Journal of Aligner Orthodontics, 01/2024

Nowadays, aligner orthodontics offers a range of treatment possibilities for almost every type of malocclusion. The latest developments in software and printers provide practitioners with options for altering aligner margins, material stiffness and thickness, and other key aspects in aligner orthodontics like direct printed aligners. Covering the palate and using aligners with longer margins instead of scalloped aligners and torque elements in aligner therapy increases the biomechanical force transferred onto the posterior teeth and enables the practitioner to improve predictability when widening the arches without major loss of crown torque. The present article describes the treatment of two patients with in-office aligners and coverage of the maxillary palate. Keywords: aligner orthodontics, in-office aligners, OnyxCeph software, palatal coverage, transverse expansion

One of the most frequent types of transposition affects maxillary canines and first premolars, and in cases of both transposition correction and consolidation, root control is particularly crucial when delivering aligner treatment. The purpose of the present study is to outline an alternative method to optimise root control during aligner treatment of dental transposition. A 25-year-old woman presented with a skeletal Class III and dental Class I malocclusion, a normodivergent facial pattern, moderate maxillary crowding with proclined maxillary incisors, mild mandibular crowding with proclined mandibular incisors, and complete transposition of the maxillary right canine and first premolar. The orthodontic treatment was approached in two phases. In the first phase, transposition was consolidated by moving the maxillary right first premolar into the maxillary right canine position, and an additional aligner stage was performed after provisional aesthetic restoration on the maxillary right first premolar to improve the overall alignment and occlusion. The second phase was planned to combine aligners with an auxiliary made from an 0.18-mm stainless steel wire bonded directly on the tooth and a miniscrew placed distal to the lateral incisor. A G-Spring-TAD was bonded on the maxillary right canine to control root tipping and connected to a temporary anchorage device to cope with the reaction forces. The G-Spring-TAD is essentially a bondable uprighting spring but, instead of using a vertical slotted bracket and a wire as anchorage, it is bonded on the enamel and connected to a temporary anchorage device in order to have a stable anchorage point. The device described can be considered a valid and effective auxiliary for root control during aligner treatment. Keywords: aligners, sectional wires, transposition

The present case report demonstrates a hybrid approach using removable clear devices to gain space through transverse expansion and presents a documented case of treatment with expansion splints. Clear aligners are becoming more popular among practitioners for treatment of complicated cases. Hybrid approaches help to simplify such cases by providing anchorage or performing effective tooth movements where aligners show greater unpredictability or inefficiency. They could also be considered more environmentally friendly, since they reduce the need for a high number of aligners and multiple refinements. Dental crowding is one of the most common chief complaints in orthodontics. Gaining space through dental expansion and uprighting of the posterior teeth is an effective method of resolving crowding and can be achieved efficiently using clear removable expansion splints. The present report documents a successful case of resolution of crowding through dental expansion using modified expansion splints. Keywords: adult orthodontics, clear aligner therapy, crowding, in-house aligners, Invisalign, transverse expansion

Clear aligners and lingual appliances are two aesthetic orthodontic treatment options with different characteristics and biomechanics; however, they can be combined to maximise treatment efficiency. Lingual tipping of incisors during space closure occurs frequently in fixed orthodontic treatment, especially with lingual appliances because the force is applied to the lingual side of the teeth. This case report presents a skeletal Class II patient with the chief complaint of maxillomandibular protrusion, for whom the treatment plan involved the extraction of the four first premolars to create space for incisor retraction. After 18 months of treatment with lingual appliances, significant anterior torque loss was observed, despite the use of pre-torqued archwires during space closure. A decision was made to correct the anterior torque loss using clear aligners. After 6 weeks of aligner treatment, both maxillary and mandibular incisor torque were significantly improved. Thus, clear aligners could be employed to correct incisor torque loss after fixed orthodontic treatment. Keywords: anterior torque loss, clear aligners, hybrid treatment, lingual appliances, protrusion

Aim:To compare the quality of the initial digital setups created by Invisalign (Align Technology, San Jose, CA, USA) and by an orthodontist. Methods:Twenty-six consecutively treated Invisalign patients were enrolled retrospectively in the study and their initial iTero (Align Technology) scans were collected. Initial malocclusion characteristics (vertical overlap, horizontal overlap, molar classification, canine classification, maxillary and mandibular crowding) were recorded. A digital setup was created for each patient using uDesign version 6.0 software (uLab Systems, San Mateo, CA, USA) and two groups were then formed: initial digital setups created by an Invisalign technician and digital setups created by an orthodontist. The quality of the setups was measured objectively for both groups using the American Board of Orthodontics Objective Grading System. Results:With the exception of occlusal and interproximal contacts, there were significant differences in the scores for all the Objective Grading System categories between the setups created by the Invisalign technician and those created by the orthodontist. The total Objective Grading System score, alignment/rotation, marginal ridges, buccolingual inclination, horizontal overlap and occlusal relationships were all significantly lower (fewer point deductions) in the setups created by the orthodontist. Initial severity of horizontal overlap was correlated with a significant difference between the two groups’ horizontal overlap scores, and initial maxillary and mandibular crowding were correlated with a significant difference between the two groups’ marginal ridge scores. Conclusions:Objective Grading System scores were significantly higher (more point deductions) for initial digital setups created by Invisalign compared to those created by the orthodontist in uDesign. For the Invisalign group, initial Objective Grading System scores for horizontal overlap and marginal ridges were significantly higher when the initial malocclusion presented with excessive horizontal overlap and maxillomandibular crowding, respectively. Keywords: American Board of Orthodontics Objective Grading System, Invisalign, digital orthodontics, digital setups