Transforming Adolescent Smiles:Correcting Skeletal Mandibular Retrusion and Bimaxillary Protrusion with Clear Aligners

Maxillary protrusion combined with mandibular retraction is a highly prevalent but extremely complex maxillofacial deformity that can have a serious negative impact on patients’facial aesthetics and mental health.The traditional orthodontic treatment strategy often involves extracting 4 first premolars and conventional fixed techniques,combined with mini-implant screws,to retract the anterior teeth and improve facial protrusion.In recent years,an invisible orthodontic technique,without brackets,has become increasingly popular.However,while an invisible aligner has been used in some cases with reasonable results,there remain significant challenges in achieving a perfect outcome.This case report presents an adolescent patient with bimaxillary protrusion and mandibular retrognathia.Based on the characteristics of the invisible aligners and the growth characteristics of the adolescent’s teeth and jawbone,we designed precise three-dimensional tooth movement and corresponding resistance/over-correction for each tooth,while utilizing the patient’s jawbone growth potential to promote rapid development of the mandible,accurately and efficiently correcting bimaxillary protrusion and skeletal mandibular retrognathia.The patient’s facial aesthetics,especially the lateral morphology,have been greatly improved,and various aesthetic indicators have also shown significant changes,and to the patient’s great benefit,invasive mini-implant screws were not used during the treatment.This case highlights the advantages of using invisible aligners in adolescent maxillary protrusion combined with mandibular retraction patients.Furthermore,comprehensive and accurate design combined with good application of growth potential can also enable invisible orthodontic technology to achieve perfect treatment effects in tooth extractions,providing clinical guidance for orthodontists.

Colour stabilities of three types of orthodontic clear aligners exposed to staining agents

The aim of this study was to evaluate and compare the colour stabilities of three types of orthodontic clear aligners exposed to staining agents in vitro. Sixty clear orthodontic aligners produced by three manufacturers （Invisalign, Angelalign, and Smartee） were immersed in three staining solutions （coffee, black tea, and red wine） and one control solution （distilled water）. After 12-h and 7-day immersions, the aligners were washed in an ultrasonic cleaner and measured with a colourimeter. The colour changes （△E＊） were calculated on the basis of the Commission Internationale de I＇Eclairage L＊a＊b＊ colour system （CIE L＊a＊b＊）, and the results were then converted into National Bureau of Standards （NBS） units. Fourier transformation infrared （FT-IR） spectroscopy and scanning electron microscopy （SEM） were conducted to observe the molecular and morphologic alterations to the aligner surfaces, respectively. The three types of aligners exhibited slight colour changes after 12 h of staining, with the exception of the Invisalign aligners stained with coffee. The Invisalign aligners exhibited significantly higher AE＊ values （ranging from 0.30 to 27.81） than those of the Angelalign and Smartee aligners （AE＊ values ranging from 0.33 to 1.89 and 0.32 to 1.61, respectively, P〈O.05）. IFT-IR analysis confirmed that the polymer-based structure of aligners did not exhibit significant chemical differences before and after the immersions. The SEM results revealed different surface alterations to the three types of aligner materials after the 7-day staining. The three types of aesthetic orthodontic appliances exhibited colour stability after the 12-h immersion, with the exception of the Invisalign aligners stained by coffee. The Invisalign aligners were more prone than the Angelalign and Smartee aligners to pigmentation. Aligner materials may be improved by considering aesthetic colour stability properties.

More than just aligning the teeth:Clear aligners with multifunctional prowess

With the increasing demand for beauty and health,clear aligners(CAs)have been widely applied among patients with malocclusion.However,patients treated with CAs also face some potential complications,such as demineralization,dental caries,and periodontal diseases.In addition,some patients have additional needs to improve their quality of life,such as bleaching teeth.In order to prevent or solve these problems,the modification of CAs is a promising method because their extensive long-term contact with tooth surfaces makes them ideal devices for implementing adjuvant medical functions.In this review,we discuss various advanced CAs with medical functions based on the clinical needs of patients.As far as we know,the additional functions of CAs mainly include antibacterial,remineralization,whitening,and accelerating tooth movement.These functions are achieved by two major pathways,the combination of CAs with drugs/biomaterials and increasing the capacity or affinity of drugs.In addition,we discuss the current limitations of in vitro experiments which are designed to explore the effectiveness and properties of novel CAs,and the challenges of bringing a multifunctional appliance from proposal to clinical application.At the end of this review,we provide insights into the broader prospects for the improvement of CAs.

