Evaluation of Orthodontic Treatments with Clear Aligners and Fixed Appliances by Orthodontists

Öz

Aim: Orthodontists need to have an idea about the effectiveness of clear aligners in tooth movements in order to achieve healthy results with the treatment method they will recommend considering the treatment needs and expectations of the patients. However, the effectiveness of clear aligners in orthodontic treatments is still a matter of debate. The purpose of this survey study is to evaluate the success of tooth movement provided by clear aligners and fixed appliances by orthodontists. As a result of the study; It is aimed to help orthodontists to share their ideas and experiences about the success of these two different treatment techniques in tooth movement with other colleagues and to provide a basis for evaluating future changes in these techniques. Methods: Our survey study was carried out on the database of the Turkish Orthodontic Society (TOD) and was delivered to 2000 orthodontists registered with TOD. 440 orthodontists participated in the study. The web-based survey was prepared using Google Forms (Calif., USA) program. IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was used for statistical analysis in the study. Results: The response rate is 22%. 67.3% (296 people) of the orthodontists participating in the study use clear aligners in their treatments. There is a statistically significant difference in the use of clear aligners in treatment according to academic title (p<0.05). The rate of using clear aligners in the treatment of residency students (27.9%) was statistically significantly lower than all other titles (p<0.05). The rate of using clear aligners in the treatment of phD students (60.5%) was statistically significantly lower than that of Associate Professor, Professor and Special Dr. (p<0.05). There was no significant difference between other titles (p>0.05). Orthodontists considered fixed appliances superior to clear aligners in all tooth movements except distalization (p<0.05). Conclusion: In our study, orthodontists consider fixed appliances superior in all cases, except for distalization movement, in terms of tooth movement. Another situation to consider is; as the number of treatments performed by orthodontists with aligners increases, the rate of finding aligners to be successful also increases.

Anahtar Kelimeler

• Clear Aligner Appliances;
• Orthodontic Appliances, Fixed
• Orthodontics;
• Tooth Movement Techniques
• Diş Hareketi Teknikleri;
• Ortodonti;
• Sabit Ortodontik Apareyler;
• Şeffaf Plak Apareyleri

Şeffaf Plaklar ve Sabit Apareyler İle Yapılan Ortodontik Tedavilerin Ortodontistler Tarafından Değerlendirilmesi

Öz

Amaç: Ortodontistlerin, hastaların tedavi ihtiyaçlarını ve beklentilerini göz önüne alarak önerecekleri tedavi yöntemiyle sağlıklı sonuçlara ulaşabilmesi için, şeffaf plakların diş hareketlerindeki etkinliği hakkında fikir sahibi olmaları gerekmektedir. Ancak şeffaf plakların ortodontik tedavilerdeki etkinliği halen tartışma konusudur. Bu anket çalışmasının amacı, ortodontistlerin şeffaf plaklarla ve sabit apareylerle sağlanan diş hareketinin başarısını değerlendirmeleridir. Çalışma sonucunda; hekimlerin bu iki farklı tedavi tekniğinin diş hareketindeki başarısı hakkındaki fikirlerini ve deneyimlerini diğer meslektaşlarıyla paylaşmaları ve bu tekniklerde gelecekte yaşanabilecek olan değişimlerin değerlendirilmesi için kullanılacak bir temel oluşturmalarına yardımcı olmak amaçlanmaktadır. Yöntem: Anket çalışmamız Türk Ortodonti Derneği (TOD) veri tabanı üzerinden yürütülmüş ve TOD’a kayıtlı 2000 hekime ulaştırılmıştır. Çalışmaya 440 hekim katılmıştır. Anket formları elektronik ortamda Google Formlar (Calif., ABD) programı kullanılarak hazırlanmıştır. Çalışmada istatistiksel analizler için IBM SPSS Statistics 22 (IBM SPSS, Türkiye) programı kullanılmıştır. Bulgular: Yanıtlama oranı %22’dir. Çalışmaya katılan hekimlerin %67.3’ü (296 kişi) tedavilerinde şeffaf plak kullanmaktadır. Akademik ünvana göre tedavide şeffaf plak kullanma oranları açısından istatistiksel olarak anlamlı farklılık bulunmaktadır (p<0.05). Uzmanlık öğrencilerinin tedavide şeffaf plak kullanma oranları (%27.9) diğer tüm ünvanlardan, doktora öğrencilerinin tedavide şeffaf plak kullanma oranları (%60.5), Doç.Dr, Dr.Öğretim Üyesi ve Uzman Dr’lardan istatistiksel olarak anlamlı düzeyde düşüktür (p<0.05). Diğer ünvanlar arasında anlamlı bir farklılık bulunmamaktadır (p>0.05). Hekimler, distalizasyon hariç tüm diş hareketlerinde sabit apareyleri şeffaf plaklardan üstün görmüşlerdir (p<0.05). Sonuçlar: Yaptığımız çalışmada hekimler, diş hareketi konusunda distalizasyon hareketi haricinde diğer tüm durumlarda sabit apareyleri üstün görmektedir. Göz önünde bulundurulması gereken bir diğer durum ise; hekimlerin plaklarla yaptığı tedavi sayısı arttıkça plakları başarılı bulma oranlarının da artış göstermesidir.

