Abstract
Objective
Based on our previous pilot study, the objective of this extended study was to compare (a) casts to their corresponding digital ClinCheck® models at baseline and (b) the tooth movement achieved at the end of aligner therapy (Invisalign®) to the predicted movement in the anterior region.
Materials and methods
Pre- and post-treatment casts as well as initial and final ClinChecks® models of 50 patients (15–63 years of age) were analyzed. All patients were treated with Invisalign® (Align Technology, Santa Clara, CA, USA). Evaluated parameters were: upper/lower anterior arch length and intercanine distance, overjet, overbite, dental midline shift, and the irregularity index according to Little. The comparison achieved/predicted tooth movement was tested for equivalence [adjusted 98.57% confidence interval (− 1.00; + 1.00)].
Results
Before treatment the anterior crowding, according to Little, was on average 5.39 mm (minimum 1.50 mm, maximum 14.50 mm) in the upper dentition and 5.96 mm (minimum 2.00 mm, maximum 11.50 mm) in the lower dentition. After treatment the values were reduced to 1.57 mm (minimum 0 mm, maximum 4.5 mm) in the maxilla and 0.82 mm (minimum 0 mm, maximum 2.50 mm) in the mandible. We found slight deviations between pretreatment casts and initialClinCheck® ranging on average from −0.08 mm (SD ± 0.29) for the overjet and up to −0.28 mm (SD ± 0.46) for the upper anterior arch length. The difference between achieved/predicted tooth movements ranged on average from 0.01 mm (SD ± 0.48) for the lower anterior arch length, up to 0.7 mm (SD ± 0.87) for the overbite. All parameters were significantly equivalent except for the overbite (−1.02; − 0.39).
Conclusion
Performed with aligners (Invisalign®), the resolvement of the partly severe anterior crowding was successfully accomplished. Resolving lower anterior crowding by protrusion of the anterior teeth (i.e., enlargement of the anterior arch length) seems well predictable. The initial ClinCheck® models provided high accuracy compared to the initial casts. The achieved tooth movement was in concordance with the predicted movement for all parameters, except for the overbite.
Zusammenfassung
Ziel
Basierend auf unserer vorangegangenen Pilotuntersuchung war das Ziel dieser erweiterten Studie, a) Anfangsmodelle zu Behandlungsbeginn mit der korrespondierenden Anfangsposition im ClinCheck® und b) die mittels Aligner-Therapie (Invisalign®) erreichten Zahnbewegungen mit den prognostizierten Bewegungen im anterioren Bereich zu vergleichen.
Material und Methode
Anfangs- und Endmodelle sowie Anfangs- und Endpositionen des ClinChecks® von insgesamt 50 Patienten (15 bis 63 Jahre alt) wurden analysiert. Alle Patienten waren ausschließlich mit Invisalign® (Align Technology, Santa Clara, CA, USA) behandelt worden. Die evaluierten Parameter waren: anteriore Zahnbogenlänge in Maxilla und Mandibula, intercanine Distanz in Maxilla und Mandibula, Overjet, Overbite, dentale Mittellinienverschiebung (Maxilla zu Mandibula) sowie der Irregularitätsindex nach Little. Der Vergleich prognostizierte und erreichte Zahnbewegung wurde getestet auf Äquivalenz [adjustiertes 98,57%-Konfidenzintervall (− 1,00; + 1,00)].
Ergebnisse
Die prätherapeutisch vorliegenden frontalen Engstände (nach Little) von im Mittel 5,39 mm (minimal 1,50 mm, maximal14,50 mm) in der Maxilla und 5,96 mm (minimal 2,00 mm, maximal11,50 mm) in der Mandibula wurden durch die Behandlung auf 1,57 mm (minimal 0 mm, maximal 4,5 mm) in der Maxilla und 0,82 mm (minimal 0 mm, maximal 2,50 mm) in der Mandibula reduziert. Es zeigten sich lediglich geringe Abweichungen zwischen Anfangsmodell und Anfangs-ClinCheck® von im Durchschnitt − 0,08 mm (SD ± 0,29) für den Parameter Overjet und von bis zu − 0,28 mm (SD ± 0,46) für die obere anteriore Zahnbogenlänge. Die Differenz zwischen erreichter und prognostizierter Zahnbewegung betrug von durchschnittlich 0,01 mm (± 0,48) für die untere anteriore Zahnbogenlänge bis 0,7 mm (± 0,87) für den Overbite. Alle Parameter waren signifikant äquivalent außer dem Overbite (− 1,02; − 0,39).
Schlussfolgerung
Die Auflösung der teilweise sehr starken frontalen Engstände wurde durch die Aligner-Behandlung (Invisalign®) erfolgreich durchgeführt. Die Engstandsauflösung mittels Protrusion der Unterkieferfrontzähne (d. h. Vergrößerung der anterioren Zahnbogenlänge) erscheint gut voraussagbar. Der Anfangs-ClinCheck® bietet verglichen mit dem Anfangsmodell eine hohe Genauigkeit. Die erreichten Zahnbewegungen waren bei allen Parametern, außer dem Overbite, in Übereinstimmung mit den vorausgesagten Bewegungen.
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Acknowledgments
We would like to thank the staff at the Institute for Medical Biometry, Epidemiology and Computer Science at the University of Medicine of Johannes Gutenberg University in Mainz for their kind assistance and advice in this investigation and for statistical analysis of the data.
Danksagung
Wir danken den Mitarbeitern des Instituts für Medizinische Biometrie, Epidemiologie und Informatik an der Universitätsmedizin der Johannes Gutenberg-Universität Mainz für ihre freundliche Unterstützung und Beratung bei der Ermittlung und statistischen Analyse der Daten.
Conflict of interest
On behalf of all authors, the corresponding author states that there are no conflicts of interest.
Interessenkonflikt
Die korrespondierende Autorin gibt für sich und ihre Koautoren an, dass kein Interessenkonflikt besteht.
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Krieger, E., Seiferth, J., Marinello, I. et al. Invisalign® treatment in the anterior region. J Orofac Orthop 73, 365–376 (2012). https://doi.org/10.1007/s00056-012-0097-9
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DOI: https://doi.org/10.1007/s00056-012-0097-9