CLINICAL APPLICATIONS AND CONSIDERATIONS OF EXTRACTION TREATMENTS WITH CLEAR ALIGNER THERAPY
Pelin Ece Balaban
Bahçeşehir University, Faculty of Dentistry, Department of Orthodontics, İstanbul, Türkiye
Balaban PE. Clinical Applications and Considerations of Extraction Treatments with Clear Aligner Therapy. In: Hancıoğlu Kırcelli B, editor. What We Know About Clear Aligners. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.127-141.
ABSTRACT
The scope of malocclusions that can be treated with clear aligners has been broadened by the rapid advancements in this field. Yet, extraction treatment with clear aligners is still considered challenging. In this chapter, the indications for extractions, the advantages of diagnostic evaluation and treatment planning with digital technologies, the key points to consider when planning the extraction treatments with clear aligners, the main differences with fixed appliance therapy, and finally how to detect and manage complications that may occur in the course of the treatment will be discussed. Evidence-based recommendations from recent studies will be presented to plan realistic and predictable tooth movements as well as to overcome the undesirable side effects associated with clear aligners.
Keywords: Orthodontic appliances; Removable; Tooth extraction; Orthodontic anchorage procedures; Tooth movement techniques; Complications
Kaynak Göster
Referanslar
- Chou B, Nickel JC, Choi D, Garfinkle JS, Freedman HM, Iwasaki LR. Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in adolescents with moderate to severe malocclusions. Angle Orthod. 2023 Nov 1;93(6):644651.
- Gaffuri F, Cossellu G, Lanteri V, Brotto E, Farronato M. Comparative effectiveness of Invisalign and fixed appliances in first-premolar extraction cases. J Clin Orthod. 2020 May;52(5):294-301.
- Song JH, Lee JH, Joo BH, Choi YJ, Chung CJ, Kim KH. Treatment outcome comparison of Invisalign vs fixed appliance treatment in first premolar extraction patients. Am J Orthod Dentofacial Orthop. 2024 Apr;165(4):399-413. [Crossref] [PubMed]
- Jiang T, Jiang YN, Chu FT, Lu PJ, Tang GH. A cone-beam computed tomographic study evaluating the efficacy of incisor movement with clear aligners: Assessment of incisor pure tipping, controlled tipping, translation, and torque. Am J Orthod Dentofacial Orthop. 2021 May;159(5):635-643.
- Dai FF, Xu TM, Shu G. Comparison of achieved and predicted tooth movement of maxillary first molars and central incisors: First premolar extraction treatment with Invisalign. Angle Orthod. 2019 Sep;89(5):679-687. [Crossref] [PubMed] [PMC]
- Dai FF, Xu TM, Shu G. Comparison of achieved and predicted crown movement in adults after 4 first premolar ex traction treatment with Invisalign. Am J Orthod Dentofacial Orthop. 2021 Dec;160(6):805-813. [Crossref] [PubMed]
- Tang Z, Chen W, Mei L, Abdulghani EA, Zhao Z, Li Y. Relative anchorage loss under reciprocal anchorage in mandibular premolar extraction cases treated with clear aligners. Angle Orthod. 2023 Jul 1;93(4):375-381. [Crossref] [PubMed] [PMC]
- Meade MJ, Weir T. Predicted and achieved overjet and overbite measurements with the Invisalign appliance: a retrospective study. Angle Orthod. 2024 Jan 1;94(1):3-9. [Crossref] [PubMed] [PMC]
- Dai F, Sang Y, Zeng J, Wang H, Pan Y, Zhao J, et al. How accurate is predicted root movement achieved in four first-premolar extraction cases with Invisalign? Orthod Craniofac Res. 2024 Dec;27(6):985-995. [Crossref] [PubMed]
