Statement of problem
One of the major challenges in restorative dentistry is to provide optimal esthetics in a minimally invasive way. The optimization of dental esthetics and function is directly related to the position and alignment of the anterior teeth, but whether prerestorative clear aligner therapy will enhance esthetics and minimize restorative needs is unclear.
The purpose of this clinical study was to evaluate the effect of prerestorative maxillary and mandibular second premolar to second premolar clear aligner therapy in minimizing the need for restorative treatment.
Material and methods
Fifty adult patients treated with clear aligners (Invisalign Go; Align Technology) were included in this study. Previously generated 3-dimensional orthodontic simulations and clinical photographs in the ClinCheck/6.0 software program were used. Three restorative treatment plans for each participant were generated for initial (no aligners), Express (after using 7 aligners), and Lite Packages (after using 20 aligners) by 2 blinded restorative dentistry instructors. The maxillary and mandibular teeth in the smile-line (to the second premolars) were included. Assessment criteria were the estimated number of restorations, restoration surfaces and preparations and incisal edge inclusion, and the need for gingival leveling. The Friedman test and Cochran Q test were used for statistical analyses (α=.05).
A strong positive correlation was found between the 2 instructors (P<.001). Estimated number of restorations (10 [3 to 16]a) decreased significantly for Express (6 [0 to 14]b) and Lite Packages (4 [0 to 8]c) (P<.001). The estimated number of restoration surfaces (28.5 [9 to 48]a) decreased significantly for Express (15 [0 to 42]b) and Lite Packages (9.5 [0 to 24]c) (P<.001). While the estimated number of teeth to be prepared for recontouring (7 [0 to 16]a) was significantly less for Express (3 [0 to 10]b) and Lite Packages (0 [0 to 4]c) (P<.001), the incisal edge inclusion (10 [3 to 16]a) was significantly less for Express (6 [0 to 14]b) and Lite Packages (4 [0 to 8]c) (P<.001). The need for gingival leveling (26 [52%]a) decreased significantly for Express (20 [40%]a) and Lite Packages (7 [14%]b) (P<.001).
Prerestorative short-term clear aligner therapy might conserve tooth structure and reduce the number of restorations. The application of the Invisalign Lite Package was more effective than the Invisalign Express Package for second premolar to second premolar alignment.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Prosthetic Dentistry
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Longevity of direct resin composite restorations in maxillary anterior crown fractures: a 4–year clinical evaluation.Oper Dent. 2022; 47: 138-148
- Longevity of direct diastema closure and recontouring restorations with resin composites in maxillary anterior teeth: a 4–year clinical evaluation.J Esthet Restor Dent. 2021; 33: 590-604
- Clinical effectiveness of direct anterior restorations - a meta-analysis.Dent Mater. 2015; 31: 481-495
- Interdisciplinary management of anterior dental esthetics.J Am Dent Assoc. 2006; 137: 160-169
- Five-to-five clear aligner therapy: predictable orthodontic movement for general dentist to achieve minimally invasive dentistry.BMC Oral Health. 2021; 21: 1-14
- Comparing the perception of dentists and lay people to altered dental esthetics.J Esthet Restor Dent. 1999; 11: 311-324
- Canine-guide occlusion and group function occlusion are equally acceptable when restoring the dentition.J Evid Based Dent Pract. 2016; 16: 41-43
- Anterior composite restorations: a systematic review on long-term survival and reasons for failure.Dent Mater. 2015; 31: 1214-1224
- Influence of symmetry and balance on visual perception of a white female smile.J Prosthet Dent. 2018; 120: 573-582
- Forces and moments generated by removable thermoplastic aligners: incisor torque, premolar derotation, and molar distalization.Am J Orthod Dentofacial Orthop. 2014; 145: 728-736
- Emerging insights and new developments in clear aligner therapy (CAT)–a review of the literature.Am J Orthod Dentofacial Orthop Clinical Comp. 2022; 2: 311-324
- Quintessence Publishing, Istanbul2022: 35-42 Pre-restorative procedures, In book: B. Korkut, Composite restorations in anterior esthetics. 1st ed.
- Restorative and invisalign: a new approach.J Esthet Restor Dent. 2002; 14: 217-224
- An interdisciplinary approach to restorative treatment with clear aligners.J Cosmet Dent. 2020; 35: 84-94
- Clear aligner: effectiveness, limitations and considerations.J Dent Assoc Thai. 2021; 71: 231-236
- Efficacy of invisalign attachments: a retrospective study.Am J Orthod Dentofacial Orthop. 2021; 160: 250-258
- How well does invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign.Am J Orthod Dentofacial Orthop. 2009; 135: 27-35
- Clinical effectiveness of clear aligner treatment compared to fixed appliance treatment: an overview of systematic reviews.Clin Oral Investig. 2022; 26: 2353-2370
- Predictability of rotational tooth movement with orthodontic aligners comparing software-based and achieved data: a systematic review and meta-analysis of observational studies.J Orthod. 2021; 48: 277-287
- The treatment effects of invisalign orthodontic aligners: a systematic review.J Am Dent Assoc. 2005; 136: 1724-1729
- Has invisalign improved? A prospective follow-up study on the efficacy of tooth movement with invisalign.Am J Orthod Dentofacial Orthop. 2020; 158: 420-425
- 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; 20206677929
- Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: an observational study.PLoS One. 2020; 15e0228798
- Evaluation of dental midline position.Semin Orthod. 1998; 4: 146-152
- Fracture frequency and longevity of fractured resin composite, polyacid-modified resin composite, and resin-modified glass ionomer cement class IV restorations: an up to 14 years of follow-up.Clin Oral Investig. 2010; 14: 217-222
- Gingival contour assessment: clinical parameters useful for esthetic diagnosis and treatment.J Periodontol. 2008; 79: 795-801
- Accuracy of clear aligners: a retrospective study of patients who needed refinement.Am J Orthod Dentofacial Orthop. 2018; 154: 47-54
Published online: May 11, 2023
Publication stageIn Press Corrected Proof
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
© 2023 by the Editorial Council for The Journal of Prosthetic Dentistry.