Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Oral Health
Published in: BMC Oral Health 1/2023

Open Access 01-12-2023 | Aligner | Research

Effects of different designs of orthodontic clear aligners on the maxillary central incisors in the tooth extraction cases: a biomechanical study

Authors: Xuehuan Meng, Chunjuan Wang, Wenjie Xu, Rui Wang, Leilei Zheng, Chao Wang, Raffaella Aversa, Yubo Fan

Published in: BMC Oral Health | Issue 1/2023

Login to get access

Abstract

Background

Controlling the 3D movement of central incisors during tooth extraction cases with clear aligners is important but challenging in invisible orthodontic treatment. This study aimed to explore the biomechanical effects of central incisors in tooth extraction cases with clear aligners under different power ridge design schemes and propose appropriate advice for orthodontic clinic.

Methods

A series of Finite Element models was constructed to simulate anterior teeth retraction or no retraction with different power ridge designs. These models all consisted of maxillary dentition with extracted first premolars, alveolar bone, periodontal ligaments and clear aligner. And the biomechanical effects were analysed and compared in each model.

Results

For the model of anterior teeth retraction without power ridge and for the model of anterior teeth no retraction with a single power ridge, the central incisors exhibited crown lingual inclination and relative extrusion. For the model of anterior teeth no retraction with double power ridges, the central incisors tended to have crown labial inclination and relative intrusion. For the model of anterior tooth retraction with double power ridges, the central incisors exhibited a similar trend to the first kind of model, but as the depth of the power ridge increased, there was a gradual decrease in crown retraction value and an increase in crown extrusion value. The simulated results showed that von-Mises stress concentration was observed in the cervical and apical regions of the periodontal ligaments of the central incisors. The clear aligner connection areas of adjacent teeth and power ridge areas also exhibited von-Mises stress concentration and the addition of power ridge caused the clear aligner to spread out on the labial and lingual sides.

