Invisalign/prosthodontic courses

 Introduction
 Indications
 Contraindications
 Advantages
 Disadvantages
 Technique
 How to use invisalign technology
 Conclusion
 References
www.indiandentalacademy.com

 Invisalign is a series of clear,
removable teeth aligners that are used for
correction of dental malocclusions.

 Invisalign was introduced in 1997 by Align
Technology, Inc.
 Aligners, also called "repositioners" or
"contact lenses for teeth“.

 Kesling set up (1945)
 Essix system (1995)

 Founded in 1997, Align began its first
commercial sales of Invisalign to orthodontists
in 1999 .
 By late 2001, Align had manufactured one
million aligners.
 In 2002, Invisalign was made available to general
dentists, and by mid-2003 dental schools began
adding Invisalign to their curriculum.
 Align Technology provides exclusive education
events at more than 60 universities worldwide.
 In 2005, it achieved a manufacturing milestone
of 15 million aligners.

 Mildly crowded and malaligned problems (1–5 mm).
Treatment that can be done with some slight lateral
and/or antero-posterior expansion, with some minor
interproximal tooth reduction, or by removal of a lower
incisor.
 Spacing problems (1–5 mm).
 Deep overbite problems (Class II division 2 type
malocclusions) where the overbite can be reduced by
intrusion and advancement of incisors.
 Narrow arches that can be expanded without tipping
the teeth too much.
 Relapse after using appliance therapy

 Crowding and spacing over 5 mm.
 Skeletal antero-posterior discrepancies (as
measured by cuspid relationships from Class I) of
more than 2 mm.
 Severely rotated teeth (more than 20 degrees).
 Open bites (anterior and posterior) that need to be
closed.
 Extrusion of teeth.
 Severely tipped teeth (more than 45 degrees).
 Teeth with short clinical crowns.
 Arches with multiple missing teeth.

 Esthetic

 The aligners are marketed as being more
comfortable than braces. Due to the
removable nature of the device, food can be
consumed without the encumbrance of
metallic braces.

 The fixed appliance group reported a more
intense decrease in overall quality of life and
more intense increase in pain beginning at
day one and extending through day seven.
 The fixed appliance group reported a more
intense decrease in functional, psycho-social
and pain-related aspects of their daily lives.

 M.G. TAYLOR5 performed a study to
determine the effect of orthodontic tooth
movement on periodontal soft tissue using
Invisalign®.
 Periodontal tissue health as measured by
papillary bleeding score and periodontal
pocket depth improved with use of
Invisalign® aligners during orthodontic
treatment.

 No Demineralisation or tooth decay.

 Post treatment alignment of the teeth was
assessed, along with the periodontal status and
caries rate during and after treatment.
 Four patients dropped out during the study
period.
 Six patients exhibited improved periodontal or
gingival status, while four patients experienced
temporary gingival bleeding and one patient
exhibited increased periodontal pocketing.

 No patients had new caries or
demineralization during the treatment.
 46 patients completed their treatment within
12 months. The average clinical hours used
were approximately 8 hours in total.
 Six of the hundred cases had one tooth or
more that failed to achieve the movements
predicted to the satisfaction of both the
patient and the clinician.

 Allows the prospective patient to review the
projected smile design, learn how long the
treatment is likely to take, compare different
plans, and make a more educated decision
about whether or not to use Invisalign.

 Patient compliance required
 Certain teeth are slightly problematic for
Invisalign aligners to rotate.

 Limited control over root movement, such as
root paralleling, gross rotation correction,
tooth uprighting and tooth extrusion.
 Limited intermaxillary correction.
 Lack of operator control

 Should the treatment go off track, or patients
fail to keep the aligners in for the required
length of time, then the next aligner in the
series will not fit, and a new set of
impressions and aligners will be necessary,
adding to the cost.

 Pricing
 In Europe, the treatment price ranges
from €3,000 to €7,800, depending on case
complexity and length

 They could be lost because the aligners can
be removed for eating.
 If a patient grinds or clenches his or her teeth
during the day or while sleeping, the aligners
can become damaged.
 Aligners may cause a slight lisp at the
beginning of treatment

 There may be cases of allergic and toxic
sensitivity reactions to Invisalign.
 Minor symptoms such as sore throat, cough,
and nausea have been reported.
 In more serious cases, the FDA has received
reports of systemic swelling or throat pain that
has extended to the upper chest and wind
passages requiring emergency medical
treatment and discontinuation of the Invisalign
treatment.

 While chairside time is greatly reduced, the
input on treatment planning, treatment Clin-
Check® revisions and mid-course ClinCheck®
assessments increases non-chairside time.18

GraberVenersdall

 When an Invisalign ® aligner is initially worn,
one could consider the way it seats over the
patient's teeth to be slightly "ill-fitting."

 Force on diagonally opposed tooth surfaces
and leaving appropriate space on the working
side.

Collection of high quality pre-treatment records
 Polyvinyl silicone material
 Aquasil (Dentsply,Weybridge, UK) single phase
impression technique
 Pentamix 2 (ESPE DentalAG, Seefeld,
Germany), a dual-phase impression technique.

 High recovery from deformation
 High dimensional stability
 High elasticity
 High tear resistance
 Extended working time
 Sharp setting curve
 Hydrophilic properties
 Extremely high precision

 Polyether material, such as Impregum (ESPE
Dental AG, Seefeld, Germany), which is a
single-phase impression technique

 Sequential removable clear plastic appliances
are then fabricated from stereolithography
models of these images

 Stereolithography is an additive manufacturing
process using a vat of liquid UV-curable
photopolymer resin and a UV laser to build parts
a layer at a time.
 On each layer, the laser beam traces a part
cross-section pattern on the surface of the liquid
resin.
 Exposure to the UV laser light cures, or, solidifies
the pattern traced on the resin and adheres it to
the layer below.

