The results of this study suggest that the use of removable

aligners facilitates oral hygiene. N Treatment with removable

aligners was associated with improved periodontal status as
evidenced by decreased plaque levels, gingival inflammation,
bleeding upon probing, probing pocket depths, and BANA scores.
N These results suggest that removable aligners be considered
when treatment planning for the adult orthodontic patient at risk
for periodontitis.

The mean accuracy of canine rotation for the

AO,IO, and N groups was 35.8%.

There was no significant difference in accuracy

ofrotation between canines with attachments
only, interproximal reduction only, or neither
attachments nor interproximal reduction.
Deviation in the predicted
(grey) and achieved (color)
anterior tooth positions. Redcolor indicates greater than 15
of deviation.

The highest accuracy was achieved by the IO

group,indicating that the presence of
interproximal contact may be a critical factor
in the success of canine rotation.

Labially placed, centrally located, verticalellipsoid attachments were the most

commonly prescribed attachment shapes for
correcting malrotations. These attachments
offered little clinical improvement over
using no attachments at all.

An occlusal force such as that generated during swallowing, when

acting on an aligner, increases the measurable intrusive forces and
rotary moments present during the rotation of a maxillary central
incisor.

Because these observations were independent of the material used

and the direction of activation, biomechanical principles associated
with this force increase can be identified.

Although as a result of the swallowing force the forces and moments

delivered by the aligner were increased by a far greater magnitude
than the ideal values to be read in the literature, a negative impact
on the rate of root resorption appears unlikely because of the pulse
character of the force peaks

For clear understanding of thermoformed aligner orthodontics, two fundamental

differences between bracket-based and aligner-based biomechanics must be
recognized:
N In conventional orthodontic tooth movement, a force is applied to the bracket,
which transmits this force to tooth structures, generating the mechanical-biological
chain of events that results in displacement of the tooth.
N In aligner-based tooth movement, an intentional, predetermined mismatch
between the aligner and the tooth is programmed in each treatment stage, using a
cast or virtual model set-up (alignment). The aligner, which corresponds to the new
desired tooth position, is fitted on the dental arch, producing in each mismatch a
force system that is directly transmitted to the tooth, generating a similar chain
of events that results in a new position of the teeth.

The effect of one treatment

stage (aligner) was simulated
by distally displacing the
aligner segment 0.15 mm in
the FE model.

(a) Tension-compression patterns at PDL,

in a model
without composite attachments. (b)
Tension-compression patterns at
PDL, in a model with composite
attachments.

(a) Displacement patterns at the

PDL in a model without
composite attachments. (b)
Displacement patterns at the PDL
in a
model without composite
attachments.

Equivalent stress patterns

produced by aligner on active
surfaces of attachments.

Bucco-lingual flaring of the aligner

segment during distal
displacement