- Thilagalavanian A, Weir T, Meade MJ. Analysis of predicted and achieved root angulation changes in teeth adjacent to maxillary premolar extraction sites in patients treated with the Invisalign appliance. Am J Orthod Dentofacial Orthop. 2024 Nov;166(5):423-432. [Crossref] [PubMed]
- Abu-Arqub S, Ahmida A, Da Cunha Godoy L, Kuo CL, Upadhyay M, Yadav S. Insight into clear aligner therapy protocols and preferences among members of the American Association of Orthodontists in the United States and Canada. Angle Orthod. 2023 Jul 1;93(4):417-426. [Crossref] [PubMed] [PMC]
- HartshorneJ, Wertheimer MB, et al. Emerging insights and new developments in clear aligner therapy: A review of the literature. AJO-DO Clinical Companion, Volume 2, Issue 4, 311-324. [Crossref] [PubMed]
- Morton J, Derakhshan M, Kaza S, Li C, Chen V. Design of the Invisalign system performance. Seminars in Orthodontics. 2017;23(1):3-11. [Crossref] [PubMed]
- Zhylich D, Suri S. Mandibular incisor extraction: a systematic review of an uncommon extraction choice in orthodontic treatment. J Orthod. 2011 Sep;38(3):185-95. [Crossref] [PubMed]
- Vilhjálmsson G, Zermeno JP, Proffit WR. Orthodontic treatment with removal of one mandibular incisor: Outcome data and the importance of extraction site preparation. Am J Orthod Dentofacial Orthop. 2019 Oct;156(4):453-463. [Crossref] [PubMed]
- Faerovig E, Zachrisson BU. Effects of mandibular incisor extraction on anterior occlusion in adults with Class III malocclusion and reduced overbite. Am J Orthod Dentofacial Orthop. 1999 Feb;115(2):113-24. [Crossref] [PubMed]
- Jena AK, Mohapatra M, Sharan J, Patro BK. Temporary deterioration of oral health-related quality of life (OHRQOL) in nonextraction and extraction modalities of comprehensive orthodontic treatment in adolescents. Angle Orthod 2020;90:578-86. [Crossref] [PubMed] [PMC]
- Blundell HL, Weir T, Kerr B, Freer E. Predictability of overbite control with the Invisalign appliance. Am J Orthod Dentofacial Orthop 2021;160:725-31. [Crossref] [PubMed]
- Tai S. Premolar extraction treatment. In Tai S. Clear Aligner Technique. Honover Park, IL: Quintes-sence Publishing Co, Inc; 2018. [Crossref]
- Zhu GY, Zhang B, Yao K, Lu WX, Peng JJ, Shen Y, Zhao ZH. Finite element analysis of the bio-mechanical effect of clear aligners in extraction space closure under different anchorage controls. Am J Orthod Dentofacial Orthop. 2023 May;163(5):628-644.e11. [Crossref] [PubMed]
- Liu L, Song Q, Zhou J, Kuang Q, Yan X, Zhang X, Shan Y, Li X, Long H, Lai W. The effects of aligner overtreatment on torque control and intrusion of incisors for anterior retraction with clear aligners: A finite-element study. Am J Orthod Dentofacial Orthop. 2022 Jul;162(1):33-41. [Crossref] [PubMed]
- McLaughlin RP, Bennett JC, Trevisi HJ. Anchorage control during tooth levelling and aligning. In: Systemized orthodontic treatment mechanics. United States of America: Mosby; 2001. p. 105. [Crossref] [PubMed]
- Ren L, Liu L, Wu Z, Shan D, Pu L, Gao Y, Tang Z, Li X, Jian F, Wang Y, Long H, Lai W. The predictability of orthodontic tooth movements through clear aligner among first-premolar extraction patients: a multivariate analysis. Prog Orthod. 2022 Dec 30;23(1):52. [Crossref] [PubMed] [PMC]