 Invisalign® also allows for refinement
aligners, which can be added at the end of
the scheduled treatment procedure, to finish
off any tooth movement not fully expressed.
 The ability to re-start a treatment (reboot)
that has gone off course is also available.

 Invisalign® course
 Invisalign® domain (VIP) site

 The mean accuracy of tooth movement with
Invisalign was 41%.
 The most accurate movement was lingual
tipping(47.1%), and the least accurate
movement was extrusion (29.6%)- specifically,
extrusion of the maxillary (18.3%) and
mandibular (24.5%) central incisors
 Followed by mesiodistal tipping of the
mandibular canines (26.9%).
 The accuracy of canine rotation was significantly
lower than that of all other teeth, with the
exception of the maxillary lateral incisors.

 At rotational movements greater than 15
degrees, the accuracy of rotation for the
maxillary canines fell significantly.
 Lingual crown tip was significantly more
accurate than labial crown tip, particularly for
the maxillary incisors.
 There was no statistical difference in
accuracy between maxillary and mandibular
teeth of the same tooth type for any
movements studied

 Patients treated with the Invisalign system
had a more substantial deterioration in
alignment than patients undergoing
traditional braces therapy.
 However, the Invisalign group started out
with superior mean alignment values
compared to the group having fixed
appliance therapy.

 The difference between groups was not
statistically significant and the overall
alignment scores were essentially the same.
 The Invisalign group had a deterioration of
retention in the maxillary and mandibular
anterior alignment, whereas the braces group
only suffered deterioration in retention in the
mandibular anterior alignment.

 A study was done by Theodore Eliades et al
(AJO DO 2009) to study the in-vitro cytotoxic
and estrogenic properties of Invisalign
appliances and it was shown that there was
no evidence of cytotoxicity on human
gingival fibroblasts and no stimulation of
proliferation of the MCF-7 cell line at any
concentration, indicating no estrogenicity of
aligner eluents.

 Invisalign® should be put in perspective.
 As a technique, it is just an additional part of the
armamentarium of the orthodontist.
 It is an aesthetic technique that can be used to treat
simple to moderate alignment cases, especially in the
adult.
 Much will depend on the research and development
that can be generated to improve aligner control over
tooth movement, and our understanding of treatment
and ability to plan prospectively.
 Further research is required in this field, preferably in
the form of prospective randomized controlled trials.

1. www. Aligntechnology.com [AlignTechnology
Announces Fourth Quarter and Fiscal 2007 Results]
2. www. Aligntechnology.com [AlignTechnology and
OrthoClear Complete Definitive Agreement]
3. Invisalign corporate website. [Accessed July 19, 2008]
4. Humber, PV. (2008), "One hundred consecutive Invisalign
cases analysed", Aesthetic DentistryToday 2(1): 36–41
5. Taylor MG, McGorray SP, Durrett S. et al. (2003), "Effect
of Invisalign aligners on periodontal tissues", J Dent Res:
1483

6. Linge BO and Linge L (1983), "Apical root resorption in upper anterior teeth", J
Dent Res 5(3): 173–183.
7. Gorelick L, Geiger AM, Gwinnett AJ. (1982), "Incidence of white spot formation
after bonding and banding", Am J Orthod. Feb;81(2) (2): 93–8.
8. Miller KB, (2005) "A comparison of treatment impacts between Invisalign and fixed
appliance therapy during the first seven days of treatment“
9. Hsieh, Tsung-Ju; Pinskaya, Yuliya; Roberts, W. Eugene (2005), "Assessment of
Orthodontic Treatment Outcomes: Early Treatment versus Late
Treatment",Angle Orthodontist 75 (2): 162–170
10. Joffe, L. (2003), "Current Products and Practice Invisalign: early
experiences", Journal of Orthodontics 30 (4): 348–352.
11. Kuncio, Daniel et al., D.; Maganzini, A.; Shelton, C.; Freeman, K.
(2006), "Invisalign and Traditional Orthodontic Treatment Postretention
Outcomes Compared Using the American Board of Orthodontics Objective
Grading System", Angle Orthodontist 77 (5): 864–869

12. Invisalign corporate website Accessed July 19 2008
13. Align Form 10-K, AlignTechnology, Inc. 2006
14. Lagravère M, & Flores-Mir C (2005), "The treatment effects of
Invisalign orthodontic aligners: A systematic review", J Am Dent
Assoc 136 (12): 1724–1729.
15. Akhlaghi A, et al. (2007), Outcome of Invisalign and traditional
orthodontic treatment using PAR index, 77
16. Djeu G. et al.' (2005), "Outcome assessment of Invisalign and
traditional orthodontic treatment compared with the American
Board of Orthodontics objective grading system", American Journal
of Orthodontics and Dentofacial Orthopedics 128 (3): 292–298.
17. Bishop A, Womack R, and Derakhshan M. (Sep-Oct 2002)., "An
esthetic and removable orthodontic treatment option for patients:
Invisalign", The Dental Assistant
18. L. Joffe Current Products and Practice Invisalign®: early
experiences Journal of Orthodontics,Vol. 30, 2003, 348–352
19. P. V. Humber One hundred consecutive Invisalign cases
analysed Aesthetic DentistryToday 2008 2 (1) 36-41

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