Effectiveness of Clear Aligners in Different Thicknesses

The Effectiveness of Orthodontic Treatment With Clear Aligners in Different Thicknesses

This study aimed to evaluate the effectiveness, pain, and satisfaction levels between patients treated with different thicknesses of clear aligners among Class I maxillary mild crowding cases. Two types of clear aligners with thicknesses of 0.5 and 0.75 mm were used. The null hypotheses were as follows: There is no clinical difference in effectiveness, pain, and satisfaction levels between different thickness of clear aligners. The alternate hypotheses were as follows: The thicker the clear aligner, the greater orthodontic force applied to tooth which affects the amount of orthodontic tooth movement, pain, and satisfaction levels of patients. The primary aim was to evaluate pre- and post-treatment changes in amount of orthodontic tooth movement. Maxillary cephalometric parameters were measured on lateral cephalograms and maxillary dental parameters were measured using OrthoAnalyzer, and compared before and after treatment. Visual Analogue Scale and Patient Satisfaction Evaluation Form were used in order to assess the pain and satisfaction levels of patients. Pain and satisfaction levels were measured before the aligner insertion (T0), at the 4th hour (T1), 2nd day (T2), 1st week (T3), 1st month (T4) and at the end of the treatment (T5).

Study Overview

• Status: Completed
• Conditions: Crowding, Tooth; Angle's Class I Malocclusion
• Intervention / Treatment: Device: 0.5 mm-thick Duran® clear aligner; Device: 0.75 mm-thick Duran® clear aligner

Detailed Description

The sample size was computed to detect difference in the amount of orthodontic tooth movement between groups (G*Power, University of Dusseldorf, Germany). The calculated sample size was 14 for each group, similar to the previously published study (effect size = 0.8, α = 0.05, and 1 - β = 0.80). Lateral cephalograms were taken for all patients using the X-ray device (PM 2002 EC Proline; Planmeca OY, Helsinki, Finland) in the Department of Oral and Maxillofacial Radiology. Patients who satisfied the inclusion criteria were enrolled in this study and they were randomly separated into 2 groups (Group 1 and Group 2) based on the aligner thickness, each consisted of 14 patients. Patients in Group 1 were treated with 0.5 mm-thick clear aligners, patients in Group 2 were treated with 0.75 mm-thick clear aligners. The Little's Irregularity Index were calculated using OrthoAnalyzer software (3Shape, Copenhagen, Denmark) to standardize the amount of maxillary anterior crowding at the beginning of the treatment. Initial records were taken at the beginning of the treatment using an intraoral scanner (Trios 3®, 3Shape, Copenhagen, Denmark). Scanned data has been converted to standard tessellation language (STL) files and these files have been modified to create virtual setups for orthodontic tooth movement using OrthoAnalyzer software. Virtual setups were imported into a slicing software for model preparation before printing. A stereolithographic (SLA) 3D printer and liquid photopolymer were used to print resin models. These models were used as mould for thermoforming of the aligners using a vacuum-thermoforming machine (Model No: 202, Keystone Industries, Myerstown, USA). All aligners were manually cut with straight trim lines at gingival zenith to provide better comfort for the patients. Attachments were placed according to the software and interproximal reductions were performed by the same operator (SMC). Patients were followed at 2nd day (T2), 1st week (T3), 1st month (T4) and at the end of the treatment (T5). Pre- (T0) and post-treatment (T5) digital models, lateral cephalometric radiographs were compared. Pain and satisfaction levels of patients were assessed using Visual Analogue Scale and Patient Satisfaction Evaluation Form.

• Study Type: Interventional
• Enrollment (Actual): 28
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Mersin, Turkey, 33110
    • Mersin University Faculty of Dentistry Department of Orthodontics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Angle Class I malocclusion without skeletal discrepancy,
2. Patients older than 18 years old with a full permanent dentition without supernumerary missing or impacted teeth except for 3rd molars,
3. Non-extraction cases with mild crowding in maxillary arch (2-5 mm),
4. Good oral health without periodontal disease or caries,
5. No previous orthodontic treatment,
6. Not taking pain medications.

Exclusion Criteria:

1. History of previous orthodontic or interceptive treatment,
2. Extraction cases with crowding of > 5 mm,
3. Presence of anterior or posterior openbite or crossbite,
4. Unwilling to be treated with clear aligners,
5. Presence of supernumerary, missing or impacted teeth (other than third molars),
6. Presence of any local/systemic problems or trauma, which may affect the pain level.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: 0.5 mm-thick Duran® clear aligners; 0.5 mm-thick clear aligners (Duran®; Scheu-Dental GmBH, Iserlohn, Germany).	Device: 0.5 mm-thick Duran® clear aligner; 0.5 mm-thick clear aligner was used for orthodontic treatment.
Experimental: 0.75 mm-thick Duran® clear aligners; 0.75 mm-thick clear aligners (Duran®; Scheu-Dental GmBH, Iserlohn, Germany).	Device: 0.75 mm-thick Duran® clear aligner; 0.75 mm-thick clear aligner was used for orthodontic treatment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Radiographic tooth movement	Changes in the amount of maxillary cephalometric parameters using lateral cephalometric radiographs after 6 months.	At 6th months
Orthodontic tooth movement	Changes in intercanine, interpremolar, intermolar arch expansions and dental arch perimeter (maxillary dental parameters) using OrthoAnalyzer® software after 6 months.	At 6th months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patients' pain level	Changes in patients' pain level using a 10-cm VAS using ''no pain'' and ''severe pain'' as anchor descriptions at the 4th hours, 2nd days, 1st week, 1st month, and 6th months.	At the 4th hours, 2nd days, 1st week, 1st month, and 6th months
Patients' satisfaction level	Changes in patients' satisfaction level using ''Patient Satisfaction Evaluation Form 1'' at the 4th hours, 2nd days, 1st week, 1st month; and using ''Patient Satisfaction Evaluation Form 2'' at the 6th months.	At the 4th hours, 2nd days, 1st week, 1st month, and 6th months

Collaborators and Investigators

• Sponsor: Mersin University
• Investigators: Study Director: Merve Göymen, Assoc Prof, Study Director

Publications and helpful links

General Publications

• Sachdev S, Tantidhnazet S, Saengfai NN. Accuracy of Tooth Movement with In-House Clear Aligners. J World Fed Orthod. 2021 Dec;10(4):177-182. doi: 10.1016/j.ejwf.2021.08.003. Epub 2021 Oct 5.
• Ho CT, Huang YT, Chao CW, Huang TH, Kao CT. Effects of different aligner materials and attachments on orthodontic behavior. J Dent Sci. 2021 Jul;16(3):1001-1009. doi: 10.1016/j.jds.2021.01.011. Epub 2021 Feb 12.

Study record dates

Study Major Dates

• Study Start (Actual): May 10, 2021
• Primary Completion (Actual): January 21, 2022
• Study Completion (Actual): May 20, 2022

Study Registration Dates

• First Submitted: June 28, 2024
• First Submitted That Met QC Criteria: July 15, 2024
• First Posted (Actual): July 16, 2024

Study Record Updates

• Last Update Posted (Actual): July 16, 2024
• Last Update Submitted That Met QC Criteria: July 15, 2024
• Last Verified: July 1, 2024

More Information

Terms related to this study

• Keywords: Pain; Orthodontic tooth movement; Clear aligner thickness
• Additional Relevant MeSH Terms: Stomatognathic Diseases; Tooth Diseases; Malocclusion; Malocclusion, Angle Class I
• Other Study ID Numbers: MEÜ-SCENGİZ-01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No