Influence of attachments on the efficiency of molar distalization using clear aligners – An updated systematic review

Main Article Content

Harsha.L
Nivethigaa Balakrishnan
Saravana Dinesh S P
Arya S Prasad

Keywords

Aligner technology, Clear aligners, Clinical efficiency, Invisible orthodontics, Molar distalization.

Abstract

Background: With the advent of intra oral scanning, virtual treatment planning and 3D printing, the field of orthodontics has grown beyond limits. With increasing demand for invisible orthodontic treatment, clear aligners have set a mark in providing efficient orthodontic tooth movements. Several clinical studies have been published, especially in the last decade to justify the same. Efficiency of various tooth movements with clear aligners has also been extensively studied. One of the most challenging tooth movements with clear aligners is molar distalization. The distalization for maxillary molars is needed to correct non extraction patterned class 2 malocclusions. Several studies have extensively studied the same however a sound clinical judgment is required on the basis of high level of evidence.
Objective: The objective of this systematic review was to systematically search the literature and assess the available evidence regarding the effectiveness of clear aligners in bringing about molar distalization with or without attachments.
Search Strategy: An electronic database search of published and unpublished literature in english was performed till April 2021 in the following databases: Google scholar, PUBMED,TRIP, LILAC, Web of science and Cochrane databases. The reference list of all the eligible articles were examined for additional studies. Articles were selected based on selection criteria. Reporting of this review was based on the Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines.
Selection Criteria: All prospective/retrospective clinical studies on subjects/patients treated with clear aligners to achieve molar distalization with or without attachments were included in this Systematic Review.
Data Collection And Analysis: Data extraction from the included articles was done by the authors independently.Data characteristics were extracted using data collection forms whereas the quality of the study was assessed using the Cochrane Risk of bias tool for randomized control trials and NewCastle Ottawa scale for non randomized control trials.
Results: A total of 5 articles were included in this review. The amount of molar distalization reported was 2- 3mm.
Conclusion: Of the five studies included, all the studies reported significant amounts of distalization. 3 retrospective studies concluded that distalization with aligners is the most effective of all tooth movements. One study concluded that aligners effectively achieved distalization of 2-3mm with efficacy of 87%, two other studies concluded that aligners effectively distalized the molars when tooth movement was performed using attachments, with good control over vertical dimension, and mesio-distal tipping.

