligner material was rated by the respondents to cause significantly (p < 0.001) less maximum pain than the old material (2.8 vs. 3.8). Significant reductions were obtained for duration of pain (p < 0.001) and duration of pressure (2.5 vs. 1.9 days; p = 0.001) upon insertion of the aligners. Over 90 % of the respondents indicated less or equal pain during eating, felt that the new material offered a tighter fit, and provided more favorable ratings for impairment, durability, and discoloration. Improved comfort was reported by 50 % of the respondents.


The new material was favorably rated by the patients and showed significant reductions in pain intensity, pain duration, and pressure upon insertion. Important clinical parameters like overall comfort and impairment also were improved. The clinical effectiveness of the new material remains to be investigated.



In der vorliegenden Arbeit sollte überprüft werden, wie Patienten mit Invisalign®-Behandlung den Umstieg vom herkömmlichen auf das seit 2013 gebräuchliche neue SmartTrack® Material einschätzen.

Patienten und Methoden

Insgesamt 72 Patienten im Durchschnittsalter von 29,3 ± 9,2 Jahren (68 % weiblich; 32 % männlich) beantworteten durchschnittlich 6 Monate nach dem Umstieg auf das neue Material einen Fragebogen mit 25 Items zu Schmerzen, Druck beim Einsetzen, Tragekomfort, Schleimhautirritationen, Sprachproblemen, Verfärbungen und Geschmack, um die beiden Materialien miteinander zu vergleichen.


Die Patienten geben mit dem neuen Aligner-Material signifikant verringerte maximale Schmerzen an (NRS, numerische Ratingskala, 2,8 vs. 3,8; p < 0,001). Zusätzlich waren Schmerzdauer (p < 0,001) und Dauer des Drucks nach dem Einsetzen signifikant geringer (1,9 vs. 2,5 Tage; p = 0,001). Weiterhin gaben über 90 % der Patienten weniger oder unveränderte Schmerzen beim Essen an, sie empfanden das neue Material als enger oder gleich anliegend und bewerteten es als besser oder gleich gut hinsichtlich Beeinträchtigungen, Haltbarkeit und Verfärbungen. Der Tragekomfort wurde von 50 % der Befragten als verbessert angegeben.


Das neue Material wurde von den Patienten positiv bewertet, da es signifikant zu reduzierter Schmerzstärke, kürzerer Schmerzdauer und zu geringerem Druck beim Einsetzen der Schienen führte. Auch bei weiteren klinisch relevanten Parametern wie Tragekomfort und Beeinträchtigungen, zeigten sich Verbesserungen. Eine Prüfung hinsichtlich der klinischen Effektivität steht noch aus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Bergius M, Broberg AG, Hakeberg M, Berggren U (2008) Prediction of prolonged pain experiences during orthodontic treatment. Am J Orthod Dentofac Orthop 133(3):339. e331–339. e338

  2. Bollen A-M, Huang G, King G, Hujoel P, Ma T (2003) Activation time and material stiffness of sequential removable orthodontic appliances. Part 1: ability to complete treatment. Am J Orthod Dentofac Orthop 124(5):496–501

    Article  Google Scholar 

  3. Bradley TG, Teske L, Eliades G, Zinelis S, Eliades T (2015) Do the mechanical and chemical properties of Invisalign™ appliances change after use? A retrieval analysis. Eur J Orthod 38(1):27–31

    Article  Google Scholar 

  4. Clements KM, Bollen A-M, Huang G, King G, Hujoel P, Ma T (2003) Activation time and material stiffness of sequential removable orthodontic appliances. Part 2: dental improvements. Am J Orthod Dentofac Orthop 124(5):502–508

    Article  Google Scholar 

  5. Erdinc A, Dinçer B (2004) Perception of pain during orthodontic treatment with fixed appliances. Eur J Orthod 26(1):79–85

    Article  PubMed  Google Scholar 

  6. Farronato G, Giannini L, Galbiati G, Cannalire P, Martinelli G, Tubertini I, Maspero C (2012) Oral tissues and orthodontic treatment: common side effects. Minerva Stomatol 62(11–12):431–446

    Google Scholar 

  7. Firestone AR, Scheurer PA, Bürgin WB (1999) Patients’ anticipation of pain and pain-related side effects, and their perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod 21(4):387–396

    Article  PubMed  Google Scholar 

  8. Fujiyama K, Honjo T, Suzuki M, Matsuoka S, Deguchi T (2014) Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy. Prog Orthod 15(1):64

    Article  PubMed  PubMed Central  Google Scholar 

  9. Johal A, Fleming P, Al Jawad F (2014) A prospective longitudinal controlled assessment of pain experience and oral health-related quality of life in adolescents undergoing fixed appliance treatment. Orthod Craniofac Res 17(3):178–186

    Article  PubMed  Google Scholar 

  10. Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B (2009) How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. Am J Orthod Dentofac Orthop 135(1):27–35

