Thukral R et al. Invisalign: Invisible Orthodontic Treatment.

REVIEW ARTICLE
INVISALIGN: INVISIBLE ORTHODONTIC
TREATMENT- A REVIEW
Rakesh Thukral, Amit Gupta
Department of Orthodontics, Modern Dental College and Research Centre, Indore, M.P.

ABSTRACT:
Influence of appearance in personal and professional lives have led to a considerable interest among the adult
population seeking orthodontic treatment in the last few years. Invisalign or clear aligners are the new age
Aesthetic Orthodontic treatment methods developed especially for adults who are very self conscious of how
they appear. This article aims to discuss pros and cons of this device as it has the tendency to transform the
smile without interfering with the daily life of patients.
Keywords: Clear Aligners; Aesthetics; Invisalign; Removable appliances
Corresponding author Dr. Rakesh Thukral, Professor, Department of Orthodontics, Modern Dental College
and Research Centre, Indore, M.P.

This article may be cited as: Thukral R, Gupta A. Invisalign: Invisible Orthodontic Treatment- A Review. J
Adv Med Dent Scie Res 2015;3(5):S42-S44.

I
NTRODUCTION aligner is worn for approximately 20 hours per day
When patients think about correction of and is changed approximately every two weeks.
malaligned teeth, braces and wires are the each ligner will move the teeth around 0.25 to 0.3
first thing that spring to mind. However, mm.3,4
orthodontics has revolutionised according INDICATIONS FOR INVISALIGN
to the demands and needs of the patients. APPLIANCES2
Orthodontists are concerned about the aesthetics • Mild crowded and malalingned problems (1-5
and it is one of the major concerns among patients mm)
who seek orthodontic treatment. To address the • Spacing problems (1-5 mm)
increasing aesthetic demand for an alternative to • Deep overbite (Class II div 2 cases )
conventional braces, investigators have developed • Narrow arches that can be expanded without
several solutions, such as ceramic or composite tipping the teeth too much.
braces, lingual orthodontics, and clear aligners.1 • Absolute intrusion (1 or 2 teeth)
Clear aligners are the new age Aesthetic • Lower incisor extraction for severe crowding
Orthodontic treatment methods developed cases.
especially for adults who are very self conscious of • Tip molar distally
how they appear. Invisaligners are a series of clear,
custom-made, thin, removable plastic aligners,
nearly undetected and created to effectively move ADVANTAGES5,6
teeth into their desired position.2 • The trays are clear, aesthetic, comfortable - no
Invisalign was introduced in the late 1990s by metal brackets or wires to cause mouth
Align Technology Inc, and due to advanced irritation or lacerations.
technology allowed a much simpler approach to • Clear aligners are often not visible, allowing
this type of treatment. Accurate impression are patients to smile with greater confidence
taken to allow the construction of precision casts • Better oral hygiene than fixed. Unlike
which can be scanned to produce a virtual 3D traditional braces, the trays can be removed
model. This 3-D model can then be manipulated by for brushing, flossing, and eating.
the orthodontist and malocclusion is virtually • Shorter dental appointments.
corrected using proprietary software. This • Retention facilitated.
information can then be used to produce a series of • Ideal for retreatment.
clear plastic aligners that gradually correct the • Decreased occlusal abrasion from
malocclusion towards the clinician’s goal. Such parafunctional habits during treatment.
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Thukral R et al. Invisalign: Invisible Orthodontic Treatment.

• Disarticulation of the teeth may be that the aligner is tracking and to evaluating
advantageous for patients with TMJproblems. anchorage with the superimposition or surgical
• Technically much easier than lingual simulation tools and staging.
appliances. Aligners other than Invisalign are Clear path
• Approximating the treatment duration a little aligners, Inman aligners, Nuvola And Fantasmino
more precisely than braces System.
• Avoiding extractions of premolars by creating ClearPath Aligners are USFDA approved,
interdental space via interproximal reduction removable medical grade plastic appliances which
• Less frequent trips to the dental chair by patient wears instead of brackets and wires to
allowing the patients to replace their aligners correct malocclusion. Dental aligners are a modern
on their own every few weeks alternative to braces, for teeth that are in need of
• Healthier periodontal tissue and less risk of straightening. 10
enamel decalcification by avoiding brackets The Inman Aligner is a simple removable appliance
The Invisalign system also boasts improved used to align front teeth quickly and safely. It's
hygiene over traditional braces. Because the clear ideal as a standalone treatment or to prealign teeth
retainers are removable, patients can brush and prior to further cosmetic options such as bonding or
floss as they normally would, reducing the chances minimal veneers. The Inman Aligner has Nickel
of possible staining and decay that often occurs Titanium coil springs that power two aligner bows
with traditional braces. Food and drink choices are that gently oppose each other, guiding the teeth into
less restrictive, as well. If patients wish to eat their new position. These gentle forces are active
sticky candy or drink soda, they may do so after over a very large range of movement, due to it
removing their clear Invisalign retainer.2 shows fast results. Patients have to wear it 16-20
hours a day. 11
DISADVANTAGES Fantasmino® aligners are made of poly-vinyl
Since these devices are removable, they require chloride (PVC), a material with elastic
more patient motivation and self-discipline to characteristics following a plastic deformation
achieve the desired results, to be effective, in fact, when exposed to moderate loads. This
these devices must be worn 22 hours a day. These characteristic allows reducing the optimal wear
must be removed during meals, when drinking hot time to 14 h per day: the deformations subdued by
drinks that could spot or cause deformation, sugary the aligner when worn generate a force that is
drinks and during the oral hygiene at home.7 transferred to the teeth. The thickness of the PVC
Treatment time may exceed estimates due to poor aligners varies with the desired type of tooth
patient compliance to dentist’s instructions, not movement but never exceeds 1 mm. 12
wearing aligners the required number of hours per Nuvola® aligners are made of polyethylene
day, missed appointments, excessive bone growth, terephthalate glycol (PETG), a light, resistant, and
poor oral hygiene and broken appliances can very clear material. It is resistant to time and wear,
lengthen treatment time, increase the cost, and thus and its elasticity allows for a gradual tooth
can affect the quality of the end results.8 movement. PETG aligners have a thickness that
CLINICAL METHOD changes throughout the different treatment phases:
Pretreatment study models are prepared. In 0.75 mm at the beginning of treatment, 0.85 mm
addition, it is important to prepare high precision during the intermediate phase, and 1 mm at the end
impressions by using polyvinyl material. The bite of treatment. This system requires an optimal wear
is also recorded, and the impressions are sent to time of 22 h.12
the Invisalign office. Highly sophisticated Fetouh O13 conducted a study with 67 patients (34
softwares are used, which through a 3D scan fixed, 33 Invisalign) using 3 categories (crowding,
technology create a virtual patient. Other specific overbite, and overjet) to assess discrepancy index,
softwares include ‘Tooth shaper’ & ‘Autobite tool’ and other categories were reported to be within
which identify the shape of the teeth and occlude normal ranges. Seven OGS criteria were graded on
them in centric relation.2 posttreatment models: alignment, marginal ridges,
Nelson9 in his paper described the aligner software buccolingual inclination, occlusal contacts,
named the ClinCheck set-up that can be used for occlusal relationships, overjet, and interproximal
diagnosis and treatment planning and can also be contacts. Mean points lost were 19.15 points for the
used to evaluate the need for IPR, expansion, Invisalign group and 25.5 points for the braces
extraction, distalization, or proclination. This group, which indicated that the Invisalign group
software can also be used to verify the performed resulted in better treatment out.
modifications made by technician, as a consultation In a study conducted by Nedwed et al14 over 54
device to show treatment limits to patient, to verify patients it was found that the majority of patients
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Thukral R et al. Invisalign: Invisible Orthodontic Treatment.

who underwent this treatment is female (78%) and REFERENCES

this is probably related to the greater attention to 1. Acar YB, Kovan AI, Atesx M, Biren S. How
the aesthetic aspect. Efficient Are Clear Aligners? Clear Aligners vs
Traditional Orthodontic Treatment: A Systematic
CONCLUSION Review. Turkish J Orthod 2015;27(3):106-10.
2. Murthy VS, Vijay. Orthodontics Without Braces and
Influence of appearance in personal and
Wires!! A New Paradigm. Indian Journal of Dental
professional lives have led to a considerable Advancements 2011;3(2):508-11.
interest among the adult population seeking 3. Aesthetic Orthodontic appliances. In:An Introduction
orthodontic treatment in the last few years. The to Orthodontics Laura Mitchell, Nigel E.
transparency of the Invisalign appliance enhances Carter, Bridget Doubleday, editor. Oxford University
its esthetic appeal for those adult patients who are Press, 2007.223-7.
averse to wearing conventional labial fixed 4. Joffe L. Invisalign: early experiences. J Orthod 2003;
orthodontic appliances. 30(4):348–52.
Educating patients on the advantages and 5. Mehta F. Mehta S. Aligners: the rapidly growing
disadvantages of clear aligner therapy or clear trend in orthodontics around the world. Indian J
Basic Applied Med Res 2014;3(4): 402-9.
braces significantly depends on patient’s
6. Sadri I. An argument for clear aligners and clear
expectations and compliance. First, as a provider, braces. Dentistry IQ. Available at:
orthodontist must rule out conventional braces by http://www.dentistryiq.com/articles/2013/10/an-
having a clear communication with the patient. If argument-for-clear-aligners-and-clear-braces.html
the patient desires no treatment responsibilities, is 7. Muggiano F, Quaranta A. The Aesthetic Alternative
compliant in visiting the office monthly, and in Orthodontics With Sequential Aligners: The
wishes to have all of the treatment performed by Invisalign System. WebmedCentral Orthodontics
the dentist, then conventional braces is the only 2013;4(10):1-6.
treatment to recommend. Clear aligner therapy can 8. About Clear Aligner Therapy. Available at:
be ruled out immediately. However, if patients https://www.tahsda.org.tw
9. Nelson G, Invisalign Summit 2005, Part II, Pacific
desire the benefits of clear aligner therapy, the pros
Coast Society of Orthodontists Bulletin Summer
and cons must be presented to them. First, the 2006
patient must understand their compliance and 10. Available at:www.clearpathdental.com/clear-path-
responsibilities. They need to consistently wear the aligner.php
aligners 22 to 23 hours per day and only remove 11. Available at : http://www.inmanaligner.com/how-it-
them to eat. One of the benefits of the aligner works
systems is the opportunity to see the end result of 12. Ercoli F, Tepedino M, Parziale V, Luzi C. A
straight teeth and the progression of tooth comparative study of two different clear aligner
movement during the multitude of stages.6 It is systems. Progress in Orthodontics 2014;15(3):1-5.
essential to continuously motivate each patient 13. Fetouh O. Comparison of Treatment Outcome of
Invisalign and Traditional Fixed Orthodontics by
during treatment to properly wear aligners to avail
Model Analysis Using ABO Objective Grading
benefits of the treatment, ensure patient compliance System [master’s thesis]. Buffalo: State University
as well as patient self discipline. of New York; 2008.
14. Nedwed V, Miethke RR. Motivation, acceptance and
problems of Invisalign patients. J Orofac Orthop.
2005;66(2):162-73.

Source of support: Nil Conflict of interest: None declared

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