- Martínez-Lozano D, Castellanos-Andrés D, López-Jiménez, AJ. Staging of Orthodontic Tooth Movement in Clear Aligner Treatment: Macro-Staging and Micro-Staging—A Narrative Review. Applied Sciences, 2024;14(15):6690. [Crossref] [PubMed]
- Yang Y, Yang R, Liu L, Zhang X, Jiang Q, Fan Q, et al. The effects of aligner anchorage preparation on mandibular first molars during premolar-extraction space closure with clear aligners: A finite element study. Am J Orthod Dentofacial Orthop. 2023 Aug;164(2):226-238. [Crossref] [PubMed]
- Liu JQ, Zhu GY, Wang YG, Zhang B, Yao K, Zhao ZH. Different biomechanical effects of clear aligners in closing maxillary and mandibular extraction spaces: Finite element analysis. Am J Orthod Dentofacial Orthop. 2023 Jun;163(6):811-824.e2. [Crossref] [PubMed]
- Kawamura J, Tamaya N. A finite element analysis of the effects of archwire size on orthodontic tooth movement in extraction space closure with miniscrew sliding mechanics. Prog Orthod. 2019;20:3. [Crossref] [PubMed] [PMC]
- Iliadi A, Koletsi D, Eliades T. Forces and moments generated by aligner-type appliances for orthodontic tooth movement: A systematic review and meta-analysis. Orthod Craniofac Res. 2019 Nov;22(4):248-258. [Crossref] [PubMed]
- Wang YG, Zhu GY, Liu JQ, Wang YF, Zhao ZH. Dynamic biomechanical changes of clear aligners during extraction space closure: Finite element analysis. Am J Orthod Dentofacial Orthop. 2024 Mar;165(3):272-284.e3. [Crossref] [PubMed]
- Ravera S, Castroflorio T, Garino F, Daher S, Cugliari G, Deregibus A. Maxillary molar distalization with aligners in adult patients: a multicenter retrospective study. Prog Orthod 2016;17:12. [Crossref] [PubMed] [PMC]
- Garnett BS, Mahood K, Nguyen M, et al. Cephalometric comparison of adult anterior open bite treatment using clear aligners and fixed appliances. Angle Orthod. 2019;89:3-9. [Crossref] [PubMed] [PMC]
- Nucera R, Dolci C, Bellocchio AM, Costa S, Barbera S, Rustico L, Farronato M, Militi A, Portelli M. Effects of Composite Attachments on Orthodontic Clear Aligners Therapy: A Systematic Review. Materials (Basel). 2022 Jan 11;15(2):533. [Crossref] [PubMed] [PMC]
- Cheng Y, et al. Torque movement of the upper anterior teeth using a clear aligner in cases of extraction: a finite element study. ProgOrthod. 2022;23(1):26. [Crossref] [PubMed] [PMC]
- Lin JC, Tsai SJ, Liou EJ, Bowman SJ. Treatment of challenging malocclusions with Invisalign and miniscrew anchorage. JClinOrthod. 2014;48:23-36.
- Dasy H, Dasy A, Asatrian G, Rózsa N, Lee HF, Kwak JH. Effects of variable attachment shapes and aligner material on aligner retention. Angle Orthod. 2015;85(6):934-40. [Crossref] [PubMed] [PMC]
- Chan E, Darendeliler MA. The Invisalign® appliance today: A thinking person’s orthodontic appliance. Seminars in Orthodontics. 2017;23(1):12-64. [Crossref] [PubMed]
- Meng X, Wang C, Xu W, Wang R, Zheng L, Wang C, Aversa R, Fan Y. Effects of different designs of orthodontic clear aligners on the maxillary central incisors in the tooth extraction cases: a biomechanical study. BMC Oral Health. 2023 Jun 22;23(1):416. [Crossref] [PubMed] [PMC]
- Koru Akan BE, Hancıoğlu Kircelli B, Paşaoğlu Bozkurt A, Gögen H. A finite element analysis of the effects of semipontic design on tooth movement during mesialization of the mandibular second molar with clear aligners. Am J Orthod Dentofacial Orthop. 2024 Nov;166(5):490-502. [Crossref] [PubMed]