Conclusions

The central incisors are prone to losing torque and extruding in tooth extraction cases. Double power ridges have a certain root torque effect when there are no auxiliary designs, but they still cannot rescue tooth inclination during tooth retraction period. For tooth translation, it may be a better clinical procedure to change the one-step aligner design to two-step process: tilting retraction and root control.
Appendix
Available only for authorised users
Literature
1.
Awad MG, Skander E, Ashley S, Vaid N, Makki L, Ferguson DJ. Accuracy of digital predictions with CAD/CAM labial and lingual appliances a retrospective cohort study. Semin Orthod. 2018;24(4):14.CrossRef
2.
Noll D, Mahon B, Shroff B, Carrico C, Lindauer SJ. Twitter analysis of the orthodontic patient experience with braces vs Invisalign. Angle Orthod. 2017;87(3):377–83.PubMedCrossRef
3.
White DW, Julien KC, Jacob H, Campbell PM, Buschang PH. Discomfort associated with Invisalign and traditional brackets: a randomized, prospective trial. Angle Orthod. 2017;87(6):801–8.PubMedPubMedCentralCrossRef
4.
Tamer I, Oztas E, Marsan G. Orthodontic Treatment with Clear Aligners and the scientific reality behind their marketing: a Literature Review. Turk J Orthod. 2019;32(4):241–6.PubMedPubMedCentralCrossRef
5.
Boyd RL. Esthetic orthodontic treatment using the invisalign appliance for moderate to complex malocclusions. J Dent Educ. 2008;72(8):948–67.PubMedCrossRef
6.
Marya A, Venugopal A, Vaid N, Alam MK, Karobari MI. Essential attributes of Clear Aligner Therapy in terms of Appliance Configuration, Hygiene, and Pain levels during the pandemic: a brief review. Pain Res Manag. 2020;2020:6677929.PubMedPubMedCentralCrossRef
7.
Almasoud NN. Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign((R)) aligners during the first week of orthodontic treatment. Korean J Orthod. 2018;48(5):326–32.PubMedPubMedCentralCrossRef
8.
Barone S, Paoli A, Razionale AV, Savignano R. Computational design and engineering of polymeric orthodontic aligners. Int J Numer Method Biomed Eng. 2017;33(8):e2839.PubMedCrossRef
9.
Vaid NR, Sabouni W, Wilmes B, Bichu YM, Thakkar DP, Adel SM. Customized adjuncts with clear aligner therapy: “The Golden Circle Model” explained! J World Fed Orthod. 2022;11(6):216–25.PubMedCrossRef
10.
Kravitz ND, Dalloul B, Zaid YA, Shah C, Vaid NR. What percentage of patients switch from Invisalign to braces? A retrospective study evaluating the conversion rate, number of refinement scans, and length of treatment. Am J Orthod Dentofacial Orthop. 2023;163(4):526–30.PubMedCrossRef
11.
Fiori A, Minervini G, Nucci L, d’Apuzzo F, Perillo L, Grassia V. Predictability of crowding resolution in clear aligner treatment. Prog Orthod. 2022;23(1):43.PubMedPubMedCentralCrossRef
12.
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;14:68.PubMedPubMedCentralCrossRef
13.
Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod. 2015;85(5):881–9.PubMedCrossRef
14.
Gu J, Tang JS, Skulski B, Fields HW Jr, 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;151(2):259–66.PubMedCrossRef
15.
16.
Galan-Lopez L, Barcia-Gonzalez J, Plasencia E. A systematic review of the accuracy and efficiency of dental movements with Invisalign(R). Korean J Orthod. 2019;49(3):140–9.PubMedPubMedCentralCrossRef
17.
Zheng M, Liu R, Ni Z, Yu Z. Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis. Orthod Craniofac Res. 2017;20(3):127–33.PubMedCrossRef
18.
Dai FF, Xu TM, Shu G. Comparison of achieved and predicted crown movement in adults after 4 first premolar extraction treatment with Invisalign. Am J Orthod Dentofacial Orthop. 2021;160(6):805–13.PubMedCrossRef
19.
Dai FF, Xu TM, Shu G. Comparison of achieved and predicted tooth movement of maxillary first molars and central incisors: first premolar extraction treatment with Invisalign. Angle Orthod. 2019;89(5):679–87.PubMedPubMedCentralCrossRef
20.
Dardengo Cde S, Fernandes LQ, Capelli Junior J. Frequency of orthodontic extraction. Dent Press J Orthod. 2016;21(1):54–9.CrossRef
21.
