Keywords :
Attachments, Clear aligner, Finite element analysis, Rotations
Citation Information :
Aggarwal R, Singh G, Sharma S, Singh RK, Kannan S, Goyal V. Clear Aligner Orthodontic Therapy of Rotated Mandibular Incisors: A Finite Element Study. J Oral Health Comm Dent 2024; 18 (3):116-125.
Introduction: As a discrete and patient-friendly substitute for conventional fixed orthodontic appliances, clear aligner therapy has become increasingly popular. Using finite element analysis (FEA), this study assesses how well different composite attachments work to achieve rotational mobility of the mandibular lateral incisors. Orthodontic treatment has been transformed by Align Technology's Invisalign™ system and CAD/CAM technology, but rotational movements are still difficult, particularly for cylindrical and small teeth.
Material and methods: The alveolar bone, aligner systems, and periodontal ligament (PDL) were all included in the three-dimensional (3D) finite element model of the mandibular arch. Teeth with T-shaped composite attachments, half-ellipsoids, horizontal rectangles, and no attachments had their rotational forces examined. Forces were calibrated using strain gauge systems, and computer models examined stress distribution and displacement in teeth, aligners, and surrounding tissues. Importantly, while prior studies predominantly focused on larger teeth like canines and premolars, this investigation uniquely assessed the effects on smaller mandibular incisors, where maintaining structural integrity poses additional challenges. These findings provide valuable insights for clinicians in choosing appropriate instrumentation techniques for minimally invasive endodontic treatment.
Results: Results indicated that composite attachments significantly enhanced rotational movement compared to aligners without attachments. Among the attachment designs, the horizontal rectangular attachment yielded the highest rotational efficacy, followed by the T-shaped attachment. Stress patterns showed concentration in the labioincisal and cervical regions, with stress values remaining within physiological limits, suggesting no harm to periodontal structures. The aligner with T-shaped attachments exhibited the least distortion, improving its functional efficiency.
Align Technology, Inc. The Invisalign Reference Guide. Santa Clara, InvisalignTM; 2002.
Elsasser WA. Some observations on the history and uses of the Kesling positioner. Am J Orthod 1950;36(5):368–374. DOI: 10.1016/0002-9416(50)90076-5.
Konda P, Tarannum SA. Basic principles of finite element method and its applications in orthodontics. J Pharm Biomed Sci 2012;16(11):1–4.
Cortona A, Rossini G, Parrini S, et al. Clear aligner orthodontic therapy of rotated mandibular round-shaped teeth: A finite element study. Angle Orthod 2019. DOI: 10.2319/020719-86.1.
Kravitz ND, Kusnoto B, Agran B, et al. Influence of attachments and interproximal reduction on the accuracy of canine rotation with Invisalign: A prospective clinical study. Angle Orthod 2008;78(4): 682–687. DOI: 10.2319/0003-3219(2008)078[0682:IOAAIR]2.0.CO;2.
Rosvall MD, Fields HW, Ziuchkovski J, et al. Attractiveness, acceptability, and value of orthodontic appliances. Am J Orthod Dentofacial Orthop 2009;135(3):276-e1–12. DOI: 10.1016/j.ajodo.2008.09.020.
Ramalho A, Vale Antunes P. Reciprocating wear test of dental composites against human teeth and glass. Wear 2007;263:1095–1104. DOI: 10.1016/j.wear.2007.01.086.
Huang HL, Tsai MT, Yang SG, et al. Mandible integrity and material properties of the periodontal ligament during orthodontic tooth movement: A finite-element study. Appl Sci 2020;10(8):2980. DOI: 10.3390/app10082980.
Kravitz, ND, Kusnoto, B, BeGole, E, et al. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. Am J Orthod Dentofac Orthop 2009;135:27–35. DOI: 10.1016/j.ajodo.2007.05.018.
Hahn W, Engelke B, Jung K, et al. Initial forces and moments delivered by removable thermoplastic appliances during rotation of an upper central incisor. Angle Orthod 2010;80(2):239–246. DOI: 10.2319/033009-181.1.
Hahn W, Engelke B, Jung K, et al. The influence of occlusal forces on force delivery properties of aligners during rotation of an upper central incisor. Angle Orthod 2011;81(6):1057–1063. DOI: 10.2319/013111-62.1.
Garino F, Castroflorio T, Daher S, et al. Effectiveness of composite attachments in controlling upper-molar movement with aligners. J Clin Orthod 2016;50(6):341–347. PMID: 27475935.
Brezniak N. The clear plastic appliance: A biomechanical point of view. Angle Orthod 2008;78(2):381–382. DOI: 10.2319/0003- 3219(2008)078[0381:TCPA]2.0.CO;2.