    Article  Google Scholar 

  11. Krieger E, Seiferth J, Marinello I, Jung BA, Wriedt S, Jacobs C, Wehrbein H (2012) Invisalign® treatment in the anterior region. J Orofac Orthop Fortschritte der Kieferorthopädie 73(5):365–376

    Article  PubMed  Google Scholar 

  12. Krukemeyer AM, Arruda AO, Inglehart MR (2009) Pain and orthodontic treatment: patient experiences and provider assessments. Angle Orthod 79(6):1175–1181

    Article  PubMed  Google Scholar 

  13. Kuncio D, Maganzini A, Shelton C, Freeman K (2007) Invisalign and traditional orthodontic treatment postretention outcomes compared using the American Board of Orthodontics objective grading system. Angle Orthod 77(5):864–869

    Article  PubMed  Google Scholar 

  14. Liu Z, McGrath C, Hägg U (2011) Changes in oral health-related quality of life during fixed orthodontic appliance therapy: an 18-month prospective longitudinal study. Am J Orthod Dentofac Orthop 139(2):214–219

    Article  Google Scholar 

  15. Long H, Zhou Y, Pyakurel U, Liao L, Jian F, Xue J, Ye N, Yang X, Wang Y, Lai W (2013) Comparison of adverse effects between lingual and labial orthodontic treatment: a systematic review. Angle Orthod 83(6):1066–1073

    Article  PubMed  Google Scholar 

  16. Mandall N, Matthew S, Fox D, Wright J, Conboy F, O’Brien K (2008) Prediction of compliance and completion of orthodontic treatment: are quality of life measures important? Eur J Orthod 30(1):40–45

    Article  PubMed  Google Scholar 

  17. Meier B, Wiemer KB, Miethke R-R (2003) Invisalign®—patient profiling. J Orofac Orthop Fortschritte der Kieferorthopädie 64(5):352–358

    Article  PubMed  Google Scholar 

  18. Miethke R-R, Brauner K (2007) A comparison of the periodontal health of patients during treatment with the Invisalign® system and with fixed lingual appliances. J Orofac Orthop Fortschritte der Kieferorthopädie 68(3):223–231

    Article  PubMed  Google Scholar 

  19. Miethke R-R, Vogt S (2005) A comparison of the periodontal health of patients during treatment with the Invisalign® system and with fixed orthodontic appliances. J Orofac Orthop Fortschritte der Kieferorthopädie 66(3):219–229

    Article  PubMed  Google Scholar 

  20. Miller KB, McGorray SP, Womack R, Quintero JC, Perelmuter M, Gibson J, Dolan TA, Wheeler TT (2007) A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment. Am J Orthod Dentofac Orthop 131(3):302. e301–302. e309

  21. Nedwed V, Miethke R-R (2005) Motivation, acceptance and problems of Invisalign® patients. J Orofac Orthop Fortschritte der Kieferorthopädie 66(2):162–173

    Article  PubMed  Google Scholar 

  22. Otasevic M, Naini FB, Gill DS, Lee RT (2006) Prospective randomized clinical trial comparing the effects of a masticatory bite wafer and avoidance of hard food on pain associated with initial orthodontic tooth movement. Am J Orthod Dentofac Orthop 130(1):6. e9–6. e15

  23. Phan X, Ling PH (2007) Clinical limitations of Invisalign. J Can Dent Assoc 73(3):263

    PubMed  Google Scholar 

  24. Premaraj T, Simet S, Beatty M, Premaraj S (2014) Oral epithelial cell reaction after exposure to Invisalign plastic material. Am J Orthod Dentofac Orthop 145(1):64–71

    Article  Google Scholar 

  25. Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL (2015) Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod 85(5):881–889

    Article  PubMed  Google Scholar 

  26. Scheurer PA, Firestone AR, Bürgin WB (1996) Perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod 18(4):349–357

    Article  PubMed  Google Scholar 

  27. Shalish M, Cooper-Kazaz R, Ivgi I, Canetti L, Tsur B, Bachar E, Chaushu S (2012) Adult patients’ adjustability to orthodontic appliances. Part I: a comparison between Labial, Lingual, and Invisalign™. Eur J Orthod 34(6):724–730

    Article  PubMed  Google Scholar 

  28. Zhou Y, Wang Y, Wang X, Volière G, Hu R (2014) The impact of orthodontic treatment on the quality of life a systematic review. BMC Oral Health 14(1):66

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Justus Benrath.

Ethics declarations

Conflict of interest

A.K. Bräscher, R.E. Feldmann, Jr., and J. Benrath declare that they have no competing interests. D. Zuran is clinical speaker for Invisalign®, including giving seminars and certifications for the Invisalign® technique.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Additional information

A.-K. Bräscher and D. Zuran contributed equally to the manuscript.

An erratum to this article is available at

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bräscher, AK., Zuran, D., Feldmann, R.E. et al. Patient survey on Invisalign® treatment comparen the SmartTrack® material to the previous aligner material. J Orofac Orthop 77, 432–438 (2016).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: