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Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess ... 	 Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess ...
 

Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess ... Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess ...

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    Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess ... 	 Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess ... Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess ... Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess ... Presentation Transcript

    • Evidenced Based Dentistry Spring 2006 Group 4 Kevin Hancock Jess Havron Bayne Heersink Alec Helms Nathan Johnson
      • Is Invisalign ® orthodontics better for most young adult patients?
      • What are the pros and cons of this method versus conventional orthodontics?
    • What is Invisalign ® ?
      • A series of clear plastic aligners
      • Made of thin, see-through plastic
      • Fit over the buccal, lingual, and occlusal surfaces of teeth
      Photo: Invisalign.com
    • What is Invisalign ® ?
      • Bite impressions are made.
      • 3-D computer imaging technology is used to transform the bite impressions into a custom-made series of clear and removable aligners.
      Photo: Invisalign.com
    • What is Invisalign ® ?
      • Worn for a minimum of 20 hours per day (removed for eating, brushing, and flossing)
      • Aligners changed every two weeks
      Photo: Invisalign.com
    • What is Invisalign ® ?
      • Each tray moves a tooth or group of teeth 0.25 – 0.30 mm.
      • Average treatment time is approximately one year.
      Photos: Invisalign.com
      • Is Invisalign ® orthodontics better for most young adult patients?
      • What are the pros and cons of this method versus conventional orthodontics?
    • Treatment Arches with multiple missing teeth Teeth with short clinical crowns Severely tipped teeth (more than 45 degrees) Extrusion of teeth Open bites (anterior and posterior) Severely rotated teeth (more than 20 degrees) Narrow arches that can be expanded without tipping the teeth too much Centric relation and centric occlusion discrepancies Deep overbite problems (Class II, div. 2 malocclusions) Skeletal anterio-posterior discrepancies of more than 2 mm Spacing problems (1-5mm) Crowding and spacing over 5 mm Mildly crowded and malaligned problems (1-5mm) Difficult to Treat with Invisalign ® Possible to Treat with Invisalign ®
    • Advantages of Invisalign ®
      • Ideal asthetics
      • Ease of use for the patient
      • Comfort of wear
      • Simplicity of care and better oral hygiene
      • Potential metal allergy reactions associated with conventional fixed appliances are avoided
    • Advantages (continued)
      • Elimination of treatment options in detail before beginning treatment
      • Evaluation of treatment options in detail before beginning treatment
      • The virtual treatment model can serve as a motivation tool for the patient
    • Disadvantages of Invisalign ®
      • Limited control over movement
      • Limited intermaxillary correction
      • Lack of operator control
      • Additional time and documentation required if changes have to be made once the treatment has started
      • Slight intrusion (.25-.5 mm) of posterior teeth may occur
      • Study of 54 Invisalign ® patients after 3-6 months treatment (12 questions)
      • 78% female
      • 44% ages 20-30
      • 35% no pain; 54% mild pain (lasting 2-3 days after placement of new aligner)
      • 93% said it did not alter normal speech patterns
      • 0% reported TMJ pain
      • 89% were satisfied with treatment
    • Invisalign ®
      • Systematic Review of available literature
      • Purpose
        • “ To determine the magnitude of the reported treatment effects of Invisalign ® ”
        • “ To help determine which Invisalign ® treatment indications are supported by the evidence”
    • Invisalign ®
      • Computerized search of online databases (PubMed, Medline, etc.)
      • 1 st Search: “Invisalign ”
      • 2 nd Search: “Invisalign treatment effects”
      • “ Humans”
      • “ Clinical Trials”
    • 1st Study
      • Vlaskalic and Boyd
      • 38 patients
      • Placed into three groups depending on severity
      • Treatment times (20-32 months)
      • Percentage of patients completing treatment: 61.5 – 90%
    • 2 nd Study
      • Bollen and colleagues
      • “ Evaluating the effect of activation time and material stiffness in the ability to complete use of a first set of prescribed aligners”
      • 51 subjects
      • Randomization into four groups
      • Conclusions: 15 patients completed study (71% dropout rate!); two week activation, simple cases, no extractions, low PAR index score (more likely to complete initial set of aligners)
    • Conclusions
      • Both studies had flaws
      • 1 st Study: small sample size; not randomized, no specific parameters concerning crowding, etc.
      • 2 nd Study: small sample size, large dropout rate, didn’t follow patients through complete treatment
      • Therefore, no strong conclusions could be made about Invisalign’s indications or limitations
      • Need better and additional clinical trials
    • Invisalign ®
      • Outcome assessment of Invisalign ® and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system
      • A retrospective records analysis of non-extraction patients
      • 2 groups, each with 48 patients who were, at the time the study began, the first patients the orthodontist had completed treatment with Invisalign ® , and his other patients he had completed treatment simultaneously with fixed orthodontics
      • Patients had treatment with one system or the other
      • The groups were controlled for case complexity
    • Pretreatment
      • Patients were evaluated using the Discrepancy Index (DI) to classify patients according to levels of malocclusion
      • DI consists of 10 categories- overjet, overbite, anterior open bite, lateral open bite, crowding, occlusion, lingual posterior crossbite, buccal posterior crossbite, cephalometrics, and “other”
      • This allowed the case complexities to be controlled in the study
    • Post treatment
      • Each group was measured for 8 different categories using the ABO’s objective grading system (OGS) to determine if satisfactory treatment outcome was achieved
      • Categories are alignment, marginal ridges, buccolingual inclination, occlusal contacts, occlusal relations, overjet, interproximal contacts, and root angulations
    • Statistical tests used in the study
      • Power test- to determine how many patients in each group would yield a study with statistical weight
      • Chi-square tests- to determine any differences in distribution between the two groups with regard to pretreatment malocclusion and post-treatment results
      • Also used Wilcoxon-2 sample tests and Spearman correlation tests to determine if any significant differences were present between individual DI and OGS categories between the two groups, and used to examine differences in treatment time
      • A P-value of 0.05 was used as the level of statistical significance
    • Results of the study
      • While the difference in ages of the patients in the two groups was statistically significant, the mean DI scores (for pre-treatment evaluation of the cases) were not significant (P=0.9066)
      • This suggests the two groups were evenly matched in terms of difficulty of the cases
      • The OGS scores (for post-treatment evaluation) were statistically significant (P<0.0001)
      • 4 categories had the greatest discrepancies- buccolingual inclination, occlusal contacts, occlusal relationships, and overjet
      • Only 10 Invisalign ® cases received passing grades, while the fixed orthodontics group received 23 passing grades
      • Invisalign ® patients had a shorter treatment duration than the fixed orthodontics group (1.4 years versus 1.7 years)
    • Discussion
      • Differences in ages between the two groups is mostly due to Invisalign’s contraindication for use on persons with non-erupted teeth
      • Tooth movement in patients should still be similar, regardless of age, and most of the patients in both groups were adults who were finished growing
      • Mean DI scores were similar in each category for both groups, meaning that pre-treatment occlusions for both groups were similar, and thus statistically insignificant
      • Treatment time may be a factor, because even though Invisalign ® can produce faster results, the occlusion may not be as ideal
    • Conclusions
      • Invisalign ® did not score as well on the Objective Grading System as did fixed orthodontics, and was deficient in the categories of occlusal contacts, posterior torque, and especially anterior-posterior discrepancies
    • Study limitations
      • Because the Invisalign ® patients were the first 48 the orthodontist completed treatment, patients who did not complete Invisalign ® treatment were not included in the study, nor were patients with extractions
      • Since the 48 Invisalign ® patients were the first the orthodontist ever treated using the Invisalign ® system, the operator’s skill is a factor; with time the operator’s technique will improve
      • To be truly fair, the 48 Invisalign ® cases should be compared to the operator’s first 48 fixed orthodontics patients in order to downplay the effect of operator skill on the results
      • So…
      • What are the pros and cons of this method versus conventional orthodontics?
      • Is Invisalign ® orthodontics better for most young adult patients?
    • Before Invisalign ® After Invisalign ®
    • References Journal of Orofacial Orthopedics, Urban and Vogel, Band 66, Number 2, March 2005, pages 162-173. Lagravere, Manuel C., and Carlos Flores-Mir. &quot;The Treatment Effects of Invisalign Orthodontic Aligners: a Systematic Review.&quot; JADA 136 (2005): 1724-1729. PubMed . Lister Hill Library, Birmingham, AL. Djeu, G., Shelton, C., Maganzini, A. “Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system.” AJODO 128 (2005): 292-298. Pubmed. Lister Hill Library, Birmingham, AL.