CLEAR ALIGNERS

INTRODUCTION
 Clear aligners are nearly transparent colourless almost invisible removable
appliance.

 These appliances offer an excellent alternative to unaesthetic orthodontic

treatment with labial fixed appliances .

 The success of these type of appliances is intimately related to the compliance

in wearing the appliance for a minimum number of hours and following the
required schedule of changing the aligners as per sequence assigned to the case.

 Timing of wear: 22h/day

 History
◦ Dr. H.D.Kesling in 1945, made a rubber positioner to refine the final stages
of orthodontic treatment based on diagonostic setup.
◦ Sheridan et al. introduced IPR for resolution of lower anterior crowding,
and alignment of teeth with the help of labiolingual clear plastic retainer
◦ His appliance is named as ‘ESSIX appliance’.
 Steps in treatment
1. Collection of high quality records and case selection.
2. High precission impression with PVS or intraoral scanning by(laser
,destructive white light or CT)
3. 3D virtual –setup and treatment progress stages
4. Approval of treatment steps on the web.
5. Construction of aligners’ delivery to the doctor
6. Issue of aligners and review.
7. Finishing and retention.
Types of clear aligner system
INVISALIGN (USA)-The sequential clear plastic aligner were first
used by align technology .
CLEAR SMILE SYSTEM -Other system of transparent character are
formed in Australia
K clear system(Europe)
Clear path system
Donatello aligners(3-D printing)
 The Invisalign System
 The Invisalign system initially offered treatment of minor and simple malocclusion.
 Over the years, this system has evolved to treat more complex cases of malocclusion
and those requiring extractions. The appliance has also evolved for use with
attachments on tooth surfaces.

 One of these innovations is the new aligner material, Smart Track, introduced in 2013.
 According to the manufacturer, this new material ensures better control of tooth
movement.
 It also offers a lower and uniform force level over time as well as a tighter fit of the
aligners. Patients have reported improved comfort when utilising the new material.
 Due to these innovations, recently Invisalign has recommended changing of aligners
weekly instead of every 2 weeks.
Indication
Mild crowding & spacing malaligned problem 1-5mm
Deep overbite in Cl II div 2, where intrusion & advancement of incisors
Narrow arches where expasion is indicated without tipping
Tipping molars distally.

INDICATIONS FOR NEW GENERATION

Crowding & spacing above 5mm.
CO-CR discrepancies
Deviation in Antero-post CL I cuspid relationship of more than 2mm
Severely rotated teeth of more than 20deg
Ant & post overbite correction
Molar uprighting & high labially placed canines.
Blocked out teeth needing dental expansion
Steps and treatment stages with
Invisalign system of clear aligners
1.A collection of high-quality records.
• extra and intraoral photographs
• lateral (and PA if required) cephalograms OPG and relevant X-rays.
• High quality impressions are obtained with a polyvinylsiloxane material.
• The bite is also recorded. T
• he impressions are sent to the Invisalign office.
• Since 2007, the iTero scanner, has replaced the need for traditional dental
impressions.
2.Interactive Treatment Planning:
this step is called ‘Clin Check’provides 3D modelling of the whole treatment.

3.Clinical management with Invisalign aligners:

Provides following treatment modalities:
 Invisalign Full : for complex malocclusion
 Invisalign lite : less complex problems (14aligners)
 Invisalign i7 : minor dental corrections (7 aligners)
 Invisalign Teen : for teenagers
 The Clear Smile System
◦ This system is predominantly suitable for mild malocclusions such as crowding 4
mm/arch and spacing up to 5 mm and similar overjet.
◦ Once, a case is selected by the doctor, the following records are to be submitted to
'Clear Smile' office:
1. Essential records: include completed Clear Smile Treatment Planner Form, upper
and lower high-quality study models or PVS impressions and bite records.
2. Case set-up and training correctors: At this stage, a treatment plan and
approximate number of appliances needed are predicted and if treatment is
accepted then set of PVS impressions is submittéd. The first correctors to be
received are training correctors, which are a passive set of aligners to test the
accuracy and enhance the acceptance of active aligners. Treatment proceeds with a
group of correctors from 1 to 12 or more.
3. Active treatment:
7 It starts with the first group of corrector group 1. Each group of correctors has
four sets (four upper and four lower) or four only for single arch treatment.
Correctors are changed every 2 weeks New PVS impression are submitted after
each three groups, that is at groups 4,7 and 10.
 The K Clear system from K-Line
Europe
◦ K-Line Europe GmbH is a company located in Düsseldorf, Germany
K Clear accessories include composite engagers, precision force indentations, clear
buttons, hooks, elastics, thermoforming pliers, Carriere molar distaliser, interproximal
reduction (IPR) strips and IPR gauges
Steps and treatment stages The practitioners use the web portal to register the case and
send clinical photos, radiographs and all required patient records.
1. Either 3D scans or impressions are sent to the company
2. Within 3-5 days, a digital treatment plan is formulated and uploaded to the portal,
3. Upon confirmation, the K Clear aligners are produced and shipped within an average
of 14 days. Dental support and troubleshooting are available all through the treatment
duration.
◦ Indications
1. Dental spacing up to 5 mm
2. dentoalveolar discrepancy
3. Diastema
4. Dental crowding up to 5 mm
5. dentoalveolar discrepancy
6. Increased overjet
7. Anterior open bite of dental origin up4 mm
8. Anterior deep bite
9. Anterior cross-bitePosterior cross-bite
10. Dental class II and class III corrections
11. Anterior space regaining
12. Eruption guidance in growing patients
 The ClearPath system
◦ ClearPath is a USFDA approved technology that fabricates series of clear wafer-thin
transparent plastic removable aligners that gently guide the teeth from their present to
the desired position.
◦ The system aims to address most dental malocclusions, ranging from crowding,
spacing, cross-bites, open bites, deep bites, proclinations and rotations.
◦ ClearPath has made several advancements over classic aligner systems almost
eliminating the use of attachments, buttons, engagers and elastics.
Three Conditions Where Clearpath Recom Mends The Use Of Elastic Button
Technique (EBT) Namely:
◦ 1.extrusion of anteriors by >1-2mm
◦ 2.Rotation of cuspids and bicuspids by >40-50 degrees
◦ 3.Translation/bodily movements >4-5mm
◦ Limitations:
◦ 1.Mixed dentition /skeletal cases and does not aim to correct complex
malocclusions in the anterior-posterior relationship.
The Donatello Aligners
◦ 3D printed objects manufactured with an optimised technol ogy that is
purposely fit for aligners. (“licensed by a Swiss company: 3D Objects AND
Data Software (Taverne, Switzerland)."
1. Easy to use software and hardware that allows each orthodontist to print their
patient's orthodontic aligners independently.
2. Drives efficiency and cost-savings through eliminating delivery times.
3. The workflow for clinicians is simple and easy to use.
4. It ensures a high-quality service in the shortest time frame
◦ Indications:
◦ Dental spacing
◦ Diastema
◦ Overcrowding
◦ Increased overjet
◦ Dental Anterior and posterior open bite
◦ Class II and Class III cases of dental origin
◦ Anterior space regaining in growing pateints
◦ Eruption guidance
◦ Severe rotations exceeding 30 degrees
◦ Crown and Root torquing
Material

