Clear Alidgner S

CLEAR
ALIGNERS
Presented by:-
Dr. Neelima Singh
III year PG
CONTENTS
 Introduction
 History
 Advantages and disadvantages
 Cases for clear aligners
 Basic Principles with Aligner
• Force
• Engagement
• Anchorage
• Extrusion
• Intrusion
• Torque
• Root inclination
2
 Attachments
• Conventional attachments
• Optimized attachments
 Scanning and digitization
 Clincheck software
• Staging of tooth movement
 Placing attachments
 Biomechanics
• Correction of deep bite and open bite
• Rotation
• Extrusion
• Torque control
• Power ridges
• Auxiliaries
 Conclusion
 References
3
INTRODUCTION
4
HISTORY
1945 • Dr. Kesling created a rubber-based ‘
Tooth Positioning appliance’
Tamer İ, Öztaş E, Marşan G. Orthodontic Treatment with Clear Aligners and The Scientific Reality
Behind Their Marketing: A Literature Review. Turk J Orthod 2019 5
1964
• Nahoum
• introduced vaccum formed dental contour
appliance for retention.
1971 • Ponitz
• Introduced thermoformed plastic appliance called
‘Invisible Retainer’
1985
• McNamara
• Worked on ‘invisible retainers’ & used these
for minor tooth movements.
1993 • John J. Sheridan

• Developed an aligner system, which he called
ESSIX, using clear, polymeric shell appliances
1998 • Zia Chishti & Kelsey wirth
• Launched align technology – first orthodontic
appliance made using transparent &
thermoplastic polymeric material with
CAD/CAM technology.
AlMogbel A. Clear Aligner Therapy: Up to date review article. Journal of orthodontic science. 2023;12. 8
ADVANTAGES OF CLEAR ALIGNERS
1. Minimum visibility – aesthetic

2. Removability
3. Easier to maintain oral hygiene
4. Comfortable, less irritation to soft tissues
5. Understandable – virtual treatment demo
6. Excellent tool for final correction after orthodontic correction
7. Pre calculation of tooth movement
DISADVANTAGES OF CLEAR ALIGNERS
1. Initially difficulty in speech

2. Pain from tooth movement due to aligner changes
3. Need for clinical experience
4. Loss of aligners during treatment
5. High cost
GOOD CASES TO START WITH CLEAR
ALIGNERS
DEEP BITES INTRUSIONs
MILD TIPPED
GENERALIZED
AND
SPACING (LESS
ROTATED
THAN 5mm)
TEETH
EASY
CASES
DIFFICULT CASES FOR CLEAR
ALIGNERS
Open bites
Extrusions
Crowding and
spacing over
5mm
severely tipped
teeth (more
DIFFICULT than 45°)
Arches with
multiple missing CASES
teeth
Teeth with short
clinical crowns
Skeletal
anteroposterior
discrepancies of more than 20°
more than 2mm rotations
BASIC PRINCIPLES WITH ALIGNER
Clear aligner treatment is an orthodontic technique.

As such, the orthodontic principles of force application,
engagement, anchorage, and biomechanics need to be applied
to clear aligner technique.
FORCE
oClear aligners move teeth by exerting a push force.
oDifference in tooth position – deforms the aligner
oOptimized attachments – active, flat surface
Shetty S., Shaikh N. Clear aligner therepy – A review, Journal of Dental Specialities 2021;9(2):46–52 14
ENGAGEMENT
Aligners engage teeth by enclosing the tooth in aligner material.
Long clinical crown and larger surface area provide better

engagement
short clinical crowns and less surface area ---- less engagement
ANCHORAGE
oAligners offer good control on anchorage
oEg- distalizing 2nd molar.
EXTRUSION
oSingle tooth extrusion – difficult
INTRUSION
Performed without concurrent extrusion of the posterior segments.
As a result, clear aligners offer extremely good vertical control.
ROOT INCLINATIONS
Optimized root control attachments – control of root inclinations.
Long, vertical rectangular attachments will offer control of root
inclinations as well.
ATTACHMENTS
CONVENTIONAL ATTACHMENTS
passive attachments – Increase the engagement.
They act as handles
21
BEVELED ATTACHMENTS
Beveled surface is the active surface.
The bevel provides a flat surface for the aligner to push against to
effect the desired tooth movement.
Can be both - Horizontal & vrtical
OPTIMIZED ATTACHMENTS
Automatically placed by the software when it detects certain thresholds
of tooth movement.
They are designed :-
 to control point of application of force
 the direction of force
the amount of force applied
which is customized for each individual tooth.
All optimized attachments have an active surface that varies in
geometry based on the unique morphology of each tooth.
Droplet shaped
Bevelled
• Correct rotation
• > 5° rotation to be
• Extrusion
corrected
• Gentle force
• Mesial for mesial
rotation & vice versa
SCANNING AND DIGITIZATION
Initially – impression taken by orthodontist
Advent of intraoral scanners – manipulate teeth

