Recent developments in software technology have made it possible to create a virtual three-dimensional model of the dental arches from digitally scanned casts of a patient's dentition. This modelmay then be manipulated with software to produce stages of tooth movement from the initial malocclusion to the final desired occlusion. A sterolithograghic model is made for each stage of tooth movement which is the basis for construction of a series of clear and thin overlay appliances. These appliances are worn full time by the patient to move the teeth according to the programmed stages of movement. Malocclusions involving mild to moderate crowding and space closure have been proven to be successfully treated with this appliance. Experience with this appliance has demonstrated excellent patient compliance with less discomfort, improved esthetics and oral hygiene control, when compared with fixed orthodontic appliances. Orthodontic treatment with this appliance is a potentially useful alternative approach to fixed appliances for treatment of a variety of malocclusions in patients with fully erupted permanent teeth.
Crowding ; Dental Arch ; Dentition ; Diagnosis* ; Esthetics ; Humans ; Malocclusion* ; Oral Hygiene ; Orthodontic Appliances ; Patient Compliance ; Tooth ; Tooth Movement

The purpose of this paper is to review two recently reported, long-term studies of several chemical methods to control gingivitis and decalcification in adolescent orthodontic patients. The first study(gingivitis study) was designed to determine whether conventional toothbrushing and twice daily use of a brush-on 0.4 per cent SnF2 gel containing more than 90 per cent available Sn2+ would be more effective for controlling plaque accumulation and gingivitis in the presence of orthodontic appliances than conventional toothbrushing alone. The second study(decalcification study) was designed to compare the effectiveness of controlling decalcification in orthodontic patients with either a 1100 ppm F tooth paste used alone, this same toothpaste and a 0.05 percent NaF rinse or this toothpaste and a 0.4 percent SnF2 gel. In the gingivitis study, sixty-five consecutively treated adolescents who were to receive full-mouth fixed orthodontic appliances were assigned to two groups according to age and sex criteria. In the decalcification study an additional 30 subjects(95 total) were similarly assigned to a third group. The first group(control, n=35) used only toothbrushing with a standard fluoride(1100 ppm F) toothpaste. The second group used toothbrushing with a similar dentifrice supplemented with a 0.4 percent SnF2 gel(SnF2 gel group, n=30) used twice daily for the entire 18-month study period. The third group(in the decalcification study only) used a similar toothpaste and 0.05 percent NaF rinse(NaF rinse group, n=30). Clinical assessments of plaque accumulation using the Plaque Index, gingival inflammation using the Gingival Index, and coronal staining were completed single-blinded before appliances were placed and 1, 3, 6, 9, 12 and 18 months after appliances were placed. Decalcification was assessed single blind on all labial surfaces of all erupted teeth before appliances were placed and 3 months after appliances were removed. The results of the gingivitis study indicated that the SnF2 gel group had significantly lower scores for the Plaque Index(p<0.01) and Gingival Index(p<0.001) at all examinations during orthodontic treatment than did the control group. In the SnF2 gel group, one subject developed mild coronal staining and two subjects developed moderate staining. In the decalcification study, when pre-treatment levels of decalcification were subtracted from post-treatment values, significantly lower decalcification scores(p<0.05) were found for both whole mouth and first molars in the NaF rinse and gel groups as compared with the control group(toothpaste alone). Although the gel group consistently had less decalcification than the rinse group, this difference only approached statistical significance.
Adolescent* ; Dentifrices ; Gingivitis* ; Humans ; Inflammation ; Molar ; Mouth ; Orthodontic Appliances ; Periodontal Index ; Tooth ; Toothbrushing ; Toothpastes

Objective: The purpose of this study was to examine the effectiveness and mechanism of clear aligner therapy for the correction of anterior open bite in adult nonextraction cases. Methods: Sixty-nine adult patients with anterior open bite were enrolled and classified into Angle’s Class I, II, and III groups. Fifty patients presented with skeletal open bite (mandibular plane angle [MPA] ≥ 38°), whereas 19 presented with dental open bite. Fifteen cephalometric landmarks were identified before (T1) and after (T2) treatment. The magnitudes of planned and actual movements of the incisors and molars were calculated. Results: Positive overbite was achieved in 94% patients, with a mean final overbite of 1.1 ± 0.8 mm. The mean change in overbite was 3.3 ± 1.4 mm. With clear aligners alone, 0.36 ± 0.58 mm of maxillary molar intrusion was achieved. Compared with the Class I group, the Class II group showed greater maxillary molar intrusion and MPA reduction. The Class III group showed greater mandibular incisor extrusion with no significant vertical skeletal changes. Conclusions Clear aligners can be effective in controlling the vertical dimension and correcting mild to moderate anterior open bite in adult nonextraction cases. The treatment mechanism for Class III patients significantly differed from that for Class I and Class II patients. Maxillary incisor extrusion in patients with dental open bite and MPA reduction with mandibular incisor extrusion in patients with skeletal open bite are the most significant contributing factors for open bite closure.