◦ Invisalign-Transparent incospicous strong flexible polyurethane.

◦ Invisalign smart track material - stretch over the teeth and return back to
original shape , flexible material with improved adabtibility ,and shape
memory
◦ K- Liner uses a special blend of TPU (Thermoplastic polyurethane) +
PC(Polycarbonate) + PETG (Polyethylene Terephthalate Glycol)-improved
elasticity ,high transparency , high impact resistance
◦ CLEARCORRECT ALIGNER- a custom formulation of medical-grade
polyurethane which is biocompatible.
◦ CLEARGUIDE-highly esthetic, truely clear aligners.
◦ CLEARPATH-Advanced 3D- techniques , transparency of appliances enhances
its esthetic appeal.
 ATTACHMENTS
An object added to computer representation of tooth’s geometry that may or may
not be added to the real tooth . There are 3 types of attachment( Real
,Virtual,Window) ,Base,Cavity,Channel,Dynamic
attachment,Engagement,Footprint,Orientation,Position, Prominence)

CLASSIFICATIONS:
There are 3 fundamental categories of attachments:
• Those that assist movements
• Those that augment appliance retention
• Those that provide or support auxiliary functions

There are three common types of attachments: ellipsoid, bevelled and rectangular.

bevelled precision used to extrude maxillary central

rectangular precision
incisors. attachments
BIOMECHANICS WITH ALIGNER SYSTEM

◦ In Aligners ,the plastic encapsulates the tooth. The natural

undercuts of the teeth provide the retention and the active
component to move teeth is provided by the elastic
deformation of the aligner.
(A) Difficult movements include controlling:
1.TORQUE :By (Power ridges)
2. Root parallelism: by (Power arms)
Hand-made power arms in combination with aligners

3. ROTATIONS: newer optimized attachments,(Ellipsoid)

4. BODILY MOVEMENT:(Rectangular attachments)
5.EXTRUSION:(Bevelled attachments)
(B) Elastics for correction of class II & class IIIcorrections :Align Technology by
using prototype hooks

(C) Expansion with aligners:Arch expansion mainly due to tipping movement, which has
important significance for guiding the application of Invisalign aligners offer by ClinCheck.

(D) Orthognathic surgery: ClinCheck offers movement, and movement offers a window
into the future, threedimensional models, refine treatment plans through combination of
orthodontic treatment planning and virtual surgical planning

(E) Invisalign First : are designed specifically to address a broad range of younger patients
malocclusions, including shorter clinical crowns, management of erupting dentition, and
predictable dental arch expansion

(F) Bite jump advancement : was used in 2 mm increments: effective in correcting mild to
severe Class II malocclusions in growing patients
◦ ADVANTAGES OF ALIGNERS
◦ Esthetics,Removable,Comfort
◦ No reported root resorption,Less discomfort and pain
◦ Hygiene,Less Chair time
◦ Vertical control,Fewer emergencies
◦ Control of bruxism,Treatment in deep bite cases

◦ LIMITATIONS OF ALIGNER
◦ Conditions that can be difficult to treat with an Invisalign appliance are:-
◦ Crowding and spacing over 5 mm
◦ Centric-relation and centric-occlusion discrepancies
◦ 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.
◦ Depends on patient Compliance
◦ CYTOTOXICITY AND ADVERSE
REACTIONS OF ALIGNERS
◦ Several adverse clinical events—eg, difficulty breathing, swollen throat,
anaphylactic reaction, swollen lips, laryngospasm, blisters—were reported in the
medical reports. Invisalign aligners are composed of polyurethanes, and
isocyanate is a critical component required for polyurethane synthesis.
◦ Health effects of isocyanate have been well documented in the literature. In an
in-vitro cytotoxicity study, oral epithelial cells exposed to Invisalign aligners
showed increased cell death, compromised membrane integrity, and reduced cell-
to-cell contact and mobility, which may be the mechanism for isocyanate allergy