- Blundell HL, Weir T, Meade MJ. Deep overbite reduction in adolescent patients treated with Invisalign: A retrospective analysis. Am J Orthod Dentofacial Orthop. 2024 Dec;166(6):515-523. [Crossref] [PubMed]
- Greco M, Rombolà A, Monterossi AS. Active power arm for extraction-space closure with clear aligners. J Clin Orthod. 2024 Apr;58(4):257-258. [PubMed]
- Nikolai RJ. On optimum orthodontic force theory as applied to canine retraction. Am J Orthod 1975;68:290-302. [Crossref]
- Inan A, Gonca M. Effects of aligner activation and power arm length and material on canine displacement and periodontal ligament stress: a finite element analysis. Prog Orthod. 2023 Nov 27;24(1):40. [Crossref] [PubMed] [PMC]
- Zhu Y, Hu W, Li S. Force changes associated with differential activation of en-masse retraction and/or intrusion with clear aligners. Korean J Orthod. 2021 Jan 15;51(1):32-42. [Crossref] [PubMed] [PMC]
- Cao Y, Wang ZW, Chen D, Liu L, Li DX, Li N, et al. The effect of space arrangement between anterior teeth on their retraction with clear aligners in first premolar extraction treatment: a finite element study. Prog Orthod. 2023 Sep 25;24(1):39. [Crossref] [PubMed] [PMC]
- Li N, Lei X, Cao Y, Liu L, Zhang Y, Ning Q, Gui L, Jin F. The effect of increasing the gaps between the front teeth on torque and intrusion control of the incisors for anterior retraction with clear aligners: a prospective study. BMC Oral Health. 2024 Jan 20;24(1):115. [Crossref] [PubMed] [PMC]
- Vaden JL. The Tweed-Merrifield philosophy. Semin Orthod 1996;2:237-40. [Crossref] [PubMed]
- Feng X, Jiang Y, Zhu Y, Hu L, Wang J, Qi Y, Ma S. Comparison between the designed and achieved mesiodistal angulation of maxillary canines and posterior teeth and influencing factors: First premolar extraction treatment with clear aligners. Am J Orthod Dentofacial Orthop. 2022 Aug;162(2):e63-e70. [Crossref] [PubMed]
- Ahn HW, Moon SC, Baek SH. Morphometric evaluation of changes in the alveolar bone and roots of the maxillary anterior teeth before and after en masse retraction using cone-beam computed tomography. Angle Orthod. 2013 Mar;83(2):212-21. [Crossref] [PubMed] [PMC]
- Al-Balaa M, Li H, Ma Mohamed A, Xia L, Liu W, Chen Y, et al. Predicted and actual outcome of anterior intrusion with Invisalign assessed with cone-beam computed tomography. Am J Orthod Dentofa-cial Orthop 2021;159:e275-80. [Crossref] [PubMed]
- Al-Nadawi M, Kravitz ND, Hansa I, Makki L, Ferguson DJ, Vaid NR. Effect of clear aligner wear protocol on the efficacy of tooth movement. Angle Orthod. 2021 Mar 1;91(2):157-163. [Crossref] [PubMed] [PMC]
- Khosravi R, Cohanim B, Hujoel P, Daher S, Neal M, Liu WT, et al. Management of overbite with the Invisalign appliance. Am J Orthod Dentofacial Orthop 2017;151:691-9.e2. [Crossref] [PubMed]
- Liu L, Zhan Q, Zhou J, Kuang Q, Yan X, Zhang X, et al. Effectiveness of an anterior mini-screw in achieving incisor intrusion and palatal root torque for anterior retraction with clear aligners. Angle Orthod. 2021 Nov 1;91(6):794-803. [Crossref] [PubMed] [PMC]
- Bowman SJ, Celenza F, Sparaga J, Papadopoulos MA, Ojima K, Lin JC. Creative adjuncts for clear aligners, part 3: Extraction and interdisciplinary treatment. J Clin Orthod. 2015 Apr;49(4):249-62.
- Jaber ST, Hajeer MY, Sultan K. Treatment Effectiveness of Clear Aligners in Correcting Complicated and Severe Malocclusion Cases Compared to Fixed Orthodontic Appliances: A Systematic Review. Cureus. 2023 Apr 29;15(4):e38311. [Crossref] [PubMed] [PMC]