Mishra D, Natarajan M, Urala AS. Lip profile changes in patients with Class II Division 1 malocclusion of varied growth patterns treated with maxillary premolar extractions: a pilot study. Am J Orthod Dentofacial Orthop. 2020;158(5):684–93.PubMedCrossRef
22.
Liang W, Rong Q, Lin J, Xu B. Torque control of the maxillary incisors in lingual and labial orthodontics: a 3-dimensional finite element analysis. Am J Orthod Dentofacial Orthop. 2009;135(3):316–22.PubMedCrossRef
23.
Sfondrini MF, Gandini P, Castroflorio T, Garino F, Mergati L, D’Anca K, et al. Buccolingual Inclination Control of Upper Central Incisors of Aligners: a comparison with conventional and self-ligating brackets. Biomed Res Int. 2018;2018:9341821.PubMedPubMedCentralCrossRef
24.
Cheng Y, Liu X, Chen X, Li X, Fang S, Wang W, et al. The three-dimensional displacement tendency of teeth depending on incisor torque compensation with clear aligners of different thicknesses in cases of extraction: a finite element study. BMC Oral Health. 2022;22(1):499.PubMedPubMedCentralCrossRef
25.
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.PubMedPubMedCentral
26.
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. 2014;145(6):728–36.PubMedCrossRef
27.
Milheiro A, de Jager N, Feilzer AJ, Kleverlaan CJ. In vitro debonding of orthodontic retainers analyzed with finite element analysis. Eur J Orthod. 2015;37(5):491–6.PubMedCrossRef
28.
Elkholy F, Schmidt F, Jager R, Lapatki BG. Forces and moments applied during derotation of a maxillary central incisor with thinner aligners: an in-vitro study. Am J Orthod Dentofacial Orthop. 2017;151(2):407–15.PubMedCrossRef
29.
Cortona A, Rossini G, Parrini S, Deregibus A, Castroflorio T. Clear aligner orthodontic therapy of rotated mandibular round-shaped teeth: a finite element study. Angle Orthod. 2020;90(2):247–54.PubMedCrossRef
30.
Shen T, Zhao B, Wang C, Xiao Y, Han Y, Zhao G, et al. Efficacy of different designs of mandibular expanders: a 3-dimensional finite element study. Am J Orthod Dentofacial Orthop. 2020;157(5):641–50.PubMedCrossRef
31.
Zeng W, Liu Y, Hou X. Biomechanical evaluation of internal fixation implants for femoral neck fractures: a comparative finite element analysis. Comput Methods Programs Biomed. 2020;196:105714.PubMedCrossRef
32.
Harikrishnan P, Magesh V, Ajayan AM, JebaSingh DK. Finite element analysis of torque induced orthodontic bracket slot deformation in various bracket-archwire contact assembly. Comput Methods Programs Biomed. 2020;197:105748.PubMedCrossRef
33.
Wang C, Han J, Li Q, Wang L, Fan Y. Simulation of bone remodelling in orthodontic treatment. Comput Methods Biomech Biomed Engin. 2014;17(9):1042–50.PubMedCrossRef
34.
Savignano R, Valentino R, Razionale AV, Michelotti A, Barone S, D’Anto V. Biomechanical Effects of different auxiliary-aligner designs for the extrusion of an Upper Central Incisor: a finite element analysis. J Healthc Eng. 2019;2019:9687127.PubMedPubMedCentralCrossRef
35.
Xu B, Wang Y, Li Q. Modeling of damage driven fracture failure of fiber post-restored teeth. J Mech Behav Biomed Mater. 2015;49:277–89.PubMedCrossRef
36.
Bachiri A, Djebbar N, Boutabout B, Serier B. Effect of different impactor designs on biomechanical behavior in the interface bone-implant: a comparative biomechanics study. Comput Methods Programs Biomed. 2020;197:105723.PubMedCrossRef
37.
Eram A, Zuber M, Keni LG, Kalburgi S, Naik R, Bhandary S, et al. Finite element analysis of immature teeth filled with MTA, Biodentine and Bioaggregate. Comput Methods Programs Biomed. 2020;190:105356.PubMedCrossRef
38.
Xie Q, Li D. The cross-sectional effects of ribbon arch wires on class II malocclusion intermaxillary traction: a three-dimensional finite element analysis. BMC Oral Health. 2021;21(1):501.PubMedPubMedCentralCrossRef
39.
Gomez JP, Pena FM, Martinez V, Giraldo DC, Cardona CI. Initial force systems during bodily tooth movement with plastic aligners and composite attachments: a three-dimensional finite element analysis. Angle Orthod. 2015;85(3):454–60.PubMedCrossRef