Anahtar Kelimeler

• Diş Hareketi Teknikleri;
• Ortodonti;
• Sabit Ortodontik Apareyler;
• Şeffaf Plak Apareyleri

Kaynakça

1. 1. AlSeraidi M, Hansa I, Dhaval F, Ferguson DJ, Vaid NR. The effect of vestibular, lingual, and aligner appliances on the quality of life of adult patients during the initial stages of orthodontic treatment. Prog Orthod. 2021;22(1):4–9.
2. 2. Weir T. Clear aligners in orthodontic treatment. Aust Dent J [Internet]. 2017 Mar;62:58–62. Available from: https://onlinelibrary.wiley.com/doi/10.1111/adj.12480
3. 3. Melkos AB. Advances in digital technology and orthodontics: a reference to the Invisalign method. Med Sci Monit [Internet]. 2005 May;11(5):PI39—42. Available from: http://europepmc.org/abstract/MED/15874904
4. 4. Nahoum HI. The vacuum formed dental contour appliance. NY State Dent Journal. 1964;(9):385–90. 5. Vlaskalic V, Boyd RL. Clinical evolution of the Invisalign appliance. J Calif Dent Assoc. 2002 Oct;30(10):769–76.
5. 6. Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health [Internet]. 2019 Jan 23 [cited 2022 Nov 30];19(1):1–10. Available from: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-018-0695-z
6. 7. Drake CT, McGorray SP, Dolce C, Nair M, Wheeler TT. Orthodontic Tooth Movement with Clear Aligners. ISRN Dent [Internet]. 2012 Aug 14;2012:1–7. Available from: https://www.hindawi.com/journals/isrn/2012/657973/
7. 8. Lagravere MO, Flores-Mir C. The treatment effects of Invisalign orthodontic aligners. The Journal of the American Dental Association [Internet]. 2005 Dec;136(12):1724–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002817714624545
8. 9. Boyd RL. Surgical-orthodontic treatment of two skeletal Class III patients with Invisalign and fixed appliances. J Clin Orthod. 2005;39(4):245–58.