digitally.
25
Behind Their Marketing: A Literature Review. Turk J Orthod 2019
CLINCHECK SOFTWARE
• Used by Invisalign
• 3-D interpretation of treatment plan.
Upadhyay M, Arqub SA. Biomechanics of clear aligners: hidden truths & first principles. Journal of the
World Federation of Orthodontists. 2022 Feb 1;11(1):12-21. 26
• Orthodontist completes virtual setup
technician add smart force attachments
• Desired movement achieved – treatment approved
STAGING
 Segmental staging-
Easy first, difficult in the end
 Simultaneous staging-
Mehta S, Patel D, Yadav S. Staging orthodontic aligners for complex orthodontic tooth movement. Turkish
28
Journal of Orthodontics. 2021 Sep;34(3):202.
 V staging pattern-
• typically applied to upper arch
• distalization of maxillary dentition
 A staging pattern-
 M staging pattern-
• In premolar extraction cases
• Closing space – alignment of ant. – molar movements
Mehta S, Patel D, Yadav S. Staging orthodontic aligners for complex orthodontic tooth movement. Turkish
29
Journal of Orthodontics. 2021 Sep;34(3):202.
PLACING ATTACHMENTS
adjustment of the attachment template is checked
Teeth are prepared
Apply the composite roughly in the attachment template.
30
Place the template and apply pressure while curing
attachments
remove excess composite with a bur.
First test aligner fit.
The active bevel of the attachment must be in contact

with the aligner.
31
BIOMECHANICS
SHAPE MOLDING
BY ATTACHMENTS EFFECT
19% 80%
DEEP BITES
OPEN BITES
ATTACHMENTS
Use of :-
WATERMELON SEED
EFFECT
ROTATIONS
• Used to be corrected using auxiliaries

• Optimized attachments
EXTRUSIONS
• Similar to rotations
• Use of optimized extrusion attachments.

• Gingivally bevelled attachment .
• Can be placed on single tooth or group of teeth.
Another method :-
Changing the elastics 3-4 times a day.
Power-Grip pressure relief device
TORQUE CONTROL
• Bevelled attachments
• Can be placed on any surface
Power Ridges
o Alternative to attachments for torque control
o Engineered corrugations at specific locations
o Function in 2 ways:-
• Additional force as close to gingival margin to increase the
torque control.
• Stiffen gingival third of aligner to make it more resilient
AUXILIARIES
• Class II or Class III elastics

• Directly attached or bonded buttons
ROOT PARALLELISM
• Power arms are gingival extensions introduced in Invisalign

• Clinical application not as beneficial as fixed appliances
• Molar root control is more difficult than canine
• Root position of canine remain upright in premolar
extraction cases
• But molar tend to tip ‘mesially’ – ‘Dumping’
CONCLUSION
43
REFERENCES
• Mehta S, Patel D, Yadav S. Staging orthodontic aligners for complex
orthodontic tooth movement. Turkish Journal of Orthodontics. 2021
Sep;34(3):202.
• Tamer İ, Öztaş E, Marşan G. Orthodontic Treatment with Clear Aligners
and The Scientific Reality Behind Their Marketing: A Literature Review.
Turk J Orthod 2019
• AlMogbel A. Clear Aligner Therapy: Up to date review article. Journal of
orthodontic science. 2023;12.
• Shetty S., Shaikh N. Clear aligner therepy – A review, Journal of Dental
Specialities 2021;9(2):46–52
• Upadhyay M, Arqub SA. Biomechanics of clear aligners: hidden truths &
first principles. Journal of the World Federation of Orthodontists. 2022 Feb
1;11(1):12-21.
• Bichu YM, Alwafi A, Liu X, Andrews J, Ludwig B, Bichu AY, Zou B.
Advances in orthodontic clear aligner materials. Bioactive Materials. 2023
Apr 1;22:384-403.
• Principle and biomechanics of aligner treatment, nanda
44
45

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CLEAR

1993 • John J. Sheridan

1. Minimum visibility – aesthetic

1. Initially difficulty in speech

DEEP BITES INTRUSIONs

Clear aligner treatment is an orthodontic technique.

Long clinical crown and larger surface area provide better

Advent of intraoral scanners – manipulate teeth

technician add smart force attachments

• Desired movement achieved – treatment approved

Teeth are prepared

Apply the composite roughly in the attachment template.

remove excess composite with a bur.

First test aligner fit.

The active bevel of the attachment must be in contact

• Used to be corrected using auxiliaries

• Use of optimized extrusion attachments.

Power-Grip pressure relief device

• Class II or Class III elastics

• Power arms are gingival extensions introduced in Invisalign

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