40.
Jiang T, Wu RY, Wang JK, Wang HH, Tang GH. Clear aligners for maxillary anterior en masse retraction: a 3D finite element study. Sci Rep. 2020;10(1):10156.PubMedPubMedCentralCrossRef
41.
Ozturk F. Finite-element modelling of two-disc shrink fit assembly and an evaluation of material pairs of discs. Proc Institution Mech Eng Part C: J Mech Eng Sci. 2010;225(2):263–73.CrossRef
42.
Pedersen P. On Shrink Fit Analysis and Design. Comput Mech. 2005;37(2):121–30.CrossRef
43.
Özel A, Temiz Ş, Aydin MD, Şen S. Stress analysis of shrink-fitted joints for various fit forms via finite element method. Mater Design. 2005;26(4):281–9.CrossRef
44.
Liu Y, Hu W. Force changes associated with different intrusion strategies for deep-bite correction by clear aligners. Angle Orthod. 2018;88(6):771–8.PubMedPubMedCentralCrossRef
45.
Comba B, Rossini SP, Castroflorio G, Deregibus T. A. A ThreeDimensional Finite Element Analysis of UpperCanine Distalization with Clear Aligners, Composite Attachments, and Class II Elastics. JCO. 2017:24 – 8.
46.
Yokoi Y, Arai A, Kawamura J, Uozumi T, Usui Y, Okafuji N. Effects of attachment of Plastic Aligner in closing of Diastema of Maxillary Dentition by Finite element Method. J Healthc Eng. 2019;2019:1075097.PubMedPubMedCentralCrossRef
47.
Gay G, Ravera S, Castroflorio T, Garino F, Rossini G, Parrini S, et al. Root resorption during orthodontic treatment with Invisalign(R): a radiometric study. Prog Orthod. 2017;18(1):12.PubMedPubMedCentralCrossRef
48.
Mantovani E, Castroflorio E, Rossini G, Garino F, Cugliari G, Deregibus A, et al. Scanning electron microscopy evaluation of aligner fit on teeth. Angle Orthod. 2018;88(5):596–601.PubMedPubMedCentralCrossRef
49.
Upadhyay M, Arqub SA. Biomechanics of clear aligners: hidden truths & first principles. J World Fed Orthod. 2022;11(1):12–21.PubMedCrossRef
50.
Haouili N, Kravitz ND, Vaid NR, Ferguson DJ, Makki L. Has Invisalign improved? A prospective follow-up study on the efficacy of tooth movement with Invisalign. Am J Orthod Dentofacial Orthop. 2020;158(3):420–5.PubMedCrossRef
51.
Kim WH, Hong K, Lim D, Lee JH, Jung YJ, Kim B. Optimal position of attachment for removable thermoplastic aligner on the Lower Canine using finite element analysis. Mater (Basel). 2020;13(15).
52.
Ahmed T, Padmanabhan S, Pottipalli Sathyanarayana H. Effects of varying attachment positions on palatal displacement of maxillary incisors with clear aligner therapy: a three-dimensional finite element analysis. J Orofac Orthop. 2023;84(3):178–88.PubMedCrossRef
53.
Zhang Y, Gao J, Wang X, Wang J, Zhang X, Fang S, et al. Biomechanical factors in the open gingival embrasure region during the intrusion of mandibular incisors: a new model through finite element analysis. Front Bioeng Biotechnol. 2023;11:1149472.PubMedPubMedCentralCrossRef
Metadata
Title
Effects of different designs of orthodontic clear aligners on the maxillary central incisors in the tooth extraction cases: a biomechanical study
Authors
Xuehuan Meng
Chunjuan Wang
Wenjie Xu
Rui Wang
Leilei Zheng
Chao Wang
Raffaella Aversa
Yubo Fan
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-023-03106-8

Other articles of this Issue 1/2023

BMC Oral Health 1/2023 Go to the issue

Research

Change in surface properties of two different dental resin composites after using various beverages and brushing

Research

Molar-root incisor malformation — a systematic review of case reports and case series

Research article

Antibiotic prophylaxis and surgical site infections in orthognathic surgery – a retrospective analysis

Research

Comprehensive positional and morphological assessments of the temporomandibular joint in adolescents with skeletal Class III malocclusion: a retrospective CBCT study

Research

Identification and susceptibility testing of oral candidiasis in advanced cancer patients

Research

Theobromine versus casein phospho-peptides/Amorphous calcium phosphate with fluoride as remineralizing agents: effect on resin-dentine bond strength, microhardness, and morphology of dentine