Treatment of class II malocclusion with Invisalign®: A pilot study using digital model-integrated maxillofacial cone beam computed tomography

Shih-Yin Lin; Min-Chih Hung; Li-Hsin Lu; Jui-Sheng Sun; Shih-Jaw Tsai; Jenny Zwei-Chieng Chang

doi:10.1016/j.jds.2022.08.027

Treatment of class II malocclusion with Invisalign®: A pilot study using digital model-integrated maxillofacial cone beam computed tomography

J Dent Sci. 2023 Jan;18(1):353-366. doi: 10.1016/j.jds.2022.08.027. Epub 2022 Sep 15.

Authors

Shih-Yin Lin¹, Min-Chih Hung², Li-Hsin Lu², Jui-Sheng Sun^{3

4}, Shih-Jaw Tsai², Jenny Zwei-Chieng Chang²

Affiliations

¹ Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan.
² School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Department of Orthopedic Surgery, College of Medicine, China Medical University, Taichung, Taiwan.
⁴ Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

Background/purpose: The treatment effects of Invisalign® are still obscure due to methodological limitations of previous studies. We introduced a method to comprehensively evaluate the dental and skeletal changes of Class II malocclusion treated non-extraction with Invisalign® and compare with the virtual simulation of ClinCheck® using digital models integrated into maxillofacial cone-beam computed tomography (CBCT).

Materials and methods: The pretreatment (T1) and posttreatment (T2) scanned digital images of actual dentitions were integrated into maxillofacial CBCT images. To evaluate three-dimensional movement of maxillary teeth and change of mandible position, T1 and T2 digital model-integrated maxillofacial CBCT images were superimposed using voxel-based registrations of stable cranial base structures. To evaluate movement of mandibular teeth, model-integrated mandibular CBCT superimposition was registered on mandibular basal bone. To compare achieved and predicted tooth movements, the actual dental images and the virtual digital models created by ClinCheck® were registered on the T1 dentitions.

Results: For simulated upper first molar (U6) distalization of more than 1 mm, treatment accuracy ranged from 31.1% to 40.1%, which was significantly less than virtual planning and previous reports. In unilateral Class II subjects, the amount of U6 distalization on the Class II side was not significantly different from contralateral side, indicating efficacy of sequential distalization was questionable. Those with favorable overjet correction showed evidence of condylar distraction.

Conclusion: Digital model-integrated CBCT superimpositions reflected the actual treatment changes in comparison with the virtual simulation, and showed that ideal occlusion was not achieved in mild to moderate Class II adult patients treated non-extraction with Invisalign®.

Keywords: Class II malocclusion; ClinCheck®; Cone beam computed tomography; Digital model; Invisalign®.