Effect of 3D anchorage attachment on the alleviating tipping/extrusion of premolars for en-mass distalization of maxillary molars with clear aligners:A finite element study

This study aimed to explore the optimal invisible orthodontic force system during the en-mass distalization of two maxillary molars to minimize the side effect of anchorage loss by changing the direction of the application of the orthodontic force system.A high bio-fidelity 3D finite element model including maxilla,periodontal ligament,dentition,clear aligner,3D anchorage attachment and mini-implant was established.Different lengths of lateral hooks of 3D-printed anchorage attachments and mini-implant positions into the palatal alveolus were considered.A 200 g distal force was applied to the lateral hooks of different horizontal lengths(3.26 mm,6.52 mm and 9.78 mm)with the mini-implant as the application point.Using ABAQUS software,orthodontic tooth movements under 12 different clinical treatment designs were analyzed and calculated.The 3D anchorage attachment enhanced the anchorage of anterior teeth and alleviated the tipping/extrusion of premolars.In contrast to without clear aligners,length of the lateral hook had a negligible effect on both mesial tipping and buccal tipping with clear aligners,which could then be ignored.The change in mesial tipping was less and nearly remained constant despite of the different heights of the mini-implant.The 3D anchorage attachment assisted clear aligner can avoid the side effects of anterior tooth proclination caused by insufficient anchorage.The length of the lateral hook,and height of the mini-implant in this invisible orthodontic force system hardly affects the tooth movement of anchorage units.Clear aligners can effectively control the rotation and tipping of anchorage units caused by 3D anchorage attachment.

Effects of Mandibular Extractions with Clear Aligners:A Finite Element Analysis

This study was aimed at analysing the mechanical characteristics of different mandibular extraction modes using a clear aligner.Three experimental schemes of different extraction patterns were designed to treat mandibular crowding,including extraction of one mandibular central incisor,bilateral first premolars,and bilateral second premolars.The stress distribution during the space closing was analysed using the finite element method.When a central incisor was extracted,a significant retraction force was found in the anterior region,in line with the design expectation.The posterior teeth,which were designed to move mesially,acted as anchorage for anterior retraction,and were subjected to a mesial force.The anterior teeth were retracted when the bilateral first premolars were extracted.The lateral incisors and canines were subjected to a significant distal force and moment,while the central incisors and canines were subjected to lingual forces and moments.Additionally,the canines were subjected to a non-designated intruding force.The molars were designed to move mesially when the bilateral second premolars were extracted.All molars were subjected to a significant mesial force,while the lingual force on the front teeth was slight.The bilateral second molars were subjected to non-design mesial moment and extrusive force.The bilateral first molars were subjected to a non-designated mesial moment,and the bilateral first premolars on both sides were subjected to non-designated intrusive force and distal moment.When one incisor was extracted,attachments on the anterior teeth had a controlling effect on the tooth axis,but the anterior teeth still tended to tilt.When the bilateral first premolars were extracted,the anterior teeth showed a tendency for lingual inclination.The risk of distal inclination of the canines and lingual inclination of the central incisor increased.When the bilateral second premolars were extracted and the posterior teeth were designed to move mesially,the teeth on both sides of the extraction sites showed an obvious bowing effect.

Advances in orthodontic clear aligner materials

Rapid technological improvements in biomaterials,computer-aided design(CAD)and manufacturing(CAM)have endorsed clear aligner therapy(CAT)as a mainstay of orthodontic treatment,and the materials employed for aligner fabrication play an all-important role in determining the clinical performance of clear aligners.This narrative review has attempted to comprehensively encompass the entire gamut of materials currently used for the fabrication of clear aligners and elucidate their characteristics that are crucial in determining their performance in an oral environment.Historical developments and current protocols in aligner fabrication,features of contemporary bioactive materials,and emerging trends related to CAT are discussed.Advances in aligner material chemistry and engineering possess the potential to bring about radical transformations in the therapeutic applications of CAT;in the absence of which,clear aligners would continue to underperform clinically,due to their inherent biomechanical constraints.Finally,while innovations in aligner materials such as shape memory polymers,direct three-dimensional(3D)printed clear aligners and bioactive materials combined with clear aligner materials are essential to further advance the applications of CAT;increased awareness of environmental responsibilities among aligner manufacturers,aligner prescribing clinicians and aligner users is essential for better alignment of our climate change goals towards a sustainable planet.

‘Invisible’ orthodontics by polymeric ‘clear’ aligners molded on 3D-printed personalized dental models

The malalignment of teeth is treated classically by metal braces with alloy wires,which has an unfavorable influence on the patients appearance during the treatment.With the development of digitization,computer simulation and three-dimensional(3D)printing technology,herein,a modern treatment was tried using clear polymeric aligners,which were fabricated by molding polyurethane films via thermoforming on the 3D-printed personalized dental models.The key parameters of photocurable 3D printing of dental models and the mechanical properties of the clear aligner film material were examined.The precision of a 3D-printed dental model mainly relied on characteristics of photocurable resin,the resolution of light source and the exposure condition,which determined the eventual shape of the molded clear aligner and thus the orthodontic treatment efficacy.The biocompatibility of the polyurethane filmmaterial was confirmed through cytotoxicity and hemolysis tests in vitro.Following a series of 3D-printed personalized dental models and finite element analysis to predict and plan the fabrication and orthodontic processes,corresponding clear aligners were fabricated and applied in animal experiments,which proved the efficacy and biocompatibility in vivo.Clinical treatments of 120 orthodontic cases were finally carried out with success,which highlights the advantage of the clear aligners as an esthetic,compatible and efficient appliance.