Different biomechanical effects of clear aligners in closing maxillary and mandibular extraction spaces: Finite element analysis. 2023

Jun-Qi Liu, and Guan-Yin Zhu, and Yi-Gan Wang, and Bo Zhang, and Ke Yao, and Zhi-He Zhao
State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, and Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China.

BACKGROUND Compared with fixed treatments, clear aligners (CAs) have the advantages of comfort, esthetics, and hygiene, and are popular among patients and orthodontists. However, CAs exhibit control deficiencies in extraction patients because of insufficient root control and retention effects. These deficiencies can magnify biomechanical differences in bimaxillary dentition, further causing different orthodontic requirements between maxillary and mandibular dentition. This study aimed to elaborate on the biomechanical characteristics of bimaxillary dentition in extraction space closure and provided feasible biomechanical compensation strategies for use in clinical practice. METHODS We constructed a 3-dimensional (3D) bimaxillary model based on patient data. Several 3D modeling-related software was used to generate a standard first premolar extraction model, CAs, and attachments. Subsequently, finite element analysis was performed to demonstrate the biomechanical effects. RESULTS The maxillary and mandibular dentition showed a roller coaster effect during space closure. Compared with the maxillary dentition, the mandibular posterior teeth exhibited stronger relative anchorage causing greater anterior teeth retraction. The tipping and vertical movements of the anterior teeth were related to tooth length. The longer the anterior tooth, the less tipping and greater vertical displacement occurred. Generally, when having the same retraction distance, the mandibular dentition exhibited greater retroclination and fewer extrusions. Both mechanical and retention compensations should be considered to prevent these unwanted tipping movements. Adding specific attachments to bimaxillary dentitions compensated for the retention and root control deficiencies of CAs. CONCLUSIONS When applying CAs to extraction patients, different biomechanical effects can present in the bimaxillary dentition because of specific dentition morphologies. To effectively treat these patients, mechanical compensation through overcorrection of the target position should be designed on the basis of bimaxillary control deficiencies, and retention compensation by adding specific attachments should also be considered according to the overcorrections.

UI MeSH Term Description Entries
D008334 Mandible The largest and strongest bone of the FACE constituting the lower jaw. It supports the lower teeth. Mylohyoid Groove,Mylohyoid Ridge,Groove, Mylohyoid,Grooves, Mylohyoid,Mandibles,Mylohyoid Grooves,Mylohyoid Ridges,Ridge, Mylohyoid,Ridges, Mylohyoid
D009968 Orthodontic Appliances, Removable Dental devices such as RETAINERS, ORTHODONTIC used to improve gaps in teeth and structure of the jaws. These devices can be removed and reinserted at will. Clear Aligner Appliances,Clear Dental Braces,Invisalign,Aligner Appliance, Clear,Aligner Appliances, Clear,Appliance, Clear Aligner,Appliance, Removable Orthodontic,Appliances, Clear Aligner,Appliances, Removable Orthodontic,Brace, Clear Dental,Braces, Clear Dental,Clear Aligner Appliance,Clear Dental Brace,Dental Brace, Clear,Dental Braces, Clear,Orthodontic Appliance, Removable,Removable Orthodontic Appliance,Removable Orthodontic Appliances
D004955 Esthetics, Dental Skills, techniques, standards, and principles used to improve the art and symmetry of the teeth and face to improve the appearance as well as the function of the teeth, mouth, and face. (From Boucher's Clinical Dental Terminology, 4th ed, p108) Cosmetic Dentistry,Aesthetics, Dental,Dental Esthetic,Dental Esthetics,Esthetic, Dental,Cosmetic Dentistries,Dentistries, Cosmetic,Dentistry, Cosmetic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001696 Biomechanical Phenomena The properties, processes, and behavior of biological systems under the action of mechanical forces. Biomechanics,Kinematics,Biomechanic Phenomena,Mechanobiological Phenomena,Biomechanic,Biomechanic Phenomenas,Phenomena, Biomechanic,Phenomena, Biomechanical,Phenomena, Mechanobiological,Phenomenas, Biomechanic
D014087 Tooth Movement Techniques Orthodontic techniques used to correct the malposition of a tooth or teeth. Tooth Depression,Tooth Intrusion,Tooth Movement, Minor,Tooth Uprighting,Orthodontic Tooth Movement,Depression, Tooth,Depressions, Tooth,Intrusion, Tooth,Intrusions, Tooth,Minor Tooth Movement,Minor Tooth Movements,Movement Technique, Tooth,Movement Techniques, Tooth,Movement, Orthodontic Tooth,Movements, Orthodontic Tooth,Orthodontic Tooth Movements,Technique, Tooth Movement,Techniques, Tooth Movement,Tooth Depressions,Tooth Intrusions,Tooth Movement Technique,Tooth Movement, Orthodontic,Tooth Movements, Minor,Tooth Movements, Orthodontic,Tooth Uprightings,Uprighting, Tooth,Uprightings, Tooth
D020342 Finite Element Analysis A computer based method of simulating or analyzing the behavior of structures or components. Analysis, Finite Element,Analyses, Finite Element,Element Analyses, Finite,Element Analysis, Finite,Finite Element Analyses

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