Continued Evolution of Clear Aligners

Clear aligner treatment (CAT) is an effective method of orthodontic care. As digital technology improves and research on applied biomechanics of CAT grows, this approach should be considered for a variety of patient conditions and dentition types. Multiple options for the manufacture of clear aligners, including creating them in office, are available. Patients and providers alike recognize the benefits of CAT. Patients appreciate the esthetic advantages as the clear plastic is molded precisely to their teeth. Adult and children both value the ability to remove the aligners to avoid food restrictions that come with fixed orthodontic appliances. The ability to remove the trays allows for optimal oral hygiene, leading to better periodontal parameters during active treatment.¹ Patient comfort and quality of life are also improved compared to fixed treatments.^2,3

In digital treatment planning, the clinician controls planned movements of individual teeth and timing. As intraoral scanners become more common, aligner fit and precision improve.⁴ CAT is able to treat a variety of conditions in children, teens, and adults.⁵ In younger patients, the ability to balance comfort, correction, and hygiene is advantageous. “Phase I” or interceptive aligners are useful in the mixed dentition. Young patients who have oral sensory concerns or dietary needs contraindicated to fixed appliances have new options for care with CAT. In 2018, the United States Food and Drug Administration provided clearance for a CAT company to manufacture Class II correction appliances, opening the doors to skeletal changes with CAT.

As the knowledge behind the biomechanics of CAT improves, adult treatment will become more effective. CAT can readily be modified to fit individualized care, including single-arch aligners opposing traditional fixed braces or sectionalized braces to upright molars. Aligners can be used in conjunction with temporary anchorage devices and some sleep appliances.⁵

Arguably, the success of CAT rests in patient compliance. Some aligners offer “compliance indicators” that change color when the proper amount of wear is achieved. Many aligner manufacturers have developed smartphone applications to help patients track their treatment. They offer push notification options to remind patients when to progress with treatment.

Dental monitoring devices have taken compliance a step further. These are physical attachments for the patient’s smartphone that allows them to scan their teeth so their compliance and progression can be tracked remotely by their provider. Some devices are purchased through the aligner companies, while others are found through third-party vendors. They can reduce the number of treatment visits, and, in some cases, reduce treatment time.^6,7

CAT is an orthodontic digital workflow that is under constant improvement and development to meet the increasing needs of today’s patients and providers. Undoubtedly, it will continue to change the landscape of interdisciplinary care.

References

1. Miethke RR, Brauner K. A comparison of the periodontal health of patients during treatment with the Invisalign system and with fixed lingual appliancesJ J Orofac Orthop. 2007;68:223-231.
2. Miller KB, McGorray SP, Womack R, et al. A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment. Am J Orthod Dentofacial Orthop. 2007;131:3021-3029.
3. Azaripour A, Weusmann J, Mahmoodi B, et al. Braces versus Invisalign: gingival parameters and patients’ satisfaction during treatment: a cross-sectional study. BMC Oral Health. 2015;15:69.
4. Kravitz ND, Groth C, Jones PE, Graham JW, Redmond WR. Intraoral digital scanners. J Clin Orthod. 2014;48:337-347.
5. Weir T. Clear aligners in orthodontic treatment. Aust Dent J. 2017;62(Suppl 1):58-62.
6. Sangalli L, Alessandri-Bonetti A, Dalessandri D. Effectiveness of dental monitoring system in orthodontics: A systematic review. J Orthod. 2023:14653125231178040.
7. Hansa I, Katyal V, Ferguson DJ, Vaid N. Outcomes of clear aligner treatment with and without Dental Monitoring: A retrospective cohort study. Am J Orthod Dentofacial Orthop. 2021;159:453-459.

From Decisions in Dentistry. October/November 2024;10(6):46.