9. 10. Boyd RL, Waskalic V. Three-dimensional diagnosis and orthodontic treatment of complex malocclusions with the invisalign appliance. Semin Orthod. 2001;7(4):274–93.
10. 11. Castroflorio T, Garino F, Lazzaro A, Debernardi C. Upper-incisor root control with Invisalign appliances. J Clin Orthod. 2013;47:346–51.
11. 12. Wajekar N, Pathak S, Mani S. Rise & review of invisalign clear aligner system. IP Indian Journal of Orthodontics and Dentofacial Research. 2022;8(1):7–11.
12. 13. D’Antò V, Bucci R, de Simone V, Huanca Ghislanzoni L, Michelotti A, Rongo R. Evaluation of Tooth Movement Accuracy with Aligners: A Prospective Study. Materials [Internet]. 2022 Apr 4;15(7):2646. Available from: https://www.mdpi.com/1996-1944/15/7/2646
13. 14. Papadimitriou A, Mousoulea S, Gkantidis N, Kloukos D. Clinical effectiveness of Invisalign® orthodontic treatment: a systematic review. Prog Orthod [Internet]. 2018 Dec 28;19(1):37. Available from: https://doi.org/10.1186/s40510-018-0235-z
14. 15. Krieger E, Seiferth J, Saric I, Jung B, Wehrbein H. Accuracy of Invisalign® treatments in the anterior tooth region. First results. J Orofac Orthop. 2011;72:141–9.
15. 16. Richmond S, Shaw WC, O’Brien KD, Buchanan IB, Jones R, Stephens CD, et al. The development of the PAR Index (Peer Assessment Rating): reliability and validity. Eur J Orthod. 1992 Apr;14(2):125–39.
16. 17. Djeu G, Shelton C, Maganzini A. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. American Journal of Orthodontics and Dentofacial Orthopedics [Internet]. 2005 Sep;128(3):292–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0889540605006268
17. 18. Gu J, Tang JS, Skulski B, Fields HWJ, Beck FM, Firestone AR, et al. Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index. Am J Orthod Dentofacial Orthop. 2017 Feb;151(2):259–66.
18. 19. Hennessy J, Garvey T, Al-Awadhi EA. A randomized clinical trial comparing mandibular incisor proclination produced by fixed labial appliances and clear aligners. Angle Orthodontist. 2016;86(5):706–12.
19. 20. Drake CT, McGorray SP, Dolce C, Nair M, Wheeler TT. Orthodontic tooth movement with clear aligners. ISRN Dent. 2012;2012:657973.
20. 21. Simon M, Keilig L, Schwarze J, Jung BA, Bourauel C. Treatment outcome and efficacy of an aligner technique - regarding incisor torque, premolar derotation and molar distalization. BMC Oral Health. 2014;14(1):1–7.
21. 22. Kanpittaya P, Changsiripun C, Jaruprakorn T, Komolpis R, Chengprapakorn S, Laoamata V, et al. Clear Aligner: Effectiveness, Limitations and Considerations. 2021;231.
22. 23. Kravitz ND, Kusnoto B, Agran B, Viana G. Influence of Attachments and Interproximal Reduction on the Accuracy of Canine Rotation with Invisalign: A Prospective Clinical Study. Angle Orthod [Internet]. 2008 Jul 1;78(4):682–7. Available from: https://doi.org/10.2319/0003-3219(2008)078[0682:IOAAIR]2.0.CO
23. 24. Grünheid T, Loh C, Larson BE. How accurate is Invisalign in nonextraction cases? Are predicted tooth positions achieved? Angle Orthod. 2017 Nov;87(6):809–15.
24. 25. Zhang XJ, He L, Guo HM, Tian J, Bai YX, Li S. Integrated three-dimensional digital assessment of accuracy of anterior tooth movement using clear aligners. Korean J Orthod. 2015 Nov;45(6):275–81. 26. Hahn W, Zapf A, Dathe H, Fialka-Fricke J, Fricke-Zech S, Gruber R, et al. Torquing an upper central incisor with aligners - Acting forces and biomechanical principles. Eur J Orthod. 2010;32(6):607–13.
25. 27. Simon M, Keilig L, Schwarze J, Jung BA, Bourauel C. Forces and moments generated by removable thermoplastic aligners: incisor torque, premolar derotation, and molar distalization. Am J Orthod Dentofacial Orthop [Internet]. 2014 [cited 2022 Jul 3];145(6):728–36. Available from: https://pubmed.ncbi.nlm.nih.gov/24880843/
26. 28. Iliadi A, Koletsi D, Eliades T. Forces and moments generated by aligner-type appliances for orthodontic tooth movement: A systematic review and meta-analysis. Orthod Craniofac Res. 2019;22(4):248–58.
27. 29. Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. American Journal of Orthodontics and Dentofacial Orthopedics [Internet]. 2009 Jan;135(1):27–35. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0889540608008597
28. 30. Khosravi R, Cohanim B, Hujoel P, Daher S, Neal M, Liu W, et al. Management of overbite with the Invisalign appliance. American Journal of Orthodontics and Dentofacial Orthopedics. 2017 Apr 1;151(4):691-699.e2.
29. 31. Glassick A, Gluck AJ, Kotteman W, Messersmith M. Aligner Corner - Evaluating the Efficacy of Lower Incisor Intrusion with Clear Aligners. J Clin Orthod. 2017;LI(4):234–9.
30. 32. Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review. Angle Orthod [Internet]. 2015 Sep 1;85(5):881–9. Available from: http://meridian.allenpress.com/angle-orthodontist/article-pdf/85/5/881/1398312/061614-436_1.pdf
31. 33. Lombardo L, Arreghini A, Ramina F, Huanca Ghislanzoni LT, Siciliani G. Predictability of orthodontic movement with orthodontic aligners: a retrospective study. Prog Orthod. 2017;18(1).
32. 34. Jiang T, Jiang YN, Chu FT, Lu PJ, Tang GH. A cone-beam computed tomographic study evaluating the efficacy of incisor movement with clear aligners: Assessment of incisor pure tipping, controlled tipping, translation, and torque. Am J Orthod Dentofacial Orthop. 2021 May;159(5):635–43.
33. 35. Verma P, George AM. Efficacy of clear aligners in producing molar distalization: Systematic review. APOS Trends in Orthodontics. 2021;11(4):317–24.
34. 36. Ravera S, Castroflorio T, Garino F, Daher S, Cugliari G, Deregibus A. Maxillary molar distalization with aligners in adult patients: a multicenter retrospective study. Prog Orthod. 2016;17:12.
35. 37. Long H, Wu Z, Yan X, Wang Q, Liu L, Wang Y, et al. An objective system for appraising clear aligner treatment difficulty: clear aligner treatment complexity assessment tool (CAT–CAT). BMC Oral Health [Internet]. 2020;20(1):1–8. Available from: https://doi.org/10.1186/s12903-020-01300-6
36. 38. Pavoni C, Lione R, Laganà G, Cozza P. Self-ligating versus Invisalign: analysis of dento-alveolar effects. Ann Stomatol (Roma). 2011 Jan;2(1–2):23–7.
37. 39. Houle JP, Piedade L, Todescan RJ, Pinheiro FHSL. The predictability of transverse changes with Invisalign. Angle Orthod. 2017 Jan;87(1):19–24.
38. 40. Zhou N, Guo J. Efficiency of upper arch expansion with the Invisalign system. Angle Orthod. 2020 Jan;90(1):23–30.
39. 41. Li W, Wang S, Zhang Y. The effectiveness of the Invisalign appliance in extraction cases using the the ABO model grading system: a multicenter randomized controlled trial. Int J Clin Exp Med. 2015;8(5):8276–82.
40. 42. Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health [Internet]. 2019 Dec 23;19(1):24. Available from: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-018-0695-z