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References

1. Ziuchkovski JP, Fields HW, Johnston WM, Lindsey DT. Assessment of perceived orthodontic appliance attractiveness [Internet]. Vol. 133, American Journal of Orthodontics and Dentofacial Orthopedics. 2008. p. S68–78. Available from:http://dx.doi.org/10.1016/j.ajodo.2006.07.025
2. Rosvall MD, Fields HW, Ziuchkovski J, Rosenstiel SF, Johnston WM. Attractiveness, acceptability, and value of orthodontic appliances [Internet]. Vol. 135, American Journal of Orthodontics and Dentofacial Orthopedics. 2009. p. 276.e1–276.e12. Available from: http://dx.doi.org/10.1016/j.ajodo.2008.07.011
3. Gkantidis N, Zinelis S, Karamolegkou M, Eliades T, Topouzelis N. Comparative assessment of clinical performance of esthetic bracket materials [Internet]. Vol. 82, The Angle Orthodontist. 2012. p. 691–7. Available from: http://dx.doi.org/10.2319/092511-605.1
4. Boyd RL. Esthetic Orthodontic Treatment Using the Invisalign Appliance for Moderate to Complex Malocclusions [Internet]. Vol. 72, Journal of Dental Education. 2008. p. 948–67. Available from: http://dx.doi.org/10.1002/j.0022-0337.2008.72.8.tb04570.x
5. Gay G, Ravera S, Castroflorio T, Garino F, Rossini G, Parrini S, et al. Root resorption during orthodontic treatment with Invisalign®: a radiometric study [Internet]. Vol. 18, Progress in Orthodontics. 2017. Available from: http://dx.doi.org/10.1186/s40510-017-0166-0
6. Eliades T, Athanasiou AE. Orthodontic Aligner Treatment: A Review of Materials, Clinical Management, and Evidence. Thieme; 2020. 200 p.
7. Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review [Internet]. Vol. 85, The Angle Orthodontist. 2015. p. 881–9. Available from: http://dx.doi.org/10.2319/061614-436.1
8. Papadimitriou A, Mousoulea S, Gkantidis N, Kloukos D. Clinical effectiveness of Invisalign® orthodontic treatment: a systematic review [Internet]. Vol. 19, Progress in Orthodontics. 2018. Available from: http://dx.doi.org/10.1186/s40510-018-0235-z
9. Ravera S, Castroflorio T, Garino F, Daher S, Cugliari G, Deregibus A. Maxillary molar distalization with aligners in adult patients: a multicenter retrospective study [Internet]. Vol. 17, Progress in Orthodontics. 2016. Available from: http://dx.doi.org/10.1186/s40510-016-0126-0
10. Auladell A, De La Iglesia F, Quevedo O, Walter A, Puigdollers A. The efficiency of molar distalization using clear aligners and mini-implants: Two clinical cases. Int Orthod. 2022 Mar;20(1):100604.
11. Zheng M, Liu R, Ni Z, Yu Z. Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta-analysis. Orthod Craniofac Res. 2017 Aug;20(3):127–33.
12. Robertson L, Kaur H, Fagundes NCF, Romanyk D, Major P, Flores Mir C. Effectiveness of clear aligner therapy for orthodontic treatment: A systematic review. Orthod Craniofac Res. 2020 May;23(2):133–42.
13. Alfawal AMH, Burhan AS, Mahmoud G, Ajaj MA, Nawaya FR, Hanafi I. The impact of non-extraction orthodontic treatment on oral health-related quality of life: clear aligners versus fixed appliances-a randomized controlled trial. Eur J Orthod [Internet]. 2022 Apr 8; Available from: http://dx.doi.org/10.1093/ejo/cjac012
14. Gao M, Yan X, Zhao R, Shan Y, Chen Y, Jian F, et al. Comparison of pain perception, anxiety, and impacts on oral health-related quality of life between patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatment. Eur J Orthod. 2021 Jun 8;43(3):353–9.
15. Gvozdeva LM, Danilova MA, Alexandrova LI, Dmitrienko IV. [The results of orthodontic treatment using aligners from the perspective of quality of life of patients with dentoalveolar anomalies]. Stomatologiia . 2021;100(2):73–5.
16. Zhang B, Huang X, Huo S, Zhang C, Zhao S, Cen X, et al. Effect of clear aligners on oral health-related quality of life: A systematic review. Orthod Craniofac Res. 2020 Nov;23(4):363–70.
17. Higgins JPT, Thomas J. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2019. 728 p.
18. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration [Internet]. Vol. 62, Journal of Clinical Epidemiology. 2009. p. e1–34. Available from: http://dx.doi.org/10.1016/j.jclinepi.2009.06.006
19. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928.
20. Table S3-1: Newcastle-Ottawa scale for assessment of quality of included studies–Cohort studies [Internet]. Available from: http://dx.doi.org/10.7717/peerj.8815/supp-4
21. Guyatt GH, Thorlund K, Oxman AD, Walter SD, Patrick D, Furukawa TA, et al. GRADE guidelines: 13. Preparing summary of findings tables and evidence profiles-continuous outcomes. J Clin Epidemiol. 2013 Feb;66(2):173–83.
22. Simon M, Keilig L, Schwarze J, Jung BA, Bourauel C. Treatment outcome and efficacy of an aligner technique – regarding incisor torque, premolar derotation and molar distalization [Internet]. Vol. 14, BMC Oral Health. 2014. Available from: http://dx.doi.org/10.1186/1472-6831-14-68
23. Garino F, Castroflorio T, Daher S, Ravera S, Rossini G, Cugliari G, et al. Effectiveness ofComposite Attachments in Controlling Upper-Molar Movement with Aligners. J Clin Orthod. 2016 Jun;50(6):341–7.
24. Caruso S, Nota A, Ehsani S, Maddalone E, Ojima K, Tecco S. Impact of molar teeth distalization with clear aligners on occlusal vertical dimension: a retrospective study [Internet]. Vol. 19, BMC Oral Health. 2019. Available from: http://dx.doi.org/10.1186/s12903-019-0880-8
25. Rossini G, Schiaffino M, Parrini S, Sedran A, Deregibus A, Castroflorio T. Upper Second Molar Distalization with Clear Aligners: A Finite Element Study [Internet]. Vol. 10, Applied Sciences. 2020. p. 7739. Available from: http://dx.doi.org/10.3390/app10217739
26. Angelieri F, de Almeida RR, Janson G, Castanha Henriques JF, Pinzan A. Comparison of the effects produced by headgear and pendulum appliances followed by fixed orthodontic treatment [Internet]. Vol. 30, The European Journal of Orthodontics. 2008. p. 572–9. Available from: http://dx.doi.org/10.1093/ejo/cjn060
27. Al-Thomali Y, Basha S, Mohamed RN. Pendulum and modified pendulum appliances for maxillary molar distalization in Class II malocclusion – a systematic review [Internet]. Vol. 75, Acta Odontologica Scandinavica. 2017. p. 394–401. Available from: http://dx.doi.org/10.1080/00016357.2017.1324636
28. Caprioglio A, Fontana M, Longoni E, Cozzani M. Long-term evaluation of the molar movements following Pendulum and fixed appliances [Internet]. Vol. 83, The Angle Orthodontist. 2013. p. 447–54. Available from: http://dx.doi.org/10.2319/050812-378.1
29. Kirjavainen M, Hurmerinta K, Kirjavainen T. Facial profile changes in early Class II correction with cervical headgear. Angle Orthod. 2007 Nov;77(6):960–7.
30. Haydar S, Üner O. Comparison of Jones jig molar distalization appliance with extraoral traction [Internet]. Vol. 117, American Journal of Orthodontics and Dentofacial Orthopedics. 2000. p. 49–53. Available from: http://dx.doi.org/10.1016/s0889-5406(00)70247-2
31. Brickman CD, David Brickman C, Sinha PK, Nanda RS. Evaluation of the Jones jig appliance for distal molar movement [Internet]. Vol. 118, American Journal of Orthodontics and Dentofacial Orthopedics. 2000. p. 526–34. Available from: http://dx.doi.org/10.1067/mod.2000.110332
32. Bussick TJ, McNamara JA. Dentoalveolar and skeletal changes associated with the pendulum appliance [Internet]. Vol. 117, American Journal of Orthodontics and Dentofacial Orthopedics. 2000. p. 333–43. Available from: http://dx.doi.org/10.1016/s0889-5406(00)70238-1
33. Papadopoulos MA. Orthodontic Treatment of the Class II Noncompliant Patient: Current Principles and Techniques. Elsevier Health Sciences; 2006. 398 p.
34. Ghosh J, Nanda RS. Evaluation of an intraoral maxillary molar distalization technique [Internet]. Vol. 110, American Journal of Orthodontics and Dentofacial Orthopedics. 1996. p. 639–46. Available from: http://dx.doi.org/10.1016/s0889-5406(96)80041-2